[Psychotherapic interventions for bipolar disorder in children and adolescents]. / Interventions psychothérapiques dans le trouble bipolaire chez l'enfant et l'adolescent.

OBJECTIVE: To review the options for psychosocial interventions in pediatric bipolar disorders. METHODS: A comprehensive literature review of randomized clinical trials and open-label studies was conducted. RESULTS: Randomized controlled trials show that psychosocial interventions involving families (i.e. family-focused treatment) or individual and family therapy (i.e. multi- or individual-family psychoeducational psychotherapy, child- and family-focused cognitive-behavioral therapy, dialectical behavior therapy) may be effective through added benefit to pharmacotherapy. All these interventions share numerous common therapeutic elements such as psychoeducation and skills training. Individual interventions (i.e. interpersonal and social rhythm therapy and cognitive-behavioral therapy) are to date less well documented. However that may be, outcome studies remain few, and numerous methodological limitations (small sample sizes, designs not very rigorous) restrict the interpretability and generalisability of their results. In addition, most studies were conducted in specialty centers with highly trained therapists, and the feasibility and acceptability of these interventions in practice settings remain to be shown. CONCLUSION: Despite recent developments in identifying effective psychosocial interventions, numerous critical gaps remain, and more longitudinal studies are needed to clarify how these interventions work.

[The adolescent abstainers: A risk group?] / Les adolescents abstinents : un groupe à risque ?

OBJECTIVE: If abstinence from substance in adolescents may nowadays be regarded statistically as a deviant behavior, what is its significance from a developmental point of view? The aim of this article is to examine the mental health characteristics and the social integration of adolescent abstainers. METHODS: A comprehensive literature review of epidemiological studies including data on adolescent abstainers was conducted. RESULTS: Compared to the abundant literature devoted to adolescent substance abusers, few studies report data on adolescent abstainers. In addition, many methodological problems limit their interpretability and their comparison. However that may be, this body of work suggests that if abstinence may be due to something intrinsic about the individual (such as psychosocial adjustment difficulties, personality traits or gender), many other environmental factors (such as family background of temperance, cultural practices, upbringing or religion) may determine abstaining behavior. By this way, from a psychopathological angle, adolescent abstainers certainly constitute a more heterogeneous group than the adolescent substance abusers. Some of them are quite psychologically healthy, whereas others are more socially withdrawn and may suffer from emotional disorders. CONCLUSION: In terms of prevention, these data highlight the need for longitudinal prospective studies examining the psychosocial status of adolescent abstainers, their antecedents, their outcome and their motivations.

[Pharmacological treatment of bipolar disorder in children and adolescents]. / Traitement pharmacologique du trouble bipolaire chez l'enfant et l'adolescent.

OBJECTIVE: To review the options for acute and maintenance pharmacological treatment of bipolar disorder in children and adolescents. METHODS: A comprehensive literature review of randomized clinical trials and open-label studies was conducted. RESULTS: Published data from randomized controlled trials show that antipsychotics are significantly more effective than mood stabilizers in the treatment of manic or mixed episodes. Few data are available related to the treatment of depressive episodes. No trials of selective serotonin reuptake inhibitors have been conducted. Only open trials suggest that lithium and lamotrigine may be effective, whereas quetiapine did not demonstrate efficacy relative to placebo in two studies. Studies regarding the effectiveness of antipsychotics and mood stabilizers for the comorbid disorders are also few and inconclusive. Although long-term treatment is a core aspect of the management of children and adolescents with bipolar disorder, there is a lack of consistent efficacy data. If non-controlled trials suggest that lithium, lamotrigine, quetiapine, ziprazidone, and the combination of risperidone and divalproex or lithium may be useful in some conditions, only aripiprazole has shown efficacy relative to placebo for long-term symptom reduction and relapse prevention. Safety data show that the most frequently reported adverse events in children and adolescents treated with mood stabilizers are gastrointestinal and neurological, whereas use of antipsychotics is mainly related to weight gain and sedation. Lastly, while results from studies having evaluated the impact of pharmacological treatment on neuropsychological functioning are inconsistent, some of them nevertheless suggest that treatment with mood stabilizers may be associated with specific impairments. CONCLUSION: Despite recent developments in identifying effective pharmacological interventions, numerous critical gaps remain.

[Alcohol use in children: An unrecognized fact]. / La consommation d'alcool chez les enfants : une réalité méconnue.

Although drinking problems are now well documented in adolescents and young people, few data are available on alcohol use in children younger than 12. In France, studies have shown that 60-70% of 11-year-olds reported having tasted alcohol drinks, 4-7% having experienced drunkenness at least once, and that 5-8% might be regarded as "regular" alcohol users. By comparison, the prevalence of child drinking in the United States seems to be lower. All studies show that parental alcohol-specific attitudes and parental educational practices have a strong influence on the initiation of alcohol use in children. Some of them also indicate that early-onset drinking in children may be related to psychosocial functioning in other life areas, such as problem behaviors, low school engagement, and poor relationships with parents, in association with temperamental and environmental risk factors similar to those described in substance use disorders. Since epidemiological studies showed that early initiation of alcohol use is linked to later alcohol-related problems, these data call for further attention to children's perceptions and attitudes with respect to alcohol in research to prevent alcohol misuse.

[Alcohol use in young adolescents. A survey in French secondary schools]. / Consommation d'alcool chez les jeunes adolescents : enquête en milieu scolaire.

Among young adolescents, early use of alcohol has been shown to be related to later alcohol use disorders and alcohol-related problems in numerous epidemiologic studies. However, if drinking problems are now well documented in young people, few data are available on alcohol use in children and young adolescents. The purpose of this study was to examine the perceptions and attitudes with respect to alcohol use among young adolescents entering their first year of secondary school (mean age, 11.5 years). Data were collected from the ESPACE program, a preventive program conducted in the educational district of Limoges, France. Of the 2268 respondents with complete data, 73.4% (77.1% in males vs. 69.9% in females; P<0.001) reported having tasted alcohol drinks and 3.7% (4.9% in males vs. 2.6% in females; P=0.004) having experienced drunkenness at least once. Of these adolescents, 5.4% (8.5% in males vs. 2.4% in females, P<0.001) reported consuming alcohol at least once per month, which may be considered as a sort of regular drinking pattern. Taking age, sex, and level of alcohol consumption into account, experience of drunkenness (21.9% in regular users vs. 3.7% in occasional users), tobacco use (25.8% in regular users vs. 12.6% in occasional users and 1.5% in nonusers) and cannabis use (6.0% in regular users vs. 0.9% in occasional users and 0.2% in nonusers) were found to be significantly more frequent in regular alcohol users than in other students (P<0.001). Data analysis also showed that regular alcohol users felt significantly more frequently depressed, lacking self-assurance, dissatisfied with their physical appearance and their way of life, and they felt that they exhibited significantly more impairments in their interactions with parents, peers, and the school environment. Similarly, they were found to have significantly more frequently an inclination for risk behaviors and a significantly more positive view of drinking than other students. These results look almost like those reported in adolescents and young people, and show that the alcohol abuse pattern is drawn early in childhood. They also highlight the value of epidemiologic investigations for planning preventive interventions.

[Issues related to consent to healthcare decisions in children and adolescents]. / Problèmes liés au consentement chez l'enfant et l'adolescent.

The process of consent to healthcare decisions in children and adolescents often set physicians difficult problems. From what age is a child able to understand the information given to him or her about illness and treatment? Is an ill child indeed in the capacity to give his or her voluntary consent to treatment? How to define and to assess the capacity of an ill child to take part in treatment decisions? More than the age of the child, it is his or her level of cognitive, emotional and social development and its interactions with illness that will determine his or her degree of involvement in the decision-making process. There is a moral and ethical need to respect the rights and autonomy of every individual, regardless of age. This does not mean viewing children and adolescents as rational and autonomous decision-makers. This implies that we must promote their developmentally appropriate participation in shared decision-making with parents and physicians. Therefore, instead of asking, "should children and adolescents be granted absolute autonomy in decision making?" we ought to ask, "should we treat children and adolescents like people?"

[Antidepressant use in children and adolescents]. / Indications des antidépresseurs chez l'enfant et l'adolescent.

Relative to placebo, selective serotonin reuptake inhibitors (SSRI) are efficacious for paediatric affective disorders, although their clinical effects appear relatively modest in major depressive disorder, intermediate in obsessive-compulsive disorder, and stronger in anxiety disorders. If SSRIs modestly increase the risk of occurrence of suicidal ideation and behavior, several studies show that their use is associated with a significant decrease in the suicide rates in children and adolescents, probably because of their efficacy, compliance, and low toxicity in overdose.

Inter-annual variations in the abundance of young-of-the-year of migratory fishes in the Upper Paraná River floodplain: relations with hydrographic attributes.

In this study, we identified and characterized the hydrographic attributes related to the success of recruitment of migratory fishes in the Upper Paraná River floodplain. To achieve our objectives, we analyzed inter-annual variations in the abundance of young-of-the-year (YOY; index of recruitment) of six migratory species and their relations with hydrographic attributes. Recruitment was related to the intensity, duration (in different fluviometrical levels), elasticity, number of pulses, greater uninterrupted overflow and delay of the floods (all obtained using the PULSO software). Collections of fish were conducted in the period between January 1987 and November 2007 in distinct environments (river channels, secondary channels and connected and disconnected floodplain lakes) distributed along three subsystems (Paraná, Baía and Ivinheima). Relations between recruitment and the attributes of interest were determined through analysis of covariance. In the studied period, the highest abundances of YOY were registered in 2007, followed by 1992, 1993, 2005 and 1988. The abundance of YOY was positively correlated with an intensity of high water levels (potamophase) and the duration of potamophase 1 and negatively with the duration of low water levels (limnophase) and a delay of flood. Higher hydrometric levels (540 and 610 cm for Paraná and 325 and 450 cm for Ivinheima) and greatest uninterrupted overflow presented different relations (significant interactions) among subsystems, but all with positive effects on recruitment. Results evidenced that recruitment responded better when floods started in January with potamophase intensities above 610 cm and water levels above 450 cm over a period of 50 days and repeated every two years (or > 610 cm for 38 days and repeated every two or three years). Therefore, artificial control of the floods at intervals of two or three years by manipulating the discharge of dams located upstream from the floodplain in a way that promotes potamophases with the potential to ensure recruitment of migratory species may become an important tool for conservation of migratory fish species in the floodplain.

Inter-annual variations in the abundance of young-of-the-year of migratory fishes in the Upper Paraná River floodplain: relations with hydrographic attributes / Variações interanuais na abundância de jovens-do-ano de peixes migradores da planície de inundação do Alto Rio Paraná: relação com atributos hidrográficos

In this study, we identified and characterized the hydrographic attributes related to the success of recruitment of migratory fishes in the Upper Paraná River floodplain. To achieve our objectives, we analyzed inter-annual variations in the abundance of young-of-the-year (YOY; index of recruitment) of six migratory species and their relations with hydrographic attributes. Recruitment was related to the intensity, duration (in different fluviometrical levels), elasticity, number of pulses, greater uninterrupted overflow and delay of the floods (all obtained using the PULSO software). Collections of fish were conducted in the period between January 1987 and November 2007 in distinct environments (river channels, secondary channels and connected and disconnected floodplain lakes) distributed along three subsystems (Paraná, Baía and Ivinheima). Relations between recruitment and the attributes of interest were determined through analysis of covariance. In the studied period, the highest abundances of YOY were registered in 2007, followed by 1992, 1993, 2005 and 1988. The abundance of YOY was positively correlated with an intensity of high water levels (potamophase) and the duration of potamophase 1 and negatively with the duration of low water levels (limnophase) and a delay of flood. Higher hydrometric levels (540 and 610 cm for Paraná and 325 and 450 cm for Ivinheima) and greatest uninterrupted overflow presented different relations (significant interactions) among subsystems, but all with positive effects on recruitment. Results evidenced that recruitment responded better when floods started in January with potamophase intensities above 610 cm and water levels above 450 cm over a period of 50 days and repeated every two years (or > 610 cm for 38 days and repeated every two or three years). Therefore, artificial control of the floods at intervals of two or three years by manipulating the discharge of dams located upstream from the floodplain ...

Este estudo buscou identificar e caracterizar os atributos hidrográficos relacionados ao sucesso do recrutamento de peixes migradores na planície de inundação do Alto Rio Paraná. Para isso, foram analisadas as variações interanuais na abundância de jovens do ano (indexador do recrutamento) de seis espécies de peixes migradores e sua relação com os atributos hidrográficos intensidade, duração (em diferentes níveis fluviométricos), elasticidade, número de pulsos, maior cheia contínua e atraso das cheias. As capturas foram realizadas no período de janeiro de 1987 a novembro de 2007 em diferentes ambientes (canal do rio, canais secundários e lagoas abertas e fechadas) distribuídos em três subsistemas (Paraná, Baía e Ivinheima). A relação entre recrutamento e os atributos foi avaliada através de análises de covariância. No período estudado, a maior abundância de jovens-do-ano ocorreu em 2007, seguida de 1992, 1993, 2005 e 1988, sendo incipiente nos demais anos. A abundância de jovens do ano relacionou-se positivamente com a intensidade de potamofase e duração de potamofase 1 e negativamente com a duração do período de águas baixas (limnofase) e atraso no início das cheias. Níveis hidrométricos mais elevados (540 e 610 cm no Rio Paraná e 325 e 400 cm no Rio Ivinheima) e as maiores cheias contínuas apresentaram relações distintas para os subsistemas (interação significativa), com respostas positivas no recrutamento. Os resultados permitem evidenciar que a melhor resposta no recrutamento foi verificada na cheia iniciada em janeiro, com intensidade de potamofase superior a 610 cm, com níveis superiores a 450 cm por mais de 50 dias e repetida a cada dois anos (ou >610 cm durante 38 dias e repetida a cada dois ou três anos). Diante disso, o controle artificial das cheias pela manipulação de vazão das hidrelétricas a montante, que permita a ocorrência de potamofases com potencial para assegurar sucesso no recrutamento dos peixes migradores, a cada ...

Inter-annual variations in the abundance of young-of-the-year of migratory fishes in the Upper Paraná River floodplain: relations with hydrographic attributes

In this study, we identified and characterized the hydrographic attributes related to the success of recruitment of migratory fishes in the Upper Paraná River floodplain. To achieve our objectives, we analyzed inter-annual variations in the abundance of young-of-the-year (YOY; index of recruitment) of six migratory species and their relations with hydrographic attributes. Recruitment was related to the intensity, duration (in different fluviometrical levels), elasticity, number of pulses, greater uninterrupted overflow and delay of the floods (all obtained using the PULSO software). Collections of fish were conducted in the period between January 1987 and November 2007 in distinct environments (river channels, secondary channels and connected and disconnected floodplain lakes) distributed along three subsystems (Paraná, Baía and Ivinheima). Relations between recruitment and the attributes of interest were determined through analysis of covariance. In the studied period, the highest abundances of YOY were registered in 2007, followed by 1992, 1993, 2005 and 1988. The abundance of YOY was positively correlated with an intensity of high water levels (potamophase) and the duration of potamophase 1 and negatively with the duration of low water levels (limnophase) and a delay of flood. Higher hydrometric levels (540 and 610 cm for Paraná and 325 and 450 cm for Ivinheima) and greatest uninterrupted overflow presented different relations (significant interactions) among subsystems, but all with positive effects on recruitment. Results evidenced that recruitment responded better when floods started in January with potamophase intensities above 610 cm and water levels above 450 cm over a period of 50 days and repeated every two years (or > 610 cm for 38 days and repeated every two or three years). Therefore, artificial control of the floods at intervals of two or three years by manipulating the discharge of dams located upstream from the floodplain in a way that promotes potamophases with the potential to ensure recruitment of migratory species may become an important tool for conservation of migratory fish species in the floodplain.

Este estudo buscou identificar e caracterizar os atributos hidrográficos relacionados ao sucesso do recrutamento de peixes migradores na planície de inundação do Alto Rio Paraná. Para isso, foram analisadas as variações interanuais na abundância de jovens do ano (indexador do recrutamento) de seis espécies de peixes migradores e sua relação com os atributos hidrográficos intensidade, duração (em diferentes níveis fluviométricos), elasticidade, número de pulsos, maior cheia contínua e atraso das cheias. As capturas foram realizadas no período de janeiro de 1987 a novembro de 2007 em diferentes ambientes (canal do rio, canais secundários e lagoas abertas e fechadas) distribuídos em três subsistemas (Paraná, Baía e Ivinheima). A relação entre recrutamento e os atributos foi avaliada através de análises de covariância. No período estudado, a maior abundância de jovens-do-ano ocorreu em 2007, seguida de 1992, 1993, 2005 e 1988, sendo incipiente nos demais anos. A abundância de jovens do ano relacionou-se positivamente com a intensidade de potamofase e duração de potamofase 1 e negativamente com a duração do período de águas baixas (limnofase) e atraso no início das cheias. Níveis hidrométricos mais elevados (540 e 610 cm no Rio Paraná e 325 e 400 cm no Rio Ivinheima) e as maiores cheias contínuas apresentaram relações distintas para os subsistemas (interação significativa), com respostas positivas no recrutamento. Os resultados permitem evidenciar que a melhor resposta no recrutamento foi verificada na cheia iniciada em janeiro, com intensidade de potamofase superior a 610 cm, com níveis superiores a 450 cm por mais de 50 dias e repetida a cada dois anos (ou >610 cm durante 38 dias e repetida a cada dois ou três anos). Diante disso, o controle artificial das cheias pela manipulação de vazão das hidrelétricas a montante, que permita a ocorrência de potamofases com potencial para assegurar sucesso no recrutamento dos peixes migradores, a cada dois ou três anos, pode tornar-se uma importante ferramenta para a preservação das espécies migradoras na planície.

[Adolescence and schizophrenia]. / Adolescence et schizophrénie.

Whilst early onset schizophrenias are rare all studies show a clear increase in the incidence and prevalence of the disorder from the age of 15 onwards. The clinical picture in adolescence is similar to that described in adults although the diagnosis of schizophrenia at this age is still difficult, as the disorder shares many common symptoms with the affective psychoses (particularly with bipolar disorder). Some clinical features, the premorbid history and past family history can help with the differential diagnosis in this situation. Studies on the fate of schizophrenic adolescents show that the disorder has particularly harmful consequences on the individuals' development and psychosocial adaptation. The risk of suicide or accidental death are highlighted. This may be partly explained by the progressive deterioration of cognitive function seen, with the progression and the prevalence of co-morbid disorders (conduct disorders, substance abuse). Paradoxically there are few objective data available as yet about the efficacy of the different treatment strategies offered ; medical and psychotherapeutic, behavioural or psychosocial. Whilst early intervention programmes for adolescents at high risk of schizophrenia have been introduced, their utility and efficacy remain to be shown.

Improved laboratory values of the H2 Lyman and Werner lines for constraining time variation of the proton-to-electron mass ratio.

Two distinct high-accuracy laboratory spectroscopic investigations of the H2 molecule are reported. Anchor lines in the EF1Sigmag+-X1Sigmag+ system are calibrated by two-photon deep-UV Doppler-free spectroscopy, while independent Fourier-transform spectroscopic measurements are performed that yield accurate spacings in the B1Sigmau+-EF1Sigmag+ and I1Pig-C1Piu systems. From combination differences accurate transition wavelengths for the B-X Lyman and the C-X Werner lines can be determined with accuracies better than approximately 5 x 10(-9), representing a major improvement over existing values. This metrology provides a practically exact database to extract a possible variation of the proton-to-electron mass ratio based on H2 lines in high-redshift objects. Moreover, it forms a rationale for equipping a future class of telescopes, carrying 30-40 m dishes, with novel spectrometers of higher resolving powers.

[Theory of mind in Asperger syndrome]. / Syndrome d'Asperger et théorie de l'esprit.

INTRODUCTION: Theory of mind deficit can be used to explain social and communication impairments that define the autism spectrum disorder. Theory of mind is the ability to attribute mental states to self and others in order to understand and predict behavior. It involves the distinction between the real world and mental representations of the world. Several studies established that high functioning autistic individuals and individuals with Asperger syndrome (ASP) tend to be as proficient as controls in understanding first order false belief tasks. In contrast, they still lag behind their typical peers in understanding second order false belief tasks or more advanced tasks of theory of mind (e.g., Baron-Cohen, 1993). Most of these studies focus on the adult population and it seems particularly interesting to investigate whether children with ASP would present the same pattern of strengths and deficits as adults. In our research, children with ASP were tested in an advanced task of theory of mind based on a visual presentation of comic strips and in a more traditional assessment of false belief understanding: the Smarties test. METHOD: Two experimental groups participated in this study: a group of 16 high functioning children and adolescents with autism or with Asperger syndrome (ASP) and a group of 16 typically developing children matched on gender and age (CONT). The task was designed to assess the ability of children with ASP to infer the mental state of others. Stimuli were 26 different comic strips depicting a short story. Each comic strip was composed of three pictures and was shown on the upper half of the screen. Then three pictures numbered 1 to 3 showing possible outcomes of the scenario were superimposed on the bottom half of the screen. Only one of these three pictures represented a plausible conclusion to the scenario. This experiment contained two conditions: A Character intention (CI) condition and a Physical causality (PC) condition. The comic strips in the CI condition involved one character whose intentions had to be inferred by the subject in order to choose the correct picture. Comic strips in PC condition only required to understand physical causalities. Subjects were asked to watch the comic strip attentively and then they were required to make a choice between the three story endings by pressing the corresponding keyboard button. Both answers and response times were recorded. Additionally, all participants were enrolled in the classical false belief (Smarties) task. RESULTS: Comic strips: An ANOVA [2 groups (CONT/ASP) x 2 conditions (CI/PC)] was performed on the number of correct responses. Neither the Group nor the Condition factor was significant (p>0.05). In contrast, the interaction Group x Condition reached significance level [F(1-30)=4.3, p<0.05)]. Further analysis revealed that performance of the ASP group was significantly higher in the CP (M=10.8, SD=2.5) than in the CI (M=9.8, SD=2) condition [t (1-14)=2.9, p<0.001)], whereas there was no condition difference in the control group (p>0.05). False belief: all ASP participants succeeded in the task. DISCUSSION: Our data clearly demonstrated that children and adolescents with Asperger syndrome or high functioning autism exhibited an impairment in understanding the intention of others. In the comic strip task, children with ASP have more difficulties in the character's intention condition than in the physical causality condition. This impairment is not imputable to a deficit in taking into account the context (Weack Central Coherence theory) since they performed as well as controls in the physical causality condition which also required the processing of the whole scene. In contrast, all children with ASP succeeded at the false belief task. These contradictory findings suggest that, although testing theory of mind, the two tasks do not tap similar mechanisms. It is possible that the use of verbal material in the false belief task improved performance of the ASP children who are known to present particular strengths in this domain. Another possible explanation that needs further testing would be that the level of complexity differs between the two tasks.

[An assessment of stress in adolescent inpatients]. / Une mesure du stress des adolescents hospitalisés.

UNLABELLED: Hospitalisation often remains stressful for adolescents. Therefore the improvement of life conditions and management of poorly adolescents during their hospital stay grows into an important concern in the medical staff. However, there is a lack of standardized instruments for an objective and reproducible assessment of problems related to this subject. The Hospital Stress Rating Scale (HSRS), validated in hospitalized adult patients, seems to be an interesting tool allowing an assessment of the level of stress and to specify the stressful factors. SUBJECTS AND METHODS: During ten months, 107 adolescent inpatients, 39 males and 68 females, aged on average 13.5 +/-1.5 years, were included in the study. In addition to the HSRS, in a version adapted for adolescents, two other self-report questionnaires were used: the Toulouse Stress Rating Scale (TSRS), which is a rating scale validated to assess the level of stress and to identify the clinical manifestations of stress in adolescents, and the Toulouse Coping Rating Scale (TCRS), which is a rating scale validated to assess the coping style of adolescents in stressful situations. The sociodemographic and clinical characteristics of the studied subjects were collected by a standardized questionnaire. RESULTS: A significant correlation was found between the HSRS mean total score and the TSRS mean total score. The HSRS item by item analysis showed that the nature of the stressors varied according to the clinical characteristics of the subjects. Lastly, the coping style was found having a significant influence on the level of stress reported by the subjects. CONCLUSION: Even if they were obtained in a relatively small sample, these results show that the HSRS is a useful tool to assess the stress reported by the hospitalized adolescents. Such an instrument may be useful to plan aid and preventive strategies and to assess their impact in hospitalized adolescents.

[Sleep in adolescents and its disorders. A survey in schools]. / Le sommeil des adolescents et ses troubles.

OBJECTIVES: Numerous studies emphasized the high prevalence of sleep problems in adolescents. However, it remains to be seen whether these problems are developmental or if they are related to pathological conditions. In order to try to answer this question, we conducted an epidemiological study investigating the prevalence and correlates of sleep disorders in a population of high school adolescents. METHOD: The sample for this investigation consisted of 652 high school students (344 males and 308 females), aged 13 to 19 years (mean age: 15.1 1.2 years), attending colleges in the North of France. Data for the study were obtained by means of revised versions of the INSERM self-report questionnaires for adolescents. One questionnaire included 113 response choice items investigating the sleep parameters and the sociodemographic, behavioural, health, and environmental condition of the subject. This questionnaire was completed by a self-portrait questionnaire including 27 response choice items about mood, anxiety, instability and the quality of relations with others. In addition, a clinical examination was performed by the clinicians of the school health department in order to investigate the medical history of the subject and his (her) pubertal development. RESULTS: In a first step, statistical analysis showed some significant differences in sleep rates and troubles between males and females. If the total sleep time was found similar in males and females, females were found exhibiting significantly earlier bedtime (p<0.01) and waking time (p<0.005) than males. In addition, trouble falling asleep (p<0.0001), nightmares (p<0.001), need for daytime sleep (p<0.05), and stimulant pill intake (p<0.05) were found significantly more frequent in females. Then, the adolescents were classified into two subgroups. "Insomnia group" included the students who answered "often" or "always" to one of the five questions about: having trouble falling asleep, the occurrence of early awakenings, their need for daytime sleep, sleeping pill intake, and bad sleep quality. "Non insomnia group" included those who answered "never" or "sometimes" in response to the five questions. Results showed that 233 adolescents (35.7%) exhibited persistent sleep disorders, insomnia type. 40.2% of females and 31.6% of males were included in the "insomnia group" (p<0.05). Pubertal development was found significantly more advanced in the "insomnia group" adolescents, more particularly in females. In the same way, concerns about body weight (46.7% vs 38.8%; p<0.005), size and shape (15% vs 8%; p<0.01) were found significantly more frequent in the "insomnia group"; 32.3% of the "insomnia group" adolescents vs 17.9% in the "non insomnia group" reported health problems (p<0.0001). School difficulties were found significantly more frequent in the "insomnia group" compared to the "non insomnia group". The proportion of subjects who have previously repeated at least one school year (p<0.01), who reported bad school performances (p<0.01), and who reported to be "sometimes" or "often" away from school (p<0.01) was significantly higher in the "insomnia group" than in the "non insomnia group". In the same way, data showed that school investing was also significantly weaker in the "insomnia group" adolescents (p<0.01). The proportion of subjects who believed that their relations with parents (12.4% vs 6%; p<0.05), teachers (21.4% vs 10.5%; p<0.0001), or peers (10.2% vs 4.1%; p<0.002) was found significantly higher in the "insomnia group". Risk behaviours were also significantly more frequent in the "insomnia group" adolescents: suicidal ideation (25.1% vs 11.7%; p<0.001), suicide attempt (7.3% vs 3.6%; p<0.05), psychotropic drug use (11% vs 4.9%; p<0.02), regular stimulant drug use (10% vs 5.1%; p<0.005), regular tobacco use (7.8% vs 2.2%; p<0.001), regular alcohol use (13.3% vs 8.3%; p<0.05), and illicit drug use (5.2% vs 1%; p<0.001). Lastly, all the dimensions of the self-portrait were found significantly more affected or negative in the "insomnia group" than in the "non insomnia group". For example, the proportion of subjects who described themself usually sad (10.2% vs 3.4%; p<0.001), anxious (54.9% vs 40.5%; p<0.0001), downcast (41.1% vs 32.6%; p<0.05), or instable (56.9% vs 41.7%; p<0.0001) was significantly higher in the "insomnia group". CONCLUSION: In this descriptive study, if some data suggest that pubertal development may be involved in the sleep rates or troubles observed in adolescents, the results also show that persistent sleep disorders are significantly associated with physical, psychological or social difficulties. In summary, this study shows that it is essential to take an interest in the quality of sleep in adolescents, which may be a way to approach their psychosocial difficulties.

[Role of implicit theories in primary school]. / Rôle des théories implicites à l'école primaire.

Since the 50s, the role of implicit theories in the organization and interpretation of information has gained increasing acceptance among both cognitive and social psychologists. These implicit theories refer to the two different assumptions people may make about the malleability of personal attributes. They may believe that a highly valued personal attribute, such as intelligence or morality, is fixed, i.e. a nonmalleable trait-like entity (entity theory), or that the attribute is a malleable quality that can be changed and developed (incremental theory). The identification of these two theories allows us to understand the cognition, emotion and behavior of individuals in achievement situations. Many studies carried out in the primary school show that children who hold an entity theory of personal attribute (i.e. they consider badness like a stable quality) have a strong tendency to attribute their failures to a fixed trait. They are more likely to attribute failures to their bad abilities. In contrast, children who hold an incremental theory of personal attribute (i.e. they consider badness as a malleable quality) are more likely to understand the same negative outcomes in terms of specific factors: they attribute them to a lack of effort. In addition, several studies have shown that entity theorists are more likely than incremental theorists to react helplessly in the face of failure. They are more likely to show negative affect and behaviors. This helpless response pattern is characterized by a lack of persistence. In contrast, incremental theorists try harder and develop better strategies and continue to work. Finally, several studies demonstrate that environmental factors play an important role in the implicit theories elaboration.

[Role of the implicit theories of intelligence in learning situations]. / Rôle des théories implicites de l'intelligence chez les élèves en situation d'apprentissage.

Most studies have tried to explain the school difficulties by analysing the intellectual factors that lead to school failure. However in addition to the instrumental capacities, authors also recognize the role played by other factors such as motivation. More specifically, the theory of achievement motivation aims to determine motivational factors involved in achievement situations when the students have to demonstrate their competencies. This paradigm attributes a central place to beliefs in order to explain children's behavior in academic situations. According to Dweck, it seems that beliefs about the nature of intelligence have a very powerful impact on behavior. These implicit theories of intelligence create a meaning system or conceptual framework that influences the individual interpretation of school situations. Thus, an entity theory of intelligence is the belief that intelligence is a fixed trait, a personal quality that cannot be changed. Students who subscribe to this theory believe that although people can learn new things, their underlying intelligence remains the same. In contrast, an incremental theory of intelligence is the belief that intelligence is a malleable quality that can increase through efforts. The identification of these two theories allows us to understand the cognition and behavior of individuals in achievement situations. Many studies carried out in the academic area show that students who hold an entity theory of intelligence (ie they consider intelligence like a stable quality) have a strong tendency to attribute their failures to a fixed trait. They are more likely to blame their intelligence for ne-gative outcomes and to attribute failures to their bad intellectual ability. In contrast, students who hold an incremental theory of intelligence (ie they consider intelligence as a malleable quality) are more likely to understand the same ne-gative outcomes in terms of specific factors: they attribute them to a lack of effort. This differential emphasis on traits versus specific mediators in turn fosters different reactions to negative events. Several studies have shown that entity theorists of intelligence are more likely than incremental theorists to react helplessly in the face of failure. They are not only more likely to make negative judgments about their intelligence from the failures, but also more likely to show negative affect and behaviors. This helpless response pattern is cha-racterized by a lack of persistence, and performance decrements. In contrast, incremental theorists, who focus more on behavioral factors (eg effort, problem-solving strategies) as causes of negative achievement outcomes, tend to act on these mediators. They try harder and develop better strategies and continue to work. Some authors have tendency to consider implicit theories of intelligence as a disposition or a stable dimension. But in the last few years, several studies showed that people's theories are not fixed traits; they are beliefs that may be influenced. These studies also suggested that students use the two types of beliefs and that the context determines the choice between the two types of theories. According to these authors, the psychological state of the student depends on dispositional factors but also on situational factors. Thus, several studies have tried to demonstrate that it is possible to modify experimentally implicit theories of intelligence and subsequent cognitions and behaviors by modifying situational factors. Several studies have demonstrated that it was possible to induce students to adopt one of the two theories of intelligence by presenting them a scientific article that compelling argued for either an entity or an incremental view of intelligence. The results showed that participants who had received the entity theory induction exhibited more evidence of a helpless reaction to failure. These studies show that some of the judgments and reactions associated with implicit theories can be experimentally induced by manipulating participant theories. However in the context of school difficulties, only few works have been conducted. We think that the model of the motivation of achievement would allow us to better understand maladjusted behaviors that engender failure and scholastic exclusion. In one study, reseachers have demonstrated that children with mental disorders are less likely than other children to hold an incremental theory of their intellectual abilities. Other studies have demonstrated that entity theorists interpret their bad results according to their global intelligence level by negatively judging their global abilities ("I think I am stupid"). It is interesting to note that these students make the same attributions as depressive students. These results reveal the need to determine systems of beliefs within populations with anxiety or depressive symptoms in order to characterise their motivational profiles. Indeed, we think that these symptoms contribute to modify implicit theories of intelligence and the nature of the subsequent scholastic achievement. Finally, we think that it is inte-resting to demonstrate the positive motivational effects of the experimental induction of the incremental theory. A series of studies showed that children's theories of intelligence expe-rimentally induced will influence their tendency to persevere in the face of failure. Like normally developing children, children with mental disorders were more likely to prefer challenging activities and report high levels of interest-enjoyment when the task was presented as one which is improvable. It suggests that although children with difficulties are pessimistic about improving their intellectual capacities, if a new task is introduced in a way that highlights the possibility of self-improvement (incremental theory), then they will pursue the challenge in an adaptive manner (strong perseverance, enjoy, and important interest). These results are very inte-resting. Indeed, highlighting an incremental theory had a po-sitive motivational effect on behavior in achievement situations. In addition, all these results also may open up several interesting perspectives for the treatment of learning disabi-lities. The results should lead to plan programmes of cognitive therapy in order to modify beliefs that underlie maladjusted achievement behaviors of children and adolescents in scholastic failure.

[A rare and not very studied disorder: childhood-onset schizophrenia. A case report]. / Un trouble rare et peu étudié: la schizophrénie chez l'enfant. A propos d'une observation.

UNLABELLED: Childhood-onset schizophrenia is rare: its prevalence is about 50 times lower than the one observed in adulthood. It is also frequently unrecognized, notably because its clinical aspect varies with age. The authors report the case of a prepubertal girl who developed a typical clinical picture of schizophrenia (paranoid subtype) by age 9. CASE REPORT: The patient was 10 years old when she was hospitalized for a relapse of a suspected childhood-onset schizophrenia. Several significant mental disorders were found in her family history: her mother was treated for mood disorders (including dysthymia and major depression with postpartum onset), while her father and a aunt exhibited schizophrenic disorders. In addition, prenatal and perinatal events (including probable prenatal maternal infection and obstetric complications) were reported by her mother. Demonstrable impairments were already present in her premorbid development: from the age of 3.5, she showed significant manifestations of behavioural inhibition and separation anxiety, severe difficulties in social adaptation, and language abnormalities (qualified by her general practitioner as selective mutism). At the age of 9, when her mother was hospitalized for a diabetes mellitus, she suddenly showed auditory and visual hallucinations associated with delusions. Their content included filiation, somatic, and persecutory themes. Grossly disorganized behaviour (and more particularly catatonic motor behaviours including catatonic rigidity and negativism and bizarre postures) was also observed. Negative symptoms (eg anhedonia, affective flattening, and alogia) were noted. Her IQ scores were 74 in the verbal subtests and 53 in the performance subtests. Because the diagnostic of childhood-onset schizophrenia was suspected, a neuroleptic treatment, haloperidol 3 mg/day, was tried. After a partial remission during a few months period (characterized by a decrease in delusions, anxiety and sleep difficulties), she showed a relapse leading to her hospitalization. At the time of her admission, she showed severe manifestations of separation anxiety including agitation, anger, crying, and insomnia, for which she received a short-lived treatment by lorazepam. When sedation was obtained, the clinical picture proved similar to the one previously observed: hallucinations, delusions, grossly disorganized behaviour, and thought disorder were noted. As soon as the diagnostic of childhood-onset schizophrenia was confirmed, she was administered a new antipsychotic agent, amisulpride, at dose of 600 mg/day. This treatment was going on during several weeks with no significant clinical effect. Because the early onset of the disorder, the family history of schizophrenia, and the lack of effectiveness of the two previously administered antipsychotic agents, a treatment with clozapine was started at the dose of 12,5 mg/day. From the outset of this treatment, clinically significant reductions in hallucinations and disorganized behaviours were noted. Dose was then progressively increased until 200 mg/day, resulting in significant improvement in cognitive and motor functioning. The patient is now in an educational institute. Her adaptation is considered satisfactory, in spite of regular exacerbations of delusions in response to stressful life events. Treatment with clozapine is going on, without any significant undesirable clinical effects. DISCUSSION: If an abrupt onset is rarely observed in prepubertal children, all the authors report that patients with very early onset schizophrenia show to have demonstrable impairments in their premorbid language as well as in their motor and social development. In addition, several studies suggest that more pronounced early developmental abnormalities are usually associated with a poor outcome in schizophrenia. The clinical picture also agrees with recent studies showing that in children paranoid subtype is as frequent as seen in adult disorders. If genetic factors play a significant role in the pathogenesis of schizophrenia, the notion that such factors may be more salient in very early onset and more severe cases is now usually accepted. However, a number of environmental factors, including prenatal maternal infections and perinatal complications, may also be implicated in the pathogenesis of schizophrenia, in addition to genetic factors. Because a significant relationship between stressful life events and exacerbations in positive symptoms was found in the case reported, the authors examine the role of such stress factors in the pathogenesis of schizophrenia and in the course of illness. A brief review of studies that have examined the effects of antipsychotic agents in children with schizophrenia underscores the paucity of data available to guide clinicians in this area. However, these data suggest that children who receive conventional neuroleptics experience significant adverse effects, primarily sedation and extrapyramidal symptoms. In addition, they suggest that new antipsychotic agents, such as clozapine, may be more effective than conventional neuroleptics, particularly in negative symptoms. Lastly, the authors emphasize the poor outcome usually reported in childhood-onset schizophrenia, highlighting the need of a long-term pharmacological and behavioural treatment. CONCLUSION: This case report, such as others, supports the hypo-thesis that there is a clinical continuity between early and later onset schizophrenia. It also suggests that very early onset schizophrenia is a more severe form of the disorder and may be secondary to greater familial vulnerability. Consequently, systematic studies of these patients may be particularly informative and may provide important informations for understanding the etiologic processes involved in the pathogenesis of schizophrenia.

[Hearing impairment and psychopathological disorders in children and adolescents. Review of the recent literature]. / Déficience auditive et troubles psychopathologiques chez l'enfant et l'adolescent.

OBJECTIVE: Hearing impairment is a multifaceted condition with medical and social aspects. If the neuropsychiatric impact of deafness on children has been investigated by researchers from a variety of fields and backgrounds, their conclusion is that children with hearing impairment follow many different developmental pathways. The aim of this paper is to examine the relationships between hearing impairment and mental health and the effect of impaired communication on family development. METHOD: From a review of the literature, the authors examine the relationships between hearing impairment and mental disorders in children and adolescents in terms of prevalence, clinical features and etiological factors. The fami-ly dynamics and the parents-child interactions were also explored. RESULTS: The assessment of psychiatric disorders in hearing-impaired children sets some methodological pro-blems. Accurate evaluation is hampered by the immature language exhi-bited by many hearing-impaired children and by the difficulties that may be encountered in establishing rapport if the child does not understand the examiner's verbal exchanges. Several authors point out the lack of communication skills and experiences with hearing-impaired children on the part of many examiners. In addition, delays have been observed for the development of social maturity in hearing-impaired children and the parents' descriptions may reflect their own worries, rather than the emotional-behavioral functioning of the child. The measurement of psychiatric symptoms is then compromised insofar as many of the assessment procedures are highly verbal and were standardized for normal-hearing children. These difficulties may explain that the pre-valence rates of mental disorders in hearing-impaired children and adolescents found in the literature vary from 15% to 60%. If autism and deafness may both confound each others' dia-gnosis, several studies also point out the high comorbidity observed between these 2 conditions. The significance of this association remains unclear. Many of the authors conclude that hearing impairment is unlikely to be an etiological factor in autism. However, auditory impairment may be a marker for brain damage in autism. Although some studies showed high rates of depression and anxiety disorders, particularly social phobias, in deaf and hard-of-hearing children and adolescents, most of the studies conclude that the prevalence of affective disorders in hearing-impaired children and adolescents is comparable with estimates of prevalence for hearing young people. A number of studies have suggested that deaf children show greater degrees of impulsivity than hearing children. However, it seems that this background of greater impulsivity does not lead to higher rates of attention-deficit/hyperactivity disorder (ADHD) among deaf children. Using standardized instruments to estimate the prevalence of ADHD in this population, recent studies conclude that deaf children with hereditary deafness are not at greater risk of developing ADHD but that children with acquired deafness are, and that this difference is probably related to the medical conditions and family climates distinguishing these two groups. Psychotic disorders are no more common among hearing-impaired young people than among young people with normal hearing. However, some recent studies showed that the presentation of schizophrenia can differ in deaf people because of the high frequency of visual hallucinations observed in them. Lastly, if primitive personality has been described as being more prevalent among hearing-impaired children and adolescents, most of the studies found a normal range of emotional-behavioral functioning in them. In summary, if varying incidences of emotional disturbances and behavioral problems have been reported for hearing-impaired children and adolescents, except autism, it seems that children with hearing impairment experience the same range of mental health problems as hearing children. A variety of demographic, medical and educational factors were investigated as possible etiological factors for the psychiatric disorders observed in hearing-impaired children. Factors such as medical conditions, degree of deafness, communication ability and social deprivation may play a role. However, many studies also emphasize that a number of other variables, including educational methods, parental adaptation and parental support, may have an impact, positive or negative, on the development of the hearing-impaired child. By this way, numerous investigations have shown that deaf children of deaf parents attain better emotional and cognitive development than do deaf children of hearing parents. CONCLUSION: A number of questions remain about the neuropsychiatric and psychosocial aspects of hearing-impairment in children. For instance, few studies have been conducted to examine the impact of the different methods of communication and education on the psychosocial adjustment of deaf children. However, this review clearly show that appropriate and effective management can occur only when the mental health professionals are know-ledgeable and sensitive to the unique characteristics and experiences of hearing-impaired children and adolescents.