Results of the Examination of Hearing in 180 Children Hospitalised at the Centre de Psychothérapie infantile in Armentières
Results of the Examination of Hearing in 180 Children Hospitalised at the Centre de Psychothérapie infantile in Armentières (1962)
Communication co-signed by Bruno Castets, R. Lefort, A. Tomatis and M. Reyns, presented to the Société médico-psychologique and published in the Annales médico-psychologiques (no. 1, June 1962, pp. 109-112). The authors report on the systematic audiometric examination of 180 children placed in an open psychiatric setting in Armentières, and establish a constant link between mental disorders in the child — particularly disorders of language and psycho-motor development — and objectifiable audiometric disorders. This study marks the entry of the Tomatis apparatus into the field of child psychiatry and inaugurates a reflection on the role of the affective investment of audition in the genesis of psychic disorders in the child.
Results of the examination of hearing in 180 children hospitalised at the Centre de Psychothérapie infantile in Armentières
by Messrs Bruno Castets, R. Lefort, A. Tomatis and M. Reyns
Extract from the Annales médico-psychologiques, no. 1, June 1962, pp. 109-112.
This work reports on the systematic instrumental audiometric examination of 180 children out of 230 placed in an open psychiatric setting under a free service regime.
I. — Population examined
This population is made up of children whose ages range from 7 to 13 years, the largest number being from 10 to 12 years old. These children are all natives of the Nord region and especially of the departments of the Nord and the Pas-de-Calais. They were admitted to the service because they presented mental disorders. In 128 of them, language disorders and the delay of psycho-motor development dominate; in 41 others, disorders of character and behaviour, particularly notable in the family setting, are to the fore; 11 of them, finally, owe their entry into the service to the fact that they have been admitted under the nosological criteria of classical psychiatry, without the character disorders being linked to their state.
Though tempting in certain respects, we have renounced in this work a classification referring to the nosological criteria of classical psychiatry, because the clinical elements with which we have to deal, in many cases, did not seem to us liable to be interpreted as unlabelled affective disorders secondary to difficulties of a family order. Finally, any classical nosology can only concern the mental psychic disorders of the child as those of the adult; this is to neglect the fact that the child fails — that one can never definitively classify him on the clinical aspect with mental retardation.
We have dwelt on the technical details, for it matters to identify, among the 180 children examined, all those of the service who appeared capable of grasping and applying the instructions, all in all very simple, proposed to the patient during an audiometric examination.
II. — Results of the audiometric examination
Out of 180 children examined, only 103 gave interpretable results. Among the 103 children:
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12 present a bilateral hypoacusis of transmission;
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1 presents a unilateral hypoacusis of transmission;
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1 presents a bilateral hypoacusis of mixed type;
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1 presents a unilateral hypoacusis of mixed type;
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15 present a bilateral hypoacusis of indeterminate type;
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5 present a unilateral hypoacusis of indeterminate type;
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5 present a bilateral deafness of transmission;
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5 present a unilateral deafness of indeterminate type;
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5 present a bilateral recto-lateral deafness, including one with hypoacusis of indeterminate type;
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2 present a substantially normal audiogram.
Without dwelling on the technical details, it matters to note:
1° — that most of the children examined present a defect of auditory selectivity, that is, prove incapable of recognising a tonal variation. This order of disorder, currently under study, cannot be measured in a sufficiently rigorous manner for it to be reported here, but the role it may play in disorders of the perception of speech should nonetheless be signalled.
2° — a certain number of the hypoacuses observed, whether of mixed type or hypoacusis of transmission, present a very irregular curve of predominance of deficit in certain frequency bands.
3° — it may be noted that over the whole of the 103 children examined, otitic alterations are found in only about thirty cases. In no case are neurological disorders or neurological antecedents found that might explain the existence of the hearing disorders.
As for the 71 children whose audiogram could not be interpreted, their existence bears witness to the reservations that must be brought to the audiometric interpretation in clinical cases such as audiometry. The behaviour of these children shows a defect of adaptation to the conditions of the examination as it was practised. Limited by rigid considerations of time, the operators were unable to adapt their technique to the motor instability and lapses of attention of these children, whom it would have been necessary to take at length, in conditions which unfortunately we did not have at our disposal.
III. — Observations and conclusions
Far from resolving any of the questions that may arise concerning the disorders of intelligence and the disorders of character in the child, the information gathered in this systematic audiometric investigation can only add to them.
One may first ask what may be the place of hearing disorders in the genesis of the mental disorders observed. What is poorly heard is poorly or not at all understood. It is hard to be astonished that a child who does not grasp an order or an instruction is incapable of obeying it. But one also conceives — the cause being ignored by the child’s family — his failures, that is, the defect of investment, as interpreted as facts of ill-will and punished as such. But one likewise conceives the repercussion of such a chain of events upon the relation of the child with those around him, the role, and in an equally determining way, that it may play in the re-establishment of this chain of events, although for this child whom one is not incapable of teaching and who may, soon, take on the appearance of a retarded and then of a backward child if not qualified as lazy, of remaining, who is not unaware of the feeling of isolation, of rejection, of alienation, which comes from the fact of not hearing. This, if it is held true of the adult, must hold infinitely more of the child.
The child constitutes the primary path of access to that ensemble of socio-cultural structure pre-existing each of us, of which language is the model and into which all thought must integrate in order to be, and in order to be communicable.
It remains to specify the moment and the cause of the hearing disorder. Of the children observed, none is deaf-mute, but almost all present disorders of verbal expression and psycho-motor disorders in the sense in which Ajuriaguerra understands them, that is, disorders of tonic-motor integration. One cannot a priori dismiss an organic aetiology at the origin of these hearing disorders. One may however note that in the present cases, this aetiology does not appear, the concept of otitis not containing in itself that of hypoacusis or of deafness. Moreover, the antecedents of otitis are found in only about thirty of the children who form the object of this work and whose audiometric examination could be brought to fruition. On the other hand, the acquisition of a differentiated sensory perception, such as that of a word, like the acquisition of a movement or attitude, is linked to the affective investment of what is acquired. One is justified in asking to what extent the hearing disorders observed in the children afflicted with mental disorders studied in this work might be due jointly to an organic cause that remains to be elucidated and to a defect of investment or a disinvestment of audition, the share of each aetiology remaining to be determined in each case.
Summary
The authors report the results of the audiometric examination of 180 children from 7 to 13 years, presenting mental disorders. In the near totality of cases (103) in which the examination could be brought to fruition, significant hearing disorders were brought to light. Starting from these results, the authors raise the question of the place of hearing disorders in the genesis of psychic disorders in the child and that of the meaning of these hearing disorders.
Work of the Centre de Psychothérapie Infantile of the H.P.A. of Armentières.
Chief Medical Officer: Dr B. Castets.
Source: Castets B., Lefort R., Tomatis A., Reyns M., “Résultats de l’examen de l’audition chez 180 enfants hospitalisés au Centre de Psychothérapie infantile d’Armentières”, Annales médico-psychologiques, no. 1, June 1962, pp. 109-112. Offprint printed by A. Coueslant in Cahors (serial no. 98,585). Digitised document from Alfred Tomatis’s personal archives.