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Les enfants exposés aux violences conjugales constituent une population vulnérable en possible souffrance psychique et à risque de développer ultérieurement des conduites d’agression ou de victimisation. La difficulté pour les équipes soignantes est de pouvoir accéder précocement à ces enfants car la plupart des familles concernées ne viennent pas consulter spontanément. Il est donc important d’aller à la rencontre des enfants exposés aux violences conjugales et de leurs familles grâce à des équipes mobiles de pédopsychiatrie pour évaluer les possibles difficultés psychiques. Ces équipes mobiles sont alertées par des professionnels de première ligne qui ont connaissance de ces situations (comme par exemple, les gendarmes, policiers, travailleurs sociaux, pédiatres, médecins généralistes, professionnels de l’Éducation nationale, etc.). L’efficacité de l’accès aux soins psychiques pour ces enfants dépend de la réactivité de la prise en charge (dans les 72 heures qui suivent l’intervention des professionnels de première ligne, ici la Gendarmerie nationale) et de la nécessité de pouvoir se déplacer au domicile de ces familles (les premiers rendez-vous ont lieu, à la demande des parents, tout d’abord chez eux).

Cet article rend compte de plus de 10 ans de fonctionnement d’une équipe mobile d’urgence pédopsychiatrique, l’EMUP – équipe mobile basée aux urgences pédiatriques qui y accueille en blouse blanche les jeunes et leurs familles, mais sort des urgences dès le 2e rendez-vous en se déplaçant sans blouse blanche au domicile ou au CMP – et permet d’illustrer ainsi l’importance du passage, accompagné par cette équipe mobile, de l’espace-temps de l’urgence à l’espace-temps du soin et de l’élaboration psychiques. Le dispositif TEARS (dispositif Téléphonique d’évaluation chez les Enfants et Adolescents du Risque Suicidaire sur une durée d’un an après la crise suicidaire) a pour objectif de prolonger précisément la continuité de ce travail psychique qui s’inscrit dans une nouvelle temporalité. Le dispositif TEARS a été établi suite à une étude longitudinale d’une année des effets de l’EMUP sur le risque suicidaire et les tentatives de suicide chez les préadolescents/adolescents de moins de 16 ans. Cette recherche met en évidence l’importance de l’environnement familial dans la prise en charge des crises suicidaires avec une sévérité d’autant plus élevée des idéations suicidaires chez le jeune que l’attachement aux figures parentales est insécure et le fonctionnement familial chaotique, et un risque suicidaire d’autant plus faible que l’alliance thérapeutique a pu se construire avec le père et la mère. C’est dire l’importance de se déplacer à domicile et d’aller ainsi vers les membres de la famille qu’il serait difficile de rencontrer ailleurs, comme cela peut être le cas des pères. Le changement d’espace-temps, renforcé par le changement d’environnement social (changement de binômes), permet d’accéder à différentes représentations en fonction de l’environnement spatial (selon le lieu), temporel (selon la temporalité convoquée) et relationnel (selon la configuration professionnelle et familiale des entretiens). Les changements d’environnement spatial, temporel et relationnel entraînent un changement de perspectives, condition nécessaire au processus de changement. L’équipe mobile assure ainsi auprès du jeune, de ses parents, et de façon plus générale sa famille, une fonction majeure de passeur d’espace-temps (de l’espace-temps de l’urgence à l’espace-temps du soin et de l’élaboration psychiques) qui permet de les accompagner vers le changement (d’une représentation de soi unique et figée à une pluralité et mobilisation des représentations).

Les équipes mobiles en psychiatrie de l’enfant et de l’adolescent (EMPEA) sont diversifiées mais partagent des principes communs ici présentés. Elles vont à la rencontre des jeunes en souffrance et de leurs familles, et leur permettent si besoin d’accéder à des soins adaptés après avoir évalué leurs difficultés. Les EMPEA travaillent sur les liens entre l’équipe mobile, le jeune, sa famille, et les partenaires. Ce travail s’inscrit dans le mouvement d’aller vers l’autre et offre l’intérêt au jeune et à sa famille, mais aussi aux professionnels, de mobiliser les représentations figées, (re)initialiser les liens, construire une alliance thérapeutique, sortir de l’isolement, et (re)prendre place dans un réseau familial, scolaire ou social. Population Il s’agit d’une population vulnérable d’enfants, préadolescents et adolescents qui ne vient pas consulter dans les dispositifs de soins ambulatoires classiques, soit parce que le jeune et/ou sa famille sont non-demandeurs (absence de demande explicite d’aide), soit parce que la demande relève d’une situation de crise nécessitant une réponse rapide que les dispositifs habituels ne peuvent apporter. Les indications fréquemment retrouvées sont les troubles anxiodépressifs, troubles des conduites, et psychoses émergentes. Missions Les missions comportent toutes un temps d’évaluation mais peuvent différer selon le type d’EMPEA : prévention et soutien, accès aux soins, et/ou soins. Fonctionnement Les EMPEA se déplacent en binôme de professionnels (en moins de 48h si nécessaire à une semaine maximum de délai de réactivité, garantissant ainsi la disponibilité de l’équipe). Ce sont des équipes pluridisciplinaires permettant de croiser des regards différents : médecins psychiatres, infirmiers, psychologues, assistantes sociales, éducateurs, etc. Travail en réseau Il concerne tant le réseau d’amont (notamment les professionnels de l’Éducation nationale, médecins généralistes, pédiatres qui sont des médiateurs de première ligne repérant les jeunes en difficulté) que le réseau d’aval (notamment le secteur; les EMPEA sont des alternatives à l’hospitalisation mais peuvent aussi parfois y recourir au décours de leur suivi). Nombre, durée et lieux d’intervention Les nombre et durée d’intervention diffèrent selon les EMPEA et leurs missions (2-6 rendez-vous en moyenne à 10 rendez-vous maximum pour beaucoup d’EMPEA; durée totale d’intervention de 1 mois pour des soins intensifs de type hospitalisation à domicile à 6 mois renouvelables plusieurs fois pour du soin au long cours). Mais cette durée est toujours limitée pour que l’EMPEA ne devienne pas saturée. Les lieux d’intervention sont également variables (l’intérêt du domicile est particulièrement à souligner) et choisis par le jeune et sa famille afin qu’ils soient actifs et acteurs de la rencontre. La mobilité se caractérise par la possibilité, voire nécessité, de changer de lieux d’intervention afin de mobiliser les représentations. Certaines EMPEA utilisent un bureau mobile qui constitue un lieu/espace transitionnel et de transition entre le domicile et le lieu de soin, et entre l’espace familial groupal (domicile) et un espace plus individualisé (entretien du jeune dans le bureau mobile garé près du domicile). Conclusion Les EMPEA sont des courroies de transmission permettant d’établir un pont entre un réseau d’amont (les médiateurs) et un réseau d’aval (comme le secteur), et constituent donc des outils précieux (leur évaluation est une perspective importante), mais complémentaires d’un dispositif à appréhender dans sa globalité. Elles facilitent le passage d’un espace-temps situé dans l’ici et maintenant à un nouvel espace-temps associé au lieu de soin et au temps de l’élaboration psychique, et accompagnent, tel un passeur, le jeune et sa famille dans ce mouvement.

International audience; The case study of Michael Jackson illustrates the concepts of high potential, talent, and precocity in the musical domain. Studying this case of exceptional musical talent highlights the usefulness of a multidimensional approach to exploring human potential, which is not limited to academic abilities. It offers a better understanding of the process of transforming a gift into talent and allows us to examine the asynchronies observed in some high-potential individuals between extreme talent and impaired socioaffective development-the interplay between strength and fragility where cognitive functioning cannot be dissociated from emotional functioning.

Le trauma vient faire effraction dans la vie psychique du sujet en y provoquant une rupture, et la perception du temps en est altérée. Le temps est arrêté, gelé sur l’événement traumatique. Les définitions du trauma seront dans un premier temps abordées en s’interrogeant, à partir de ces définitions, sur la contribution des médias au développement du trauma. Puis nous centrerons notre propos sur le temps figé du trauma et l’intérêt de convoquer le passé et le futur dans le processus thérapeutique afin de remettre en mouvement et continuité la temporalité du sujet. Plus précisément, la thérapie et le travail d’accompagnement du thérapeute permettront, entre autres, de passer d’un temps suspendu monophasique, où il est souvent nécessaire d’accueillir le sujet dans sa sensorialité et corporalité, à un temps dynamique multiphasique, où il redevient possible pour le sujet de se projeter dans le futur et se remémorer le passé. Le rôle de la mémoire collective et du groupe dans la (re)construction de la mémoire individuelle, d’une enveloppe contenante et de la conscience de soi sera aussi discuté. Enfin, le passage de l’effroi sensoriel au récit, du kyste sensoriel traumatique à l’élaboration psychique, du temps figé du trauma au temps de la mobilisation psychique, sera développé. Il est nécessaire de pouvoir disposer de divers outils thérapeutiques adaptés à ces différents temps. L’efficacité d’une approche thérapeutique dépendra de sa cohérence, tant pour le sujet que pour le thérapeute, dans le contexte de leurs temporalité, ressources et singularité, et de l’alliance thérapeutique qui pourra se développer.

International audience; Current research suggests that alterations in neurodevelopmental processes, involving gene X environment interactions during key stages of brain development (prenatal period and adolescence), are a major risk for schizophrenia. First, epidemiological studies supporting a genetic contribution to schizophrenia are presented in this article, including family, twin, and adoption studies. Then, an extensive literature review on genetic disorders associated with schizophrenia is reviewed. These epidemiological findings and clinical observations led researchers to conduct studies on genetic associations in schizophrenia, and more specifically on genomics (CNV: copy-number variant, and SNP: single nucleotide polymorphism). The main structural (CNV) and sequence (SNP) variants found in individuals with schizophrenia are reported here. Evidence of genetic contributions to schizophrenia and current knowledge on genetic syndromes associated with this psychiatric disorder highlight the importance of a clinical genetic examination to detect minor physical anomalies in individuals with ultra-high risk of schizophrenia. Several dysmorphic features have been described in schizophrenia, especially in early onset schizophrenia, and can be viewed as neurodevelopmental markers of vulnerability. Early detection of individuals with neurodevelopmental abnormalities is a fundamental issue to develop prevention and diagnostic strategies, therapeutic intervention and follow-up, and to ascertain better the underlying mechanisms involved in the pathophysiology of schizophrenia.

International audience; The impact of the Neurofibromatosis type 1 (NF1) on cognition have been subject to much clinical investigation, but environmental modifiers of disease expression have not yet been systematically investigated. The aim of this paper is to determine the role of demographic and environmental factors such as age, sex, socioeconomic status, parental NF1 status and neurological complications on the cognitive, behavioural and academic outcomes in NF1. Participants included 206 children aged 4-18 years seen within the Manchester clinical research NF1 service. Multiple linear regression models were used to study the effect of the hypothesized predictor variables on cognitive, behavioural and academic outcomes. Relative to population norms, 80% of the NF1 sample demonstrated significantly lower scores in at least one cognitive, behavioural or academic domains. Family history of NF1 and lower SES were independently associated with poorer cognitive, behavioural and academic outcomes. Neurological problems such as epilepsy and hydrocephalus were associated with lower IQ and academic skills. Cognitive and behavioural phenotypes emerge commonly via a complex interplay between genes and environmental factors, and this is true also of a monogenic condition such as NF1. Early interventions and remedial education may be targeted to risk groups such those with familial NF1, families with lower SES and those with associated neurological comorbidities.

We have been sensitized to children with high intellectual potential (HIP) having difficulties given the number of children consulting in our outpatient medico-psychological centres for scholastic problems (possibly leading to school failure), anxiety disorders or behavioral disorders such as attention deficit/hyperactivity disorder (ADHD), and in which a high intellectual potential was discovered during psychological assessments. It is the contrast, and more precisely the paradox, between the high intellectual potential of these children and their scholastic difficulties (including school failure), and the psychic suffering expressed by some of them, which led us to question, challenge and propose therapeutic and educational care adapted to these children. It is in this context that we created in December 2005 the CNAHP (National Center for Assistance to High Potential children and adolescents) which is a public centre integrated into the hospital-university department of child and adolescent psychiatry at Rennes. It is noteworthy that not all children with HIP have difficulties, and children with school failure or behavioral problems are not always children with HIP. However, it is necessary not to minimize the problem raised by children with HIP with difficulties by ignoring its frequency or by considering that these children are "intelligent" enough to manage by themselves and do not need to be helped, whereas some of them can show school failure and even be de-scholarized. Indeed, based on the definition of the World Health Organization (WHO) of an intellectual Quotient (IQ) above 130 (level corresponding to a statistical threshold), the frequency of children with HIP represents 2.3% of the population of schoolchildren aged 6 to 16. The frequency is therefore not so rare. However, it remains to be determined by French epidemiological studies what is the actual frequency of children with difficulties within a population of children with HIP. The analysis of the CNAHP research data from a clinical population (children with HIP consulting for difficulties) highlights that children with HIP can show major school problems (including school failure, defined here as having or foreseeing repetition of a grade), which corresponds to 7.5% of 611 children with HIP consulting at the CNAHP) and socioemotional problems (emotional regulation disorders) in relation to their high intellectual potential. In particular, anxiety disorders were the most frequent psychiatric disorders observed in this population (40.5%) and were significantly associated with high verbal potential. This significant association requires further studies to avoid establishing a simplistic unidirectional and reductive linear cause-effect relationships. Indeed, a high verbal potential can elicit and/or reinforce anxiety-producing representations, but anxiety disorders may also lead to a defensive over investment of verbal language. The results are discussed in this article and suggest that scholastic and/or psychological difficulties encountered by some children with HIP can be related to their high intellectual potential. It is necessary to develop therapeutic and educational care adapted to these children from a better understanding, based on research results, of their possible difficulties but also cognitive abilities. Even when children with HIP have scholastic and/or psychological difficulties, some of their cognitive skills can be preserved contrary to appearances, with for example, as seen in the CNAHP results, excellent attentional capacities shown by cognitive tests contrasting with behavioral attention deficit reported by parents. These skills are important to identify as they are resources which support the therapeutic and educational project. It is probably through an articulation among professionals from national education, health and research, in alliance with the family (parents, child, and siblings), that advances will be made. In the same way that professionals have been interested in children with intellectual disabilities, it is important to be concerned by children with HIP and difficulties located at the other end of the continuum. It is a question of ethics which concerns both caregivers and teachers. It is also a societal issue that concerns all of us given that the expression of high intellectual and creative potential in children may be essential to the societal development of innovative strategies and each nation's future. Finally, the discussion can be extended to all children, independent of their potential. What we learn from children with HIP and difficulties can be applied to each child: it is important at family, school and societal levels to facilitate the expression of the potential of children, to value their skills, and to help them to remove possible inhibitions of their potential based on individualized projects. The acceptance of singularity and differences in children can contribute to tolerance and the development of creativity, in the interest of the subject and of society.

International audience; The role of melatonin has been extensively investigated in pathophysiological conditions, including autism spectrum disorder (ASD). Reduced melatonin secretion has been reported in ASD and led to many clinical trials using immediate-release and prolonged-release oral formulations of melatonin. However, melatonin’s effects in ASD and the choice of formulation type require further study. Therapeutic benefits of melatonin on sleep disorders in ASD were observed, notably on sleep latency and sleep quality. Importantly, melatonin may also have a role in improving autistic behavioral impairments. The objective of this article is to review factors influencing treatment response and possible side effects following melatonin administration. It appears that the effects of exposure to exogenous melatonin are dependent on age, sex, route and time of administration, formulation type, dose, and association with several substances (such as tobacco or contraceptive pills). In addition, no major melatonin-related adverse effect was described in typical development and ASD. In conclusion, melatonin represents currently a well-validated and tolerated treatment for sleep disorders in children and adolescents with ASD. A more thorough consideration of factors influencing melatonin pharmacokinetics could illuminate the best use of melatonin in this population. Future studies are required in ASD to explore further dose-effect relationships of melatonin on sleep problems and autistic behavioral impairments.

This chapter develops the perspective of giftedness in France implemented at the National Center for Assistance to children and adolescents with High Potential (CNAHP). First, we present the debate about the terminology used to describe gifted children in France which varies according to the underlying theoretical conceptions and representations (e.g., gift, precocity, talent, or potential). The term high potential has been preferentially chosen given that it reflects both the cognitive capacities of children and adolescents (high intellectual and/or creative potential), and the fact that this potential can be expressed or inhibited by their difficulties (emotional, behavioral, and/or school problems).

Background Several studies suggest significant relationships between migration and autism spectrum disorder (ASD) but there are discrepant results. Given that no studies to date have included a pathological control group, the specificity of the results in ASD can be questioned. Aims To compare the migration experience (premigration, migratory trip, postmigration) in ASD and non-ASD pathological control groups, and study the relationships between migration and autism severity. Method Parents’ and grandparents’ migrant status was compared in 30 prepubertal boys with ASD and 30 prepubertal boys without ASD but with language disorders, using a questionnaire including Human Development Index (HDI)/Inequality-adjusted Human Development Index (IHDI) of native countries. Autism severity was assessed using the Child Autism Rating Scale, Autism Diagnostic Observation Schedule and Autism Diagnostic Interview-Revised scales. Results The parents’ and grandparents’ migrant status frequency did not differ between ASD and control groups and was not associated with autism severity. The HDI/IHDI values of native countries were significantly lower for parents and grandparents of children with ASD compared with the controls, especially for paternal grandparents. Furthermore, HDI/IDHI levels from the paternal line (father and especially paternal grandparents) were significantly negatively correlated with autism severity, particularly for social interaction impairments. Conclusions In this study, parents’ and/or grandparents’ migrant status did not discriminate ASD and pathological control groups and did not contribute either to autism severity. However, the HDI/IHDI results suggest that social adversity-related stress experienced in native countries, especially by paternal grandparents, is potentially a traumatic experience that may play a role in ASD development. A ‘premigration theory of autism’ is then proposed.

BackgroundSeveral studies have reported anxiety disorders in children with high intellectual potential (HIP). However, there are discrepant results possibly as a result of methodological biases (different/absent definitions of HIP, small sample sizes, non-validated/adapted/specific tools for assessing anxiety and a single observational source).AimsTo examine more thoroughly the relationships between HIP and anxiety in large samples of children using clear definitions of HIP, different observational sources and specific assessments of anxiety.MethodChildren with HIP (n= 211, total IQ ≥130) were compared with children without HIP (n= 397, total IQ ResultsThere were significantly more children with HIP who had anxiety disorders than children without HIP based on the child psychiatric diagnosis. Moreover, based on the child's self-evaluation, children with a high Verbal Comprehension Index (VCI ≥130) were significantly more anxious than children with a VCI ConclusionsThe results highlight the importance of using multiple observational sources and conducting analyses on different dimensions of intellectual functioning (such as VCI and PRI), rather than only on the composite total IQ score. High verbal potential might be a factor of vulnerability for anxiety, whereas high perceptual reasoning might be a protective factor. Further studies are necessary to understand better the mechanisms underlying these results.

Background: Several studies suggest significant relationships between migration and Autism Spectrum Disorder (ASD) but there are discrepant results. Given that no study included a pathological control group, the specificity of the results in ASD can be questioned. Aims: To compare the migration experience (premigration, migratory trip, postmigration) in ASD and non-ASD pathological control groups, and study relationships between migration and autism severity.Method: Parents’ and grandparents’ migrant status was compared in 30 prepubertal ASD boys and 30 prepubertal non-ASD boys with language disorders, using a questionnaire including Human Development Indices (IDH/IDHI) of native countries. Autism severity was assessed using the Child Autism Rating Scale, Autism Diagnostic Observation Schedule and Autism Diagnostic Interview-Revised scales. Results: The parents’ and grandparents’ migrant status frequency did not differ between ASD and control groups and was not associated with autism severity. The HDI/IHDI values of native countries were significantly lower for parents and grandparents of ASD children compared to controls, especially for paternal grandparents. Furthermore, HDI/IDHI levels from the paternal line (father and especially paternal grandparents) were significantly negatively correlated with autism severity, particularly for social interaction impairments.Conclusions: In this study, parents’ and/or grandparents’ migrant status did not discriminate ASD and pathological control groups and did not contribute either to autism severity. However, the HDI/IHDI results suggest that social adversity-related stress experienced in native countries, especially by paternal grandparents, is potentially a traumatic experience which may play a role in ASD development. A “premigration theory” of autism is then proposed.

International audience; Modeling in other organism species is one of the crucial stages in ascertaining the association between gene and psychiatric disorder. Testing Autism Spectrum Disorder (ASD) in mice is very popular but construct validity of the batteries is not available. We presented here the first factor analysis of a behavioral model of ASD-like in mice coupled with empirical validation. We defined fourteen measures aligning mouse-behavior measures with the criteria defined by DSM-5 for the diagnostic of ASD. Sixty-five mice belonging to a heterogeneous pool of genotypes were tested. Reliability coefficients vary from .68 to .81. The factor analysis resulted in a three- factor solution in line with DSM criteria: social behavior, stereotypy and narrowness of the field of interest. The empirical validation with mice sharing a haplo-insufficiency of the zinc-finger transcription factor TSHZ3/Tshz3 associated with ASD shows the discriminant power of the highly loaded items.

Dans ce dossier Histoire et Actualite des Troubles Autistiques : Diversite des Approches (2e partie), nous retrouvons la multidisciplinarite presentee dans le premier dossier, permettant de confronter des regards differents, en esperant que de cette confrontation pourront emerger de nouveaux eclairages creatifs, des echanges constructifs et des questionnements...

Les Troubles du Spectre Autistique (TSA) touchent 1 % de la population generale, majoritairement des garcons, et ont une etiologie complexe. Les progres recents de la genetique moleculaire permettent aujourd’hui dans 25 a 30 % des cas de poser un diagnostic de maladie rare. Du diagnostic standard (notamment par le caryotype moleculaire) a la recherche (Next Generation Sequencing ), nous proposons dans la premiere partie de cet article de faire la synthese pratique des liens entre genetique et psychiatrie dans le cadre des TSA. Dans la deuxieme partie sont discutes certains mecanismes permettant d’expliquer comment des maladies genetiques aussi diverses et nombreuses, impliquant des chromosomes et genes differents, peuvent aboutir a un phenotype clinique commun de TSA. Il se degage de cette discussion, en conclusion, la proposition de changer la grille de lecture des TSA en se situant dans une approche multidimensionnelle, dynamique et developpementale, mais aussi transnosographique permettant de suivre et comparer les trajectoires evolutives des dimensions considerees.

International audience

Resume Les enfants a haut potentiel intellectuel (EHP) peuvent etre en difficulte scolaire et/ou psychologique. Des etudes epidemiologiques sont necessaires pour determiner la reelle frequence des EHP en difficulte. Les resultats du Centre national d’aide aux enfants et adolescents a haut potentiel (CNAHP) montrent que les EHP peuvent presenter des problemes scolaires averes (dont l’echec scolaire : 7,5 % sur 611 EHP consultant) et socio-emotionnels en lien avec leur haut potentiel intellectuel (notamment, des troubles anxieux associes au haut potentiel verbal). C’est dire l’importance de proposer des prises en charge therapeutiques et pedagogiques adaptees a ces enfants. C’est une question d’ethique et de societe.

Williams Beuren syndrome (WBS) is a multiple malformations/intellectual disability (ID) syndrome caused by 7q11.23 microdeletion and clinically characterized by a typical neurocognitive profile including excessive talkativeness and social disinhibition, often defined as “overfriendliness” and “hyersociability”. WBS is generally considered as the polar opposite phenotype to Autism Spectrum Disorder (ASD). Surprisingly, the prevalence of ASD has been reported to be significantly higher in WBS (12%) than in general population (1%). Our study aims to investigate the molecular basis of the peculiar association of ASD and WBS. We performed chromosomal microarray analysis and whole exome sequencing in six patients presenting with WBS and ASD, in order to evaluate the possible presence of chromosomal or gene variants considered as pathogenic. Our study shows that the presence of ASD in the recruited WBS patients is due to i) neither atypically large deletions; ii) nor the presence of pathogenic variants in genes localized in the non-deleted 7q11.23 allele which would unmask recessive conditions; iii) moreover, we did not identify a second, indisputable independent genetic diagnosis, related to pathogenic Copy Number Variations or rare pathogenic exonic variants in known ID/ASD causing genes, although several variants of unknown significance were found. Finally, imprinting effect does not appear to be the only cause of autism in WBS patients, since the deletions occurred in alleles of both maternal and paternal origin. The social disinhibition observed in WBS does not follow common social norms and symptoms overlapping with ASD, such as restricted interests and repetitive behavior, can be observed in “typical” WBS patients: therefore, the terms “overfriendliness” and “hypersociability” appear to be a misleading oversimplification. The etiology of ASD in WBS is likely to be heterogeneous. Further studies on large series of patients are needed to clarify the observed variability in WBS social communication, ranging from excessive talkativeness and social disinhibition to absence of verbal language and social deficit. Electronic supplementary material The online version of this article (10.1186/s13023-019-1094-5) contains supplementary material, which is available to authorized users.

Clinical observations suggest early self-consciousness disturbances in schizophrenia. A double mirror combining the images of two individuals sitting on each side of the mirror was used to study self–other differentiation in 12 individuals with early onset schizophrenia (EOS) and 15 individuals with adult onset schizophrenia (AOS) compared to 27 typically developing controls (TDC) matched on age and sex. The effects of intermodal sensory perception (visual–tactile and visual–kinesthetic) on self–other recognition were also studied. The results showed that EOS and AOS individuals, independently of age and schizophrenia severity, were centered on their own image compared to TDC, with both significant earlier self-recognition and delayed other-recognition during the visual recognition task. In addition, there was no significant effect of intermodal sensory stimulation on self–other recognition in EOS and AOS patients, whereas self-centered functioning was significantly increased by visual–tactile stimulation and decreased by visual–kinesthetic stimulation in TDC. The findings suggest that self–other recognition impairments might be a possible endophenotypic trait of schizophrenia.

Prior observations and studies suggest self-consciousness disorders in schizophrenia and Autism Spectrum Disorder (ASD), two neurodevelopmental disorders sharing social communication impairments. First, the relationships between schizophrenia and autism are explored regarding social communication impairments. Then, self-consciousness disorders in schizophrenia and autism are described and discussed in relation with impairments of body self leading to impairments of self-other differentiation, a deficit of theory of mind and empathy, and their consequences on social communication. Also, neurological dysfunction involved possibly in self-consciousness disorders in schizophrenia and autism is presented. In conclusion, a new model is proposed integrating results of studies presented here and stating the existence of bodily self-consciousness disorders in schizophrenia and autism associated with altered/absent intermodal sensory integration (especially visual-kinesthetic-tactile integration). This would result in problems of self-other differentiation, leading in turn to a deficit of theory of mind and empathy as well as social communication impairments. This model opens new perspectives to understand better self-consciousness disorders and social communication impairments in schizophrenia and ASD and to develop therapeutic strategies.

Resume La famille est le lieu ou s’exerce la grande majorite des violences envers les enfants. L’enfant peut etre maltraite et il se retrouve alors victime d’une violence intentionnelle qui lui est destinee. L’enfant peut aussi etre « expose » indirectement a la violence intrafamiliale, violence dont il est temoin, comme c’est le cas des violences conjugales, mais qui le place dans une situation qu’il subit et dont les consequences peuvent etre pour lui deleteres. L’exposition a la violence intrafamiliale peut en effet entrainer chez les enfants mineurs, ce d’autant que cette exposition est precoce et repetee, des difficultes psychiques s’exprimant par des symptomes internalises ou emotionnels et/ou des symptomes externalises, difficultes qui vont perturber leur developpement psychoaffectif. Ces enfants/adolescents accedent peu souvent au soin de facon directe a partir d’une demande de consultation faite par leur representant legal. Les etablissements scolaires et services sociaux peuvent reperer des enfants et adolescents en souffrance et les orienter, mais interviennent souvent tardivement quand les symptomes sont deja installes, apres plusieurs mois voire annees d’exposition a la violence intrafamiliale. Les services de gendarmerie peuvent avoir alors un role de prevention lors de leurs interventions « sur le terrain » des violences intrafamiliales ou lors de rencontres avec le representant legal violente au moment d’un depot de plainte. C’est ainsi qu’un partenariat a ete mis en place depuis 6 ans entre la pedopsychiatrie et les services de gendarmerie donnant lieu a un dispositif innovant : l’equipe mobile de crise intrafamiliale (CrIFEM). Ce dispositif permet aux enfants/adolescents et aux familles de mobiliser le travail psychique de chacun, de desamorcer certains conflits impactant negativement la dynamique familiale et d’orienter, apres evaluation, les enfants/adolescents qui necessiteraient un suivi sur le plan psychologique.