Internet Gaming Disorder in Adolescents With Psychiatric Disorder: Two Case Reports Using a Developmental Framework

Internet gaming disorder (IGD) has been a controversial entity with various opinions about its clinical relevance as an independent mental disorder. This debate has also included discussions about the relationships between problematic gaming, various psychiatric disorders, and personality traits and dimensions. This paper outlines a developmental-theory based model of Internet gaming misuse inspired by the treatment of two adolescent inpatients. The two clinical vignettes illustrate distinct developmental pathways: an “internalized pathway” via the development of social anxiety, emotional and behavioral avoidance; and an “externalized pathway” with a low level of emotional regulation strategies and impulsivity. In both clinical cases, attachment issues played a key role to understand the specific associations of risk and maintaining factors for IGD, and gaming behaviors may be seen as specific forms of maladaptive self-regulatory strategies for these two youths. These clinical observations support the assumption that gaming use problematic in adolescents should be viewed with a developmental approach, including key aspects of emotional development that represent significant targets for therapeutic interventions

Irritabilité chez l'enfant et l'adolescent : contribution à la caractérisation du trouble disruptif avec dysrégulation émotionnelle et proposition d'un modèle étiologique développemental basé sur les mécanismes de simulation-prédiction

The Disruptive Mood Dysregulation Disorder (DMDD) was coined in 2013 in the DSM-5 to characterize children and adolescents with severe and persistent symptoms of irritability associated with repeated temper outbursts. The child’s emotional responses are grossly out of proportion in intensity or duration to the situation and inconsistent with his developmental level. While the diagnosis of DMDD is frequently associated with externalized disorders (disruptive behavioral disorder, attention deficit disorder), the risk factors and the natural course of DMDD puts them closer to depressive disorders. Most of the literature about the etiological mechanisms involved in DMDD symptoms has been devoted to cognitive processes (abnormalities in threat response systems, in reward system, in cognitive control) following the Research Domain Criteria framework mostly developed in adults with depression. However, such explanations are insufficient for reporting the (1) role of child/parent and child/children interactions and (2) the role of low-order cognitive skills such as motor and perceptive abilities and (3) the role of language competence in the emergence of emotional regulation in children. For the advocates of a “constructivist” view of emotions (Barrett 2006) emotional states result from the simulation of the sensory consequences of motor activities, in particular from interoceptive stimuli. Such ongoing flow of information that helps to guide decisions is only experienced as an emotion when they become conscious and recognized as such by the subject himself. This theory is consistent with the assumption that early emotional regulation development is acquired through repeated sensorimotor interactions with caregivers that help the infant to probabilistically refine his simulation-perception system to better predict his internal and external environment. This theory also supports the importance of the words/speech used by the parent when referring to the putative child’s mental states in progress to develop the child’s ability to categorize his own emotions. Firstly, it has been postulated that DMDD is a developmental condition primarily affecting the child’s ability to categorize emotions. The natural history of patients with DMDD should differ from those with episodic depressive disorder. The symptoms of irritability in DMDD should be chronic, with an onset around 1-3 year of age, and become apparent only when the social expectations about the child’s level of emotion discrimination increases. Secondly, it has been postulated that youths with DMDD should be developmentally impaired in dimensions involved in the development of emotional regulation. A higher rate of speech and motor disabilities should be found in youths with DMDD compared to those with episodic depressive disorder. Thirdly, it has been postulated that youths with DMDD should present more sensory processing difficulties compared to those with episodic depressive disorder. Indeed, a child with difficulties to integrate his own sensory inputs would have more difficulties to build a consistent and elaborated representation of his own perceptions, and ultimately to categorize his emotional states.Le diagnostic de Trouble Disruptif avec Dysrégulation Emotionnelle (TDDE) a été proposé en 2013 pour caractériser les difficultés de jeunes qui souffrent d'une irritabilité chronique accompagnée de crises de rage répétées disproportionnées à l'âge de développement. Bien que les jeunes avec un TDDE présentent très fréquemment des troubles externalisés associés (ex : trouble des comportements perturbateurs, trouble déficit de l'attention), les facteurs de risque et l'évolution naturelle du TDDE les rapprochent des troubles dépressifs. La plupart des travaux sur l'étiologie du TDDE se sont focalisées sur des perturbations cognitives (anomalie des systèmes de réponses à la menace, perturbations des systèmes de la récompense, déficit des mécanismes d'inhibition motrice) sur le modèle des études conduites sur la dépression de l'adulte. Ce modèle tient très peu compte (1) du rôle des interactions parents/enfant et enfant/enfants, (2) du rôle des compétences motrices, et (3) du développement du langage dans le développement des capacités de catégorisation des émotions. Barrett-Fedelman a proposé un modèle constructiviste des émotions qui souligne l'importance des systèmes de simulation-prédiction des conséquences intéroceptives de nos actions dans l'expérience émotionnelle. Cette hypothèse permet de rendre compte de l'importance de l'environnement dans le développement des capacités de catégorisation des émotions. Les interactions répétées et synchrones avec les parents aident l'enfant à affiner de façon probabiliste son système de simulation-prédiction pour mieux prédire son environnement interne et externe (en particulier les réactions des partenaires interactifs). L'attribution d'états émotionnels à l'enfant, puis les conversations avec l'entourage permettent à l'enfant de rendre compte de ses perceptions en y attachant un concept émotionnel appris. L'enrichissement des échanges avec le milieu permet à l'enfant de partager, synchroniser, et continuer d'affiner ses catégories émotionnelles. Notre première hypothèse de travail est que les jeunes avec un TDDE présentent un trouble affectant le développement des compétences émotionnelles, en particulier la catégorisation des émotions. Les symptômes de TDDE doivent apparaitre dans la petite enfance en se dévoilant à mesure que les exigences de l'environnement deviennent plus importantes, à la différence des jeunes avec un trouble dépressif épisodique. Notre seconde hypothèse est que les jeunes avec un TDDE présentent des difficultés dans des dimensions développementales impliquées dans l'émergence des capacités de régulation des émotions. La fréquence des troubles du langage et de la motricité devrait être plus importante chez les jeunes avec TDDE comparée aux jeunes avec un trouble dépressif épisodique. Notre troisième hypothèse est que les jeunes avec TDDE présentent davantage de troubles d'intégration sensori-motrice comparés aux jeunes avec un trouble dépressif épisodique. En effet des problèmes d'intégration des information perceptives peut se traduire par des difficultés pour construire une représentation élaborée et stable des perceptions. En conséquence ces jeunes pourraient présenter plus des difficultés à catégoriser leurs expériences sous forme de concept émotionnel sur la base d'invariants perceptif

Irritabilité chez l'enfant et l'adolescent : contribution à la caractérisation du trouble disruptif avec dysrégulation émotionnelle et proposition d'un modèle étiologique développemental basé sur les mécanismes de simulation-prédiction

The Disruptive Mood Dysregulation Disorder (DMDD) was coined in 2013 in the DSM-5 to characterize children and adolescents with severe and persistent symptoms of irritability associated with repeated temper outbursts. The child’s emotional responses are grossly out of proportion in intensity or duration to the situation and inconsistent with his developmental level. While the diagnosis of DMDD is frequently associated with externalized disorders (disruptive behavioral disorder, attention deficit disorder), the risk factors and the natural course of DMDD puts them closer to depressive disorders. Most of the literature about the etiological mechanisms involved in DMDD symptoms has been devoted to cognitive processes (abnormalities in threat response systems, in reward system, in cognitive control) following the Research Domain Criteria framework mostly developed in adults with depression. However, such explanations are insufficient for reporting the (1) role of child/parent and child/children interactions and (2) the role of low-order cognitive skills such as motor and perceptive abilities and (3) the role of language competence in the emergence of emotional regulation in children. For the advocates of a “constructivist” view of emotions (Barrett 2006) emotional states result from the simulation of the sensory consequences of motor activities, in particular from interoceptive stimuli. Such ongoing flow of information that helps to guide decisions is only experienced as an emotion when they become conscious and recognized as such by the subject himself. This theory is consistent with the assumption that early emotional regulation development is acquired through repeated sensorimotor interactions with caregivers that help the infant to probabilistically refine his simulation-perception system to better predict his internal and external environment. This theory also supports the importance of the words/speech used by the parent when referring to the putative child’s mental states in progress to develop the child’s ability to categorize his own emotions. Firstly, it has been postulated that DMDD is a developmental condition primarily affecting the child’s ability to categorize emotions. The natural history of patients with DMDD should differ from those with episodic depressive disorder. The symptoms of irritability in DMDD should be chronic, with an onset around 1-3 year of age, and become apparent only when the social expectations about the child’s level of emotion discrimination increases. Secondly, it has been postulated that youths with DMDD should be developmentally impaired in dimensions involved in the development of emotional regulation. A higher rate of speech and motor disabilities should be found in youths with DMDD compared to those with episodic depressive disorder. Thirdly, it has been postulated that youths with DMDD should present more sensory processing difficulties compared to those with episodic depressive disorder. Indeed, a child with difficulties to integrate his own sensory inputs would have more difficulties to build a consistent and elaborated representation of his own perceptions, and ultimately to categorize his emotional states.Le diagnostic de Trouble Disruptif avec Dysrégulation Emotionnelle (TDDE) a été proposé en 2013 pour caractériser les difficultés de jeunes qui souffrent d'une irritabilité chronique accompagnée de crises de rage répétées disproportionnées à l'âge de développement. Bien que les jeunes avec un TDDE présentent très fréquemment des troubles externalisés associés (ex : trouble des comportements perturbateurs, trouble déficit de l'attention), les facteurs de risque et l'évolution naturelle du TDDE les rapprochent des troubles dépressifs. La plupart des travaux sur l'étiologie du TDDE se sont focalisées sur des perturbations cognitives (anomalie des systèmes de réponses à la menace, perturbations des systèmes de la récompense, déficit des mécanismes d'inhibition motrice) sur le modèle des études conduites sur la dépression de l'adulte. Ce modèle tient très peu compte (1) du rôle des interactions parents/enfant et enfant/enfants, (2) du rôle des compétences motrices, et (3) du développement du langage dans le développement des capacités de catégorisation des émotions. Barrett-Fedelman a proposé un modèle constructiviste des émotions qui souligne l'importance des systèmes de simulation-prédiction des conséquences intéroceptives de nos actions dans l'expérience émotionnelle. Cette hypothèse permet de rendre compte de l'importance de l'environnement dans le développement des capacités de catégorisation des émotions. Les interactions répétées et synchrones avec les parents aident l'enfant à affiner de façon probabiliste son système de simulation-prédiction pour mieux prédire son environnement interne et externe (en particulier les réactions des partenaires interactifs). L'attribution d'états émotionnels à l'enfant, puis les conversations avec l'entourage permettent à l'enfant de rendre compte de ses perceptions en y attachant un concept émotionnel appris. L'enrichissement des échanges avec le milieu permet à l'enfant de partager, synchroniser, et continuer d'affiner ses catégories émotionnelles. Notre première hypothèse de travail est que les jeunes avec un TDDE présentent un trouble affectant le développement des compétences émotionnelles, en particulier la catégorisation des émotions. Les symptômes de TDDE doivent apparaitre dans la petite enfance en se dévoilant à mesure que les exigences de l'environnement deviennent plus importantes, à la différence des jeunes avec un trouble dépressif épisodique. Notre seconde hypothèse est que les jeunes avec un TDDE présentent des difficultés dans des dimensions développementales impliquées dans l'émergence des capacités de régulation des émotions. La fréquence des troubles du langage et de la motricité devrait être plus importante chez les jeunes avec TDDE comparée aux jeunes avec un trouble dépressif épisodique. Notre troisième hypothèse est que les jeunes avec TDDE présentent davantage de troubles d'intégration sensori-motrice comparés aux jeunes avec un trouble dépressif épisodique. En effet des problèmes d'intégration des information perceptives peut se traduire par des difficultés pour construire une représentation élaborée et stable des perceptions. En conséquence ces jeunes pourraient présenter plus des difficultés à catégoriser leurs expériences sous forme de concept émotionnel sur la base d'invariants perceptif

A booklet to help for perinatal psychological assistance in maternity wards. Enhancing early screening and continuity of care between pre- and post-natal periods

International audiencePrenatal depression is a major public health issue, with potential negative consequences on the women's health, on her family, as well as on the early development of the child. Screening for prenatal depression is still scarce in France, although some very effective screening tools are now available. The pregnancy follow-up is a good opportunity to start a dialogue about the woman's mental health, using some French validated assessment tolls such as the EPDS, the PRAQ-R2 and the MIBS. Our proposition is to gather these scales into a perinatal follow-up booklet in order to ensure some continuity between the pre and postnatal periods. (C) 2021 l'Academie nationale de medecine. Published by Elsevier Masson SAS. All rights reserved

Music Therapy for Children With Autistic Spectrum Disorder and/or Other Neurodevelopmental Disorders: A Systematic Review

International audienceBackground: Several studies have reported contradictory results regarding the benefits of music interventions in children and adolescents with neurodevelopmental disorders (NDDs), including autism spectrum disorder (ASD). Methods: We performed a systematic review according to the PRISMA guidelines. We searched the Cochrane, PubMed and Medline databases from January 1970 to September 2020 to review all empirical findings, except case reports, measuring the effect of music therapy on youths with ASD, intellectual disability (ID), communication disorder (CD), developmental coordination disorder (DCD), specific learning disorder, and attention/deficit hyperactivity disorder (ADHD). Results: Thirty-nine studies (N = 1,774 participants) were included in this review (ASD: n = 22; ID: n = 7; CD and dyslexia: n = 5; DCD: n = 0; ADHD: n = 5 studies). Two main music therapies were used: educational music therapy and improvisational music therapy. A positive effect of educational music therapy on patients with ASD was reported in most controlled studies (6/7), particularly in terms of speech production. A positive effect of improvisational music therapy was reported in most controlled studies (6/8), particularly in terms of social functioning. The subgroup of patients with both ASD and ID had a higher response rate. Data are lacking for children with other NDDs, although preliminary evidence appears encouraging for educational music therapy in children with dyslexia. Discussion: Improvisational music therapy in children with NDDs appears relevant for individuals with both ASD and ID. More research should be encouraged to explore whether oral and written language skills may improve after educational music therapy, as preliminary data are encouraging

Early interventions for youths at high risk for bipolar disorder: a developmental approach

International audienceIn recent decades, ongoing research programmes on primary prevention and early identification of bipolar disorder (BD) have been developed. The aim of this article is to review the principal forms of evidence that support preventive interventions for BD in children and adolescents and the main challenges associated with these programmes. We performed a literature review of the main computerised databases (MEDLINE, PUBMED) and a manual search of the literature relevant to prospective and retrospective studies of prodromal symptoms, premorbid stages, risk factors, and early intervention programmes for BD. Genetic and environmental risk factors of BD were identified. Most of the algorithms used to measure the risk of developing BD and the early interventions programmes focused on the familial risk. The prodromal signs varied greatly and were age dependent. During adolescence, depressive episodes associated with genetic or environmental risk factors predicted the onset of hypomanic/manic episodes over subsequent years. In prepubertal children, the lack of specificity of clinical markers and difficulties in mood assessment were seen as impeding preventive interventions at these ages. Despite encouraging results, biomarkers have not thus far been sufficiently validated in youth samples to serve as screening tools for prevention. Additional longitudinal studies in youths at high risk of developing BD should include repeated measures of putative biomarkers. Staging models have been developed as an integrative approach to specify the individual level of risk based on clinical (e.g. prodromal symptoms and familial history of BD) and non-clinical (e.g. biomarkers and neuroimaging) data. However, there is still a lack of empirically validated studies that measure the benefits of using these models to design preventive intervention programmes

Navigating in Troubled Waters: The Developmental Roots of Disruptive Mood Dysregulation Disorder

International audienc