Pr Pierre FOURNERET
Service de psychopathologie du développement de l’enfant et de l’adolescent
Dédié à la prise en charge et à l’accompagnement pédopsychiatrique des situations complexes (niveau 3), ce service est composé de 4 unités fonctionnelles, orientées sur l’évaluation et la prise en charge globale et pluridisciplinaire des troubles du comportement et de la régulation émotionnelle de l’enfant et de l’adolescent (enfant de moins de 16 ans).
Thématiques de Recherche
Professeur de psychiatrie – option enfant & adolescent – à la Faculté de Médecine Lyon Est (Université Claude Bernard Lyon 1), les travaux scientifiques du Dr Pierre Fourneret s’inscrivent dans le champ des neurosciences cognitives et développementales. Après un Ph.D en neuropsychologie consacré aux troubles de la conscience de soi dans les pathologies psychiatriques et neurologiques, son intérêt s’est porté vers les troubles du neurodéveloppement de l’enfant et de l’adolescent (troubles des apprentissages, troubles du langage oral, TDAH et TSA). Co responsable du master 2 de philosophie Culture & Santé (Université Jean Moulin Lyon 3 & UCB Lyon I), il s’intéresse également à l’épistémologie des sciences médicales et de la pédopsychiatrie en particulier. Il est également coordonnateur local et régional de l’enseignement universitaire de l’option de pédopsychiatrie.
Chef du service Psychopathologie du Développement de l’enfant et de l’adolescent à l’Hôpital Femme Mère Enfant (Hospices Civils de Lyon), il coordonne enfin l’animation de la Task Force régionale en psychiatrie périnatale qui porte un projet de base de données régionales via la fondation FondaMental® destinée à favoriser la recherche clinique et fondamentale en périnatalité.
Les Axes de recherche:
Neurosciences cognitives et du Développement
Troubles du neuro développement
Psychopathologie de l’enfant et de l’adolescent
Psychiatrie périnatale
Épistémologie des sciences
Les Collaborations:
Université Lyon 3 – Pr Elodie Giroux
Université de Genève – Pr Edouard Gentaz
Unité de rattachement
Equipe Neuroscience Sociale et Développement comparé.
Institut des Sciences Cognitives Marc Jeannerod – UMR 5229 CNRS & UCB Lyon I
Directeur : Pier Franscesco FERRARI
Ouvrages récents
Le développement neurocognitif de la naissance à l’adolescence. Sous la direction de P. Fourneret & E.Gentaz. Collection Pédia – Editions Elsevier Paris 2022
Les enfants DYS. Sous la direction de P. Fourneret & D. Da Fonseca. Collection Pédia – Editions Elsevier Paris 2018
Publications
1. Clinical intuition in psychology through the prism of personalized psychiatry
Gauld C, Masri Y, Fourneret P
Front Psychol. (2023)— Full Text
2. Motor deficits in autism differ from that of developmental coordination disorder
Martel M, Finos L, Bahmad S, Koun E, Salemme R, Sonié S, Fourneret P, Schmitz C, Roy AC
Autism. (2023) — Résumé
A vast majority of individuals with autism spectrum disorder experience impairments in motor skills. Those are often labelled as additional developmental coordination disorder despite the lack of studies comparing both disorders. Consequently, motor skills rehabilitation programmes in autism are often not specific but rather consist in standard programmes for developmental coordination disorder. Here, we compared motor performance in three groups of children: a control group, an autism spectrum disorder group and a developmental coordination disorder group. Despite similar level of motor skills evaluated by the standard movement assessment battery for children, in a Reach-to-Displace Task, children with autism spectrum disorder and developmental coordination disorder showed specific motor control deficits. Children with autism spectrum disorder failed to anticipate the object properties, but could correct their movement as well as typically developing children. In contrast, children with developmental coordination disorder were atypically slow, but showed a spared anticipation. Our study has important clinical implications as motor skills rehabilitations are crucial to both populations. Specifically, our findings suggest that individuals with autism spectrum disorder would benefit from therapies aiming at improving their anticipation, maybe through the support of their preserved representations and use of sensory information. Conversely, individuals with developmental coordination disorder would benefit from a focus on the use of sensory information in a timely fashion.
Keywords: action representation; autism spectrum disorder; developmental coordination disorder; feedback control; feedforward control; internal models; kinematics.
3. Trouble dissociatif de l’identité de l’adolescent : de l’autodiagnostic à la maladie transitoire [Dissociative identity disorder in adolescents: From self-diagnosis to transient illness]
Anselmetti C, Fourneret P, Gauld C
Med Sci (Paris). (2023) — Résumé
The category of dissociative identity disorder (DID) has puzzled medical science and fascinated popular culture for almost 200 years. Its occurrence in young people raises at least two new questions addressed by science studies and embedded philosophy: self-diagnosis (related to cyberchondria and mass media-induced illness) and transient disease (related to looping effect and identity claim specific to adolescence). In an attempt to refine the sociocognitive model, we analyze the impact of these notions in understanding the local ecological niche in which contemporary adolescent DID occurs.
© 2023 médecine/sciences – Inserm.
4. Healthcare pathways and practitioners’ knowledge about ADHD in children. Encephale
Willig TN, Dajon M, Assathiany R, Brun L, Fourneret P, Massé M, Monge A, Piollet A, Thiollier MC, Cortese S, Purper Ouakil D
Encephale. (2023 ) — Résumé
Introduction: Access to care for children and adolescents affected by ADHD in France remains below the levels attained in most industrialised countries. To contribute to improving ADHD care in France, we assessed existing ADHD knowledge among medical doctors (MDs) and described associated care pathways in two large French regions in 2021. We produced tools to evaluate the regional impact of implementing a stepped-care pathway for ADHD.
Methods: A SurveyMonkey® study was sent to professionals from two regions in France accounting for 14 million inhabitants, allowing them to describe their role in child/adolescent ADHD, as well as their representations and knowledge about the disorder.
Results: Around 9.4% of all MDs potentially involved with children took part in the study; 34.9% considered themselves untrained, 40.5% were involved in ADHD care at a first-tier level, and 19.6% at a second-tier level. Access to a second or third-tier service for ADHD was associated with mean waiting times of 5.7 and 8.5 months, respectively. Initiation of stimulant therapy remained mainly restricted to second or third-tier MDs, and adaptation of dosage or change in the galenic formulation was rarely performed by first-tier MDs (27.2% and 18%, respectively). Training in neurodevelopmental disorders and tier-level were the strongest determinants of knowledge, attitudes and self-assessed expertise about ADHD.
Conclusions: This study provides insight into training needs for MDs regarding healthcare pathways in ADHD and should support the implementation of health policies, such as a stepped healthcare access for ADHD. The study design and dissemination have been validated and will be available in France and other countries facing similar obstacles in care pathways for ADHD. Official recommendations on ADHD in children and adults are being updated in France, and our data and the survey design will be a starting point for their implementation.
Keywords: ADHD; Attitude; Attitudes; Care pathway; Connaissances; Formation; France; Knowledge; Medical doctors; Médecin; Parcours de santé; TDAH; Training.
Copyright © 2023 L’Encéphale, Paris. All rights reserved.
5. Why Is Psychiatry so Intimately Linked to the Brain?
Gauld C, Fourneret P, Micoulaud-Franchi JA
Front Psychiatry. (2022 ) — Full Text
Pas de résumé
6. TDAH dans l’enfance et trouble psychotique à l’âge adulte : quel lien ? [ADHD during childhood and subsequent psychotic disorder: A link?]
Gering A, Fourneret P, Poulet E, Geoffray MM, Jurek L
Encephale. (2021) — Résumé
Objectifs |
Le Trouble du Déficit de l’Attention/Hyperactivité (TDAH) est un trouble neurodéveloppemental fréquemment associé à des comorbidités psychiatriques. Certaines études mettent en évidence un sur-risque de trouble psychotique à l’âge adulte consécutif à un TDAH diagnostiqué durant l’enfance. L’objectif de cette revue est de clarifier cette association sur le plan physiopathologique et de mieux comprendre ses conséquences dans la prise en charge des sujets TDAH à risque.
Méthode |
Nous avons réalisé une revue de la littérature narrative à partir d’une recherche de la base PubMed (MEDLINE). Les articles évoquant les interactions entre TDAH et troubles psychotiques, sur le plan génétique, clinique et biologique ont été retenus.
Résultats |
Le TDAH et les troubles psychotiques partagent des facteurs de risque communs qu’ils soient néonataux, environnementaux et génétiques. Un dysfonctionnement du système dopaminergique est retrouvé dans les deux troubles, avec une régulation anormale des activités phasiques et toniques des neurones dopaminergiques. Notre revue se propose de faire un point sur le modèle « dynamique » des anomalies dopaminergiques afin de proposer des pistes de compréhension pour la prise en charge médicamenteuse du TDAH, avec ou sans trouble psychotique associé. Ce modèle permet de comprendre pourquoi le méthylphénidate n’a pas été associé à un surrisque significatif de trouble psychotique. L’association entre le TDAH et les troubles psychotiques pourrait s’expliquer par certaines comorbidités communes aux deux troubles tels que les troubles liés à l’usage de substances, dont l’apparition après un TDAH pourrait médier l’émergence d’un trouble psychotique. Notre revue s’intéresse aussi aux erreurs de diagnostic possible entraînant des biais épidémiologiques, certains signes cliniques non spécifiques pouvant être retrouvés à la fois dans le TDAH mais aussi chez les personnes à risque de développer un trouble psychotique.
Conclusion |
Le TDAH et les troubles psychotiques partagent des signes cliniques et des facteurs de risque, en lien avec des éléments physiopathologiques communs. La perspective dimensionnelle et longitudinale des troubles psychiatriques devrait permettre, à l’avenir, de mieux appréhender les liens potentiels unissant TDAH et troubles psychotiques.
7. How to improve in France ADHD transition support from childhood to adulthood.
Fourneret P, Zimmer L, Rolland B
Encephale. (2021)
Pas de résumé disponible
8. FHighs and Lows in Motor Control Development
Martel M, Fourneret P, Finos L, Schmitz C, Catherine Roy A
J Mot Behav. (2020) — Résumé
Motor control is classically described as relying on two components: anticipatory control (feedforward processing) and online control (feedback processing). Here we aimed to unveil the developmental steps of both feedback and feedforward control in 5-10 years old children, using a simple and ecological task. We manipulated object’s weight in a reach-to-displace paradigm. When the weight was known before lifting it, anticipatory processes were quantifiable during the reaching phase. Conversely, an unknown weight triggered online corrections during the displacing phase. Movement kinematics revealed that children anticipate this objet property as young as 5 y-o. This anticipation becomes adequate around 7 y-o and is paralleled by poor online corrections. This simple yet relevant paradigm should allow quantifying deviations from neurotypical patterns in disorders of motor control.
Keywords: Reach-and-grasp; anticipatory control; children; kinematics; motor development; online control.
9. Disparate regulatory status of methylphenidate for adults with ADHD across Europe
Chappuy M, Boulanger A, Nourredine M, Fourneret P, Rolland B
Lancet Psychiatry. (2020)
Pas de résumé disponible
10. White matter microarchitecture and structural network integrity correlate with children intelligence quotient
Suprano I, Kocevar G, Stamile C, Hannoun S, Fourneret P, Revol O, Nusbaum F, Sappey-Marinier D
Sci Rep. (2020) — Résumé
The neural substrate of high intelligence performances remains not well understood. Based on diffusion tensor imaging (DTI) which provides microstructural information of white matter fibers, we proposed in this work to investigate the relationship between structural brain connectivity and intelligence quotient (IQ) scores. Fifty-seven children (8-12 y.o.) underwent a MRI examination, including conventional T1-weighted and DTI sequences, and neuropsychological testing using the fourth edition of Wechsler Intelligence Scale for Children (WISC-IV), providing an estimation of the Full-Scale Intelligence Quotient (FSIQ) based on four subscales: verbal comprehension index (VCI), perceptual reasoning index (PRI), working memory index (WMI), and processing speed index (PSI). Correlations between the IQ scores and both graphs and diffusivity metrics were explored. First, we found significant correlations between the increased integrity of WM fiber-bundles and high intelligence scores. Second, the graph theory analysis showed that integration and segregation graph metrics were positively and negatively correlated with WISC-IV scores, respectively. These results were mainly driven by significant correlations between FSIQ, VCI, and PRI and graph metrics in the temporal and parietal lobes. In conclusion, these findings demonstrated that intelligence performances are related to the integrity of WM fiber-bundles as well as the density and homogeneity of WM brain networks.
