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

Background

The Early Start Denver model is one of the interventions recommended by the French High Authority on Health since 2012 for the very early care of children with Autism Spectrum Disorders. This program, developed in the United States, has shown the best evidence of effectiveness in an intensive form of delivery that is difficult to generalize to other culturally different contexts. Consequently, its implementation in the French health care system has required some adaptations that have not yet been evaluated. After a summary of the method's features and the results of studies of its effectiveness, this first retrospective descriptive observational study aims to characterize the implementation and practice of this intervention in France. In doing so, it also aims to better understand the potential obstacles to the implementation of early intervention and thus propose avenues for improvement.

Material and method

A census of French units offering the Denver model was conducted from June to October 2020. A questionnaire sent to the participating units made it possible to explore different dimensions: first, the characteristics of these units, including their composition. Secondly, their integration into the care network and the children's care pathway. Practice and delivery modalities were also assessed. Finally, the objective was to highlight the difficulties that the teams may have faced when implementing the model. The data were collected in Microsoft Excel® software in order to perform a descriptive statistical analysis.

Results

In total, 92% of the units surveyed participated in the study and returned the questionnaire. Our results highlight a significant heterogeneity in the deployment of the Denver method at the national level and underline the limit of resources available in the territory, particularly in its intensive delivery form.

Conclusion

Further research is still needed to study the feasibility and effectiveness of ESDM interventions deployed in the specific context of the French healthcare system. In addition, significant work remains to be done to establish rapid and identifiable pathways for early intervention in young children with ASD.

Objectives

The primary aim of this study was to explore the influence of antenatal class attendance on paternal security and bonding in the postpartum period, while the secondary aim was to investigate fathers’ interest in attending antenatal classes.

Methods

A total of 375 fathers living in France answered several questions online about their participation in prenatal classes as well as questionnaires assessing the sense of postnatal security and bonding quality.

Results

In general, the results showed a non-significant difference in terms of bonding and sense of security between fathers who attended multiple sessions and those who attended fewer or no sessions of antenatal classes. Nevertheless, participation in prenatal classes and socio-demographic factors explain together a significant part of the paternal feeling of postnatal security and bonding. In addition, a majority of the participants stated that they would be interested in participating or increasing their participation in birth/childbirth preparation and parenting classes.

Conclusions

These results highlight the importance of further exploring the effect of prenatal classes on the paternal postpartum experience in order to propose adapted and inclusive prenatal accompaniments for future fathers.

We report the case of a 12-year-old boy with nonverbal autism, intellectual disability, and hypermobility spectrum disorder. The patient was hospitalized in a French multidisciplinary neurobehavioral inpatient unit due to extreme self-harming behaviors. This major self-aggression led to a multi-fractured nose and to a growing risk of life-threatening traumatic injuries (risk of cervical fracture and spinal cord injury caused by forceful headbanging). These challenging behaviors required for a time the day-to-day skills of at least four caregivers and resulted in a rare escalation of restraint measures and in exceptional adaptations by our psychoeducational team. Clinical improvement was obtained after managing all causes of somatic pain and discomfort, as well as stabilizing the patient's mood and anxiety. We offered both sensorimotor developmental approaches with proprioceptive compressive garment and therapeutic body wrap, as well as protective equipment and specific psychoeducational interventions adapted to his severe self-injurious behaviors and to his developmental abilities.

Aim

The child's place in our society has largely evolved over the past few decades. This has led to numerous public policies to tackle social inequalities in health care from an early age. Parenting support is one of the enhanced strategy actions and aims put in place, in particular, to strengthen the bonds of attachment and promote a child's development. The quality of attachment and parent–child interactions is correlated with parents’ representations of their children. The objective of the study is to report current parental representations of newborn children in the French population in general.

Method

As part of the PERL study, an ancillary study was conducted on parental representations. The interviews were conducted with the control families. The analysis was based on the method of conceptual categories in order to bring out the salient elements relating to parental representations and feelings associated with parenthood.

Results

Among the analyzed discourses, parents have constructed the representations of their child, from the child's age of 4 months. These representations identify the 4-month-old child as being capable of making choices, having preferences, acting in the environment, and communicating with others. In addition, parents’ representations of themselves highlighted various feelings experienced concerning parenthood, the exercise of this new role, and the new parental behaviors towards the child, as a result of the disruption of being a parent. Parents also experienced a variety of feelings associated with parenting, parenthood, and their new role.

Importance

The non-stress test (NST) is an effective method for evaluating fetal movement and heart rate; however, it is associated with a large number of false-positive results. Music therapy induces maternal relaxation and reduces anxiety.

Objective

The aim of this study was to evaluate the effect of NST with music therapy on fetal parameters and maternal trait and state anxiety.

Method

This randomized clinical trial included 80 women, who were in gestational age of 32–42 weeks, referred to Asali Hospital. The participants were randomly assigned into two groups; the intervention group received 20 minutes of music therapy along with NST whereas the control group did not. Spielberg State-Trait Anxiety Inventory was used to access trait and state anxiety in the two groups. The data were recorded using a questionnaire and statistically analyzed using SPSS.

Results

The mean age of the participants and gestational age were not significantly different between the two groups (P = 0.73 and P = 0.95, respectively). The outcomes of the NST test showed that fetal heart rate was not statistically different between the two groups, P = 0.09. Acceleration (P = 0.01), short-term heart rate variability (P < 0.01), long-term heart rate variability (P < 0.01), fetal movement (P < 0.01), and minimal reactive time (P < 0.01) were significantly different between the two groups. Trait and state anxiety were also significantly lower in the intervention group (P = 0.01 and P < 0.01, respectively).

Interpretation

Music therapy is significantly associated with the increase in fetal movement and heart rate and reduced reactive time in NST. State and trait anxiety levels decreased following this intervention.

Conjugal violence is a social problem whose impact extends beyond the couple, to the children who are exposed.

Objective

To study the psychological impact of exposure to conjugal violence in children and adolescents in child psychiatry consultation and the factors associated with their capacity for resilience.

Patients and methods

We conducted a cross-sectional study on a sample of 30 children and adolescents, aged between 6 and 18 years and exposed to conjugal violence. Patients were recruited from the child psychiatry unit of the Hospital University of HediChaker of Sfax. We conducted clinical interviews to identify the psychological impact of conjugal violence on children. The resilience evaluation was done by self or hetero passation of the Child and Youth Resilience Measure (CYRM).

Results

Children and adolescents exposed to conjugal violence suffered from trauma-related disorders and stressors in 40% of cases, mood disorders in 33.3% of cases and externalized disorders in 6.6% of cases. We found that children were more resilient than adolescents in the area of emotional care provided by their parents (12.66 ± 2.02 vs. 9.46 ± 2.69 among adolescents; P = 0.001). In contrast, adolescents were significantly more resilient than children in the area of contextual factors including spirituality (6.46 ± 1.4 vs. 4.53 ± 1.06; P = 0.000), education (11.13 ± 2.13 vs. 8.4 ± 1.54; P = 0.000) and culture (11.13 ± 2.13 vs. 8.4 ± 1.54; P = 0.000). The child's education and good mental health for the mother were associated with better resilience in the children. The child's exposure to conjugal violence by being both a witness and a victim was associated with a reduced capacity for resilience.

Conclusion

Exposure to conjugal violence has a significant impact on the mental health of children exposed. The study of resilience and associated factors could thus be useful in order to limit the deleterious repercussions on children and provide them with harmonious development both on the somatic and psychological levels.