[How to talk about a serious event to a child?] / Comment parler d'un événement grave à un enfant ?

How to talk about a serious event to a child? Talking to a child about a serious event is difficult. Should we be afraid of causing him trauma? We will present two clinical situations each involving a pedophile father. The contrasting evolutions make it possible to highlight the important elements to be taken into account in this type of situation, by insisting on the variables relating to the child rather than the pressure that can be put by the entourage and the urgency of the event. Then, we will discuss the case of the death of a loved one and an other on the announcement to a child of a collective disaster: the spread of the Covid-19.

Comment parler d'un événement grave à un enfant ? Parler à un enfant d'un événement grave est difficile. Faut-il craindre de susciter chez lui un traumatisme ? Nous présenterons d'abord deux situations cliniques impliquant chacune un père pédophile. Les évolutions contrastées permettent de faire ressortir les éléments importants à prendre en compte dans ce type de situation, en insistant sur les variables relatives à l'enfant plutôt que sur la pression qui peut être mise par l'entourage et l'urgence de l'événement. Puis nous évoquerons le cas du décès d'un proche et un autre sur l'annonce à un enfant d'une catastrophe collective, la propagation du Covid-19.

Mental disorders in obese children and adolescents.

OBJECTIVE: To evaluate the type and frequency of psychiatric disorders in obese children and adolescents; to assess the correlation between psychopathology and severity of obesity; to explore the relationship between psychiatric disorders in obese children and obesity and psychopathology in their parents. METHODS: One hundred fifty-five children referred and followed for obesity were evaluated (98 girls and 57 boys; age, 5 to 17 years). Psychiatric disorders were assessed through a standardized diagnostic interview schedule (K-SADS R) and self-report questionnaires completed by the child (STAIC Trait-anxiety and CDI for depression) or his (her) parents (CBCL or GHQ). These obese children were compared with insulin-dependent diabetic (IDDM) outpatient children (N = 171) on questionnaire data. RESULTS: Eighty-eight obese children obtained a DSM-IV diagnosis, most often an anxiety disorder (N = 63). Psychological disorders were particularly pronounced in those obese children whose parents were disturbed. There was no correlation between severity of obesity in the child or his (her) parents and frequency of psychiatric disorders. Compared with diabetic children, they displayed significantly higher internalized and externalized questionnaire scores and poorer social skills. CONCLUSION: These results highlight the importance of including a child psychiatric component in the treatment of obesity, which must engage the whole family.

Binge eating and psychopathology in severely obese adolescents.

OBJECTIVE: The authors describe binge eating and psychopathology in severely obese adolescents who are seeking treatment for obesity and search for specific psychological features that may be associated with binge eating. METHOD: Obese adolescents (n = 102) were assessed with the Binge Eating Scale (BES), the State-Trait Anxiety Inventory for Children (STAIC), the Beck Depression Inventory (BDI), Coopersmith's Self-Esteem Inventory (SEI), and the Body-Esteem subscale from the Piers-Harris Children's Self-Concept Scale (PHCSS). They were also evaluated with the Montgomery and Asberg Depression Rating Scale (MADRS) and the Brief Scale for Anxiety (BSA). Two subgroups (i.e., binge eaters and non-binge eaters) were then established according to the BES score. RESULTS: Binge eating symptoms were frequent in this population and the binge eating dimension was related to high levels of anxiety and depression, as well as to low levels of self-esteem and body-esteem. The dimensions of anxiety and depression were associated specifically with binge eaters. DISCUSSION: As observed in the obese adult population, binge eating symptoms were found frequently in severely obese adolescents seeking treatment and were related strongly to studied parameters. Obese adolescents who binge eat are a subgroup with high psychopathologic distress.

Psychopathology and quality of life for adolescents with asthma and their parents.

Asthma is known to have a direct impact on the quality of life of children with asthma and their families as a consequence of the attacks on day-to-day life. Psychopathological factors may be associated with poor quality of life by modulating the handicap and the patient's experience of it. The authors' objective was to evaluate the relationship between emotional and behavioral problems and quality of life, as assessed by the Pediatric Asthma Quality of Life Questionnaire and the Pediatric Asthma Caregiver's Quality of Life Questionnaire. The study group consisted of 100 adolescent outpatients with asthma who were undergoing regular checkups: 70 boys and 30 girls, ages 12 to 19. They were evaluated by means of self-administered questionnaires completed by their parents. Path analysis was used to propose a model of relationships between psychopathology and quality of life. The quality of life of the children with asthma and their parents was clearly associated with the presence or absence of psychological problems in the patients. Emotional problems were associated with the quality of life of both the patients and their parents; behavioral problems had a smaller effect on the quality of life of the parents only. The authors proposed a structural model of the quality of life of adolescents with asthma and their parents in which quality of life is dependent on psychological variables and is responsible for emotional problems. Multivariate analyses indicated that the quality of life of the children with asthma and their parents and the correlation between quality of life and psychopathology depended little on medical variables such as the duration of illness, its pretreatment severity, or hospitalizations in the past year. In contrast, the quality of life of the parents depended on that of the children and vice versa. This study showed that scores on the Pediatric Asthma Quality of Life Questionnaire and the Pediatric Asthma Caregiver's Quality of Life Questionnaire reflected not only the medical status of the patients but also psychological variables, which appeared to be a consequence of the functional handicap associated with asthma. Patients who assess the quality of their lives as poor would benefit from psychological evaluation and support.