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Since March 2017, minors returning from the terrorist groups' operation areas benefit from a medical and psychological assessment by referral centres throughout France. At the Avicenne hospital in Bobigny (AP-HP, 93), a team assesses the children of jihadists who land at Paris-Roissy-Charles-de-Gaulle airport. This evaluation raises unprecedented clinical questions and confronts professionals with challenges related to the history of these children and the context of their return.

La langue maternelle des enfants dont les parents viennent d’ailleurs condense de nombreux ingredients de la transmission familiale. Elle est a la fois un outil et un objet de transmission et sa maitrise par les enfants les conduit sur la voie du bilinguisme, experience culturelle, affective et cognitive, porteuse de nombreux benefices. Pourtant, tous les enfants qui grandissent dans un contexte plurilingue ne l’investissent pas necessairement, ou s’en separent. Dans la migration, les langues minoritaires resistent plus ou moins bien selon les pratiques sociales et culturelles des familles, et elles sont souvent conduites a disparaitre au fil des generations. Cependant, d’une generation a l’autre, ces langues et leur transmission refletent la vitalite des relations affectives et des affiliations au sein de la famille. Cela constitue, donc, pour les cliniciens, un marqueur important a considerer dans le suivi de nos jeunes patients.

Resume Les catastrophes, qu’elles soient naturelles, accidentelles, ou intentionnelles touchent les bebes, les enfants et les adolescents. La reconnaissance des traumatismes psychiques est etablie depuis bien longtemps chez les adultes du fait des travaux anciens chez les militaires et renouveles dans d’autres contextes traumatiques. On reconnait aujourd’hui l’impact de l’effraction psychique des experiences traumatiques a tous les âges de la vie et en particulier chez les tres jeunes enfants qui sont le plus vulnerables du fait de leur dependance aux adultes qui prennent soins d’eux. S’appuyant sur notre experience au sein de la CUMP 93, nous aborderons les aspects cliniques observes chez les enfants en situation de catastrophe et les modalites d’evaluation et de prise en charge immediates.

Since March 2017, minors returning from the terrorist groups' operation areas benefit from a medical and psychological assessment by referral centres throughout France. At the Avicenne hospital in Bobigny (AP-HP, 93), a team assesses the children of jihadists who land at Paris-Roissy-Charles-de-Gaulle airport. This evaluation raises unprecedented clinical questions and confronts professionals with challenges related to the history of these children and the context of their return.

International audience; This qualitative exploratory study examined transcultural and familial factors involved in bilingualism and minority language transmission among French and Arabic-speaking children. Participants included 30 children aged 4 to 6 years, born in France, and their bilingual French-Maghrebi Arabic-speaking parents. Children’s bilingual language profiles were assessed with the ELAL Scale for Maghrebi Arabic (minority language) and the Neel Scale for French (majority language). Mothers participated in qualitative interviews about cultural and language practices and representations. Interview contents were compared with the children’s language profiles. Results indicated that parents closely associated the transmission of the Arabic language with their cultural heritage transmission. The parents of fluent bilinguals had a strong desire to transmit the minority language. Mothers of minority language dominant bilingual children reported little perception of change in their lives since migration. Half of the mothers of majority language dominant bilingual children reported relationship or emotional difficulties with their children. Four minority language transmission types were identified: direct parent-child transmission; indirect transmission through private classes; indirect transmission through visits to family in the parents' native countries; and alternative transmission by another family member. Direct parent-child transmission was most frequent among the fluent bilinguals. Families' processes of hybridity were related to language transmission and bilingual development of children. Parental cultural affiliations to native country were related to minority language transmission. Perception of change since migration and affiliation to host country may also play a role in harmonious bilingual development. Moreover, the quality of family relationships can affect minority language transmission.

The early identification and access to health care of toddlers with autism spectrum disorder (ASD) - or at risk of developing it - is a crucial public health issue, as care and intervention may be more effective in younger children in order to improve their development and prognosis. However, there are still disparities in identification and health care access for children with ASD despite better screening methods. Given that misdiagnosis and delayed diagnosis are often due to the cultural gap between clinician and patient in some psychiatric disorders such as depression or schizophrenia, we examined this question concerning ASD and wondered to what extent ethno-cultural or migratory status might have an impact on the age at which a child is diagnosed. The only published review looking for independent factors influencing age of diagnosis concludes that the factors that have been proved to play a role are: socioeconomic status; symptom severity; level of parental concern, and family interactions with the health and education systems prior to diagnosis. The impact of ethno-cultural or migratory status is less clear. And yet, all these factors may be interconnected: migrants have on average a lower socioeconomic status, minorities don't have the same access to health care, and cultural background can have an influence on what is expected of a child's development and health. In order to try and clarify this issue and to analyze the way in which the international literature approaches the subject, we carried out a systematic review.Six databases were interrogated: Pubmed, Embase, Psychinfo, WebOfScience, Cochrane and Cinahl using the key words "ASD", "pervasive developmental disorder", "diagnosis", "age", "migrant", "ethnicity", "cross cultural". We narrowed neither the period of time not selected the articles by their method, as our objective was to collect the entirety of the articles written on the subject. We completed this review by including the pertinent references made in the articles.Twenty articles were included, all epidemiological and observational, about children diagnosed in specialized centers. Published between 2002 and 2019, they cover a 20-year research period, between 1992 and 2016. The methods are disparate: the diagnosis criteria used are from DSM IV, IV TR and ICD; data originate from medical records, phone or internet surveys, and Medicaid healthcare claims. Comparison of the age at diagnosis is the principal objective for only thirteen studies; statistical data analyses vary, especially concerning adjustments. Seventy-five percent of the articles originate from North America where the compared populations are defined by ethnic and racial categories that are not used in some other countries, notably in Europe. Only five explore the link between migratory status and age at diagnosis. The research results concerning the impact of ethnicity are contradictory, while those concerning migratory status seem to indicate that migrant children are likely to be diagnosed later. But the articles and their methods being too heterogeneous, it was difficult to make a meta-analysis and impossible to reach a scientific conclusion.Nevertheless, this review highlights the existence of a lot of confounding factors and raises many issues. It shows that the United States produces most of the studies whose conclusions cannot be generalized because of the particular history and organization of this country. In Europe, where belonging to minority groups is thought to be through migratory status, studies are rare. There is an urgent need for new research in order to clarify the connection between migratory status and socioeconomic factors, to precisely define the independent variables influencing diagnosis -such as access to healthcare- and finally to explore the possibility of different symptomatic expressions depending on cultural backgrounds. This review falls within studies currently carried out by the psychiatric service at Avicenne hospital in Bobigny, France about ASD in a transcultural context.

Dans le cadre de la validation de l’outil d’evaluation langagier pour allophone et primo arrivants (ELAL d’Avicenne), nous avons ete au Sri Lanka a la rencontre des enfants tamouls. Apres une etude approfondie des resultats de ce test, nous avons valide l’outil. La prise en compte des dimensions historiques telles que la guerre, linguistiques, culturelles est indispensable dans l’etude du parcours langagier des enfants. Une evaluation langagiere complete permet de faire des liens et d’avoir une meilleure comprehension des enjeux de la langue au sein de la famille. A partir des evaluations langagieres au Sri Lanka, nous avons pu mieux comprendre les enjeux de la langue pour les enfants tamouls en France.

Les enfants de migrants sont souvent exposes a plus d’une langue des leur plus jeune âge. Afin de mieux evaluer ces derniers dans toutes leurs competences linguistiques et d’adapter les prises en charge qui leur sont destines, il est necessaire d’utiliser des tests adaptes. A ce jour, l’ELAL d’Avicenne est le seul test d’evaluation des competences langagieres des enfants plurilingues. Dans le cadre de sa validation transculturelle, en langue soninke, nous avons ete en Mauritanie, rencontrer des enfants monolingues. L’analyse des evaluations langagieres recueillies dans ce contexte, nous donne des pistes quant a l’influence de la culture sur le developpement langagier des enfants de migrants soninkes ainsi que les modalites de transmission de la langue maternelle.

Faire la part de ce qui est dysfonctionnel par rapport a des modalites de fonctionnement langagier specifiques a un contexte plurilingue, etablir l’existence de reelles competences linguistiques dans une langue exogene, eviter d’assigner a une categorie pathologique des enfants qui n’ont juste pas beneficie d’une bonne immersion en francais, valoriser les ressources linguistiques disponibles dans la langue maternelle. L’ELAL d’Avicenne a ete concu dans ce but. Son administration en Algerie a 20 locuteurs arabophones (de 4 ans, 7 mois a 5 ans, 11 mois) nous confirme sa sensibilite et nous renseigne sur un effet du contexte sociolinguistique algerien.

Bereavement in an infant constitutes a complex process with a distinct temporality. It is closely linked to family bereavement. Based on a clinical example, it is possible to detail the necessary stages as well as the difficulties to take into account during this very specific ordeal which the sudden loss of a parent represents.

Migrant women are disproportionately more likely to experience traumatic events in their country of origin, during migration and after arriving in the host country. Homeless women are more likely to be exposed to multiple victimizations in childhood (emotional or physical maltreatment) and in adulthood (sexual abuse, street victimization). This study&rsquo, s objective was to describe the factors associated with the likelihood of post-traumatic stress disorder (PTSD) among homeless migrant mothers in the Paris region. Face-to-face interviews were conducted by bilingual psychologists and interviewers in a representative sample of homeless families in the Paris region. PTSD was ascertained using the Mini International Neuropsychiatric Interview (MINI) (n = 691 mothers). We studied PTSD in mothers using weighted Poisson regression. Homeless migrant mothers had high levels of PTSD (18.9%) in the 12 months preceding the study. In multivariate analysis, PTSD was associated with departure from the country of origin because of violence (PR = 1.45 95% CI 1.03, 2.04), depression in the preceding 12 months (PR = 1.82 95% CI 1.20, 2.76), and residential instability (PR = 1.93 95% CI 1.27, 2.93). Homeless migrant mothers have high levels of traumatic events and PTSD. Improvements in screening for depression and PTSD and access to appropriate medical care are essential for this vulnerable group.

The native language is a vehicle for transmission and inscription into a culture. In children of migrants who grow up between two languages and two cultures, language develops in a context of bilingualism. This specific context requires bilingual assessments to ensure that a child's complete skills are assessed. The language assessment of non-French-speaking children and first-time immigrants, has been set up at Avicenne hospital in Bobigny. It is the first transcultural tool for the assessment of native languages.

Bereavement in an infant constitutes a complex process with a distinct temporality. It is closely linked to family bereavement. Based on a clinical example, it is possible to detail the necessary stages as well as the difficulties to take into account during this very specific ordeal which the sudden loss of a parent represents.

Trauma-related disorders in children. The discovery of posttraumatic stress disorder (PTSD) in children is a recent finding. Nowadays we know that young age does not protect from traumatism. However, PTSD will display differently according to age. Epidemiology shows that PTSD is a less frequent occurrence than being exposed to traumatic events, but that certain groups may be more likely to be affected. A chronic course of the disorder is always possible and can interfere with every aspect of the child's development. Even if parents minimize the disorder, practitioners should carefully examine the signs of PTSD after the trauma and repeat this examination several times in the first few weeks.Troubles liés aux traumatismes chez les enfants. L’existence des troubles post-traumatiques chez l’enfant est récente. Aujourd’hui nous savons que le jeune âge ne protège pas du traumatisme. En revanche, le trouble de stress post-traumatique s’exprime différemment selon l’âge. L’épidémiologie montre que la survenue du trouble est moins fréquente que l’exposition à des événements traumatiques, mais qu’elle peut être élevée dans certains groupes. La chronicisation du trouble, toujours possible, interfère avec tous les aspects du développement de l’enfant. Même si les parents minimisent les troubles, le praticien doit rechercher attentivement, après la survenue d’un traumatisme, les signes de trouble de stress post-traumatique et répéter cet examen plusieurs fois dans les premières semaines.

The native language is a vehicle for transmission and inscription into a culture. In children of migrants who grow up between two languages and two cultures, language develops in a context of bilingualism. This specific context requires bilingual assessments to ensure that a child's complete skills are assessed. The language assessment of non-French-speaking children and first-time immigrants, has been set up at Avicenne hospital in Bobigny. It is the first transcultural tool for the assessment of native languages.

Alors meme que la langue joue un role fondamental dans la transmission psychique, chez les enfants d’immigres, l’acces a la bilingualite est difficile a cause d’un positionnement collectif complexe et difficile par rapport au bilinguisme. Une pluralite linguistique non assumee pourrait desorganiser ou ralentir la structuration du langage au point que le bilinguisme puisse etre associe aux troubles du langage. Quelques donnees epidemiologiques, une pratique clinique doublee d’une recherche dans le champ transculturel, nous indiquent que ces troubles ne sont pas forcement imputables a la bilingualite. Des parametres psychologiques et culturels se combinent de maniere defavorable pour generer des difficultes d’acces au langage. En effet, des facteurs psychologiques, d’autres inherents a la complexite des contextes pluriels et inegalitaires, se potentialisent et donnent leur specificite a ces troubles du langage. Il s’y ajoute que certaines manifestations contingentes a la pluralite linguistique (mutisme selectif, l’attrition de la langue maternelle) sont imputables a des facteurs de nature culturelle et psychologique qui s’inserent dans un tableau clinique plus large. Une methodologie specifique, associant une epreuve d’evaluation langagiere pour allophones et primo-arrivants (ELAL Avicenne) et une grille d’entretien interrogeant les pratiques langagieres intrafamiliales, se revele efficace quant au reperage de ces troubles du langage.

Le centre du langage d’Avicenne est un centre de reference des troubles du langage et des apprentissages qui a la double singularite d’etre implante dans un service de pedopsychiatrie et dans une banlieue multiculturelle, defavorisee. Cela nous a permis d’une part de penser les troubles du langage dans une optique relationnelle, affective et developpementale et d’autre part de nous interesser aux enjeux de transmission des langues maternelles dans une approche complementariste. Nous avons cree un outil d’evaluation du langage en situation de bilinguisme, l’elal d’Avicenne©, qui nous aide dans la demarche diagnostique des enfants de migrants presentant des troubles du langage oral. Les problematiques en lien avec le clivage migratoire infiltrent la clinique de nos patients et de leurs parents et rentrent en resonance avec les enjeux de separation/individuation a l’œuvre dans le developpement du langage. Le concept de metissage permet de comprendre la complexite des affiliations de ces enfants mais aussi le potentiel creatif des migrants et de leurs enfants qui trouvent de nouvelles manieres de faire avec les deux cultures.

The drawing is used as a mediation tool in the framework of a cross-cultural consultation "bilingual group". Clinical reference materials show that this mediation is suitable for children having difficulties switching between the language spoken at home and that spoken at school.

Dans nos societes modernes ou la circulation des personnes est permanente, maitriser plusieurs langues est a la fois un atout precieux et un fait relativement banal. Dans le champ du soin en situation transculturelle, nous portons une attention particuliere aux transmissions familiales qui contribuent a asseoir les enfants dans des affiliations solides et qui les preparent a creer d’autres affiliations a la societe dans laquelle ils se developpent. Nous discuterons la transmission de la langue maternelle, objet et un outil de construction, en contexte d’exil.

Interviews conducted with young women of Maghrebine origin in France show that norms of virginity represent a central means by which women negotiate Maghrebine-French identity and handle intergenerational relations. From the legacy of the colonial era to the current interethnic context, notions of virginity have played a significant role, in both official French discourse, and in the parental transmission of social values across generations. Standards of virginity stand as symbolic markers of women’s identity positioning. Yet, women also reinterpret, transform and appropriate codes of virginity according to life experience and situational context.

EVALUATION LANGAGIERE EN LANGUE MATERNELLE POUR LES ENFANTS ALLOPHONES ET LES PRIMO-ARRIVANTS. UN NOUVEL INSTRUMENT : L’ELAL D’AVICENNE Apres un rappel des recherches anterieures menees sur le bilinguisme, nous nous proposons de presenter l’ELAL d’Avicenne (Evaluation langagiere pour allophones et primo-arrivants), outil de recherche cree par le Centre du langage du Service de psychopathologie de l’enfant et de l’adolescent de l’hopital Avicenne (Bobigny, Seine-Saint-Denis, France). Hormis le fait que l’ELAL d’Avicenne est un outil d’evaluation langagiere, son but est de faciliter, chez l’enfant dit « bilingue », l’etude du bilinguisme et des facteurs intervenant dans la qualite du bilinguisme. Au terme de la phase exploratoire, cet article analyse les interets et la pertinence de ce test pour les enfants dits bilingues.

Suite au conflit Libanais de juillet 2006, des prises en charge d’urgence medico-psychologique ont ete proposees des l’accueil des refugies a l’aeroport de Roissy-Charles de Gaulle. Comprenant psychiatres, pedopsychiatres, psychologues et infirmiers, ces interventions precoces ont permis en particulier de reveler l’intensite de la reactivation traumatique chez les parents victimes du precedent conflit et ses consequences sur les enfants de tout âge. Cet article propose une reflexion sur le destin du trauma qui se nourrit de l’evenement lui-meme tout autant de ce qu’il vient reactiver dans l’histoire individuelle et dans l’histoire collective. Nous tenterons egalement de voir comment, au-dela de la realite de la destructivite de ce mal, les sujets peuvent faire de la malediction d’un desastre inflige la chance d’une force creee.

Il apparait comme une evidence que les enfants grandissant dans un milieu bilingue ou monolingue avec une autre langue maternelle que le francais deviennent bilingues de fait. La realite du bilinguisme chez les enfants de migrants est plus mitigee avec des formes multiples d’integration des langues en lien avec l’histoire familiale, la culture, les parcours migratoires. Du bilinguisme additif, jusqu’a l’absence de maitrise dans les deux idiomes, le bilinguisme se decline telle une palette qu’il convient de decrire dans sa complexite afin d’en comprendre mieux les avantages et les difficultes. De cette comprehension, peuvent emerger des outils utiles aux parents, aux soignants et aux enseignants afin de leur permettre de mieux accompagner ces enfants parfois vulnerables dans leur developpement. Le bilinguisme en soi est un facteur de creativite.

Resume Les sujets confrontes a des deuils traumatiques au cours de catastrophes naturelles doivent faire face a une double problematique : celle du traumatisme psychique (ils ont assiste a des deces de proches ou d'inconnus, ont vu leur propre vie menacee), et celle de pertes brutales et massives. Nous rappelons d'abord les concepts de traumatisme psychique, de deuil, de deuil traumatogene et de deuil post-traumatique, ainsi que les particularites du deuil chez l'enfant. Nous rapportons ensuite le debut de la prise en charge psychotherapique de deux fillettes victimes du tsunami de 2004, et endeuillees par celui-ci. Nous pensons qu'il est necessaire, lors de la prise en charge psychotherapique d'enfants ayant survecu a des catastrophes naturelles, de s'attacher aux aspects psychotraumatiques, aux processus de deuil, et aux interactions entre ces deux niveaux.

International audience

The medico-psychological emergency unit in Seine-Saint-Denis (93) was involved in managing the families of the victims of the AF447 flight crash which took place on the night of 31 May and 1 June 2009 between Rio de Janeiro (Brazil) and Paris. It is interesting to study the system set up at the airport, the symptomatology observed, and the parameters of the efficiency of the care provided.

BackgroundMigrant adolescents are at a higher risk than their native-born counterparts of psychiatric disorders, and their care is a public health issue. In France, transcultural psychotherapy is a treatment provided by a group of therapists designed to meet the specific needs of these patients when usual care appears ineffective. The objective of this study was to explore the therapeutic elements at work in transcultural psychotherapy.MethodsWe conducted a qualitative study crossing the perspectives of adolescents receiving transcultural psychotherapy, their parents, their first-line therapist (FLT), and the transcultural therapists. The families were chosen by purposive sampling. Data were collected during semi-structured individual (for FLTs) and group (families and transcultural therapists) interviews that explored the therapeutic elements involved and effective in transcultural psychotherapy. We usedinterpretative phenomenological analysis(IPA) to examine the data. In all, 44 participants were questioned: three adolescents (2 girls and 1 boy, all aged 18 to 21 years) and their parents (3 mothers and 1 father), three FLTs (2 child psychiatrists and 1 psychologist), and the 34 therapists participating in the three transcultural psychotherapy groups.ResultsThe analysis uncovered three themes: (1) the perceived effectiveness of the group’s functioning; (2) the recounting of the individual, family, and cultural history to allow for complexity and nuance; and (3) the personal investment by therapists, made possible by the group.ConclusionsOur results show some therapeutic elements at work in transcultural psychotherapy that enable it to meet the particular needs of some migrant adolescents that are unmet in standard therapy. Continuing to study transcultural psychotherapy and assess its effectiveness is essential for promoting and optimizing psychiatric care for migrant adolescents.