Até o momento, são escassos os estudos que se propuseram a investigar o funcionamento cognitivo das crianças e adolescentes com Transtorno Obsessivo-Compulsivo (TOC). Os estudos disponíveis apontam que essa população apresenta pior desempenho nos testes neuropsicológicos que avaliam as funções executivas, a memória não-verbal, o funcionamento visuoespacial e a velocidade de processamento, em comparação aos sujeitos saudáveis. Mesmo com esses achados, poucos autores averiguaram a influência dos tratamentos de primeira linha para o TOC [Terapia Cognitivo- Comportamental (TCC) e inibidores de recaptura de serotonina (IRS)] na cognição. Vale ressaltar que tais estudos expressam resultados divergentes, não havendo um consenso sobre a melhora ou manutenção dos déficits no desempenho dos jovens após o tratamento. Diante deste contexto, o presente estudo teve como objetivos: A) Comparar as características sociodemográficas e clínicas e o funcionamento cognitivo de uma amostra pediátrica com TOC e sujeitos saudáveis; B) Verificar as modificações no funcionamento cognitivo do grupo TOC após 14 semanas de tratamento farmacológico ou psicoterápico. Para isso, foram avaliados 82 crianças e adolescentes com TOC e 82 controles saudáveis, com idades entre 6-17 anos, com questionários para avaliação de sintomas psiquiátricos e uma bateria de testes neuropsicológicos. Todos os participantes do estudo foram submetidos às avaliações na linha de base. Os pacientes, após randomização para TCC em grupo ou fluoxetina (FLX), foram reavaliados findadas 14 semanas de tratamento. A análise dos dados indicou que os pacientes apresentam desempenho cognitivo global pior que os controles, havendo diferenças significativas no QI de execução, nas habilidades visuoconstrutivas, na memória episódica não verbal e na flexibilidade mental. Variáveis clínicas, como idade de início dos sintomas, gravidade dos sintomas do TOC, dimensões dos sintomas obsessivo-compulsivos e comorbidades, não correlacionaram com o pior desempenho dos pacientes nos diferentes testes neuropsicológicos. Após 14 semanas de tratamento, embora os pacientes tenham apresentado melhora clínica dos sintomas obsessivo-compulsivos, o mesmo não ocorreu com as diferentes funções neuropsicológicas, mesmo naquelas que estavam prejudicadas na linha de base. De acordo com os resultados do presente estudo, as crianças e adolescentes com TOC apresentam pior desempenho cognitivo global em provas neuropsicológicas quando comparados aos controles saudáveis. O fato da melhora dos sintomas não ser acompanhada da melhora do desempenho neuropsicológico dos pacientes, sugere que as alterações cognitivas observadas no grupo TOC sejam relacionadas à própria neurobiologia do transtorno, independentemente da gravidade dos sintomas. Futuros estudos longitudinais serão necessários para aumentar a compreensão do funcionamento cognitivo dos jovens com TOC e as implicações do tratamento na sua cognição no longo prazo / To date, only a few studies have investigated the cognitive functioning of children and adolescents with Obsessive-Compulsive Disorder (OCD). These studies indicate that youth with OCD present a worse performance in neurocognitive tests that assess the executive functions, nonverbal memory, visuospatial functioning and processing speed. Despite these findings, only a few authors have investigated the influence of Cognitive-Behavioral Therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) on the cognition of youth with OCD. It is worth noting that these studies express divergent results, and there is no consensus on the improvement or maintenance of the cognitive deficits after treatment. In this context, the present study aimed: A) To compare the sociodemographic/ clinical characteristics and the cognitive functioning of youth with OCD and healthy controls; B) To verify the changes in cognitive functioning of children and adolescents with OCD after 14 weeks of randomized pharmacological or cognitive-behavioral treatment. Eighty-two children and adolescents with OCD and 82 healthy controls, aged between 6 and 17 years, were evaluated by means of structured questionnaires and a battery of neuropsychological tests. All participants underwent assessments at baseline. The OCD group, after being randomized to group CBT or Fluoxetine (FLX), was re-evaluated after 14 weeks of treatment. Data analyses indicated that patients presented a worse cognitive performance when compared to the healthy controls, with significant differences in performance IQ, visuoconstructive skills, nonverbal memory, and mental flexibility. Clinical variables, such as age of onset, severity of OCD symptoms, OCD dimensions and comorbidities, did not correlate with poorer performance on neuropsychological tests. Although patients had clinical improvement after 14 weeks of treatment, the same did not occur with the cognitive performance, even in those functions which were impaired at baseline. According to the results of the present study, youth with OCD present a worse cognitive performance when compared to controls. The fact that the improvement of the symptoms is not followed by the improvement of the neuropsychological performance suggests that the cognitive deficits observed in the OCD group may be related to the neurobiology of the disorder, regardless of the symptom severity. Future longitudinal studies will be needed to further clarify the cognitive functioning of youth with OCD and the implications of treatment on their cognition in the long run

Evidências apontam para forte relação independente entre maus tratos na infância, comportamentos disruptivos e prejuízos em funções executivas. No entanto, ainda não é completamente compreendido como estes três fatores se relacionam entre si. Esta pesquisa avaliou a relação entre maus-tratos na infância e transtornos do comportamento disruptivo, testando desempenho em funções executivas como possível mediador e moderador desta relação. A presente pesquisa está inserida no estudo \"Coorte de escolares de alto risco para o desenvolvimento de psicopatologia e resiliência na infância e adolescência - projeto Prevenção\", projeto integrante do Instituto Nacional de Ciência e Tecnologia de Psiquiatria do Desenvolvimento para Infância e Adolescência (INCT-INPD), o qual incluiu 2500 crianças em idade escolar de São Paulo e Porto Alegre (Brasil). As crianças foram extensamente avaliadas com entrevistas diagnósticas, relatos de pais e da própria criança sobre maus tratos e com testes neuropsicológicos. Resultados indicam associação de maus tratos na infância e transtornos do comportamento disruptivo, porém não foi encontrada associação entre maus tratos e funções executivas. Crianças com transtornos do comportamento disruptivo apresentaram pior desempenho em teste específico para avaliação de flexibilidade cognitiva. Desempenho em funções executivas não agiu como mediador ou moderador da associação entre maus tratos e transtornos do comportamento disruptivo. Desta forma, os resultados indicam que a associação entre experiências de maus tratos e transtornos do comportamento disruptivo ocorre independentemente do desempenho em funções executivas. Futuros estudos longitudinais são fundamentais para confirmar estes resultados e elucidar os mecanismos cognitivos envolvidos nesta associação causal / Empirical evidences point to a strong independent relationship between maltreatment in childhood, disruptive behaviors and impairments in executive functions. However, how these three factors are interrelated it is not completed understood yet. This study evaluated the relationship between childhood maltreatment and disruptive behavior disorders, testing performance in executive functions as possible mediator and moderator factor in this relationship. This research is part of the study \"Cohort of high-risk students for the development of psychopathology and resilience in childhood and adolescence - Prevention Project\", a member project of the National Institute of Science and Developmental Psychiatry Technology for Children and Adolescents (INCT -INPD) in which is included 2,500 schoolchildren from São Paulo and Porto Alegre (Brazil). The children were evaluated with diagnostic interviews, reports of parents and children themselves about maltreatment and with neuropsychological tests, which included evaluation of inhibitory control, working memory, cognitive flexibility and planning. Results indicate association of childhood maltreatment and disruptive behavior disorder, but no association was found between maltreatment and executive functions. Children with Disruptive Behavior Disorders showed worse performance in specific task for assessment of cognitive flexibility. Performance in executive functions didn\'t work as a mediator or modifier variable in the association between childhood maltreatment and disruptive behavior disorder. Thus, the study results indicate that the association between experiences of maltreatment and disruptive behavior disorder occurs regardless of the performance in executive function in a community sample. Future longitudinal studies are essential to confirm these findings and elucidate the cognitive mechanisms involved on this causal association

Até o momento, são escassos os estudos que se propuseram a investigar o funcionamento cognitivo das crianças e adolescentes com Transtorno Obsessivo-Compulsivo (TOC). Os estudos disponíveis apontam que essa população apresenta pior desempenho nos testes neuropsicológicos que avaliam as funções executivas, a memória não-verbal, o funcionamento visuoespacial e a velocidade de processamento, em comparação aos sujeitos saudáveis. Mesmo com esses achados, poucos autores averiguaram a influência dos tratamentos de primeira linha para o TOC [Terapia Cognitivo- Comportamental (TCC) e inibidores de recaptura de serotonina (IRS)] na cognição. Vale ressaltar que tais estudos expressam resultados divergentes, não havendo um consenso sobre a melhora ou manutenção dos déficits no desempenho dos jovens após o tratamento. Diante deste contexto, o presente estudo teve como objetivos: A) Comparar as características sociodemográficas e clínicas e o funcionamento cognitivo de uma amostra pediátrica com TOC e sujeitos saudáveis; B) Verificar as modificações no funcionamento cognitivo do grupo TOC após 14 semanas de tratamento farmacológico ou psicoterápico. Para isso, foram avaliados 82 crianças e adolescentes com TOC e 82 controles saudáveis, com idades entre 6-17 anos, com questionários para avaliação de sintomas psiquiátricos e uma bateria de testes neuropsicológicos. Todos os participantes do estudo foram submetidos às avaliações na linha de base. Os pacientes, após randomização para TCC em grupo ou fluoxetina (FLX), foram reavaliados findadas 14 semanas de tratamento. A análise dos dados indicou que os pacientes apresentam desempenho cognitivo global pior que os controles, havendo diferenças significativas no QI de execução, nas habilidades visuoconstrutivas, na memória episódica não verbal e na flexibilidade mental. Variáveis clínicas, como idade de início dos sintomas, gravidade dos sintomas do TOC, dimensões dos sintomas obsessivo-compulsivos e comorbidades, não correlacionaram com o pior desempenho dos pacientes nos diferentes testes neuropsicológicos. Após 14 semanas de tratamento, embora os pacientes tenham apresentado melhora clínica dos sintomas obsessivo-compulsivos, o mesmo não ocorreu com as diferentes funções neuropsicológicas, mesmo naquelas que estavam prejudicadas na linha de base. De acordo com os resultados do presente estudo, as crianças e adolescentes com TOC apresentam pior desempenho cognitivo global em provas neuropsicológicas quando comparados aos controles saudáveis. O fato da melhora dos sintomas não ser acompanhada da melhora do desempenho neuropsicológico dos pacientes, sugere que as alterações cognitivas observadas no grupo TOC sejam relacionadas à própria neurobiologia do transtorno, independentemente da gravidade dos sintomas. Futuros estudos longitudinais serão necessários para aumentar a compreensão do funcionamento cognitivo dos jovens com TOC e as implicações do tratamento na sua cognição no longo prazo / To date, only a few studies have investigated the cognitive functioning of children and adolescents with Obsessive-Compulsive Disorder (OCD). These studies indicate that youth with OCD present a worse performance in neurocognitive tests that assess the executive functions, nonverbal memory, visuospatial functioning and processing speed. Despite these findings, only a few authors have investigated the influence of Cognitive-Behavioral Therapy (CBT) and selective serotonin reuptake inhibitors (SSRIs) on the cognition of youth with OCD. It is worth noting that these studies express divergent results, and there is no consensus on the improvement or maintenance of the cognitive deficits after treatment. In this context, the present study aimed: A) To compare the sociodemographic/ clinical characteristics and the cognitive functioning of youth with OCD and healthy controls; B) To verify the changes in cognitive functioning of children and adolescents with OCD after 14 weeks of randomized pharmacological or cognitive-behavioral treatment. Eighty-two children and adolescents with OCD and 82 healthy controls, aged between 6 and 17 years, were evaluated by means of structured questionnaires and a battery of neuropsychological tests. All participants underwent assessments at baseline. The OCD group, after being randomized to group CBT or Fluoxetine (FLX), was re-evaluated after 14 weeks of treatment. Data analyses indicated that patients presented a worse cognitive performance when compared to the healthy controls, with significant differences in performance IQ, visuoconstructive skills, nonverbal memory, and mental flexibility. Clinical variables, such as age of onset, severity of OCD symptoms, OCD dimensions and comorbidities, did not correlate with poorer performance on neuropsychological tests. Although patients had clinical improvement after 14 weeks of treatment, the same did not occur with the cognitive performance, even in those functions which were impaired at baseline. According to the results of the present study, youth with OCD present a worse cognitive performance when compared to controls. The fact that the improvement of the symptoms is not followed by the improvement of the neuropsychological performance suggests that the cognitive deficits observed in the OCD group may be related to the neurobiology of the disorder, regardless of the symptom severity. Future longitudinal studies will be needed to further clarify the cognitive functioning of youth with OCD and the implications of treatment on their cognition in the long run

Children and parents who visited child and adolescent psychiatry (CAP) for the first time were interviewed in the presence of their therapists about the first meeting. The interview was intended to make the attendants describe in their own words what the meeting was like for them. The interview was repeated after six months to get complementary information. Research assistants, reflectors, helped the interviewer to prevent from bias and to hold on to the theme. The grounded theory approach was utilised in papers I, II, and III, and qualitative content analysis was used in paper IV. Children appreciated the therapist being in an active as well as in a more passive but alert position, moving between asking adjusted questions and including the parents. The therapists’ skill of listening was also important to them. For the parents, it was important what happened between their child and the therapists. They questioned their own role and presence. Also, they focused on the plan for the meeting and for the coming process. Certain things that happened in the dialogue were useful after the meeting. The results indicate that what was helpful was connected to family therapy matters rather than psychiatric ones. The therapists balanced between a psychiatric and a family therapeutic position, and it was a dilemma for them how to best fulfil their assignment in the organisation as they perceived it. Two competing discourses were found in the first meeting; Structuring, which stood for structure, planning and expertise, while Collaboration represented negotiations of how to work together, empowerment and emotional aspects. The Structuring discourse tended to dominate. Both discourses consisted of valuable elements that needed to be included to ensure that the atmosphere would not be too strict or too flexible. The findings are tentative because of the lack of studies to compare to, and because of the few interviews made. / Det första möte som sker mellan familjemedlemmar och personal antas ha stor betydelse för hur den fortsatta kontakten artar sig. Det är ett tillfälle när var och en kan vara öppen för intryck och nyfiken på hur kommunikationen utvecklas och vilken hjälp som ska till. Förutsättningarna för mötet är etablerade på många plan. Föräldrarna och barnen har tidigare erfarenheter av både personliga och professionella kontakter, och de har förväntningar på vad som ska eller bör ske under det första samtalet. Personalen befinner sig i ett sammanhang där de har förväntningar på sig från organisationen. De har utbildning och erfarenhet och har anammat organisationens kultur och vanor i större eller mindre utsträckning. Både inom det psykiatriska eller det psykoterapeutiska området har det varit brist på studier som rör det första samtalet mellan professionell och patient/klient. Detta väckte ett intresse att studera området närmare. Syftet med studien var därför att försöka ta reda på mer om det första mötet ansikte mot ansikte mellan personal och familjemedlemmar. Vad händer där och hur upplevs det här mötet av dem som deltar? Ytterligare ett syfte var att försöka ta reda på vilka diskurser som påverkar det som sker mellan deltagarna. Vilka underliggande meningar har deltagarnas tankar och sätt att bete sig, och som har förankring i allmänna föreställningar om hur ett möte av det här slaget går till? Hur framträder det i deltagarnas kommunikation med varandra? För att finna svar på dessa frågor gjordes forskningsintervjuer inom två veckor respektive sex månader efter det första mötet på BUP (barn- och ungdomspsykiatrin). Vid intervjuerna deltog de som varit närvarande vid det första samtalet, d v s personal, föräldrar och barn. Intervjuaren hade till sin hjälp forskningsassistenter, reflektörer, vars uppgift var att bidra till att alla fick komma till tals och att man höll fokus på hur det var under det första samtalet. Fyra delstudier genomfördes. I de tre första användes analysmetoden grundad teori, och i den fjärde kvalitativ innehållsanalys. Den första delstudien lyfte fram barnens perspektiv. Barnen uppskattade om behandlarna befann sig ömsom i en aktiv ömsom i en passiv position, där de samtidigt var alerta i förhållande till barnen. De gillade att behandlarna å ena sidan anpassade sig och sina frågor till barnen och å andra sidan tog med föräldrarna i samtalet. Behandlarnas förmåga att lyssna och att hjälpa barnen att uttrycka sig var viktig för barnen. De tog också upp vikten av att behandlarna höll reda på tiden, så att samtalet inte blev för långt för dem. För föräldrarna, i delstudie II, visade det sig vara avgörande vad som skedde mellan deras barn och behandlarna. De ifrågasatte sin egen roll i mötet, och var tveksamma till om de borde vara närvarande eller inte. Dessutom var de inriktade på hur upplägget av samtalet såg ut och hur den fortsatta planeringen skulle bli. Vissa teman och yttranden i dialogen kunde vara till nytta för samspelet därhemma. Fynden i delstudien antyder att det som var till hjälp snarare låg på ett familjeterapeutiskt plan än ett psykiatriskt. I delstudie III framkom att behandlarna nedtonade sin egen insats och lyfte fram det viktiga i familjemedlemmarnas bidrag till hur mötet blev. Behandlarna balanserade mellan ett psykiatriskt och ett familjeterapeutiskt förhållningssätt. De mest tillfredsställande arbetsuppgifterna rörde att lyssna på barns och föräldrars berättelser och att hitta sätt att uppmuntra och stödja deras vägar till att må och fungera bättre. De önskade möta familjemedlemmarna på deras villkor, men hade också att samla information för bedömning och fortsatt planering. Det innebar ett dilemma för dem hur de bäst skulle kunna uppfylla de uppgifter som de uppfattade att BUP-organisationen gett dem. Två konkurrerande diskurser framträdde i delstudie IV. De var inflätade i varandra och stod att finna hos var och en av parterna barn, föräldrar och behandlare. Det syntes pågå balanserande eller konkurrens mellan de sociala röster som ingick i diskurserna. Diskursen Strukturering innehöll sociala röster som rörde exempelvis inramning av mötet, expertis och kategoriseringar medan diskursen Samarbete inriktades mot aspekter som öppenhet, sam-skapande och en utvidgad dialog. Om diskursen Strukturering skulle överväga blev följden antingen ett undertryckande och okänsligt förhållningssätt och diskursen Samarbete skulle om den övervägde kunna skapa ett otydligt eller alltför flexibelt förhållningssätt. Den förra diskursen tycktes dominera, men båda diskurserna syntes innehålla delar som behövdes för att det första mötet skulle uppfattas som givande. Fynden i studien är preliminära av två skäl. Dels finns få eller inga studier att jämföra med; dels var antalet intervjuer begränsat.

Evidências apontam para forte relação independente entre maus tratos na infância, comportamentos disruptivos e prejuízos em funções executivas. No entanto, ainda não é completamente compreendido como estes três fatores se relacionam entre si. Esta pesquisa avaliou a relação entre maus-tratos na infância e transtornos do comportamento disruptivo, testando desempenho em funções executivas como possível mediador e moderador desta relação. A presente pesquisa está inserida no estudo \"Coorte de escolares de alto risco para o desenvolvimento de psicopatologia e resiliência na infância e adolescência - projeto Prevenção\", projeto integrante do Instituto Nacional de Ciência e Tecnologia de Psiquiatria do Desenvolvimento para Infância e Adolescência (INCT-INPD), o qual incluiu 2500 crianças em idade escolar de São Paulo e Porto Alegre (Brasil). As crianças foram extensamente avaliadas com entrevistas diagnósticas, relatos de pais e da própria criança sobre maus tratos e com testes neuropsicológicos. Resultados indicam associação de maus tratos na infância e transtornos do comportamento disruptivo, porém não foi encontrada associação entre maus tratos e funções executivas. Crianças com transtornos do comportamento disruptivo apresentaram pior desempenho em teste específico para avaliação de flexibilidade cognitiva. Desempenho em funções executivas não agiu como mediador ou moderador da associação entre maus tratos e transtornos do comportamento disruptivo. Desta forma, os resultados indicam que a associação entre experiências de maus tratos e transtornos do comportamento disruptivo ocorre independentemente do desempenho em funções executivas. Futuros estudos longitudinais são fundamentais para confirmar estes resultados e elucidar os mecanismos cognitivos envolvidos nesta associação causal / Empirical evidences point to a strong independent relationship between maltreatment in childhood, disruptive behaviors and impairments in executive functions. However, how these three factors are interrelated it is not completed understood yet. This study evaluated the relationship between childhood maltreatment and disruptive behavior disorders, testing performance in executive functions as possible mediator and moderator factor in this relationship. This research is part of the study \"Cohort of high-risk students for the development of psychopathology and resilience in childhood and adolescence - Prevention Project\", a member project of the National Institute of Science and Developmental Psychiatry Technology for Children and Adolescents (INCT -INPD) in which is included 2,500 schoolchildren from São Paulo and Porto Alegre (Brazil). The children were evaluated with diagnostic interviews, reports of parents and children themselves about maltreatment and with neuropsychological tests, which included evaluation of inhibitory control, working memory, cognitive flexibility and planning. Results indicate association of childhood maltreatment and disruptive behavior disorder, but no association was found between maltreatment and executive functions. Children with Disruptive Behavior Disorders showed worse performance in specific task for assessment of cognitive flexibility. Performance in executive functions didn\'t work as a mediator or modifier variable in the association between childhood maltreatment and disruptive behavior disorder. Thus, the study results indicate that the association between experiences of maltreatment and disruptive behavior disorder occurs regardless of the performance in executive function in a community sample. Future longitudinal studies are essential to confirm these findings and elucidate the cognitive mechanisms involved on this causal association

No description available.

A child diagnosed with a life-threatening illness such as cancer, and is hospitalized for extensive periods of time, is faced with innumerable stressful and traumatic circumstances. This emotionally challenging life situation can bring on much emotional distress such as anxiety. Thus, it has become imperative that the oncology child is assisted and supported, in his individual struggle to cope with the harshness of his strained reality. In this study the hospitalized oncology child was provided with a means of support and intervention through the use of Gestalt play therapy. Gestalt play therapy was conducted to assist the child to express and work through feelings of anxiety and related emotional distress associated with his present life experience. Gestalt play therapy was presented with six case studies. The researcher explored and described the experiences of each case study from which, the researcher drew conclusions and made recommendations. / Social Work / M.Diac. (Play Therapy)

The special needs domain has long been recognised as problematic and adversarial. Much research has focused on areas of contention, such as the relationships between parents and practitioners, especially in educational settings, or on problems within the structure and operation of the domain. This study adopts a whole system approach in combining discussion of the structural basis of tension within the domain with an investigation of how both parents and practitioners describe, experience and respond to tensions within the special needs domain; such tensions being viewed as facets of the 'struggle' and 'fight' metaphor. Whole systems approaches are derived from the systems discipline, which developed initially out of the nineteenth century interest in organic and engineering systems, but more recently has focused on organisational and inter-organisational arrangements, including the part people play in enabling or disabling such arrangements. It is a strongly interdisciplinary approach more commonly found in organisational studies than in the social sciences more generally. Fifteen practitioners, from health and education settings, and twelve parents of children and young people with diagnoses of high functioning autism spectrum conditions participated in the study. The participants' stories of their experiences of the special needs domain were collected using a narrative inquiry approach. The data was analysed using concepts and theoretical frameworks derived from the work of Pierre Bourdieu, Uri Bronfenbrenner and Charles Wright Mills. An exploration of the influences shaping the special needs domain revealed a number of areas of unresolved tension, some of which result in tensions for those involved in the domain such as can be described as 'fight', and some of which might be addressed by structural changes to the systems comprising the special needs domain such as those envisaged in forthcoming legislation. However importantly the empirical study found that many tensions and struggles experienced by both parents and practitioners did not emanate from the structures of the domain and therefore were unlikely to be amenable to structural changes. Parents 'struggle' to maintain their identity as 'good' parents, to acquire information and to navigate the system in order to access services and resources. Practitioners experience conflict as they seek to access information and training, engage in the complex choreography of cooperating and collaborating in interagency and interprofessional working and endeavour to harmonise their professional practice with agency and public policy priorities. The thesis concludes with a brief discussion of the relationship between whole system approaches and other interdisciplinary approaches to investigating complex problems in the human sciences. It is suggested that systems diagramming techniques such as systems mapping and rich pictures are useful additions to the sociologist's toolkit.

A child diagnosed with a life-threatening illness such as cancer, and is hospitalized for extensive periods of time, is faced with innumerable stressful and traumatic circumstances. This emotionally challenging life situation can bring on much emotional distress such as anxiety. Thus, it has become imperative that the oncology child is assisted and supported, in his individual struggle to cope with the harshness of his strained reality. In this study the hospitalized oncology child was provided with a means of support and intervention through the use of Gestalt play therapy. Gestalt play therapy was conducted to assist the child to express and work through feelings of anxiety and related emotional distress associated with his present life experience. Gestalt play therapy was presented with six case studies. The researcher explored and described the experiences of each case study from which, the researcher drew conclusions and made recommendations. / Social Work / M.Diac. (Play Therapy)

Le trouble du spectre de l’autisme (TSA) est défini par l’atteinte de deux domaines: une diminution de la réciprocité sociale et une inflexibilité comportementale. Il n'existe pas de test diagnostique ni de mesure des mécanismes impliqués. En population adulte TSA, l’utilisation d’un jeu d’interaction dynamique, dyadique et intégratif présentant alternativement un contexte social ou non social, a permis d’obtenir un phénotype computationnel de la réciprocité sociale révélant une insensibilité au type de contexte, une utilisation de stratégie spécifique à ce groupe et une variation de performance dépendante de la sophistication de l’adversaire. Cette étude vise à étendre cette compréhension de la réciprocité sociale en population TSA pédiatrique et de la distinguer d'éléments psychopathologiques comme l'anxiété ou les symptômes de TDAH, parfois associés ou confondus avec des symptômes autistiques. L’analyse des données de performance des participants au jeu a permis de valider son utilisation en population pédiatrique, en répliquant l’impact du type d’algorithme sur la performance des participants. Une approche dimensionnelle utilisant des outils standardisés et permettant la quantification de la sévérité des symptômes autistiques, TDAH et troubles anxieux, a permis de spécifier l’impact des symptômes autistiques et anxieux sur la performance des participants contre un algorithme de type ToM d’ordre 0. Cette étude est une étape dans la compréhension des mécanismes impliqués dans l'interaction sociale au cours du développement, et dans la capacité à les mesurer. Des analyses computationnelles complémentaires permettront d’affiner ce phénotype computationnel en apportant des précisions quant aux stratégies utilisées pendant le jeu et à la flexibilité des participants à varier dans leur utilisation. / Autism Spectrum Disorder (ASD) is defined by two main domains of impairment: decreased social reciprocity and behavioural inflexibility. There is no diagnostic test or measurement of the mechanisms involved. A study with ASD adults used a dynamic, dyadic and integrative interaction game which alternately presents a social or non-social context, it resulted in a computational phenotype of social reciprocity revealing insensitivity to the type of context, a use of strategy specific to this group and a variation in performance depending on the opponent’s sophistication. This study aims to extend this understanding of social reciprocity in the pediatric ASD population and to distinguish psychopathological symptoms such as anxiety or ADHD symptoms, which are sometimes associated or confused with autistic symptoms. Analysis of the participants’ performance data validated its use in the pediatric population by replicating the impact of the algorithm on the participants’ performance. A dimensional approach using standardized tools and allowing the quantification of the autistic, ADHD and anxiety disorders symptoms’ severity, permits the emphasis of the impact of autistic and anxious symptoms on participants’ performance against a ToM-0 agent. This study is a step in the understanding of the mechanisms developed in social interaction during development and in the ability to measure them. Complementary computational analyzes will help refine this computational phenotype by giving more details about the strategies used during the game and the participants' flexibility to vary in their use.