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Comment le pédopsychiatre, qui accompagne des enfants ou adolescents sujets à des psychotraumatismes complexes, est-il amené à penser la dimension clinique mais aussi socio-politique de sa pratique ? Nous discutons ici certains des questionnements qui peuvent être ceux du clinicien dans le domaine de la psychotraumatologie, jusqu'à se réinterroger sur les principes actifs fondamentaux de l'intervention soignante, et en particulier en matière de santé mentale. What do child psychiatrists who work with children or adolescents suffering from complex psychotraumatic disorders think about the clinical and socio-political dimensions of their practice? In this article, we discuss some of the questions that clinicians in the field of psychotraumatology may ask themselves, to the point of re-examining the fundamental active principles of healthcare intervention, particularly in the field of mental health. [ABSTRACT FROM AUTHOR]

Exposure to screens among young, developing children is a recurring topic in both the mainstream media and the medical community. Many people are warning about their harmful effects. National and international recommendations have been drawn up to govern the exhibition. Several scientific publications address this subject, and some authors go so far as to suggest "the etiology of autism" in the case of too early and intense use of screens during early childhood. The question also arises for children with Autism Spectrum Disorder (ASD). The aim of this article is to carry out a narrative review of the literature on the relationship between screens and ASD, in order to help the treating physician (general practitioner, pediatrician, child psychiatrist) to advise these families. [ABSTRACT FROM AUTHOR]

Abstract Background Secondary traumatization is a common occupational hazard for professionals working with distressed and traumatized people, especially children. If not properly managed, secondary traumatization can lead to symptoms similar to posttraumatic stress disorder. This condition is known as secondary traumatic stress (STS) and is linked to adverse mental health outcomes, such as burnout. Nevertheless, exposure to a traumatic event or its disturbing details can contribute to personal transformation, allowing an individual to move beyond pre-traumatic functioning and awareness. This process is called posttraumatic growth and is associated with positive mental health outcomes. The current study examined the relationship between STS and burnout and whether posttraumatic growth moderates this relationship in a sample of child psychiatrists. Methods An online questionnaire was designed and distributed to participants. A total of 59 child psychiatrists working in Turkey completed measures including the Copenhagen Burnout Inventory-work burnout subscale, the Posttraumatic Growth Inventory, and the Secondary Traumatic Stress Scale. Results While STS was positively related to burnout (r = 0.661, p < .001), posttraumatic growth moderated this relationship. In other words, the relationship between STS and burnout was weaker for child psychiatrists with higher posttraumatic growth. Conclusions Promoting posttraumatic growth may be a good way to reduce burnout among child psychiatrists. Individual or group supervision can promote posttraumatic growth by providing a supportive environment for child psychiatrists. Balancing workloads and creating time for self-care can also contribute to their growth.

Background: Secondary traumatization is a common occupational hazard for professionals working with distressed and traumatized people, especially children. If not properly managed, secondary traumatization can lead to symptoms similar to posttraumatic stress disorder. This condition is known as secondary traumatic stress (STS) and is linked to adverse mental health outcomes, such as burnout. Nevertheless, exposure to a traumatic event or its disturbing details can contribute to personal transformation, allowing an individual to move beyond pre-traumatic functioning and awareness. This process is called posttraumatic growth and is associated with positive mental health outcomes. The current study examined the relationship between STS and burnout and whether posttraumatic growth moderates this relationship in a sample of child psychiatrists. Methods: An online questionnaire was designed and distributed to participants. A total of 59 child psychiatrists working in Turkey completed measures including the Copenhagen Burnout Inventory-work burnout subscale, the Posttraumatic Growth Inventory, and the Secondary Traumatic Stress Scale. Results: While STS was positively related to burnout (r = 0.661, p <.001), posttraumatic growth moderated this relationship. In other words, the relationship between STS and burnout was weaker for child psychiatrists with higher posttraumatic growth. Conclusions: Promoting posttraumatic growth may be a good way to reduce burnout among child psychiatrists. Individual or group supervision can promote posttraumatic growth by providing a supportive environment for child psychiatrists. Balancing workloads and creating time for self-care can also contribute to their growth. [ABSTRACT FROM AUTHOR]

Suite à l'évolution des politiques en santé publique de plus en plus ressentie par les équipes de secteur de pédopsychiatrie comme un désamour de la part des tutelles, il semble important de préciser les missions des centres médico-psychologiques (CMP) pour enfants et adolescents et de témoigner, à l'attention des collègues et des partenaires, de la créativité de ces structures de plus en plus sollicitées par les usagers. Une journée d'étude s'est tenue à l'hôpital Ste-Anne à Paris en juin 2019 pour faire entendre les spécificités du travail de secteur en pédopsychiatrie. Participant à la première table ronde intitulée « du terroir au territoire », nous reprendrons ici ce que nous avons tenté de rendre plus visible de la pratique professionnelle en CMP, à partir de la mise en œuvre de savoirs associés, à l'heure où les politiques de santé publique se situent à l'échelle du territoire. Nous avons pu préciser dans quelles conditions et dans quelles situations le pédopsychiatre intervient. La place à laquelle il est mis et à laquelle il se met lui-même est étroitement liée au savoir qu'il détient et à l'expertise qui lui est conférée. Cette réflexion à portée épistémologique semble un détour pertinent afin d'éclairer sa prise de parole au plus près de la population. Following the evolution of public health policies, which are increasingly experienced by workers in this field as a lack of interest from the supervisory authorities, the aim was to clarify the missions of the medical-psychological centers (CMP) for children and adolescents and above all to testify, for the benefit of colleagues and partners, to the creativity of these structures, to which users are flocking. A study day on the specificities of sector work in child psychiatry was held at the Ste-Anne Hospital in Paris in June 2019. As a participant in the first round table entitled "From the land to the territory", I will take up here what I tried to make more visible regarding professional practice in CMPs, based on the implementation of associated knowledge, at a time when public health policies are situated at the territorial level. I set out how and where the child psychiatrist intervenes in the CMP. It depends on both his own knowledge and what is expected. This epistemological thinking could help the child psychiatrist to communicate directly with the people he serves. [ABSTRACT FROM AUTHOR]

En pédopsychiatrie, le modèle classique de prise en charge, les consultations thérapeutiques, implique la continuité du suivi par le même thérapeute dès le premier entretien. Ce modèle nécessite toutefois des ressources en personnel qui ne sont souvent plus disponibles dans nos systèmes de soins. Selon le lieu, les enfants attendent plusieurs mois à plusieurs années avant d'obtenir un premier rendez-vous avec un spécialiste. À Genève, une unité pédopsychiatrique ambulatoire pour enfants d'âge préscolaire propose depuis plusieurs années une approche différente dans laquelle les familles sont d'abord vues par un pédopsychiatre expérimenté lors d'une consultation unique (CU), avec pour objectifs de réduire le temps d'attente avant le premier rendez-vous, soulager l'anxiété parentale, donner un premier conseil et/ou avis et orienter si nécessaire les familles vers un autre thérapeute au sein de la même unité ou vers une autre structure. À travers une étude observationnelle menée entre mars 2019 et février 2020 auprès de 79 familles ayant bénéficié de ce modèle, nous avons cherché à évaluer sa pertinence, son acceptation par les familles et les thérapeutes ainsi que ses avantages et inconvénients. Les données ont été collectées dans une unité de pédopsychiatrie ambulatoire pour enfants d'âge préscolaire, la Guidance infantile, qui fait partie des Hôpitaux Universitaires de Genève. Les résultats de cette étude ont montré la pertinence de ce modèle et son acceptabilité par les familles nécessitant une aide psychiatrique pour leurs enfants en âge préscolaire. La majorité des familles apprécie la rapidité de la prise en charge, plus importante à leurs yeux que la continuité des soins par le même thérapeute. Les cliniciens, qui au début émettaient des réserves quant au changement de thérapeute, sont eux aussi satisfaits par ce modèle, soulignant notamment l'apport positif de la CU à l'établissement de l'alliance thérapeutique. Ce modèle devrait cependant pouvoir être utilisé avec une certaine flexibilité. Il semble en effet opportun que le thérapeute de la CU puisse dans certains cas prévoir une deuxième séance afin d'approfondir l'évaluation initiale, et également qu'il puisse continuer lui-même le suivi s'il estime lors de la CU que la famille est à risque de rupture de soins en cas de changement de thérapeute ou de délai d'attente supplémentaire. In child psychiatry, the classic model of care, which is the therapeutic consultations, implies a continuity of care by the same therapist from the first session. The strong emotional charge which emerges from this first consultation favours the therapeutic alliance. This model requires staff resources which are often no longer available in our care systems. Depending on the area, children have to wait several months to several years to get a first appointment with a specialist. A Geneva outpatient child psychiatric unit for preschool children has experimented a different approach in which families are first seen by an experienced child psychiatrist for a single consultation (SC) with the following objectives: to reduce the waiting time before the first appointment, to relieve parental anxiety, to give initial advice and to refer families to care with another therapist if needed, either within the same unit or to another structure. In this article, we examine, through an observational study, the relevance of this model, its acceptance by families and therapists, as well as its advantages and limitations. An observational study was conducted between March 2019 and February 2020 among 79 families who benefited from this model. The data were collected in an outpatient child psychiatry unit for preschool children, the Guidance infantile, which is part of the Geneva University Hospitals. Exclusion criteria were: no French speaking, the presence of a legal third party during the session (minor protection service, lawyer), or a known clinical contraindication to a change of therapist. Four questionnaires were distributed along the study. The first and second were respectively completed by the family and the therapist immediately after the SC. The third was filled out by the family by telephone two months after the SC and the fourth was completed by the second therapist in charge of the therapy after the SC, if therapy took place in the same unit. At the end of the 79 SCs, 41 indications for continuation of care in the Guidance were made, 26 of them also including a parallel referral to an outpatient care structure. 24 patients were referred only to outpatient care, and for 14 patients no further care was indicated or desired by the parents. The SCs lasted between 60 and 90 minutes. Regarding their concern about their child, 65% of families noticed a reduction of anxiety immediately after the SC and 51% two months after the SC. 75% answered that the SC helped them to better tolerate the wait before the rest of the treatment. However, this waiting time was still perceived as too long by 22% of families. Most parents (51% after the SC and also after 2 months) perceived the change of therapist as "not problematic at all". When the patient was redirected toward a junior therapist inside the same care unit, the written report and oral transmissions facilitated the follow-up. All of the second therapists considered that the change of clinician had no negative impact on the establishment of a therapeutic alliance. On the contrary, 63% of them noted that the SC had favored the alliance. Good clinical practice requires the development of therapeutic models that take into account their quality, effectiveness and cost effectiveness. The lack of child psychiatrists, together with the increase in needs, pushes us to think about new modes of care which take into account the particularity of child psychiatric care in which the therapeutic alliance constitutes a major stake. The results of this observational study show the relevance and acceptability of this model in a population of families seeking psychiatric help for preschool children. The families noted fare more advantages than inconveniences with this new practice. The majority of them appreciated the rapid management of care, which was more important to them than the continuity of care by the same therapist. The clinicians, who were mainly doubtful about this model, gave a positive evaluation, in particular by realizing that the therapeutic alliance was not negatively impacted by the change of therapist. However, this model should be applied with some flexibility by allowing a second session when clinically useful to improve the evaluation or the referral and by allowing the SC's therapist to continue the assessment and the treatment with families who are at risk of disruption of care if there is a change of therapist or an additional waiting period. [ABSTRACT FROM AUTHOR]

Le but de notre étude était de déterminer le profil sociodémographique, clinique et thérapeutique de la population de nouveaux consultants dans un service de pédopsychiatrie d'un hôpital général. Il s'agit d'une étude descriptive rétrospective sur dossiers. Elle a porté sur les nouveaux patients ayant consulté entre janvier et novembre 2018 au service de pédopsychiatrie de l'hôpital Mongi Slim à Tunis. La collecte des données a été effectuée à l'aide d'une fiche d'exploitation informatique préétablie, élaborée pour les besoins l'étude. Le traitement statistique des données a été réalisé à l'aide du logiciel SPSS 20.0. Notre étude a porté sur 1 013 dossiers. L'âge moyen des consultants était de 8 ans et 5 mois. Le sex-ratio était de 1,54. Les patients dans 65,84 % des cas ont été adressés par un médecin. L'enfant était l'aîné de sa fratrie dans 35 % des cas. Les enfants fréquentaient l'école primaire dans 49,3 %. Les motifs de consultations étaient les difficultés scolaires dans 23,4 % et les troubles du comportement dans 15,1 %. Les diagnostics psychiatriques les plus fréquemment retenus étaient le handicap intellectuel (15,69 %) et les troubles dépressifs (12,63 %). Une prise en charge en psychothérapie a été indiquée pour 33,6 % des patients. Une prise en charge médicamenteuse a été nécessaire dans 14,25 % des cas. La connaissance du profil des consultants en pédopsychiatrie nous permettra d'adapter la formation des futurs médecins et pédopsychiatres aux spécificités de la population et de faire évoluer les modalités des prises en charge et l'offre de soins. We propose to explore the sociodemographic, clinical and therapeutic characteristics of patients who presented to a child and adolescent psychiatric outpatient department. It is a retrospective descriptive study focused on patients who consulted at the first time the child and adolescent psychiatric outpatient department of the Mongi Slim Hospital between January and November 2018. We have collected the sociodemographic data of the child and his parents. We specified who accompanied the child the consultation in a child psychiatry consultation, the reason for consultation and the origin of the request for the child psychiatry consultation. The psychiatric diagnoses were retained according to the criteria of the DSM-5. For patients requiring follow-up, the indicated management methods have been specified. After collection, the statistical processing of the data was carried out using SPSS 20.0 software. We collected 1013 cases. The children average age was 8 years and 5 months with extremes ranging from 7 months to 19 years. The sex-ratio was estimated at 1.54. In the case of an age of over 11 years, the female sex was predominant with a sex-ratio equal to 0.86; (P < 10−3). The consultants lived in the north of Tunisia in 98.7% of cases, within 94.9% of cases in the north-eastern governorates. The children were the eldest of their siblings in 35% of cases. Children attended primary school in 49.3%. We find that 879 patients were accompanied by one or both parents while five adolescents (four girls and one boy) consulted alone in the service. Among the 1013 patients included in our study, 65.84% (667 patients) were referred to our consultation by doctors. The reasons for consultations were academic difficulties in 23.4%, behavioral problems in 15.1% and language disorders in 11.3% of cases. We did not retain a diagnosis according to DSM-5 criteria for 76 consultants (7.5%), a psychiatric diagnosis was made for 768 patients (75.8%) and a psychiatric diagnosis was suspected, but deferred for 169 consultants (16.7%). Twenty-five of them had an associated organic comorbidity. The psychiatric diagnoses were intellectual disability in 15.69%, depressive disorders in 12.63%, adjustment disorders in 9.47% and autism spectrum disorder in 9.2%. Following the first consultation, we indicated a psychiatric follow-up for 919 consultants (90.7%), among which 635 patients (69.1%) consulted again. Among the 919 patients requiring follow-up, hospitalization in psychiatric hospital was indicated in 11 patients (1.2%). We indicated psychotherapy for 326 patients (35.5%). The psychotherapies indicated were of the type: Listening and support in 280 patients (85.9%), Eye Movement Desensitization And Reprocessing in 23 patients (7.1%), Cognitive and Behavioral Therapy in 21 patients (6.4%) and Narrative Exposure Therapy for Kids in 2 patients (0.6%). One or both parents were referred to an adult psychiatric consultation in 61 cases (6%). An intervention by the child protection representative was requested in 7.6% of cases (70 patients) while an intervention with the school structures attended was necessary for 17.2% of the consultants (158 patients). Medication was necessary in 14.25% of cases. The prescribed therapeutic classes were anxiolytics (23.7%), neuroleptics (16%), psychostimulants (16%) and antidepressants (13%). The most prescribed drugs were Hydroxyzine in 23.7%, Methylphenidate (14.5%), Risperidone (11.4%) and Sertraline (11.4%). Knowing the profile of the child psychiatry outpatient will allow us to adapt the training of future doctors and child psychiatrists according to needs and to the specificities of the population. [ABSTRACT FROM AUTHOR]

Abstract Background The COVID-19 pandemic has directly impacted the field of child and adolescent psychiatry, affecting all aspects of the lives of children and their families and increasing their risk of distress and mental health issues, especially among children with preexisting psychiatric disorders. Child and adolescent psychiatrists (CAPs) across the world have had to adapt their practice, due to lockdown and social distancing measures. This study aimed to explore how CAPs experienced their clinical practice in these singular conditions. Methods This exploratory international qualitative study used the Inductive Process to analyse the Structure of lived Experience (IPSE) approach, which is a five-stage inductive process used to explore the lived experience of participants in depth and to analyze their structure of lived experience. This study took place from March through July 2020 through individual in-depth video interviews. The sample size was determined according to the principles of theoretical sufficiency. Results 39 CAPs from 26 countries participated (age range 32–70 years; 23 women). Data analysis produced a structure of lived experience comprising three central axes of experience: (1) lost in space, lost in time, describing CAPs’ experience of disorganization of their clinical practice in the dimensions of lived time and lived space, (2) the body—of CAPs and patients—underlining their disconcerting experience of both sensory aspects and the non-embodied encounter during clinical practice, and (3) unpleasant emotions, with angst and loneliness the two main feelings coloring their clinical practice experience. Conclusions This analysis of the structure of lived experience of CAPs went beyond the sole context of the pandemic and revealed key aspects of what usually organizes CAP clinical practice. It identified two blind spots or conceptual voids within the child and adolescent psychiatry field: first, the intrinsic therapeutic function of a CAP clinical practice and, second, the important diagnostic and therapeutic function of the embodied encounter during CAP consultations. Beyond the context of COVID-19, further research should investigate these aspects to better define what a CAP does in practice and to increase both attractiveness and recruitment in this specialty.

Le développement des bébés accueillis en Maison d'Accompagnement Parents Enfants (MAPE) avec leur mère a interrogé conjointement les professionnels de ces structures d'accueil et ceux de la pédopsychiatrie. Cette convergence de préoccupations pour ces enfants a permis l'élaboration d'un travail conjoint entre les MAPE de l'AVVEJ et l'unité de pédopsychiatrie périnatale de l'EPS Erasme dans le but d'amener ces dyades vers le soin psychique et d'évaluer le développement des bébés. Le cadre a été défini par une convention qui prévoit 3 consultations pour ces dyades dont une consultation d'évaluation du développement du bébé par le Brunet-Lézine Révisé. L'étude a permis de souligner le niveau de développement inférieur à la moyenne de ces enfants mais aussi les différents avantages de la mise en place de ce parcours pour ces dyades. Ces résultats confirment la nécessité de poursuivre ce travail conjoint et ouvre la voie à une réflexion plus spécifique sur la façon de soutenir de manière intégrée le développement de ces bébés. Development of infants living in maternal and parental centers (called MAPE in French) with their mothers jointly questioned the professionals of these structures and child perinatal psychiatry. This convergence of concern about these children led to the development of joint work between the MAPEs of an associative structure (Association Vers la Vie pour l'Education des Jeunes AVVEJ, Île-de-France) and the perinatal child psychiatry unit of EPS Erasme (Île-de-France) in order to bring these dyads to psychic care and to assess infant development. The framework was defined by an agreement made by these two units. The protocol is made of three perinatal psychiatric mother-infant consultations - accompanied by an educator from the MAPE. The first one is to explain the protocol and take information about the current situation of the dyad. The second is a consultation to assess the development of the baby by Brunet-Lézine Révisé (a French developmental scale) which is video recorded. The third one is to explain the assessment results to the mother, paying attention to present the baby's strengths and weaknesses. To do so, Child Psychiatrists showed some selected parts of the videos to the mother. All the consultations are coordinated by the childcare worker from the child psychiatric unit, also supporting an active participation from the mother. The study not only confirms the developmental delay of these children but also the various advantages of the implementation of this protocol for these dyads. These results confirm the need to continue this joint work and open the way to more specific investigation on how to support these infants' development in an integrated manner. We also propose perspectives for future joint work with the dyads and maternal and parental centers. [ABSTRACT FROM AUTHOR]

Over 700,000 children throughout the U.S. have received insurance coverage through welcome mat effects of Medicaid expansion, including children with autism spectrum disorder (ASD). Utilizing health workforce data from the Health Resources and Services Administration, we examined workforce growth (2008–2017) among three types of health providers for children with ASD as a result of Medicaid expansion: child psychiatrists, board-certified behavioral analysts (BCBAs) and pediatricians. We found that state Medicaid expansion was associated with a 9% increase in BCBAs per 100,000 children one year after enactment, a 5% increase in child psychiatrists, and was not associated with growth in pediatricians. Results indicate the importance of new policies that directly address a shortage of providers for children with ASD. [ABSTRACT FROM AUTHOR]

L'objectif de cette étude était de décrire le parcours de soins des enfants de 18 à 30 mois à risque élevé de troubles du spectre de l'autisme (TSA) suivis en protection maternelle et infantile (PMI) dans les Bouches du-Rhône. L'objectif secondaire était d'évaluer la faisabilité du dépistage systématique des TSA en consultation de PMI. Les enfants inclus dans l'étude descriptive du parcours de soins avaient 18 à 30 mois et un risque élevé de TSA au M-CHAT-R. Les données de la consultation de dépistage, 6, 12 et 24 mois après leur consultation ont été recueillies rétrospectivement. Pour l'étude qualitative transversale, des entretiens ont été menés auprès de médecins de PMI. Parmi les 2458 enfants dépistés entre septembre 2015 et décembre 2018, 76 enfants (3,1 %) avaient un risque élevé de TSA (M-CHAT-R ≥ 8). Ils ont bénéficié rapidement de mesures de socialisation, pour atteindre une importante intégration en école ordinaire. Le délai médian de consultation d'un médecin spécialiste à partir du dépistage était de 81 jours [40 ; 145]. Les principaux freins au dépistage systématique des TSA exprimés par les médecins de PMI étaient : le temps nécessaire au dépistage, la barrière de la langue, les difficultés de compréhension, l'offre de diagnostic et de soins limitée. Des leviers spécifiques au contexte de consultation de PMI ont été rapportés. De nombreuses actions peuvent être entreprises entre les âges de deux et trois ans pour ces enfants dépistés à risque élevé de TSA en PMI. The objective of this study was to describe the care pathway, socialization, and the modalities of scholarization of children aged 18 to 30 months at high risk of Autism Spectrum Disorders (ASD) followed in Maternal-Child Health Services (PMI) in the Bouches du-Rhône area in France. The secondary objective was to evaluate the feasibility of systematic screening for ASDs in PMI consultations. A mixed observational (quantitative-qualitative) study was carried out in the Bouches-du-Rhône department in France. The children included in the care pathway descriptive study were 18 to 30 months of age and at high risk for ASD at the M-CHAT-R (M-CHAT-R ≥ 8). Data from the screening visit, and 6, 12 and 24 months thereafter were collected retrospectively. For the cross-sectional qualitative study, interviews were conducted with PMI medical practitioners. From September 2015 to December 2018, of the 2458 children screened, 76 children (3.1%) were at high risk for ASD (M-CHAT-R ≥ 8) and the socialization of these children was initially poor since it was done only within the family (69% at the time of screening). These children quickly benefited from socialization measures, achieving a significant integration into regular school. Indeed, the schooling rate was very high at 24 months after the screening since 89% of the children were enrolled in school, most in regular schools, with human support. The care provided by a speech therapist, a psychomotrician or a psychologist increased over time. However, the speech therapist's follow-up was a little later than that of the psychomotrician. The median time to see a child psychiatrist or neuropaediatrician or pediatrician from screening was 81 days [40; 145]. Nine interviews were conducted with the referring PMI medical practitioners in the Bouches-du-Rhône department. The main barriers to routine screening for ASDs expressed by PMI medical practitioners were: the time required for screening, language and comprehension barriers, and limited diagnostic and care options. Levers specific to the PMI consultation setting were reported. This study provides a glimpse of certain characteristics of the care, socialization and schooling pathway of these very young children, which is little documented to date in France. In view of the elements resulting from the interviews, as well as the large number of children having been screened over three years (n = 2458), the feasibility of systematic screening for ASD at 18–30 months in the context of consultations with PMIs in the department seems to be established. Although specialized care management is confronted with structures, and the time frames described and studied were long, many actions can be undertaken between the ages of two and three years for these children. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic has directly impacted the field of child and adolescent psychiatry, affecting all aspects of the lives of children and their families and increasing their risk of distress and mental health issues, especially among children with preexisting psychiatric disorders. Child and adolescent psychiatrists (CAPs) across the world have had to adapt their practice, due to lockdown and social distancing measures. This study aimed to explore how CAPs experienced their clinical practice in these singular conditions. Methods: This exploratory international qualitative study used the Inductive Process to analyse the Structure of lived Experience (IPSE) approach, which is a five-stage inductive process used to explore the lived experience of participants in depth and to analyze their structure of lived experience. This study took place from March through July 2020 through individual in-depth video interviews. The sample size was determined according to the principles of theoretical sufficiency. Results: 39 CAPs from 26 countries participated (age range 32–70 years; 23 women). Data analysis produced a structure of lived experience comprising three central axes of experience: (1) lost in space, lost in time, describing CAPs' experience of disorganization of their clinical practice in the dimensions of lived time and lived space, (2) the body—of CAPs and patients—underlining their disconcerting experience of both sensory aspects and the non-embodied encounter during clinical practice, and (3) unpleasant emotions, with angst and loneliness the two main feelings coloring their clinical practice experience. Conclusions: This analysis of the structure of lived experience of CAPs went beyond the sole context of the pandemic and revealed key aspects of what usually organizes CAP clinical practice. It identified two blind spots or conceptual voids within the child and adolescent psychiatry field: first, the intrinsic therapeutic function of a CAP clinical practice and, second, the important diagnostic and therapeutic function of the embodied encounter during CAP consultations. Beyond the context of COVID-19, further research should investigate these aspects to better define what a CAP does in practice and to increase both attractiveness and recruitment in this specialty. [ABSTRACT FROM AUTHOR]

We describe the attitudes of child psychiatrists toward diagnosis delivery (DD) and explore potential stressful factors associated with the process. Eighty Israeli child psychiatrists completed a questionnaire on their perceptions of DD of schizophrenia, autism spectrum disorder (ASD), and attention deficit/hyperactivity disorder (ADHD). We also conducted semi-structured in-depth interviews with 12 child psychiatrists who were asked to share their personal experience with DD. The questionnaire responses revealed that child psychiatrists perceived schizophrenia and ADHD as the most and least severe disorders, respectively, and its treatment as being ineffective and effective, respectively. They expressed negative perceptions toward DD of schizophrenia and positive perceptions toward DD of ADHD. The results of linear regressions revealed that some factors predicted distress accompanying DD in all three diagnoses, such as lack of professional experience, negative perceptions of DD, and the effect of parents' attitudes of opposition to the diagnosis. The interviews revealed that DD was often described by psychiatrists as an emotional experience and that the psychiatrists' age, and whether the psychiatrists identified more with the child or the parent, affected their attitude toward DD. Lastly, the psychiatrists expressed feelings of loneliness in the procedure of DD and their wish to share and reflect on their experiences with others. These findings may contribute to a better understanding of the clinically important topic of DD in child psychiatry that has not been adequately addressed and help deal with psychiatrists' challenges in this task.

We describe the attitudes of child psychiatrists toward diagnosis delivery (DD) and explore potential stressful factors associated with the process. Eighty Israeli child psychiatrists completed a questionnaire on their perceptions of DD of schizophrenia, autism spectrum disorder (ASD), and attention deficit/hyperactivity disorder (ADHD). We also conducted semi-structured in-depth interviews with 12 child psychiatrists who were asked to share their personal experience with DD. The questionnaire responses revealed that child psychiatrists perceived schizophrenia and ADHD as the most and least severe disorders, respectively, and its treatment as being ineffective and effective, respectively. They expressed negative perceptions toward DD of schizophrenia and positive perceptions toward DD of ADHD. The results of linear regressions revealed that some factors predicted distress accompanying DD in all three diagnoses, such as lack of professional experience, negative perceptions of DD, and the effect of parents' attitudes of opposition to the diagnosis. The interviews revealed that DD was often described by psychiatrists as an emotional experience and that the psychiatrists' age, and whether the psychiatrists identified more with the child or the parent, affected their attitude toward DD. Lastly, the psychiatrists expressed feelings of loneliness in the procedure of DD and their wish to share and reflect on their experiences with others. These findings may contribute to a better understanding of the clinically important topic of DD in child psychiatry that has not been adequately addressed and help deal with psychiatrists' challenges in this task. [ABSTRACT FROM AUTHOR]

Copyright of Ozel Egitim Dergisi is the property of Ankara University, Faculty of Educational Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Cet article présente les apports du premier livre de Colette Chiland consacré à l'enfant de 6 ans et son avenir (1971), livre dans lequel on retrouve en germe l'essentiel des préoccupations cliniques et scientifiques à venir de celle qui fut une des grandes figures de la pédopsychiatrie française de la deuxième moitié du XXe siècle et du début du XXIe siècle. Des problématiques psychopathologiques majeures, toujours d'actualité, y sont travaillées : le normal et le pathologique chez l'enfant, les relations entre niveau social, QI, et santé mentale, l'échec scolaire, la dyslexie, les mesures préventives, curatives et politiques du pédopsychiatre et de son équipe dans la cité. This article presents the contributions of the first book by Colette Chilands dedicated to the six-year-old child and its future (1971). In this work, we find the main forthcoming clinical and scientific concerns of a person who has been one of the greatest figures of French child psychiatry of the second half of the 20th and the beginning of the 21th century. Major current psychopathology issues are analyzed: child normal and pathological behavior, relations between social status, IQ, mental health, school failure, and dyslexia, and the child psychiatrist's preventive, curative and political measures in society. [ABSTRACT FROM AUTHOR]

La durée de psychose non traitée est une mesure importante associée au pronostic de schizophrénie. Le phénomène de migration constitue une vulnérabilité dans le développement d'une psychose. Cette étude s'est intéressée à la rencontre entre proches de patient et pédopsychiatre dans le contexte de la prise en charge de la schizophrénie à début précoce en situation transculturelle. L'objectif de ce travail est de mieux comprendre les mécanismes qui pourraient expliquer, chez les patients en situation transculturelle, une durée de psychose non traitée allongée pour mieux y répondre. Trois proches de patients atteints de schizophrénie à début précoce (DSM-5) en contexte transculturel et de migration et deux pédopsychiatres ont été inclus dans une étude qualitative. Ils ont été interviewés au moyen d'un questionnaire semi-structuré. Les deux patients dont les proches ont été inclus étaient de sexe masculin. Au moment de l'étude, ces patients avaient 18 et 23 ans, pour un âge de début de la maladie à 13 et 17 ans respectivement. Les durées de psychose non traitées retrouvées étaient 18 et 36 mois respectivement. Les mécanismes qui pourraient expliquer chez les patients en situation transculturelle une durée de psychose non traitée allongée sont les difficultés de compréhension entre le savoir expert médical et le savoir des familles notamment leur représentation de la maladie. Cette incompréhension, la stigmatisation de la psychiatrie et une barrière de la langue perçue par les professionnels peuvent fragiliser des liens thérapeutiques, et ainsi modifier le parcours de soins. The duration of untreated psychosis is an important measurement associated with the prognosis for schizophrenia and is defined as the period from the onset of psychotic symptoms to the first specific pharmacological treatment. The migration phenomenon constitutes a vulnerability in the development of psychosis. This study focused on interviews with the relatives of two patients as well as child psychiatrists in the context of treating early onset schizophrenia in a transcultural situation. This study's goal is to understand the mechanisms that could explain, among patients in a transcultural situation, an extended duration of untreated psychosis and how to deal with it in a better way. Three relatives of each of the two patients with early onset schizophrenia (DSM-5) and two child psychiatrists were included in a qualitative study. They were interviewed using a semi-structured questionnaire during 60 minutes. The interviews were recorded on audio support and transcribed verbatim. Each transcription was reviewed by two independent assessors, in double readings. The duration of untreated psychosis has been measured retrospectively, using the medical record by defining the time of initiation of treatment and the collection of information from families, in order to define the moment of onset of the disorders. The time between these two moments was then calculated. The data analysis chosen was a thematic qualitative analysis. At the time of the study, the two male patients were 18 and 23 years old, with an age of onset of the disease at 13 and 17 years respectively. The periods of untreated psychosis found for them were respectively 18 and 36 months. In a transcultural situation, the mechanisms, which might explain a longer duration of untreated psychosis in patients are difficulties in understanding between the medical expert's knowledge and that of the family, namely their representation of the illness. This misunderstanding, the stigma faced by psychiatry, and the language barrier perceived by professionals can weaken therapeutic relationships, thus modifying the care pathway. [ABSTRACT FROM AUTHOR]

Copyright of Gümüshane Üniversitesi Saglik Bilimleri Dergisi is the property of Gumushane University, Faculty of Health Sciences and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Zofia Szymańska was trained as a child psychiatrist in Paris before and during World War I. She practiced in revolutionary Russia and in interwar Warsaw. She survived the Warsaw Ghetto in hiding with nuns and after the war became a state employee in communist Poland. An examination of Szymańska's career both before and after World War II introduces us to the development of child welfare services; the transformation of philanthropy into professional social work; the training of psychiatrists, teachers and social workers; the participation of Jewish and Polish women in these fields; the history of crime among and punishment of juveniles; the history of special needs education among Jews and in Poland; aid provided to Jews during World War II; and connections between Catholic institutions and the state in postwar Poland. This outline of Szymańska's biography allows us to consider twentieth-century narratives of disruption and continuity. [ABSTRACT FROM AUTHOR]

There is a great crisis in child-adolescent psychiatry, but we will not solve it just only by increasing the number of psychiatrists or psychiatric wards. The young patients described in Agnieszka Wlazło�s editorial indeed should not end up in a psychiatry department, but that does not mean they do not need any institutional support at all. In this commentary I would like to add two simple but important remarks: we need a serious discussion of the consequences of childhood trauma and mental problems in adolescence and also a well-functioning prevention system to avoid them. [ABSTRACT FROM AUTHOR]

Objectives: Psychotherapy is an effective, recommended treatment for pediatric anxiety disorders. Nevertheless, individuals with mental health conditions often do not receive psychotherapy, with variation across provider types. This study sought to examine psychotherapy claims surrounding medication initiation in U.S. children with diagnosed anxiety disorders.Methods: The study cohort included privately insured children (3-17 years) with a diagnosed anxiety disorder initiating a medication to treat anxiety from 2004 to 2014. We examined psychotherapy claims in the 3 months before and 3 months after medication initiation and described children with multiple (2+) psychotherapy claims per 3-month period.Results: Of the 75,024 children initiating a medication for anxiety (median age = 14 years, 58% female), 35% had multiple psychotherapy claims before medication initiation, with variation by age, anxiety disorder, and psychiatric comorbidity and with little change across time. Psychotherapy claims after medication initiation varied by whether the child had prior psychotherapy: 80% in children with prior psychotherapy and 30% in children without prior psychotherapy claims (44% of children diagnosed by a psychiatrist, 21% of children diagnosed by a pediatrician).Conclusion: Many privately insured children do not have claims for psychotherapy before or after pharmacotherapy initiation for anxiety. Findings can inform future research and efforts to ultimately increase appropriate psychotherapy utilization in children with anxiety disorders. [ABSTRACT FROM AUTHOR]

Childhood trauma has widespread implications on individuals across the length of a lifetime, impacting physical, mental, and emotional health. The author uses narrative to explore the past schooling experiences of an educator in public education, who was being abused at home throughout childhood. Through past-to-present storytelling, the author examines the ways in which practices and policies within public education systems have had, and may continue to have negative impacts on students living with complex (childhood) trauma. The author draws upon the work of Dr. Bruce Perry and Maia Szalavitz and their The Boy Who was Raised as a Dog And Other Stories from a Child Psychiatrist's Notebook, emphasizing their research in relational health and connectedness to support the healing of children with complex trauma. She considers the challenges in creating authentic, healing spaces in mainstream schools for traumatized students, and how the embodiment of holistic education values, beliefs, and practices can offer the love and nurturance needed to support the healing of children living with trauma. [ABSTRACT FROM AUTHOR]

The climate of domestic violence is a major risk factor for the health and development of children from an early age, and on parenting.With the help of clinical examples, the author illustrates the psychic consequences on the child. The role of pediatricians and perinatal care professionals is essential for taking this issue into account. Training on this subject is necessary to remove reluctance, to be more comfortable in dealing with these issues and to work in interdisciplinarity. [ABSTRACT FROM AUTHOR]

This article reports on a Danish study on interprofessional collaboration between child psychiatrists and educational psychologists concerning children who are categorised as being at risk. Methodologically, the analysis is grounded in qualitative interviews with psychologists. A Foucauldian approach is applied to narratives and experiences that occur within these interviews concerning external collaboration with child psychiatrists. The article is informed by the research tradition that has problematised the significance of psychiatry and diagnoses in the field of special needs education and social pedagogy. We thus enquire into how the rise of diagnostics and medicalisation affects our understanding of children's difficulties. We discuss a paradox that is present in Denmark and other countries. As educational policies emphasise inclusion, the field of schooling experiences a huge rise in children with medical diagnoses. We argue that diagnostic knowledge is itself an insufficient basis for action and must be considered in relation to teachers’ overall training and teachers’ situated professionalism. [ABSTRACT FROM AUTHOR]

Objective: This study compared management by child psychiatrists of mental health crises among youths with and without autism spectrum disorder (ASD).Methods: A custom online mental health crisis services survey was administered to members of the American Academy of Child and Adolescent Psychiatry. The survey probed three domains of crisis management: willingness to work with youths with a history of mental health crisis, comfort level in managing a mental health crisis, and availability of external resources during a crisis. Child psychiatrists reporting on management of youths with ASD (N=492) and without ASD (N=374) completed the survey.Results: About 75% of psychiatrists in both groups were willing to accept a child with a history of a mental health crisis in their practice. During a crisis, psychiatrists caring for youths with ASD had less access to external consultation resources, such as a crisis evaluation center or other mental health professionals, compared with those caring for youths without ASD. Psychiatrists also expressed concerns about the ability of emergency department professionals and emergency responders to manage mental health crises among youths in a safe and developmentally appropriate manner, particularly among those with ASD.Conclusions: Child psychiatrists are in need of more external resources to manage youths with ASD who are experiencing a mental health crisis. There is also a need to develop best practice procedures for emergency responders who are working with youths experiencing a mental health crisis. [ABSTRACT FROM AUTHOR]

Objective: The survey assessed self-reported monitoring by child psychiatrists of children prescribed second-generation antipsychotics, facilitators and barriers to monitoring, and steps taken to adhere to monitoring.Methods: The authors anonymously surveyed 4,144 U.S. child psychiatrists. Descriptive statistics and multiple linear regressions were utilized to describe results and identify correlates of monitoring.Results: Among responders (N=1,314, 32%), over 95% were aware of all guidelines, over 80% agreed with most guidelines, but less than 20% had adopted and adhered to most guidelines. Awareness of guidelines, working within an academic practice, and fewer years in practice predicted adherence.Conclusions: Child psychiatrists have generally not adopted the guidelines for monitoring children on second-generation antipsychotics. Interventions to improve monitoring should target child psychiatrists in nonacademic practices and those who have been out of training for longer periods. Future research should assess family barriers to monitoring. [ABSTRACT FROM AUTHOR]

Objective: This study explores whether patient-specific and clinician-specific factors are associated with child psychiatrists' use of second generation antipsychotics (SGAs) in the management of aggression in children with attention-deficit/hyperactivity disorder (ADHD). The patient-specific factors included patient's race, caregiver status, and patient engagement in psychotherapy.Methods: Child psychiatrists attending an annual conference (n = 156) were asked to complete an anonymous questionnaire on clinical decision making. Each participant was randomized to one of eight vignettes on a physically aggressive male teenager with methylphenidate-responsive ADHD. Patient race, caregiving status, and patient engagement in psychotherapy were systematically varied. Respondents rated how likely they were to prescribe an SGA and whether they would adjust the patient's current medication.Results: Seventy-five percent of participants (n = 117) were uncomfortable with adding an SGA, and 61% (n = 95) were likely to make medication adjustments to the current stimulant. None of the patient-specific factors were related to management recommendations. However, inpatient psychiatrists compared with non-inpatient psychiatrists reported a higher likelihood of using antipsychotics (OR = 2.40, 95% CI [1.181, 4.879], p = 0.016). Midwestern psychiatrists compared with those from other regions also reported a higher likelihood of using antipsychotics (OR = 3.07, 95% CI [1.376, 6.857], p = 0.005). Academic psychiatrists compared with nonacademics were less likely to endorse making adjustments to the current medication regimen (OR = 0.49, 95% CI [0.860, 0.274], p = 0.013).Conclusions: When presented with a hypothetical case, the vast majority of child psychiatrists surveyed advised that additional information was needed before adding an SGA. Many felt the need for more psychosocial information and greater clarity of possible comorbid diagnoses. [ABSTRACT FROM AUTHOR]

Progress in epidemiological, molecular and clinical genetics with the development of new techniques has improved knowledge on genetic syndromes associated with autism spectrum disorder (ASD). The objective of this article is to show the diversity of genetic disorders associated with ASD (based on an extensive review of single-gene disorders, copy number variants, and other chromosomal disorders), and consequently to propose a hierarchical diagnostic strategy with a stepwise evaluation, helping general practitioners/pediatricians and child psychiatrists to collaborate with geneticists and neuropediatricians, in order to search for genetic disorders associated with ASD. The first step is a clinical investigation involving: (i) a child psychiatric and psychological evaluation confirming autism diagnosis from different observational sources and assessing autism severity; (ii) a neuropediatric evaluation examining neurological symptoms and developmental milestones; and (iii) a genetic evaluation searching for dysmorphic features and malformations. The second step involves laboratory and if necessary neuroimaging and EEG studies oriented by clinical results based on clinical genetic and neuropediatric examinations. The identification of genetic disorders associated with ASD has practical implications for diagnostic strategies, early detection or prevention of co-morbidity, specific treatment and follow up, and genetic counseling. [ABSTRACT FROM AUTHOR]

Author(s): Fred R. Volkmar [sup.1] Author Affiliations: (1) grid.47100.32, 0000000419368710, Yale School of Medicine, , New Haven, USA Fred R. Volkmar M.D. Editor One of the pioneers in autism research, [...]

Objectives: The objectives of this study were to examine the experiences of dual-trained child psychiatrists and paediatricians in Australia and New Zealand and inform the review of the Dual Fellowship Training Programme by the Royal Australian and New Zealand College of Psychiatrists and Royal Australasian College of Physicians.Methods: All dual-trained child psychiatrists and paediatricians and current trainees were electronically surveyed in 2015.Results: Seven out of eight specialists (88%) and four out of six trainees (67%) responded. Six (55%) completed or were undertaking training as part of the Dual Fellowship Training Programme. Most respondents entered dual training without difficulty, found the transition from paediatrics to adult psychiatry challenging, and were reassured by their decision to undertake dual training on reaching advanced training in child psychiatry. Benefits and downsides of dual training were noted during and following training. A significant proportion of specialists (55%) were working in hospital-based environments, especially consult liaison services, suggesting that they added long-term value to both the fields of child psychiatry and paediatrics.Conclusions: The Dual Fellowship Training Programme remains a valuable vehicle for gaining skills in paediatrics and child psychiatry. There is support for its continuation by previous and current participants. [ABSTRACT FROM AUTHOR]

Medical malpractice litigation involving seven to nine figure settlements has been on the rise over the past decade. Given the life-altering scope of these incidents, forensic child psychiatrists may be asked to opine on the effects of a permanent perinatal injury on normal human development. Whether forensic child psychiatrists can assess risk of future psychiatric effects from such incidents is an important question. This paper is spurred by two separate cases, each involving a male infant having a portion of their genitals accidentally amputated by an obstetrician-gynecologist (OB/GYN) during a routine circumcision. In each case, the genitals were repaired, but permanent defects remained. The question arises how such injuries would affect these children as they matured. An analysis of the literature supported that there are risks of psychiatric effects of such birth-related injuries. Such predictions are made with reference to what is already known about human development, and by an exploration of the literature on the psychiatric effects of comparable injuries to children. [ABSTRACT FROM AUTHOR]

Preadolescence is a key period in the early stages of eating disorder development. The aim of the present study was, firstly, to investigate restrained, emotional and external eating in a general population-based sample of 11-12 year olds. Secondly, we sought to explore how these eating behaviours are associated with possible predictors of eating disorders, such as body dissatisfaction, weight status and mental disorders. A subsample of 1567 children (47.7% boys; 52.3% girls) from the Copenhagen Child Cohort (CCC2000) completed web-based questionnaires on eating behaviours and body dissatisfaction using The Eating Pattern Inventory for Children (EPI-C) and The Children's Figure Rating Scale. Mental disorders were assessed using the online version of the Development and Well-Being Assessment (DAWBA) based on parental replies with final DSM-IV diagnoses determined by experienced child- and adolescent psychiatrists. Height and weight were measured at a face-to-face assessment. The results showed that restrained eating was significantly associated with overweight, body dissatisfaction and emotional disorders in both genders. Emotional eating showed similar associations with overweight and body dissatisfaction in both genders, but was only associated with mental disorders in girls. External eating was significantly associated with body dissatisfaction and neurodevelopmental disorders in both genders, but was only associated with overweight in girls. Our findings show that problematic eating behaviours can be identified in preadolescence, and co-exist with weight problems and mental disorders. Thus restrained, emotional and external eating was, in different ways, associated with overweight, body dissatisfaction and mental disorders. Our findings point to significant eating behaviours in preadolescence, which could constitute potential predictors of later eating disorder risk. [ABSTRACT FROM AUTHOR]

This study's objectives were to gain insight into reasons for the considerable rise in pediatric bipolar disorder (PBD) and what impact the new diagnosis of disruptive mood dysregulation disorder (DMDD) may have on child psychiatric treatment. A purposive sample of 10 child psychiatrists was interviewed for this qualitative study. Interviews were transcribed and coded for themes. Participants believe that PBD is often misdiagnosed and overdiagnosed, though their understandings of the reasons behind this vary. The majority attribute it to providers trying to help children who need services but do not fit a diagnostic category, and undertrained professionals diagnosing children. Most see DMDD as positive, though opinions on how it might impact children and treatment vary. All see family as vital in the treatment process. Participants in this exploratory study support a team approach and social workers have a key role as part of this team. [ABSTRACT FROM AUTHOR]

The article presents an overview on the revisions to the American Academy of Child and Adolescent Psychiatry (AACAP) Code of Ethics. Topics discussed include the obligation of child and adolescent psychiatrists (CAPs) to promote youth well-being and development, the importance of decision-making of patients, parents and legal guardians, and the medical ethics framework.