Institutions thérapeutiques, stratégies de prise en charge et capacité de désymbolisation chez les enfants TDAH

Abstract

This thesis explores the factors associated with the therapeutic institution that contribute to the desymbolisation of ADHD children at the Etoug-Ebé National Rehabilitation Centre for the Disabled. It starts from the observation that ADHD children are present where they are not expected and absent where they are expected. This is akin to desymbolisation. Psychoanalytic research into this phenomenon attributes it to a deficiency in the development of the child's psychological processes, reducing it to a linear causality. However, not only is ADHD multifactorial, but any therapeutic institution also poses the problem of otherness, i.e. the acceptance of others as thinking and autonomous subjects by each of the social actors who have emotional relationships and intellectual ties with them (Enriquez, 2019). Hence the following research problem: ‘While current work on therapeutic institutions shows their effect on individual psychic processes, very few studies have taken this into account, particularly with the symbolisation process in ADHD children’. The study was based on an exploratory paradigm and adopted a qualitative approach. It involved two informants and five ADHD children from the inclusive school at the Etoug-Ebé National Centre for the Rehabilitation of People with Disabilities. Data were collected using the Rorschach test and semi-structured interviews with the ADHD children and the informants respectively. The Rorschach data were analysed using the French approach of Nina Rausch de Traubenberg (1977), updated by the interpretation approach of Chabert et al. (2020). Interviews were processed using thematic content analysis. The results show that while ADHD children have inattention, hyperactivity and impulsivity in common, each of them also has risk factors of their own which lead them to externalise their behaviour in one way or another. Failure to target these factors in treatment contributes to the desymbolisation of the children. The rigidity of the therapeutic framework also hinders their thought processes. Treatment as it is carried out with children only takes care of the child. The parent is reduced to a mere informant for the child's well-being. Failure to take these factors into account when caring for these children in the reception centre constitutes a kind of violence for them that calls into question their subjectivation process, a prerequisite for their ability to symbolise.