Neuropsychiatrie de l''Enfance et de l''Adolescence最新文献

Context

Art-mediated activities and cultural care have become a component of most hospital institutions for children and adolescents. Yet their funding is not specified. Based on the experience of a university hospital department, we would like to consider measures that might encourage their continuation.

Methods

We conducted an observational study and interviews (n = 15) to list all the activities carried out by an external contributor in 2023, their themes, the target audience, their objectives, the nature of the contributors, the existence of a formalized agreement, funding, as well as their frequency and duration.

Results

Thirty-five different partners carried out 685 actions in 2023, 10% of which were carried out outside the hospital. The themes addressed are extremely varied (sports, performing arts, literature, visual arts, etc.). These activities represent an average of 210 interventions per unit, or 4 per week. However, they are less numerous in the intensive care unit and units for autistic patients with challenging behaviors, and virtually absent from outpatient units. Finally, specific funding or agreements are often absent.

Discussion

Despite their frequency and the substantial investment made by the team and its partners, there are a number of weaknesses. We are developing the idea that the creation of a cultural policy co-constructed between a cultural and sponsorship department and the clinical components (in our case, child psychiatry) would make it possible to resolve some of these weaknesses and promote a better inclusion in patient care.

Objective

The quality of the very early emotional experiences in a child's life are recognized today as foundational in the mental health of becoming an adult. Unsurprisingly, clinicians and health authorities agree on the importance of early detection and treatment of any mental health issues experienced by the preschool child. This is even more important and challenging as young children do not yet have the language skills necessary to express their distress. But do the caregivers in charge of these populations have the best tools at their disposal to carry out that important mission in an efficient and scientifically robust manner reflecting the latest research findings and scientific literature? This is the question we try to answer in this paper.

Method

We revisited the theoretical underpinnings behind the concept of mentalization as playing a key role in the ability to understand the other's inner reality. We then carried out an extensive review of scientific papers written over the past 30 years on the subject. We examined mental representations of the adult on the child and analyzed those mentalizations as key inputs. We focused on extracting cross analyses of the mentalizations of one child by several adults with different functions in the life of the child. In this process, we used the PRISMA methodology applied to large international medical databases.

Results

We found that the qualitative approach, usually associated with a lengthy process, has been overwhelmingly used in trying to assess patients’ mental states and to analyze the mentalizations on the patient, adult or child. Furthermore, cross analyses of mentalizations from more than one adult on a given child were almost nonexistent, despite having high epistemic and clinical potential.

Conclusions

There is a dearth of reliable quantitative tools, able to capture and analyze the mentalizations on a patient, that are scientifically robust, transposable, and easy to implement in a clinical setting. The absence of such tools for medical professionals in charge of assessing preschool children contributes, in our view, the low detection and poor treatment of mental disorders in that particularly vulnerable population. We believe there is here an urgent unmet need and that such tools should be designed, validated, and deployed into the target populations as early as possible.

In this article, we propose a reflection on the place of spontaneous creation in the therapeutic care of adolescents presenting a first episode of psychotic decompensation. Based on the clinical case of Emilio, 13 years old, and the examination of the productions produced during interviews, the act of creation is considered as a self-therapeutic attempt to adapt the world. The theoretical-clinical analysis of the transferential productions and positioning of the subject points to the possibility of emergence, at the initiative of the adolescent, of a place of address allowing this passage from an almost delusional private scenario to an authentic creation addressed to another becoming a witness to the authorship of the creation initiated by the subject. Therefore, the act of creation as addressed can be thought of as a possible compensatory elaboration coming to mask the deleterious effects of the lack of symbolic inscription of the psychotic adolescent. The act of compensatory creation, by generating a possible identity, even purely functional and stereotypical, for the subject thus allows the psychotic adolescent to once again enter into a bond with the other in a more peaceful manner.

Over the past year, several controversial articles have been written in the press and scientific journals about the benefits and harms of time-out (TO). The aim of this article is to review the scientific literature outlining the conclusions of meta-analyses carried out on parenting programs including TO, and on the TO procedure itself. Then, we describe the characteristics of the TO to understand how parents/educators use it and to assess its efficiency. The results show that the TO is not an isolated educational strategy but is included in a more comprehensive process with a before (establishment of the educational framework, rules to be followed) and an after (debriefing, explanations of inappropriate behavior) called time-in. Thus, it is difficult to assess the effectiveness of a TO without considering a wider temporality, including time-in. Moreover, the age of the child, the TO's duration and any behavioral or mental problems in the dyad child/parent are important factors that highlight the plurality of the TO. Further scientific research is necessary to assess its effectiveness considering the epidemiological characteristics of each protagonist. We need to look more closely at which TO is the best for which child and by which parent.

The article presents a new conceptualization of attachment – which is no longer envisaged as a general trait of the person but as relationship-specific behavioral and representational functioning – along several continua (security, deactivation, hyperactivation, and disorganization of the attachment system). The notion of ‘multiple models’ and its link with disorganized attachment are discussed. The author highlights the need to differentiate cases in which there are two contradictory representations of a same event from those in which distinct models exist for different relationships, the latter case – unlike the former – not being pathological. This conceptualization enables a finer examination of attachment processes in both practice and research. The Attachment Multiple Model Interview (AMMI) is presented with examples in clinical and research settings. It is now possible to disentangle the relative contribution of attachment to each figure whether with the mother, the father, another attachment figure (for example among placed children or among the elderly), a therapist, or a romantic partner. In addition to each one's specific role and their additive effects, the interaction effects of these different attachments can also account for counterbalancing mechanisms (resilience) in psychological development. Similarities across relationships (or rigid functioning) as well as variation can also be investigated.

Considering the increase in terrorist attacks worldwide in recent years and their particularly devastating nature, research following these events, including the World Trade Center attacks of September 11th, 2001, has intensified with greater attention to the mental health of survivors. To assess the impact of terrorist acts on children and adolescents, this systematic review used PubMed, Scopus, PsychINFO, and ProQuest databases without publication date limitations. Only studies assessing posttraumatic stress symptoms and psychological, social, and developmental consequences in children and adolescents in the months and years following direct or indirect exposure to terrorist acts were included. Data were extracted according to a range of predefined fields, and studies were checked for reliability using a study quality assessment tool. Eighteen articles were included: thirteen quantitative descriptive studies, four qualitative studies, and one that used a mix of quantitative and qualitative methods. The articles highlight the various difficulties faced by children and adolescents who have been exposed to terrorism during their development (such as posttraumatic stress disorder, neurocognitive, sensorimotor, emotional disorders, etc.), sometimes concomitant with the loss of a loved one killed during the event, and the trauma of their parent also having repercussions on them, effects that are even more important the older they are.

Introduction

Sexual violence in schools among children and adolescents is a public health problem. Its frequency and its short- and long-term consequences are often underestimated due to the non-specific socio-demographic and clinical characteristics of the victims.

Aim

To describe the socio-demographic and clinical characteristics of child victims of sexual violence in schools.

Materials and methods

We conducted a retrospective, descriptive and analytic study of 30 psychiatric expert reports carried out for children and adolescents who had been exposed to sexual violence in the school environment. Patients were presented to the department of child psychiatry of the CHU Hédi Chaker of Sfax, following requisitions from the national police services. The psychiatric expert reports were collected over a period of six months from January 2019 to June 2019.

Results

The average age of our patients was 11.7 ± 3 years, 57% of whom were male. The perpetrator of the sexual violence was a male in 86.7% of cases, a minor at the time of the events in 53.3% of cases and a teacher or a member of the school staff in 30% of cases. Sexual abuses consisted of sexual touching in 56.6% of cases, exhibitionism in 30% of cases and anal penetration in 26.7% of cases. Sexual abuse was repeated in 53% of cases, mainly for exposure to pornography. The victim's expert examination concluded to mainly anxiety symptoms (in 76.7% of cases) and sleep disorders (in 46.7% of cases). A post-traumatic stress disorder was retained in 16.7% of cases.

Conclusion

The results of our study suggest that sexual violence in the school environment can concern different socio-demographic classes. Sexual violence between minors seems quite frequent and the clinical manifestations presented by the victims are non-specific. This encourages the conduct of awareness-raising campaigns among workers with children to prevent this phenomenon.