Xavier Benarous

Abstract: Difficulty modulating sensory information has been described in children with developmental disorders. However, the relation of sensory processing difficulties (SPD) to emotional regulation problems remains poorly understood. The aim of this study is to determine the rate and patterns of SPD in youth with disruptive mood dysregulation disorder (DMDD). Participants were DMDD patients aged 6-16 years presenting at a university hospital in outpatient or inpatient facilities (n = 30). For each participant, the parent-reported Sensory Profile, the Affective Lability Scale, the Beck Depression Inventory-Second Edition, the Child Behavior Checklist/4-18, and the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version were completed. The scores of the Sensory Profile of the DMDD youths were compared to those obtained in a clinical control group and to the manual scores for same-age typically developing youths. SPD were reported in 53% of the subjects in the DMDD group compared to 33% in the clinical control group (p = 0.405). Youths with DMDD showed a significant difference on almost all items of the Sensory Profile compared to typically developing youth. The Sensory Profile was found to discriminate best between the participants with DMDD and those in the clinical control group with regard to the category "Behavioral outcomes of sensory processing" and the factor "Fine motor/perceptual behavior." All types of sensory processing patterns were reported in the DMDD youths: sensation avoiding (40%), low registration (27%), sensory sensitivity (20%), and sensation seeking (10%). As a group, youths with DMDD have significantly more SPD when compared to typical youths. Therefore, SPD could be an important factor to consider in youths with DMDD when providing comprehensive assessment and therapeutic interventions.

Abstract: Introduction Catatonia is a rare and severe psychomotor condition in children and adolescents. In the current report, we aimed to review the recent literature. Method Using a PRISMA approach, we searched MEDLINE between 1982 and 2017 using the keywords ‘CATATONIA’ and ‘CHILD’ or ‘ADOLESCENT’. In total, we reviewed 130 reports (controlled study, N = 4; clinical chart, N = 23; case report, N = 54; and editorial/review, N = 42). Results Several aspects seem to be age specific: (1) although the clinical presentation resembles that in adults, some symptoms are important in children and adolescents (e.g., psychomotor regression). (2) Associated disorders are similar to that found in adults; however, schizophrenia is more frequently observed than mood disorder. Additionally, a history of neurodevelopmental disorders maybe encountered. (3) Morbidity and mortality are among the worst in child psychiatry. (4) Underlying organic conditions are highly prevalent (> 20% of the cases), and their search is warranted because some diagnoses may result in specific treatments (e.g., immune-suppressor therapy for autoimmune conditions). (5) Symptomatic approaches – high dose of benzodiazepines and electroconvulsive therapy (ECT) – are as efficient in children or adolescents as they are in adults, but this finding needs to be acknowledged because a resistance against the use of ECT or high-dose medication exists among child psychiatrists. Discussion Recent advances in child and adolescent catatonia research have offered major improvements in understanding catatonia and in new therapeutic opportunities. The syndrome is rare, but these advances need to be acknowledged in order to direct patients to centers that have developed a specific expertise.

Abstract: Compared to the large number of studies exploring difficulties in emotion recognition in maltreated children, few (N=12) have explored the cognitive aspect of theory of mind, i.e., the ability to understand others’ thoughts and intentions. A systematic review of these studies shows inconsistent results regarding cognitive theory of mind tasks. Youths with a history of maltreatment are more likely to fail at false belief tasks (N=2). However, results are less conclusive regarding other tasks (perspective-taking tasks, N=4; and hostile attribution tasks, N=7). Additionally, only one study controlled for potential psychopathology. Measures of psychopathology and other cognitive abilities, in addition to theory of mind, are required to establish a specific association between maltreatment and the cognitive dimension of theory of mind.

Abstract: Context: Substance Use Disorders (SUDs) are highly prevalent among inpatient adolescents with psychiatric disorders. In this population, substance use and other psychiatric outcomes can reinforce one another. Despite the need for integrated interventions in youths with dual diagnoses, few specific instruments are available. App-based technologies have shown promising results to help reduce substance use in adolescents, but their applicability in youths with associated severe psychiatric disorders is poorly documented. We aim to evaluate the feasibility of an ecological momentary assessment (EMA) intervention for all substance users, and of a smart-phone application for cannabis users (Stop-Cannabis), for outpatient treatment after hospital discharge. Methods and analysis: All inpatient adolescents with psychiatric disorders hospitalized between 2016 and 2018 in a university hospital will be systematically screened for SUD and, if positive, will be assessed by an independent specialist addiction team. Participants with confirmed SUDs will be invited and helped to download an EMA app and, if required, the Stop-Cannabis app the week preceding hospital discharge. Information about the acceptability and use of both apps and the validity of EMA data in comparison to clinical assessments will be assessed after 6 months and one year. Discussion: This research has been designed to raise specific issues for consideration regarding the sequence between substance use, contextual factors, and other psychiatric symptoms among adolescents with comorbid severe psychiatric disorders. A better understanding of the mechanisms involved will inform the development of integrated treatment for dual disorders at that age. Ethics and dissemination: The study has already been approved and granted. Dissemination will include presentations at international congresses as well as publications in peer-reviewed journals. Trial registration: European Clinical Trials Database: Number 2016-001999-30.

Abstract: In 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.

Abstract: Objectives. We examined whether kindergarten teachers' ratings of children’s prosocial skills, an indicator of noncognitive ability at school entry, predict key adolescent and adult outcomes. Our goal was to determine unique associations over and above other important child, family, and contextual characteristics.Methods. Data came from the Fast Track study of low–socioeconomic status neighborhoods in 3 cities and 1 rural setting. We assessed associations between measured outcomes in kindergarten and outcomes 13 to 19 years later (1991–2000). Models included numerous control variables representing characteristics of the child, family, and context, enabling us to explore the unique contributions among predictors.Results. We found statistically significant associations between measured social-emotional skills in kindergarten and key young adult outcomes across multiple domains of education, employment, criminal activity, substance use, and mental health.Conclusions. A kindergarten measure of social-emotiona...

Abstract: Background: Efficacy trials suggest that structured psychological therapies may significantly reduce recurrence rates of major mood episodes in individuals with bipolar disorders. Aims: To compare the effectiveness of treatment as usual with an additional 22 sessions of cognitive-behavioural therapy (CBT). Method: We undertook a multicentre, pragmatic, randomised controlled treatment trial (n = 253). Patients were assessed every 8 weeks for 18 months. Results: More than half of the patients had a recurrence by 18 months, with no significant differences between groups (hazard ratio = 1.05; 95% CI 0.74–1.50). Post hoc analysis demonstrated a significant interaction (P = 0.04) such that adjunctive CBT was significantly more effective than treatment as usual in those with fewer than 12 previous episodes, but less effective in those with more episodes. Conclusions: People with bipolar disorder and comparatively fewer previous mood episodes may benefit from CBT. However, such cases form the minority of those re...

Abstract: Aims: To investigate what patterns of bruising are diagnostic or suggestive of child abuse by means of a systematic review Methods: All language literature search 1951–2004 Included: studies that defined patterns of bruising in non-abused or abused children <18 years Excluded: personal practice, review articles, single case reports, inadequate confirmation of abuse Two independent full text reviews using standardised data extraction and critical appraisal forms Studies ranked by study design and definition of abuse used Results: Twenty three studies included: seven non-abusive bruising, 14 abusive bruising, and two both Non-abusive: The prevalence, number, and location of bruises is related to increased motor development Bruising in non-independently mobile babies is very uncommon (<1%) Seventeen per cent of infants who are starting to mobilise, 53% of walkers, and the majority of schoolchildren have bruises These are small, sustained over bony prominences, and found on the front of the body Abuse: Bruising is common in children who are abused Any part of the body is vulnerable Bruises are away from bony prominences; the commonest site is head and neck (particularly face) followed by the buttocks, trunk, and arms Bruises are large, commonly multiple, and occur in clusters They are often associated with other injury types that may be older Some bruises carry the imprint of the implement used Conclusion: When abuse is suspected, bruising must be assessed in the context of medical, social, and developmental history, the explanation given, and the patterns of non-abusive bruising Bruises in non-mobile infants, over soft tissue areas, that carry the imprint of an implement and multiple bruises of uniform shape are suggestive of abuse Quality research across the whole spectrum of children is urgently needed