Risk Factor Profile in Inpatients with School Refusal: a Dimensional Model.

BACKGROUND: School attendance problems have an impact on the social, academic, and professional development of young people. School refusal and truancy are described as school attendance problems. Clarifying the developmental trajectory of school refusal would allow a better understanding of the phenomenon including earlier detection and improved management. Following a dimensional model, we can consider school refusal as an internalizing problem and truancy as an externalizing problem implying the existence of different risk factor profiles. SUBJECT AND METHOD: We conducted a retrospective study on four groups of child and adolescent inpatients (school refusal (SR), truancy (TR), behavior disorder without deschooling (BD), and eating disorder (ED). Each subject was included in one of the groups based on a checklist criterion and the diagnoses made at the end of hospitalization. We then compared groups with descriptive statistics (Chi² and Fisher's exact test) to highlight the developmental trajectory and the possible risk factors profile in SR. RESULTS: Delayed language development, attachment disorder, attentional deficit and hyperactivity disorder, physical abuse, and substance abuse were predominantly reported in BD and TR. Learning disorders were mostly present in BD, TR, and SR. Family interactions were more violent and aggressive in BD and TR than in ED and SR. We observed more violent and conflictual relationships with peers in BD and TR. In SR, subjects seemed to experiment with more isolation and rejection. Behavioral disorder non-specified, ODD, and CD seemed more frequent in BD and TR. We found anxiety disorder and mood disorders more frequently in the SR group. CONCLUSION: Inpatients with severe SR are characterized by internalizing problems and difficulties in emotional dysregulation and problems socializing with peers. Inpatients with BD and TR were associated with externalizing problems and difficulties in behavioral regulation skills.

Inpatient with an Anxious School Refusal: A Retrospective Study.

BACKGROUND: School refusal has an impact on the mental health and on future of young people. This phenomenon cannot only be linked to school dysfunction but must be considered in a larger set of processes. Recent studies propose an understanding of school refusal in terms of psychopathology and individual functioning as well as in terms of associated environmental and family factors. SUBJECTS AND METHODS: We conducted a retrospective study on youths admitted in our child psychiatric unit at HUDERF with an anxious school refusal behavior. The medical records of all 442 patients, admitted in the unit between 1996 and 2019, were inspected. It allows the inclusion of 71 patients, aged from 8 to 16 years. RESULTS: 16% of all patients present an anxious school refusal (ASR). There is a significant difference of sex, in inpatients with anxious school refusal, with 70.42% of male (p<0.0003). Concerning familial and parental characteristics, family separation (56.3%), conflict at home (27%), contact rupture with the father (25.3%) were associated with the onset of the school refusal. Parental psychiatric illness was frequently reported with maternal psychiatric illness (46.5%) and paternal history of psychiatric illness (28.2%). Maltreatment (30.9%) was also frequently observed in our inpatient population of youths with ASR. Concerning school and peers' relationships, we observe relational difficulties with peers (46.5%), bullying (26.7%), academic difficulties (36.6%) or change of school or moving home (19.7%). Mood and adjustment disorder were the most frequent associated diagnosis in our sample. CONCLUSION: We confirmed that patient with anxious school refusal that need inpatient care were usually male, with more complex psychopathologies in term of comorbidities and familial maltreatment or psychiatric loading. They also have much more peers and school problems.

Use of Video Games in a Child And Adolescent Psychiatric Unit.

BACKGROUND: Video game has become the preferred form of play among youth. Substantial research has mainly examined problems related to potential negative effects of video games ranging from sedentary screen time, exposure to violence, and excessive or problematic gaming. However, over the past two decades, the use of video games in psychotherapy has become increasingly popular with a lot of applications. SUBJECTS AND METHODS: After a review of the use and the effectiveness of commercial video games in the psychotherapy framework, we will share our experience in the use of video games in a child and adolescent psychiatric unit. We will illustrate it with the presentation of specific case reports. RESULT: As video games are highly popular among children and adolescents, they are also interesting tools in the psychotherapeutic work with them. It's a new kind of play therapy, considering the setting, the psychological material that expresses during the game, the interpersonal relationships between gamers, the projective representation within the avatars, the cognitive strategies within the game. CONCLUSIONS: Video games represent an essential tool in taking care of child psychiatric patients because of their popularity. They contribute greatly to build the patient/psychotherapist relationship. They help to approach cognitive, emotional and social patient's functioning, and also psychopathologic understanding and then psychiatric diagnosis.