Prendre soin du bébé et de sa famille : une expérience de recherche–action en périnatalité

Objective

Authors present a clinical research led in France (area Lorraine in the east of the country) where several towns are associated with children presenting severe language delay. This language delay appears to be linked to a low socioeconomic context. Public psychiatry hospital and services of maternal and child protection (medical and social service called “Protection maternelle et infantile” in France) are associated to contribute at better infant development using home based assessment and intervention by a clinical psychologist. Objective is to show that home observations can reduce language delay in this population.

Methods

Forty-nine families have been studied and have benefited of psychological accompaniment. This clinical group has been compared with a control group of 42 families living in the same area but without accompaniment. Each family in clinical group have benefited from 23 sessions of home observation from pregnancy to 24 months. Sessions began two months before birth and stopped at 48 months. Several tools are used: clinical scales evaluation; psychometric test for assessment of psychomotor skills, oral language; mother-infant interactions studied with video. Qualitative analysis of parents–infant interactions and statistic comparisons (clinical group vs. control group) are used to analyze the development of the children from birth to 48 months.

Results

Toddlers of clinical group that have benefited of home observation and care at home by clinician psychologist present at 2 years old less developmental language disorder and development of psychomotor skills is better than control group. This research led at family's home shows that the intervention of clinician psychologist permits the parents to take care spontaneously of the baby, this promotes play activities and narrative verbal exchange. This research suggests that prevention of severe language delay can be easily led with home based assessment and intervention. These first results indicate the prospects for the continuation of this action research of primary prevention.     

Syndrome de choc toxinique streptococcique ou syndrome de Kawasaki ? À propos de 2 cas cliniques d’enfants présentant une pleuropneumopathie à streptocoque bêta hémolytique du groupe A

We report 2 cases of children with group A streptococcus pyogenes pleuropneumonia, in one child associated with Kawasaki disease and in the other with streptococcal toxic shock syndrome. These 2 features, with theoretically well-defined clinical and biological criteria, are difficult to differentiate in clinical practice, however, likely due to their pathophysiological links. In case of clinical doubt, an echocardiography needs to be performed to search for coronary involvement and treatment including intravenous immunoglobulins, and an antibiotic with an anti-toxin effect such as clindamycin has to be started early.     

La pédopsychiatrie en héritage : qu’avons-nous reçu ? Que souhaitons-nous transmettre ? Point de vue d’un pédopsychiatre de secteur

The work of empty

Child psychiatry is dependent of the evolution of representations and social practices with children. Each generation inherits from its masters, but is forced to sort through their concepts to fit the clinical picture contemporaries, however, abandoning the tools that had relevance in previous years.

The generational effect

The formative years influences each generation. The author refers to the method of transmission that was occurring before the televised consultations by directly observing the masters of the 1970s.

Inventory of wills

Each generation tries inventory in the will of the previous. The author wishes to convey to future practitioners the ability to think dialectically, in each case, the ecosystem of the child with psychodynamic internal motions, using the tools of the time, but preserving the ethical objective of the discipline: to support women and men of the future to enable them to live a little better overall.     

Prévalence de l’autisme et autres troubles envahissants du développement : données des registres français de population. Générations 1995–2002

Aim and background

In France, prevalence data of pervasive developmental disorders in children are rare despite recently dedicated public health plans aimed to improve the knowledge and types of care of these disorders. Within this context, the two French childhood disabilities registers of Haute-Garonne and Isere counties have been asked to provide recent prevalence data on autism spectrum disorders.

Methods

These two population-based registers record all the cases of pervasive developmental disorders in children residing in covered counties in their eighth year of life, after parental approval. Data are actively collected from the medical records available in various data sources. The main data source is the “county house for people with disabilities” i.e. the local authority which determines the orientation for special education and the decision of special allocation for disabled children. Other data sources are “autism resource centres” and psychiatric hospitals. Diagnoses were coded according to the International Classification of Disease (ICD 10). For this analyze, diagnoses selected were typical and atypical autism (F84.0 and F84.1), Asperger disorder (F84.5), other pervasive developmental disorders (F84.8) and pervasive developmental disorders not otherwise specified (F84.9). The data presented here concerned children born between 1995 and 2002. Prevalence rates were calculated for 10 000 children living in their eighth year of life in each counties.

Results

The overall prevalence rate in the eighth year of life over the whole study period was 31.9 per 10,000 children in Haute-Garonne and 34.9 per 10,000 in Isere, with a significant increasing trend between 1995 and 2002 in Haute-Garonne county. The sex-ratio was 3.8 and 3.5 respectively in Haute-Garonne and Isere. In both counties, about half of the children had an associated intellectual deficiency and about one third if only severe impairment (defined by an IQ below 50) was considered. An epilepsy was more often present when an intellectual deficiency was associated.

Conclusion

Data from the two French registers were quite comparable and demonstrated that prevalence rates of pervasive developmental disorders in the eighth year of life were in the lower range of those published in the international literature.     

Adolescentes victimes d’abus sexuel et trajectoire délinquante : quels facteurs de résilience ?

Introduction

This study concerns resilience related to juvenile delinquency among victims of sexual abuse: sexual abuse has been recognized as a powerful risk factor for the emergence of deviant and criminal behavior.

Objective

Our study aims to explore and highlight the protective factors that prevent victims of sexual abuse from engaging in a delinquent trajectory.

Method

The sample consists of teenage girls who have revealed, at minimum last year, their intergenerational abuse. These girls, all between 12 and 18 years old are divided into sub-groups: the non-offender victims and the victims who are also offenders. Each teenage victim is compared to a normative population on different psychological functioning dimensions: self-esteem (Harter's self-perception profile for adolescents), aggressiveness (the Buss–Perry Aggression questionnaire) and post-traumatic stress, with the Impact of Event scale Revised, (IES-R)-Horowitz. We analyze family characteristics, such as familial attachment and family climate, social characteristics, such as associations with peers, and environmental factors, such as reactions to revelations of sexual abuse, the presence of family and extra-familial resources, psychological care.

Results and conclusion

The results show that teenage victims of sexual assault present lower self-esteem and a negative self-perception in all fields, except for the perception of their attractiveness. Over-investment of this single dimension of self-perception can lead to a sexualization of their relationships with others and expose them to the risk of sexual revictimisation. The comparative analyses between the adolescent delinquent and non-delinquent victims highlight risk factors in connection with setting them off on a delinquent trajectory and protective factors supporting their resilience. The results highlight specific characteristics to the offender juvenile victims supporting a delinquent trajectory: aggressiveness, PTSD, defensive strategy of avoidance and characteristics of abuse (chronicity of abuse). The victim committed in delinquent trajectories presented more aggressiveness, consumeristic behaviour, post-traumatic stress and defensive strategy of avoidance than non-offender victims. Delinquent behaviour, just like substance abuse, could be a strategy of risk avoidance in connection with reliving sexual trauma, which hinders the process of resilience. Compared to the process of resilience, immediate and differed paternal support (during and after the revelations) seems the most important factor of protection. Being able to benefit from psychological councelling and having an extra-familial resource (a significant relationship with someone in the social environment) also constitute factors that support the resilience of these teenagers and prevent them from going down the path of delinquency. The interventions should aim at establishing a therapeutic alliance with these young girls during the early process of revealing the sexual abuse and mobilize and activate the support of the father (when he is not the abuser) or of a meaningful paternal figure as early as possible during the revealing phase and to accompany him in this restructuring function.     

Le processus de rumination mentale chez les enfants de 8 à 11 ans : adaptation et validation française de la Children's Response Styles Scale/échelle des styles de réponses chez les enfants

ObjectiveAccording to the Response Styles Theory, people respond to a depressive state with two types of processes: mental rumination and distraction. The main objective of our study was be to validate in French the Children's Response Styles Scale. Moreover, it also aimed to determine the associations of rumination and distraction with the gender of the participants and the intensity of their depressive symptoms.MethodsIn order to validate the Children's Response Styles Scale, we translated and administrated it with the Children's Engagement Scale and the Children's Depression Inventory to a total of 144 children aged 8 to 11 years old (mean = 9.48; standard-deviation = 1.06)ResultsOur statistical analyses brought out a two-dimensional factor structure, with a satisfactory internal consistency for the subscale rumination (α = 0.78; ω = 0.78) and an excellent one for the subscale distraction (α = 0.85; ω = 0.85). Furthermore, we could distinguish a greater propensity to rumination in girls, an absence of difference between the two sexes in regard to distraction, a positive correlation between rumination and depression, as well as an absence of correlation between distraction and depression.ConclusionThe French version of the Children's Response Styles Scale seems to be a valid and adequate scale for measuring the use of rumination and distraction in school-aged children. Moreover, our results reinforce the data previously collected in English-speaking countries and highlight the correlations between rumination and depressive symptoms, themes still little explored together in French children.     

Traumatisme et psychanalyse : comment passer de l’excitation à la mise en représentation ?

Objectives

This article develops the psychoanalytical theories of trauma in Freud's work and that of other psychoanalysts. The author will show the place of traumatism prior to language acquisition and its specificities. We will propose a method of treatment, group therapy.

Freud's theory

Usually traumatism designates a psychological impact of events, which are painful for a person and his life. This term is over-used in common language. Actually in France “trauma” usually results in immediate intervention of psychological treatments. In psychoanalytical theory, the notion of trauma is at the heart of Freud's work. This notion has varied greatly from 1905 to 1931. Many psychoanalysts work on the place of trauma in self-development. But in this article, we will examine the work of only two other authors: Ferenczi and Winnicott. These psychoanalysts work on “narcissic damage”. This problem corresponds to the absence of an adequate response from the object to a stressful situation and constitutes a mutilation of the self. The conception of trauma has many meanings: the first theory is that of the overwhelming of the defense mechanism of the subject and the other is repressed memory in relationship to theories of sexuality. The second theory is that trauma interrupts the self-continuity. In this situation, the subject clings to perceptive sensations. There is an interruption in the cycle of representation. It is not possible to use the representation mechanism. Actually many children who turn to child psychiatrists have pasts filled with traumas. There have not constructed transitional areas, which would permit them to create psychological spaces differentiating the imaginary from the real. For other children, however, the notion of trauma is difficult to recognize in their own lives.

Clinical case

Here, the author will present an observation of a child who had a trauma at the age of 8 months. His trauma was very precocious, occurring at a time prior to the child's language acquisitions and he didn’t have the skills to express his emotion. In therapy groups, he is able to remember the sound of the American ambulance siren, and with this sound, he expresses this psychological disorganization with great anxiety. It is probably the only memory he has been able to keep of this extremely traumatic experience. This analysis will show that the only memory of the child is an auditory one.

Conclusion

The author concludes with the interest of group's therapies permitting the emotional expression through play rather than through language. When there are group therapies, the children are going to have a certain excitation, and they feed off of each other; this group dynamic helps to transform the excitation into representation. The group therapies enable the children to reconstruct their pasts and repress the trauma. This therapy results in an associative representation: the children live emotional experiences and they translate these emotions into images (figurability). Then they arrive at a representation with a scenario and exceptionally at verbalization.     

Qui sont les adolescents consultant pour demande de prise en charge d’une obésité dans une Maison des adolescents ? Phénotypes d’une cohorte de 200 patients

Common obesity is a frequent reason for outpatient visits to adolescent clinics. Its high risk of persistence or progression into adulthood is well known. This article is a study of 200 clinical charts of obese adolescents that visited our clinic. The physical, metabolic, psychological, and social characteristics of these patients when they first started their follow-up are described. Body image disturbance and the everyday psychosocial impact of obesity were the most frequent reasons for the first visit. Two-thirds of the adolescent girls had already had unsuccessful follow-ups by other teams or doctors. The average age was 14.5 years and the average body mass index z-score was above 7.4. They suffered from musculoskeletal or respiratory disorders but had few metabolic complications at that stage. Various personal or family psychological and social characteristics were frequently observed as well as certain types of eating disorders. This data may be useful in establishing different profiles that could be used to adapt obese patient care for adolescents.     

Syndrome de Jacobsen : à propos d'un cas

The Jacobsen Syndrome is characterized by a distal deletion of the long arm of chromosome 11. Its phenotypical expression is very variable. It associates facial dimorphism, congenital heart defects, digital anomaly, mild to moderate psychomotor retardation, a delay of the language, and a thrombocytopenia. We describe the case of a newborn girl with Jacobsen syndrome. She had facial dimorphism, interventricular septal defect, bilateral syndactyly of the fourth and fifth toes, left pyeloureteral duplication, and thrombocytopenia.