70

In this paper, we describe a “model” clinical situation where the arrangement of care and pedagogical work have to struggle—in order to maintain an acceptable quality of life—between the severity of the syndrome and the institutional rules, theoretically conceived for the well-being of the person with a disability but sometimes not well adapted to a minority of patients that is less favored psychically. This paper aims to suggest a possible—and relatively easy—solution to situations in which people with severe autism and intellectual disability (SAID) become very difficult to manage in a socio-educational setting and are therefore made to spend long periods of time hospitalized in psychiatric units. We stress that severe autism is very difficult to differentiate from severe/profound mental impairment because the autistic triad (difficulties in social and verbal interactions, difficulties in anticipating, and abnormal sensory perceptions) is present in both situations. Severe autism affects around 0.1% of the general population and requires intensive psycho-educational care and a very significant human and economic investment. These difficult situations, where the person is in crisis with agitation, a very high level of anxiety, and aggression toward themselves and/or others, are well known by socio-educational teams caring for this population. It is here, when, on the one hand, the person needs to be provided with structure via an activity, but, on the other hand, they cannot stand the frustration of not succeeding in this activity, that “mirror psychopedagogy” finds all of its value.