Psychomotor manifestations in learning disorders
Mathilde Etienne, Séverine Jacquet, psychomotor therapists, & Philippe Scialom, psychomotor therapist, psychologist.
Translated by Juliette Maceda, Dewi Lecuyer, Berland Alexis, Marine Fruitier, Camille Baud
1. Definition and classification
During their schooling, many children encounter difficulties in learning. This deterioration in school performance is secondary to sociocultural, environmental, or intrinsic factors. These difficulties are most often re-educated thanks to the introduction of care; thus, allowing a better adaptation during the continuation of their studies.
The appearance of severe, specific and persistent difficulties in school learning amongst intelligent children, without psychological, social or cultural difficulties, has led researchers to question the origin of these disorders. The first case was that of a child with a significant and persistent reading disability. Hence, this is the first description of developmental dyslexia (Pringle Morgan, 1896). The term "learning disorders" first appeared in the "learning desabilities" terminology by Kirk in 1963. Since then, the literature has been full of definitions. We can retain that of Rutter, M., 1989, who defines them as "a set of learning difficulties that can not be attributed to intellectual retardation, physical handicap, or adverse environmental conditions. These difficulties are unexpected given other aspects of development, they appear very early in life and interfere with normal development. They often persist in adulthood”.
To define these learning disorders, various criteria have been retained by the International Classification of Diseases (ICD-10) and the Diagnostic and Statistical Manual of Mental Illnesses (DSM-5).
In ICD-10, we find them in the chapter entitled "Disorders of psychological development" in the section dedicated to specific disorders of the development of school achievements. They are referred to as "diagnostic criteria common to specific disorders of school achievement". There are 5 criteria :
· "The test score, administered individually, is at least two standard deviations below the expected level, given chronological age and IQ
· The disorder interferes significantly with school performance or activities of daily living
· The disorder does not result directly from a sensory deficit
· Schooling takes place in the usual norms
· The IQ is greater than or equal to 70
In the DSM-5, Specific Learning Disorders (SLD) are grouped under the more generic term of “neuro-developmental disorders”. “Specific learning disorders have a neurodevelopmental origin, they hinder the ability to learn and therefore the access to academic skills (such as reading, writing or arithmetic) that are the basis of other learning . These specific learning disorders are unexpected due to normal development in other areas.”
The DSM-5 highlights 4 diagnostic criteria :
· "The persistence for at least six months of one of the six symptoms of SLD despite individualized care and targeted educational adaptation.
· The evaluation is done in two steps: it must include a "diagnosis assessment" followed by a second "assessment for intervention", determining the "specific" help to be provided to the student. The diagnostic assessment includes quantifiable measures of academic difficulties, showing that the level attained is below the expected level given age, resonating on academic success and daily life. This implies the need for a “comprehensive” clinical evaluation using standardized adapted tests, executed individually.
· The age at which SLD occurs may be variable, most often in primary school, but SLD may not fully manifest until adolescence.
Enumeration of disorders whose existence eliminates the diagnosis of SLD :
Mental disorders, sensory disturbances (hearing, vision); neurological disorders; instruction disorders, lack of knowledge of the language which must have improved before making the diagnosis of SLD.
These specific learning disorders most often refer to basic learning skill disorders. They are also called "dys syndrome". We distinguish :
Reading specifity: dyslexia
This is a disorder of reading acquisition and automation. There are 3 forms :
Phonological dyslexia : which is a deficit of the reading assembly path, that is to say a problem of decryption.
Surface dyslexia : which is a disorder of the address or lexical and grammatical way, that is to say a problem of global word recognition.
Mixed dyslexia : which is an impairment of the 2 reading procedures.
Language specificity: dysphasia
It is a disorder of the oral language acquisition and the automation recognized by William Wilde in 1853. In 1958, Ajuriaguerra uses the term of audimutity which he replaced by dysphasia in 1965.
According to the Quebec Order of Speech-Language Pathologists and Audiologists, dysphasia is "a primary language disorder, in the expressive or expressive and receptive spheres, which is observed by variable impairments affecting the development of more than one component of language, phonology, morphology, syntax, semantic, pragmatic. In addition to a heterogeneity of the manifestations of this disorder from one individual to another, it is characterized, in the same individual, by its persistence, the variability of the clinical portrait over time, as well as a high probability of little evolution without intervention. "
Arithmetic specificity: dyscalculia
This is basically a disorder of numeracy and arithmetic skill. It implies difficulties regarding the construction and operations of numbers. It occurs during the child’s development through :
· Extended and more frequent use of immature counting processes (on the fingers)
· Difficulties in memorizing arithmetic facts
Difficulties in arithmetic operations learning : additions, subtractions,
· And mathematical problem solving
Spelling specificity : dysorthographia
This is an important and long-lasting lack of assimilation of spelling rules. Phonographic conversion, segmentation of sentence components, application of orthographic conventions, and grammatical spelling are altered.
Writing specificity : dysgraphy
It is an "attack of the sculptural graphic function manifesting itself at the level of the spatial components of writing, whereas the morphosyntactic structures are not affected. (Postel, 1993) and apart from any neurological damage.
The main features are :
· Graphic slowness
· A bad layout organization
· Improper work printing
· Faulty layout
· Calligraphic standards not respected
Irregular spaces between words and letters (telescoping, welding,
absence of liaison)
· Lines of writing not respected
They can be grouped into 4 categories (according to Gaddes and Edgell cit in Albaret (1995, p.71).
Writing alteration : tremors, badly formed letters, telescoping or absence of connection, absences of loops, ironed lines, migraphy for example.
Spatial disturbances : misalignment of the letters, tight words, absence of margin, ascending or descending lines
Syntactic disorders : difficulties in writing grammatically correct answers in response to a question while oral expression does not suffer from such
Reluctance to write
The Developmental Coordination Disorder (DCD) and Dyspraxia
The Developmental Coordination Disorder (DCD)
Laurence Vaivre Douret defines it in 1999 as a « marked disturbance of the motor coordination development. This excludes any general medical infection and pervasive developmental disorders, any intellectual backwardness or important motor retardation. »
According to the DSM-IV (1994) DCD is characterized by
· - Performances in the daily activities requiring a good motor coordination are clearly below the level expected taking into account the chronological age of the subject and its intellectual level (measured by tests).
· That can result by important backwardness in the stages of the psychomotor development (e.g., crawling, sitting down, walking), by acts like dropping objects, by “awkwardness”, bad athletic performances or a bad hand-writing.
· The disturbance interferes to a significant degree with academic success or the activities of the everyday life.
· - The disturbance is not due to a general medical affection and does not answer the criteria of a pervasive developmental disorder.
· If mental backwardness, the motor difficulties exceed those usually associated with this one.
The warning signs are:
- Difficulties in the activities of the daily life
- Important slowness in the various motor activities
- Trouble with school learning.
The repercussions are:
- Behavioral and academic troubles (school refusal, avoidance of certain activities) (Cantell & al., 1994; Roofing stone & al., 1991)
- Emotional and interpersonal troubles (victimization, lowering self-esteem and oneself feeling of personal effectiveness) (Chen & Cohn, 2003; Roofing stone & al., 1991; Skinner & Piek, 2001)
- Worsened risk of mental health problems to appear (depression, anxiety) (Rasmussen & Gillberg, 2000; Sigurdsson & al., 2002)
The specific disorder of driving coordination: The dyspraxia
It can be defined as an incapacity to conceive, program and carry out a gesture. Various forms of dyspraxia were listed:
The ideomotor dyspraxia: it relates to the gestures to be carried out in the absence of real handling of objects. They are thus gestures with aiming symbolic system or that are mimed. (greeting, imitation of gestures carried out by others)
The ideational dyspraxia: it relates to the trouble in using, handling objects.
The dressing dyspraxia: which relates to the gestures in relation with getting dressed. Buttons done up, tying shoelaces, to put clothes in the right sense are difficult.
The visuo-spatial or constructional dyspraxia: it refers to assembling activities. The subject has troubles in building in 2D, 3D, to transpose from the 2D to the 3D.
And the Attention Deficit Disorder with or without Hyperactivity
It is characterized by the symptomatic triad:
- defect of behavioral inhibition which is source of errors of inattention.
- lack of self-contrôle which is often the cause of an agitation on the motor plan
2. Concept of comorbidity
The learning disorders are called specific because they alter a particular field in the cognitive operating area of the subject. The functional translation of the disorder is not the etiologic resultant of one factor but the expression of the convergence of a plurality of factors. These troubles are related to a dysfunction of the neurological system and in correlation with genetic and inherited factors. The prematurity and perinatal factors are also additional factors in the emergence of such disorders. (Finnström & collar., 2003)
Frequently, these disorders are found, for the same person,
associated to each other and to other disorders.
In France, an inter-ministerial plan « in favor of the children suffering from a specific disorder of the spoken and written language » is set up in March 2001. It gives rise to the ministerial bulletin HOS/01/2001/209 of May 4th, 2001, calling to specialize certain hospital services in centers of reference for the learning disorders of the spoken and written language. Those ones have a role of expertise. The work with plurality of professionals allows achieving the diagnosis and the implementation of coordinated and specific nursing to the disorders of the child. By the means of these structures a research on the frequency of these disorders among the population and of their comorbidity is also realized.
The pure form of dyslexia is not very frequent. In more than 1 case out of 2, dyslexia is resulting from dysphasia. It
is found also often associated with the attention deficit disorder with/without hyperactivity, with a DCD and with psycho-affective disorders.
· There is a close relation between dysphasia and the attention deficit. It can be primary or secondary. This is in particular due to the linguistic effort it requires them for each activity./ The working memory is often altered, and a slowness of treatment is often associated. Dysphasia is often associated with dyslexia. A study from Lasserre, Gely & Heral (1994) shows that more than half of the children suffering from dysphasia present a psychomotor retardation. The incidence of this comorbidity is evaluated to be around 25%. The deficits generated by the difficulty of using the oral language is very often source of anxiety.
Pure dyscalculia is rare. It is found concomitant with troubles of spatial organization and also with inefficient motor coordinations. It is particularly characterized by a poverty of the knowledge of oneself’s own body and of the mental representation of the body. It is found often associated with oral or written speech difficulties, but also with attention deficit disorders.
· Dyspraxia: Among the specific learning disorders, dyspraxia is one of the disorder which affects more the psycho-emotional sphere. Still badly known, before being diagnosed the children are often described as clumsy, having « two left hands ».
· Regarding dysorthography, according to the report of the Inserm: « even if some neuropsychological case studies report that troubles with orthographical production without troubles for reading, all researches relating to the learning skills and the development consider that the disorders for orthographical production are systematically associated with those for reading, and in particular with dyslexia. »
· The children presenting learning skills disorder often have an associated dysgraphia, in 30 to 40% of the cases (Mayahra and al, 1990) up to 67% of the cases (Waber and Bernstein, 1994). According to Albaret (1995) and the studies of Corraze (1981) dysgraphia is often concomitant with a DCD, a developmental dyspraxia or with dyslexia. It is also frequently found at the people prone to AD/HD because of a damage of the graphemic system (Caramazza, 1987). We can find it in dystonia and writer's cramp (De Ajuriaguerra, 1974). It can be associated as well with disorders of lateral dominance (ambidextria, opposed predominance, ambi-laterality).
· Regarding the Developmental Coordination Disorder: The association of DCD and dyslexia is frequent but not systematic. The frequency observed varies from 29 to 70% from one study to another according to the criteria selected to make this evaluation.
· The Attention Deficit Disorder: The epidemiological studies (Mayes and Calhoun in 2006) show that 71% of the subjects having a ADD with or without Hyperactivity are prone also to one or more learning skills disorders. The association AD/HD with dyslexia is present in 33% of the cases, with dyscalculia in 26% of the cases, with dysorthography in 25% of the cases and in 63% with a dysgraphia
In order to talk about the comorbidity of the psychomotor symptomatology most often met in learning skills disorders, here is a summary table:
Learning disorders do not originate from a cognitive, sensory or motor impairment or from the existence of a pervasive developmental disorder or traumatic injury. The socio-cultural, economic and emotional dimensions are not etiological factors but are conducive to the aggravation or improvement of these disorders. Early detection of learning disturbances through reference centres for learning difficulties in oral and written language is therefore a fundamental first step for the child. It will make it possible to identify its difficulties, to bring a different accompaniment in the learning process. During the psychomotor evaluation « taking into account soft signs must more than ever retain the attention of the psychomotrician, who is one of the professionals in the best position to detect them, appreciate their disruptive or disabling nature and implement appropriate therapeutic strategies » Soppelsa, R. Albaret, J.M. et Corraze, J. (2009).
Recent studies on the comorbidity of learning disordershave led authors to use less and less of the term « specifics ». The disappearance of this term is undoubtedly a reflection of the current debate about the frequency of the coexistence of these disorders. « Given the complexity of the etiology of learning disabilities, and more generally neurodevelopmental disorders, the need for truly interdisciplinary research is emerging to make the link between behavioural aspects, neuropsychological data, brain characteristics and the contributions of molecular genetics. Only then will we be able to make progress in understanding these disorders and improve the early follow-up of the children who carry them » Albaret (2013).
3. Perceptual-motor function
Understanding how the nervous system elaborates perceptual-motor coordination, which enables coordinated movements to be produced and acts effectively in the environment, enables the psychomotor to better understand the difficulties of school learning.
In the learning process, two senses play an essential role: sight and hearing. « When we talk about receiving information, we are not talking about the physical state of the eye that sees or the ear that hears, but rather about how what we see or hear is treated by the brain. This central process of receiving information is called perception » (Destrempes-Marquez, D., Lafleur L., 1999, p.19).
Perception is the psycho-physiological phenomenon that connects us to the sensitive world through our senses. Perception is the process of collecting and processing sensory information.
The perceptual-motor sphere is based on the need to process selected information in the environment and in the subject's memory, to develop internal models of the environment and to select and adapt a control program stored in the nervous system. This is what distinguishes the perception of sensation in this dimension of cognitive processing from sensation. The chosen response to a situation (what to do?) and the observable kinematics of movement (how to do?) are considered as expressions of the adequacy of the content of internal models and spatio-temporal commands generated by the engine program. This conception of relations between perception and action is based on the existence of two distinct ‘sensori-motor and cognitive‘ compartments and different levels of control of the action, requiring more or less cognitive investment. In this perspective, the sensor-motor compartment ensures the direct dialogue between the organism and its environment, thanks to the coordinated mobilization of pre-adapted and pre-wired motor instruments in the nervous circuitry (motor programs). The cognitive compartment provides , through the game of intentional and thoughtful controls, predictive management of these sensory-motor instruments.
« The motor exploration of the elements of the real is not limited to adding sensory data of muscular, articular and labyrinthic origin, it promotes the interaction of all sensitivities and, above all, it reinforces a strategy of multi-sensory discovery of the real which makes its perception richer and more differentiated » (Paoletti, R., p.156).
In cognitive psychology, perception is defined as the subject's reaction to external stimulation manifested by chemical, neurological phenomena at the level of the sensory organs and the central nervous system, as well as by various mechanisms that tend to adapt this reaction to its object through processes such as the representation of the object, the differentiation of this object from others (Ruel, P.H.).
It is known, as Geschwind (1968) established, that the brain possesses areas of hemispheric associations (angulargyrus and callous body) that allow interaction between the various sensory and motor systems of the organism. C'est ce phénomène d'intégration inter-sensorielle et afféro-référentielle qui semble donner à l'homme sa supériorité sur les animaux inférieurs (Ayres, 1975; Bryan et Bryan, 1978). This new knowledge suggests that it is important to pay much more attention to the integrity and neurological maturity signs of the brain than to the dominance of a particular hemisphere, without denying the specific functions of each hemisphere. These relatively recent neurobiological data must now serve as a basic framework for understanding certain academic learning problems, just as they must serve as a reference field for the study of perceptual-motor phenomena (Ruel, P.H.).
-Perception: authors' review
For J. Piaget (1969), the relationship between the different sensory modalities is gradually being established. At first the sensations are confused, then they are organised and put in place as they happen. Thus, our receptors are constantly bombarded with information about both the environment and what is happening in the body, and all this informations are stored and linked to what the subject is experiencing on the affective plan.
For Piaget (1969), the dynamics of the action allows the development of the child's cognitive constructions, the action makes it possible to assimilate objects and knowledge, the action adapts itself according to interactions with the environment.
The sensory modalities then make it possible to collect information from the surrounding or internal universe, to stay in contact with it, to adjust according to its modifications. « The exchanges it provokes with the environment also include a form or structure, which determines the various possible circuits between the subject and the objects. It is in this structuring of the behaviour that its cognitive aspect consists. Perception, sensory-motor learning (custom), an act of understanding, reasoning, etc. all amount to structuring, in one way or another, the relationship between the environment and the organism » (Piaget, 1967, p.12).
Emotional and cognitive life are inseparable, but distinct. Any exchange with the environment presupposes a structuring and valorization and these two aspects cannot be reduced to each other, they are therefore also distinct.
« The work of psychology is comparable to that of embryology, first, descriptive work which consists in analyzing the phases and periods of morphogenesis up to the final equilibrium constituted by adult morphology, but research which becomes "causal" as soon as the factors ensuring the passage from one stage to the next are highlighted » (Piaget, 1967, p.55).
Wallon, through a psychobiological approach, demonstrates the importance of movement in the child's psychological development, body language precedes verbal language. He establishes relationships between psychomotor disorders and behavioural disorders. Henri Wallon wrote in his book De l’acte à la pensée (1942), that their mutual and reciprocal growth « is achieved, among other things, by the activity of the individual which is inconceivable without the social milieu », without the environment.
Ajuriaguerra (1971) emphasizes the role of the tonic function as the basis for bodily action in a mode of relationship with others. Perception is directly related to the external and internal world, i. e. to the quality and maturity of the perceptual systems involved and the experience of the individual.
For Le Boulch (1984), psychomotor education is a prerequisite for the other apprenticeships to which it prepares the child by allowing to exercise itself in order to develop the necessary prerequisites for disciplinary apprenticeships. It targets child development, not knowledge integration. Motor and sensory experiences and their perceptual-motor integration are a prerequisite for cognitive structuring on which learning is based. « In the United States the term psychomotor is hardly used and replaced by « perceptual-motor domain », perhaps, this term highlights, more clearly, the problems posed by perceptual structuring which play a fundamental role in the genesis of difficulties in mathematics » (Le Boulch, J., 1984, p33).
4. From Sensory to Perceptual
These sensory signals are initially devoid of meaning. The child will gradually be able to give them meaning and make sense of them. Differents signals (exteroceptive, proprioceptive, visceroceptive) are then combined and stored in memory. This is why the same situation will not be perceived in the same way by a subject or another, because all the informations he receives are physiologically processed and always related to the individual experience.
The informations received are classified in two groups:
- Exteroceptive information informs us about the outside (out of the body) and are captured by our 5 senses: tactile, visual, auditory, taste and olfactory.
- Interoceptive information informing us about the inside (inside of the body) and more particularly the proprioception. This particular meaning is very important, it allows the development, representation and use of the body (deep sensitivity, vestibular system in the inner ear, necessary for static equilibration, dynamic and sensorimotor coordination).
The senses are therefore essential to the motricity and the development of the child. However, sensory skills are developed very early in the fetal life and allow the baby to be in an early contact with the environment, whether this environment is intra-uterine or extra-uterine.
In the daily life, performance and motor skills are based on the flexibility of the sensorimotor system and the efficiency (precision and speed) of relationships between perception and action. The notion of perceptual-motor coordination accounts for the mediation performed by sensory systems, in the development of complex movements (inter-segmental and inter-articular coordination) and their adaptation to events, which take place in the environment. (subject-environment coordination). Thus, to move while avoiding obstacles, to slow down, to intercept an object supposes to establish spatio-temporal relations between independent elements (the subject and the obstacle, the hand and the balloon). These two types of coordination (inter-segmental and interarticular), are often combined to perform complex gestures in coincidence with a rhythm (dance, rhythmic gymnastics and sports), to hit or intercept a ball or to oppose an opponent . (Chollet, G.)
The perceptual-motor sphere is directly related to school learning and learning is underpinned by the bodily aspect and more precisely the motor as the perceptivo-motor fits very early on the body plan, basis of future learning.The perceptual-motor sphere that allows the child to develop the cognitive aspect of his feeling, as an intellectual elaboration of the sensation that is interwoven with affectivity and which will be remembered, of all that includes the sensory-motor that would become intellectualized and integrated in the intelligence of the subject."If the sensory information on a content of knowledge is numerous and diversified, the perception of this content will be more accurate and more complete. This is why the teacher, when he realizes that, despite all his efforts, his verbal explanations are not understood by the student, spontaneously seeks to find other access to his understanding (...) if audiovisual documents already represent a progress compared to an exclusively verbal teaching, it remains that the pedagogical situation most rich in sensory information is that which leads the child to be physically active "(Paoletti, R., 1999, p. 156).
The psychomotor education that will allow, thanks to strategies of perceptual-motor stimulation, to support the school learning of the child, as well as its cognitive, social and emotional development.Perceptivo-motor behaviors develop and enrich different psychomotor domains namely: the perceptual organization (sensation and perception, attention, discrimination, representation, memory), the body diagram (body image, somatognosia, postural adjustment), spatial organization (orientation, structuring), temporal organization (duration, temporal and rhythmic adaptation, orientation, structuring). Exercises can be proposed by the psychomotor to improve perceptual-motor deficits. The psychomotor will have to develop in the child the visual perception, the visuo-perceptive constancy or conservation of the form, the visuo-motor coordination, the discrimination of the forms (orientation, color, size ...), the perception of the positions or spatial relationships, perceptions: auditory, tactile, proprioceptive or kinesthetic.
In the broad sense, perception proceeds from a complex and coordinated act in response to a specific stimulus that reaches the appropriate sensory organ. Just as there is no sensation without environment, there is no perception without movement because the body responds to the perceived sensations. The cognitive processes underlying the tasks of discrimination, recognition, identification, and so on, are at the base of the acquisition of school learning. As perceptual abilities can improve with practice, as Gibson's (1969) work testifies, several authors have suggested that a well-known perceptual and motor preparation of the child could facilitate learning and preventing some of the minor learning difficulties observed in reading and writing in particular.
Dyspraxia and dyslexia: school consequences of perceptual-motor disorder
Dyspraxia:In the case of visual-constructive dyspraxia, there is a deficit of spatial perception thus making it difficult to construct spatial landmarks and mental representations (mental rotations for example). It is up to the psychomotor therapist to find ways to compensate for these perceptual difficulties by proposing an individualized treatment that will allow the child to discover the sensory and motor skills he possesses to explore and know what surrounds him. It is important for the child to observe well (look, listen, touch, handle, taste, ...).The psychomotor therapist must exercise the child's abilities in terms of visual differentiation (visu-perceptual conservation, perception of forms, position, orientation, spatial directions), auditory differentiation, tactile perception, proprioception and haptic (discovery of the physical characteristics of objects and phenomena of the environment, awareness of the body at rest and in motion). It will be necessary to encourage the child to explain verbally his perceptive judgments and find concrete means, strategies to check them in contact with the objective reality.
Dyslexia: In the case of dyslexia, the child may have a disturbance of visual perception and auditory perception. When the disorder is at the level of visual perception, the child has difficulties in decoding the information transmitted by the eyes: he then confuses letters, he reads the words from right to left and this configuration can appear opposite a written task, a copy of drawings, difficulties that even lead to visual-motor tasks and, for example, in eye-hand coordinations where it will be difficult for him to catch a ball, to shoot a ball, to jump a rope, and so on... When the disorder is at the level of auditory perception, the child will hardly differentiate the sounds, confuse words of identical consonance, and the consequence will be to answer a question wrongly asked them for example causing then difficulties in learning while the child is able to understand what is asked of him. The considerable effort he will have to make to understand what is expected of him will be a brake on his cognitive investment and will always put him in a position of dual task leading to difficulties of attention and concentration and a fatigability, these elements attentional being the consequence of perceptual disturbance. If it's misdiagnosed, the child's difficulties are poorly managed and the consequences for the risk of school failure are important.
For a human, and much more for a child, perceptual-motor functions, visual-motor and auditory-motor, exert a primordial and preponderant role on its evolution and its internal and external action, as well as on his adaptation. "It is an undeniable fact that modern psychobiology recognizes and that the philosophers of antiquity have stigmatized by the following statement:" Nothing reaches intelligence if it does not first pass through the senses. " The processes of thought, language and motor functions all depend on perceptual processes and their action is disturbed if they are deficient. Why would it be different in the experience of the child who engages in the process of schooling ? (Ruel, P.H., p.109).
5 The learning trouble and the affective « environment ».
how to define the affective « sphere » independently of the cognitive sphere given their
The freudian’s theory demonstrate that the pulsion is a dynamic process, unconscious
who consist in a push, that is an energetic trust, a motricity factor. This energetic trust makes the organism reach into a goal the appeasement of the tension state. It's in the object (the within for orality) and favor to it the drive can reach his goal.
During the latency period (6-11 year) situated between the Oedipe's end and the puberty. Drives are sublimate. That is that their goal is no longer sexual but cognitive. The school's learning substitute itself to the object of usual love, which is good because children go to CP at 6 and learn to read write and count.
The origin of the drive being foremost physiological at first (hungriness, coldness, sleepness, need to be lifted, need to attachment) it is express between two different poles:
the affective pole who is pure feeling, permanent and identical and free. It while be canalized (it's the secondarisation of primary process), socialized, adapted to the principle of reality by binding itself to representation.
– the representation pole evolves with the child and change depending on his developmental acquisition. The idea that the child has of his feeling evolves thus whit the new possibilities of his body and maturity. The representation is the origin of thought, reflection, language, pictures, that is of the cognitive sphere.
Therefore, secondarily the opposition between affect and representation is just a change of point of view from where/which we look at the same subject and his psychocorporal body. Thenceforth the link between affect and representation is like the link between cognitive and sensory or even between emotion and thought, language. The affectivity being so in constant interaction with cognitive process, three cases of figure are interesting to us.
The affective sphere helps the subject motivation towards learnings and his development (regular development).
The affective sphere interferes with the cognitive or development process at the detriment of these later, generate cognitive or development troubles (anxiety interferes with the learning process).
The developmental and cognitive troubles have repercussion on the affective sphere, potentially the malaise of the whole subject’s personality (the failure generate anxiety ‘or’ ever depression, phobic troubles….).
The latter two configurations drive to an intrication and a reciprocal potentiation of the two spheres making sometime difficult to distinguish who came first (‘joke’ about chicken on the egg).
It’s why most of the time, the therapist must face suffering where the two aspects cognitive and affective, are linked. The intrication is sometime so significant that it can lead to à false diagnosis based on the belief that a targered re-education will restore the affective equilibrium on a well conducted psychotherapy will erased the learning difficulties. In fact a supported therapy neglecting the whole of the parameters in play in the scholar difficulties would bring to the young patient at best a brief relief.
This begs the question of the best angle to address the patient aim to an anxiety sedation or re-educate a disorder by aiming at the symptom?
This question stays minor when the teamwork and the good knowledge and user multidisciplining allow a global support mainly if the communication between the different caregivers generates synthesis noticeable on the patient. It is the point of the institutional psychotherapy. Beyond those most favourable case to the evolution of the child, psychomotor therapy possesses in itself this overall apprehension of different points of view.
The psychomotor approach is interested by the psychosomatic link which unify the two side of the same person. The therapeutic strategy will adapt to the context, to the request, to ensure the return of a social affective and cognitive wellbeing.
For that the therapeutic project will consider the person as a at whole. It will flow the guide line that the patient will the most easily expose leading him gradually to harmonise the union flux between the two poles of the same trouble.
The psychomotor profile allows to evaluate depending on the context and the anamnesis all the troubles and their expression depending on the relation to the other. It let see the burden of the anxiety disorder. If it is a reaction or the origin of the patient’s difficulties.
Usually the intrication is so big that the psychomotor approach in particular between the other types of approach is really helpful to approach the subject as a whole.
We can cite some fields where the affective sphere increases or initiate some troubles for example: The temporal structure: the experiments of fluctuation of the perception of time is linked to interest of boredom, the pleasure or pain, the temporal structuring can be influenced by anxiety.
The Tonic function: It reflects for example the affective pole of writing or else express itself in the tonic-emotionnal dialog/relation. Affective deficiency where abuse overdetermine development trouble, structuring in space and therefore in learning troubles.
The grown distortions: “a tonic imbalance during a child growth lead to an imbalance between the growth of the bones and the stretching of the muscles. Abused children are in chronic state of hypertonicity and can developed a psychosocial dwarfism”. (Robert-Ouvray S., & Servant-Laval A. (in Scialom P., Giromini F., & Albaret J. M. (2011), T. 1, p. 151).
In the case of psychogenic dwarfism, the growth of those children often starts again during periods of separation of their family, which highlights the relational influence on the development.
The laterality: An insidious choice leads some child to invest as a superior member contradictory director with their neurologic laterality. It’s not about thwarted left handed (or right handed) but more upsetting. In this case most of the time we find ourselves in the anamnesis in the oedipian conflict’s year, a collusion between two events: a trauma about separation (of the parents) and the development of lateralization. Everything happens as if the loyalty conflict of love choice between the parents, express itself by a compromise influencing the neurological development in progress during this period (myelination, lateralisation are intense between four and six simultaneously with the oedipian and identificatory structuration). The compromise consists to not choose between the father and the mother. The symbolic equivalence is so to don’t choose between left and right. All this lead some of those children to consult for special, lateral or graphism troubles, consistent of their lateral body investment and diverted special.
Let’s look at a last example of factor influencing cerebral plasticity: early children (QI>130) have good success affects and yet many of them develop eventually scholar affective anxious troubles. They have a tendency to naturally develop what works well and fast without developing work, but this risk to be done at the detriment of other cognitive potential which need attempt to develop. First visible consequences can be seen with an IQ test, this maturity gap is widening exhibiting a disharmonious profile. From a certain significative threshold those gaps are worrisome. Generally, we see lower investment of the original potential more sensorimotor and constructing itself on the ground of the psychomotor therapist body experience. Whence some scholar difficulty in smart child
Although the determination of the trouble’s origin is fundamental. The therapeutic act in psychomotor transcends the approaches that look only at innate or acquired aspect, neurological or psychogenic. The psychomotor therapist most adapts and justify during all the support the difficult therapeutic balance that he operates in moving the focus of his relational work of a pole to the other depending of the variation of the evolution and the opportunities which turns to him. This professional exercise is without a doubt the most exposed to this work of equilibrist.
Scialom P., Giromini F., & Albaret J. M. (2011). Manuel d’Enseignement de Psychomotricité. T 1. Paris. Solal-Deboeck.
 More informations in Scialom P., Point de vue psychanalytique sur la latéralité in Scialom P., Giromini F., & Albaret J. M. (2011), T. 1, pp. 212-213.