Langlois, V., Mubarak, A., Cognard-Bessette, S., Stikarovska, I., Emond-Nakamura, M., Paquette, D., St-André, M., and Cyr, C.
La cooccurrence de diagnostics (dx) en santé mentale réfère à la présence de deux ou plusieurs dx chez un même enfant et peut s'avérer synonyme d'une symptomatologie complexe et difficile à traiter. Afin d'identifier des leviers d'intervention dans le traitement de ces enfants, la présente étude examine si des facteurs familiaux, tels les symptômes dépressifs, le stress parental et la sensibilité chez les mères, sont associés à la cooccurrence de dx chez de jeunes enfants d'âge préscolaire. Pendant quatre ans, des parents et leurs enfants (1–5 ans) ont été sollicités à une clinique spécialisée de psychiatrie du Centre hospitalier universitaire Sainte-Justine de Montréal (Canada). Un protocole d'évaluation et d'observation a été proposé à un tiers des familles ayant pris part au projet. Notre étude porte sur les 54 enfants et parents ayant participé à ce protocole. La sensibilité maternelle a été observée via la procédure de la situation étrangère et les mères ont complété des questionnaires sur le stress et la dépression. Les dx des enfants ont été posés par les psychiatres. Les analyses montrent des difficultés cliniques sur le plan de la sensibilité (39 %), du stress (67 %) et de la dépression (43 %) chez de nombreuses mères. Le stress et la dépression ne sont pas associés à la présence de dx cooccurrents ; mais, les mères moins sensibles sont deux fois plus à risque que leur enfant présente plus d'un dx. L'étude souligne l'importance du parent dans les traitements des enfants avec une symptomatologie plus complexe. L'intervention dyadique améliorant la sensibilité parentale est discutée. Co-occurrence of mental health diagnoses (dx) refers to the presence of two or more dx in the same child and may imply a more complex profile of symptoms and be more difficult to treat. Treatments for children with co-occurring dx often appear successful for some of the symptoms, while other symptoms persist with clinical efforts. Although it is well documented that an early onset of disorders in the preschool period is associated with numerous adverse outcomes in the middle childhood or adolescence periods (e.g., antisocial behavior, peer rejection), little is known about risk and protective factors associated with the co-occurrence of psychopathological disorders in preschool children. To better identify intervention leverages for the treatment of these children, this study examines whether the quality of the family environment (maternal sensitivity, stress and depressive symptoms) is associated with the presence of co-occurring psychiatric dx among preschool age children. During four years, parents and children (1–5 years old) were approached at a specialized psychiatric clinic at the Sainte-Justine University Hospital Center in Montreal. An assessment and observation protocol was administered to a third of these families. Our study comprises the 54 children and their parents who participated to this protocol. In this sample, 37% of the children were diagnosed with an attention deficit hyperactivity disorder, 24% with a disruptive disorder, 39% with an oppositional defiant disorder and 46% with an anxiety disorder. Overall, 42 children (78%) were diagnosed with two or more dx. Maternal sensitivity was observed during the very well-validated Strange Situation Procedure. Mothers completed questionnaires on parental stress and their depressive symptoms. Children were diagnosed by the clinic's psychiatrists. Analyses showed clinical level difficulties of sensitivity (39%), stress (67%) and depression (43%) in a significant portion of the mothers. Parental stress and depression were not associated with co-occurring dx in children; however, less sensitive mothers were more likely to have children with more than one dx. Precisely, children of less sensitive mothers were more than twice as likely to present co-occurring disorders as children with more sensitive mothers. Parental sensitivity, i.e., the ability to observe, interpret correctly and respond in a timely and appropriate manner to the child needs, is more problematic in mothers of children with a more complex symptomatology. This study highlights the importance of parental involvement in the treatment of these preschool children. Parent–child dyadic interventions, such as the Attachment Video feedback Intervention (AVI), to optimize parental sensitivity are discussed. [ABSTRACT FROM AUTHOR]