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Objectives: Within a strong interdisciplinary framework, improvement in the quality of care for children with autistic spectrum disorders through a 2year implementation program of Practice Parameters, aimed principally at improving early detection and intervention. Method: We developed Practice Parameters (PPs) for Pervasive Developmental Disorders and circulated the PPs to all child and adolescent psychiatrists practicing in the region. Results: PP development and parallel information strategies resulted in a significant decrease of 1.5years in the mean-age-at-diagnosis. However, further analysis indicated that improvement was only transient. Conclusion: Despite the encouraging improvement in mean-age-at-diagnosis 2years after PP implementation, other indicators showed a failure to maintain the improvements. A systematic screening program would be the most reliable method to reinforce the PPs

RésuméFondé sur les résultats d’une recherche sur les représentations de l’origine dans la procréation médicalement assistée ( pma), cet article présente une réflexion sur ce qui reste inexprimé chez des parents ayant conçu leurs enfants à l’aide de la fécondation in vitro ( fiv) homologue. Dans les entretiens de recherche, les parents de notre groupe ont montré des difficultés à exprimer leurs vécus, associées à un besoin paradoxal de « révéler » la pma. Après analyse, une fonction importante du silence en tant que trace traumatique du vécu psychique de la stérilité, a été mise à jour. Ce silence, accompagnant un dire et s’opposant ainsi au secret, a aussi été interprété comme le signe d’un indicible. Les pma forcent à penser la procréation qui est fondamentalement irreprésentable. C’est ainsi que le silence pointe à la fois le trauma de la sexualité stérile et l’impossible assimilation du réel de l’origine, réel qui est le propre de toute procréation, mais particulièrement mis en évidence lors de pma., Based on the results of a research study concerning the representations of the origin, this paper presents an analysis of the unspoken among sterile parents who have had children after autologous ivf. During the research interviews, various difficulties for all parents to explain their personal experience were encountered along with a paradoxical need of disclosure about the ART treatment. After an analysis of the data, an important function of silence as a traumatic lasting impression of the sterility was revealed. One can differentiate this type of silence from the notion of secrecy, as silence is always accompanied with talk, and thus, the parents’ silences were likewise interpreted as a sign of that which can not be said. The art compel parents to conceive procreation which is fundamentally unthinkable. Silence highlights the trauma of sterile sexuality, as well as the impossible assimilation of the origin’s “real”, a “real” that is present in all procreation, but particularly shown by art.

RésuméFondé sur les résultats d’une recherche sur les représentations de l’origine dans la procréation médicalement assistée ( pma), cet article présente une réflexion sur ce qui reste inexprimé chez des parents ayant conçu leurs enfants à l’aide de la fécondation in vitro ( fiv) homologue. Dans les entretiens de recherche, les parents de notre groupe ont montré des difficultés à exprimer leurs vécus, associées à un besoin paradoxal de « révéler » la pma. Après analyse, une fonction importante du silence en tant que trace traumatique du vécu psychique de la stérilité, a été mise à jour. Ce silence, accompagnant un dire et s’opposant ainsi au secret, a aussi été interprété comme le signe d’un indicible. Les pma forcent à penser la procréation qui est fondamentalement irreprésentable. C’est ainsi que le silence pointe à la fois le trauma de la sexualité stérile et l’impossible assimilation du réel de l’origine, réel qui est le propre de toute procréation, mais particulièrement mis en évidence lors de pma., Based on the results of a research study concerning the representations of the origin, this paper presents an analysis of the unspoken among sterile parents who have had children after autologous ivf. During the research interviews, various difficulties for all parents to explain their personal experience were encountered along with a paradoxical need of disclosure about the ART treatment. After an analysis of the data, an important function of silence as a traumatic lasting impression of the sterility was revealed. One can differentiate this type of silence from the notion of secrecy, as silence is always accompanied with talk, and thus, the parents’ silences were likewise interpreted as a sign of that which can not be said. The art compel parents to conceive procreation which is fundamentally unthinkable. Silence highlights the trauma of sterile sexuality, as well as the impossible assimilation of the origin’s “real”, a “real” that is present in all procreation, but particularly shown by art.

Objectives: Within a strong interdisciplinary framework, improvement in the quality of care for children with autistic spectrum disorders through a 2year implementation program of Practice Parameters, aimed principally at improving early detection and intervention. Method: We developed Practice Parameters (PPs) for Pervasive Developmental Disorders and circulated the PPs to all child and adolescent psychiatrists practicing in the region. Results: PP development and parallel information strategies resulted in a significant decrease of 1.5years in the mean-age-at-diagnosis. However, further analysis indicated that improvement was only transient. Conclusion: Despite the encouraging improvement in mean-age-at-diagnosis 2years after PP implementation, other indicators showed a failure to maintain the improvements. A systematic screening program would be the most reliable method to reinforce the PPs