Episodic Experiences of Child Physical Abuse, Early Relational Trauma and Post-Traumatic Play: Theoretical Considerations and Clinical Illustrations.

Through symbolic and make-believe play, children can give meaning to their emotional experiences. For children who have experienced trauma, play provides the means to transform their past and tame the intrusive images and feelings associated with it. The quality of parent-child interactions plays a vital role in the development of mental representational capacity, which is essential for children's ability to engage in symbolic play. However, in child maltreatment situations, the unpredictability and insecurity of the parent-child relationship can have a profound impact on children's ability to play. This article aims to explore how the post-traumatic play of children who have suffered from episodic experiences of physical abuse differs from that of children who have experienced early relational traumas (ERT) resulting from chronic exposure to maltreatment and neglect. A theoretical and clinical analysis of the first play therapy session of a child who lived episodic experiences of physical abuse and that of a child who was exposed to ERT is presented. This analysis is informed by the Children's Play Therapy Instrument and the theories proposed by Chazan and Cohen in Journal of Child Psychotherapy, 36(2), 133-151 (2010), and Romano in Le Journal Des Psychologues, 279, 57-61 (2010). The nature of the relationship between children and their primary caregivers and the child-therapist relationship are also discussed. ERT appear to compromise the development of diverse abilities in children. Among them, access to the world of mental representations, which depends to a large extent on the presence of mindful and attentive parents, and their ability to capture and respond contingently to the playful proposals of children.

Impact of Early Relational Trauma on Psychic Processes: Implications for Treatment of vulnerable Children and Families / Impacto do Trauma Relacional Precoce nos Processos Psíquicos em Famílias Vulneráveis: Implicações para o Tratamento de Crianças e Famílias

ABSTRACT Numerous works and clinical research conducted in various institutions have cast fresh light on the notion of trauma and have contributed to the emergence of the concept of early relational trauma. Early relational trauma is a form of trauma rendered complex by the multiplicity of its sources and its modes of expression. Its main features are often attachment and acting-out disturbances. In families where such trauma occurs, links could sometimes be perverted and form a narcissistic configuration. This mode of functioning, organized around negativity, impacts the plurality of psychic processes and interferes with the treatment approaches of multidisciplinary teams. In order to promote a multifocal approach to care tailored to differences in situations, educational and socio-judicial practitioners.

RESUMO Inúmeros trabalhos e pesquisas clínicas realizados em diversas instituições trouxeram à luz a noção de trauma e contribuíram para o surgimento do conceito de trauma relacional precoce. O trauma relacional precoce é uma forma de trauma complexo pela multiplicidade de suas fontes e seus modos de expressão. Suas principais características são frequentemente distúrbios de apego e atuação. Nas famílias onde ocorre tal trauma que às vezes pode ser pervertido em configurações narcísicas, esse modo de funcionamento organizado em torno da negatividade impacta a pluralidade do psíquico e interfere nas abordagens de tratamento das equipes multidisciplinares. Para promover uma abordagem multifocal de cuidados adaptados às diferenças de situações, profissionais de educação e sócio judiciais.

Development and Validation of a Measure of Attachment Disorders Based on DSM-5 Criteria: The Early TRAuma-Related Disorders Questionnaire (ETRADQ).

BACKGROUND: A review of the scientific literature showed few valid tools for assessing reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED), two diagnostic entities traditionally grouped under "attachment disorders." The Early TRAuma-related Disorders Questionnaire (ETRADQ), a caregiver report, was developed to assess attachment disorders in school-age children based on the Diagnostic and Statistical Manual of Mental Disorders-Fifth edition criteria. This study sought to validate this instrument. METHOD: Caregivers of school-age children from the community (n = 578) and caregivers of at-risk children adopted or in out-of-home care (n = 245) completed a sociodemographic questionnaire, the ETRADQ, the Relationship Problem Questionnaire, the RADA (RAD and DSED Assessment) interview, and the Barkley Functional Impairment Scale for Children and Adolescents. RESULTS: Confirmatory factor analysis of the ETRADQ items supported the expected organization of the measure, that is, two second-order factors and five subfactors: (1) RAD scale (three subscales: Low selective attachment, Low social and emotional responsiveness, Emotional unpredictability) and (2) DSED scale (two subscales: Interactions with unfamiliar adults, Social disinhibition). All scales showed excellent internal consistency, test-retest reliability, convergent validity, and known-group validity. CONCLUSIONS: Results support the reliability and validity of the ETRADQ.

Mentalization-Based Training Program for Child Care Workers in Residential Settings.

Most of the children placed in child welfare residential care have experienced complex traumas linked to various forms of abuse and neglect, which have many important developmental impacts. Research shows that maltreatment is associated with increased aggression and disruptive behavior, internalizing difficulties, violence towards self and others, sexualized behaviors, academic difficulties, and early drug abuse. These experiences also negatively affect the attachment system and the mentalization process of the child. Consequently, working with this population represents a challenge for child care workers. This article describes a mentalization-based training program for child care workers who care for children aged six to 12 years old. First, the general framework of the training program is presented. Then, some of the therapeutic strategies used to improve the children's mentalizing capacity are described. Those strategies are adapted to the psychic functioning level of the child. Finally, a summary of a preliminary study of the program's efficacy are presented. This work suggests that mentalization-based interventions might represent a valuable approach in child welfare residential care.

[Attachment and Mentalization in Child Psychiatry: A Window Into Children and Parents Functioning]. / L'attachement et la mentalisation en pédopsychiatrie : une fenêtre sur le fonctionnement des enfants et de leurs parents.

Objectives Mental health professionals who work with children face various challenges, requiring them to consider factors that aim to promote healthy adaptation in their clients. There is a growing body of literature showing that child attachment pattern, as well as mentalizing ability in both children and their parents, are related to various indicators of well-being including mental health. However, studies assessing these constructs in clinical samples are sparse. Method Forty-nine children (2-6 years of age) and their parents were recruited through the Clinique spécialisée 0-5 ans of the Hôpital en santé mentale Albert-Prévost (HSMAP). A two-hour laboratory visit was carried out where parents and children completed individual and parent-child dyad tasks and filled out questionnaires. Various dimensions of parent and child functioning were assessed including the mother-child attachment relationship and parents' mentalization ability. Results Preliminary results indicated that child attachment pattern was related to children's behavioral and executive functioning as well as parents' psychiatric symptoms and parenting-related stress. Moreover, parents in our sample had lower levels of mentalizing abilities than those found in normative samples. Parents' mentalizing ability was related to the presence of psychiatric symptoms, parenting-related stress, and a history stressful life events. Conclusion These results highlight the need for mental health professionals working in a child psychiatric clinic to consider the child's attachment pattern and the mentalization ability of children and their parents, throughout the assessment process and subsequent implementation of interventions. In the last section of the manuscript, we present different ways we have integrated these concepts into our clinical work with children and parents referred to HSMAP.

Sofrimento nos laços pais-filhos: práticas educativas fundadas na mentalização na proteção da infância / Suffering in the parent-child relationship: mentalizing interventions in youth protection / El sufrimiento en la relación padre-hijo: intervenciones basadas en la mentalización adaptadas a la protección de la infancia

A maioria das crianças e dos adolescentes que vivem sob a proteção da juventude viveram traumas complexos ligados à negligência, aos maus tratos e às diversas formas de abusos. Sugerimos que esses jovens, bem como seus pais, apresentam dificuldades quanto à capacidade de mentalização e demonstram um funcionamento psíquico característico dos modos de pensar pré-mentalizantes. Este artigo apresenta a operacionalização dos diferentes modos de pensar (teleológico, de equivalência psíquica e fictício). São apresentados os princípios subjacentes a um programa de intervenção baseado na mentalização que poderão ser utilizados pelos educadores que trabalham com crianças e adolescentes em situação de vulnerabilidade...

Children and adolescents under the responsibility of the youth protection have experienced complex traumas concerning neglect, mistreatment, and various forms of abuse. The authors suggest that, as their parents, they show significant difficulties to mentalize as well as a pre-mentalizing mode of psychic functioning. This article presents the operationalization of the different pre-mentalizing modes of thought (teleological, psychic equivalence, and pretend-mode). This study also presents the underlying principles from a mentalizing intervention program that can be used by educators who work with vulnerable children and adolescents...

La mayoría de los niños y adolescentes bajo la custodia del servicio de protección de la infancia han vivido traumas complejos relacionados con el abandono, el maltrato y diversas formas de abuso. Los autores sugieren que éstos presentan, al igual que sus padres, deficiencias significativas en cuanto a la capacidad de mentalización y un funcionamiento característico de los modos pre-mentalizadores. Este artículo presenta una operacionalización de los diferentes modos de funcionamiento mental, teleológico, equivalente y ficticio; y expone igualmente los principios subyacentes a un programa de intervención basado en la mentalización y dirigido a los educadores que trabajan con estos niños y adolescentes...

L'enfant borderline en devenir II : validation préliminaire de l'Échelle de traits de personnalité limite pour enfants.

Objectives The Borderline Personality Disorder (BPD) is a severe psychopathology related to great personal and family distress, which aetiology goes back to childhood. Empirical data supports a certain temporal stability of personality traits from childhood to adolescence and adulthood. Several authors argue that it is possible to identify in children and adolescents personality traits that could be associated with the characteristics of BPD observed in adulthood. However, only few instruments have been developed to assess child and adolescent traits associated with BPD. This article aims to present the results of the first validity study of the French version of the Borderline Personality Features Scale for Children (BPFS-C).Method The French version of the instrument, which has been developed using translation/back-translation was administered to 262 children, aged 9 to 12 years old (M = 10.52; ÉT = 0.96), attending regular schools in Quebec (55.70% were girls). Forty-three bilingual children (M = 10.65, SD = 0.98; 60.50% were girls) completed the two versions of the questionnaire (English and French), on a one-week interval. In addition, 23 English-speaking children from Quebec (M = 10.42, SD = 1.12) completed the original version of the questionnaire.Results The first validity study of the French version of the instrument shows a very satisfactory internal consistency. The correlations between the English and French versions of the instrument are significant. The principal component analysis revealed a four component model that have similarities with the four subscales of the English version, but differs in the distribution of items originally belonging to the subscale Identity problems of the BPFS-C.Conclusions The results of the first validity study of the French version of the instrument are promising. However, further research is needed in order to demonstrate the temporal stability as well as the construct validity of this measure. The instrument should also be validated with children from a clinical population with a higher preponderance of biological and environmental risk factors associated with the development of BPD. Finally, it would be interesting to establish the standardized values of the instrument allowing clinicians to identify which scores can be considered normal and which may indicate a strong presence of borderline personality traits. The identification of personality traits and behaviours associated with BPD in children and adolescents could promote prospective research and increase knowledge about the aetiology, characteristics, and trajectory of BPD throughout child development.

[Attitudes of general physicians and family medicine residents towards patients with borderline personality disorder]. / Attitudes des médecins omnipraticiens et des résidents en médecine familiale à l'endroit des personnes souffrant d'un trouble de personnalité limite.

OBJECTIVES: Several studies suggest that health professionals show negative attitudes towards people with Borderline Personality Disorder (BPD). Many publications have focused on the attitudes of nurses or other type of clinicians like social workers or psychologists. Few researches concern the attitudes of general physicians towards BPD even if they are the main professionals involved in the evaluation and treatment of these patients. Additionally, patients with BPD frequently consult general physicians and, because of the difficulties interacting with these patients, they do not always receive the treatments required by their condition. This research aims to assess the attitudes of general physicians and family medicine residents regarding patients presenting with this disorder. METHOD: Forty family medicine residents and thirty-five general physicians were compared to thirty-nine mental health professionals using the Attitudes toward people with BPD Scale (ABPDS; Bouchard, 2001). This measure has two subscales labeled Comfort when interacting with someone who has BPD and Positives perceptions about BPD. The internal consistency of the scale as well as the two distinct factors are satisfactory. The participants also complete a socio-demographic questionnaire. Means, t tests, ANOVAs and factorial ANOVAs are completed in order to compare the three groups on the ABPDS and explore the influence of variables such as sex, age, years of experience, and professional setting (urban or rural) on the results. RESULTS: The results show that general physicians have similar attitudes than mental health professionals towards people presenting with BPD and that family medicine residents present less positive attitude than the other two groups. In addition, clinicians with less experience tend to have less positive attitudes towards people with BPD and clinicians from urban settings seem to have more positive attitude. It was difficult to determinate which variables influence the results because the years of experience, the professional settings and the title of the participants are extremely related. The factorial ANOVAs show no interaction effect between these three variables. CONCLUSION: Several studies show that health professionals present negative attitudes toward patients with BPD. This study reveals that general physicians and family medicine residents show respectively similar attitudes or less positive attitudes than other mental health professionals. These results underline the importance of providing specific training about BPD to family medicine residents. Because general physicians guide the evaluations and interventions concerning these patients and mental health professionals interact regularly with BPD, it will be helpful if all the clinicians receive more specific training regarding this disorder.

Mentalization and attachment representations: a theoretical contribution to the understanding of reactive attachment disorder.

This article proposes an understanding of children with reactive attachment disorder (RAD) through psychoanalytic thought and mentalization theory. RAD is presented followed by a discussion on attachment and the need for a better understanding of this disorder. Theories from British psychoanalytic thinkers are used to describe what might be transpiring in the early relationship between mother and child. Particular attention is given to how children's internal objects are influenced by a compromised early mother-child relationship.