{"title":"儿童保护中的行为问题:从复杂创伤的概念出发的理解与干预","authors":"Sandrine Bonneton, Aziz Essadek","doi":"10.1016/j.encep.2025.05.004","DOIUrl":null,"url":null,"abstract":"<p><strong>Introduction: </strong>Adolescents supported by child protection services (CPS) represent a population exposed to repeated relational trauma that significantly increases the risk of developing complex trauma characterized by polymorphic symptomatology. The behavioral problems presented by adolescents followed by CPS may fit within this nosographic framework. They can lead to major difficulties in adapting to their environment, especially when the trajectory of polyvictimization is pronounced. Unfortunately, the failure of professionals to recognize this diagnosis remains frequent. As a result, institutional responses are often poorly adapted to the needs of the adolescents concerned, promoting an excessive psychiatrisation of their behavioral manifestations at the expense of a comprehensive and holistic approach rooted in their traumatic history.</p><p><strong>Method: </strong>This work offers a theoretical-clinical reflection on complex trauma expressed through behavioral problems among adolescents supported by CPS. It is based on the main recent clinical and scientific contributions, particularly research related to integrative and systemic approaches.</p><p><strong>Results: </strong>Theoretical and clinical data highlight both the importance and the difficulties of identifying manifestations of complex trauma among adolescents supported by CPS, especially when they present behavioral problems. The analysis emphasizes the contributions of clinical support systems and trauma-informed practices in structuring institutional responses. These practices, particularly the Attachment, Regulation of Affect, Competence (ARC) model, by promoting a developmental and relational understanding of behavioral symptoms, provide a structured framework for operationalizing the educational support of adolescents within CPS, moving beyond crisis management logic and enabling the effective use of specific care modalities when necessary.</p><p><strong>Discussion: </strong>Recognizing traumatic history, often marked by polyvictimization, appears essential to adequately meet the needs of the adolescents concerned. While integrative and systemic approaches represent promising levers for transforming professional practices within CPS, their implementation remains marginal in France. Avenues for reflection and research are discussed to promote the concrete adoption of these models by institutions, particularly in terms of training, team support, and structuring connections between institutions, with the aim of building better-coordinated educational and therapeutic interventions.</p>","PeriodicalId":51042,"journal":{"name":"Encephale-Revue De Psychiatrie Clinique Biologique et Therapeutique","volume":" ","pages":""},"PeriodicalIF":1.0000,"publicationDate":"2025-09-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"[Behavioral problems in child protection: Understanding and intervening from the concept of complex trauma].\",\"authors\":\"Sandrine Bonneton, Aziz Essadek\",\"doi\":\"10.1016/j.encep.2025.05.004\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Introduction: </strong>Adolescents supported by child protection services (CPS) represent a population exposed to repeated relational trauma that significantly increases the risk of developing complex trauma characterized by polymorphic symptomatology. The behavioral problems presented by adolescents followed by CPS may fit within this nosographic framework. They can lead to major difficulties in adapting to their environment, especially when the trajectory of polyvictimization is pronounced. Unfortunately, the failure of professionals to recognize this diagnosis remains frequent. As a result, institutional responses are often poorly adapted to the needs of the adolescents concerned, promoting an excessive psychiatrisation of their behavioral manifestations at the expense of a comprehensive and holistic approach rooted in their traumatic history.</p><p><strong>Method: </strong>This work offers a theoretical-clinical reflection on complex trauma expressed through behavioral problems among adolescents supported by CPS. It is based on the main recent clinical and scientific contributions, particularly research related to integrative and systemic approaches.</p><p><strong>Results: </strong>Theoretical and clinical data highlight both the importance and the difficulties of identifying manifestations of complex trauma among adolescents supported by CPS, especially when they present behavioral problems. The analysis emphasizes the contributions of clinical support systems and trauma-informed practices in structuring institutional responses. These practices, particularly the Attachment, Regulation of Affect, Competence (ARC) model, by promoting a developmental and relational understanding of behavioral symptoms, provide a structured framework for operationalizing the educational support of adolescents within CPS, moving beyond crisis management logic and enabling the effective use of specific care modalities when necessary.</p><p><strong>Discussion: </strong>Recognizing traumatic history, often marked by polyvictimization, appears essential to adequately meet the needs of the adolescents concerned. While integrative and systemic approaches represent promising levers for transforming professional practices within CPS, their implementation remains marginal in France. Avenues for reflection and research are discussed to promote the concrete adoption of these models by institutions, particularly in terms of training, team support, and structuring connections between institutions, with the aim of building better-coordinated educational and therapeutic interventions.</p>\",\"PeriodicalId\":51042,\"journal\":{\"name\":\"Encephale-Revue De Psychiatrie Clinique Biologique et Therapeutique\",\"volume\":\" \",\"pages\":\"\"},\"PeriodicalIF\":1.0000,\"publicationDate\":\"2025-09-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Encephale-Revue De Psychiatrie Clinique Biologique et Therapeutique\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.encep.2025.05.004\",\"RegionNum\":4,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q4\",\"JCRName\":\"NEUROSCIENCES\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Encephale-Revue De Psychiatrie Clinique Biologique et Therapeutique","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.encep.2025.05.004","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q4","JCRName":"NEUROSCIENCES","Score":null,"Total":0}
[Behavioral problems in child protection: Understanding and intervening from the concept of complex trauma].
Introduction: Adolescents supported by child protection services (CPS) represent a population exposed to repeated relational trauma that significantly increases the risk of developing complex trauma characterized by polymorphic symptomatology. The behavioral problems presented by adolescents followed by CPS may fit within this nosographic framework. They can lead to major difficulties in adapting to their environment, especially when the trajectory of polyvictimization is pronounced. Unfortunately, the failure of professionals to recognize this diagnosis remains frequent. As a result, institutional responses are often poorly adapted to the needs of the adolescents concerned, promoting an excessive psychiatrisation of their behavioral manifestations at the expense of a comprehensive and holistic approach rooted in their traumatic history.
Method: This work offers a theoretical-clinical reflection on complex trauma expressed through behavioral problems among adolescents supported by CPS. It is based on the main recent clinical and scientific contributions, particularly research related to integrative and systemic approaches.
Results: Theoretical and clinical data highlight both the importance and the difficulties of identifying manifestations of complex trauma among adolescents supported by CPS, especially when they present behavioral problems. The analysis emphasizes the contributions of clinical support systems and trauma-informed practices in structuring institutional responses. These practices, particularly the Attachment, Regulation of Affect, Competence (ARC) model, by promoting a developmental and relational understanding of behavioral symptoms, provide a structured framework for operationalizing the educational support of adolescents within CPS, moving beyond crisis management logic and enabling the effective use of specific care modalities when necessary.
Discussion: Recognizing traumatic history, often marked by polyvictimization, appears essential to adequately meet the needs of the adolescents concerned. While integrative and systemic approaches represent promising levers for transforming professional practices within CPS, their implementation remains marginal in France. Avenues for reflection and research are discussed to promote the concrete adoption of these models by institutions, particularly in terms of training, team support, and structuring connections between institutions, with the aim of building better-coordinated educational and therapeutic interventions.
期刊介绍:
Une revue française de renommée internationale.
- Un comite de rédaction représentant tous les aspects de la prise en charge psychiatrique du patient.
- Une sélection rigoureuse d''articles faisant l''objet de plusieurs expertises.
- Des travaux d''auteurs et de chercheurs de renommée internationale.
- Des indexations dans les grandes bases de données (Current Contents, Excerpta Medica, etc.).
- Un facteur d''impact qui témoigne de la grande notoriété de la revue.
La tribune des publications originales de haut niveau.
- Une très grande diversité des sujets traités, rigoureusement sélectionnés à travers des sommaires dynamiques :
- des éditoriaux de médecins référents,
- une revue de presse sur les actualités internationales,
- des articles originaux pour approfondir vos connaissances,
- des mises au point et des cas cliniques pour engager votre réflexion sur les indications et choix possibles au travers de mises en situation clinique,
- des dossiers thématiques pour faire le tour d''une question.
- L''actualité de l''AFPB : L''Encéphale publie régulièrement des comptes rendus de l''Association française de psychiatrie clinique.