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

Understanding how autism spectrum disorder occurs in children is a key issue in current research. This opens up the possibility of earlier detection of this neurodevelopmental disorder in order to facilitate access to care for these children. To this end, we propose here a developmental model of autism spectrum disorder based on three successive phases: a first undifferentiated phase, from birth to 6 months; a prodromal phase from 6 to 12 months; and a symptomatic phase from 12 months. The description of these phases is based on a recent scientific literature review.

Introduction

Sexual violence against minors has important psychological repercussions throughout life. In adolescents, it can result in endangerment or self-aggressive behaviour such as suicide attempts. Its detection by health professionals is therefore an important issue in order to provide these young people with appropriate medical and social care. Professional recommendations call for systematic hospitalization of adolescents who have attempted suicide, but these recommendations have not yet been widely applied. At the Robert-Ballanger hospital (Aulnay-sous-Bois, Seine-St-Denis, France), a specific protocol has been established between paediatrics and child psychiatry departments, allowing all suicidal adolescents to be hospitalized in paediatrics. We conducted a study to take advantage of this hospitalization time to better identify sexual violence in adolescents.

Methods

We conducted a retrospective study based on the analysis of the medical records of 138 adolescents hospitalized in the paediatric ward and followed by the child psychiatry liaison team at the centre hospitalier Robert-Ballanger (Aulnay-sous-Bois) in 2021.

Results

We found significantly more sexually assaulted adolescents among those hospitalized for suicidal gestures or ideas (12 out of 54; 22%) than among those hospitalized for other reasons (5 out of 84; 6%). The sexual assaults described by the adolescents concerned were consistent with data from epidemiological studies and French victimization surveys : they mainly concerned girls (14 out of 17), were repeated assaults in three quarters of cases, and were intrafamilial assaults in one third of cases. The disclosure was often made to a caregiver (for 5 of 17 adolescents). Adolescents with a history of sexual assault were more concerned with intrafamilial violence but also with school harassment. We found a significantly higher number of suicide attempts among sexually assaulted adolescents, as well as a higher number of suicide attempts requiring hospitalization in intensive care.

Conclusion

Paediatric hospitalization of adolescents attempting suicide appears to be an interesting tool for identifying a history of sexual assault in these young people. Our study highlights an over-representation of sexually assaulted adolescents among those treated for suicidal thoughts or suicide attempts, as well as specific factors that should be vigilantly monitored. A reassuring environment, awareness-raising among professionals, and special attention to detail could all help to improve detection and hence protection and appropriate therapeutic follow-up.

Chronic tics/Tourette syndrome (TS) are among neurodevelopmental disorders including attention deficit hyperactivity disorder (ADHD), learning disabilities, and autism spectrum disorders. Of these, ADHD is by far the most frequently associated, present in > 50% of individuals with TS. Thus, it would seem useful, if ADHD were to be considered sufficiently disabling so as to offer methylphenidate treatment to the patients concerned. Nevertheless, and alas, this is done far too rarely for fear that methylphenidate can increase tic severity. However, even if this possibility exists, it is an exception easy to correct if necessary. Also, the galenic formula of methylphenidate can play a determining role in its tolerance to tics, and several attempts at treatment are sometimes necessary.

Objective

The purpose of this research was to establish an overview of the social support provided by the adults to a bereaved child. The death of a sibling is a terrible experience for a child. Social support is an effective protective factor against the high risk of psychological distress. However, adults are reluctant to get involved because many do not know how to support a bereaved child. To date, few studies have looked at how to empower relatives to engage with the child.

Methodology

We conducted an exploratory inductive qualitative study. Seven adults who had been involved with a child experiencing the loss of a sibling participated in a cycle of three group workshops. An analysis by coding, categorizing, and relating the data set was conducted.

Results

The results identified four phenomena that lead adults to avoid dealing with the child's grief. These are grief anxiety, grief cognitions, feeling of legitimacy, and tendency to avoid. The way parents and child function also contributes to the barriers participants identified to engaging with the bereaved child.

Conclusions

Categorizing and relating the phenomena led to a better understanding and a new knowledge of the difficulties encountered by the adults around a bereaved child. Clinical and research perspectives emerged from our results, notably the identification of a reference person, the design of an inventory of the bereaved child's needs, and collaborative work between parents, child, and their relatives, in order to promote adult involvement and prevent psychosocial risks for the bereaved child.

Background

In France, child psychiatry care can involve significant ethical challenges. Following the last recommendations of the Controller General of places of deprivation of liberty (CGLPL) and the modifications of the law framing the control measures (seclusion room and restraints) in adult psychiatry, it is necessary to reflect on their operationalization in providing care in order to find the balance between the imperatives of protection and the respect of the young people hospitalized in child psychiatry.

Aim

To develop recommendations concerning the use of seclusion and restraint in child psychiatry in the light of recent legislative changes and associated ethical issues.

Methods

Within the framework of the national commission of psychiatry, a working group bringing together many child psychiatrists was set up in 2021 to reflect on contemporary issues in our discipline. One of the axes studied – in connection with the forensic psychiatry group – was specifically concerned with isolation and restraint in child psychiatry. An analysis of the ethical issues based on the four principles of Beauchamp and Childress is defined and adapted for the child psychiatric context.

Results

The working group identified the legal and ethical issues specific to their discipline. Based on the ethical analysis of two difficult support situations in child psychiatry: (1) the practice of electroconvulsive therapy with adolescents; and (2) the management of violence in young people with autism and intellectual disabilities, the main conflicts of values were identified referring to the principles of non-maleficience, beneficence, autonomy and justice.

Conclusion

Based on research in childhood ethics, the relational dimension of autonomy is discussed with reference to the concepts of “shared vulnerability” and “shared care planning”. Specific recommendations for child psychiatry are proposed in order to promote the recognition as moral agents of children and adolescents hospitalized in child psychiatry.

There is a strong link between the development of spoken language in children and the development of their mathematical skills. The objective of the current research is to identify studies and synthesize the scientific knowledge acquired to date on mathematical vocabulary in children. The research method used was a systematic literature review. The results are presented in a narrative synthesis. This review showed that different terminologies are identified in the articles. Mathematical vocabulary is most often assessed in comprehension only, and it is a strong predictor of many mathematical and cognitive skills. The review points out also that children with mathematics learning difficulties have difficulties with mathematical vocabulary. Furthermore, the present synthesis highlights the interest of explicit learning of mathematical vocabulary in children between the ages of 6 and 11 years, particularly through shared reading for the youngest. Finally, no study has investigated mathematical vocabulary in French.

The notions of crisis and emergency are frequently mixed up by family members, as well as by many professionals, although they are not synonymous. In child psychiatry, an emergency is an acute pathological situation which is associated with the idea that the child's life is in danger. While an emergency requires immediate care, a crisis requires the development of new ways of seeing and navigating the world, as well as new adaptive mechanisms to deal with these changes. Following the new child-adolescent mental health policy developed by the Belgian Ministry of Public Health in 2015, the therapeutic unit for adolescents (10 to 18-year-old) at the Vincent Van Gogh Hospital dedicated two of its fifteen beds to the treatment of child psychiatric crises. The objective of this paper is to present the functioning of the “crisis beds” device within the hospital unit. We will begin with a definition of the notion of crisis and of the theoretical models of intervention offered in clinics. This will be followed by an explanation of the historical context behind the implementation of the crisis beds in the Vincent Van Gogh hospital and a description of how this device works. We will conclude with an overview of three clinical cases which illustrate the extent of the treatment provided in the crisis unit and the different possible outcomes at the end of the stay. The influence of individual intrapsychic and systemic factors on the crisis and its aftermath will be highlighted through these cases.

Young children in residential nurseries constitute a particularly vulnerable population due to their overexposure to traumatic experiences. In addition to these negative events that are at the origin of the protection measure, there are traumas that can be generated by the rupture, the separation and the placement. Additionally, convergent research has highlighted wide-ranging negative trajectories attributable to both the short and long-term consequences of abuse and neglect and their neurobiological impact on health and development. As a result, while child maltreatment was once considered a social problem, it is now recognized by the WHO as a global public health problem. There is an urgent need to equip child protection services to be able to respond to the unique, specific and particular needs of trauma-exposed children as soon as possible; the first months in child welfare service can provide a powerful opportunity. The PEGASE experiment of a coordinated care pathway, implemented in April 2019, aims to improve the identification of developmental delays and psychological disorders in children under the age of three, as well as the provision of early care.