Child attachment and ADHD: a systematic review.

Attention Deficit/Hyperactivity Disorder (ADHD) is a frequent neurodevelopmental disorder in children. ADHD has a multifactorial origin, combining genetic and environmental factors. Several studies suggested an influence of early parent-child relationships on the symptomatic expression of ADHD. In this review, we examine the studies that have investigated the links between attachment and ADHD in children. We searched for studies published between January 2000 and November 2019 on PsychInfo, PubMed, and Scopus. Selected studies included a theoretically based measure of attachment and an explicit measure of ADHD symptoms or an ADHD diagnosis. Studies that included children from adoption, institutionalization, or mistreatment were not included. We found only 26 studies meeting the inclusion criteria. Almost all these studies indicated a link between the attachment type and the presence of attentional difficulties and hyperactivity. However, associations were better explained, in several studies, by confounding factors such as comorbidities, cognitive difficulties, or contextual factors. The method used to assess attachment and parental mental health also had an impact. An increasing number of studies show a link between the type of attachment and the presence of attentional difficulties and hyperactivity in children. However, the nature of this link remains unclear. Implications for future research are discussed.

Transition of Mental Health Care for Transgender Youth Aged Between 16 and 24 Years Old.

BACKGROUND: The transitional age (16-24 years old) is a clinically vulnerable period particularly important in mental health care. While several studies focus on this problem, few consider the specificity of the transgender population, a minority at risk of mental health issues. The purpose of this paper is to establish a review of the current literature addressing the transitional age and the transgender population in order to identify the issues met by this specific population in the transition of mental health care. METHODS: A systematic search of the English literature was conducted in Pubmed and ScienceDirect. The PRISMA method was used to illustrate the process of identification, selection, evaluation of eligibility and inclusion of the selected articles. RESULTS: 12 studies were selected, of which five were specifically addressing the transition of care. No specific guidelines were highlighted. The main barriers to mental health care access were the lack of trained professionals, waiting time before a first appointment, past negative experiences of care and the cost of it. CONCLUSION: Enhancing scientific research focusing on that theme is essential to improve the mental health care of this specifically vulnerable population.

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.

Emotional status of children aged 7 to 17 of health workers and in the general population during the COVID-19 pandemic: A cross-sectional comparative study in Belgium.

Background: We assessed the mental health of children and adolescents aged 7 to 17 and their parents immediately after the first wave of the COVID-19 pandemic. Method: A survey online was conducted in Belgium between May 29th and August 31st 2020. Results: (1) Anxious and depressive symptoms were self-reported by one out of four children and hetero-reported by parents for one out of five children; (2) Anxiety scores were higher in children compared to adolescents; (3) Social introversion scores were significantly higher in adolescents compared to children; (4) No significant differences for anxio-depressive symptoms were found between healthcare worker parents and the other parents. Children's self- or hetero-reported symptoms were not found to be connected to parents' professional activities. Conclusions: This cross-sectional survey adds evidence to the impact the COVID-19 pandemic has had on children's and adolescents' emotional state, in particular on their levels of anxiety and depression.

Objectif: Nous avons évalué la santé mentale d'enfants et d'adolescents âgés de 7 à 17 ans et de leurs parents immédiatement après la première vague de la pandémie de COVID-19. Méthodologie: Une enquête en ligne a été réalisée en Belgique entre le 29 mai et le 31 août 2020. Résultats: (1) Les symptômes anxieux et dépressifs étaient auto-déclarés par un enfant sur quatre et hétéro-déclarés par les parents pour un enfant sur cinq ; (2) Les scores d'anxiété étaient plus élevés chez les enfants par rapport aux adolescents ; (3) Les scores d'introversion sociale étaient significativement plus élevés chez les adolescents par rapport aux enfants ; (4) Aucune différence significative pour les symptômes anxio-dépressifs n'a été trouvée entre les parents travailleurs de la santé et les autres parents. Les symptômes auto- ou hétéro-déclarés par les enfants ne se sont pas avérés être liés aux activités professionnelles des parents. Conclusions: Cette enquête transversale ajoute des preuves de l'impact de la pandémie de COVID-19 sur l'état émotionnel des enfants et des adolescents, en particulier sur leurs niveaux d'anxiété et de dépression.

Borderline personality disorder and adolescent suicide attempt: the mediating role of emotional dysregulation.

BACKGROUND: Emotional dysregulation seems to be a core feature of Borderline Personality Disorders (BPD). In addition, recent research in the adolescent population has shown that suicidal behaviours have been associated with maladaptive strategies of emotion regulation. METHODS: This study examined the relative contributions of emotional dysregulation to suicide attempt history in a clinical sample of borderline adolescents. Data were analyzed from 85 participants of the Collaborative European Research Network on Borderline Personality Disorder. Participants completed measures of BPD traits and symptoms, suicide behaviours, emotional dysregulation, attachment styles and lifetime depressive disorders. RESULTS: In an SEM model, lifetime depressive disorders and insecure attachment styles have a significant direct effect on lifetime suicide attempt, but only lifetime depressive disorders have an indirect effect through emotion dysregulation. The results suggest that emotional dysregulation has a mediating role in suicide attempts among BPD adolescents. CONCLUSIONS: These findings call for the development of interventions targeting the role of emotion dysregulation in effectively predicting and preventing suicidality in borderline adolescents.

Study of resilience and loneliness in youth (18-25 years old) during the COVID-19 pandemic lockdown measures.

This study evaluated the risks and protective factors in mental health in 825 emerging adults aged from 18 to 25 years old in Belgium and in Italy. Resilience, loneliness and social, and family context were explored to determine their specific role in coping with the emotional distress that spread worldwide during the coronavirus disease 2019 (COVID-19) pandemic. We conducted an online survey on the secured platform Research Electronic Data Capture©. Data were collected between April 7th and May 4th, 2020. The primary outcomes were the resilience scale for adults (RSA) and the University of California Los Angeles Loneliness Scale. The secondary outcomes included mental health status in terms of professional help seeking, use of psychotropic drugs, admission to a psychiatric department before and during lockdown measures. Responders were divided into three groups following the mental healthcare needs (MHCN) before and after the lockdown measures. The group who experienced an increase in MHCN represented almost 5% of the assessed youth. Statistically significant differences were found in means of RSA total score and RSA perception of self. This study enlightens the possibly traumatic impact of the COVID-19 pandemic on at-risk youth's mental health. Early detection and intervention should be structured in large-scale disasters.

The Transition from Child and Adolescent Mental Health Services (CAMHS) To Adult Mental Health Services (AMHS): What about Autism Spectrum Disorder?

BACKGROUND: Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder and a long-term condition that may require psychiatric life-long care. Transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) possibly concerns a great portion of patients with ASD. This study focuses on transitional age youth (TAY) with ASD and proposes specific innovative tools to manage the transition process. SUBJECTS AND METHODS: This explorative study focuses on TAY with ASD. Data on socio-demographic characteristics and personal medical history was collected. Three self-rated questionnaires were used: the Health of The Nation Outcome Scales For Children And Adolescents (HoNOSCA-SR), to assess care need, the World Health Organization Quality of Life-BREF (WHOQOL-BREF) scale and the Transition Readiness and Appropriateness Measure (TRAM), to evaluate barriers to functioning. RESULTS: The sample was composed of 10 patients with ASD aged from 17 to 18. The majority of them were male (70%) and born in Belgium (60%). The median (interquartile range) age of ASD diagnosis was 16 (13-17). The comorbidity rate was 60% for psychiatric disorders and 30% for somatic diseases; 80% of the participants were under psychotropic drugs. The average questionnaires scores were respectively: HoNOSCA-SR = 21.63 (±9.90), WHOQOL-BREF physical health = 50.88 (±19.14), psychological health = 36.13 (±13.97), social relationships = 48.50 (±18.23) and environment = 59.38 (±14.08); TRAM's number of barriers to functioning were 4.25 (±1.39). CONCLUSIONS: These preliminary data, accompanied by current recommendations, allow to clarify the strategies to an optimal transition in ASD. Special insight is given to strategies to reach a well-managed transition from CAMHS to AMHS, such as the assessment of psychiatric and somatic comorbidities, the care need continuity, the elaboration, in advance, of a transition plan, the assessment of the barriers to functioning, and the involvement of young patients and their families.

Outpatient Care in Psychiatry for Transitional Age Youth (16 to 24 Years Old): Which Trajectories of Psychiatric Care in French-Speaking Belgium?

BACKGROUND: Transitional age youth (TAY) are a particularly at-risk population in mental health. They have specific needs, not currently covered between child and adolescent mental health services (CAMHS) and adult mental health services (AMHS), mainly because of existing barriers. This retrospective study was carried out to describe sociodemographic and clinical characteristics of patients who attended a new outpatient program specifically conceived for TAY in Brussels, Belgium. Outcomes related to trajectories of psychiatric care were analysed, such as leading symptom, consultation's referral and requester, and final orientation. SUBJECTS AND METHODS: The total sample included 243 patients aged from 16 to 24 years old who presented for care in this outpatient program between October 2019 and May 2021. Data were retrospectively extracted from each patient's electronic medical records. RESULTS: The sample was mainly composed by female participants; the average age was 18.7 (±2.0) years. General practitioner (18.9%), child and adolescent psychiatrist (18.1%), psychologist (11.5%) and adult psychiatrist (7.4%) referred patients. Leading symptoms were divided into three dimensions: internalizing (67.5%), externalizing (21.8%) and psychotic (10.7%) ones. After first assessment, 81.5% of youth were followed-up in our specific outpatient program. Overall, at the end of data collection, youth were orientated towards ongoing follow-up in this program (37%), AMHS care (21.8%), end of psychiatric care (17.3%) and CAMHS care (4.1%). 19.8% patients discontinued the proposed care. CONCLUSIONS: This psychiatric outpatient program for TAY represents an innovative contribution to reinforce CAMHS-AMHS interface in French-speaking Belgium. The analysis of trajectories in psychiatric care suggests positive outcomes of this TAY-tailored clinical program to achieve high quality standard of care in youth mental health. Future research and clinical implementation programs should further explore which factors influence decision-making process in TAY psychiatric assessment and care.

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.

Differential profiles of four groups of children referred to an autism diagnostic service in Belgium: Autism-specific hallmarks.

OBJECTIVE:: This article aims at exploring distinctive hallmarks of autistic disorders compared to other groups presenting mimicking and/or overlapping conditions. METHOD:: The exploratory study involved 196 children with autism, intellectual disability, language impairment and psycho-affective disorders previously referred to an autism diagnostic service. The autism discriminative tool (ADT), a behavioural checklist, was used to compile and analyse the children's profiles based on the clinical information gathered during diagnostic assessments. All samples were compared and analysed separately according to the checklist's four domains. RESULTS:: Children with autism showed greater frequency and severity of impairments on the ADT's social and communication categories. These children also differed from other groups in terms of specific rigid behaviours and high frequency of atypical sensory responses. CONCLUSIONS:: Results illustrate the psychopathology of autism spectrum disorder suspected children referred to a specialized autism diagnostic service, doing so by providing us with specific clinical profiles.

New perspectives in Child and Adolescent Psychiatry.

Mental and behavioural problems during childhood and adolescence are a serious public concern and are increasing actually and in the next 10 years. In Belgium, policymakers have reorganize mental health care for children and adolescents in care circuits and care network that include and support intersectoral collaborations. They also support creation of mobile out-reach team for crisis and assertive care to help patient and their families in the least restrictive environment possible. Specific programs are developed for double diagnosis and disabled children but also juvenile offenders with psychiatric problems. The care network should also assure a rapid liaison function to the first line professionals.

Teenage pregnancy: a psychopathological risk for mothers and babies?

INTRODUCTION: Teen pregnancy remains a public health problem of varying importance in developing and developed countries. There are risks and consequences for teen parents and the child on the medical and socioeconomic level. METHOD: We conducted a literature search on multiple databases, focusing on the risk and the consequences of teen pregnancy and childbearing. We used different combined keywords as teen pregnancy, teen mother, teenage parents, teenage childbearing, teenage mother depression. Our search included different type of journals to have access on different views (medical, psychological, epidemiologic). RESULTS: The teen mothers are more at risk for postnatal depression, school dropout and bad socioeconomic status. The babies and children are more at risk for prematurity and low birthweight and later for developmental delays and behavior disorders. CONCLUSIONS: Pregnancy in adolescence should be supported in an interdisciplinary way (gynecologist, psychologist, child psychiatrist, midwives, pediatrician). We need further studies that allow targeting patients most at risk and personalizing maximum support.

Nonlinear dynamics of runaways among children and adolescents: disruptive disorder or step toward a suicide attempt?

The aim of this study is to analyze the decision-making process whereby susceptible adolescents end up choosing the option to run away or attempt suicide. Our basic hypothesis is that this transition is largely based on cooperative mechanisms. The runaway state is regarded as a potential precursor of the suicidal one. A mathematical model incorporating these processes is developed from which the time evolution and the values of the susceptible, runaway and suicidal populations are evaluated in terms of a number of key parameters. It is shown that for appropriate ranges of parameter values the interactions present in the system eventually end up counteracting both runaway and suicidal attempts. Quantitatively this is shown by the existence of stable solutions of the model equations in which the populations of both suicidal and runaway individuals end up being zero, although in some cases a significant temporary enhancement can take place. But as the parameters are varied beyond these ranges the system starts sustaining non-trivial stable states, in which the populations of suicidals or runaways are maintained at non-zero levels. This hints at prevention strategies and crisis management such as separation from the environment and specific treatment different from those dispending traditional adolescent psychiatric units.

A 5 years' experience of a parent-baby day unit: impact on baby's development.

Introduction: Psychiatric Mother-Baby Units are well established in France, United Kingdom, and Australia, mostly in full-time hospitalization. Inpatient units are considered as best practice for improving outcomes for mothers and babies when the mother is experiencing severe mental illness and many studies have showed the effectiveness of care for the mother or the mother-infant relationship. Only a limited number of studies have focused on the day care setting or on the development of the baby. Our parent-baby day unit is the first day care unit in child psychiatry in Belgium. It offers specialized evaluation and therapeutic interventions focused on the baby and involves parents with mild or moderate psychiatric symptoms. The advantages of day care unit is to reduce the rupture with social and family living. Aims: The objective of this study is to evaluate the effectiveness of parent-baby day unit in prevention of babies' developmental problems. First, we present the clinical characteristics of the population treated in the day-unit in comparison to the features presented in the literature review about mother-baby units, which usually receive full-time treatment. Then, we will identify the factors that might contribute to a positive evolution of the baby's development. Materials and methods: In this study, we retrospectively analyze data of patients admitted between 2015 and 2020 in the day unit. Upon admission, the 3 pillars of perinatal care - babies, parents, and dyadic relationships - have systematically been investigated. All the families have received a standard perinatal medico-psycho-social anamnesis, including data on the pregnancy period. In this unit, all the babies are assessed at entry and at discharge using the diagnostic 0 to 5 scale, a clinical withdrawal risk, and a developmental assessment (Bayley). Parental psychopathology is assessed with the DSM5 diagnostic scale and the Edinburgh scale for depression. Parent-child interactions are categorized according to Axis II of the 0 to 5 scale. We have evaluated the improvement of children symptomatology, the child development and the mother-child relation between the entrance (T1) and the discharge (T2) and we have compared two groups of clinical situations: a group of patients with a successful evolution (considering baby's development and the alliance with the parents) and a group of unsuccessful evolution during hospitalization. Statistical analysis: We use descriptive statistics to characterize our population. To compare the different groups of our cohort, we use the T-test and non-parametric tests for continue variables. For discrete variables, we used the Chi2 test of Pearson. Discussion: The clinical population of the day unit is comparable to the mother-baby units in terms of psychosocial fragility but the psychopathological profile of the parents entering the day unit shows more anxiety disorder and less post-partum psychosis. The babies' development quotient is in the average range at T1 and is maintained at T2. In the day unit, the number of symptoms as well as the relational withdrawal of the babies is reduced between T1 and T2. The quality of parent-child relationship is improved between T1 and T2. The children of the group of pejorative evolution had a lower developmental quotient at the T1 and an overrepresentation of traumatic life events. Conclusion: These results indicate that parent-baby day unit lead to positive outcomes in clinical situations with anxio-depressive parents, relational withdrawal of the babies, functional problems of the babies but not when a significant impact on the development of the baby already exists. The results of this study can guide therapeutic approaches for the benefit of care in parent-baby day units, and improve the development of the child and of the dyadic relationships.

Dimensional model on how familial vulnerability and environmental factors impact transitional age youth psychopathology: The Transition_psy study.

Background: Understanding psychopathology in transitional age youth (TAY) requires a complex model, incorporating familial vulnerability and environmental factors. A trans-diagnostic and dimensional approach seems the most appropriate. Transition_psy study aims to assess factors playing a role in TAY psychopathology and to define predictors. Materials and methods: This article presents part of the Transition_psy study results, a case-control observational study. Youth aged 17 years old were recruited between June 2020 and December 2021, from both clinical [clinical population (CP) group] and non-clinical settings [non-clinical population (NCP) group]. Participants completed self-report questionnaires. The primary outcome to assess TAY psychopathology was the Youth-Self Report (YSR). We evaluated care needs with the Health of The Nation Outcome Scales For Children And Adolescents (HoNOSCA-SR) and quality of life with the World Health Organization Quality of Life - BREF (WHOQoL-BREF). Exposure factors included familial vulnerability, childhood, and present environmental factors, such as first-degree family history of psychopathology, the Childhood Trauma Questionnaire (CTQ) and the Family Assessment Device (FAD). YSR scores were compared, between groups, according to exposure factors with ANOVA and linear regression. We performed best subsets selection of multivariable analyses based on the Akaike Information Criterion. This study was registered with ClinicalTrials.gov (Identifier: NCT04333797). Results: A total of 220 TAY (CP = 106, NCP = 114) were included in the study. Participants were aged 17 years old. The majority were female (69.1%), single (96.8%), and born in Belgium (82.3%). Clinical data were all significantly different between CP and NCP groups. YSR scores were found statistically different according to group (p < 0.001), first-degree family history of psychopathology (p < 0.001), CTQ (p < 0.001), and FAD (p < 0.001). Predictive dimensional model suggested that TAY psychopathology can be predicted by group, CTQ and FAD. Significant positive correlation was found between YSR and HoNOSCA (rho = 0.81) and negative correlation between YSR and physical and psychological health (rho = -0.69 and -0.71, respectively). Conclusion: This study findings allowed to present a predictive dimensional model on TAY psychopathology, including belonging to a clinical population at transitional age, childhood trauma, and family dysfunction. Further research is needed to replicate Transition_psy study results in other samples. The proposed model could be used in clinical practice to improve assessment of TAY psychopathology.

Case report: From anxiety disorders to psychosis, a continuum in transitional age youth?

Introduction: To date, among individuals meeting ultra-high risk criteria for psychosis, the relationship between the presence of anxiety disorders and the risk of psychotic transition raises several unanswered questions. Case description: This case report describes the clinical progression of a 17-year-old male initially presenting anxious symptoms meeting the DSM-V criteria for panic disorder. The patient also reported social withdraw, mild depressive symptoms, insomnia and fatigue. Over a 6 month period, a gradual onset of subthreshold psychotic symptoms suggested a prodromal phase of a psychotic disorder. Diagnostic assessment and therapeutic intervention: A detailed assessment of UHR criteria for psychosis was performed. The overall level of social and occupational functioning was assessed by the SOFAS, which showed a 35% drop over a 12 months period. The CAARMS, has also been administered. The patient met the diagnostic criteria for UHR, APS group. The care plan included psychiatric follow-up, pharmacologic treatment, individual psychological follow-up and individual and familial psychoeducation. Over a 6 months period, the patient did not experienced a first psychotic episode and presented a partial improvement of psychotic symptoms. Conclusion: The DSM-V categorical approach does not seem to adapt well to early clinical presentations in transitional age youth. A transdiagnostic and dimensional approach allows to better identify at-risk patients of psychiatric disorders and implement early intervention strategies.

Child, adolescent, and parent mental health in general population during a year of COVID-19 pandemic in belgium: a cross-sectional study.

BACKGROUND: This study aims to evaluate the mental health status of children, adolescents and their parents during the first year of COVID-19 pandemic in Belgium. METHOD: Analysis compared results before and during the second national lockdown, which started on November 2nd 2020. A cross-sectional online survey was conducted between May 2020 and April 2021. RESULTS: Two hundred and eighteen adults and 273 children fully completed the survey. Almost one in five children (17.9%) presented moderate-to-severe scores of depression. Adolescents presented a higher level of depression than children (p = 0.007). The rate of moderate-to-severe depression scores (10.8% to 21%, p = 0.007) and internalized symptoms increased during the second lockdown (p < 0.001). Parents' depression (p < 0.001) and anxiety (p = 0.027) levels also increased during the second lockdown. Logistic regression showed that the use of psychotropic medication in parents and parents' depression scores were risk factors for children to have worse depression scores. CONCLUSION: The second lockdown appears to worsen the effects of the pandemic on children's and parents' mental health. There is a need to implement specific interventions targeting both children/adolescents and their parents to support them during lockdown periods and improve mental health outcomes.

Interpersonal Relatedness and Non-suicidal Self-Injurious Behaviors in Female Adolescents With Borderline Personality Disorder.

Background: Psychopathological models of adolescent borderline personality disorder (BPD) suggest that non-suicidal self-injuring (NSSI)-a particularly frequent symptom in girls-may constitute a way of coping with distress resulting from interpersonal concerns they typically experience as a developmental psychopathological feature. Objectives: Our objective was to investigate the relationship in BPD female adolescents between NSSI and the Sidney Blatt two-polarities model of personality development, which focuses on the psychological processes of interpersonal relatedness and self-definition. Methods: The study was conducted within the European Research Network on Borderline Personality Disorder in Adolescence, using the Depressive Experience Questionnaire (DEQ). Results: BPD patients (n = 59; mean age = 16.6 ± 1.3) scored significantly higher than healthy controls on the two DEQ sub-factors assessing the more immature forms of Interpersonal Relatedness (Neediness) and Self-definition (Self-criticism) and significantly lower on the more mature form of Self-definition (Efficacy). BPD adolescents with NSSI showed significantly higher scores on both mature and immature forms of Interpersonal Relatedness (Neediness and Connectedness) compared to BPD adolescents without NSSI. A logistic regression analysis showed that the subfactor Neediness of the DEQ was the only significant predictor of the presence of NSSI among BPD adolescents. Conclusions: The preliminary results of this study suggests that NSSI in adolescents with BPD is developmentally linked to high developmental concerns in the domain of interpersonal relatedness, which may be taken into consideration in clinical practice. More studies are necessary to better understand the relationships between NSSI and developmental psychopathology in borderline adolescents.

Study Protocol: Transition_psy a Multicenter Prospective Longitudinal Cohort Study Assessing Risk and Protective Factors to Develop Psychopathology in Transitional Age Youth in Belgium.

Introduction: Emerging adults are a particularly at-risk population in mental health. The primary aim of the Transition_psy study is to evaluate changes in mental health care need and quality of life during transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS). The relationship between these changes and genetic or environmental vulnerabilities and clinical dimensions representing risk and protective factors to the development of psychopathology will be analyzed. We also aim to explore how each factor plays, specifically, a role in developing internalizing and externalizing symptoms, in order to predict the most common paths of psychopathology in transitional age youth (TAY). Methods and Analysis: Transition_psy is a multicenter prospective longitudinal cohort study. The transversal and trans-diagnostic approach consists of a dimensional evaluation: 300 youth at the age of 17 will be included in a cohort of in-patients, out-patients and control group. Participants will be assessed at baseline (T0) and 24 months later (T1). The primary objective to determine changes in self-rated Health Of The Nation Outcome Scales For Children And Adolescents (HONOSCA-SR) and WHO Quality of Life-BREF (WHOQOL-BREF) scores between T0 and T1. Pearson correlation and mediation analysis will be performed. A secondary objective analysis using mediation and moderation models with several dimensional aspects, including self-reported and cognitive measures, will be conducted to disentangle the potential relationships between the two scores. Discussion: Transition from CAMHS to AMHS occurs at a crucial age in terms of the continuum between adolescent and adulthood psychopathology. This collaborative and cohesive protocol between CAMHS and AMHS represents the first national cohort study about Transition Psychiatry in French-speaking Belgium. Ethics and Dissemination: The study protocol was approved by the Institutional Review Boards (IRB) of the three participating sites. Results will be published in peer-reviewed journals and disseminated at national and international conferences. This trial was registered in ClinicalTrials.gov (Identifier: NCT04333797) on 3 April 2020.