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L'Encéphale
Volume 39, n° 1
pages 29-37 (février 2013)
Doi : 10.1016/j.encep.2012.02.003
Received : 22 October 2010 ;  accepted : 19 October 2011
Troubles du comportement et troubles fonctionnels du nourrisson : caractéristiques, interactions mère-enfant, alliance et évolution après une psychothérapie brève parent-enfant. Étude pilote
Infants and toddlers behavioral and functional disorders: Characteristics, mother-child interactions, alliance and outcome after a brief parents-child psychotherapy. A pilot study
 

M.-J. Hervé a, , A. Jaussent b, M. Paradis a, C. Rattaz a, S. Lopez a, V. Evrard a, M.-C. Picot b, M. Maury a
a Service de médecine psychologique pour enfants et adolescents, hôpital St-Éloi, CHU de Montpellier, 80, avenue Augustin-Fliche, 34295 Montpellier cedex 5, France 
b DIM, recherche clinique et épidémiologique, hôpital de la Colombière, CHU de Montpellier, 34295 Montpellier cedex 5, France 

Auteur correspondant.
Résumé

Les objectifs de cette étude étaient, dans une population de 49 jeunes enfants âgés de trois à 30 mois présentant des troubles fonctionnels (TF) et/ou du comportement, d’évaluer après une intervention thérapeutique brève l’évolution de l’enfant, des parents et des interactions mère-enfant et de comparer les enfants avec et sans trouble du comportement afin de mieux comprendre pourquoi les enfants avec des troubles du comportement (TC) évoluent moins bien que les autres. Deux évaluations ont été effectuées, l’une avant le traitement, l’autre un mois après la fin de la thérapie, incluant une évaluation des symptômes de l’enfant, des symptômes anxieux et dépressifs des parents, des interactions mère-enfant et de l’alliance thérapeutique. Les résultats montrent une amélioration des symptômes de l’enfant, des symptômes anxieux et dépressifs de la mère et des symptômes anxieux du père. Sur le plan des interactions, les mères deviennent plus sensibles, le nombre de mères contrôlantes et non disponibles diminue, tandis que les enfants deviennent plus coopératifs et moins passifs. Les enfants avec des problèmes de comportement sont plus âgés, avec un âge de début des troubles plus tardif. Ils ont avant la thérapie des mères ayant plus de symptômes anxio-dépressifs que ceux présentant des problèmes fonctionnels. L’alliance thérapeutique, évaluée par la mère à la première consultation, est plus basse. Après la thérapie, ces enfants ont une moins bonne évolution et leurs mères restent plus anxieuses et moins sensibles. Cette étude souligne certaines particularités des jeunes enfants présentant des TC et confirme la plus grande difficulté à les traiter. Il apparaît nécessaire d’élaborer des prises en charge spécifiques.

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Summary
Objectives

Functional and behavioral disorders are the most frequent reasons for consultation in infant psychiatry, but there are still few studies about the efficacy of parents-child psychotherapies. Functional disorders appear to be easier to treat than behavioral disorders. The aim of this study was: (1) to assess outcome after a brief psychotherapy in a population of 49 infants aged 3 to 30 months, presenting functional or behavioral disorders; (2) to compare characteristics before therapy and outcomes for children with functional disorders and with behavioral disorders, to have a better understanding of the worse outcome of children with behavioral disorders.

Methods

Two assessments were performed, one before treatment and the second a month after the end of the therapy including the infant’s symptoms (Symptom Check-list), parents’ anxious and depressive symptoms (Hospital Anxiety and Depression scale) and mother-infant interactions (Crittenden Experimental Index of adult-infant relationship). The therapeutic alliance was assessed by the therapist and the parents after the first consultation (Working Alliance Inventory).

Results

The assessments after therapy show complete or partial improvement in the child’s symptoms, in the mother’s anxious and depressive symptoms and in the father’s anxious symptoms. During interaction, the mothers become more sensible, the number of controlling and of unresponsive mothers decrease, while the children become more cooperative and less passive. Initial characteristics and outcome are however different according to the type of the child’s disorder. The children with behavioral disorders are older and present an association of several symptoms. The disorder onset is later. Their mothers are, before therapy, more anxious and depressive. The therapeutic alliance is weaker. After therapy, despite the fact that their mothers’ affective state and that interactive behavior improves, the mothers are more anxious and less sensible, while the children no longer differ from the group without behavioral disorder from the point of view of opposition (assessed during mother-child interaction).

Conclusion

Although this study is limited by the lack of a control group and the sample size, it underlines some particularities of infants and toddlers presenting behavioral disorders and the difficulties involved in their treatment. One can wonder if these characteristics are specific of the behavioral disorders or if they are the result of an older dysfunction, complicated by the developmental evolution of the child and the duration of the difficulties. The small number of cases, among the children with behavioral disorders, presenting a preexistent functional disorder, the absence of difference in the duration of the disorders, and the different disorder’s onset plead in favor of the first hypothesis. The behavioral disorders often associate child psychopathology, dysfunctional parents-child-relationships and environmental factors difficult to modify with a brief therapy focused on the relationship. It would appear necessary to develop specific treatments for this population.

The full text of this article is available in PDF format.

Mots clés : Troubles fonctionnels, Troubles du comportement, Jeune enfant, Interactions mère-enfant, Alliance thérapeutique

Keywords : Behavioral disorders, Functional disorders, Mother-infant interaction, Therapeutic alliance




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