ABSTRACT
The Italian Society of Childhood and Adolescent Neuropsychiatry (SINPIA) created a Working Group dedicated to the study of Severe Social Withdrawal (SSW) in children and adolescents. The Working Group produced an online questionnaire aimed at mapping and evaluating the cases of SSW that contacted the NPIA Services in the last year. The questionnaire was proposed to the Italian Child Neuropsychiatrists by email invitation from July to October 2020. The questionnaire had two independent sections: a first one, about the general characteristics of SSW, to be completed once ("Section A");a second one, optional, to be completed once for each SSW patient met in the last 12 months (from June 2019 to of June 2020) ("Section B"). At the closing date of the survey (3-12-2020), 119 "Section A" and 136 "Section B" answers had been collected. We illustrate the survey results and discuss possible risk factors, diagnostic frameworks, prognostic indicators, and treatments. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (Italian) Il gruppo di lavoro della Societa Italiana di Neuropsichiatria dell'Infanzia e dell'Adolescenza (SINPIA), dedicato al ritiro sociale grave in eta evolutiva, ha realizzato un questionario finalizzato al mappaggio delle situazioni di ritiro che hanno contattato i Servizi nell'ultimo anno e alla valutazione delle stesse. Il questionario, diviso in due parti, una da compilare una sola volta e una opzionale, da compilare per ciascun ragazzo con le caratteristiche del ritiro sociale grave con cui il compilatore fosse venuto in contatto negli ultimi 12 mesi (dal mese di giugno 2019 al mese di giugno 2020), e stato proposto agli specialisti italiani in tre ondate ravvicinate. Al momento della chiusura dell'indagine (3/12/2020), i questionari parte A ricevuti sono stati 119, a fronte di 136 questionari parte B. Vengono illustrati i risultati dell'indagine e discussi i possibili fattori di rischio, inquadramenti diagnostici, indicatori prognostici e trattamenti. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
Social withdrawal in adolescence presents itself as a spectrum of phenomena ranging from the variant of the norm to severe psychopathology. According to recent data, this condition involves almost 100.00 youths, mostly male. This work summarizes the clinical characteristics of Serious Social Withdrawal (RSG), the possible paths of diagnosis and management, and its correlation with the phenomena induced by the COVID-19 pandemic. The main aspects of this phenomenon are self-reclusion at home for 6 months, with rare exits and early school leaving, reduction of direct communication with family members and external relations, partly substituted from virtual relationships via web. The typical onset is in pre-adolescence, with a second peak at the threshold of adulthood, occasionally associated with frustration, bullying or exposure to narcissistic traps. The family systemic function could be displaced by the social withdrawal. Primary and secondary social withdrawal differential diagnosis represents a complex and discussed topic also due to the potentially pathogenic role of social withdrawal itself. RSG does not appear in diagnostic manuals as a nosological entity "per se", but as a symptom of other pathologies (anxiety disorders, mood disorders, etc.) but it is placed in the intersection of individual, developmental, family and social trajectories. On one side the "evolutionary" role of RS can be linked to a temporary narcissistic reorganization in adolescence or could represents the onset of a structured disorder of affective and emotional functioning. Services and Mental Health Specialists may have difficulties to reach less severe patients or with lower efficient family networks. The difficulties of reorganizing the NPIA Services in the COVID-19 are discussed maintaining flexible and multidimensional interventions. The standard situation of the Services forces to structure the interventions based on the available resources, and not only based on clinical needs;earliness and integration of the interventions are related to a more favorable prognosis. In a second section, we discuss the specific characteristics of the reception, diagnosis and care pathways of patients with RSG in an out-patient and semi-residential setting, and in a hospital setting (from the A&E to admission to the Day Hospital). Italian Care Services organizational characteristics are heterogeneous, with diversified protocols, structures and paths. The prevention and an early and synergistic care and stable and formal collaboration agreements between health, social and educational skills are fundamental. The available diagnostic tools are discussed, as well as the criteria for the direct care project, based on necessity, coherence, feasibility, both to the minor and to the family and its environment, and their possible use by a mobile and competent team. The general and practical theoretical aspects of home and semi-residential interventions are outlined. The path and effectiveness indicators and their modification from the beginning of 2020, still in progress due to the distortions induced by the COVID-19 pandemic, are discussed. We focus on changes in the very concept of "school" and "presence", and to their meaning for narcissistically fragile, anxious or depressed subjects. Possible semi-residential, therapeutic, rehabilitative, intensive, complex and coordinated interventions are discussed in detail, with particular regard to their transitional role between acute and hospitalization, as an "enlarged psychic space". Finally, the existing experiences in the hospital, ward and A&E setting are mentioned. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
ABSTRACT
The health emergency due to the COVID-19 pandemic provided a remodelling of spaces and times due to the distancing needs with a reduction on common social connections. The lockdown has weighed on those children and adolescents specifically who already showed social withdrawal, self-confinement at home, with poor social relationships in the usual social contexts, including school and peer groups, defined in this article as children and adolescent with severe social withdrawal, or in other contexts as Hikikomori, and including a wide range of conditions that can range from dysfunctional ways (albeit transitory) to face with the adolescent phase to specific clinical and psychopathological disorders. In almost all the NPIA services, in the phase 1 of the COVID pandemic, the therapeutic interventions with these adolescents and their families continued "remotely" by telemedicine and through NPI interviews, psychotherapy sessions, psychoeducational groups, networks between NPIA services, social service and school in video connection, as a new opportunity to invest in experiences, teaching and relationships with mixed results. The evaluation of the outcomes and the responses of adolescents and families to the telemedicine could also help to define of what has been activated in the emergency context can be remained in ordinary clinical activity even "beyond COVID-19" or, in the serious event of a forthcoming COVID. The SINPIA promoted the formation of a dedicated Working Group in order to: define one of the most significant and current manifestations of adolescent distress across all Services;verify the point of view of Child Neuropsychiatrists among the behavioural phenotype and personality structures of patients with severe social withdrawal and how much the NPIA Services organization could respond to the needs of these adolescents;study the development course of the personality in subjects with severe social withdrawal;verify how the behaviour of these young people has changed in the era of COVID-19 emergency (pre-COVID phase, Lockdown Phase 1, Re-opening Phase 2-3). Three working subgroups respectively focused on defining: the 'social withdrawal' disorder as a symptom and not as a disorder, the need to define ad hoc assessment and treatment protocols and to identify indicators of prognosis within a range of comorbidities;and finally, to trace good practices and treatment remodelling with a focus on early interventions. (PsycInfo Database Record (c) 2021 APA, all rights reserved) Abstract (Italian) L'emergenza Sanitaria dovuta alla diffusione pandemica COVID-19, ha previsto un rimodellamento di spazi e tempi dovuto alle necessita di distanziamento con riduzione delle comuni connessioni sociali. Il lockdown ha gravato, in modo specifico, sui quei ragazzi e adolescenti che gia si trovavano in situazioni di isolamento, autoreclusione in casa, volontariamente allontanatisi dai contesti sociali abituali, inclusa la scuola e i gruppi di pari, in questo testo definiti minorenni con "Ritiro Sociale Grave", in altri contesti Hikikomori, inseriti in una vasta gamma di condizioni che possono spaziare da modalita disfunzionali, per quanto transitorie, di affrontare la fase evolutiva adolescenziale fino a franchi quadri psicopatologici. In quasi tutti i Servizi di NPIA, nella fase 1 dell'emergenza, gli interventi con questi ragazzi e relative famiglie, sono proseguiti "da remoto", in telemedicina, attraverso colloqui NPI, sedute di psicoterapia, gruppi psicoeducativi, reti tra servizi NPIA, sociali e scuola in videocollegamento, mediate dal PC, nuova opportunita di investire sulle esperienze, sulla didattica e sulle relazioni, fornendo risultati alterni. La valutazione degli outcome e delle risposte di ragazzi e famiglie alla proposta 'online' portera anche a definire quanto di cio che e stato attivato dall'urgenza, potra essere conservato nell'attivita clinica ordinaria anche 'oltre' il COVID-19" o, nella grave eventualita di un prossimo COVID". La SINPIA ha deciso di attivare un Gruppo di Lavoro dedicato per poter definire in modo trasversale a tutti i Servizi una delle piu significative manifestazioni del disagio adolescenziale odierno;verificare il punto di vista dei Neuropsichiatri Infantili sul fenotipo comportamentale e sulle strutture di personalita dei pazienti con ritiro sociale grave e quanto l'organizzazione dei Servizi di NPIA potesse rispondere ai bisogni di questi ragazzi;studiare quale sia lo sviluppo della personalita nel Ritiro Sociale Grave;verificare come si sia modificato il comportamento di questi ragazzi in epoca di emergenza sanitaria COVID-19 (fase pre-COVID, Fase di Lockdown Fase 1, Fase di Riapertura 2-3). Tre sottogruppi di Lavoro si sono dedicati alla definizione del disturbo 'ritiro sociale' come sintomo e non come patologia in se, alla necessita di definire protocolli di valutazione e trattamento ad hoc e individuare di indicatori di prognosi all'interno di una gamma di comorbidita. Infine tracciare buone prassi con il focus sugli interventi precoci, attraverso una rimodulazione di quelli esistenti. (PsycInfo Database Record (c) 2021 APA, all rights reserved)