Diversity, epistemic injustice and medicalization

This Viewpoint explores challenges within the neurodiversity framework, with a particular focus on autism, and discusses three critical aspects: the risk of epistemic injustice, the balance between over and undermedicalization, and the terminological complexities associated with the "neuro-" prefix. It underscores the importance of a balanced approach that avoids overmedicalization while providing essential support, addresses concerns about the indiscriminate use of "neurodiverse", questions the terminology on neurodiversity, and suggests considering a broader term like "biopsychosocial diversity". Ultimately, this Viewpoint advocates for a measured approach to neurodiversity, emphasizing historical context and a diverse perspective to foster collaboration between cognitive science and behavior research.

Motor deficits in autism differ from that of developmental coordination disorder

LAY ABSTRACT

A vast majority of individuals with autism spectrum disorder experience impairments in motor skills. Those are often labelled as additional developmental coordination disorder despite the lack of studies comparing both disorders. Consequently, motor skills rehabilitation programmes in autism are often not specific but rather consist in standard programmes for developmental coordination disorder. Here, we compared motor performance in three groups of children: a control group, an autism spectrum disorder group and a developmental coordination disorder group. Despite similar level of motor skills evaluated by the standard movement assessment battery for children, in a Reach-to-Displace Task, children with autism spectrum disorder and developmental coordination disorder showed specific motor control deficits. Children with autism spectrum disorder failed to anticipate the object properties, but could correct their movement as well as typically developing children. In contrast, children with developmental coordination disorder were atypically slow, but showed a spared anticipation. Our study has important clinical implications as motor skills rehabilitations are crucial to both populations. Specifically, our findings suggest that individuals with autism spectrum disorder would benefit from therapies aiming at improving their anticipation, maybe through the support of their preserved representations and use of sensory information. Conversely, individuals with developmental coordination disorder would benefit from a focus on the use of sensory information in a timely fashion.

Toward recovery-oriented perinatal healthcare: A participatory qualitative exploration of persons with lived experience and health providers' views and experiences

BACKGROUND

Perinatal mental health disorders (PMHD) remain often undetected, undiagnosed, and untreated with variable access to perinatal mental health care (PMHC). To guide the design of optimal PMHC (i.e., coproduced with persons with lived experience [PLEs]), this qualitative participatory study explored the experiences, views, and expectations of PLEs, obstetric providers (OP), childcare health providers (CHPs), and mental health providers (MHPs) on PMHC and the care of perinatal depression.

METHODS

We conducted nine focus groups and 24 individual interviews between December 2020 and May 2022 for a total number of 84 participants (24 PLEs; 30 OPs; 11 CHPs; and 19 MHPs). The PLEs group included women with serious mental illness (SMI) or autistic women who had contact with perinatal health services. We recruited PLEs through social media and a center for psychiatric rehabilitation, and health providers (HPs) through perinatal health networks. We used the inductive six-step process by Braun and Clarke for the thematic analysis.

RESULTS

We found some degree of difference in the identified priorities between PLEs (e.g., personal recovery, person-centered care) and HPs (e.g., common culture, communication between providers, and risk management). Personal recovery in PMHD corresponded to the CHIME framework, that is, connectedness, hope, identity, meaning, and empowerment. Recovery-supporting relations and peer support contributed to personal recovery. Other factors included changes in the socio-cultural conception of the peripartum, challenging stigma (e.g., integrating PMH into standard perinatal healthcare), and service integration.

DISCUSSION

This analysis generated novel insights into how to improve PMHC for all users including those with SMI or autism.

Healthcare pathways and practitioners' knowledge about ADHD in children

INTRODUCTION

Access to care for children and adolescents affected by ADHD in France remains below the levels attained in most industrialised countries. To contribute to improving ADHD care in France, we assessed existing ADHD knowledge among medical doctors (MDs) and described associated care pathways in two large French regions in 2021. We produced tools to evaluate the regional impact of implementing a stepped-care pathway for ADHD.

METHODS

A SurveyMonkey® study was sent to professionals from two regions in France accounting for 14 million inhabitants, allowing them to describe their role in child/adolescent ADHD, as well as their representations and knowledge about the disorder.

RESULTS

Around 9.4% of all MDs potentially involved with children took part in the study; 34.9% considered themselves untrained, 40.5% were involved in ADHD care at a first-tier level, and 19.6% at a second-tier level. Access to a second or third-tier service for ADHD was associated with mean waiting times of 5.7 and 8.5 months, respectively. Initiation of stimulant therapy remained mainly restricted to second or third-tier MDs, and adaptation of dosage or change in the galenic formulation was rarely performed by first-tier MDs (27.2% and 18%, respectively). Training in neurodevelopmental disorders and tier-level were the strongest determinants of knowledge, attitudes and self-assessed expertise about ADHD.

CONCLUSIONS

This study provides insight into training needs for MDs regarding healthcare pathways in ADHD and should support the implementation of health policies, such as a stepped healthcare access for ADHD. The study design and dissemination have been validated and will be available in France and other countries facing similar obstacles in care pathways for ADHD. Official recommendations on ADHD in children and adults are being updated in France, and our data and the survey design will be a starting point for their implementation.

[Dissociative identity disorder in adolescents: From self-diagnosis to transient illness]

The category of dissociative identity disorder (DID) has puzzled medical science and fascinated popular culture for almost 200 years. Its occurrence in young people raises at least two new questions addressed by science studies and embedded philosophy: self-diagnosis (related to cyberchondria and mass media-induced illness) and transient disease (related to looping effect and identity claim specific to adolescence). In an attempt to refine the sociocognitive model, we analyze the impact of these notions in understanding the local ecological niche in which contemporary adolescent DID occurs.

Comparison of relative areas of interest between major depression disorder and postpartum depression

INTRODUCTION

Postpartum depression (PPD) is defined as a major depressive disorder (MDD) beginning after childbirth. Wide debates aim to better understand PPD's specificities compared with MDD. One of the keys in differentiating PPD from MDD is to systematically study scientific "Areas Of Interest" (AOIs) of these disorders.

METHODS

In November 2021, we performed an extraction and textual computational analysis of associated terms for PPD and MDD, using the biomedical database PubMed. We performed an undirected lexical network analysis to map the 150 first terms in space. Then, we used an unsupervised machine learning technique to detect word patterns and automatically cluster AOIs with a topic-modeling analysis.

RESULTS

We identified 30,000 articles of the 554,724 articles for MDD and 15,642 articles for PPD. Four AOIs were detected in the MDD network: mood disorders and their treatments, risk factors, consequences and quality of life, and mental health and comorbidities. Five AOIs were detected in the PPD network: mood disorders and treatments, risk factors, consequences and child health, patient's background, and the challenges of screening.

DISCUSSION AND CONCLUSION

Limitations are both methodological, in particular due to the qualitative interpretation of AOIs, and are also related to the difficult transferability of these research results to the clinical practice. The partial overlap between AOIs for MDD and for PPD suggest that the latter is a particular form of the former.

Factors Associated with Increased or Decreased Stress Level in French Children during the First COVID-19 Lockdown

In spring 2020, governments of many countries implemented lockdown measures to prevent the spread of the COVID-19 pandemic. Worldwide, the pandemic forced about 1.5 billion children to stay at home for several weeks and to experience homeschooling. The objective of this study was to assess the variation in stress levels and associated factors in school-aged children in France during the first COVID-19 lockdown. A cross-sectional study using an online questionnaire was designed by an interdisciplinary team involving hospital child psychiatrists and school doctors. Between 15 June and 15 July 2020, Educational Academy of Lyon (France) invited the parents of school-aged children to participate in this survey. The first part of the questionnaire concerned the children with data on lockdown conditions, socio-demographic data, daily rhythms (eating and sleeping), perceived stress variations, and feelings. The second part assessed parental perspectives on their child's psychological state and use of the mental health care system. Multivariate logistic regression was performed to identify factors associated with stress variation (increased or decreased). A total of 7218 questionnaires were fully completed by children from elementary school to high school with a balanced sex ratio. In summary, 29% of children reported a higher stress level during the lockdown, 34% reported a lower stress level, and 37% reported no stress variation in the usual situation prior to COVID-19. Parents were most often able to identify signs of increased stress levels in their children. The most influential factors in the variation of stress for children were academic pressure, family relationships, and fear of being infected or infecting a family member with SARS-CoV-2. Our study underlines the high impact of school attendance stressors on children in usual conditions and encourages vigilance for children whose stress levels have decreased during the lockdown but who may have increased difficulty re-exposing themselves upon deconfinement.

Detection of clinical high risk for psychosis in child and adolescent mental health services: Validation of the first step with the French versions of the Prodromal Questionnaire (fPQ-16) and scale of Perceptual and Cognitive Aberrations (fPCA)

AIM

To validate the French versions of the 16-items Prodromal Questionnaire (PQ-16) and the 9-items scale of Perceptual and Cognitive Aberrations (PCA) to facilitate screening of psychosis risk in native French-speaking young individuals referred to Child and Adolescent Mental Health Services.

METHOD

Participants (N = 87, age range 10-18 years) were diagnosed with a non-psychotic disorder according to the Diagnostic and Statistical Manual of Mental Disorders. The French versions of the PQ-16 and PCA were developed using a forward-backward translation procedure. Psychometric properties were tested including (i) internal validity with Pearson correlations and Cronbach's coefficients, and (ii) external validity by correlations with each other's.

RESULTS

(i) Correlations between fPQ-16 and fPCA total scores and individual items were mostly >.4. Cronbach's coefficients were .80 for the fPQ-16 and .61 for the fPCA. (ii) The fPQ-16 and fPCA total scores were significantly correlated with a large effect size (r_s  = 0.66).

CONCLUSION

The fPQ-16 and the fPCA are psychometrically acceptable instruments for the screening of potential psychotic symptoms in French-speaking children and young adolescents under 18 years old referred to Child and Adolescent Mental Health Services.

Newborns' Bonding and Attachment, Their Rhythms and Needs, Supporting Parents Appropriately: Guidelines for Interventions During the Perinatal Period from the French National College Of Midwives

A newborn's sleep-wake rhythms are very specific, neurologically determined, and different from the pattern of adults; they require an adaptable and predictable response by parents, which will promotes bonding and attachments, constructed at the early stages of development. It also will influence the quality of subsequent emotional relationships and adaptation to life events. This parental adaptability should receive multiprofessional support starting in the perinatal period, focused on the screening and management of psychological vulnerability.

How Does Comparison With Artificial Intelligence Shed Light on the Way Clinicians Reason? A Cross-Talk Perspective

In order to create a dynamic for the psychiatry of the future, bringing together digital technology and clinical practice, we propose in this paper a cross-teaching translational roadmap comparing clinical reasoning with computational reasoning. Based on the relevant literature on clinical ways of thinking, we differentiate the process of clinical judgment into four main stages: collection of variables, theoretical background, construction of the model, and use of the model. We detail, for each step, parallels between: i) clinical reasoning; ii) the ML engineer methodology to build a ML model; iii) and the ML model itself. Such analysis supports the understanding of the empirical practice of each of the disciplines (psychiatry and ML engineering). Thus, ML does not only bring methods to the clinician, but also supports educational issues for clinical practice. Psychiatry can rely on developments in ML reasoning to shed light on its own practice in a clever way. In return, this analysis highlights the importance of subjectivity of the ML engineers and their methodologies.

Explanatory hypotheses of the ecology of new clinical presentations of Dissociative Identity Disorders in youth

Dissociative Identity Disorders (DIDs) are controversial psychiatric conditions encountered in clinical practice and nosology. DID as described in the international classifications has little similarity with the clinical picture of "DID" met in current youth psychiatry. From this Perspective, we hypothesize that this current clinical presentation does not satisfy the categorical criteria of the international classifications. Based on the two terminological challenges related to the definition of DID (i.e., the notion of dissociative disorders and the different meanings of the term identity), we propose to differentiate two distinct entities from each other. The first is medical and listed in diagnostic criteria of international classifications; the second comes from popular culture and refers to the vast majority of clinical presentations received in daily clinical practice-presented under the term Dissociative Identity Conditions (DIC). Since the status of DIC is a hot topic in current clinical psychiatry, we aim to identify eight possible explanations that can be provided to support its occurrence: (1) impact of iatrogenicity; (2) factors of suggestibility and desire for social acceptability; (3) psychoanalytic explanations; (4) neuropsychological explanations; (5) socio-cognitive explanations; (6) emotional labeling; (7) narrative explanations; (8) and transient illnesses explanations. In conclusion, we sustain that DIC results from a narrative interpretation of medical discourse by popular culture, developing in patients presenting undeniable distress. Such a transient disease fits in an ecological niche, which echoes the values of society, persisting under the action of a need for narrative continuity of the self.

Association of Attention-Deficit/Hyperactivity Disorder in Childhood and Adolescence With the Risk of Subsequent Psychotic Disorder: A Systematic Review and Meta-analysis

IMPORTANCE

Growing evidence supports an association between attention-deficit/hyperactivity disorder (ADHD) in childhood and subsequent psychotic disorders. Both disorders share physiopathological features such as attention deficits, dopaminergic imbalance, and genetic susceptibility. However, the results of epidemiologic studies have been conflicting.

OBJECTIVE

To provide a quantitative synthesis of studies exploring the association between ADHD and the risk of subsequent psychotic disorder.

DATA SOURCES

A systematic literature search of the MEDLINE, Scopus, PsycInfo, and Web of Science databases was performed from inception until the final analysis on July 7, 2020. No restriction of language was applied.

STUDY SELECTION

Cohort and case-control studies examining the relative risk of developing a psychotic disorder in people diagnosed with ADHD at younger than 18 years compared with control individuals without ADHD.

DATA EXTRACTION AND SYNTHESIS

Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Meta-analysis of Observational Studies in Epidemiology (MOOSE) guidelines were followed in reporting results. Two independent reviewers extracted the data and assessed the risk of bias of individual studies using the Newcastle-Ottawa Scale. Preferably adjusted odds ratios (aORs) or hazard ratios from the identified studies were extracted, and ORs were computed when they were not adjusted. A random-effects model was used to calculate the pooled relative effect using the meta package in R.

MAIN OUTCOMES AND MEASURES

An association between ADHD (exposure) and psychotic disorder (outcomes); both diagnoses were based on international classification.

RESULTS

A total of 15 studies were included in the review. Twelve studies were pooled in the meta-analysis, representing 1.85 million participants. A diagnosis of ADHD in childhood was associated with a significant increase in the risk of subsequent psychotic disorder, with a pooled relative effect of 4.74 (95% CI, 4.11-5.46; I2 = 43% [95% CI, 0%-70%]). No significant between-group differences were found for subgroup analyses according to psychotic disorder (odds ratio [OR], 5.04; 95% CI, 4.36-5.83) or schizophrenia (OR, 4.59; 95% CI, 3.83-5.50) outcomes, cohort (OR, 4.64; 95% CI, 4.04-5.34) or case-control (OR, 6.81; 95% CI, 4.21-11.03) study design, and adjusted (OR, 4.72; 95% CI, 4.11-5.46) or unadjusted (OR, 3.81; 95% CI, 1.39-10.49) estimates. Meta-regressions were not significant when sex and bias score were used as covariates. No evidence of publication bias was found.

CONCLUSIONS AND RELEVANCE

These findings suggest that childhood ADHD is associated with an increased risk of a subsequent psychotic disorder. Further studies are required to determine the mechanisms linking these common conditions and whether early intervention for ADHD might reduce the risk of subsequent psychotic disorder.

FOOD ADDICTION AS A PROXY FOR ANOREXIA NERVOSA SEVERITY: NEW DATA BASED ON THE YALE FOOD ADDICTION SCALE 2.0

The contribution of an addictive process to anorexia nervosa (AN) is an area of growing interest. Yet, little is known about how the food addiction concept (FA) may be of interest in understanding AN. This study investigates prevalence of FA diagnostic and its association with markers of severity in individuals with AN. We conducted a retrospective study in a sample of 73 patients with AN. We assessed FA with the Yale Food Addiction Scale 2.0, depressive and anxiety disorders, impulsivity (Beck Depression Inventory, STAI, BIS-11) and eating behavior (BITE, EDE-Q). Prevalence of FA in our sample was 47%. FA was significantly associated and positively correlated with the binge-eating/purging subtype of AN, higher levels of depression, anxiety and greater eating psychopathology. FA was not associated with level of impulsivity nor leptin and IGF-1 blood levels. The relationship between FA severity and AN severity was mediated by the severity of binge eating behaviors. Our results suggest that the presence of FA may represent a more severe variant of AN. Longitudinal studies are needed to better understand the etiologic process between FA and AN.

Chromatin remodeling dysfunction extends the etiological spectrum of schizophrenia: a case report

BACKGROUND

The role of deleterious copy number variations in schizophrenia is well established while data regarding pathogenic variations remain scarce. We report for the first time a case of schizophrenia in a child with a pathogenic mutation of the chromodomain helicase DNA binding protein 2 (CHD2) gene.

CASE PRESENTATION

The proband was the second child of unrelated parents. Anxiety and sleep disorders appeared at the age of 10 months. He presented febrile seizures and, at the age of 8, two generalized tonic-clonic seizures. At the age of 10, emotional withdrawal emerged, along with a flat affect, disorganization and paranoid ideation, without seizures. He began to talk and giggle with self. Eventually, the patient presented daily auditory and visual hallucinations. The diagnosis of childhood onset schizophrenia (DSM V) was then evoked. Brain imaging was unremarkable. Wakefulness electroencephalography showed a normal background and some bilateral spike-wave discharges that did not explain the psychosis features. A comparative genomic hybridization array (180 K, Agilent, Santa Clara, CA, USA) revealed an 867-kb 16p13.3 duplication, interpreted as a variant of unknown significance confirmed by a quantitative PCR that also showed its maternal inheritance. Risperidone (1,5 mg per day), led to clinical improvement. At the age of 11, an explosive relapse of epilepsy occurred with daily seizures of various types. The sequencing of a panel for monogenic epileptic disorders and Sanger sequencing revealed a de novo pathogenic heterozygous transition in CHD2 (NM_001271.3: c.4003G > T).

CONCLUSIONS

This case underlines that schizophrenia may be, sometimes, underpinned by a Mendelian disease. It addresses the question of systematic genetic investigations in the presence of warning signs such as a childhood onset of the schizophrenia or a resistant epilepsy. It points that, in the absence of pathogenic copy number variation, the investigations should also include a search for pathogenic variations, which means that some of the patients with schizophrenia should benefit from Next Generation Sequencing tools. Last but not least, CHD2 encodes a member of the chromodomain helicase DNA-binding (CHD) family involved in chromatin remodeling. This observation adds schizophrenia to the phenotypic spectrum of chromodomain remodeling disorders, which may lead to innovative therapeutic approaches.

Highs and Lows in Motor Control Development

Motor control is classically described as relying on two components: anticipatory control (feedforward processing) and online control (feedback processing). Here we aimed to unveil the developmental steps of both feedback and feedforward control in 5-10 years old children, using a simple and ecological task. We manipulated object's weight in a reach-to-displace paradigm. When the weight was known before lifting it, anticipatory processes were quantifiable during the reaching phase. Conversely, an unknown weight triggered online corrections during the displacing phase. Movement kinematics revealed that children anticipate this objet property as young as 5 y-o. This anticipation becomes adequate around 7 y-o and is paralleled by poor online corrections. This simple yet relevant paradigm should allow quantifying deviations from neurotypical patterns in disorders of motor control.

Topological Modification of Brain Networks Organization in Children With High Intelligence Quotient: A Resting-State fMRI Study

The idea that intelligence is embedded not only in a single brain network, but instead in a complex, well-optimized system of complementary networks, has led to the development of whole brain network analysis. Using graph theory to analyze resting-state functional MRI data, we investigated the brain graph networks (or brain networks) of high intelligence quotient (HIQ) children. To this end, we computed the "hub disruption index κ," an index sensitive to graph network modifications. We found significant topological differences in the integration and segregation properties of brain networks in HIQ compared to standard IQ children, not only for the whole brain graph, but also for each hemispheric graph, and for the homotopic connectivity. Moreover, two profiles of HIQ children, homogenous and heterogeneous, based on the differences between the two main IQ subscales [verbal comprehension index (VCI) and perceptual reasoning index (PRI)], were compared. Brain network changes were more pronounced in the heterogeneous than in the homogeneous HIQ subgroups. Finally, we found significant correlations between the graph networks' changes and the full-scale IQ (FSIQ), as well as the subscales VCI and PRI. Specifically, the higher the FSIQ the greater was the brain organization modification in the whole brain, the left hemisphere, and the homotopic connectivity. These results shed new light on the relation between functional connectivity topology and high intelligence, as well as on different intelligence profiles.

[The schizophrenic's chilhood]

Pathology of adolescence and young adult, schizophrenia can begin in very rare cases during childhood. Two early clinical forms of the disorder have been identified by epidemiological studies: one beginning at the age of 15; the other around 9 years old; While many questions remain unsanswered about the neurobiological and environmental factors - common or distinct - of these two clinical phenotype, both are related to a profoun and lasting alteration of the neurocognitive development whose origin would clearly go back to infancy or to the antenal period. Here we will present a possible story back of schizophrenia in the light of the latest neuroscientific studies in imagery and genetics from adolescence to antenal period.

[Learning disorders in ADHD: How are they related?]

Learning difficulties in general and learning disabilities in particular are almost constant in attention deficit disorder with or without hyperactivity (ADHD). Despite a major research effort, the extent and diversity of these comorbid events still raise many questions about the exact nature of their pathogenetic condition (simple consequences of ADHD or specific related disorders?) and consequently the best way to support them. This article aims to present a brief review of the current data.

Hemispheric Differences in White Matter Microstructure between Two Profiles of Children with High Intelligence Quotient vs. Controls: A Tract-Based Spatial Statistics Study

Objectives: The main goal of this study was to investigate and compare the neural substrate of two children's profiles of high intelligence quotient (HIQ). Methods: Two groups of HIQ children were included with either a homogeneous (Hom-HIQ: n = 20) or a heterogeneous IQ profile (Het-HIQ: n = 24) as defined by a significant difference between verbal comprehension index and perceptual reasoning index. Diffusion tensor imaging was used to assess white matter (WM) microstructure while tract-based spatial statistics (TBSS) analysis was performed to detect and localize WM regional differences in fractional anisotropy (FA), mean diffusivity, axial (AD), and radial diffusivities. Quantitative measurements were performed on 48 regions and 21 fiber-bundles of WM. Results: Hom-HIQ children presented higher FA than Het-HIQ children in widespread WM regions including central structures, and associative intra-hemispheric WM fasciculi. AD was also greater in numerous WM regions of Total-HIQ, Hom-HIQ, and Het-HIQ groups when compared to the Control group. Hom-HIQ and Het-HIQ groups also differed by their hemispheric lateralization in AD differences compared to Controls. Het-HIQ and Hom-HIQ groups showed a lateralization ratio (left/right) of 1.38 and 0.78, respectively. Conclusions: These findings suggest that both inter- and intra-hemispheric WM integrity are enhanced in HIQ children and that neural substrate differs between Hom-HIQ and Het-HIQ. The left hemispheric lateralization of Het-HIQ children is concordant with their higher verbal index while the relative right hemispheric lateralization of Hom-HIQ children is concordant with their global brain processing and adaptation capacities as evidenced by their homogeneous IQ.

[Developmental approach of executive functions: From infancy to adolescence]

Given the importance of the relationship between executive function (EF) and many aspects of child development - including the development of reasoning, emotion regulation, school performance, and wider self-regulation itself - research on the development of EF from infancy to the end of adolescence has become one of the scientific priorities of the last decade. Improving our knowledge on the maturative trajectory of EF and the functional weight of different internal and environmental factors, supposed to optimize their efficiency, can only promote a better understanding of EF and its role in the normal development of the child as well as of those at risk of poor outcome either because of neurodevelopmental disorders or psychopathological disorders. This article aims to update the recent literature in this area. It appears that executive function grows very gradually and evolves from a relatively simple and unitary model in young children to a more complex one - differentiated, integrated, and tripartite - in adolescence.

[The Severe Chronic Irritability Concept: A clinical dimension to consider in child and adolescent]

INTRODUCTION

For a decade, the concept of irritability has known a renewed interest in infant and child psychopathology. Indeed, longitudinal follow-up studies clearly highlighted their predictive value - in the short, medium and long terms - of a broad field of behavioral disorders and emotion dysregulation. This dimensional and transnosographic approach of irritability, coupled with the latest neuroscience data, points out that irritability could be the equivalent of a psychopathological marker, covering both a neurobiological, cognitive and emotional component. It is a major challenge today to better understand the developmental sequence of severe chronic irritability and its predictive influence on the etiology of mental disorders from childhood to adulthood.

METHOD

We briefly review here the latest current data on this topic.

RESULTS

The important point is that chronic and non-episodic irritability in children, associated with strong emotional sensitivity to negative events and frequent access of anger, could have a predictive value for progression to anxiety disorder or severe mood disorder but not to bipolar disorder as it was believed until now. The risk of developing a bipolar disorder would be more frequently correlated with the notion of transient and episodic irritability in a context of previous family history of bipolar disorder.

CONCLUSION

Further studies are expected to narrow the discriminative validity of this notion of severe irritability and confirm or not its relevance as a major clinical criterion of Severe Mood Disorders in children and adolescents introduced in the last version of DSM (DSM-5).

Wechsler profiles in referred children with intellectual giftedness: Associations with trait-anxiety, emotional dysregulation, and heterogeneity of Piaget-like reasoning processes

BACKGROUND/PURPOSE

It is common that intellectually gifted children (IQ ≥ 130) are referred to paediatric or child neuropsychiatry clinics for socio-emotional problems and/or school underachievement or maladjustment. Among them, those displaying developmental asynchrony - a heterogeneous developmental pattern reflected in a significant verbal-performance discrepancy (SVPD) on Wechsler's intelligence profile - are thought to be more emotionally and behaviourally impaired than others. Our purpose was to investigate this clinical dichotomy using a cognitive psychopathological approach.

METHODS

Trait-anxiety and emotional dysregulation were investigated in two groups of referred gifted children (n = 107 and 136, respectively), a pilot-study of reasoning processes on extensive Piaget-like tasks was also performed in an additional small group (n = 12).

RESULTS

Compared to those with a homogenous Wechsler profile, children with a SVPD exhibited: 1) a decreased prevalence of social preoccupation-anxiety (11.1% versus 27.4%; p < 0.05); 2) an increased prevalence of emotional dysregulation (58.7% versus 41.3%; p < 0.05); and 3) an increased prevalence of pathological cognitive disharmony on Piaget-like tasks (87.5% versus 0.0%; p < 0.05).

CONCLUSION

The results support a clinical dichotomy of behaviourally-impaired children with intellectual giftedness, with developmentally asynchronous ones exhibiting more severe psychopathological features. This suggests that developmental asynchrony matters when examining emotional and behavioural problems in gifted children and call for further investigation of this profile.

[From tic disorders to Tourette syndrome: current data, comorbidities, and therapeutic approach in children]

Motor tics are frequently observed in children during development. Usually transient and benign, they can become chronic over time, join various morbid disorders (vocal tics, attention deficit and hyperactivity disorder, and obsessive-compulsive disorders) and move toward genuine Tourette syndrome. In this case, it will be necessary to prevent impacts - mainly in terms of quality of life and emotional and relational problems - using a global therapeutic strategy combining psychoeducational approaches with appropriate medication.

Profils comportementaux d’enfants surdoués consultant en pédopsychiatrie : importance de la dysharmonie intellectuelle

Il est fréquent que des enfants intellectuellement surdoués soient adressés en consultation de pédopsychiatrie pour des problèmes socio-émotionnels et/ou une inadaptation scolaire paradoxale. Ces enfants sont classiquement décrits comme présentant des problèmes d’ordre anxio-dépressif, et comme étant plutôt de grands surdoués ou intellectuellement dysharmoniques. Nous avons testé ces assertions chez 143 enfants surdoués (QI > 130) vus en consultation, en utilisant le profil intellectuel de Wechsler et l’inventaire de comportements pour enfant d’Achenbach. Ces enfants présentaient des problèmes comportementaux significatifs dans tous les domaines explorés, sans prédominance des problèmes anxio-dépressifs. Les plus surdoués (QI > 145) ne présentaient pas plus de problèmes que les autres. Les enfants au profil intellectuel dysharmonique présentaient plus de problèmes agis en général, et plus d’agressivité en particulier. Ces résultats suggèrent que la dysharmonie du développement intellectuel est facteur à prendre en compte pour comprendre les problèmes émotionnels et comportementaux des enfants surdoués.

[Suicide attempts of 48 children aged 6-12 years]

AIM

Research is limited on suicide attempts in children under 13 years of age. The objective of this study was to provide an in-depth description of this population.

MATERIALS AND METHODS

The present study is both retrospective and descriptive. Data were collected retrospectively from a file containing the causes for hospitalization of each child admitted into the Department of Child Psychiatry at the hôpital Femme-Mère-Enfant (hospices civils de Lyon). We included all patients under 13 years of age who were hospitalized for a suicide attempt between 2008 and 2011. The methods used to collect the medical records consisted in using a form made up of four major parts: suicide attempts, social environment, medical history, and therapy.

RESULTS

The 26 girls and 22 boys included had a mean age of 11.52 years. The boys were younger than the girls (P=0.047) and their parents were usually separated (P=0.034). The boys used more violent means to commit suicide in comparison to the girls (P=0.048). On average, children using violent means were younger (P=0.013). Boys underwent more psychotherapy (P=0.027) and were prescribed more psychotropic medication in comparison to girls (P=0.051). Adjustment disorders (37.5%) and depression (27%) were the two main diagnoses for hospitalization. They were hospitalized on average (±standard deviation) 9.6 days (±10 days). Psychotherapy was organized when leaving the hospital (98%) with legal measures (8.3%), change of residence (12.5%), and prescription of psychotropic drugs (37.5%). None had physical complications.

DISCUSSION

In children under 13 years of age, attempted suicide was more frequent in girls than boys. However, the sample included 18 girls and nine boys who were 12 years old (sex ratio of 12-year-olds, 0.5). There were more boys (16 boys/eight girls) in the children under 12 (sex ratio of 8- to 11-year-olds, 1.6). Children under 11 used more violent means (P=0.01). The literature also reports that more violent means lead to a greater risk of death by suicide. Consequently, suicidal behavior in children under 11 years of age is closer to a behavior of a person who has committed suicide than an adolescent attempting suicide. As a result of the sex ratio and non-violent means, 12-year-old children's behavior can be considered like that of adolescents. One factor that could explain children's attempted suicide is family cohesion. The children in this study were most often from broken families and had a difficult relationship with their parents. From 1981 to 1985, more than 50% of children who consulted for their first suicide attempt were not hospitalized. Now hospitalization is recommended for all children who consult for attempted suicide. They are hospitalized on average 8.9-9 days. Individual psychotherapy is systematic. The main difference between the treatments for adolescents and children is the importance of the social worker who will require legal measures or changing residences when necessary.

CONCLUSION

The sex ratio in 6- to 12-year-olds attempting suicide is higher than the sex ratio in adolescents attempting suicides. Insecure attachment was found in all families in this sample. This population is particularly at risk knowing that in adulthood, the risk of death by suicide is higher when there is a background of attempted suicide by violent methods. These children should always be hospitalized for a psychological and socioenvironmental evaluation.

What MEG can reveal about inference making: the case of if...then sentences

Characterizing the neural substrate of reasoning has been investigated with regularity over the last 10 years or so while relying on measures that come primarily from positron emission tomography and functional magnetic resonance imaging. To some extent, these techniques—as well as those from electroencephalography—have shown that time course is equally worthwhile for revealing the way reasoning processes work in the brain. In this work, we employ magnetoencephalography while investigating Modus Ponens (If P then Q; P//Therefore, Q) in order to simultaneously derive time course and the source of this fundamental logical inference. The present results show that conditional reasoning involves several successive cognitive processes, each of which engages a distinct cerebral network over the course of inference making, and as soon as a conditional sentence is processed.

Syntax at hand: common syntactic structures for actions and language

Evidence that the motor and the linguistic systems share common syntactic representations would open new perspectives on language evolution. Here, crossing disciplinary boundaries, we explore potential parallels between the structure of simple actions and that of sentences. First, examining Typically Developing (TD) children displacing a bottle with or without knowledge of its weight prior to movement onset, we provide kinematic evidence that the sub-phases of this displacing action (reaching + moving the bottle) manifest a structure akin to linguistic embedded dependencies. Then, using the same motor task, we reveal that children suffering from specific language impairment (SLI), whose core deficit affects syntactic embedding and dependencies, manifest specific structural motor anomalies parallel to their linguistic deficits. In contrast to TD children, SLI children performed the displacing-action as if its sub-phases were juxtaposed rather than embedded. The specificity of SLI’s structural motor deficit was confirmed by testing an additional control group: Fragile-X Syndrome patients, whose language capacity, though delayed, comparatively spares embedded dependencies, displayed slower but structurally normal motor performances. By identifying the presence of structural representations and dependency computations in the motor system and by showing their selective deficit in SLI patients, these findings point to a potential motor origin for language syntax.

[Childhood onset schizophrenia: current data and therapeutic approach]

Childhood schizophrenia is a rare but serious developmental disorder affecting most of the fields involved in the child's adaptive functioning: motor, emotional, cognitive, and social. The clinical expression of the disorder mainly depends on the child's age and the IQ level at the time the first clinical symptoms appear. The progression of childhood schizophrenia is generally poor, with different outcome studies suggesting a continuity of the process between childhood and adulthood. This stresses the importance of diagnosing the disorder early and initiating the adapted therapeutic measures as quickly as possible, including cognitive remediation (a new therapeutic tool to correct or anticipate cognitive disorders), which can prevent pejorative development.

[Which treatments for infantile colics?]

BACKGROUND

Infantile colics or excessive crying represent a source of stress for parents and a frequent reason for encounter in primary care.

OBJECTIVE

To assess the effectiveness of treatments of this syndrome from a systematic review.

INFORMATION SOURCES

Medline, Cochrane and Embase databases.

SELECTION OF STUDIES

We used the following inclusion criteria: therapeutic assessment of infant colics or excessive crying, randomized controlled trials or meta-analyses, published in English or French language. Thirty-one randomized controlled trials and one meta-analysis have been included.

RESULTS

Allopathic drugs have not proved effectiveness (simethicone, lactase) and some of them can cause potentially serious adverse reactions (dicyclomine). Protein hydrolysate or soy formulas seem to be effective, but soy milk can induce allergies. Sucrose solutions provide some benefit in studies with low level of evidence. Effectiveness is likely for a probiotics (Lactobacillus reuteri) and for herbal mixtures containing fennel extracts. Evidence is lacking for manual (osteopathy, acupuncture) and behavioural therapies (decreased stimulations, reassurance of parents).

LIMITATIONS

The definition of infantile colics and the methods used for crying measurement changed across trials. The included trials were of variable quality, especially with no double-blind procedure in 17 trials.

CONCLUSION

The most validated treatments for infantile colics are the substitution of cows' milk by a hydrolysed formula, the use of L. reuteri and of fennel extracts.

Quantification des mouvements prostatiques lors de l'irradiation prostatique

Decrease treatment uncertainties is one of the most important challenge in radiation oncology. Numerous techniques are available to quantify prostate motion and visualise prostate location day after day before each irradiation: CT-scan, cone-beam-CT-Scan, ultrason, prostatic markers... The knowledge of prostate motion is necessary to define the minimal margin around the target volume needed to avoid mispositioning during treatment session. Different kind of prostate movement have been studied and are reported in the present work: namely, those having a large amplitude extending through out the whole treatment period on one hand; and those with a shorter amplitude happening during treatment session one the other hand. The long lasting movement are mostly anterior-posterior (3 mm standard deviation), secondary in cranial-caudal (1-2 mm standard deviation) and lateral directions (0.5-1 mm standard deviation). They are mostly due to the rectal state of filling and mildly due to bladder filling or inferior limbs position. On the other hand, the shorter movement that occurs during the treatment session is mostly variation of position around a steady point represented by the apex. Ones again, the rectal filling state is the principle cause. This way, during the 20 minutes of a treatment session, including the positioning of the patient, a movement of less than 3 mm could be expected when the rectum is empty. Ideally, real time imaging tools should allow an accurate localisation of the prostate and the adaptation of the dosimetry before each treatment session in a time envelope not exceeding 20 minutes.