Personality traits and disorders in childhood. Clinical evaluation and diagnosis

Objective: aim of the paper is to examine the controversial issue of personality traits and disorders in childhood. Method: a literature review of clinical and research data was performed, and a conceptual synthesis was proposed. Results: although there are still few longitudinal studies able to clarify the evolution of personality traits from childhood to adulthood, a growing number of studies confirmed emerging personality patterns in childhood and the need for early intervention and prevention. after a discussion of clinical and research data on continuity vs discontinuity in personality disorders, we propose a conceptual synthesis of emerging personality patterns in childhood, conjugating both top-down (theoretical) and bottom-up (research) perspectives. Conclusions: the literature review showed that a deeper understanding of personality and mental functioning in childhood is still required and that emerging personality patterns and disorders need specific assessment and empirical derived classication that takes into account the developmental perspectiv

The co-occurrence between gender dysphoria and autism in trans youth: a critical commentary through a single case study

Introduction: In recent years, a higher incidence of traits that seem to be related to Autism Spectrum Conditions (ASC) in individuals with Gender Dysphoria (GD) and of gender variant traits in autistic users, compared to the general population have been highlighted. Therefore, several studies investigated the possible co-occurrence between these two conditions and the consequences in terms of assessment and treatment. Methods: A literature review were conducted to investigate the co-occurrence of GD and ASC. Then, through a single case this co-occurrence is investigated in deep. Autistic traits and gender variant behaviors are evaluated and described at the beginning of the treatment, after a year, and at the end of the treatment. Results: From the literature review different criticisms can be made: the diagnoses of both conditions are often not accurate, the tools used to evaluate autistic traits and gender dysphoria often are not appropriate and methodological criticalities are found on the studies that investigate the co-occurrence. Relying on the account of a trans adolescent followed in a psychoanalytic psychotherapy, more critical aspects are pointed out. Autistic traits can be better understood as massive defenses related to high discomfort of the GD, like social and relational problems, complex perception of the body and difficult behavioral patterns. Conclusion: This study underlines the need to deepen this co-occurrence, to avoid incurring in incorrect and hasty diagnoses and to focus on some aspects of GD and ASC that need attention and knowledge, in order to better define the guidelines for a correct assessment and treatment. The medicalization and a tendency to pathologize these conditions have led to a simplistic overlap while a more complex view and investigation are needed

CPAP-Q Sort: personality, traits and disorders in childhood

Introduction: The controversy over the existence of personality disorders in childhood has continued due to the limitations of studies in this research area, to the reluctance to apply adult personality diagnoses to children and to the difficulty of the assessment. The aim of this work is the validation of the CPAP-Q (Child Personality Assessment Q-Sort; Fortunato, Speranza, Tanzilli, Lingiardi, 2018), a Q-Sort instrument able to assess the childhood personality. Methods: The validation procedure includes: 150 children (M=7,8; 70% male), from 4 to 11 years old evaluated by 150 clinicians. Children are in treatment from 2 to 12 months. The procedure includes other instruments: an ad-hoc questionnaire for information on the clinician, on the child and his/her family, CPNI (Coolidge, 2002), CBCL (Achenbach, 2001) and PDC-C (Malberg, Rosenberg & Malone, 2017). For the validation procedure, it was conducted the Q-Factor analysis to obtain Emerging Personality Patterns empirically derived. To evaluate the internal coherence of each Factor it was measured the Cronbach’s alpha. Then it was evaluated the correlation between the Q-Factor’s and the other instruments. Results: 8 factors emerged from the Q-Factor analysis (High Functioning, Inhibited/Withdrawn, Dysphoric/Anxious, Inhibited/Depressive, Obsessive, Borderline/Dysregulated, Borderline/Impulsive, Schizoid). The Cronbach’s alpha reached really good or excellent levels for each Q-Factors. The correlations highlight a good construct and criterion validity. Conclusions: Data define that it’s possible to evaluate the developmental pathways for emerging personality patterns in childhood and how these may lead to personality disorders in adolescence and adulthood. Preliminary data is promising and seems to confirm that the Q-Sort procedure is the best way to assess childhood personality and its elements

La valutazione della personalità nell’infanzia: dati preliminari sulla validazione di uno strumento Q-Sort

Introduction: The debate on childhood personality disorders still rages, despite a growing number of studies confirming that it is possible to evaluate childhood personality from a developmental perspective (Caspi et al. 2005, Widiger et al. 2009, McAdams & Olson 2010). Certain authors have inquired whether it is appropriate to evaluate personality in childhood, given the developmental features of mental functioning, but others, with the support of empirical and clinical data, confirmed the early structuring of PDs and the need for early intervention and prevention. The Psychodynamic Diagnostic Manual, Second Edition (PDM-2; Lingiardi and McWilliams 2017) states that young children do have personalities and traits that may persist over time, and it underlines the importance of assessment even in childhood. The controversy over the existence of personality disorders in childhood has continued due to the limitations of studies in this research area and to the reluctance to apply adult personality diagnoses to children. The aims of this work are: to develop a Q-Sort assessment procedure for the evaluation of children personality and to give a contribution on the debate of childhood personality (Fortunato & Speranza, 2018). Methods: From a literature review we derived seven Emerging Personality Patterns and four Personality Organizations. Through the four Mental Functions defined by the PDM-2 (cognitive and affective processes, identity and relationships, defense and coping, Self-awareness and self-direction) we described the characteristics of each patterns and we derived 200 items that describe specific patterns of affect, cognition, motivation and behavior in childhood with a straightforward manner. Beyond the consideration of whether it is better not to label, avoiding stigmatization and leaving the development to have its course or rather is it higher risk to do so for traits that exist and could lead to a structured pathology without intervention, we would like to consider emerging personality patterns in childhood as developmental trajectories that can be examined. We believe that investigating the precursors and pathways of personality disorders during childhood, integrating developmental issues, biological vulnerabilities, and problematic environments, has the potential to define a longitudinal developmental approach to personality development and psychopathology. Our approach tries to address this challenge, conjugating both top-down (theoretical) and bottom-up (research) perspectives, based on research and clinical evidence (Fortunato & Speranza, 2018). First Personality Organization is the Healthy Personality, the second one is the Neurotic Personality Organization that includes: Inhibited/Withdrawn Emerging Personality Pattern, Pathological Obsessiveness Emerging Personality Pattern and Dysphoric Emerging Personality Pattern. The third one is the Borderline Personality organization that includes: Dysregulated Emerging Personality Pattern and Pathological Narcissism Emerging Personality Pattern. The last one is the Psychotic Personality Organization that includes: Suspicious Emerging Personality Pattern and Schizoid emerging personality pattern. Items and Patterns were tested through theoretical and statistical consensus. The theoretical consensus was obtained by 30 expert clinicians that evaluated on a 5-point Likert scale each Pattern and item. The statistical consensus involved 42 clinicians assessing 42 children (M=7.92; 64% male). Afterwards, we started with the validation procedure. Seventy-six clinicians evaluated 76 children (M=8,6; 77% male), from 4 to 11 years old, in treatment from 2 to 12 months. Procedure includes other instruments: CPNI (Coolidge, 2002), CBCL (Achenbach, 2001) e PDC-C (Malberg, Rosenberg, Malone, 2017). Results: Theoretical consensus: clinicians rated 4 or 5 to all the Patterns and most of the items, only few items were rated 3. Statistical consensus: we evaluated the mean score and the standard deviation (SD) for each item. Only 16 out of 200 items reached a SD lower than 1.50 and a little mean score. Then, to evaluate the internal coherence of each Pattern, we measured the Cronbach’s alpha that reached really good or excellent levels for each Emerging Patterns. According to the consensus results, we modified the problematic items to obtain the final version of the instrument. For the validation procedure we conducted the Q-Factor analysis to obtain Emerging Personality Patterns empirically derived. Eight Q-Factor were found: High Functioning, Inhibited/Withdrawn, Dysphoric/Anxious, Inhibited/Depressive, Obsessive, Borderline/Dysregulated, Borderline/Impulsive, Schizoid. Then we evaluated the correlation between the Q-Factor’s and the other instruments. Correlations highlight a good construct and criterion validity. Validation procedure highlights the Q-Sort’s validity to evaluate childhood personality. Conclusions: Using the literature and research data, this study defined possible developmental pathways for emerging personality patterns in childhood. We consider that it is possible to define emerging patterns that may lead to personality disorders in adolescence and adulthood. The study of childhood personality can inform us about mental functioning, precursors and pathways of development. Preliminary data is promising and seems to confirm that the personality can be investigated during childhood. The Q-Sort procedure is the best way to assess childhood personality and its elements

Psychodiagnostic Chart–Child (PDC–C): a valid and clinically sensitive diagnostic tool for patient-tailored intervention planning

The reliable clinical-diagnostic evaluation of child patients is crucial. The present research sought to examine the validity of the Psychodiagnostic Chart – Child (PDC–C) in assessing children’s mental functioning and personality organization, according to the framework of the Psychodynamic Diagnostic Manual, Second Edition (PDM–2). A sample of 209 clinicians assessed 209 children (aged 4–11 years) who had been in their care between 2–12 months, using the PDC-C. Each clinician also completed a clinical questionnaire to provide demographic information, the Child Behavior Checklist to evaluate children’s behavioral problems and social competences, and the Childhood Personality Assessment Q-Sort measure to assess children’s emerging personality patterns. The findings suggest that the PDC–C is a valid diagnostic tool that takes into account children’s full range of functioning. Moreover, the measure has good sensitivity and appears clinically useful in differentiating between certain clinical populations according to psychological characteristics. The PDC–C could promote more accurate assessment during childhood and inform the development of individualized therapies. One of the advantages of the tool is its ability to capture individual variations in child functioning (illuminating strengths and psychological vulnerabilities), even within children in the same diagnostic group. Of note, additional research is needed to establish the utility of PDC–C ratings in predicting clinically relevant constructs and to monitor the processes and outcomes of interventions

A Short History of a Controversial Diagnosis

This work retraces the history of gender identity, a construct which came to light at the end of the sixties, and whose path we will follow up until the present day. In detail, the work focuses on the situations in which a person – belonging to what is commonly known as the trans* world – lives with a lack of correspondence between assigned birth gender and actual gender experience. We will revisit the different diagnoses connected to gender variance – in childhood, adolescence and adulthood – that have been put forward, and examine the different diagnostic classifications that have been used up to now, in order to reach the discussion of this theme in a psychoanalytic field. We will highlight how, alongside pathologizing theories, the psychiatric and psychoanalytic fields have become enriched via theoretical and clinical knowledge that enhance and recognize the depth of the subjective experience of trans* people, without stopping therefore, at a simply reductive diagnosis

Attachment patterns and complex trauma in a sample of adults diagnosed with gender dysphoria

The current study investigated attachment representations and complex trauma in a sample of gender dysphoric adults. Although it has been proven that the psychological wellbeing of gender diverse persons is largely mediated by family acceptance and support, research on their relationships with parental figures is scarce. A total of 95 adults took part in the study. The attachment distribution was as follows: 27% secure, 27% insecure and 46% disorganized. Regarding early traumas, 56% experienced four or more traumatic forms. Further, gender dysphoric adults showed significantly higher levels of attachment disorganization and polyvictimisation, relative to controls. Comparisons of subgroups, defined by natal gender, showed that trans women, compared to control males, had more involving and physically and psychologically abusive fathers, and were more often separated from their mothers; trans men, relative to female controls, had more involving mothers and were more frequently separated from and neglected by their fathers. The research has several implications for treatment, clinical health psychology, family support and education

The intergenerational transmission of attachment during middle childhood in lesbian, gay, and heterosexual parent families through assisted reproduction: The mediating role of reflective functioning

the present study examined the attachment patterns distribution of 60 lesbian mothers, 50 gay fathers, and 42 heterosexual parents through assisted reproduction and their 76 children, using the Adult Attachment Interview (AAI) and the Friends and Family Interview (FFI), respectively. the study also explored the intergenerational transmission of attachment through reflective functioning (AAI-RF). all families lived in italy and children were aged 6-12 years (Myears = 8.11, SD = 2.17; 48.68% assigned female at birth). the AAI patterns distribution was similar across family types and did not significantly differ from international and national normative data. similarly, children's FFI attachment patterns were evenly distributed between family types, and no significant differences emerged in comparison to international and national normative data referring to middle childhood samples. mediational models revealed that, in all three family types, parents with greater AAI coherence of mind exhibited higher AAI-RF, which, in turn, was associated with increased FFI attachment security in children. Furthermore, parents' AAI coherence of mind directly influenced children's FFI attachment security. the results support and expand hypotheses regarding the intergenerational transmission of attachment in lesbian, gay, and heterosexual parent families through assisted reproduction, while offering unique indications to support these families during middle childhood

Familial hypercholesterolaemia in children and adolescents from 48 countries: a cross-sectional study

Background: Approximately 450 000 children are born with familial hypercholesterolaemia worldwide every year, yet only 2·1% of adults with familial hypercholesterolaemia were diagnosed before age 18 years via current diagnostic approaches, which are derived from observations in adults. We aimed to characterise children and adolescents with heterozygous familial hypercholesterolaemia (HeFH) and understand current approaches to the identification and management of familial hypercholesterolaemia to inform future public health strategies. Methods: For this cross-sectional study, we assessed children and adolescents younger than 18 years with a clinical or genetic diagnosis of HeFH at the time of entry into the Familial Hypercholesterolaemia Studies Collaboration (FHSC) registry between Oct 1, 2015, and Jan 31, 2021. Data in the registry were collected from 55 regional or national registries in 48 countries. Diagnoses relying on self-reported history of familial hypercholesterolaemia and suspected secondary hypercholesterolaemia were excluded from the registry; people with untreated LDL cholesterol (LDL-C) of at least 13·0 mmol/L were excluded from this study. Data were assessed overall and by WHO region, World Bank country income status, age, diagnostic criteria, and index-case status. The main outcome of this study was to assess current identification and management of children and adolescents with familial hypercholesterolaemia. Findings: Of 63 093 individuals in the FHSC registry, 11 848 (18·8%) were children or adolescents younger than 18 years with HeFH and were included in this study; 5756 (50·2%) of 11 476 included individuals were female and 5720 (49·8%) were male. Sex data were missing for 372 (3·1%) of 11 848 individuals. Median age at registry entry was 9·6 years (IQR 5·8-13·2). 10 099 (89·9%) of 11 235 included individuals had a final genetically confirmed diagnosis of familial hypercholesterolaemia and 1136 (10·1%) had a clinical diagnosis. Genetically confirmed diagnosis data or clinical diagnosis data were missing for 613 (5·2%) of 11 848 individuals. Genetic diagnosis was more common in children and adolescents from high-income countries (9427 [92·4%] of 10 202) than in children and adolescents from non-high-income countries (199 [48·0%] of 415). 3414 (31·6%) of 10 804 children or adolescents were index cases. Familial-hypercholesterolaemia-related physical signs, cardiovascular risk factors, and cardiovascular disease were uncommon, but were more common in non-high-income countries. 7557 (72·4%) of 10 428 included children or adolescents were not taking lipid-lowering medication (LLM) and had a median LDL-C of 5·00 mmol/L (IQR 4·05-6·08). Compared with genetic diagnosis, the use of unadapted clinical criteria intended for use in adults and reliant on more extreme phenotypes could result in 50-75% of children and adolescents with familial hypercholesterolaemia not being identified. Interpretation: Clinical characteristics observed in adults with familial hypercholesterolaemia are uncommon in children and adolescents with familial hypercholesterolaemia, hence detection in this age group relies on measurement of LDL-C and genetic confirmation. Where genetic testing is unavailable, increased availability and use of LDL-C measurements in the first few years of life could help reduce the current gap between prevalence and detection, enabling increased use of combination LLM to reach recommended LDL-C targets early in life

Credere e avere fiducia nella complessità. Commento critico alla co-occorrenza tra disforia di genere e autismo

Di recente, nella letteratura scientifica è emersa una correlazione tra le condizioni di Disforia di Genere (DG) e Disturbi dello Spettro Autistico (DSA). In questo lavoro, a cavallo tra clinica e ricerca, gli autori propongono un commento critico a tale co-occorrenza, attraverso il racconto di un caso clinico di un adolescente transgender e una discussione della letteratura a riguardo. Gli autori indicano i rischi di una ipersemplificazione di diagnosi così complesse, e offrono una loro lettura delle aree di sovrapposizione tra le due categorie dia- gnostiche.In recent years, scientific literature has found a correlation between Gender Dysphoria (GD) and Autism Spectrum Disorders (ASD). In this contribu- tion, straddling between clinical observations and research findings, the authors propose a critical comment on this co-occurrence. They review existing literature and report a psychoanalytic account of a therapy with a transgender adolescent. The authors highlight the risk of an over-simplistic view of two complex diagnoses and offer their interpretation to understand overlapping areas between the two diagnos- tic categories