No full-text available
To read the full-text of this research,
you can request a copy directly from the authors.
Against Le Packing: A Consensus Statement
Abstract
Amaral, David Rogers, Sally J Baron-Cohen, Simon Bourgeron, Thomas Caffo, Ernesto Fombonne, Eric Fuentes, Joaquin Howlin, Patricia Rutter, Michael Klin, Ami Volkmar, Fred Lord, Catherine Minshew, Nancy Nardocci, Franco Rizzolatti, Giacomo Russo, Sebastiano Scifo, Renato van der Gaag, Rutger Jan Letter United States J Am Acad Child Adolesc Psychiatry. 2011 Feb;50(2):191-2.
... Due to the absence of empirical studies supporting TBW, its usefulness with children and adolescents with ASD has become controversial, mainly in France [23][24][25]. French regulation authorities asked for clinical studies to be performed to define whether TBW should be continued on the basis of relevant scientific research [26]. The current study aimed to evaluate the feasibility of comparing wet TBW versus dry TBW in children and adolescents with ASD and severe injurious behaviours in the context of a single-blind randomized controlled trial [27]. ...
Introduction
The use of therapeutic body wraps (TBW) has been reported in small series or case reports, but has become controversial.
Objectives
This is a feasibility, multicentre, randomized, controlled, open-label trial with blinded outcome assessment (PROBE design).
Setting
Children with autism and severe-injurious behaviours (SIB) were enrolled from 13 specialized clinics.
Interventions
Dry-sheet TBW (DRY group) vs. wet-sheet TBW (WET group).
Primary outcome measures
3-month change in the Aberrant Behaviour Checklist irritability score (ABC-irritability) within per-protocol (PP) sample.
Results
From January 2008 to January 2015, we recruited 48 children (age range: 5.9 to 9.9 years, 78.1% male). Seven patients (4 in the DRY group, 3 in the WET group) were dropped from the study early and were excluded from PP analysis. At endpoint, ABC-irritability significantly improved in both groups (means (standard deviation) = -11.15 (8.05) in the DRY group and -10.57 (9.29) in the WET group), as did the other ABC scores and the Children Autism Rating scale score. However, there was no significant difference between groups. All but 5 patients were rated as much or very much improved. A repeated-measures analysis confirmed the significant improvement in ABC-irritability scores according to time (p < .0001), with no significant difference between the two groups (group effect: p = .55; interaction time x group: p = .27). Pooling both groups together, the mean 3-month change from baseline in ABC-irritability score was -10.90 (effect size = 1.59, p < .0001).
Conclusions
We found that feasibility was overall satisfactory with a slow recruitment rate and a rather good attrition rate. TBW was a safe complementary therapy in this population. There was no difference between wet and dry TBW at 3 months, and ABC-irritability significantly decreased with both wet and dry sheet TBW. To assess whether TBW may constitute an alternative to medication or behavioural intervention for treating SIB in ASD patients, a larger randomized comparative trial (e.g. TBW vs. antipsychotics) is warranted.
Trial registration
ClinicalTrials.gov NCT03164746.
This article proposes a chiastic reading of Elle s’appelle Sabine, examining how director Sandrine Bonnaire folds time. She represents her sister, the subject of the film, in the present and past, but also offers points of comparison between herself and her sibling. The film has a doubled set of ethical challenges: documentary ethics and ethics of care implicate Bonnaire both as filmmaker and as sister. In turn, Sandrine and Sabine together direct those ethical challenges towards the viewer and the state.
Ce mémoire rend compte des mobilisations collectives contestataires qui ont pour sujet la psychiatrie et/ ou la santé mentale dans la période 2000 à 2020 en France. L’analyse s’appuie sur un corpus d’articles de la presse nationale, un corpus d’entretiens avec des militants engagés dans les mobilisations, une période d’observation d’un collectif militant ainsi qu’une étude de cas d’un hôpital en lutte en 2018, composée d’entretiens de militants et des textes issus du mouvement.
The controversy over packing therapy used in psychiatry was studied here to illustrate how leading associations can influence public health policies. The main French associations of parents with autistic children succeeded in obtaining the prohibition of packing, announced by the French Secretary of State to the Ministry of Health in April 2016. Parents and professionals who had observed the positive effects of packing when nothing else worked for their part wondered what could be done for self-harming patients. The political authorities followed the opinion of the main associations of parents with autistic children at the expense of that of professionals. In this paper, the actions and discourse of the associations against packing are explored, as are the arguments of the psychiatrists who defend packing therapy. The different phases in the controversy from the first opposition in 2005 and the role of opinion leaders in associations are analyzed. The strategies to discredit psychiatry and to promote behavioral methods are also studied to understand the shift in the balance of power from professionals to association leaders. The mobilization of the associations prompted some psychiatrists to conduct evidence-based research and to formalize their practice. The controversy over packing, involving political decision-making processes, ethical issues and clinical questions, enables us to illustrate a case of lobbying by associations.
Cette thèse interroge les processus de construction de la réalité́ à l’oeuvre lors de l’émergence duproblème politique de l’autisme. Un mécanisme largement bottom-up s’est imposé, sousl’impulsion déterminante de « coalitions de causes » (notamment celle des associations deparents) qui ont opéré un véritable travail de capacitation et d’expertisation pour s’approprier destravaux de recherche, contester la légitimité du pouvoir médical, revendiquer des droits auprès despouvoirs publics en utilisant différentes armes, médiatiques, et judiciaires principalement.Expliquer pourquoi l’autisme est devenu un problème politique au milieu des années 1990 jusqu’àêtre reconnu « grande cause nationale » en 2012 suppose d’analyser, sur un temps long, lesprocessus qui changent le statut de l’autisme (d’un problème familial d’abord, social ensuite,politique enfin) et en définissent les traitements publics possibles.
Slowly Stitching Together Subject, Body, Group and Institution : From Wet Packs to Institutional Psychotherapy
The technique of the wet pack offers new possibilities for psychotherapy with autistic and psychotic children and adolescents by focusing attention on the body. Not only the physical body, but the image of the body, as developed by several authors since Freud. For reasons which are still difficult to elucidate, wet packing was presented as a dangerous procedure by an organization of parents of autistic children. This article reviews the history of wet packing and tries to show how, on the contrary, it can open new ways of thinking about the psychopathology and psychotherapy of psychoses, and thus contribute to better care for children afflicted with autism and other invasive developmental problems.
Neuropsychoanalysis is a new school of thought attempting to bridge neuroscience and psychoanalysis. Yet few neuroscientists and psychiatrists would have heard of it if it had not recently received public support from notable neuroscientists. The present paper discusses whether such support is warranted.
Since decades, there exists a controversy about the place of evidence-based practice in French child psychiatry, in the context of a large influence of psychoanalysis in this country. Although an increasing group of professionals is oriented at an international standard of care based on methodologically sound empirical evidence, recent events may reinforce the misleading generalization that French professionals involved in child mental health do not implement modern clinical practices based on empirical scientific knowledge. As recent examples we briefly men-tion the following two, both related to the management of individuals with autism and other pervasive developmental disorders (PDDs): 1. An international group of experts in PDDs published in the February 2011 issue of the Journal of the American Academy of Child Psychiatry, a consensus statement considering as ''unethical'' and ''against evidence-based practice parameters'' an ''alleged form of therapy'' labeled as ''le packing'', implemented by some French practitioners for severe behavioral prob-lems in children and adolescents with PDDs [1]; 2. In September 2011, a movie (''The Wall''), focusing on the management of individuals with autism in France, was diffused on the internet. According to this movie, psychoanalysts treat individuals with PDDs using anach-ronistic, non-evidence-based and unethical methods [2]. These events have led us to further reflect on the implementation of evidence-based practice in child psy-chiatry and allied disciplines in France. Beyond any polemics, we wish to clarify that in France many professionals in child mental health do not include controversial
The author, a child psychiatrist, calls for a dialogue between psychoanalysis and neuroscience (both from his clinical joint practices with neuropediatricians and on a theoretical level) to found a new approach to the questions of neurodevelopmental and psychopathological disorders. He briefly discusses two examples. The first example is developmental and concerns the links between the archaic grasping reflex and adhesive identification. He shows how the phenomena observed in the two fields can find a logical sequence. The second example concerns a therapeutic technique (wrapping) that is used to soothe self-injurious behaviours in children with autism. Here, again, both approaches are used to better understand the phenomenon in question. Bridges must be built to open new theoretico-clinical and therapeutic collaborations. One could imagine data integration from these two heterogeneous subdomains to form a new complex subdomain, from which productivity is guaranteed.
Due to the inexistence of an aetiology-based intervention for autistic spectrum disorders (ASD) families and professionals are exposed to diverse and sometimes conflictive recommendations when they have to decide the most adequate alternative for treatment.
To elaborate treatment guidelines agreed by consensus at the ASD Study Group of the (National) Institute of Health Carlos III.
Information about treatment of ASD was searched and gathered through available evidence based medical (EBM) databases. The data generated was complemented with practice parameters published elsewhere, reports from prestigious international institutions, focus oriented searches in PubMed and, finally, the opinion and experience of a multidisciplinary Study Group with extensive experience in treating ASD in Spain. Most popular treatment methods were reviewed as well as the common elements to be considered in successful support programs.
No simple treatment algorithm can be produced at this time, and the level of available evidence based recommendations are in the weaker degrees of EBM classifications. Nevertheless, there is widespread agreement to stress that education, with special incidence in the development of communication and social competence, with the addition of community support are the main means of treatment. They can be complemented, depending on individual needs, with medication, behavioural approaches and cognitive-behavioural therapy for associated psychological problems in persons with higher cognitive level. Support to families and community empowerment are essential elements for the quality of life of persons with ASD.
has served as speaker for, or has served on the advisory boards of Dr. van der Gaag has participated in a not-for-profit Eli Lilly and Co. research trial. Drs Sciffo, and Volkmar report no biomed-ical financial interests or potential conflicts of interest
- Eli Lilly
- Co Janssen
- Shire
Disclosure: Dr. Fuentes has received research support from, has served as speaker for, or has served on the advisory boards of Eli Lilly and Co., Janssen, and Shire. Dr. van der Gaag has participated in a not-for-profit Eli Lilly and Co. research trial. Drs. Amaral, Baron-Cohen, Bourgeron, Caffo, Fombonne, Howlin, Klin, Lord, Minshew, Nardocci, Rizzolatti, Rogers, Russo, Rutter, Sciffo, and Volkmar report no biomed-ical financial interests or potential conflicts of interest. 0890-8567/$36.00/©2011 American Academy of Child and Adolescent Psychiatry DOI: 10.1016/j.jaac.2010.11.018 REFERENCES
Persons with autism spectrum disorders: identification, understanding, inter-vention http://www.autismeurope.org/files/files/persons-with-autism-spectrum-disorders-identification-understanding-intervention.pdf
- Fuentes C J Barthélémy
- P Howlin
- Van
- Gaag
Barthélémy C, Fuentes J, Howlin P, Van der Gaag RJ. Persons with autism spectrum disorders: identification, understanding, inter-vention. Autism Europe Official Document on Autism; 2009. http://www.autismeurope.org/files/files/persons-with-autism-spectrum-disorders-identification-understanding-intervention.pdf. Accessed December 19, 2010.
Le Packing avec les Enfants Autistes et Psychotiques. Ramonville-Saint-Agne: Erès
- P Delion
Delion P. Le Packing avec les Enfants Autistes et Psychotiques.
Ramonville-Saint-Agne: Erès; 2003.
DSM-5 development: 299.00 autistic disorder: proposed revision
- American Psychiatric Association
American Psychiatric Association. DSM-5 development: 299.00
autistic disorder: proposed revision. www.dsm5.org/Proposed
Persons with autism spectrum disorders: identification, understanding, intervention
- C Barthélémy
- J Fuentes
- P Howlin
- R J Van Der Gaag
Barthélémy C, Fuentes J, Howlin P, Van der Gaag RJ. Persons with
autism spectrum disorders: identification, understanding, intervention. Autism Europe Official Document on Autism; 2009.
http://www.autismeurope.org/files/files/persons-with-autismspectrum-disorders-identification-understanding-intervention.pdf.
Accessed December 19, 2010.
Intercollegiate Guidelines Network. Assessment, diagnosis and clinical interventions for children and young people with autism spectrum disorders: a national clinical guideline
- Sign-Scottish
SIGN-Scottish Intercollegiate Guidelines Network. Assessment,
diagnosis and clinical interventions for children and young people
with autism spectrum disorders: a national clinical guideline. 2007.
http://www.sign.ac.uk/pdf/sign98.pdf. Accessed December 19,
2010.
REFERENCES