La remédiation cognitive (RC) est une approche brève et focalisée favorisant un meilleur fonctionnement neuropsychologique et une meilleure qualité de vie. Les processus neuropsychologiques ciblés concernent les fonctions exécutives ; l’attention et la cognition sociale. En intervention précoce la RC vise à éviter un surhandicap chez les enfants et les adolescents présentant un trouble du neurodéveloppement en prévenant aussi des complications émotionnelles et/ou comportementales associées. Elle complète les prises en charge habituelles ou les optimise. Concernant la cognition sociale, elle favorise le développement de la théorie de l’esprit et protège d’une faiblesse de l’inhibition comportementale. Facteur de réhabilitation chez les adultes, la RC est facteur d’inclusion chez les plus jeunes et favorise le maintien dans leur environnement écologique. Nous proposons le programme de remédiation cognitive NEAR (Neuropsychological Educational Approach to Remediation), développé depuis 2002 par Alice Medalia, à des collégiens avec trouble du spectre de l’autisme (TSA) ou Trouble déficit de l’attention avec ou sans hyperactivité (TDA/H). Outil thérapeutique attractif pour les plus jeunes il a fait preuve de son intérêt chez les adultes ; intègre la métacognition et optimise la généralisation dans la vie quotidienne. La réalisation d’un bilan médical et neuropsychologique au C3RP-Enfants/Adolescents (Centre référent en remédiation cognitive et réhabilitation psycho-sociale) est un prérequis et les bénéfices sont évalués au terme du programme. Dans une étude de faisabilité, les jeunes ont témoigné se sentir plus motivés, confiants et compétents. La RC semble représenter une nouvelle ressource thérapeutique pour les plus jeunes dont l’efficience reste à évaluer scientifiquement.

Cognitive remediation is a brief and focused therapeutic approach for adults, children or adolescents with cognitive impairments as observed in psychiatric disorders. Executive functioning, social cognition and attention are the main dimensions trained with specific programs. Metacognition is also targeted and contributes to a better quality of life and to better adaptation in daily life. For children and adolescents the objective of cognitive remediation is to maintain the subject in his or her ecological environment (family, school, leisure). Neuropsychological dimensions, such as executive functions, attention, and social cognition are the targets of varied programs. Cognitive remediation helps to avoid over-handicap and may prevent some emotional and behavioral complications. The scientific background for cognitive remediation consists of studies involving the schizophrenic population, and cerebral plasticity is the basis of the theory. Different steps are described by researchers, distinguishing cognitive training (step 1) and adaptation in daily life (step 4). Cognitive training is a bottom-up approach, and daily life adaptation is a top-down approach as described by neuropsychological theories. For adults with schizophrenia, cognitive remediation acts on specific neuropsychological dimensions of hypofrontality. For children and adolescents presenting neurodevelopmental disorders such as autism or ADHD, attention, flexibility and inhibition are targets for therapy. And for emotional disorders such as anxiety, or for depressive disorders, even if there is a paucity of programs and studies, we have the knowledge that attentional bias as identified by cognitive-behavioral therapies can be modified. Despite this knowledge for emotional disorders there are insufficient studies about the validation of the cognitive remediation approach for children and adolescents.

A special cognitive remediation program was developed by Alice Medalia for adults with schizophrenia. We thus developed a program for adolescents with ASD or ADHD. It is administered through an outpatient platform which associates computerized sessions of cognitive remediation and bridging groups that help adolescents to generalize the cognitive benefits of those sessions to daily life. Adolescents receive medical, psychological and neuropsychological evaluation at the beginning of the program, and benefits are evaluated at the end of the program. Thirty sessions are proposed, and each session has a mean duration of 75 mn: 40 mn of cognitive exercises and 35 mn of bridging group. The objective of the bridging group is the generalization of the cognitive exercises to daily life. During each session, the computerized program adjusts to the young subject's performances. The therapist gives support in order to provide a positive learning experience.

Adolescents reported feeling more motivated, confident and competent as a result of participating in the program. Cognitive remediation facilitates inclusion of young people in their ecological environment, such as school.

Cognitive remediation is a brief and focused approach which is supported by the cerebral plasticity hypothesis. The optimization of executive functions, cognitive and social-cognitive dimensions is an objective that can be applied to many psychiatric disorders in children and adolescents. It is a promising tool for treating these young subjects even if more studies on its efficacy are needed.