Tools and Methods for Anxiety Disorder Assessment among Children and Adolescents in Cognitive and Behavioral Therapies‏

International audienceThis chapter provides an overview of current knowledge on the assessment of anxiety disorders in children and adolescents in relation to CBT treatment. Although the dimensional and categorical approaches have often been presented as opposed, today they appear to be compatible, particularly after the publication of version 5 of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which overcomes this opposition and uses the two in combination. Nevertheless, a good working knowledge of these theoretical constructs is needed to choose among the many available clinical tools, questionnaires, tests, etc. The abundance and variety of these instruments means that they need to be selected on a case-by-case basis. especially with children, with whom clinical methodology often requires the participation of an external informant (parent, other close adult). Finally, despite the traditional division between the practices used in assessment and therapy, it is now possible, and even essential, to reconcile evaluative and therapeutic approaches on a single dynamic and longitudinal continuum. Here, we examine this particular issue in the case of cognitive and behavioral therapies, wherein the role of the various instruments that we survey includes the assessment both of the treated psychopathologies and of the effectiveness of the therapies themselves. We offer recommendations for the selection and use of clinical tools in screening and treatment for anxiety disorders in children and adolescents

Anxiété de séparation et refus scolaire anxieux chez l’enfant : étude de cas

International audienceThe aim of this study was to present the cognitive-behavioral therapy of a child with a separation anxiety disorder and severe school refusal behavior. Epidemiologic studies suggest that anxiety separation disorder in pre-pubescent children affects between 4 to 5% of the general population (Massi et al., 2001). The identified risk factors include attachment (Brumariu and Kerns, 2010) or parental practices such as overprotection (Mofrad et al., 2009). The researchers and clinicians Blatter-Meunier and Schneider (2011) created the family program against separation anxiety (PFAS) which is an empirically verified behavioral treatment of separation anxiety. The first four sessions contain psychoeducation about the difference between normal anxiety, pathological anxiety and anxiety during child growth. The child begins to develop positive thoughts against fear and anxiety. It also provides the opportunity to explore the child's personal experiences about the disappearance of fear, to talk about other situations and to identify avoidant behaviors and parental dysfunctional thoughts which could maintain fear of separation. Then, the child and their family choose anxiety exposition situations and the active phase of the therapy begins. This program was followed in cognitive-behavioral therapy with Maeva, a 7-year-old girl and her family. Maeva was a smiling and joyful girl when she was with her mother. As soon as her mother left the room, she became anxious, bit her nails, asked the time and pretended to have something to find in her mother's handbag. According to her mother, Maeva never slept alone. She used to sleep with her parents and she had slept with her grandmother since her grandfather had died. Severe separation anxiety began at the same time as her parent's separation. For six weeks, Maeva had cried every morning in front of the school and entered the classroom late. Crying fits lasted longer and longer and Maeva was unable to participate in learning and class activities. The psychotherapist used the Screen for Child Anxiety Related Emotional Disorders (SCARED; Birmaher, 1997), the Children Depression Inventory (CDI; Kovacs, 1981, 1992), the Schedule for Affective Disorders and Schizophrenia for School-Age-Children Present and Lifetime version (Kiddie-SADS-PL; Puig-Antich and Chambers, 1978), behavioral observations from Maeva's mother and teacher and the Situations Émotions Cognitions Comportements Anticipations (SECCA; Cottraux, 1990) to assess psychopathological disorders and to do the functional analysis and case conceptualization. Maeva and her mother quickly and actively adhered to this program. The girl no longer worried about separation and going to school. She gained autonomy and maturity. Indicators used to assess symptoms and behaviors before, after and two months after the therapy decreased considerably. The overall improvement in total anxiety was 55% and 66% about separation anxiety. Social interactions were no longer a problem. The main difficulty was to plan sessions with Maeva's grandmother who was constantly unavailable. Maeva's parents were asked to become mediators between therapy and the grandmother. They had to include the grandmother in exercises at home and to teach her psychoeducation elements they had seen in sessions. This case also provided an opportunity to highlight the importance of including family members and the child's environment in case conceptualization, functional analysis and the child's individual care in cognitive-behavioral therapy.L’objectif de ce travail est de présenter la prise en charge en thérapie comportementale et cognitive (TCC) d’une enfant souffrant d’anxiété de séparation se manifestant par un refus scolaire anxieux à travers une étude de cas. Les données épidémiologiques semblent indiquer que le trouble anxiété de séparation chez les enfants pré-pubères est de l’ordre de 4 à 5 % dans la population générale (Massi et al., 2001). En ce qui concerne les facteurs de risque identifiés, ils incluent notamment l’attachement (Brumariu et Kerns, 2010) ou encore les pratiques parentales comme la surprotection (Mofrad et al., 2009). D’autre part, en ce qui concerne l’âge de début, il semble exister un pic vers 5–7 ans, lors de l’entrée au cours préparatoire (Doerfler et al., 2008). Les chercheuses et cliniciennes Blatter-Meunier et Schneider (2011) ont créé le programme familial contre l’anxiété de séparation (PFAS) qui est un programme thérapeutique comportemental du traitement de l’anxiété de séparation vérifié empiriquement. Ce programme a été suivi dans la prise en charge de Maeva âgée de 7 ans et de sa famille. Ce cas clinique est également l’occasion de souligner la place centrale de l’intégration de la famille et de l’environnement de l’enfant dans la conceptualisation de cas, l’analyse fonctionnelle et dans la prise en charge d’enfants en TCC

Contribution de la Screen for Child Anxiety Related Emotional Disorders au dépistage et au diagnostic des troubles anxieux chez l'enfant d'âge scolaire

International audienceChildren's anxiety disorders were for a long time viewed as poorly differentiated; however, many researchers recently brought evidence that syndromes similar to adult ones are clearly recognizable among very young children. The best instruments for diagnosing these disorders are time-consuming structured interviews like the Schedule for Affective Disorders and Schizophrenia for School Age Children (Kiddie-SADS). Is it possible to shorten the diagnostic procedure using “paper/pencil” questionnaires as diagnostic tests? The aim of this study was to test the diagnostic value of the Screen for Child Anxiety Related Emotional Disorders (SCARED), which comprises a self-report form and a parent-report form, and assesses four DSM anxious disorders. We examined 69 children aged 6 to 12 (36 boys) addressed to a school psychology facility using both self-report and parent-report SCAREDs and Kiddie-SADSs. Indices were defined, based on threshold-scores on the four SCARED syndrome scales. Theses indices all showed high sensitivity, but have different specificities: maximal for separation anxiety disorder, moderate for panic disorder and social phobia, but poor for generalized anxiety disorder. The SCARED-based indices performed well as screen for these four anxious disorders. In addition, they allow substantial time economy in the process of diagnosing separation anxiety disorder, panic disorder, and social phobia.On a longtemps considéré que les troubles anxieux des enfants étaient peu différenciés, mais de nombreux travaux ont montré au cours des dernières années que des syndromes très semblables à ceux des adultes sont repérables précocement chez l’enfant. Les instruments privilégiés pour le diagnostic de ces troubles sont des entretiens structurés très chronophages tels que la Schedule for Affective Disorders and Schizophrenia for School Age Children (Kiddie-SADS). Est-il possible d’alléger la démarche diagnostique en utilisant en première intention des questionnaires « crayon-papier » comme tests de dépistage ? Le but du présent travail est de tester l’intérêt diagnostique du questionnaire Screen for Child Anxiety Related Emotional Disorders (SCARED) dont il existe deux formes destinées l’une aux enfants, l’autre aux parents et qui évalue quatre troubles anxieux spécifiques. Pour ce faire, on a examiné 69 enfants (dont 36 garçons) âgés de six à douze ans vus dans une consultation de psychologie scolaire, au moyen de la SCARED et de la Kiddie-SADS. On a défini des indices à partir de notes seuils aux différentes échelles des deux formes de la SCARED. Ces indices ont tous une sensibilité élevée mais diffèrent par leur spécificité, maximale pour l’angoisse de séparation, modérée pour le trouble panique et la phobie sociale, mais médiocre pour l’anxiété généralisée. Les indices dérivés de la SCARED présentent un intérêt certain dans le dépistage de ces quatre troubles anxieux et permettent un gain de temps substantiel pour le diagnostic de l’angoisse de séparation, du trouble panique et de la phobie sociale

Contribution de la SCARED (Screen for Child Anxiety Related Emotional Disorders), de la CBCL (Child Behavior CheckList) et de la Kiddie-SADS (Schedule for Affective Disorders and Schizophrenia for School-Age Children) à l'évaluation des troubles anxieux chez l enfant d âge scolaire

On s est proposé : 1) de déterminer si les formes auto-et-hétéro-évaluatives du questionnaire Screen for Child Anxiety Related Emotional Disorders (SCARED), la Youth- Self Report (YSR) et la Child Behavior ChekList (CBCL) constituent de bons prédicteurs des diagnostics des différents troubles anxieux posés à l aide de l'entretien semi-structuré Schedule for Affective Disorders and Schizophrenia for School-Age-Children- Present version (Kiddie-SADS-P) sur un échantillon français d enfants consultants ; 2) de vérifier l aptitude de la SCARED à discriminer les enfants consultants des enfants tout-venant ; 3) d étudier l influence du sexe sur le niveau d anxiété et 4) d évaluer le niveau de concordance parents/enfants dans l évaluation de ces troubles. Méthode : 69 enfants âgés de 6 à 12 ans, consultant pour une aide psychologique au sein de Réseaux d Aide Spécialisée aux Enfants en Difficulté (RASED) ont été évalués au moyen de l'entretien semi-structuré Kiddie-SADS et des questionnaires SCARED, CBCL et YSR. Les protocoles de la SCARED (forme enfant et forme parent) ont été comparés à ceux d'un groupe témoin composé de 48 dyades enfant/parent issus des mêmes écoles. Résultats: Les scores d'anxiété auto-évalués par les enfants à la SCARED constituent de bons prédicteurs des critères de troubles anxieux évalués au moyen de l'entretien Kiddie-SADS. Contrairement aux études internationales, aucune différence entre les filles et les garçons n'apparait dans notre échantillon. A cause du faible taux d'accord entre parent/enfant sur le niveau des troubles anxieux, les deux évaluations apparaissent nécessaires pour l'obtention d'un diagnostic adéquat.The aims of this study were : 1) to examine if the self-report and other-report forms of the questionnaire Screen for Child Anxiety Related Emotional Disorders (SCARED), the Youth Self-Report (YSR), and the Child Behavior ChekList (CBCL) are good predictors of the different anxiety disorders diagnosed using the semi-structured interview Schedule for Affective Disorders and Schizophrenia for school-age children-Present version (Kiddie-SADS-P) on a French sample of referred children, 2) to check the ability of the SCARED to discriminate referred and non-referred children, 3) to study the influence of gender on the anxiety level, and 4) to evaluate the level of parent/child agreement in the assessment of these disorders. Method: 69 children aged 6 to 12 years, referred to a "RASED" (a psychological/educational support facility located in the French schools) were assessed using the Kiddie-SADS semi-structured interview, and the SCARED, CBCL and YSR questionnaires. The SCARED questionnaires (self-report and parent-report) were compared with a control group scores of 48 parent/child dyads selected from the same schools. Results: The self-reported SCARED anxiety scores are good predictors of anxiety disorders criteria, assessed using the Kiddie-SADS interview. Contrary to international studies, no difference between girls and boys appears in our sample. Because of the low levels of agreement between parent/child about levels of anxiety disorders the two assessments appear necessary to obtain a proper diagnosis.NANTERRE-BU PARIS10 (920502102) / SudocSudocFranceF

Corrélation Entre Les Symptômes Anxieux et Les Schémas d'inadaptation Précoces Auprès de Participants Âgés de 10 à 15 Ans

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Autism and creative process

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Pourquoi Game of Thrones est un cas clinique

La série d'HBO déclenche une hystérie planétaire chaque saison depuis 2011. On a tenté d'expliquer cette frénésie avec l'aide de psychologues

Do Emotional Disorders Influence the Developmental Course of Executive Functioning? A Pilot Study with Parents-Infants Aged between 6- and 24-Months

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Stratégies de coping et sentiment de compétence parentale des parents d’enfants atteints de troubles autistiques

International audienceIntroductionNumerous studies have been done about the impact of the diagnosis of autism spectrum disorder on the parents’ quality of life and the family as a whole. Confronting child suffering, day-to-day disability management and difficulties in integrating the child have an impact on the physical and mental well-being of parents. Parenting with a child suffering from a disability requires significant cognitive, emotional and behavioral adjustments by the parents. New knowledge in this field would make possible to adjust as much as possible the therapeutic management, in particular in the accompaniment of parents experience and parenting role. The main objective of this study is to identify links between coping strategies of parents to deal with the stressful events induced by the child's disability and their sense of parental competence. The second objective is to observe whether the integration of parents into the therapeutic management of the child has an impact on well-being.MethodThirty-three parents of children with autism spectrum disorder completed the WCC-R, PANAS, QAECEP and ASR. We have studied the links between coping strategies adopted by parents to deal with the stressful events induced by the child's disability and their sense of parental competence, a factor influencing their subjective well-being. We were interested in the consequences of the integration by the professional team of the parent in the care of the child on the feeling of parental competence.ResultsCoping strategies centered on emotions disrupt feelings of parental satisfaction. In addition, parents who are satisfied with their role tend to express a better sense of subjective well-being and parental skill than the less satisfied parents. Finally, the integration of the parent in the child care process promotes the sense of parental competence.ConclusionIt seems important to note that the better the feeling of parental competence, the less the depressive symptomatology is high. The results confirm the need for professional teams in charge of the autism spectrum disorder child to integrate, support and help parents in their parenting role. This support allows them to develop a good sense of parental competence and fosters their sense of well-being.IntroductionLe présent article a pour objectif d’étudier les répercussions de l’autisme de l’enfant sur le bien-être psychique des parents. La parentalité auprès d’un enfant handicapé nécessite d’importants ajustements cognitifs, émotionnels et comportementaux de la part des parents. L’hypothèse principale est que des difficultés d’adaptation dans ces différents domaines pourraient générer de la souffrance et impacter le sentiment de bien-être des parents. De nouvelles connaissances dans ce champ permettraient d’ajuster au mieux les prises en charge thérapeutiques, notamment dans l’accompagnement du parent dans son vécu et son rôle parental.MéthodeTrente-trois parents d’enfants atteints de troubles autistiques ont rempli la WCC-R, la PANAS, le QAECEP et l’ASR. Nous avons étudié les liens existants entre les stratégies de coping adoptées par les parents pour faire face aux évènements stressants induits par le handicap de l’enfant et leur sentiment de compétence parentale, facteur influençant leur bien-être subjectif. Nous nous sommes intéressés aux conséquences de l’intégration, par l’équipe professionnelle, du parent dans la prise en charge de l’enfant sur le sentiment de compétence parentale.RésultatsLes stratégies de coping centré sur les émotions perturbent le sentiment de satisfaction parentale. De plus, les parents satisfaits dans leur rôle ont tendance à exprimer un meilleur sentiment de bien-être subjectif que les parents se disant moins satisfaits. Enfin, l’intégration du parent dans le processus de soin de l’enfant favorise son sentiment de compétence parentale.ConclusionLe soutien des parents leur permettrait de développer un bon sentiment de compétence parentale et de favoriser leur sentiment de bien-être

Psychological Disorders and Ecological Factors Affect the Development of Executive Functions: Some Perspectives

International audienceThe links between deficits in executive functions (EFs) (e.g., mental flexibility, inhibition capacities, etc.) and some psychological disorders (e.g., anxiety and depressive disorders) have been investigated in the past decades or so