[Theoretical and practical aspects of cognitive remediation in intellectual disabilities: Relevance of the Cognitive Remediation Therapy program (CRT)].
BACKGROUND
Teenagers and adults with intellectual disabilities are nowadays "over-handicapped", often due to lack of care in self-sufficiency and continued learning, two essential domains for living in a community. Their cognitive limits, particularly on the executive functions, could be an obstacle to their involvement in the daily life activities, through their difficulties to plan, anticipate, shift and maintain information in working memory. These high level mental functions can be taught with the CRT program (Cognitive Remediation Therapy - Wykes and Reader 2005) developed in other pathologies and providing an adaptation regarding the developmental level of the person.


METHODS
Firstly, it is essential to determine cognitive developmental levels of the teenager or the adult, using standard tools, such as Wechsler scales. Secondly, functional and/or adaptative levels have to be assessed using specific tools, such as the Vineland Adaptative Behavior Scale 2nd Edition (VABS-II, Sparrow et al., 2005) and the Functional Intervention Scale (EFI, Willaye et al., 2005). Finally, in order to clearly distinguish what are the preserved and impaired cognitive domains, standard tools assessing executive functions such as the Wisconsin Card Sorting Test, the Tower of London, Stroop Test and BADS are used if possible for the patient. The setting of cognitive remediation programs, previously developed for schizophrenic patients, requires adaptation for teenagers and adults with intellectual disabilities, taking into account the limitation of their cognitive abilities. In this paper, we will show that the CRT method for cognitive remediation is particularly relevant for subjects with intellectual disabilities. This method is hence focused on strategies and exercises to improve working memory, categorization and moreover executive functions. Of course this method might need adaptations, with examples based on simplification of the different tasks, notably for verbal materials, and with variations of the media used. These sessions will be part of a wider individualized caring project, allowing the person to transfer the cognitive acquisitions to his/her daily life.


CONCLUSIONS
The use of cognitive programs adapted to people with intellectual disabilities can provide benefits in the development of autonomy and daily life activities, leading to a better quality of life and self-esteem.
Centre ressources autisme région centre, centre universitaire de pédopsychiatrie, CHRU Bretonneau, 2, boulevard Tonnellé, 37044 Tours cedex 9, France. Electronic address: i.carteau@chu-tours.fr.
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Carteau-Martin
Service hospitalo-universitaire, centre référent en remédiation cognitive et réhabilitation psychosociale (C3RP), université Paris Descartes, centre hospitalier Sainte-Anne, 1, rue Cabanis, 75014 Paris, France.
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Amado
UMR 930 imagerie et cerveau, Inserm, université François-Rabelais de Tours, CHRU de Tours, centre universitaire de pédopsychiatrie, 37044 Tours cedex 9, France.
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Thillay
Centre ressources autisme région centre, centre universitaire de pédopsychiatrie, CHRU Bretonneau, 2, boulevard Tonnellé, 37044 Tours cedex 9, France.
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Houy-Durand
Centre ressources autisme région centre, centre universitaire de pédopsychiatrie, CHRU Bretonneau, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; UMR 930 imagerie et cerveau, Inserm, université François-Rabelais de Tours, CHRU de Tours, centre universitaire de pédopsychiatrie, 37044 Tours cedex 9, France.
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Barthelemy
Centre ressources autisme région centre, centre universitaire de pédopsychiatrie, CHRU Bretonneau, 2, boulevard Tonnellé, 37044 Tours cedex 9, France; UMR 930 imagerie et cerveau, Inserm, université François-Rabelais de Tours, CHRU de Tours, centre universitaire de pédopsychiatrie, 37044 Tours cedex 9, France.
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Bonnet-Brilhault
D000293:Adolescent; D000328:Adult; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D056344:Executive Function; D006801:Humans; D008607:Intellectual Disability / Q000523:psychology / Q000628:therapy*; D008570:Memory, Short-Term; D009483:Neuropsychological Tests / Q000592:standards; D055815:Young Adult
Adolescents et adultes; Cognitive remediation; Déficience intellectuelle; Functional assessment; Intellectual disabilities; Quality of life; Qualité de vie; Remédiation cognitive; Teenagers and adults; Évaluation fonctionnelle