Création en établissement médico-social d’un programme d’entraînement à la reconnaissance des émotions faciales chez l’adulte TSA avec retard mental : une étude pilote

Abstract

Objectifs

De nombreux travaux étayent la présence d’un déficit de traitement des émotions faciales au sein des troubles du spectre de l’autisme (TSA). Bien que plusieurs programmes d’entraînement aient été créés afin de remédier à cette difficulté, peu d’entre eux ont fait l’objet d’une validation auprès d’un public TSA avec retard mental et, à notre connaissance, aucune donnée de la littérature ne mentionne l’existence d’un programme destiné aux adultes TSA avec retard mental. Cet article rend compte de la faisabilité et de l’évaluation au sein d’un établissement médico-social, d’un programme d’apprentissage des émotions faciales auprès d’adultes TSA avec retard mental.

Méthode

Dans un premier temps, nous avons réalisé une étude pilote explorant l’élaboration et la mise en œuvre d’un programme d’apprentissage des émotions faciales auprès d’adultes TSA avec retard mental au sein d’un institut médico-éducatif. En seconde instance, une évaluation avant et après programme a été conduite auprès de six jeunes adultes TSA avec retard mental. Le programme s’articulait autour de quatre modules : psychoéducation, orientation de l’attention sociale et du regard, émotions faciales, matching.

Résultats

Après dix séances d’entraînement, l’évaluation pré et post programme indique une amélioration significative en lecture des émotions faciales et un transfert des compétences dans la vie quotidienne.

Conclusion

L’ensemble des résultats met en évidence la pertinence en milieu médico-social d’un programme spécifique au traitement des émotions faciales chez l’adulte TSA avec retard mental. L’absence de données dans la littérature sur la réhabilitation psychosociale à destination de ce public nécessite de futurs travaux de recherche dans ce domaine.

Objectives

Many studies (Harms et al., 2010) support the presence of a deficit in facial emotion recognition in Autism Spectrum Disorder (ASD). Several hypotheses have been evoked to explain this phenomenon as an orientation process deficit in social attention (Dawson et al., 1998), an atypical visual exploration of the face with gaze avoidance (Klin et al., 2002) or a deficit in central coherence with an analytical, rather holistic, treatment of the faces (Frith and Happé, 1994). Although several training programs have been created to remedy this difficulty, few of them have been validated with an ASD population with intellectual disabilities and, to our knowledge, there is no evidence in the literature of the existence of a specific program for ASD adults with intellectual disabilities. This article reports on the feasibility and assessment of a facial emotion recognition program for adults with intellectual disabilities in a medico-social setting.

Methods

First, a feasibility study was conducted to explore the development and implementation of a facial emotion recognition training program for adults with intellectual disabilities in a medical educational institute. The program's methodology was based on the cognitive models of facial emotion treatment strategies by ASD (social attention deficit, atypical visual exploration of the faces and gaze avoidance, deficit in central coherence) organized into four modules : psychoeducation, directing social attention and gaze, facial emotions, matching. The aim of the psychoeducation module was to present emotions and deficiency in the treatment of facial emotions in Autism Spectrum Disorder. The directing social attention and gaze module proposed two group games to increase the focus on the gaze and the facial emotions module presented a specific training methodology of facial emotion recognition with photographs. Finally, the matching module consisted of an emotion photographs categorization task. A pilot assessment was conducted with six young ASD adults (four men and two women, age range 18–20 years) with intellectual disabilities (IQ = 46), both before and after the program, using the Affected Recognition task from the NEPSY-II neuropsychological battery and the McKinnon & Krempa questionnaire. Five of the six subjects were readers. However, assessment with the Analec test showed that all readers had a significantly low speed of reading and a major deficit in text comprehension.

Results

All objectives were achieved. A program presentation to the teams and the management made strong institutional commitment possible. Similarly, psychoeducation seems to have favored the participation of ASD people in the program, with a participation rate of 100% at the end of the sessions. Program assessment after ten training sessions shows a significant improvement of the Affected Recognition scores from the NEPSY-II neuropsychological battery (P < 0.05) with, however, a small effect size (d = 0,21). The McKinnon & Krempa questionnaire demonstrates a transfer of skills to everyday life, with a significant increase in the overall score and subscale scores for joint attention (P < 0.01), greetings and compliments (P < 0.05), social games, self-awareness and ability to self-regulate (P < 0.05), understanding emotions and social cues (P < 0.05), social relationships (P < 0.05).

Conclusion

The overall results highlight the relevance of a specific program for the treatment of facial emotions in ASD adults with intellectual disabilities. The lack of data in the literature on psychosocial rehabilitation for this population creates a need for future research in this area.