Comportements d’attachement d’enfants d’âge préscolaire consultant en pédopsychiatrie : lien avec des caractéristiques psychologiques maternelles

ObjectivesThe aim of this study was to examine whether variables related to mothers’ psychological functioning could be associated with mother-child attachment insecurity in children referred to an outpatient mental health clinic.MethodTwenty-nine children (23–71 months) and their mothers participated in this study. According to child age, mother-child attachment was assessed using the Strange Situation or the Separation-Reunion Procedure. Mothers’ symptoms of depression, anxiety and parental stress were assessed using self-report inventories.ResultsAvoidant attachment was marginally related to maternal depression and significantly associated with maternal anxiety. Greater parental stress was related to more disorganized and less secure attachment behaviors. A marginal association was also found between maternal stress and ambivalent attachment behaviors.ConclusionThese results support the importance of pursuing research on possible links between maternal psychological determinants and mother-child attachment in children referred to outpatient mental health clinics.     

Perspectives croisées des adolescents et des soignants sur les médiations thérapeutiques en psychiatrie : une étude qualitative

ObjectiveWe aimed to explore the adolescents’ and caregivers’ lived experiences during therapeutic mediation in an adolescent psychiatric inpatient unit.MethodsThis qualitative study, using semi-structured interviews and photo-elicitation, took place in the CHU of Rouen. Data were collected, until theoretical sufficiency was reached, through semi-structured interviews and a photo-elicitation tool. Inductive Process to analyze the Structure of Lived-Experience was used to process the data.ResultsEighteen participants were included, 10 caregivers and 8 teenagers. The crossed analyses of adolescents’ and caregivers’ interviews showed four lived experiences: to verbalize, to meet, to feel with the body and to grow up. The analysis concluded there was a divergence in the representation of the purpose of therapeutics mediations between adolescents and caregivers.Perspectives We suggest verbalization is not central. We propose to go through the body and to consider the reactivation of the separation individuation process.     

Deuxième vague : quid des patients atteints d’anorexie mentale hospitalisés en pédopsychiatrie ?

BackgroundIn child and adolescent psychiatry departments, the number of hospitalizations for anorexia nervosa (AN) has been increasing in recent years. In the phase of severe undernutrition, these patients may exhibit disturbances in their immune functions. Based on this observation, many French practitioners had chosen to avoid long hospitalizations during the first wave of COVID-19. They had in mind a risk of contagion between adolescents, in which infections can be frequently asymptomatic. Fear of an increased risk of a severe form of COVID-19 in AN patients has led to early returns home, where they would probably be safer than in our departments. Is this strategy still relevant for the second wave? Has an increased risk of a severe form been identified in the adolescent AN patients?MethodWe have recalled the French recommendations on the subject. Then we carried out a review of the international literature via Medline, Google Scholar as well as data from the American organization Center for Disease Control and Prevention.ResultsThe evolution of knowledge about the pandemic has clearly established a lower risk of infection in adolescents than in adults. It seems that the virus spares this population, most of them remaining asymptomatic or paucisymptomatic. Reassuringly, AN or low body weight has not been shown to pose a risk for the severe form of COVID-19. Conversely, the literature reports that lockdown worsens the symptoms of AN (food restriction, hyperactivity) in at least a third of these patients. Most of the patients expressed a high level of anxiety during the first lockdown. It may even have been difficult for these patients to continue to access care when they were confined.ConclusionIn the end, it seems wise not to reproduce the strategy of early return home in adolescents with AN. Current data support the need for continuity of care, as well as the continuation of hospital care when necessary, while a too rapid discharge runs the risk of destabilizing the patient in an already long and difficult course of care in the usual time.     

Impacts des facteurs maternels sur l’allaitement maternel en réanimation néonatale

ObjectiveAdmission at birth to a Neonatal Intensive Care Unit (NICU) complicates breastfeeding especially for preterm babies despite hospital staff trained to encourage breastfeeding. The aim of this study was to find factors related to the mother, the pregnancy or the neonate influencing breastfeeding rate on a NICU.Patients and methodsThis was a retrospective study including neonatal admissions to the NICU at Antoine-Béclère University Hospital from 1st May 2009 to 30th April 2010. Data was collected from medical notes. The breastfeeding rate (at initiation and at discharge) was analysed with regards to maternal age, method of procreation, type of pregnancy (single or multiple), parity, mode of delivery (vaginal delivery or C-section), birthweight, gestational age and intra-uterine growth restriction (IUGR).ResultsThe study was based on 460 neonates having complete documentation. The average maternal age was 32 years. Premature infants represented 74.8% of the population (median gestational age = 34 weeks) of which 57% were less than 33 weeks (42.6% of all infants, n = 196). The median birthweight was 1900 g with 17.6% of IUGR infants. Breastfeeding rate at initiation was 58.7 and 43.9% at discharge (mean admission days: 17.1 [0–180], median = 8 days). For infants born of multiple pregnancies (24.3% of the population) 51.6% were born of medically assisted pregnancies (MAP) and 17.6% of spontaneous pregnancies. Breastfeeding rate among these infants was 57.1% at initiation and 45.5% at discharge. It was higher in infants born of MAP at initiation (70.3% versus 55.8% for spontaneous pregnancies, P < 0.05) and at discharge (49.5% versus 42.5% for spontaneous pregnancies). For these infants, average maternal age was higher for breastfed infants (33.9 versus 32.1 years for the formula-fed, P < 0.05). Breastfeeding rate in infants born to primipares was higher at initiation (64.9% versus 53.6% for multipares, P < 0.05) and at discharge (48.5% versus 40.8% for multipares, P < 0.05). The rate of infants breastfed was influenced neither by maternal age alone (31.8 ± 5.6 versus 31.4 ± 5.7 years for formula-fed), nor by type of delivery (56.7% for infants born by C-section versus 62.5% for infants born by vaginal delivery), nor gestational age (33.2 ± 4.3 weeks for breastfed, versus 33.4 ± 4.2 weeks for formula-fed infants), nor birthweight (2060 ± 978 g for breastfed versus 2055 ± 909 g for formula-fed infants), nor IUGR (58% versus 58.8% for eutrophes).DiscussionOur maternal population was different as 16.7% of deliveries were accounted for by MAP, superior to the French average (< 10%). We describe for the first time MAP as a positive influencing factor on breastfeeding rates in newborns admitted to a NICU. A better breastfeeding information policy during pregnancy, higher maternal age and increased multiple pregnancies would explain a higher breastfeeding rate among the women who had MAP. An impact of increasing maternal age was found on the rate of breastfed infants born of MAP. Primiparity was also a contributing factor for breastfeeding. Professional formation for all hospital staff concerned would be essential to give out clear and consistent information to families and to encourage support and intimacy throughout hospitalisation as well as at discharge.     

L’expérience d’une équipe de liaison en addictologie pour adolescents en établissement soin/étude

“La clinique Dupré” is a psychiatric inpatient clinic associating long-term hospitalization and ambulatory treatment with upper secondary schooling for adolescents and young adults (care and studies program). In this article, we first describe how the recent opening of a consultation liaison in addictology was established as a response to the substance use disorder among the hospitalized adolescents. Then we show how the emotional dysregulation associated with substance use disorder drove us to develop an integrative psychotherapeutic intervention that reduces or halts the use and abuse of substances and helps to regulate emotions.     

Le délaissement parental : quelles conséquences sur la régulation émotionnelle des enfants et adolescents placés en famille d’accueil ?

Objective

Parental abandonment is part of trajectory discontinuity during the placement of foster children and adolescents. In addition to a deleterious experience suffered before placement, parental abandonment is considered as variable linked to emotional regulation (coping strategies and temperament dimensions) of children and adolescents in foster family.

Vécus de familles d’enfants autistes en période de confinement : étude exploratoire

ObjectiveThe lockdown periods associated with the Covid-19 pandemic are a particularly significant challenge for families of children with autism. Exchanges by e-mail and interviews were aimed at collecting testimonies from parents for a better understanding of their difficulties and the help provided by the mobilization of professionals.Methods and resultsEight parents of autistic children living in the Seine-Saint-Denis area agreed to testify about their experience, either in person, taking into account the barrier measures after the first lockdown, or by telephone during the second lockdown. By way of comparison, e-mails were exchanged with a mother and two fathers of autistic children from higher socio-economic backgrounds living in other parts of France or Belgium. While at the beginning of the first lockdown, some children may have felt soothed by being at home with their parents, the extension of the situation led to crises related to feelings of anxiety or boredom. Despite the closure of many medical-social facilities, professionals mobilized to continue helping families and children whose routines were disrupted.ConclusionDepending on the conditions of lockdown, the families’ experiences differed and evolved over time. The major problems encountered by some families were the worsening of their child's troubles (self-harm, tantrums, violence, and shouting). Pedagogical tools were adapted by the teachers, activity sheets were sent out, group workshops were organized, and consultations were given at a distance. The teams of the child psychiatry services and the medico-social services have mobilized themselves and have shown reactivity and inventiveness in order to ensure the care and follow-up of children and their families.     

Psychomotricité et trouble du déficit de l’attention/hyperactivité : évaluation d’un programme de rééducation basé sur des mises en situation rythmique

Aim of the studyThis study aimed at investigating the effects of a rhythm-based therapeutic program among ADHD children by assessing performance in attentional and executive domains.Participants and methodTwenty-one children (mean age: 9.1, SD: 1.8; 3 females) who previously received a diagnosis of ADHD benefited from a rhythm-based training program (8 to 12 training sessions) delivered during a psychomotor therapy. The program consisted of rhythmic perceptuo-motor exercises, including sensorimotor synchronization to external beats (metronome, music). Attentional and executive performances were assessed with a test-retest experimental design.ResultsAttentional and executive performance improved in different domains: inhibition, cognitive impulsiveness and visuo-spatial working memory. A slight improvement was visible for divided attention, whereas sustained auditory attention, selective visual attention and delay aversion did not change after intervention.ConclusionThese results are in favor of tight relations between a rhythmic training program and some attentional and executive functions among ADHD children, with beneficial effects of the training on a variety of cognitive performances. This study seems promising for the purpose of supplementing chemical treatments among a range of ADHD patients in cognitive domain.