Infant and dyadic assessment in early community-based screening for autism spectrum disorder with the PREAUT grid.

BACKGROUND: The need for early treatment of autism spectrum disorders (ASD) necessitates early screening. Very few tools have been prospectively tested with infants of less than 12 months of age. The PREAUT grid is based on dyadic assessment through interaction and shared emotion and showed good metrics for predicting ASD in very-high-risk infants with West syndrome. METHODS: We assessed the ability of the PREAUT grid to predict ASD in low-risk individuals by prospectively following and screening 12,179 infants with the PREAUT grid at four (PREAUT-4) and nine (PREAUT-9) months of age. A sample of 4,835 toddlers completed the Checklist for Autism in Toddlers (CHAT) at 24 months (CHAT-24) of age. Children who were positive at one screening (N = 100) were proposed a clinical assessment (including the Children Autism Rating Scale, a Developmental Quotient, and an ICD-10-based clinical diagnosis if appropriate) in the third year of life. A randomly selected sample of 1,100 individuals who were negative at all screenings was followed by the PMI team from three to five years of age to identify prospective false negative cases. The clinical outcome was available for 45% (N = 45) of positive children and 52.6% (N = 579) of negative children. RESULTS: Of the 100 children who screened positive, 45 received a diagnosis at follow-up. Among those receiving a diagnosis, 22 were healthy, 10 were diagnosed with ASD, seven with intellectual disability (ID), and six had another developmental disorder. Thus, 50% of infants positive at one screening subsequently received a neurodevelopmental diagnosis. The PREAUT grid scores were significantly associated with medium and high ASD risk status on the CHAT at 24 months (odds ratio of 12.1 (95%CI: 3.0-36.8), p < 0.001, at four months and 38.1 (95%CI: 3.65-220.3), p < 0.001, at nine months). Sensitivity (Se), specificity, negative predictive values, and positive predictive values (PPVs) for PREAUT at four or nine months, and CHAT at 24 months, were similar [PREAUT-4: Se = 16.0 to 20.6%, PPV = 25.4 to 26.3%; PREAUT-9: Se = 30.5 to 41.2%, PPV = 20.2 to 36.4%; and CHAT-24: Se = 33.9 to 41.5%, PPV = 27.3 to 25.9%]. The repeated use of the screening instruments increased the Se but not PPV estimates [PREAUT and CHAT combined: Se = 67.9 to 77.7%, PPV = 19.0 to 28.0%]. CONCLUSIONS: The PREAUT grid can contribute to very early detection of ASD and its combination with the CHAT may improve the early diagnosis of ASD and other neurodevelopmental disorders.

Infant's engagement and emotion as predictors of autism or intellectual disability in West syndrome.

West syndrome (WS) is a rare epileptic encephalopathy with early onset and a high risk of autistic outcome. The PréAut grid assesses this risk following WS onset by taking into account synchrony and emotion in interactions and by evaluating the baby's active desire to engage in pleasant interactions (especially the infant's early active behaviors that encourage being gazed at or kissed by the mother or to share joy with her). We followed a sample of 25 WS patients prospectively from disease onset and assessed whether the PréAut grid before 9 months, and the checklist for autism in toddlers (CHAT) at 18 and 24 months predicted autism or intellectual disability (ID) outcomes at 4 years. We found that the PréAut grid at 9 months (sensitivity = 0.83; specificity = 1) had similar prediction parameters as the CHAT at 18 months (sensitivity = 0.90; specificity = 0.83) and 24 months (sensitivity = 0.92; specificity = 1). WS patients with a positive PréAut screening at 9 months had a risk of having autism or ID at 4 years, which is 38 times that of children with a negative PréAut grid [OR = 38.6 (95 % CI 2.2-2961); p = 0.006]. We conclude that the PréAut grid could be a useful tool for the early detection of autism or ID risk in the context of WS. Further research is needed to assess the PréAut grid in other contexts (e.g. infants at high-risk for non-syndromic autism).

Motherese in interaction: at the cross-road of emotion and cognition? (A systematic review).

Various aspects of motherese also known as infant-directed speech (IDS) have been studied for many years. As it is a widespread phenomenon, it is suspected to play some important roles in infant development. Therefore, our purpose was to provide an update of the evidence accumulated by reviewing all of the empirical or experimental studies that have been published since 1966 on IDS driving factors and impacts. Two databases were screened and 144 relevant studies were retained. General linguistic and prosodic characteristics of IDS were found in a variety of languages, and IDS was not restricted to mothers. IDS varied with factors associated with the caregiver (e.g., cultural, psychological and physiological) and the infant (e.g., reactivity and interactive feedback). IDS promoted infants' affect, attention and language learning. Cognitive aspects of IDS have been widely studied whereas affective ones still need to be developed. However, during interactions, the following two observations were notable: (1) IDS prosody reflects emotional charges and meets infants' preferences, and (2) mother-infant contingency and synchrony are crucial for IDS production and prolongation. Thus, IDS is part of an interactive loop that may play an important role in infants' cognitive and social development.

Do parentese prosody and fathers' involvement in interacting facilitate social interaction in infants who later develop autism?

BACKGROUND: Whether development of autism impacts the interactive process between an infant and his/her parents remains an unexplored issue. METHODOLOGY AND PRINCIPAL FINDINGS: Using computational analysis taking into account synchronic behaviors and emotional prosody (parentese), we assessed the course of infants' responses to parents' type of speech in home movies from typically developing (TD) infants and infants who will subsequently develop autism aged less than 18 months. Our findings indicate: that parentese was significantly associated with infant responses to parental vocalizations involving orientation towards other people and with infant receptive behaviours; that parents of infants developing autism displayed more intense solicitations that were rich in parentese; that fathers of infants developing autism spoke to their infants more than fathers of TD infants; and that fathers' vocalizations were significantly associated with intersubjective responses and active behaviours in infants who subsequently developed autism. CONCLUSION: The parents of infants who will later develop autism change their interactive pattern of behaviour by both increasing parentese and father's involvement in interacting with infants; both are significantly associated with infant's social responses. We stress the possible therapeutic implications of these findings and its implication for Dean Falk's theory regarding pre-linguistic evolution in early hominins.

O complexo de Jocasta / The Jocasta complex

A autora trata das questões femininas na meia-idade, a inibição da sexualidade e o complexo de Édipo reeditado com o seu filho, agora objeto inconsciente do seu desejo incestuoso.(AU)

The author discusses the woman’s issues in middle age, the inhibition of sexuality and the Oedipus complex re-edition with her child, the current unconscious object of her incestuous desire.(AU)

Do parents recognize autistic deviant behavior long before diagnosis? Taking into account interaction using computational methods.

BACKGROUND: To assess whether taking into account interaction synchrony would help to better differentiate autism (AD) from intellectual disability (ID) and typical development (TD) in family home movies of infants aged less than 18 months, we used computational methods. METHODOLOGY AND PRINCIPAL FINDINGS: First, we analyzed interactive sequences extracted from home movies of children with AD (N = 15), ID (N = 12), or TD (N = 15) through the Infant and Caregiver Behavior Scale (ICBS). Second, discrete behaviors between baby (BB) and Care Giver (CG) co-occurring in less than 3 seconds were selected as single interactive patterns (or dyadic events) for analysis of the two directions of interaction (CG→BB and BB→CG) by group and semester. To do so, we used a Markov assumption, a Generalized Linear Mixed Model, and non negative matrix factorization. Compared to TD children, BBs with AD exhibit a growing deviant development of interactive patterns whereas those with ID rather show an initial delay of development. Parents of AD and ID do not differ very much from parents of TD when responding to their child. However, when initiating interaction, parents use more touching and regulation up behaviors as early as the first semester. CONCLUSION: When studying interactive patterns, deviant autistic behaviors appear before 18 months. Parents seem to feel the lack of interactive initiative and responsiveness of their babies and try to increasingly supply soliciting behaviors. Thus we stress that credence should be given to parents' intuition as they recognize, long before diagnosis, the pathological process through the interactive pattern with their child.

As vicissitudes do encontro Mãe/bebê: um caso de depressão / The vicissitudes of the engagement mother/baby: a depression case

Para que um pequeno infans que acaba de nascer se torne um sujeito – tal como a psicanálise o concebe – ele precisa estabelecer um laço pulsional com um outro, representado, no primeiro momento, pelo agente materno, que deverá referenciá-lo ao campo do Outro, lugar simbólico. O estabelecimento de tal laço não é inato e nem sempre se dá de uma forma muito simples. O presente trabalho pretende discutir o que se convenciona chamar de “amor materno” e suas vicissitudes; analisar as dificuldades do encontro mãe/bebê; apresentar um caso clínico em que a depressão materna incidia em um bebê de poucas semanas, e no qual a intervenção psicanalítica teve um importante papel. Para abordar a questão do apaixonar-se necessário entre a mãe e o bebê, recorre-se ao mito de Eros e Psiquê e às noções de pulsão e gozo da psicanálise lacaniana.(AU)

A just born little infans, in order to become a subject – such as psychoanalysis conceives it – must establish an drive bond to another, represented at first by the maternal agent, who should refer him to the Other´s(A) field, symbolical place. Establishing such bond is not innate and not always simple to occur. The present study aims discussing what is conventionally called “maternal love” and its vicissitudes; the difficulties of the encounter mother/baby; presenting a clinical case on which maternal depression focused on a few weeks baby, and on whom psychoanalytic intervention played an important role. To approach the issue concerning the passion needed between the mother and the baby, it is often utilized the myth of Eros and Psyche as well as the concepts of drive and joy from lacanian psychoanalysis.(AU)

O lugar vago do Pai / The vacant place of the father

A autora relata um atendimento psicanalítico de uma criança pequena que encena repitidamente, através de famílias de animais, o colapso produzido quando o pai deixa vago o lugar de pai real castrador, necessário para a resolução do complexo de Édipo. Aborda a função do animal totênico proposta por Freud, e o conceito de supereu arcaico a partir das obras de Klein e Lacan, a fim de ressaltar a função apaziguadora da castração simbólica da vida psíquica de uma criança.(AU)

The author describes a psychoanalytical treatment of a little child who shows repeatedly, through the families of animals, the crash that is produced when the father abandons the place of the real castrator father, which is necessary to the resolution of the Oedipus complex. She also broaches the function of the totemic aniimal as it was propesed by Freud, and the concept of archaic superego from the works of Klein and Lacan, in order to emphasize the function of appeasement pertaining to the symbolical castration in the psychism of a child.(AU)

Computerized home video detection for motherese may help to study impaired interaction between infants who become autistic and their parents.

Autism is a well-defined clinical syndrome after the second year of life, but information on autism in the first two years of life is still lacking. The study of home videos has described children with autism during the first year of life as not displaying the rigid pattern typical of later symptoms. Therefore, developmental/environmental factors are claimed in addition to genetic/biological ones to explain the onset of autism during maturation. Here we describe (1) a developmental hypothesis focusing on the possible implication of motherese impoverishment during the course of parent-infant interactions as a possible co-factor; (2) the methodological approach we used to develop a computerized algorithm to detect motherese in home videos; (3) the best configuration performance of the detector in extracting motherese from home video sequences (accuracy = 82% on speaker-independent versus 87.5% on speaker-dependent) that we should use to test this hypothesis.

Godente ma non troppo: o mínimo de gozo do outro necessário para a constituição do sujeito

A autora propõe utilizar o conceito lacaniano de gozo como operador central na clínica do autismo, partindo da constatação de que nos bebês cujo encaminhamento se dá rumo a esse quadro clínico pode haver presença de uma relação narcísica com os pais, mas não uma relação pulsional, que desemboque na constituição de um sujeito desejante. Essa constatação, feita a partir da análise de filmes familiares, permite conceber um importante lugar para o tratamento psicanalítico e uma direção de tratamento para bebês com sinais de risco do tipo autístico, em que a questão pulsional entre a criança e seus pais vai ser colocada em evidência(AU)

This article proposes the use of Jacques Lacan’s concept of jouissance as a central operator in the clinic of the autism, based on the observation that in babies inclined to this clinical picture may be the presence of a narcissistic relationship with the parents, but not a drive-relationship, that would lead to the constitution of a desiring subject. This verification, made after analyzing the family movies of the baby, allows conceiving an important place to the psychoanalytic treatment and a direction to the treatment of babies with signs of risk to autism, in which the drive question between the children and their parents will be placed in evidence(AU)

Bebê com risco de autismo em tratamento conjunto: visa-se a reversibilidade total? / a baby who runs the risk of being autistic, and multiple Treatment: is it possible to revert this case?

A questão do autismo é abordada a partir de um tratamento conjunto mãe-bebê, no qual a autora relata as sessões conjuntas mãe-bebê-analista, e as intercorrências durante o processo de cura.

The subject autism is discussed based on a mother-baby treatment, in which the author relates the mother-baby-analyst sessions and the interactions during the curing process.

Breve relato das idéias de Lacan sobre a histeria / A short report on Lacan’s ideas about hysteria

A autora estabelece o percurso de Lacan em torno da Histeria, ao longo de muitos anos de seu ensino. A partir de casos clínicos de Freud, especialmente Dora, com referências a Elisabeth von R. e ao sonho da Bela Açougueira, enfatiza a concepção lacaniana do eu, em oposição àquela defendida pela ego psychologie, e estabelece o desenho do jogo das identificações no caso Dora e da dualidade desejo/demanda no sonho da Bela Açougueira. Além disso, trata da questão da mascarada como recurso de acesso à feminilidade e estabelece especial atenção ao conceito de mais-de-gozar (AU)

The author has outlined Lacan´s studies of hysteria during his many years of teaching. Based upon Freud’s clinical studies of the case of Dora, with additional references to Elisabeth von R and, also, to the Beautiful Butcher’s dream, she has emphasized Lacan’s conception of the I (je) in opposition to that defined by ego psychology. The dynamics of the game of identifications in Dora’s case have been established along with the duality desire/demand in the Beautiful Butcher’s dream. Besides this, she discusses the question of masquerades as a resource to femininity and dedicates special attention to the concept beyond enjoyment(AU)

O fluxo menstrual relido a partir de sua perda

Na menopausa, a perda do fluxo menstrual revela seu valor da garantia da potência de dar à luz. A clínica mostra que, para algumas mulheres, as amenorréias menopáusicas revelam fantasias de gravidez, mesmo naquela que pensavam não mais querer filhos. Em outras, a presença de sangramentos rítmicos, produzido pelo THS (tratamento hormonal subtitutivo), dá-lhes o sentimento de serem ainda mulheres e desejáveis. Portanto, a menstruação é também a garantia de uma identidade feminina nunca adquirida definitivamente. A autora retoma Freud, em seu debate com a escola inglesa, a propósito de uma identidade a construir e não adquirida, este feminino não se confundindo com o maternal (AU)

Ritmo, presença, voz, respiração-depoimento sobre o manejo da transferência em Lacan

A autora relata fragmentos de sua análise com Lacan, com a finalidade de apontar - na técnica psicanalítica por ele utilizada, seu estilo - a trama que dá sustentação a esse trabalho. Para a autora elementos como o ritmo das sessões, a maneira como o analista se faz presente na análise, sua voz, mesmo sua respiração são base para a instalação da transferência, da associação livre, e para ultrapassagem dos momentos resistenciais da análise. Informa ainda como estes elementos são agora utilizados por ela em sua clínica psicanalítica com bebês e jovens autistas (AU)

Das paixões amorosas que suscitam a paixão da ignorância: o amor no terceiro tmpo de Édipo

Este texto trata da sexualidade e desejo femininos na menopausa, traçado um histórico do tema na psicanálise e na literatura. O pano de fundo é a tragédia grega de Édipo, na figura de Jocasta. A autora aponta a paixão pela ignorância, pelo velamento da posição desejante de Jocasta, fazendo um paralelo com o velamento deste assunto por parte dos psicanalistas, até mesmo Freud (AU)

Sexualidade feminina e menopausa

O presente trabalho propõe uma análise da menopausa como um momento de remanejamento da economia libidinal da mulher, obrigatório pela perda das promessas edipianas substituídas do falo, segunda as idéias de Freud e Lacan sobre a sexualidade feminina. O conceito de Lacan do falo como significante serve de instrumento de leitura dos textos pós-freudianos de Karen Horney e Joan Rivière, para apontar a divisão da mulher entre sua posição de objeto do desejo na feminilidade e seu lugar de sujeito enquanto tal. A menopausa, ao fazer bascular a mulher enquanto desejável é o momento em que esta cisão comparece e faz questão (AU)

Poderia a teoria Lacaniana da pulsão fazer avançar a pesquisa sobre o autismo

Observa-se frequentemente que a difusão da obra de Lacan no estrangeiro, principalmente nos países anglo-saxônicos, mas também em alguns outros países europeus, ocorre de preferência através do meio literário. Os meios médicos, principalmente hospitalares-universitários, têm pouco ou nenhum contato com sua obra. É neste contexto que a situação atual na pesquisa sobre o autismo merece ser apreciada(AU)

A voz como primeiro objeto da pulsao oral

A autora problematiza a tese freudiana segundo a qual o funcionamento psiquico e pulsional apoia-se sobre a experiencia de satisfacao das necessidades vitais do organismo, e em especial a fome. Segundo ela, aquilo que e alucinado pelo bebe no polo alucinatorio desta experiencia de satisfacao e antes de tudo a voz materna, e mais especialmente seus picos prosoticos, que devem ser tornados como primeiros objetos da pulsao oral.

O Viagra na gaveta: sobre o bom uso do Viagra na crise do casal de meia-idade

Escuta-se frequentemente dizer que, na crise da meia-idade, os homens podem atravessar um período em que seu desejo pela companheira parece amolecer ou, em todo caso, não mais se levantar como antes. Em geral, eles se inquietam e começam a duvidar da própria capacidade. Nos Estados Unidos, fala-se facilmente de ED com relação a estes casos: erectile dysfunction. Na Europa, alguns bem que trocariam suas mulheres de cinqüenta por duas de vinte e cinco(AU)

Psicanalistas que trabalham em saude publica

A autora relata neste trabalho a intervencao de psicanalistas junto a profissionais da saude. Um dos objetivos desta intervencao e trabalhar no sentido da prevencao da sindrome autistica em bebe de menos de quatro meses. As hipoteses que ela levanta permitem pensar que e possivel prever um risco de evolucao autistica, bem antes de surgirem os primeiros sintomas da propria sindrome. Isto apresenta um interesse de ordem metapsicologica, mas tambem pratica. Todos os que trabalham com o autismo sabem que, quanto mais cedo a intervencao, maior a probabilidade de a estruturacao do aparelho psiquico se produzir, mesmo que inicialmente ela nao tenha se dado.