La remédiation cognitive (RC) est une nouvelle approche thérapeutique dont le postulat repose sur l’hypothèse de la plasticité cérébrale permettant ainsi à des sujets présentant des défaillances cognitives spécifiques d’améliorer leurs fonctions exécutives ainsi que leur qualité de vie. Des programmes ont été appliqués et validés chez des adultes présentant un trouble schizophrénique et sont à l’origine du développement de programmes dédiés aux enfants présentant divers troubles psychiatriques pour lesquels des dysfonctionnements exécutifs ont été repérés. C’est le cas des enfants présentant un trouble du spectre autistique, un trouble déficit de l’attention/hyperactivité (TDA/H) ou encore une anorexie mentale. Le centre hospitalier Sainte-Anne qui a créé un centre de référence de remédiation et de réhabilitation psychosociale (C3RP) a développé, en parallèle de prises en charge destinées aux adultes, des programmes destinés aux enfants présentant des troubles du développement. Inspirés de programmes validés, français et anglo-saxons, la méthode associe des tâches papier-crayon et des jeux de société pour optimiser les fonctions d’attention, de mémorisation, de planification et de flexibilité mentale chez des enfants présentant un TDA/H ou des troubles des apprentissages. Ce programme, mené en parallèle de programmes classiques de prise en charge, témoigne dans une étude de faisabilité de sa bonne acceptation par l’enfant et sa famille ainsi que d’un impact positif sur les fonctions exécutives même si ce résultat demande à être répliqué.

The hypothesis of cerebral plasticity in psychiatric disorders has encouraged clinicians to develop cognitive remediation therapy (CRT), a new therapeutic approach based on attention, memory, planning, and mental flexibility tasks. The first cognitive remediation programs were developed and validated for adults with schizophrenia and were shown to have a positive impact on executive functions as well as on quality of life. In children and adolescents, researchers emphasized the existence of executive dysfunction in neurodevelopmental disorders such as autistic spectrum disorder, attention deficit disorder, and eating disorders. For these disorders, neuropsychological studies suggest that memory, planning, attention and mental flexibility are impaired. Despite the paucity of studies on cognitive remediation (CR) in children, preliminary results have suggested, as in adults with schizophrenia, good compliance and optimization of executive functioning. Consequently, programs dedicated to young subjects were developed in English-speaking countries, and the Department of Child and Adolescent Psychiatry of Sainte Anne Hospital (Paris) developed a new CR program for children with attention deficit disorder, academic problems, or eating disorders. These programs complete the field of CRT proposed by Sainte Anne Hospital's Remediation and Psychosocial Rehabilitation Reference Center, initially designed for adults with schizophrenia. Our team used and adapted validated tools such as Delahunty and Wykes's CRT program (translated and validated in French by Amado and Franck) and Lindvall and Lask's CRT Resource Pack. One program was developed for an adolescent with anorexia nervosa and applied to the subject and her family, but the purpose of this paper is to present a CR approach for children with attention deficit disorder or academic disorder, a 6-month program based on paper-pencil tasks and board and card games. The team was trained in different kinds of cognitive remediation, and the program was applied by a clinical nurse with the supervision of a child and adolescent psychiatrist and the department's neuropsychologists. Paper-pencil tasks were adapted from the CRT program for adults; the card and board games used were geometric figures, illusions, Rush Hour^®, Set^®, Jungle Speed^®, Color Addict^®, etc. These games are available in stores and the program can be applied at home, which helps families set aside their preoccupations with their child's academic performance. Diagnostic and neuropsychological evaluations were done before the beginning of the therapy and repeated at the end of the 6-month program. This program does not ignore the metapsychological impact of the therapy, and work on self-esteem is also done. The presence of the therapist is necessary, which seems better than a computer program, which cannot encourage the young subject in the same personalized and empathetic way. We therefore conducted the first clinical feasibility trial of cognitive remediation in young subjects and present a clinical case of a 6-year-old boy with attention deficit disorder and academic disorder. The results of neuropsychological evaluations before and after therapy suggest improvement in executive functions and better self-esteem. Satisfaction for the boy and his family was high. Even if these results need to be replicated, cognitive remediation appears to be a new therapeutic tool, complementary to classical approaches used in childhood psychiatric disorders. The Department of Child and Adolescent Psychiatry will submit this program to a research program conducted by the National Health Department to study the impact of this approach in a controlled study.