Background: Previous studies have reported a high prevalence of attention deficit hyperactivity disorder (ADHD) among people living in detention (PLD) corresponding to a five- to ten-fold increase compared to the general population. Our main study objective was to provide an updated ADHD prevalence rate for PLD, including PLD in psychiatric units. Sub-objectives included (i) comparing different ways of assessing ADHD, including DSM-5 criteria and (ii) identifying which types of PLD are more likely to have ADHD.Methods: We conducted a systematic review and meta-analysis following the PRISMA guidelines and the MOOSE checklist. PubMed/Medline, PsycINFO, and Web of Sciences were searched combining “ADHD” and “prison” keywords and synonyms for articles published between January 1, 1966 and January 2, 2018. Potential sources of variation to the meta-analytic ADHD prevalence rate were investigated using meta-regressions and subgroups analyses.Results: The meta-analysis pooled 102 original studies including 69,997 participants. The adult ADHD prevalence rate was 26.2% (95% confidence interval: 22.7–29.6). Retrospective assessments of ADHD in childhood were associated with an increased prevalence estimate (41.1, 95% confidence interval: 34.9–47.2, p < 0.001). There was no significant difference in the prevalence estimate between screenings and clinical interviews in adulthood. Only three studies used the DSM-5 definition of ADHD and results were non-significantly different with other DSM versions. We found no difference according to participants' characteristics.Conclusion: Our results confirmed the high prevalence rate of ADHD among PLD, corresponding to a five-fold increase compared to the general population. In light of such high ADHD prevalence, our results reinforce the importance of addressing this critical public health issue by (i) systematically offering ADHD screening and diagnosis to all individuals entering detention, and (ii) delivering treatment, monitoring, and care for ADHD during and after detention. These strategies may help reduce recidivism and reincarceration, as well as violence in detention settings, in addition to improving the health and wellbeing of people living in detention. Additionally, our study suggests that using screening scales may be a reliable way of assessing ADHD, although caution is needed because a complete evaluation by an experienced clinician is required to provide a formal diagnosis.

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Le mutisme sélectif : étude de 30 cas Le but de ce travail est celui de mieux comprendre le mutisme sélectif, symptôme qui se retrouve dans des tableaux cliniques divers. Nous avons étudié les dossiers de 30 cas de mutisme sélectif et nous avons examiné leurs profils psychopathologiques ainsi que leurs anamnèses personnelles et familiales. Tous ces enfants avaient développé un mutisme sélectif avant l’âge de 6 ans même si le développement du langage s’est déroulé normalement. La plupart n’avaient jamais passé par une période où ils parlaient à tout leur entourage. Ceci nous a amené à distinguer deux types de mutisme sélectif : 1 / le mutisme sélectif “ primaire ”, trouble souvent précoce où l’enfant n’a jamais parlé à tous les membres de son entourage et qui concerne la majorité des enfants de notre étude, et 2 / le mutisme sélectif “ secondaire ”, trouble faisant son apparition plus tardivement chez des enfants qui ont pu parler normalement pendant un certain temps. Nos résultats indiquent que le mutisme sélectif “ primaire ” représente un symptôme important et peu banal dans le sens qu’il est très souvent associé à un trouble de la personnalité de la petite enfance.

This paper is the work of five psychoanalysts who came together as a group in order to reflect on their work as analysts. How are we analysts to identify the unconscious resistances that may sometimes hold us back from offering psychoanalysis to some patients? Do these resistances sometimes hamper the inner freedom that we require in order to maintain a psychoanalytic focus once that process is under way? How do we manage from time to time to overcome these resistances or, better, make use of them in order to develop our understanding of the unconscious dynamics that create the link between analyst and patient? The authors discuss these issues with particular reference to clinical situations taken from classic psychoanalytic treatment cases during which the analyst had to find within him- or herself the audacity to be a psychoanalyst. Each clinical situation is different: preliminary interviews, in the course of the actual treatment, issues that emerge in the training of candidates. One of the significant features of this group lies in the fact that the participants are at different stages in their development as psychoanalysts (student, associate member, full member, training analyst). This means that their experiences complement one another and encourage a discussion of issues such as how psychoanalysis can be passed on, and the relationship between supervisor and supervisee.