The history of autism in France has been shaped by the influence of psychoanalysis and institutionalization practices that have often violated the rights of autistic individuals. As of 2016, it was estimated that 0.7 to 1% of the French population has an autism spectrum disorder, with many cases undiagnosed, leading to varying degrees of disability.
Before medical and intervention efforts, autistic individuals were often marginalized and subjected to mistreatment. The first steps toward addressing autism in France began in the 1950s, with Professor Roger Misès establishing day hospitals and creating the French classification of mental disorders in children. Interest in autism increased after the publication of Bruno Bettelheim's The Empty Fortress (1967). In the 1990s, the government, under Simone Veil, began to take action, and by the early 2000s, parents' associations began challenging the psychiatric approach that viewed autism as a mental illness tied to poor parenting. These efforts led to autism being recognized as a disability and the introduction of new policies, including four "Autism Plans" in the 2000s. These plans aimed to improve school enrollment and employment opportunities for autistic individuals, and autism is now recognized as a spectrum disorder.
The treatment of autism in France has been marked by debates over intervention methods. These debates often center on differing views between supporters of behavioral approaches and those who maintain psychoanalytic perspectives. Additionally, specific practices, such as using the term "autistic" as an insult and the overmedication of individuals with neuroleptics, have been sources of social exclusion and suffering. Recent research advocates for focusing on the unique interests of people with autism to foster a more inclusive society.
Descriptions and statistics According to sociologist Lise Demailly, autism in France is marked by intense debates and conflicts, often leading to legal disputes. She highlights the range of ideological, ethical, and practical disagreements surrounding the issue.
The field of autism in France is characterized by a variety of approaches, influenced by psychoanalysis. However, in places like Quebec, where psychoanalysis is not used, parents also express dissatisfaction with the services available. The scientific discourse on autism is now global, with much of the research coming from neurobiologists and geneticists, often in English.
While French psychiatrists and psychoanalysts face growing criticism and diminishing influence with public authorities, they continue to produce intellectual work outside mainstream scientific journals. Demailly notes that there is no single, widely accepted scientific definition of autism or understanding of its causes. Despite this, there is general agreement on the description of autism symptoms, though tensions persist. The representation of autistic people in France remains limited, with the neurodiversity movement arriving relatively late.
Descriptions
In France, autism is described as a lifelong neurodevelopmental disorder, with three main factors: genetics, brain development and behavior. It is characterized by communication difficulties, repetitive behaviors, strong resistance to change, and obsessive interests or activities. There may also be sensory sensitivities. Autistic individuals may experience additional conditions like epilepsy, hyperactivity, or sleep and eating disorders.
The French Ministry of Solidarity and Health has moved away from sub-categories of autism and now uses the term Autism Spectrum Disorder (ASD), which reflects the varying development of individuals within society.
According to Franck Ramus of the French National Centre for Scientific Research (CNRS), autism involves differences in three areas: social interaction, communication, and preferred interests or activities. These differences can lead to challenges in adapting to family and social life, causing difficulties for both the individuals and those around them.
Cognitive psychiatrist Laurent Mottron notes that while most autistic people struggle with societal adaptation, a small group, around 10%, can be verbal, relatively independent, and successful in adulthood. However, others may remain non-verbal or experience behaviors that are harder to manage.
Causes
The cause of autism is considered multifactorial, with a significant genetic component. Research has identified genetic mutations that affect communication between neurons. Claims that autism is caused by psychological factors, such as parental traits, or even gluten, vaccines, or mercury, are not supported by scientific evidence.
Some critics, like journalist Gerald Messadié, argue that psychoanalysis has contributed to the incorrect belief that autism is purely psychological. In France, the term "child psychosis" has often been linked to psychodynamic explanations of autism. However, many researchers and professionals, including psychiatrists and psychoanalysts, have suggested various psychological models to understand autism, though these views are not universally accepted.
Classification The French Classification of Mental Disorders in Children and Adolescents (CFTMEA) includes subcategories for autism, such as deficit psychosis and psychotic dysharmonia, which are not found in international classifications like the ICD-10 and DSM-5. Other forms of autism, such as infantile autism and Asperger's syndrome, are recognized in both the CFTMEA and international classifications. The recognition of autism in France has been delayed by limited research and debates within the field.
+Correspondence between ICD-10 and CFTMEA-R-2012 classificationsICD-10 Pervasive developmental disordersCFTMEA-R-2012 Pervasive developmental disorders – early psychosesF84.0 Childhood autism1.00 Early-onset autism, Kanner typeF84.1 Atypical autism1.01 Other forms of autismF84.1 + F70 to F79 Typical autism with mental delay1.02 Autism or PDD with early mental retardation/deficit psychosisF84.5 Asperger's syndrome1.03 Asperger's syndromeF 84.8 Pervasive developmental disorder not otherwise specified1.04 Multiple and complex developmental disharmony / Psychotic disharmony The use of the term "psychosis" to describe autism was criticized in the early 2000s. Some professionals, like Claude Wacjman, argue that the CFTMEA's use of "psychosis" helps align French practices with international systems, improving service coordination. However, other professionals, including Jean-Claude Maleval and Claude Wacjman, oppose broader international concepts of Autism Spectrum Disorder (ASD), seeing them as too inclusive or commercialized. Some experts, like Jacques Hochmann, suggest the term "autism spectrum" may eventually be replaced by "autism."
The classification of autism in France has been inconsistent, initially seen as a mental health condition and now classified as a disability. This has made it challenging to develop clear policies. Some critics, including Josef Schovanec, highlight the issues with classifying autistic individuals as mental health patients, leading to unwanted psychiatric treatments. Despite this, autism is officially recognized as a disability, with varying degrees of impact on an individual’s ability to function in society, from significant challenges to minimal limitations.
Epidemiology
Reference data were collected in 2010 by epidemiologist Éric Fombonne for the Haute Autorité de santé report on knowledge of autism: +Estimating the prevalence of pervasive developmental disordersSource:Fombonne, 1999Inserm, 2002Fombonne, 2003Fombonne, 2005Fombonne, 2009Number of studies included in the review2331324043PDD18,7/10 000 (1/535)27,3/10 000 (1/336)27,5/10 000 (1/364)37/10 000 (1/270)63,7/10 000 (1/156)Childhood autism7,2/10 000 (1/1389)9/10 000 (1/1111)10/10 000 (1/1000)13/10 000 (1/769)20,6/10 000 (1/485)Other childhood disintegrative disorder – –0,2/10 000 (1/50000)0,2/10 000 (1/50000)0,2/10 000 (1/50000)Asperger's syndrome –3/10 000 (1/3333)2,5/10 000 (1/4000)3/10 000 (1/3333)6/10 000 (1/1667)Atypical autism, Other PDDs11,5/10 000 (1/870)15,3/10 000 (1/654)15/10 000 (1/666.7)21/10 000 (1/476)37,1/10 000 (1/270) The prevalence of autism in France is estimated at around 1% of the population, or approximately 700,000 people, with 100,000 of them under 20 years old. The male-to-female ratio is about 4:1. Estimates vary, with some reports suggesting between 250,000 and 600,000 autistic individuals in the country. However, there is a significant under-diagnosis, and some studies show a lower prevalence in France compared to other countries.
The prevalence of autism in France has been debated, with estimates ranging from 4 to 5 per 10,000 births for typical autism, and 12 per 10,000 for all pervasive developmental disorders. The figures include various forms of autism, including atypical forms, deficit psychoses, and other related conditions. Some experts believe the increase in diagnoses may be due to improved detection rather than a true rise in cases.
Experts also note that the number of people with autism is difficult to determine, as many individuals remain undiagnosed. Some estimates suggest there are between 450,000 and 650,000 people with autism in France, based on international diagnostic criteria. A survey of 900 French people with autism showed that 55% had infantile autism, 23.5% had an unspecified pervasive developmental disorder, and 16.6% had Asperger syndrome.
According to a survey of 900 French people with autism conducted by Doctissimo and the FondaMental Institute and published in March 2013, 55% of respondents have infantile autism, 23.5% have an unspecified pervasive developmental disorder and 16.6% have Asperger syndrome.
History
France, along with Latin America, is one of the regions where psychoanalysts have historically included infantile autism in their explanations of the condition, especially after the 1970s and 1980s. Psychoanalytic practices continue to influence psychiatric approaches to autism in the country. The deinstitutionalization process in France started later than in other countries, with a high rate of institutionalization for children with autism compared to the rest of Europe. Additionally, there has been significant opposition between parent associations and health professionals regarding the treatment of autism.
In the 2010s, French parent associations, initially focused on securing institutional care and funding, began advocating for changes in the way autistic children were treated and educated. Sociologists note that these efforts were partly driven by public authorities to push forward deinstitutionalization, although this led to concerns among health professionals about the availability of resources for vulnerable families. Over the years, the classification of autism has evolved from being seen as a rare and severe disorder to a broader spectrum of related conditions, affecting around 1% of the population. Since the 1990s, autism has increasingly been viewed as a social issue, with significant legal developments, although resistance to change remains.
Before medical descriptions
Before the concept of autism was defined, individuals with the condition were often marginalized and described as "idiots", "crazy" or "wild children." One example is Victor de l'Aveyron, a child found in 1801 who exhibited behaviors now associated with autism. Dr. Jean Itard, who cared for him, also described a form of non-verbal autism in 1828, calling it intellectual mutism. In the 19th and early 20th centuries, many medical professionals viewed these individuals as suffering from hereditary degeneration, influenced by eugenic theories. Itard and Édouard Séguin were among the first to study and describe individuals who may have had autism.