Systematic review on somatization in a transcultural context among teenagers and young adults: Focus on the nosography blur.

Aims: Somatic complaints are a frequent cause for consultation in primary care. In a transcultural context, somatic complaints are typically associated with psychological distress. A recent review about somatic symptom disorders in adolescence showed some nosographic heterogeneity and outlined various etiological hypotheses (traumatic, environmental, or neurologic), separate from the cross-cultural considerations. Migrants' children encounter specific problems involving cultural mixing-issues of filiation (familial transmission) and affiliation (belonging to a group). This paper aims to provide a systematic review of somatization in transcultural contexts among teenagers and young adults, aged 13 to 24, over the past decade. Methods: This review adheres to the quality criteria set forth by the PRISMA guidelines (Preferred Reporting Items for Systematic Reviews and Meta-Analyses). Two authors queried three English databases (Medline, PsycInfo, WebOfScience) about somatization in transcultural contexts (migrant or non-Western population) among teenagers (13-18), young adults (19-24), or both. The methodological process comprised articles selection, data extraction, and then the analysis of emerging themes. Setting selection criteria to limit the transcultural field was difficult. Results: The study analyzed 68 articles. We present a descriptive analysis of the results, centered on three main themes. First, the literature highlights a nosographic muddle reflected in the combination of anxious and depressive symptoms together with the highly variable symptomatology. Second, discrimination issues were prevalent among the migrant population. Lastly, the literature review points out possibilities for improving a care pathway and reducing the diagnostic delay induced by migrants' hesitancy about Western care and the recurrent use of inappropriate diagnostic criteria. Conclusion: This review discusses the links between the nosographic muddle described here and the diagnostic delays these patients experience and raises concerns about rigid diagnostic compartmentalization. The work of the psychiatrist Frantz Fanon is here useful to understand externalized symptoms resulting from physical and psychological confinement. Discrimination issues raise questions about the cultural counter-transference health professionals experience in dealing with young migrants. Defining healthcare professionals' representations about somatic complaints in a transcultural context might be a fruitful path to explore in future research. Protocol PROSPERO registration number: CRD42021294132. Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021294132.

Bodily expression of psychological distress in adolescents: a qualitative study.

INTRODUCTION: The bodily expression of psychological disorders is one of the leading motives for consultations in adolescent medicine. The diagnostic entity corresponding to DSM-5 "Somatic symptom and related disorders" is sparsely used in the English-language literature, especially for adolescents. Qualitative studies on this topic mostly concern the experiences of healthcare professionals. This study seeks to explore the experience of adolescents expressing psychological distress through their body. METHODS: This exploratory research took place in a Paris hospital department of adolescent medicine. Our sampling method was purposive. For inclusion, patients had to be aged 11-24 years, with a "somatic symptom disorder" meeting the DSM-5 criteria. Semi-directive interviews were proposed with visual narration inspired by photoelicitation. Thematic analysis allowed us to explore the data with an inductive approach. RESULTS: Thirty adolescents were interviewed; they were 14-22 years old and mostly had somatic symptom or functional neurological disorders. Three principal themes emerged from our analysis of the interview contents: the personal, including bodily, experience of the disorder, the experience of relationships, and the question of what is visible through the body. CONCLUSION: This research allowed us to discuss the reversal of generations, the function of the DSM-5 diagnosis, illuminated by sociology, and finally, cultural pathways. It shows the importance of recognizing the reality of the adolescents' bodily feelings, reassuring them by ruling out serious causes, and supporting their search for meaning. It is important to think about a specific framework of family therapy that can make effective use of this experience of the reversal of generations.

[Multidisciplinary care of an adolescent with somatic disorders]. / Parcours de soins pluridisciplinaire d'un adolescent aux troubles somatiques.

Theo's clinical observation illustrates the management of a 14-year-old adolescent with unexplained somatic symptoms. His symptoms can be integrated into what the classification of mental illnesses calls a somatic symptom disorder, with a depressive comorbidity. The description of the care pathway shows the gradual acceptance of psychological suffering by the adolescent and his parents in a service where different professionals are involved, with sufficient time for a good therapeutic alliance to be built.

The Search for Origin of Young Adoptees-A Clinical Study.

In the current area of social media propagation, the adoptees' search for the birth family is increasingly reversed: more and more adopted adolescents are contacted directly by their birth parents, even if they did not search for them. This study explores the impact of these new forms of contact between adoptive family members and birth family members, through the qualitative analysis of clinical protocols of five adoptive families that sought counseling in a clinical setting devoted to international adoption. The interpretative phenomenological analysis revealed three themes. Two of them shared by the parents and their children: the feelings of anxiety and intrusion, as well as the feelings of guilt and debt. The last theme concerns only the parents: feelings of endangered family relations and can be divided into two sub-themes: feelings of threat by the birth family, feelings of an undermined parental role. Nevertheless, these new kinds of confrontations with the children's origins bear a potential of renegotiating adoptive family relationships and positive effects on mutual feeling of filiation. Exploring the impact of the search of adoptees by the birth family enables professionals involved in adoption to improve preventive and supportive work in the adoption process.

Multifamily Therapy for Adolescents With School Refusal: Perspectives of the Adolescents and Their Parents.

Introduction: School refusal is an important public health concern in adolescent psychiatry increasing over the past several years (5% of child and adolescent psychiatry consultations in France). Multifamily therapy has developed over 30 years. Its efficacy is validated in adult, child and adolescent psychiatry, including for children at risk of school exclusion. In this study, we aimed to explore the adolescents and their parent's experience of a multifamily therapy treatment of school refusal with a qualitative method. Materials and Methods: This qualitative study is based on an Interpretative Phenomenological Analysis approach. We conducted 15 semi-structured interviews, participants were adolescents (n = 6) and their parents (n = 9) who experienced multifamily therapy in an adolescent department in Paris. Data analysis was performed independently by two researchers. Results: For the six families, school was a source of suffering, system paralysis and social exclusion. Families reported painful emotions and separation anxiety. For teenagers, multifamily therapy increased self-confidence and allowed group experience. For parents, it gave support and relieved from feelings of stigmatization and guilt. Parents became more aware of their adolescent's suffering and their insight. They all considered that multifamily therapy improved intra-family communication and expression of emotion. Participants highlighted the benefits of intergenerational interactions, activities, group and guidance from therapists. Discussion: Multifamily therapy uses therapeutic tools from both family therapy (joining, resonance, family competence, and metacommunication) and group therapy (use of media, identity device, and mirror reactions). Parents expect school solutions from multifamily therapy and question how psychiatric treatment can deal with school, school refusal being therefore understood as a social functioning disorder.

[The olfactory workshop, smell to regain confidence]. / L'atelier olfactif, sentir pour reprendre confiance.

The perfume workshop is one of the therapeutic groups offered to young patients in the day hospital of the "Maison des adolescents" in Paris (14th arrondissement). None of them having learned to smell, this workshop allows these young people to discover a new field of experiences. Thanks to this particular mediation mobilizing this unexplored fifth sense, they connect to their sensations, access their memories and communicate them, open their imagination and discover a new medium to express themselves, share and regain self-confidence.

Correction to: Multicenter randomized controlled trial on the comparison of multi-family therapy (MFT) and systemic single-family therapy (SFT) in young patients with anorexia nervosa: study protocol of the THERAFAMBEST study.

After publication of our article [1] the authors have notified us of missing to include one name to the authorship list.

[Intercountry adoption, the parents' experience of somatic disorders in children]. / Adoption internationale, le vécu parental des troubles somatiques de l'enfant.

Most children adopted in a foreign country present somatic disorders, which can have an impact on the construction of the bond with the adoptive parents. This potential complication must be taken into account in the adoption procedure and during the post-adoption follow-up, taking on board the trauma of everyone involved.

Multicenter randomized controlled trial on the comparison of multi-family therapy (MFT) and systemic single-family therapy (SFT) in young patients with anorexia nervosa: study protocol of the THERAFAMBEST study.

BACKGROUND: Anorexia nervosa (AN) is a serious psychiatric illness that begins most of the time during adolescence. An early and efficacious intervention is crucial to minimize the risk of the illness becoming chronic and to limit the occurrence of comorbidities. There is a global consensus on optimal treatment for adolescents suffering from AN: international guidelines recommend single-family therapy that involves the patient and his/her family. Several family therapy approaches have been developed to date. However, these approaches, which imply a direct questioning of intrafamilial dynamics, are not suitable for all patients and families, and the rates of dropout or poor response to treatment remain quite high. A modality of family therapy has been adapted to AN, known as multi-family therapy (MFT), which consists in bringing together several families whose children suffers from the same illness. Objectives of the present randomized clinical trial are to evaluate whether the implementation of MFT in a multi-disciplinary treatment program for adolescents with AN is at least as efficacious as the use of systemic single-family therapy (SFT), with respect to the evolution of body mass index and other clinical outcomes 12 and 18 months after the start of treatment. A cost-efficiency analysis will also be conducted. METHODS: One hundred fifty patients meeting the inclusion criteria will be randomly assigned to one of the two treatment groups. Patients and their families will receive 10 sessions of therapy spread over 12 months. Body weight, eating disorder and other psychopathology-related symptoms, quality of family relationships, and family satisfaction with treatment will be evaluated during the treatment and at an 18 months follow-up. A cost-efficiency analysis will also be carried out. DISCUSSION: We hypothesize that MFT is at least as efficacious as SFT, but at a lesser cost. The identification of possible preferential indications for each technique could help the improvement of therapeutic indications for adolescents suffering from AN and contribute to the earliness of intervention, which is associated with a better outcome. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03350594 . Registered on 22 November 2017. IDRCB number 2016-A00818-43.

The Impact of Children's Pre-Adoptive Traumatic Experiences on Parents.

For the last decade, children are adopted increasingly at an older age. Their pre-adoptive past can bare traumatic experiences consequent to abandonment, violence, or deprivation in birth family or orphanage. The objective of this study is to explore the impact of the child's traumatic past on parental representations and subsequent parent-child interactions. The study includes 41 French parents who adopted one or more children internationally. Each parent participated to a semi-structured interview, focused on the choice of country, the trip to the child's native country, the first interactions with the child, the knowledge of the child's pre-adoptive history. The interviews were analyzed according to a qualitative phenomenological method, the Interpretative Phenomenological Analysis. Five themes emerged from this analysis: absence of affects in the narrative; denial of the significance of the child's traumatic experiences; perceptions of the uncanny concerning the child; parental worry about traumatic repetition for the child; specific structure of the narrative. These extracted themes reveal a low parental reflective function when the child's past is discussed. They highlight the impact of the child's traumatic past on parents. Exploring the impact of the child's traumatic experiences on adoptive parents enables professionals involved in adoption to provide an early support to these families and to do preventive work at the level of parental representations and family interactions.

Shifting views and building bonds: Narratives of internationally adopted children about their dual culture.

American literature on international adoption suggests that adoptees' pride in the culture of their birth country improves their self-esteem and helps them to cope with experiences of racism. Parents are therefore encouraged to teach their adopted children multicultural skills to improve their psychological well-being. French psychologists, on the contrary, suggest that adoptees should feel fully members of their adoptive country and families. These practices shed light on the respective multicultural and universalist paradigms in the US and France. Few papers, however, consider the opinions of adoptees. This study explores internationally adopted children raised in France and their spontaneous curiosity about their birth country. The present study used semi-structured interviews with 19 adoptees aged 8-18 years old, to explore their attitudes towards the culture of their birth country. Transcripts of recorded interviews were analyzed according to interpretative phenomenological analysis. While there was striking consistency of interest in birth countries, adoptees' expression of curiosity varied across time. Children described distinctive goals: knowing more about their history, finding relatives, becoming a multicultural citizen, or simply helping people. Their parents' involvement was thus seen as helpful, but adoptees stress the need to feel ready and may prefer independent ways of learning about their birth country. Adoptees' multiple feelings of belonging derive not only from multicultural training but from a lifelong construction of self. Professionals and parents may need to adapt to adoptees' individual development, distinctive time frames, and ways of learning to provide better support to them.

[The parents' experience of school refusal in adolescence]. / Le vécu parental du refus scolaire anxieux à l'adolescence.

While today's society places considerable importance on schooling and performances, school absenteeism is currently very high. One of the causes is anxiety-based school refusal. This phenomenon affects the adolescent but also has an impact on their family. Exploring the experience of the parents of teenagers presenting anxiety-based school refusal enables these families to be given better support.

Cultural identity and internationally adopted children: qualitative approach to parental representations.

Approximately 30 000 children are adopted across national borders each year. A review of the literature on the cultural belonging of these internationally adopted children shows substantial differences between the literature from English-speaking countries and that from France and Europe in general. The objective of this study is to start from the discourse of French adoptive parents to explore their representations of their child's cultural belonging and their positions (their thoughts and representations) concerning connections with the child's country of birth and its culture. The study includes 51 French parents who adopted one or more children internationally. Each parent participated in a semi-structured interview, focused on the adoption procedure and their current associations with the child's birth country. The interviews were analyzed according to a qualitative phenomenological method, Interpretative Phenomenological Analysis. The principal themes that emerged from our analysis of the interviews made it possible to classify the parents into three different groups. The first group maintained no association with the child's country of birth and refused any multiplicity of cultural identities. The second group actively maintained regular associations with the child's country of birth and culture and affirmed that their family was multicultural. Finally, the third group adapted their associations with the child's birth country and its culture according to the child's questions and interests. Exploring parental representations of the adopted child enables professionals involved in adoption to provide better support to these families and to do preventive work at the level of family interactions.

[Choosing the name in international adoption]. / Le choix du prénom dans les situations d'adoption internationale.

In the context of international adoption, the question is raised of the links which the adoptive parents may or may not maintain with the culture of the child's birth country. The name which the adoptive parents choose reflects this questioning. A study was carried out into this subject with parents and children in order to gain a better understanding of the feelings of belonging, filiation and affiliation in these situations.

[Music as mediation in a home for adolescents]. / La musique comme médiation dans une maison des adolescents.

Music as mediation in a home for adolescents. At the H6pital Cochin homeforadolescents in Paris, therapeutic workshops give young hospital patients the opportunity to express themselves outside of the daily care environment. Just like the cultural workshops, the music workshop enhances the well-being of these adolescents in difficulty. Experience sharing.

First parent-child meetings in international adoptions: a qualitative study.

International adoptions involve approximately 30,000 children worldwide each year. Nearly all of the adoptive parents travel to the child's country of birth to meet them and bring them home. The objective of this study is to analyze the adoptive parents' account of their first meetings with their child. The study includes 46 parents who adopted one or more children internationally. Each parent participated in a semi-structured interview, focused on these first parent-child meetings. The interviews were analyzed according to a qualitative phenomenological method, Interpretative Phenomenological Analysis. The principal themes that emerged from the analysis of the interviews were: the scene when the child is entrusted to the parents, the discovery of the child's body, and the first parent-child interaction. Within these three principal themes, several subthemes dealt with difficult experiences: moments of solitude and anxiety, shocking images of the children's living conditions, lack of preparation and of information about the child, poor health, parental reactions of rejection, worry about the child's body, aggressive reactions by the child, worry about the child's reactions, and contrast with the expected interaction. Thirty-two interviews included at least one of these subthemes. At the structural level of the discourse; the characteristics of 33 interviews are those described in the literature as significantly more frequent in traumatized than in non-traumatized subjects. These results raise questions about the consequences of difficult, possibly traumatic experiences, at the moment of meeting the child, and they underline the need for work on preparation and prevention before the parents leave on their journey.

[A fragrance workshop, a mediation tool for teenagers]. / L'atelier parfum, un outil de médiation auprès des adolescents.

The fragrance workshop is one of the therapies used with young people in the day hospital of the Adolescent Centre of Cochin hospital in Paris. This unique form of mediation offers, through the use of a sense which is often neglected, access to the imaginary world of teenagers, allowing regression and the evocation of memories in a contained framework.

[Trauma among children and parents within the context of international adoption]. / Trauma des enfants et des parents dans un contexte d'adoption internationale.

Although the large majority of international adoptions are problem free, some of them involve a certain degree of suffering as much for the children as for the adoptive parents. These stumbling blocks in the relationship need to be studied taking into account the trauma experienced by each of the protagonists.