Sleep problems, generally defined as difficulty initiating and/or maintaining sleep, are one of the most common comorbid conditions experienced by individuals with autism spectrum disorder (ASD). Disrupted sleep worsens child's social interaction, day to day life, academic achievement, and correlates with increased maternal distress and parental sleep disruption.

Bedtime routines and sleep hygiene is the mainstay of sleep management. If that fails, it should be combined with pharmacologic intervention but little evidence-based data exist to support such approach. To date, there are no approved medications to treat insomnia in pediatric patients, including ASD. Sleep medications are prescribed off-label although none was proven effective and safe in this population, leaving many families desperate for a better solution.

The normal sleep–wake cycle is governed by the circadian clock residing in the hypothalamus. The clock is tuned by light and by its downstream signal of darkness hormone- melatonin. Mutations in genes involved in clock and melatonin pathways and low melatonin levels have been found in individuals with ASD, which may explain problems with sleep initiation and maintenance and/or early waking.

Whereas a placebo-controlled randomized clinical trial (RCT) indicated that normal-release melatonin improves only sleep latency in children with neurodevelopmental disorders including ASD, a recently completed long-term placebo-controlled RCT indicated that prolonged-release melatonin (PRM) minitablets effectively improved both sleep latency and total sleep time (TST) in children with ASD.

Behavioral treatment strategies along with PRM pharmacotherapy can help improve the quality of life of ASD children and decrease the family and parental distress.

Patrick Luyten, PhD is Associate Professor at the Faculty of Psychology and Educational Sciences, University of Leuven, Leuven, Belgium, and Reader at the Research Department of Clinical, Educational and Health Psychology, University College London, London, UK

Depression ranks among the leading causes of disability, morbidity, and mortality in young people (YP). Although the last decades have led to considerable progress in our understanding of the causes of mood problems in YP and in the development of effective treatments, limitations of current theoretical and intervention approaches have also become increasingly clear. First, with regard to diagnosis, there is a clear shift away from a categorical, disease-oriented model to a dimensional approach that focuses on underlying systems implicated in psychopathology. The Research Domain Criteria (RDoC) is a good example of this change in approach. Second, with regard to treatment, although a variety of effective interventions for pediatric depression have been developed, they are equally effective, response rates are realtively low, with a substantial number of YP dropping out of treatment and thus being “hard-to-reach”. Together, these findings force us to ask the “hard questions” about our views concerning the nature of depression and its treatment in YP.
Based on evolutionary biological and developmental psychopathology considerations, we present an integrative developmental cascade model of depression that essentially suggests that depression emerges out of a three-pronged series of interacting impairments in the domains of stress regulation, reward, and mentalizing (SRM).
We also focus on how this model may explain in large part the heterogeneity and thus marked comorbidity of depression with other psychiatric disorders, as well as with functional somatic and somatic disorders.
We outline the implications for the development, evaluation, training and dissemination of interventions for YP with depression.

Until recently, most of what we knew about the emergence of autism in infancy relied on retrospective accounts. A new approach, the study of infants at familial risk, aims to identify the earliest “pure” manifestations of autism, before subsequent years of atypical development exacerbate, or compensate for, initial atypical development. An emerging picture from these studies is that early impairments in one or more of several functional cognitive systems are associated, respectively, with familial risk and with a later autism diagnosis. Understanding the temporal associations between these impairments over time will reveal the underlying mechanisms of atypical development in autism and inform approaches to early intervention. I will present new data from our ongoing prospective longitudinal and intervention studies.

Parental characteristics are known to predict offspring emotional and behavioral difficulties from an early age onwards. However, determinants of parental mental health and the specific ways in which parental well-being can play a role are not yet fully understood. This symposium will present data from several countries showing that parental characteristics need to be taken into account when addressing children's mental health needs. First, data from the EDEN cohort in France will show that maternal mental health varies with family circumstances and that both characteristics influence children's emotional and behavioral symptoms over the long-term. A study conducted using data from the same mother-child cohort will show the role of maternal characteristics in pregnancy in predicting children's long-term behavior. Next, two studies conducted in the UK and in the Netherlands will show the importance of paternal mental health - symptoms of anxiety and antisocial behavior - with regard to offspring well-being, whether considered alone or in combination with maternal mental health. Finally, a study from Sweden will show the interplay between parent and offspring mental health among young people transitioning to young adulthood. Overall, the research presented in this symposium will show the importance of a lifecourse and family-wide perspective when investigating mental health difficulties in children and adolescents.

Objectives: Deaf adolescents suffer with many of the same psychiatric illnesses as their hearing counterparts. However, throughout the United States and Europe, access to mental health care is often limited by problems with language and cultural barriers. The objective of this symposium is to educate physicians about evidence based treatment interventions to meet the unique health care needs of their psychiatrically ill deaf patients in a manner that helps them transition successfully to young adulthood.

Methods: This presentation aims to present a discussion of the unique challenges in meeting the mental health needs of deaf youth. The symposium consists of five psychiatric specialists from three countries (US, Spain and the Netherlands) with expertise in treating Deaf adolescents and adults. The speakers will take the participants step by step through the psychiatric assessment and treatment of deaf youth with the aim of helping them to transition successfully into healthy young adults.

Results: At the conclusion of the presentation, participants will have a better understanding of the barriers to access to care and the challenges facing deaf patients. Participants will understand the importance of language and cultural considerations in treating deaf individuals. Participants will learn how to successfully help their deaf adolescent patients transition to adults.

Conclusions: Psychiatrists from the United States and Europe attending this presentation will be in a better position to provide optimal psychiatric services to deaf and hard of hearing youth as they transition from adolescence to young adulthood.

The ELAL Avicenne is the first french transcultural for the evaluation of mother tongue in migrant children
This symposium is meant to decribe the validation of the tool and in which way it can be useful for professionnals, chldren and parents
This symposium is on behalf of AEPEA

There have been significant advances in the antenatal and neonatal care of preterm infants with increased survival of the most vulnerable extremely low birth weight infants. Preterm birth remains however a leading cause of morbidity and children born extremely preterm are at increased risk of significant disability and neurodevelopmental disorders. Increasingly the recognition of significant psychiatric and more subtle yet impairing social-emotional difficulties has been the focus of longitudinal studies. So too has the impact of preterm birth on parental mental health. Despite significant advances in neonatal intensive care practices, mental health and psychosocial supports for preterm infants and their parents can be lacking both in terms of early interventions and long term follow-up. This symposium discusses the results of two studies which explore the long term outcomes in terms of mental health and attachment of preterm infants in Ireland, an evaluation of an early intervention using video interaction guidance to support parents of preterm infants and the perceptions of NICU staff regarding attachment and social-emotional needs of preterm infants.

Mentalizing encompasses a suite of developmentally acquired psychological processes that critically assist through developmental transitions and help youths to envision themselves and others in terms of intentional mental states such as feelings, desires, wishes, goals, values, and attitudes.

In the past two decades, assessment of mentalizing processes and psychotherapy adaptations have been proposed for a number of different psychopathologies in adult forms of personality disorders. Only recently have evaluation and intervention procedures been adapted to children and adolescents.

The current symposium seeks to present the latest concepts and instruments in the evaluation of mentalizing, and further present the most recent developments in mentalization-based therapy for children. The symposium presents the key issues in assisting clinicians and researchers in reuniting the tools to foster the development of mentalization in clinical practice with youths.

Following the success of the Operationalized Psychodynamic Diagnosis for Adults (OPD-2), a multiaxial diagnostic and classification system based on psychodynamic principles has been adapted for children and adolescents by combining psychodynamic, developmental, and clinical psychiatric perspectives. In German speaking countries the OPD-KJ-2 manual has been widely used for assessing indications for therapy, treatment planning, and measuring change. For international use, OPD-KJ-2 has now been translated to English (OPD-CA-2) and Spanish (OPD-IJ-2).
In this symposium we will present empirical data on the use of this psychodynamic assessment instrument in research and clinical practice with a focus on the axes “structure” and “conflict”. The studies demonstrated that the axes were reliable and clinically valid. Further, they illustrate how the new diagnostic tool of OPD-2_CA can be used in treatment planning and evaluation .It allows for discriminating between in- and outpatient treatment, based on structural deficits, prevailing conflicts and treatment prerequisite of clinically disturbed children and adolescents. Information about structural deficits, based on the OPD-CA-2-QA, has proved to be most valuable in working with adolescents with personality disorders.

22q11.2 deletion syndrome (22q11DS), also known as Velo-Cardio-Facial syndrome, is a common genetic disorder, occurring in at least 1:4000 live births. It is associated with a specific medical, cognitive, and clinical phenotype, although a high degree of heterogeneity is observed between patients. In particular, this condition is now recognized as one of the highest known risk factors for schizophrenia and is considered as a model for understanding the development of psychosis.
This symposium is aimed for clinicians or researchers who are not familiar with 22q11DS and who would like to improve their knowledge of this condition. The four speakers will perform a joint presentation covering recent findings regarding the following topics:
- frequent medical, cognitive, and clinical characteristics
- assessment of attenuated symptoms of psychosis in 22q11DS
- risk factors associated with transition to psychosis
- marital and vocational outcome
- pharmacological and psychosocial interventions

Presentation 1
Clinical outcomes from long-term trials of different medication classes
Michael Huss

Presentation 2
Interpreting ADHD medication-induced changes in vital signs
Vinay Bhole

Presentation 3
ADHD treatment beyond symptom control
Nicoletta Adamo

Presentation 4
Delivering evidence-based, long-term ADHD care – The Dundee ADHD Clinical Care Pathway and beyond
David R Coghill

In this symposium, we address the question of the impact of psychosocial difficulties, exile and culture on family mental health during the perinatal period. Three new therapeutic models of intervention are presented to cope with these issues. An ethnopsychoanalytical and family system setting enables screening for immigrant parents-to-be and assists them in mobilising their resources. A mother-toddler group will be presented to improve affect regulation and attachment as well as mother-child bonding in very low functioning families. Finally, we present an application of the Bick-Tavistock method of closely observing babies, developed for infants suffering from severe emotional, attachment and relational distress.

In most european countries substances such as alcohol, nicotine and Cannabis are widely available. Consumption of alcohol for example is a part of many european cultures.
Substance abuse is a major health concern on a global level. Early development of a substance use resp. abuse during adolescence respectively as young adult is known to be one of the key factors for a substance use disorder in later adult life.
Substance use disorder amongst adolescents is often a challenge for treatment centers as it’s an interdisciplinary problematic between child and adolescent and adult psychiatry.
The aim of the symposium is to highlight the situation of adolescents and young adults with a substance use disorder and to compare specific treatment models for adolescents and young adults in several european countries : Switzerland, Portugal and Greece with contributions from thoses countries.
An opening session will resume the psychopathological speicifities during that life period. Three contributions from Switzerland. Portugal and Greece will focus on the treatment of those age groups in those 3 european countries.

During the last few years South East Europe is facing an ongoing burden of millions refugees coming from Asia, mainly from Syria and Afghanistan. The countries of the area are used as the gate for the refugees’ way to the Central and North Europe countries. The refugee children and adolescents are under a continuous impact of accumulative risk factors, related to pre, during and after their flight conditions, to present mental health problems.
The aim of this symposium is to present the various psychosocial and mental health issues as these are recognized and confronted in different involved countries such as Turkey, Greece, Serbia, Croatia and Cyprus.
The will be presented issues such as the impact of post traumatic stress disorder, the differences in psychopathology related to different status of immigrants, the longitudinal mental health consequences of the childhood trauma, the mental health policies which have been implemented to confront the refugee crisis and finally the role of cultural identity in clinical practice with refugee adolescents.

The characterization of brain alterations associated to the presence of psychotic symptoms has the potential of revealing neural biomarkers of psychosis, which will help the diagnosis and treatment of psychotic disorders. Neuroimaging represents a unique tool for the identification of biomarkers in vivo and in human patients. 22q11.2 deletion syndrome is a neurogenetic disease predisposing to a high risk of schizophrenia and therefore considered a model of the disease. In this symposium the authors will present neuroimaging findings in patients with 22q11DS using different imaging modalities (structural MRI, diffusion tensor imaging, resting-state fMRI). In particular, the presentations will focus on alterations in brain morphology and connectivity associated to more severe psychotic symptoms, which may serve as biomarkers of increased risk of psychosis.

Schizophrenia remains one of the most severe mental disorders often emerging during the vulnerable developmental phase of adolescence (Correll et al. 2010). Efforts at preventing psychosis, and evidence-based early treatment are crucial. Research-defined at-risk syndromes based on mainly adult data are frequently met by adolescents, and (attenuated) psychotic symptoms may also emerge, stabilize, or progress to several mental and personality disorders (Gerstenberg et al. 2015). Thus, in this age-group, the diagnostic process as well as targeted treatment of (attenuated) psychotic symptoms is challenging. Age-appropriate treatment approaches drawing from youth specific interests, addressing complex symptomatology, associated burden and reduced functioning are needed. Finally, adolescents with psychosis are treated with antipsychotics, however, this age groups seems especially vulnerable for adverse effects (Vitiello et al. 2009). Medications with the most favourable benefit/harm ratio are needed, and head-to-head studies are sparse.
Prof. Correll and Dr. Franscini will co-chair the session. First, Dr. Gerstenberg will present longitudinal data of a sample of 12- 35 year-old participants of an early recognition study for psychosis. She will focus on outcome characteristics of symptomatology and functioning, also pointing to age-related differences. Dr. Franscini and Ms. Traber-Walker developed a manual and a smartphone application for targeted treatment of adolescents at-risk for psychosis. The app provides age-appropriate and real-time access to information on symptomatology and individually enriched skills for stressful daily-life situations. Ms. Traber-Walker will present the project schedule and first data on feasibility and usability. Next, Dr. Galling will present data of a meta-analysis providing an overview of the existing integrated or intensified treatment approaches for youth with psychosis and compare their effectiveness. These data are relevant for public health and directly guide clinical work. Finally, Drs. Pagsberg and Jensen will present original data of the Tolerability and Efficacy of Antipsychotics trial (TEA). In this multicentre, blinded RCT, patients aged 12-17 years with psychosis were treated with aripiprazole or quetiapine up to 12 weeks. Dr. Pagsberg will present first efficacy data and Dr. Jensen will focus on adverse outcomes, explicitly metabolic effects in this vulnerable group of patients.

Anorexia nervosa (AN) is one of the most common chronic illnesses in adolescence with the highest mortality rates of all psychiatric disorders. In the present symposium four European experts in the field of eating disorders will present their experiences with new treatment methods as well as recent findings in outcome research.
Annemarie van Elburg, The Netherlands, will discuss how to build up an evidenced-based treatment program in AN when Family-Based Treatment is not possible. This will include outpatient treatment in private practice, in a hospital setting and criteria for admission to inpatient treatment.
Janet Treasure, UK, will present the process and outcomes from using interventions which give carers knowledge and skills to support change for patients with eating disorders across the age range.
Beate Herpertz-Dahlmann, Germany, will demonstrate that besides well-known prognostic variables such as BMI at beginning and end of treatment, treatment setting, e.g. day patient treatment, has an important influence on outcome even after 2.5 years
Elisabet Wentz and Maria Rastam, Sweden, will present the exciting results of a 30-year community based follow-up study of 47 adolescent individuals with AN in comparison to 51 matched healthy controls.
We think that our results are of relevance both for clinicians in hospital as well as in private practice.

Dropout from school may have serious negative consequences for the health and development of children of school-age. Interventions which clarify reasons for absenteeism from school and provide advice and help are therefore of great importance.
The symposium will summarize the findings of research on school absenteeism, discuss mechanisms which may lead to school dropout and provide specific suggestions about the management of problems related to school dropout.

The ESCAP workgroup works with the IACAPAP workgroup on Gender. This workgroup focuses on different aspects of gender we encounter in our clinical practice in Europe.

Witnessing the murder of your parent – unthinkable, but it overcomes some children. Which response is to be expected? How will the child respond on treatment? These and other questions are dealt with in this symposium.

Fragmented transition pathway for ID, ASD and Mental Health

Dr Lionel Lubitz

Introduction

One in three people with mild to moderate Intellectual Disability (ID) and/or Autism Spectrum Disorder (ASD) has a mental illness. Approximately 80% of these young people are high users of health care resources. However there are often no established transfer pathways to adult services, and transition is often difficult and disjointed particularly for people with severe ID or ASD with behavioural concerns.

Objectives

This study was designed to understand the needs and knowledge of practitioners involved in transition of patients with ID and/or ASD with mental health (MH) comorbidities from the Royal Children’s Hospital (RCH) Melbourne, Australia to adult services and introducing a holistic model of care.

Methods

An interview using standard question prompts to explore child health practitioners’ experience and understanding of transition, was completed internally with 27 medical professionals involved in the care of this group of patients. External interviews are planned for early 2017 with primary care, disability services, psychiatrists and community services.

Results

All practitioners recognised major deficits in our large tertiary hospital’s transition process for this patient group and the majority (76%) reported the transfer process was not well done. There was no consistent view on the right age for transition to commence, with suggested age ranging from as soon as there is a diagnosis (9%), to 14 (30%), 15-16 (38%) and 17 (23%) years of age. The role of primary care was seen as important by 73% and yet 65% recognised significant deficiencies in this area.

Problems identified by a substantial proportion of respondents including:

(1) difficulty finding skilled and/or interested adult practitioners as the major challenge (65%)
(2) fragmented adult care and a lack of shared care between tertiary and primary health care (46%)
(3) lack of case management (40%)
(4) family anxiety about transition (35%)
(5) cost of care, medication and limited time available from adult services (30%).

Conclusion

The transition of patients with ID and or ASD with MH comorbidities is challenging, and perceived to be done poorly by doctors at a major tertiary paediatric hospital in Australia. The importance of a well-developed transition process was recognised by most respondents. This presentation will also suggest mechanisms to improve transition for these individuals.

Manualized treatments for children and adolescents with ASD match the requirements for structured and easily applicable programs in basic health care systems. The manual of the Social Skills Group Training for Adolescents with ASD (KOMPASS) (Jenny et al., 2012) has been developed at the Autism Clinic at the Department for Child and Adolescent Psychiatry, University of Zurich. In the beginner’s group (KOMPASS-Basics) understanding emotions, small-talk and nonverbal communication as well as social understanding and perspective taking are conveyed. In the advanced group (KOMPASS-F) complex interactions, complex communications and theory of mind are practiced. We previously evaluated the beginner’s training and showed a reduction in ASD symptoms. Here we introduce and evaluate the KOMPASS advanced training (KOMPASS-F) together with an extended re-evaluation of the KOMPASS-Basics. In both trainings, two instructors work with 7-10 participants for 25-30 sessions and 3 information-sessions for caregivers. KOMPASS makes use of the cognitive profile typically observed in ASD, e.g. local processing, systemizing and task orientation. Therapeutic procedures include structuring, visualizing, explicit learning of implicit social rules provided on information sheets, step-by-step learning and concretizing abstract concepts.
Our re-evaluation of KOMPASS-Basics compares reduction in autistic symptom and mental health scores obtained via questionnaires rated by parents and teachers for an intervention group (ni=110) and a waiting control group (nc=56) before (pre) and after (post) 7-8 months. Follow-up data (nf=94) is collected 12 months later in the intervention group. Additionally, we investigate if patients (ne=35) from the KOMPASS-Basic-groups in other clinics show similar improvements compared to Zurich. Similarly, for the KOMPASS-F group, questionnaires were acquired at the same three timepoints (ni=53, nc=50, nf=40). Data was analysed with linear mixed-models.
For the KOMPASS-Basics group, post-hoc t-tests revealed significant declines in autistic symptoms and increase in social skills with moderate to high effect sizes. Similar effects were found in the external institutions. The waiting group showed no effects. Remarkably, KOMPASS-F training led to additional improvements over and above the social skills acquired during KOMPASS-Basics training.
In conclusion KOMPASS helps adolescents and young adults to cope better with social aspects of everyday life.

Objectives: Since the launch of the Autism Spectrum Disorder (ASD) guidelines in New Zealand in 2008, and the subsequent introduction of locality-based ASD coordinators, district health boards around the country have attempted to improve services for children and adolescents with ASD. However, the extent to which things have actually changed over the past decade remains unknown. This study sought to compare current service provision for children and adolescents and to investigate differences between the assessment and intervention phases of management in relation to national recommendations.

Methods: A nation-wide survey of practitioners working with children and adolescents with ASD was undertaken in 2016 to identify the types of services being provided and to compare current practice with that recommended by the ASD guidelines.

Results: Responses were received from practitioners in 17 out of 20 district health boards. The majority of respondents were aware of the guidelines and the presence of ASD coordinators within their organisations. Significant differences were identified between assessment of children in paediatric settings and adolescents in mental health settings. Intervention services were found to be even more variable in nature and limited in relation to recommended standards.

Conclusions: Despite the improvement in some aspects of care, further work remains to be done to reduce the variability and fragmented nature of services for for children and adolescents with ASD in New Zealand. The principles learnt from our country are likely to be relevant to service providers and planners in other countries.

Early start Denver Model (ESDM) is a developmental and behavioral model of intervention for toddlers with Autism Spectrum disorder (ASD). Previous study has shown efficacy of a 20 hours per week therapist-delivered ESDM intervention on the cognitive level of children with ASD, over a 2 year period. At the beginning, two early intervention units applying the ESDM 12 hours per week were created in France. It was essential to evaluate impact of 12 hours per week ESDM intervention with 1 therapist for 1 child on the cognitive level of children with ASD.

A prospective before-and-after trial included 19 toddlers with ASD. We showed significant improvements in all cognitive and language skills at the Mullen Scale of Early Learning (MSEL). After only 9 months, major improvements were shown in receptive Language. Moreover, we will discuss that our outcomes were similar, with a smaller intensity (12 hours versus 20 hours per week), to the study of Dawson et al. (2010).

ESDM applied 12 hours per week, by a multidisciplinary team and in collaboration with parents, may be an efficient intervention to improve cognitive and language skills of children with ASD. We will next run a multicenter randomised control trial ESDM 12 hours per week over 2 years-period.

Objectives Research is increasingly documenting the importance of children’s problem behaviors and symptom severity for parenting behaviors in parents of children with ASD. The underlying mechanisms of these child-effects, however, have not been examined thoroughly. This study examines the mediating role of parental need frustration in the relation between child maladjustment (i.e., problem behavior and autism severity) and parenting behavior (i.e., controlling parenting and autonomy support). Based on Self-Determination Theory (Deci & Ryan, 2000), we hypothesized that child maladjustment would relate to the frustration of parents’ needs for autonomy, competence, and relatedness, and via this, to controlling parenting and low autonomy support.

Methods Data were drawn from the 3rd wave of a long-term longitudinal study (Dieleman et al., in press). The sample included 116 parents, mainly mothers, of adolescents/emerging adults with ASD (Mage = 18.9). Parents completed questionnaires concerning the their parenting strategies (i.e., psychological control, over-reactive discipline, and autonomy support), their psychological need frustration, the behavioral problems, and autism severity of their child.

Results The mediation model indicated that symptom severity had a direct association with lower autonomy support (β= -.33; p < .01). Externalizing problems were associated with parental need frustration (β = .56; p < .05), which was, in turn, related with controlling parenting (β = .82; p < .001). The significant indirect association (β= .46; p < .001) indicated that the effect of externalizing problems is fully mediated by need frustration. Internalizing problems were not associated with parenting behaviors.

Conclusions Externalizing problems impede parents’ connection with their child, their parental competence and their sense of volitional functioning, feelings to which they respond by increasing controlling strategies. The direct effect of autism severity suggests that parents respond directly to their child’s autism symptoms by lowering their autonomy support, without experiencing these symptoms as a threat to their psychological needs. In addition to yielding more insight in associations between child maladjustment and parenting, these findings have practical implications. Interventions targeting adolescents and parents in this challenging developmental period could focus not only on parenting behavior but also on parents’ experiences of need frustration.

The system of psychological assistance to children with autism in Russia has changed significantly and rapidly developing in a positive vector in our day. Institutions of medical and educational profiles in their professional activities carry out rehabilitation work: medical, psychological, educational. The General trend of the increasing number of children with autism in special schools is clearly evident in the framework of one institution, where the percentage of this category of children in recent years is 15% of the total number of students in the school, among the new entrants is 30%. Teachers and psychologists work with the child regardless of what form he is educated in what type of educational organization (general, special, inclusive). However, this problem is often decisive for the content and quality of psychological assistance to children with autism. Not every type of school has qualified professionals who know the needs of the child, not everywhere there are conditions for integrated support, including psychological-pedagogical and medico-social rehabilitation component. In special school there are conditions for a comprehensive support of a child includes special program, focused on the educational needs and educational opportunities of the autistic child; compliance with gentle conditions prevents fatigue.
Effectiveness of rehabilitation largely determined the professionalism of the support of the child. Problem the professional competence of psychologists depends on the system of University education that does not offer special programs on formation of knowledge of the specifics of dysontogenesis, diagnostic tools, effective rehabilitation practices. Cooperation of universities and institutions (in Russia and abroad), which have successfully and systematically solve problems of medical-psychological-pedagogical rehabilitation of children with autism, conducting on their basis training of students, could qualitatively to enhance professional competence by minimizing problems "entering into profession" of young professionals.
Today, we have methodical and technological capabilities. We understanding - effective psychological help it is possible to provide, when it is part of a comprehensive rehabilitation, is implemented in specialized institutions with qualified specialists with a wide professional horizon.

Objectives: Very preterm (VP) birth refers to an early stressful event putting children at heightened risk for behavioral and emotional difficulties. However, it remains unknown whether early emotional difficulties persist later in childhood and, importantly, whether the severity of the perinatal stress moderates this link.

Methods: 36 VP children and 23 full-term born (FT) children participated in an 11 year-long study. Perinatal stress was assessed at birth with the Perinatal Risk Inventory (PERI groups: low PERI: 100% of FT vs. 44% of VP children; high PERI: 56% of VP children). Early emotional problems were reported by mothers at 18 months in the behavioral and emotional disorders subscale (BE) of the Symptom Checklist. Later emotional problems at 11 years of age were reported by mothers through the internalizing problems (IP) subscale of the Child Behavior Checklist.

Results: First, examining whether the severity of perinatal stress affects IP, a t-test indicated significant differences between the low (M=51.92, SD=8.43) and high (M=59.60, SD=11.64) PERI groups (t(55)=-2.865, p=.006). Second, we correlated BE at 18 months with IP at 11 years and found a significant link in the high PERI group (r=.618, p=.004) but not in the low PERI group (r=.015, p=.933). Last, controlling for socio-economic status and intelligence quotient, we performed a regression analysis predicting child IP at 11 years by group (VP vs. FT), PERI groups (high vs. low), and BE at 18 months (main effects), as well as the interaction term of BE at 18 months with either group and PERI groups. This regression model significantly explained 36% of the variance in child IP at 11 years, F(7,52)=3.68, p=.003, R2change=.140. Specifically, the interaction between BE at 18 months and PERI groups refers to a significant predictor of later IP. Further analyses revealed that BE at 18 months marginally predicted children’s IP at 11 years only in the high PERI group (β=.418, p=.063), but not in the low PERI group (β =-.048, p=.801).

Conclusion: Prematurity affects children’s emotional abilities. Importantly, the link between emotional problems in early and later childhood is moderated by the severity of the perinatal stress. In particular, children who are born with more complications, experience more stress in the perinatal period, and are more likely to sustain their early emotional difficulties later in childhood.

Introduction:
Studying early interaction is essential for understanding development and psychopathology. Automatic computational methods offer the possibility to analyse social signals through behaviours of several partners simultaneously and dynamically.
The aim of the current study was to show the validity of the aforementioned automatic method by comparing our methods with the well-validate Coding Interactive Behavior (CIB) in neglected dyads.
Methods:
20 dyads of mothers and their 13-36 months old infants were videotaped during mother-infant interaction including 10 extremely high risk and 10 low risk dyads using both 2D and 3D sensors. From 2D+3D data and 3D space reconstruction, we extracted individual parameters (Quantity of movement and Motion activity ratio for each partner) and dyadic parameters related to the dynamics of partners heads distance (Contribution to heads distance), to the focus of mutual engagement (% of time spent face to face, or oriented to the task), and to the dynamics of motion activity (Synchrony ratio, Overlap ratio, Pause ratio). Features are compared with blind global rating of the interaction by expert coders using the Coding Interactive Behavior (CIB).
Results:
We found that individual and dyadic parameters of 2D+3D motion features perfectly correlates with rated CIB maternal composite scores (maternal sensitivity, mother limit setting and mother intrusiveness) and CIB dyadic composite scores (dyadic reciprocity/synchrony and dyadic negative status).
Conclusions:
Our method may present a low-cost methodology that can employ artificial technology to detect meaningful features of human interactions and may have implications for studying dyadic behaviours in psychiatry.
Learning Objectives:
Combining both clinical rating scales and computerized methods with this promising method may enable a continuum of time-scale from a summary of entire interactions to second-by-second dynamics and have implications in early child psychiatry concerning development of parent- child interactions.

A mother’s sensitivity in responding to her infant’s signals, forms the basis of secure attachment and is protective of later mental health. Video Interaction Guidance (VIG) is a strengths based intervention using moments from a video of parent-infant interaction observed and reflected on, which enhances parental sensitive responsiveness to their infant and also supports parents’ self-awareness. The aim is to evaluate the effects of an early attachment focused intervention for parents of very preterm infants born <32 weeks GA, in the NICU.
Methods: A pragmatic randomised controlled trial in a level III NICU with preterm infants born <32 weeks’ GA and their parents. The Preterm Infant-Parent Programme for Attachment (PIPPA) is a 3 session therapeutic intervention of reflective discussion, observation of infant cues and 1 VIG session. Primary outcome: maternal sensitivity measured by the CARE-Index at 9 months CA. Secondary outcomes: Infant social-emotional problems on the Ages and Stages Questionnaire – SE. Intention to treat analysis of data of first twin is presented as primary analysis.
Results: Eighty mothers, of 98 infants, consented andwere randomly allocated to intervention and control groups. There were no differences between the groups in socioeconomic status (p<0.356) in mean birth weight (p=0.97) or gestational age (0.79). Mothers in the intervention group had attained a higher level of education than mothers in the control group (p<0.008). Subsequent analyses were adjusted accordingly. Primary Outcome: There was no statistically significant difference between the intervention and control groups in maternal sensitivity at 9 months CA. Secondary outcomes: Infants receiving the intervention had lower self-regulation problems at 12 months CA (p=0.05). Infants whose mothers had received the VIG session, had significantly fewer communication problems (p<0.002).The intervention effect was moderated by ethnicity.
Discussion and Conclusions: This brief attachment focused intervention using VIG with parents of preterm infants showed improved social-emotional outcomes at 12 months CA, while no significant effect was found on maternal sensitivity, adjusting for maternal education. Integrating and evaluating interventions such as this in the NICU can enhance social-emotional and mental health outcomes of preterm infants.

A CLINICAL TRIAL TO EVALUATE THE COMPARATIVE EFFICACY OF COGNIUM SYRUP WITH STANDARD BEHAVIOURAL THERAPY VIS-À-VIS STANDARD BEHAVIOURAL THERAPY ALONE IN CHILDREN WITH ATTENTION-DEFICIT HYPERACTIVITY DISORDER (ADHD)
Dr. Vijay Warad, Dr. Milind Patil
ABSTRACT
An open label, comparative, 16 week study was conducted to evaluate the efficacy of Cognium syrup, a poly herbal formulation, on children between 6 – 14 years of age group with attention-deficit hyperactivity disorder (ADHD). A total of 76 children were enrolled as per the DSM IV (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition) criteria for ADHD. Enrolled patients were divided in two groups. Group A received Cognium syrup along with behavioral therapy and Group B was on behavioral therapy only. Both the treatment groups were comparable in terms of the baseline scores. The statistical analysis was carried out in only 60 children as remaining were dropped from the study. Treatment with Cognium syrup led to uniform improvement in all parameters. The total symptom score (TSS) decreased in 96.6% of patients in group A compared to 46.6% in group B. The average performance score for functional impairment decreased in 80% patients in group A and in group B by 36.66%. The well tolerated Cognium syrup demonstrated significant improvement in ADHD symptoms inattention, impulsiveness and hyperactivity in intervention group, indicating a promise for ADHD children.

La famille d'un enfant ou d'un adolescent joue un rôle de premier plan dans son développement. Celui-ci est certes le patient du clinicien, mais il est aussi la plupart du temps le patient "désigné" de sa famille (index patient). Prendre en compte le système familial représente ainsi un levier de compréhension et un potentiel de changement inestimables pour le thérapeute.
Les auteurs aborderont quelques procédés cliniques pertinents dans l'approche du système familial pour le pédopsychiatre, aussi bien pour élucider une problématique au retentissement individuel que pour s'appuyer sur les ressources représentées par les membres de la famille, en vue d'un changement clinique. Deux cas cliniques illustreront les idées et les méthodes cliniques exposées.

Transition: Der Wandel von Mustern der Interaktion in Familie und Schulklasse durch systemische Interventionen. Ein sehr erfolgreiches Modell vor allem bei komplizierten und mehrschichtigen Problemen. Mit dem Hintergrund einer bindungstheoretischen und behavioralen Logik werden funktionierende Wechselwirkung beobachtet und verstärkt. So finden Erwachsene Zugänge zu Kindern und Jugendlichen, die als schwierig, speziell oder fremdartig empfunden werden, um diese Kinder passgenauer zu fördern. Es sind lebensweltorientierte Ansätze aus der aufsuchenden (mobilen) Familientherapie.

Reading Georges Perec so often, and aloud, as if drause by his written voice, absorbing his rage and need for love, I ended up paying no more attentive to the meaning of the intrigues proposed to attach myself to the writing itself, its forme. Style rather than fable ... feel rather judging ... looking after him rather than me. In the play of rhythmic scansions and syncopations, in the articulations of sonorities and sounds of speech, in the white silences placed between brackets and the cold rage in quotes, I thought then to hear a music of silence, a sad chant vocalising the phantom presence of his mother - and sometimes, even more rarely, by lending his ear better, the song of two beings.

Roland Barthes wrote: "The objective of reading aloud is not in the clarity of messages, the theater of emotions; What it seeks ... it is the instinctual incidents, it is the language covered with skin, a text in which one can hear the grain of the throat, the patina of consonants, the voluptuousness of vowels, a whole stereophony of The deep flesh".

More than others, The Disappearance is a book that is important to read aloud. This novel is what is called a lipogram, meaning that a letter is missing. Perec realized the feat of writing a novel of 280 pages, without ever appearing the letter e, the most frequently used in the French language.
But we can also understand this constraint in a more tragic way. The letter e perhaps represents the mother of Perec or his parents or the Jews exterminated by Nazism. The company then takes on a new meaning: to try to construct a text that has a meaning after their disappearance, to them.
But we also find in this text violence, crimes, rape .... murders take place one another at a steady pace ... the dead instantly leave the world without delivering the slightest message in some sort of agony? This violence without emotion is to be compared to the calm cruelty, we sometimes encounter in the tales for children. But most of all, one hears the strange music of this crazy language.

It is a music resembling a forgotten foreign language, perhaps his mother’s who no doubt spoke Yiddish better than French and whose Perec says that he has no memory: Perec's musical writing Always oscillates between a babble and a moan. Sometimes, miracle ... She is a nursery rhyme...

Perec's mother's name was Cyrla and she was called Cecile, and Perec always remembered that Sainte Cécile was the patroness of music.

On 24 July 1950, seven months before he died, André Gide made the acquaintance

Of a word that denotes a state I have been suffering from for the last few months – a very fine word: anorexia. […] It means the absence of appetite (‘not to be confused with distaste’, Littré insists). The term is used by hardly anyone except doctors – never mind: it is useful to me. To say I suffer from anorexia would be exaggerating: the worst of it is, I hardly suffer any more from it, but my physical and intellectual lack of appetite is such that I no longer know how I stay alive except by force of habit. Don’t imagine that what I have just said is written out of despair – rather, it expresses satisfaction.1.

Let us begin by noting two paradoxes here. First, the ‘satisfaction’ Gide gets out of this lack of desire: this is as much of a reversal of meaning as the opening pages of his memoir Si le Grain ne meurt [If it die] (1926). Second, the fact that in that memoir he recounts this memory: “I ate little, I slept badly […]”.I really had no taste for anything; I went to the table like a condemned man to the scaffold; I would swallow a few mouthfuls only by dint of great efforts; my mother would plead, scold or threaten, and almost every mealtime ended in tears]. This is a precise representation of what we now call anorexia – Gide was an anorexic before he had even heard the term. How then are we to read the recollections of his body in Si le Grain ne meurt?

On the first page of the memoir, we find the following scene – shocking or endearing, as you prefer:
I can […] see a fairly big table, the dining-room table no doubt, with its cloth reaching nearly to the ground; I would crawl underneath it with the concierge’s son, an infant of my age who sometimes came to play with me.
‘What are you two up to down there?’ my nursemaid would call out.
‘Nothing. We’re playing’.

And we would make a lot of noise with the few toys that we had taken with us for the sake of appearances. Actually we were enjoying ourselves in a different way: one beside the other, though not one with the other, we were enjoying what I later learned were called ‘bad habits’.

He goes on: “I realize of course the harm I am doing myself by relating this and other things that follow; I foresee how they may turn my reader against me. But the whole point in telling my story is to be truthful. Let's just say that I am writing it out of penitence”.

This autobiography is a heliotropic text: it traces a progression from a childhood full of “darkness, ugliness and deceit” into glorious sunshine – though exactly where this teleology tends is not really clear, for light seems to dawn twice: once, in the sunlit moment of revelation of the first pederastic encounter, on a North African beach, where “now at last I found my normality”: “in the glorious splendour of the evening, how my joy was clothed in its rays!”, and later in the ambiguous but equally splendid moment when, “dazzled by the azure light”, the young André becomes engaged to his cousin Emmanuèle. In this paper I shall examine this dual tendency and multiplicity of paradoxes, looking in particular at the ways Gide recalls his body in childhood and adolescence and the ways in which we can read him.

Daily and naive clinical cases of sexual awakening – or a renewed wakefulness to sexuality- but also to eroticism, lead us to revisit with adolescents what would be a red thread, monumental and eclectic, of George Bataille’s work, the dialectic of the forbidden and transgression. Without the transgression resulting from a deeply buried original drive force that is neither a moral or immoral instinct, life becomes inexistent; without prohibitions, the world collapses. Eroticism, which is shared pleasure, exchange and reciprocity, should be considered within a framework of rules, prohibitions even, which would model an instinctual life; not without a certain amount of anguish omnipresent throughout the author’s work, a certain “malaise, secret of the greatest pleasures”.

“My mother”, a posthumous novel (published in 1966, four years after George Bataille’s death), is the story of a mother's relationship with her son, Pierre, 17, the day after his father's death, violent, alcoholic, hated. Debauchery, perdition, orgy, perversion of the mother (and Pierre?), unavowable incestuous desire, sexual relations experienced in a quasi-psychotic mode so much “it is true that on two occasions at least we have allowed the delirium to bind us more deeply And more indefensibly than carnal union could have done.” For Bataille, this is the example of eroticization pushed to its extreme, the non “passage a l’acte” in a tormented and maddening chastity.

And of course, there is laughter, another keystone of the work of Georges Bataille since its beginnings around 1922; a revelation, an irony, a shaking, "a knowledge of the depths of the worlds," a suspended time in which the word can not express emotion, an outside world which not far from denying death, recalls and affirms it, and at the same time absolves (here incestuous desire).

The almost unspeakable childhood of Georges Bataille with a blind father and neuro-syphilitic dementia, abandoned in his paralytic chair by the family during the capture of Rouen by the Germans in 1914, found dead in 1915; a probably melancholic mother with at least two known suicide attempts; an adolescence marked by the encounter with and then the renunciation with religion; those are as many prisms through which one can read and understand “My mother.”

Some psychic traumas, ever present in the clinical field of adolescence, confront us with feelings of impotence. We often think of these in terms of archaic experiences qualified with terms such as “unimaginable”, “unthinkable” and even “non representable”.

Without denying the radical essence of these experiences, we will reflect on what could be considered our “duty” as analysts and psychotherapists is in the clinical study of these difficult cases: the duty to imagine what is unimaginable to the patient, of attempting to think what to him results unthinkable, to dare represent what to him results non representable in these precocious experiences that the failing process of adolescence often sheds light on. Facing these “off time” states of psychical sideration, agonistic experiences lacking representation, experiences one cannot grasp and which cannot be bound together, we must fight the evaporation of traces and images, as well as the formless, the invisibility and the risk of disappearance.
Of it depends the possibility of succeeding at making such experiences human, insofar as the subject precisely defines them through a sentiment of psychic annihilation and the painful feeling of losing his own humanity.
If one has the goal of shaping what has no shape, of understanding what feels as unimaginable, one must thus first allow oneself to imagine and recuse the argument of the unmentionable, the infigurable and the unimaginable.

To face the “formless” (D.W. Winnicott); to face the “clinic of the extreme” (R. Roussillon ); to affront the “terror of existing” (M. Corcos ); “imagining the unimaginable trauma” as the role of the analyst (P. Fédida ); “imagine despite everything” (G. Didi-Huberman).

Such a clinic confronts us not only with the need to imagine, but also with the duty to imagine, and by imagining, with the possibility of constructions.
Through an interpretation of the movie “Son of Saul” from Lazlo Nemes, we attempt to introduce elements that allow us to reconstruct and construct an experience of humanity, through past experiences of psychical annihilation and dehumanization.

Marguerite Duras hated psychology, she only delivered scum, dialogue or soliloquy (La Pléiade).
Written very quickly without knowing how she do it, in parallel to other books, Lol. V. Stein is considered as one of her masterpiece, the most enigmatic, the most phantasmagoric.
Coming from the depths of her being, in nearly automatic writing, at a moment she is confronted to her demons and her midlife crisis. Confronted with her son’s difficult adolescence and her own problem of dependence, she delivers one of her most romantic works, a true ode to impossible or misunderstood love.

In face of her imaginary world so narrated, the psy, and even Lacan in person, must delete, always preceded by the artist. Jean's enigma in regard to Lol, Lol watching this woman dancing with the man she loves is consider as a disorder of the duality, of the subjectivity, from the Self to the other, in order to try to find our self with the risk to become mad to try see the love of our love.

With recent evidence that the vast majority of mental disorders, even when they emerge in adulthood, are caused by abnormal neurodevelopment and resultant emphasis on prevention and early intervention, there is a need to put developmental neuropsychopharmacology at the top of the agenda in mental health research. The target of drug discovery should shift toward a population younger than the one that is typically included in clinical trials. Developmental therapeutic windows have not been sufficiently factored into the design of trials of psychotropic drugs for mental disorders. We should devote more research to identifying the developmental stages at which individuals are most likely to respond to particular treatments. This is not only a matter of trying to replicate what has been found in individuals with mature brains; it is about searching for new strategies that address developing brains while the therapeutic window for their effect is still open. The future of research in this area should focus on the use of drugs for primary and secondary prevention that would modify abnormal brain development and drugs that are neuroprotective and serve to protect the brain from environmental stressors.

European child mental health services and related agencies are faced with an increasing challenge in responding to the influx of refugee children. This presentation will address practice, service and research issues, and will make recommendations in the context of existing evidence.

There is strong evidence on the prevalence and complexity of these children’s mental health problems and broader needs. The existing body of literature is largely based on identifying risk factors among children with mental health problems and predominantly designing trauma-focused interventions to reduce their symptomatic distress. Recent research and services have gradually shifted to a broader and dynamic resilience-building approach based on ecological theory, i.e. at child, family, school, community and societal level. There is increasing evidence for the implementation and effectiveness of interventions at all these levels, despite the methodological constraints in their evaluation.

In Europe, child mental health services need to collaborate with all agencies in contact with refugee children, establish joint care pathways, and integrate trauma-focused interventions with family and community approaches. In low- and middle-income countries, where specialist resources are sparse, resilience-building should aim at maximizing and upskilling existing capacity. European professionals have an important training, consultative and training role in this objective. A six-dimension psychosocial model that also applies to other children who experience complex trauma is proposed, based on the World Awareness for Children in Trauma programme (WACIT: www.wacit.org).

Psychotic disorders are a leading cause of disability-adjusted life years (DALYs); and although schizophrenia occurs infrequently in childhood and early adolescence, it is the ninth main cause of DALYs in boys between the ages of 10 and 14 years, and second main cause of DALYs in both genders between the ages of 15 and 19 years. A prodromal phase, which can last several years on average, precedes a majority of first-episode psychoses; it frequently leads to some decline in psychosocial functioning already but also offers an opportunity for an early detection of psychosis, and thus, for its indicated prevention. To this, two clinical high risk approaches, which had been developed in adult samples, are currently mainly followed, the ultra-high risk (UHR) criteria and basic symptom criteria. The UHR criteria were explicitly developed to predict a first-episode psychosis within 12 months, and indeed, the majority of conversions in clinical UHR cohorts do seem to occur within the first 12 months past initial assessment. The main UHR criterion, i.e. the attenuated psychotic symptoms (APS), includes symptoms that resemble positive symptoms of psychosis like delusions, hallucinations, and formal thought disorders with the exception that some insight into the abnormal nature of these experiences is still maintained. In contrast, the basic symptom criteria aim to detect the increased risk of psychoses at the earliest possible time using first subtle disturbances in information processing, which are experienced with full insight. Ideally, these changes should be detected when the person’s coping abilities have not yet been compromised and when the initial symptoms of an emerging disorder have not yet resulted in any functional decline. First results of prospective and community studies indicate that a combination of both approaches might be most favorable to increase sensitivity and a timely risk detection, in addition to establishing a change-sensitive risk stratification approach. However, as earlier indicated by reports of increased rates of hallucinatory experiences in children of the community, developmental aspects might play an important role, recent studies suggest both UHR and basic symptom criteria might be less predictive of psychosis and less clinically relevant in children and adolescents. Thus, an early detection of psychosis in children and adolescent seems to require special efforts.

Standing as perhaps the most tangible object of developmental transitions, the
adolescent body – the body in transitions – lies at the crossroads of the biopsychosocial transformations preparing youths for social fitness and adaptation. Early psychodynamic thinkers first captured the implication of the body in transitions when considering the storm and stress of adolescence in relation to psychopathological states. Today, the neurosciences shed new light on the topic from the perspectives of cognitive, developmental, social as well
as fundamental neurosciences. The wealth of neuroscientific data yields a rich and complex picture of mental health and illness in relation to growth factors during the teenage years.
While the breadth of these discoveries can be exhilarating, puzzlement generally arises when
pondering on the clinical pertinence of these scientific breakthroughs.
As testified by fundamental neuroscience on rodents, we first find ourselves in the way our bodies have been handled by our main carers. Throughout childhood, the body is apprehended by significant others, first in the early attachment relationship, and in a somewhat independent fashion, by new attachment figures during adolescence. Critical to contemporary society, however, interactions with peers and different kinds of reflective screens shape the way youths construe both their bodily and mental selves, in more or less
integrated entities. Through the establishment of resilient networks, both at the cerebral, psychological and social levels, youths integrate the complex, context-dependent processes of activation and deactivation to adaptively navigate in the environment.
This presentation will attempt to situate the disjointed parts of scientific evidence on the body in transitions, and articulate them to potentially meaningful observations in developmental psychopathology. Our main working hypothesis postulates that the mindbrain-body triad undergoes a series programmed re-wiring in order to offer itself to being shaped by the social environment. Herein, the nature of psychopathological development rests in the disharmony and relative unpermeability of youth who fail to create new and significant
attachments and social ties. Most interestingly, contemporary resilience research further suggests that preceding socio-relational hardships, embodied processes such as interoception and embodied mentalization in early adolescence may prelude the risk to psychopathology during this key developmental window.

Youths growing up in disadvantaged families are at risk of experiencing behavioral and psychological problems and may respond less well to therapeutic interventions than those who are from more favorable backgrounds. Additionally, the experience of mental health or substance-related difficulties in adolescence, can impact educational attainement and adult socioeoconomic standing. To illustrate the complex relation between socioeconomic position and mental health and substance use, this symposium will rely on four presentations. First, data from France will show the elevated levels of behavioral and psychological difficulties in youths growing up homeless. Second, a study based in the Netherlands, will show that the efficacy of Youth Initiated Mentoring varies depending on background socioeconomic circumstances. Finally, data from the longitudinal TEMPO study based in France will show that cannabis use in adolescence is a cause of educational failure and that the experience of food insecurity is tightly related to mental health and substance use problems in young adults. Overall, this symposium will show that the relationship between socioeconomic factors and mental health in youth is bidirectional, and research in this area should be taken into account in the design of interventions aimed at supporting high-risk and community youths.

Adolescence as a time of bio-psychosocial transition confronts psychiatrists and psychotherapists with difficulties in diagnostics, crisis interventions and treatment especially with severely disturbed young persons. The diagnosis of Borderline Personality Disorder in adolescence has been avoided for years in order not to stigmatize adolescents. It was assumed that in adolescence it is difficult to differ between pathology and normality or borderline behavior and borderline disorder. Using a dimensional approach might now-a-day give a helpful orientation for the diagnosis of a Borderline Personality Disorder. The same is the case with identity diffusion as indicator. Further research is needed for the development of concepts of crisis intervention and psychotherapy of adolescents with Borderline Personality Disorder. Only few evaluated therapeutic studies of borderline treatment exist until today other than in treatment of adults. Experiences with Interventions in natural environments promoted by mobile units will be discussed. Furthermore special treatment concepts are necessary for severely disturbed adolescents with regard to their instable psychic state and instable life conditions. A psychodynamic therapeutic approach called PIM will be presented; the effectiveness of the method was shown in an inpatient RCT Study. Instead of taking the role of an expert the therapist acts as a resonant person expressing his experience in an answering mode in a symmetric relationship with the patient.

Despite longstanding general agreement that personality disorders have their roots in childhood and adolescence, diagnosing borderline personality disorder (BPD) prior to age 18 years has been controversial. To date, there is increasing evidence in support of both diagnosing and treating BPD in adolescence. Thus, national treatment guidelines, Section 3 of the new DSM-5, and the proposed ICD-11 personality disorder classification have all recently confirmed the legitimacy of the BPD diagnosis in adolescents.
In order to prevent chronicity and poor psychosocial outcomes of severe mental disorders, early intervention and maybe even indicated prevention seem to have clear advantages. Nonetheless, early detection, diagnosis, classification and staging of early BPD represent major challenges, particularly in the light of emerging dimensional models of personality disorder, new diagnosis of “nonsuicidal self-injury” and “suicidal behavior disorder”, and a common hesitation among practitioners to stigmatize their patients with a categorical diagnosis of BPD. The symposium will present latest research findings on the diagnosis and staging of early BPD. New diagnostic concepts (e.g. from section 3 of the DSM-5) and methodological approaches (e.g. neuroimaging or ecological momentary assessment) will give new insights into the topic, and will inform clinical practice in order to facilitate early detection and intervention of BPD. The symposium is part of the Global Alliance for Prevention and Early Intervention for BPD.

Transition to adulthood is the period of onset of most of the serious mental disorders that disable or kill in adult life. However, only a small proportion of young people in this age group, less than one in six, access services or receive
appropriate care. The current service configuration of distinct Child and Adolescent Mental Health Services (CAMHS) and Adult Mental Health Services (AMHS) is increasingly viewed as an impediment to holistic and comprehensive care for young people, especially those who make a transition from one model to another. There is international concern about young people who get ‘lost’ during their move from CAMHS to AMHS (hereby called transition). Disruption of care during transition may adversely affect the health, wellbeing and potential of this vulnerable group. This symposium will present initial data from the European-funded MILESTONE project, aimed at assessing the characteristics and outcomes of transition in 8 European countries: this project will provide helpful data to set up effective transition policies and practices in European countries.

In times when economic considerations increasingly dominate medical care, the issue of quality assurance continues to gain more importance.

In the psychiatric and psychotherapeutic care for children and adolescents it is especially necessary to demonstrate the effectivity of treatments, as the impact of a psychiatric or therapeutic intervention not only unfolds through its application but also through the way in which the treatment is delivered. Therefore, the satisfaction of young patients and their caregivers must be determined as an important indicator of high quality psychiatric care, taking into account aspects of developmental psychology as well as systemic, ethical and legal questions.

In Switzerland, the National Association for Quality Development (ANQ) coordinates binding quality assessments in child and adolescent mental health service, including psychiatric institutions. The results of these assessments allow for a transparent comparison between hospitals and clinics nationwide. The Swiss Association for Child and Adolescent Psychiatry has tasked a working group with the development of quality assurance questionnaires, with a view to the special requirements of child- and youth psychiatric clinics. These instruments are projected to be implemented as part of a Continuous Improvement Process (CIP) in all facilities, allowing them to steadily develop their quality assessment processes. This is the thematic area we are aiming to explore with this Symposium.

The first presentation will be dedicated to the development and assessment of psychometric properties of a questionnaire for the determination of patient and caregiver satisfaction in inpatient facilities. The second presentation will show the first clinical insights gained from our pilot study conducted in six inpatient facilities. The benchmark results will depict the benefits of these surveys to the internal quality management.
The third presentation will present a pilot study assessing satisfaction from multiple perspectives related to assertive community treatment. And finally, the fourth presentation will introduce the instrument of Treatment Adherence Measures (TAM) developed by multisystemic treatment (MST) Services as an excellent example for the efficient documentation of manual adherence and treatment quality.

This symposium will explore various situations of collective traumas and the various answers brought by the teams of child and adolescent psychiatry.

EFCAP is the European Association for Forensic Child & Adolescent Psychiatry, Psychology & other involved professions, with members in Europe as well as other countries.

The aims of EFCAP are:
*to improve facilities and to facilitate joint international scientific research to promote interdisciplinary training and interdisciplinary education.
*to exchange data obtained from research and to exchange practical experiences and innovative research and treatment methods.
*to gather information on and to contribute to national and European policy, in so far as this policy affects young people.
*to raise awareness of the need for constant change in the criminal and civil justice systems, so as to provide as well as possible for the interests and the development requirements of children and young people.

In this symposium, we will present several interventions that aims at detecting and treating young patients of pre-school age. We will describe a detecting and preventing intervention in kindergarten, the role of speech therapists with young patients with complex developmental delays, the multidisciplinary management of hyperactivity in pre-schoolers, the therapeutic action of a body-mediated group for children, and a psychotherapy centred on parenthood to treat young patients, their parents and the parent-child relationship.

The symposium is about child mental health in transcultural situation, when patients and carers do not share same language, origin and culture. We will present you in particular our latest researches about drawing and bilingualism of migrant's children with the presentation of new clinical tools. We also present you our practice in humanitarian situation with children affected by trauma conflict.

The symposium will present selected findings from the multi-center study UBICA (Understanding and breaking the intergenerational cycle of abuse). First, Dittrich et al. will talk about transgenerational effects of maternal childhood adversity (CA) and/or a history of depression on the quality of interaction with their five to twelve years old children and on children’s well-being. Based on data of the same sample, Möhler et al. will present findings on transgenerational effects of maternal CA and/or depression on the inhibitory functioning of children. Subsequently, Reichl et al. will discuss the moderating role of polymorphisms from the oxytocin receptor gene on relations between maternal CA and parenting behavior. Consequently, Dahmen et al. will compare a group of adolescent and adult mothers and their three to six months old infants regarding psychosocial risk factors, the quality of mother-child interaction and maternal and children’s well-being. Finally, Fuchs et al. will present findings about longitudinal effects of maternal CA on the adrenocortical attunement in mothers and their three years old toddlers.

Child and adolescent mental health (CAMH) problems are common, affecting about 10-20% of children globally; they are serious, having been linked to educational failure, substance misuse, (sexual) risk taking behaviour, child abuse as well as long term exclusion and dysfunction in adult life; and they are treatable with sufficient evidence available to justify the set-up of services worldwide. However, particularly in low and middle income countries (LAMIC) CAMH-needs often remain unrecognized and stigma and the allocation of resources and implementation of wider programmes remains a challenge. After giving an overview of global educational initiatives by the International Association of Child and Adolescent Psychiatry and Allied Professions (IACAPAP), this symposium explores partnerships and activities from GAZA, Oceania and Ethiopia aimed at expanding CAMH into regions where there are no or few child psychiatrists.

Brain activity during sleep may provide a unique window onto adolescent cortical maturation. Especially electrophysiological sleep characteristics such as slow waves and sleep spindles were shown to be involved in short-term and long-term modifications of the developing brain. There is increasing evidence for sleep playing an active role during processes of synaptic plasticity shaping neural networks and supporting waking functioning. Sleep also seems to be bidirectionally related to altered processes of emotions, perceptions, and cognitive functioning. Long before technical and imaging advances shed light on sleep characteristics, disturbed sleep was found to be a core feature of many mental disorders such as ADHD, anxiety disorders, depression, and schizophrenia. Sleep disruptions seem to precede onset of these disorders and may enhance symptomatology. These findings highlight the importance of understanding when and how deviations from typical sleep characteristics occur and how this impacts pathophysiology of emerging mental disorders to improve prevention and targeted treatment. Prof. Huber and Dr. Tarokh will chair the session putting all of the presentations into context and identifying their relevance for future research and potential clinical implications. First, Dr. Tarokh will review characteristics of the sleeping and waking EEG during adolescence and present data regarding the degree to which genes and environment contribute to sleep physiology. She will provide data with relevance for public health and for clinical work with adolescents reporting sleep disturbances. Dr. Prehn-Kristensen will present data that highlight the impact of sleep on the consolidation of emotional and rewarded memories in children with ADHD. Here, especially the role of slow oscillations in deviant sleep-associated memory in processes will be emphasized. Dr. Wilhelm will present recent findings indicating differential effects of sleep on emotional memory consolidation in socially anxious and healthy children and adolescents. Finally, Dr. Gerstenberg will focus on sleep spindle oscillations, waxing and waning deflections in the EEG during early deep sleep. The synchrony and density of sleep spindle oscillations may be crucial for the organization of thalamocortical pathways. Dr. Gerstenberg will shed light on associations of disturbed sleep spindle density with specific domains of psychopathology in adolescents with a major depression or early-onset schizophrenia.

Currently, two clinical high risk (CHR) approaches to the early detection of psychoses prevail: the ultra-high risk (UHR) criteria and basic symptom criteria. Both were developed and initially validated on predominately adult samples; their subsequent employment in child and adolescent samples was done with little consideration of developmental, i.e., age-related, issues. The important role of age, however, was recently highlighted by lower conversion rates to psychoses in clinical child and adolescent samples as well as by a higher prevalence and lower clinical significance of UHR and basic symptoms in children and adolescents of the community. Thereby, an age threshold of around the turn from early to late adolescence was indicated for UHR symptoms and of around the turn from adolescence to adulthood for basic symptoms.
In our symposium, we will further investigate age-specific requirements in the definition and treatment of CHR states of psychoses. To this aim, first, age-effects on the presentation of UHR symptoms in a clinical sample will be explored, following the methods employed in community samples. Next, the impact of age on the presence and severity of “co”-morbid disorders will be explored in a clinical child and adolescent sample of CHR patients of the Bi-national Evaluation of At-Risk Symptoms in children and adolescents (BEARS-Kid) study. This will be followed by a critical review of diagnostically challenges in children and adolescents associated to disorders of childhood and adolescence. Finally, based on one-year follow-up data of the naturalistic BEARS-Kid study, the efficiency of different interventions with regard to CHR symptoms in children and adolescents clinically considered at CHR of psychoses will be examined. Overall, the symposium shall highlight the special efforts required for a precise and efficient prevention of psychosis in children and adolescence and convey ways to adequately address this topic for the time being.

This symposium is dedicated to new insights from neurobiological research into underlying mechanisms and principles of anorexia nervosa (AN) and what we can learn from it for clinical practice. First Mrs Janet Treasure, UK, will open by giving an overview over previous research regarding neuroprogressive changes in patients with AN getting worse as the illness protracts over time into chronicity and with longer illness duration being an important predictor for a more direworse outcome. Social cognition appears especially affected disturbing interpersonal functioning and impacting relations with close others. She suggests a new staging model of AN with implications for differential treatment of acute and chronic patients targeting a range of maintaining factors that emerge as a consequence of neuroprogressive changes from protracted starvation. Ms Ida Wessing, Germany, will try to elucidate one of those maintaining factors by focussingfocusing on the motivational responses to food in patients with AN using highly time-sensitive magnetoencephalography. She could show enhanced early bottom-up driven but reduced later more top-down controlled brain activity. This suggests enhanced first motivational orienting towards food stimuli which then are cognitively overregulated. Mr. Sebastien Guillaume, France, will present brand new epigenetic results reflecting which genes are activated and which are silenced by methylation in patients AN cross-sectionally and longitudinally. He found differentially activated genes in AN patients vs controls and during weight gain, differing between those patients with good vs bad prognosis. Involved genes pertain to brain development and plastisticity, potentially explaining underlying psychopathology. Finally, Mr Jochen Seitz, Germany, will present his talk on the cause and effect of brain volume loss in AN using human and animal data. He could show that brain volume loss is associated with neuropsychological deficits and worse clinical prognosis. New animal results show an almost 50% reduction in astrocyte number and volume in gray and white brain matter. As astrocytes directly influecence neuronal function, this could help explain neuropsychological deficits and give rise to astrocytes as new research target, e.g. by using estrogen replacement therapy.

Creative Therapies for Early Adolescent Patients

Oral Presentation Introduction: Given the significant emotional and physical development that occurs in children as they become adolescents, therapy must also evolve to continue to engage and attune to these young individuals. The presentations will highlight different modalities for child psychiatrists to be more attuned to his or her patients and therefore improve the therapeutic alliance. The children discussed will have a variety of learning, speech and socialization obstacles and each having a unique experience relating to his or her current cultural setting. As a collaborative effort, the panelists will include mental health professionals from different disciplinaries and treatment settings including psychiatrists, a creative arts therapist and an occupational therapist in school, clinic and private practice settings.

Creativity itself is transformative. One of the most important aspects of improving the therapeutic alliance is through the conscious effort of fostering improved attunement in the doctor-patient dyad and ultimately the parent-child dyad. Four presentations will explore aspects of attunement with parent coaching, sensory integration, and explorations of culture and social ideals in different settings. The first presentation highlights the use of parent coaching with a same sex couple rearing a child of the opposite sex who had experienced significant non-verbal aggression relating to the misattunement. Third culture children, children who are from different backgrounds as their current environment, are becoming more prevalent in the world and an understanding of culture for parents and therapists are more important than ever. A case study highlights the struggles children in this group share throughout the world. Children from diverse backgrounds struggle with trying to acclimate to the home and social cultures. This is further explored through a particular case of a young girl with an eating disorder who experiences body dysmorphia relating to race. Given language barriers and delay in speech, non-verbal self-regulation is discussed to improve connection the physician-child dyad. The discussion will tie in the four cases relating to transition of age, cultural transitions, and collaboration between mental health disciplinaries from different settings of practice.

The German societies of child and adolescent psychiatry, psychosomatics and psychotherapy (DGKJP) and adult psychiatry (DGPPN) have agreed upon a consensus paper on transition from child and adolescent psychiatry to adult psychiatry. The symposium presents the motivation of the two professional societies to establish a working group on transition and reports about the results and the main content of the common position paper. There is a common presentation of the two presidents of the scientific professional societies and the main authors and the first authors of the paper. Therefore, we do not propose separated abstracts nor methods or result section to the four individual contributions.

Psychiatric issues in relation to consultations conducted with unaccompanied minors at OMP



Objective

Over the last two years, the canton of Geneva has received a record number of unaccompanied minors coming from different war zones. Initially, this influx had a significant impact on the social and educational systems. Housing, guiding and schooling of these minors was the priority. After this first phase, the main concern shifted towards the health care system and as a result the system of somatic care had to be reorganised. Since one year, the psychic care system has gradually been affected and we have witnessed a substantial increase of this population’s demand.
Most of these teenagers have experienced multiple trauma. However, when they arrive at OMP, we are faced with very heterogeneous requests for care. In this presentation, we wish to assess the situation of these minors and explain the clinical adjustments we have had to make to respond to these different requests for care.

Method and results

In order to assess the current impact of this consulting population on our health care system, we will compare the number for these specific demands and the numbers of general consultations. The periods compared are two six months periods : from October 2015 until March 2016 and October 2016 until March 2017. Then, we will present a statistical analysis of the reasons for consultations and we will highlight the average time between the arrival in Geneva and the requests for psychic care. We will also detail the various psychic disorders and the current social conditions of life. Finally, we will present different measures that we have put in place to respond to these specific requests.
We will illustrate this statistical data using three clinical situations we have experienced in our consultation work.

Conclusion

With this presentation, we hope to give an overview of the psychiatric problems resulting from this wave of migration of unaccompanied minors which is currently increasing rapidly in Europe.

Objectives:
Posttraumatic psychopathology has been identified as longstanding and devastating, particularly after childhood trauma. Still, no evidence-based prevention has been identified. Crisis Intervention Program for Children and Adolescents (CIPCA) was found at the Metin Health House (MHH) in Duhok, Kurdistan Region of Iraq (KRI), to early provide cost-effective and time-saving crisis intervention to prevents posttraumatic psychopathology among the surviving children and adolescents from the war of the Islamic State in Iraq and Syria (ISIS).
Methods:
In a pilot project supported by WHO and the Directorate of Health in Duhok governorate, 37 health professionals received one-week training of trainers (ToT) in group at the MHH. Every two certified trainers provided one-week training to a group of 30 teachers inside the camps of the Internally Displaced Peoples (IDP) around the city of Duhok. Totally, 300 IDP teachers received the CIPCA group leader certificate. Every two group leaders provided a single one-hour group intervention to 30 IDP school children. Totally, 22000 school children received CIPCA intervention, 15% showed psychological distress during the group intervention, 50% of them needed treatment.
To examine the effectiveness of CIPCA in preventing posttraumatic psychopathology, informed consent was obtained from 4500 responding school children and their caregivers to participate in a 5 years follow-up study. They were class-randomized to CIPCA intervention or controls, consequently. Caregivers filled the Child Behavior Check List (CBCL) before the CIPCA intervention and annually in 5 years.
Results:
Totally, 366 completely filled CBCL were received before the intervention. Due to lack of funding, only 28 participants were traced at the first year follow-up. All the caregivers refilled the CBCL. Both girls and boys improved in problem scores after CIPCA compared with deterioration among the controls.
Conclusions:
Improvement in problem scores among CIPCA receivers at one-year follow up seems to be promising. Funding is needed for further follow-ups to improve the evidence to confirm the effectiveness of CIPCA in preventing posttraumatic psychopathology. Updating and recent data from different child populations will be presented.

PSYCHIATRIC DISORDERS AMONG YAZIDI CHİLD AND ADOLESCENT REFUGEES IN TURKEY’S CAMP
Nasıroğlu S 1, Çeri V 2, Erkorkmaz Ü 3 and Semerci B 4
1. Sakarya University Faculty of Medicine Department of Child and Adolescent Psychiatry, Sakarya, Turkey
2. Pendik Training and Research Hospital, Department of Child andAdolescent Psychiatry, Medical School of Marmara University, Istanbul, Turkey
3.Sakarya University Faculty of Medicine Department of Biostatistics, Sakarya, Turkey
4.Department of Psychiatry, Bengi Semerci Institute, Istanbul, Turkey
Objective: To report the mental health states of a sample of Yazidi refugee children and adolescents psychiatric disorders among the children and adolescents participating in the research.
Method: The participants of this research are children and adolescents between the ages of 6-17 who live in the refugee camp in Turkey. Two child and adolescent psychiatrist speaking their mother-tongue language interviewed and evaluated each participant. Data collected include socio-demographic and past and current living situation and the Schedule for Affective Disorders and Schizophrenia for School Age Children-Present and Lifetime Version-Turkish Version (K-SADS-PL).
Results: 136 children and adolescents (76 boys, 63 girls; mean age =11.05±3.11(SD)) At the time of the assessment 43.4% had PTSD (n:59) , 27.9% depression (n=38 ), 10.3% nocturnal enuresis (n=14 ), 9.6%Behavioral Disorder (n=7), 5.1% anxiety disorder (n=13).
Conclusion: Many of the refugee children and adolescents developed psychiatric disorders, or are at risk, especially for PTSD and depression. Their lower spirit and hopelessness might be evaluated as expected consequences considering the fact that those with a psychiatric diagnosis have experienced severe war and migration traumas (loss of a loved one, friends and family left in the war zone, death directly related to war, and injuries) compared to the others.1, 2

Keywords: Child, adolescent, refugees, psychiatric disorder, risk factor
References:
1. Almqvist K, Brandell-Forsberg M. Refugee children in Sweden: Post-traumatic stress disorder in Iranian preschool children exposed to organized violence. Child abuse & neglect. 1997;21(4):351-366.
2. Steel Z, Silove D, Phan T, Bauman A. Long-term effect of psychological trauma on the mental health of Vietnamese refugees resettled in Australia: a population-based study. The Lancet. 2002;360:1056-1062.

Objectives
Children’s abuse and neglect is widely studied as a major risk factor for emotional and behavioral disorders, various somatic and psychiatric problems during adulthood. Mental health is fundamental to health. Mental illnesses are real, disabling conditions affecting all populations regardless of race or ethnicity but disparities in mental health services exist for racial and ethnic minorities, and thus, mental illnesses exact a greater toll on their overall health and productivity.
Methods
The most important bet when working with ethnic minorities is to better understand the roles of culture, race, and ethnicity, and overcome obstacles that would keep anyone with mental health problems from seeking or receiving effective treatment.
The Day Centre "THE HOUSE OF THE CHILD" is a community unit which provides customized clinical mental health services for therapeutic treatment and psychosocial rehabilitation of children victims of abuse, neglect or domestic violence. The Day Centre was founded by the non-profit voluntary Organisation “THE SMILE OF THE CHILD”. The services are based on the bio-psycho-social model approach and treatment which aims at early detection and treatment of possible mental disorders and the overall psychosocial rehabilitation of victims of abuse / neglect and the support of their carers.
Results
By identifying the many barriers to quality care faced by racial and ethnic minorities, the Day Center provides mental health services also to children who come from minority populations.
Conclusion
Different case studies highlight challenges and various levels of difficulties in this specific scheme of cooperation aiming to open an interesting dialogue on the topic.

Aim: This study aimed to assess early-onset psychiatric disorders and factors related to these disorders in a group of refugee children upon immigration due to war.
Methods: The study was conducted between January 2016- June 2016. Clinical interviews were made with 89 children and their families. Clinical interviews were carried out by native speakers of Arabic and Persian that were primarily educated with these languages and have been living in Turkey for a long time. Strengths and Difficulties Questionnaire (SDQ) that had Arabic and Persian validity and reliability were applied to both children and their families.
Results: Eighty-nine children and adolescents were interviewed within the scope of the study. Mean age of cases were 9.96±3.98 and 56.2% (n=50) were girls while 43.8% (n=39) were boys. Within these children, 47 (52,8%) has come from Syria, 27 (30,3%) from Iraq, 14 (15,7%) from Afghanistan and 1(1.1%) from Iran. Children have been living in Turkey for 22.1±13.0 months while 18.8±13.3 months, in Manisa. One psychiatric disorder was found in 44 (49,4%) of the children. Twenty-six children were diagnosed with anxiety disorders, 12 with depressive disorders, 8 with trauma and related disorders, 5 with elimination disorders, 4 with attention deficit- hyperactivity disorder, 3 with intellectual disability. It was determined that seeing a dead or an injured person during war/emigration and father’s unemployment increased the odds of psychopathology.
Discussion: Within the context of war and emigration, these children try to cope with negative circumstances they had prior to migration and the despair their parents are in. They also are not able to attend school regularly and manage to maintain their physical needs. In case of failed interventions to manage the situation, it is of no doubt that this shall have dire psychosocial consequences.

Aggressive behaviors are common during adolescence. In Greece, adolescents and their families experience a severe and enduring recession with adverse implications on mental health outcomes. This study aimed to examine the correlation of adolescent’s aggressive behavior and economic factors. The Buss– Perry Aggression Questionnaire (AQ) and three questions of the Household Food Insecurity Access Scale were administrated to a sample of 2159 students of the Greater Athens Metropolitan Area. Students that during the previous four weeks had experienced household food insecurity (anxiety- uncertainty about food, insufficient food quality or insufficient food intake) or their pocket money decreased within the last month scored on average significantly higher in the AQ compared to their counterparts who did not. The shortage in basic goods due to the actual Greek economic crisis seems to be related to aggressive behaviors during adolescence and we should take it into account in the clinical practice.

Parenting processes take place at the level of the family unit. Existing longitudinal studies are increasingly critiqued for producing results that are unrelated to the actual causal mechanisms at the level of individuals or individual families (Hamaker, Kuiper, & Grasman, 2015). In fact, some studies on parenting have addressed this concern (e.g., Keijsers, 2015; Smetana, Villalobos, Rogge, & Tasopoulos-Chan, 2010) which provides the intriguing suggestion that inferences based on research focusing at the group level (e.g., regression model), may be different from, or even contradictory to, the actual parenting processes at the level of individual families.

This symposium contribution applies novel Random-Intercept Cross-lagged panel models (Hamaker, Kuiper, & Grasman, 2015) on the link of privacy invasive parenting with adolescent secretive behaviours, to come to better estimates of how parenting operates within families. By extending a standard cross-lagged panel model, to distinguish the between-person from the within-person effects, this novel method allows to critically evaluate whether (H1) there are indeed positive effects of privacy invasive parenting on secrecy at the level of a family unit.

Dutch adolescents (n =244, mean age = 14.07, 40% boys) reported three times on perceived parental privacy invasion and secrecy from parents.

The standard cross-lagged panel model on adolescent-perceived privacy invasion and secrecy confirmed earlier studies (e.g. Hawk et al, 2013) that privacy invasive parenting predicts increased secretive behaviours over time. However, RI-CLPM, designed to improve causal inferences show a different pattern. The positive between-person correlation confirmed earlier work that in families with more secrets, more privacy invasive behaviours occur. Within-persons, however, children were more secretive in periods with lower levels privacy invasion (significant correlated change).

In contrast to inferences in earlier work, secrecy was related to decreased privacy invasion within families. Findings of standard cross-lagged panel models may thus be opposing to the processes operating within families.

Introduction : Neglectful and/or abusive parenting is a major risk factor for the infant development. Early intensive treatment may lessen the risk. The most frequent therapeutic obstacle is poor parental compliance. We developed a treatment model based on the intensive provision of support to parents combined with attachment-based guidance.
Method : 50 high -risk families were recruited in two French and Israeli Infant Mental Health units and were enrolled in a parent-infant group and individual parent-child psychotherapy. No control group was available due to ethical limitations. Each case is its own control. The infant’s developmental status, the quality of the parent infant interaction and the level of parental psychopathology were assessed at the beginning and the end of treatment (DC 0-3, CGI, BITSEA, SCL 90R, IA, PIRGAS, CIB, HOME).
Results : Despite significant dropout, the therapeutic alliance was better than expected in this type of population. The child’s developmental status and the quality of interaction improved significantly. Girls improved more than boys (p= 0,044) for PIRGAS, and the child’s outcome was inversely correlated with the number of risks factors (p<0,05).
Conclusion : Despite limitations, the intensive therapeutic approach appears promising in treating and preventing very high risk infants, and may prevent child out of home placement.

The Semente Project, developed by the Psychiatric Department (PD) of Fernando Fonseca Hospital (funded by EEA Grants), intends to implement a mental health promotion program for Children of parents with mental Illness (COPMI), a group which has been identified in several studies in the last 40 years as more vulnerable, proving to have a strong association between parental mental illness and the increase of psychiatric risk in their children. The Psychiatric Department’s population is characterized with high social risk factors and high rate of migrants. The PD has a strong community implementation, provides an easy access to COPMI and includes a Child Psychiatric Unit (CPT) integrated in the service – fundamental aspects to the implementation of the present project. This project started in April 2015 with the definition of the program and its implementation targets 3 levels of intervention: 1) Universal – health promotion for all the children of the patients, identified and evaluated for their situation; 2) Selective – prevention for cases with higher risk, providing interventions focusing in the child and family, such as Child Talk, Family Talk, Family Group Conference and Support Groups for children; 3) Specific interventions – early identification and treatment of psychopathology in child and adolescents by the CPT. For the intervention, the professionals received training in the preventive interventions with families and started to widen the goals of their work, focusing not only in treating mental illness but also on promoting mental health in COPMI families. In conclusion, this project introduced a new paradigm of intervention in the Psychiatric Department, increasing the skills of the professionals and their awareness to families needs, investing in the reinforcement of patient’s parental skills and in the enlargement of protective factors for COPMI.

Objective: The present study aimed to investigate the relationship between parental differential treatment and aggression among adolescences.. It was hypothesized that there is likely to be positive relationship between negative parental differential treatment aspects (negative affective quality and negative control) and aggression and there is likely to be negative relationship between positive parental differential treatment aspects (positive affective quality, support and Fostering independence) and aggression.
Method: Survey was conducted with 150 school students (N=150) including 75 girls and 75 boys of 9th and 10th classes. The Parental Differential Treatment Questionnaires (PDT-Q; Young, 2011) and Buss & Perry Aggression Scale (BPAQ; Buss & Perry, 1982) was used to assess parental differential treatment and aggression.
Results: Results indicated that there was a positive relationship between negative parental differential treatment aspects (negative affective quality and negative control) and aggression. The result also shows that positive relationship between positive parental differential treatment aspects (fostering independence) and aggression.
Conclusion: Parents differential treatment with their children negatively effects children’s emotions, in terms of development of aggression in them
Keywords: parental differential treatment, aggression, negative affective quality, positive affective quality, fostering independence.

Introduction
We present data from a project drawing on behavioural family therapy principles to train early intervention professionals to use a whole family intervention with families with parental mental illness (PMI) identified under the United Kingdom’s “Troubled Families” initiative. These families exhibit several factors identified as key problems in UK social policy: school disengagement, crime, drug and alcohol misuse, socio-economic marginalisation and unemployment.
Method
75 professionals were trained in an eight-session protocol to work with families with PMI in Leicestershire, UK. These professionals then implemented this protocol in their work with families over the following six months. Data were collected via pre- and post-training questionnaires, pre- and post-intervention questionnaires, and interviews with family members and focus groups with professionals.
Results
Results show positive impacts on professionals in raising awareness of the impacts of PMI on families with multiple problems and in increasing their skills in addressing these impacts. Initial results from families paint a complex picture of intersecting challenges but there are indications here too that interventions such as this can have positive impacts.
Conclusion
We conclude by exploring the implications of both the positive results and the complex lives of families for developing and implementing future interventions and training for professionals working with families with multiple challenges.

The Diagnostic and Statistical Manual (DSM-5) defines ASD by deficits in two core domains – social interaction and communication, and repetitive, restrictive behaviors – with onset during early development. This unification constitutes the first transition that needs to be considered from the scientific view point. The current categorization adds advantages, such as the availability of specifiers and the characterization of severity levels. But also, creates scientific shadows, such as classifying those without repetitive, restrictive behaviors as Social (Pragmatic) Communication Disorder; a distinction that may be adequate for homogeneity of research samples, but perhaps inadequate in fostering appropriate services for those cases in the community.

Although it has not been rule out that, in some parts of the world, there may be a real increase of new cases – due to parental age, for example, it is evident that cases of ASD are now much more frequently identified and diagnosed than before. Thus, for being an almost rare disorder, the 2015 Written Declaration on Autism by the European Parliament calls on the EU and its Member States to adopt a European Strategy for autism, including research and multinational prevalence studies, accurate detection and diagnosis, evidence-based treatment and support for all ages, and exchange of best practices. In consequence, research projects have been initiated and we expect to benefit by new data soon.

In some countries, citizens with ASD are showing now a different profile of what it used to be. This forecast the need for an adequate, if required, adaptation and transition of the services provided to this population. For example, in certain areas of Europe more and more people with ASD without intellectual disability are being currently diagnosed (cases previously described as Asperger Disorder). Or, in some countries the effort for early screening and growing social awareness are leading to very young children (in fact, babies) being diagnosed, and thus offering the chance for an informed early intervention.

Changes in classification systems, prevalence in the community, age of diagnosis, degree of associated or not intellectual disability, presence of comorbidities, individual evolution of symptomatology across development, as well as the quite diverse degree of local understanding and available services, generate marked differences in what is done in each country. Transition, across life for this population, and for all of us as service providers, remains an essential aspect to enforce.

Joaquin Fuentes, MD
ESCAP Autism Field Advisor
Chief of Child and Adolescent Psychiatry, Policlinica Gipuzkoa
Research Consultant (Pro bono), Gautena Autism Program
Donostia / San Sebastián, Spain

Although the number of females exhibiting serious aggressive behaviours is growing, the majority of studies on biomarkers, neurocognitive phenotypes, and therapeutic treatment of conduct disorder (CD) have focused on male subjects only, despite strong evidence for a differential aetiology and neurobiology of female CD. As a consequence, female CD remains a highly neglected research area resulting in a significant gap of knowledge on neurobiological mechanisms underlying the development of the disorder in females leading to an absence of sex-specific targets for prevention and intervention. In this state-of the art lecture, we will present an overview on the current state of research on CD in adolescent females, focussing on emotion processing and its underlying neurobiology. The FemNAT-CD consortium addresses these issues in a comprehensive way by studying psychopathology, cognitive, neuroendocrine, neurophysiological, epigenetic and genetic biomarkers.

Reading, writing and arithmetics are among the most important cultural abilities and represent keystone academic skills. Accordingly, children suffering from poor reading abilities typically encounter severe scholastic, academic and professional disadvantages across their lifespan, and are at risk for psychological distress and mental health problems. Developmental dyslexia is a specific learning disorder of reading, often co-occurring with impairments in written expression, affecting around 5- 10% of school children. Importantly, as a prevalent comorbidity in child and adolescent psychiatry, developmental dyslexia places a high burden on affected individuals, their families and schools. Child- friendly, non-invasive neuroimaging techniques such as electroencephalography (EEG), structural (sMRI) and functional magnetic resonance imaging (fMRI) have contributed to better understand the deficits underlying reading impairments in the brain. At first, I am summarizing the most recent findings on neural correlates of developmental dyslexia from the school child to the adult. Then, I am concentrating on the transition from prereaders to readers and present evidence for neural alterations in the brain structure and function of preschool children at-risk for developmental dyslexia that appear to impede reading acquisition at school age. These novel results in preschoolers not only show that learning to read at school builds on an already altered language processing network in children with developmental dyslexia but, moreover point to the clinical potential of using such prereading differences to predict reading outcome and guide early interventions. Because interventions in developmental dyslexia are most successful the earlier they start, it should be a major aim to identify children with poor reading outcomes at a young age to support these children when they start learning to read with evidence-based trainings.

ADHD is a heterogeneous disorder and a challenge to treat. Neurofeedback may be considered as a promising treatment option or component of the recommended multimodal treatment. It utilizes operant learning techniques with brain activity parameters to compensate deficits or to enhance self-regulation in patients. Neurofeedback has demonstrated promising and partly specific effects particularly improving inattention problems in ADHD, but effects on probably blinded outcomes are often inconclusive. This situation may reflect current inconsistencies in Neurofeedback protocols and shortcomings of evaluation studies with blinded outcomes, but it may also indicate limitations of Neurofeedback as a treatment for some ADHD patients. This important issue should be clarified in further studies.
Neurofeedback is appealing to many patients and their families and well tolerated, but there is need for more systematic evaluation to understand the specific mode of action. Future studies will need to disentangle mechanisms underlying both specific and unspecific effects of Neurofeedback. An additional challenge will be to identify robust predictors in order to decide which group of patients particularly benefits from this intervention.

Prof. Martin Holtmann, MD, PhD
Chair of Child and Adolescent Psychiatry, Ruhr-University Bochum
Medical Director, LWL-University Hospital for Child and Adolescent Psychiatry
Heithofer Allee 64
59071 Hamm, Germany

Comorbidity of mental and physical illness is a major public health problem made worse by the current tendencies of fragmentation of medicine into ever more narrow specialities. Data from the World Health Organization and a variety of other sources shows that comorbidity is increasing with the age of the population and is a main concern for significant loss of life years for people with this type of comorbidity.

The presentation will draw attention to evidence about the frequency of comorbidity and its consequences. It will also discuss options for dealing with the problem raised by this type of comorbidity.

Objective:
This keynote presentation will review longitudinal research on the effects of bullying in childhood on mental health and economic functioning into adolescence and adulthood. Bullying is the systematic abuse of power and defined as aggressive behaviour or intentional harm doing by peers that is carried out repeatedly, and involves an imbalance of power, either actual or perceived, between the victim and the bully. One in 3 children report having been bullied at some point in their lives, and 10 - 14% experience chronic bullying lasting for more than six months. Being bullied by peers is the most frequent form of abuse encountered by children, much higher than abuse by parents or other adult perpetrators.

Methods:
Review of propsective longitudinal studies.

Results:
Children who were victims of bullying are at higher risk for common somatic problems, internalizing problems and anxiety disorder or depression disorder and at highly increased risk to self-harm or think about suicide in adolescence. The mental health problems of victims and bully/victims remain in adulthood. Indeed, we showed that peer bullying in childhood has more adverse effects on diagnosed anxiety and mood disorders than being physically or sexually abused or neglected by parents. The service use of mental health services has been found to be highly increased across adulthood in those who were bullied. Victimised children reach also lower educational qualifications, were poorer in financial management and earned less than their peers even at age 50. Victims also report to have more trouble with making or keeping friends in adulthood and were less likely to live with a partner and have social support. In contrast, bullies had no increased risk for any mental or general health problems, were healthier than their peers, emotionally and physically.

Conclusions:
Being bullied has highly adverse health effects and service use implications. Sadly, many bullied children suffer in silence for fear of reprisals or shame. Children will have spent much more time with their peers than their parents by the time they reach 18 years of age. It is thus surprising that childhood bullying is not at the forefront as a major public health concern. To prevent dropping out of school, violence against oneself (e.g. self-harm) and reduce mental and somatic health problems, it is imperative for health practitioners, families and schools to address bullying.