Étude de l'attention spatiale en condition d'interférence émotionnelle chez les enfants avec un trouble autistique

Le déficit social, incluant la perturbation du traitement du regard et des émotions, est au cœur de l’autisme. Des études ont montré que les visages de peur provoquent une orientation rapide et involontaire de l’attention spatiale vers leur emplacement chez les individus à développement typique. De plus, ceux-ci détectent plus rapidement et plus efficacement les visages avec un regard direct (vs regard dévié). La présente étude vise à explorer l’effet de l’émotion de peur et de la direction du regard (direct vs dévié) sur l’attention spatiale chez les enfants autistes à l’aide d’une tâche d’attention spatiale implicite. Six enfants avec un trouble autistique (TA) ont participé à cette étude. Les participants doivent détecter l’apparition d’une cible à gauche ou à droite d’un écran. L’apparition de la cible est précédée d’une amorce (paire de visages peur/neutre avec regard direct/dévié). La cible peut être présentée soit dans le même champ visuel que l’amorce émotionnellement chargée (condition valide), soit dans le champ visuel opposé (condition invalide). Nos résultats montrent que les amorces avec un visage de peur (vs les amorces avec un visage neutre) provoquent un effet d’interférence au niveau comportemental et divergent l’attention de leur emplacement chez les enfants avec un TA.Autism is characterized by a social deficit, including difficulties in using and responding to facial expressions and gaze. Previous studies showed that fearful faces elicit a rapid involuntary orienting of spatial attention towards their location in typically developing (TD) individuals. In addition, target faces with direct gaze are detected faster and more efficiently than those with averted gaze in TD individuals. The aim of the current study is to explore the effect of fear and gaze direction (direct vs averted) on spatial attention in children with autistic disorder (AD). Six children with AD performed a covert spatial orienting task. Each trial consisted of a pair of faces (fearful/neutral with direct/averted gaze) briefly presented followed by a target presented at the location of one of the faces. Participants had to judge the location of the target (right or left visual field). The target unpredictably appeared on the side of the emotional face (fear, direct) (valid condition) or on the opposite side (neutral, averted) (invalid condition). Our results show that fearful faces have an interferent effect on the performance of AD children and divert attention from their location

Development and refinement of Rel@x : a training in hypnosis-derived communication for pediatric nurses to prevent procedural pain

IntroductionStudies in pediatric oncology have shown that hypnosis effectively reduces patients’ pain and distress during painful procedures. This remains underutilized in the healthcare system due to the staff cost and availability of hypnotherapists. To develop the use of hypnosis-derived communication, we aimed to train nurses to use hypnosis-derived communication while they perform painful procedures. ObjectivesThis study aimed to (1) develop a brief training in hypnosis-derived communication for pediatric nurses named Rel@x, (2) pretest the training with experienced pediatric oncology nurses, and (3) refine the training based on nurses’ suggestions. MethodsThe Rel@x training consists of two 4-h sessions: one related to relational aspects and another one presenting one of two selected hypnotic communication techniques (“pleasant place” or “magic glove”). Rel@x makes use of manuals, cue card reminders, visual aids, videos, and an e-learning platform. To refine Rel@x, a complete training cycle was conducted with seven female pediatric oncology nurses. A mixed method study with an evaluation questionnaire and a post-training focus group interview was conducted. ResultsQuantitative data showed that nurses overall positively rated the training program: relevance and acceptability (median average of 5.4/6); use of hypnotic communication (median average of 5.2/6); expected effects (median average of 5.4/6); program implementation (5.6/6). Two general themes emerged from the qualitative data: perceptions of hypnotic communication and the evaluation of the Rel@x training program. Based on nurses’ suggestions, Rel@x was refined by adding more practical components, more time for practice, more time between the two sessions and additional tools (cue card reminders, keywords, virtual e-learning recap module). Conclusion and clinical implicationsThe use of hypnosis-derived communication during painful procedures and the Rel@x training were viewed favorably amongst pediatric nurses. Rel@x offers a complete training in hypnosis-derived communication for pediatric nurses. This training fosters the optimal use of hypnosis-derived communication during care and may significantly reduce children’s procedural pain and distress

Changes in hair cortisol and self-reported stress measures following mindfulness-based stress reduction (MBSR) : a proof-of-concept study in pediatric hematology-oncology professionals

Background and purpose Little data is available on the effect of mindfulness amongst pediatric hematology-oncology professionals. The purpose was to further document change in biological and psychological stress following a mindfulness-based stress reduction (MBSR) program. Materials and methods We led two pre-post interventional studies (n = 12 and n = 25) and measured changes on hair cortisol concentrations, perceived stress, psychological distress and burnout. Results Professionals did not change on biological stress (d = 0.04), but improved on self-reported measures (median d = 0.58). Effects were maintained over 3 months for psychological distress, anxiety, depression, and burnout (median d = 0.66). Effects were larger if trainees participated to the retreat and if they reported higher baseline perceived stress. Conclusion In pediatric hematology-oncology professionals, an MBSR program was related with improvements in self-reported stress over 3 months. Components of the program and characteristics of trainees may influence the impact of MBSR

Quality of life, treatment beliefs, and treatment satisfaction in children treated for primary immunodeficiency with SCIg

Despite the development of subcutaneous treatment, children and adolescents with primary immunodeficiency (PID) are vulnerable to a lower quality of life (QoL) than non-clinical participants. Comparisons have been offered in rare reports with limited sample sizes. No description is available of treatment beliefs and treatment satisfaction with standard tools. The objective of this study was to describe a large sample of patients with pediatric PID on QoL, treatment beliefs and satisfaction, and identify perceived benefits and issues of treatment both in children and parents. A mail-back survey was conducted in 60 patients with PID treated with subcutaneous Ig and their parents from a clinic in Montreal (QC, Canada). We used the standardized tools to assess for QoL levels, beliefs of necessity and concerns with treatment, and dimensions of satisfaction. We collected and coded perceived benefits and issues through open-ended questions. We found lower QoL in children with PID than in healthy non-clinical participants (median d = 0.40) and similar QoL levels to children with cancer (median d = 0.12). Participants considered their treatment as less necessary and able to control the illness and less convenient than patients with other conditions. Children were more prone to consider the treatment as convenient (69 vs. 47% p = .028) but reported more discomfort (24 vs. 10% p = .043) than parents. Results suggest a lower-than-expected QoL in pediatric PID. Aspects of the illness and treatment are probably unclear to patients and their families, as necessity beliefs were lower than expected. Educational strategies should be developed and assessed to address this issue

Could we use parent report as a valid proxy of child report on anxiety, depression, and distress? : a systematic investigation of father–mother–child triads in children successfully treated for leukemia

Background Systematic assessment of emotional distress is recommended in after care. Yet, it is unclear if parent report may be used as a proxy of child report. The aim of this study was to assess agreements and differences and explore possible moderators of disagreement between child and parent ratings. Methods Sixty‐two young survivors treated for acute lymphoblastic leukemia (9–18 years) and both parents responded to the Beck Youth Inventory (anxiety and depression) and the distress rating scale on the child's status. Parents completed the Brief Symptom Inventory‐18 on their own psychological status. Systematic analyses of agreement and differences were performed. Results Mother–child and father–child agreements were fair on anxiety, depression, and distress (median intraclass correlation coefficient = 0.37). Differences between parents and children were medium sized (median d = 0.55) with parents giving higher scores than their children on anxiety, depression, and distress. Mothers reported distress more frequently than fathers (39 vs. 17%) when children reported none. The child being female and lower parental income were associated with lower agreement in fathers when rating child distress. Higher levels of parental psychological symptoms were consistently associated with lower agreement. Conclusions Parent–child differences when rating adolescent survivors’ difficulties may be more important than previously thought. Parent report probably cannot be considered as a valid proxy of older child report on such internalized domains as anxiety, depression, or distress in the after‐care clinic. Parents’ report is also likely to be influenced by their own mood, a factor that should be corrected for when using their report

Screening for distress in pediatric cancer survivors : a systematic comparison of one-step and two-step strategies to minimize detection errors

Background:Childhood cancer survivors should be routinelyscreened for psychological distress. However, existing screeningtools promoted by cancer care institutions, such as the DistressThermometer (DT) generate high rates of errors. The aim of thisstudy is to help refining strategies of screening psychologicaldistress in this population by exploring two-step methods com-bining the DT on step #1 with one question on step #2.Procedure:Data from 255 survivors of childhood acutelymphoblastic leukemia aged 13–40years were analyzed (38%13–18 years, 62% 19þyears, 53% females). We used the DTon step #1 and the individual emotion items from thePediatric Quality of Life Questionnaire (PedsQL) on step #2, todetect distress, depression and anxiety as measured by stand-ard instruments. We compared sensitivity, specificity, negativeand positive predictive values, Youden index, and clinical util-ity indices, in newly developed two-step strategies.Results:The best two-step strategies to screen anxious-depressive distress were DT 2 on step #1, with the item ofSadness on step #2, and DT 2 combined with the item ofConcerns. Two-step strategies outperformed the DT alone onthe correct identification of distressed survivors. However,two-step strategies did not outperform the DT used alone onthe correct detection of no distressed survivors. Results weresimilar when predicting depression or anxiety alone.Conclusion:Completing the DT with one single question onemotions from the PedsQL may minimize the number of par-ticipants falsely identified as distressed, which could be par-ticularly pertinent in resource-limited clinics

Psychological risk in long-term survivors of childhood acute lymphoblastic leukemia and its association with functional health status : A PETALE cohort study

Background: Recent research has suggested that long-term pediatric cancer survivors were at risk of important physical and psychological morbidities. To date, we do not know to what extent functional health status contributes to psychological risk and which domains are most important. The aim of this study was to systematically explore which functional domain could explain anxiety, depression, and distress symptoms. Procedure: We used data available for 105 adolescents and 182 adults successfully treated for childhood acute lymphoblastic leukemia at two Canadian sites part of the PETALE cohort. Participants were ≥5 years postdiagnosis, aged 22 ± 6 years, 52% female, and 49% acute lymphoblastic leukemia high-risk status. The contribution of health functional status (15D/16D questionnaires) to self-reported anxiety, depression, and distress (Beck scales and distress thermometer) was evaluated using adjusted logistic regression models. Results: Prevalence rates found for mild-severe anxiety, depression, and distress were 14%, 21%, and 30% among adolescents and 27%, 20%, and 19% among adults. Frequent health domains associated with psychological risk were sleeping and breathing in adolescents, and vitality/fatigue, discomfort/symptoms, mental function, and sleeping in adults. Mental function was systematically associated with psychological risk across age groups (median OR = 10.00, 95% CI 3.01-33.71). Exploratory mediation bootstrapping analyses suggested that the effect on psychological risk of overall health status and mental function problems was partly explained by social/work/school functioning. Conclusion: The results identified important functional health domains that could be targeted for interventions preventing psychological risk: vitality/fatigue, discomfort/symptoms, sleeping, and mental function issues. Health domains probably affect mood partly by limiting social/work/school functioning

Contributing factors of unmet needs among young adult survivors of childhood acute lymphoblastic leukemia with comorbidities

Purpose: This study aimed to: (1) describe the domains and levels of unmet needs of young adult survivors of childhood acute lymphoblastic leukemia (cALL) with comorbidities, and (2) to explore the factors associated with higher levels of unmet needs. Unmet need was considered as supportive care needs not met. Methods: The most vulnerable cALL survivors from the PETALE study cohort completed the Short-Form Survivor Unmet Needs Survey, the Brief Pain Inventory and the 15D instrument of health-related quality of life. Demographic and clinical information, including comorbidities, were obtained from medical records or self-reporting. The participants' needs and contributing factors to their needs were evaluated using nonparametric tests. Results: Of the 72 participants, 9 (13%) reported moderate/high levels of overall unmet needs. “Worry about earning money” (56%) and “Dealing with feeling tired” (51%) were the most frequent unmet needs (all levels combined). The factors associated significantly with any domain of unmet needs were: having a comorbidity, reporting altered functional health status, high ALL risk status, pain, age (<26 years), and having previously received psychological support. Conclusion: A minority of young adult survivors of cALL with comorbidities interviewed reported moderate/high levels of unmet needs. However, financial concerns and emotional health and relationship are the two domains of greatest need. Survivors with altered health condition are most at risk of experiencing moderate/high levels of unmet needs. If confirmed in larger samples, interventions should target modifiable contributors of unmet needs such as physical health and comfort, fatigue, and emotional health

Inconsistencies between measures of cognitive dysfunction in childhood acute lymphoblastic leukemia survivors : description and understanding

Objectives The frequency of cognitive difficulties in childhood cancer survivors varies according to the measurement strategy. The goal of this research is to (a) describe agreements and differences between measures of working memory and attention (b) identify contributors of these differences, such as emotional distress, affects, and fatigue. Methods We used data available for 138 adults successfully treated for childhood acute lymphoblastic leukemia (ALL) (PETALE cohort). Working memory and attention were assessed using subtests from the WAIS‐IV and self‐reported questionnaires (BRIEF‐SR and CAARS‐S:L). Potential contributors included emotional distress, anxiety, depression (BSI‐18), affects (PANAS), and fatigue (PedsQL‐MFS). We explored measurement agreements and differences using diagnostic indices and multivariate regression models. Results The frequencies of working memory and attention deficits were higher when using cognitive tests (15%‐21%) than with self‐reports (10%‐11%). Self‐reported questionnaires showed high specificity (median 0.87) and low sensitivity (median 0.10), suggesting they did not reliably identify positive cases on cognitive tests. We identified negative affectivity as a possible contributor to inconsistencies between self‐report and test results. Conclusions When measuring working memory and attention in childhood ALL survivors, cognitive test results and self‐reports should not be considered equivalent. At best, self‐report may be used for screening (high specificity), but not to assess prevalence in large samples. Self‐reported difficulties are also probably influenced by the negative mood in this population

Matériel de formation Rel@x : formation à la communication hypnotique pour prévenir la douleur

La formation Rel@x a été mise au point pour prévenir et diminuer la douleur procédurale en pédiatrie. Elle utilise les principes de la communication adaptée de l'hypnose clinique (communication hypnotique) et concerne deux techniques: l'endroit agréable et le gant magique. Les documents joints sont les éléments utilisés dans la formation: Manuels de formation (relationnel et technique), Aide-mémoires remis aux participants, Affiches pour les postes de soin.The Rel@x training was developed to prevent and decrease procedural pain in pediatrics. It uses the principles of hypnosis-derived communication (hypnotic communication) and includes two techniques: the pleasant place and the magic glove. The attached documents are elements used during training: Training manuals (interpersonal and technical), Summary briefs given to participants, Posters to be displayed in wards