Impulsive personality Traits have been highly associated with both alcohol abuse and drug addiction, but have been accorded little attention in the context of food addiction.

To study the relationship between impulsivity and food addiction in school-aged adolescents.

It is a cross-sectional, descriptive and analytical survey, conducted in a sample of secondary school students, randomly collected in 6 schools in the region of Sfax during February 2022. A pre established form of 33 questions, including socio- demographic and family information was used. Impulsivity was evaluated by the Barratt Impulsivity Scale (BIS-11; Patton et al., 1995). The BIS is a 30-item questionnaire that measures impulsivity along the following dimensions: cognitive, motor, and non-planning. The validated arabic version was used. *

The 25-item Yale Food Addiction Scale (YFAS), validated in Arabic, was used to assess food addiction in adolescents.

Our sample consisted of 360 adolescents, with an average age of 16.62 years, being male in 52.2% and with a low to medium socio-economic level in 72.7% of them.

A total of 20% of the adolescents showed a tendency to impulsivity, 23.6% had impulse control disorder.

The food addiction score of our sample ranged from 0 to 56 with an average of 16.37 ± 12.380.

The average food addiction score for adolescents with impulse control disorder was 20.21 ±14.819 while the average food addiction score for adolescents without impulse control disorder was 15.18 ± 11.291.

Food addiction was strongly associated with impulsivity (p < 0.001).In particularly, Non-planning impulsivity was most strongly correlated with food addiction (p < 0.001, r ꞊ 0.252)

Impulsivity, commonly related to addictive substance use behaviors, may be a significant risk factor for food addiction. Early monitoring of impulse control disorder may help to reduce addictive food consumption.

None Declared

Hospitalization in neonatology constitutes a narcissistic wound for the mother. This mother-baby separation disturbs the maternal identity and generates a strong feeling of failure and guilt.

To assess self-esteem in mothers of babies hospitalised during the postnatal period in the neonatal unit and to identify risk factors associated with the persistence of low self-esteem 3 months after discharge.

This was a longitudinal, descriptive and analytical study conducted between April and September 2021. The sample consisted of mothers of babies hospitalized in the neonatology department of Sfax-Tunisia for a period ranging from 5 to 15 days. Socio-demographic data were collected using a pre-established form. Self-esteem was assessed during the baby’s hospitalisation and 3 months after discharge, using the Rosenberg self-esteem scale, with 10 items, validated in Arabic.

The sample consisted of 86 mothers with a mean age of 32.17 years.

Low to very low self-esteem was found in mothers in 81.20% of cases when their babies were hospitalised and in 68.40% of cases 3 months after discharge.

Some factors were significantly related to the persistence of low self-esteem in mothers after 3 months of their babies’ hospitalisation, such as a low educational level of the mother (p=0.017), an unattended pregnancy (p=0.034), the occurrence of a post-partum complication (p=0.043) and the absence of the first smile in the baby at the age of 3 months (p=0.008).

This study shows a high prevalence of low self-esteem in mothers following hospitalization of their babies in the postnatal period. The concomitance with several socio-clinical factors contributes to the persistence of this low level of self-esteem in these mothers.

Appropriate early and multidisciplinary care helps to rebuild strong self-esteem in the young mother so that she can overcome her psychological difficulties and build a solid foundation for the mother-baby bond.

None Declared

Postnatal hospitalisation is an extremely traumatic event for both mother and baby. Such a situation reflects a psychological dysfunction with a risk of developing a post-traumatic stress disorder.

To study the level of stress in mothers of babies hospitalised during the postnatal period in the neonatal unit and to identify the risk factors associated with the persistence of high levels of stress 3 months after discharge.

This was a longitudinal, descriptive and analytical study conducted between April and September 2021. The sample consisted of mothers of babies hospitalized in the neonatology department of Sfax-Tunisia for a period ranging from 5 to 15 days. Socio-demographic data were collected using a pre-designed form. The level of stress was assessed using the 22-item “Impact of Event Scale-Revised” (IES-R), validated in Arabic.

The sample consisted of 86 mothers with a mean age of 32.17 years.

Severe stress symptoms were found in 77.90% of the mothers during their babies’ hospitalisation. They persisted in 8.90% of the young mothers 3 months after discharge from hospital.

Certain factors were significantly associated with the persistence of a high level of stress in mothers 3 months after the discharge of their babies, such as the occurrence of postpartum complications (p=0.012), the absence of visits to the baby’s intensive care unit (p=0.047) and a living environment with a single parent (p=0.034).

The present study shows that the level of stress is quite high among mothers of babies hospitalised in neonatology during the postnatal period and that this symptomatology can last for months after discharge.

Prevention and reduction of stress induced by postnatal hospitalisation through parental guidance and psychological support for mothers strengthens interactions and the mother-baby bond.

None Declared

Autism Spectrum Disorder (ASD) is a multifactorial neurodevelopmental disorder, with both contribution of genetic and non-genetic factors. A collaboration of de novo mutations and prenatal with postnatal environmental factors are likely to play a role. ASD can be syndromic or non-syndromic. The etiology of non-syndromic ASD is still relatively undefined due to its genetic heterogeneity. Contrary to non-syndromic ASD, syndromic ASD is often associated with chromosomal abnormalities or monogenic alterations. Familial cases of ASD support the strong genetic component of ASD.

To collect clinical arguments supporting a genetic cause of autism spectrum disorder.

We present a clinical study of familial cases of ASD. The families were recruited as part of a collaborative project between the department of Medical Genetic and the department of Child Psychiatry in Hedi Chaker Hospital, Sfax, Tunisia. The clinical and paraclinical data were collected retrospectively.

Our study included 11 unrelated families from southern Tunisia, each with two ASD children, among them four couples of twins. Most families (80%) are consanguineous belonging to a middle socioeconomic class. None of the parents suffered from psychiatric disorder and a familial history of autism was reported in one family. Perinatal history, including advanced maternal or paternal age, fetal suffering and/or gestational problems, was found in 35% of cases.

The average age was 9.89 ± 3.787 (3 to 17 years) with a balanced sex-ratio.

ASD was syndromic in seven out of 11 families: facial dysmorphism in half of cases (6/11 families) and/or another comorbidity in 25% of cases (celiac disease, congenital heart disease or idiopathic hydrocephaly). ASD was associated with other(s) neurodevelopmental disorder(s) in all children. Most of cases (14/22) had delayed psychomotor development and all of them had intellectual disability with various degrees. Epilepsy was identified in three cases belonging to unrelated families. Other behavioral problem was identified in 65% of cases.

When the autism spectrum disorder is syndromic and/or associated with other(s) neurodevelopmental(s) disorder(s), this points more towards a genetic origin.

Our study highlights the interest of clinical investigations to determine genetic risk factors of ASD. The identification of a genetic cause in familial cases would contribute not only to better understand the pathological processes of ASD but also to provide an appropriate genetic counseling.

None Declared

Gambling disorders have increased over time due to the easy availability of online games.

The purpose of this study is to determine the prevalence of internet gambling disorder in an adolescent population and to identify associated factors.

It was a cross-sectional, descriptive and analytical study, conducted among a sample of high school students, randomly collected in 6 schools in the region of Sfax during the month of February 2022. A pre-established form of 33 questions, including socio-demographic and family information was used.

The Arabic version of the Internet Gaming Disorder-20 (IGD-20) questionnaire was used to assess online gaming activity. It is a 20-item questionnaire on a five-point Likert scale ranging from 1 to 5 (strongly disagree to strongly agree). A respondent’s score was obtained by aggregating the 20 items. The higher the score, the more severe the gambling disorder. The cut-off score for the IGD-20 is 70. A score below 50 indicates occasional use; a score between 50 and 70 indicates problematic use; and a score above 70 indicates an online gambling disorder.

We collected 360 adolescents, 52.2% of whom were male. The mean age of our patients was 16.62 years.

A total of 4.7% of the adolescents had an online gambling disorder, 26.9% had problematic use, while 68.3% were occasional users.

The analytical study revealed that online video game addiction was associated with male gender (p ꞊0.003), the presence of relationship problems with parents (p ꞊0.000), and low academic achievement (p ꞊0.000).

We draw attention to the necessary debate between sensible and problematic use of new technologies and the need for longitudinal prevention in schools.

None Declared

Pyridoxine-dependent epilepsy (PDE) is a rare autosomal recessive disease usually associated with neonatal seizures that are sensitive to pyridoxine (vitamin B6). This disease can have a significant impact on family functioning, with significant psychological distress in parents. Post-traumatic stress disorder (PTSD), depression, and anxiety are the most common psychiatric outcomes in parents of children with PDE.

To investigate the prevalence of significant symptoms of depression, anxiety, and stress in parents of children with PDE.

The study consisted of a survey of parents accompanying their children diagnosed with PDE. The diagnosis was already confirmed by objectifying a homozygous or a compound heterozygous mutation in the ALDH7A1 gene in all siblings with heterozygous carrier parents. The Impact of Event Scale-Revised (IES-R) was used to assess parental post-traumatic stress, and the Hospital Anxiety and Depression Scale was used to screen for parental depression and anxiety.

Our study included eight unrelated families with one infant presenting a confirmed PDE disease. The average age of the children with epilepsy was 4.18 years (8 months to 12 years) with equal representation of both sexes.

Half of parents surveyed had depressive symptoms and about two thirds reported anxious symptomatology. These troubles are mainly related to the uncertain prognosis of the disease, even with vitamin B6 supplementation, and the high risk of recurrence in siblings, which led some parents to not have other children. A higher anxiety scores was reported in parents who claimed to have difficulties in providing the necessary vitamin supplements to their affected children on a regular basis. PTSD was diagnosed in three parents: most parents reported difficulties in dealing with stress, specifically in relation to the unpredictability of seizures and the unavailability of medical care for their child, which taxed their financial resources and made it difficult for them to perform their roles effectively.

Besides, being an autosomal recessive transmission disease, the notion of responsibility/guilt was not reported by either parent, and both parents are equally involved in the care of their child.

A significant proportion of children’s parents with pyridoxine-dependent epilepsy are suffering from depression, anxiety, and post-traumatic stress. A deeper understanding of the clinical expressions of these troubles could help practitioners to develop prevention and intervention strategies for these parents.

None Declared

The relationship between cyber video game addiction and impulsivity is controversial. Some studies have shown a significant link, others have found no association between the two behaviours.

To study impulsivity in adolescents with problematic use of internet video games.

This was a cross-sectional, descriptive and analytical study, conducted among a sample of adolescents randomly collected in 6 schools in the region of Sfax-Tunisia, during the month of February 2022. The rate of addiction to video games was assessed by the 20-item “Internet Gaming Disorder-20” (IGD-20) scale and impulsivity by the 30-item “Barratt Impulsivity Scale” (BIS-11). Both scales are validated in Arabic.

The study involved 360 secondary school students, with a mean age of 16.62 +/- 0.822 years. The sex ratio was 1.09.

A gaming addiction was found in 4.7% of cases.

Similarly, impulse control disorder was noted in 23.6% of adolescents.

Problematic internet game use was significantly related to motor impulsivity (p=0.025).

There was no significant association between cyber video game addiction and cognitive or non-planning impulsivity.

According to the results, impulsiveness is a factor to consider for understanding the development of addiction to internet video games. Thus, impulsiveness should be taken into account to explain problematic gaming behaviour as well as to design preventive and treatment interventions.

None Declared

For several years, strong theoretical and clinical links have been established between intra-family relationships and eating disorders.

To study intra-family relationships in adolescent with food addictive behaviour.

This was a cross-sectional, descriptive and analytical study conducted among a sample of adolescents randomly collected in 6 schools in the region of Sfax-Tunisia, during the month of February 2022. The food addiction symptomatology was assessed by the “Dimensional Yale Food Addiction Scale version 2.0 For Children” (dYFAS-C 2.0) and the family attitude was studied by the “Brief Family Relationship Scale” (BFRS) which evaluates three dimensions: cohesion, expressiveness and conflict, each having a separate score. Both scales are validated in Arabic.

The study involved 360 high school students, with a mean age of 16.62 +/- 0.822 years. The sex ratio was 1.09.

The total score for food addiction symptomatology in our sample ranged from 0 to 56 with an average of 16.37 +/- 12.380.

Of the three dimensions of the quality of intra-family relationships studied, conflict had the highest mean score: 25.29+/-9.027.

A high food dependence score was significantly related to these three dimensions of the intrafamily relationship: lack of conflict (p=0.044), cohesion (p=0.011) and expressiveness (p=0.005) presence.

The present study shows that the symptomatology of food addiction is influenced by the quality of the intra-family relationship.

Enhanced perception of the family environment and involvement of the family in possible care can help to prevent the onset of eating disorders and to plan an appropriate intervention.

None Declared

The course of adolescence is marked by feelings of insecurity, vulnerability and can be accompanied by the emergence of several mental health problems.

Having a good self-esteem brings many benefits such as security, well-being and a strong sense of confidence. Low self-esteem is often accompanied by psychological distress such as stress.

To assess the level of stress and self-esteem in young high school students and to identify the risk factors associated with low self-esteem in these adolescents.

This was a cross-sectional, descriptive and analytical study conducted among a sample of adolescents randomly collected in 6 schools in the region of Sfax-Tunisia, during the month of February 2022. The level of stress was assessed using the Lovibond Depression Anxiety Stress Scale (DASS-21) and self-esteem by the Rosenberg Self-Esteem Scale, both scales are validated in Arabic.

We collected 396 adolescents. The mean age was 16.65+/-0.897 years and the sex ratio was 0.82.

Of these adolescents, 102 had stress symptoms according to the DASS-21 scale, i.e. 26% of the sample. Stress was severe to extremely severe in 37.2% of cases.

Low to very low self-esteem was found in 65.7% of cases compared to 14.7% with high self-esteem.

In addition to the association with high levels of stress in these adolescents (p=0.002), low self-esteem was associated with other psycho-social factors such as intra-family relationship problems (p=0.014), a history of repeating a year (p=0.026), low to average school performance (p=0.027) and behavioural problems in the school environment (p=0.032).

These results suggest that the association of stress with certain psycho-social factors helps the deterioration of self-esteem in adolescents and vice versa.

Having high self-esteem may protect the individual from psychological vulnerabilities such as stress and help him/her to cope with them.

None Declared

Stress among physician parents is still poorly studied, especially during the SARS-COV-2 pandemic.

To describe the stress of being both a doctor and a parent during COVID-19 epidemic.

It was a cross-sectional, descriptive and analytical study, carried out on google drive in March 2021, and relating to 93 Tunisian medical parents. We used a questionnaire containing the parents’ personal and professional data as well as the perceived stress scale (PSS10).

The majority of parents (94.7%) were women. The average age was 34.43 years old. The average age of marriage was 29.6 years for men and 25.4 years for women. The majority of parents (89.4%) had one or two children and 70.2% were satisfied with their relationship with their children. On another side, 71.3% of doctors had to provide on duty services in the hospital, with 44.1% providing 3-4 on-calls per month, while 69% were providing on duty services in the COVID units. The average PSS score was 22.6. The distribution of scores indicated medium and high stress level in respectively 84.9% and 14% of parents. Furthermore, the PSS score was negatively correlated with the marriage age (p = 0.046, r = -0.2). On the other hand, no association was observed with the children number nor with the satisfaction of the relationship with his child.

It follows from our study that stress among physician parents is at a fairly high level. Managing this stress during a pandemic is not easy and requires the activation of several defense mechanisms.

No significant relationships.

Studies have shown that physicians manifest a clear duty to work. For parents, reconciling work with parenthood is not easy and can even lead to depression.

To determine the prevalence and the factors for depression in Tunisian physician parents.

This was a descriptive and analytical cross-sectional study of 93 Tunisian physician parents, conducted on google drive in March 2021, including a questionnaire containing the parents’ personal and professional data and the Beck Depression Inventory (BDI).

In our study, the sex ratio (M/F) was 0.05. The average age was 34.43 years old. Almost three-quarters of doctors (71.3%) were providing on duty services in the hospital while 69% were providing at least one call per month in COVID units. The average BDI score was 6.16. According to the BDI score, 60.9% of participants had depression. The BDI score was correlated with several types of dissatisfaction: dissatisfaction with the relationship with his child (p = 0.002), time devoted to the partner (0.001), time devoted to the child (p = 0.004), child’s educational style (p <0.001), time spent on leisure or personal activities (p <0.001), child’s academic performance (p = 0.001) and child’s behavior (p <0.001). Furthermore, the BDI score was associated with postponing having a child for career reasons (p = 0.038) and thinking that his career is slowed down by parenthood (p <0.001).

Depression’s rate among physician parents appears to be significant. It’s associated with a feeling of guilt and dissatisfaction, hence the necessity of an early detection and management.

No significant relationships.

Infant Schizophrenia is a severe developmental disorder affecting most areas of children's adaptive functioning; especially the social field.

The objective of this work was to study the psychosocial implications of early onset schizophrenia.

We conducted a descriptive and retrospective survey on 58 children and adolescents who were hospitalized in the child and adolescent psychiatry department of Sfax for schizophrenia according to the DSM-IV TR criteria, during 14 years (from 1 January 2000 to 31 December 2013)

In this study, patients frequently showed disruption of family interactions. Indeed, the child's relationship with his parents was marked by the withdrawal in 26% of cases, the dominance in 19% of cases and rejection in 13.7% of cases. For their part, parents demonstrated attitudes of indifference in 29% of cases, hyper protection in 28% of cases and rejection in 24% of cases.

In addition, adjustment difficulties were noted in 63.3% of cases, a tendency of isolation in 43.6% of cases and a conflictual relationship with peers in 27.3% of cases.

Academically, patients had difficulties in school in 62% of cases. It was as type of school decline in 36% of cases, absenteeism in 36% of cases, school disinvestment in 30.5% of cases and grade repetition in 12% of cases.

This study shows that children and adolescents with schizophrenia had family, social and school adjustment difficulties; which joined the literature as to the severity of early onset schizophrenia whose prognosis is often unfavorable.

The occurrence of acute leukemia (AL) in childhood causes a profound upheaval in the child itself and also within his family. Exposure to this test could contribute to the emergence of anxiety.

Our work aims to describe the characteristics of anxiety in this population during the management of the AL.

Our study, still in progress, is prospective and conducted among 20 children hospitalised in hematology department of UMC Hedi Chaker Sfax (Tunisia) during the year 2015–2016. It is performed in two times. The anxiety was assessed using the STAI scale.

The average age of our population is 7 years (minimum age = 4 years, maximum age = 11 years). The majority of our patients come from urban areas (76.9% of cases). About their sibling rank, they are mostly the youngest in 53.8% of cases, the oldest in 30.8% of cases and juniors in 7.7% of cases. The most common diagnosis is the lymphoblastic B AL (46.2% of cases).

Referring to the STAI scale, 30% of our patients were anxious and had high scores during the first evaluation. Then, the anxiety level attenuates gradually during management period and only 15% were anxious at the 2nd evaluation time.

Several factors such as hospitalisation, diagnosis announcement and cancer treatment contribute to the triggering and maintaining of anxiety. Early detection of anxiety and the good listening between the care team and the parents could appease the high level of anxiety and ensure better management.

The authors have not supplied their declaration of competing interest.

To identify correlates that might constitute risk factors for problematic video game use (PVU) among urban Tunisian secondary school students.

This multivariate cross-sectional study was carried out on 587 secondary school students, aged 14 to 20 years. They were randomly selected from seven secondary schools in the urban area of Sfax. The self-administered Fisher's nine-item questionnaire was used in this survey. To identify an associated problematic internet use video game addiction, Young's eight-item questionnaire was used. A self-administered, anonymous questionnaire covered socio-demographic, individual and family data.

The prevalence of PVU was 14.01%. In multivariate logistic regression analysis, we found that the individual risk factors for problematic video game use were anxiety symptoms (P = 0.034) and an associated problematic Internet use (P < 0.001). Playing sport was a protective factor (P = 0.011). The poor relationships within the family (P = 0.001), the lack of parental supervision of time spent on playing video game (P < 0.001) and mother profession as mid-to upper level manager (P = 0.002), predicted PVU.

The identification of risk factors can help to determine individuals at high risk, and alert mental health providers to be careful to screen these patients for PVU. Total avoidance of the Internet is unrealistic and inadvisable; but a sensibilisation outreach for youth, their families and health professionals may help to limit the onset of PVU among young people.

The authors have not supplied their declaration of competing interest.

Stuttering constitutes for children a psychological and social disability, in which the environmental context plays an important role in the installation, stabilization and aggravation or attenuation.

Our study aims to describe the socio-familial characteristics of children with stuttering.

This is a descriptive and analytical-retrospective study carried out on 80 children with stuttering and had been followed-up in the child psychiatry department of UMC Hédi Chaker Sfax (Tunisia) for more than 3 years (January 2012 to 31 December 2013).

In our study, the prevalence of stuttering in child psychiatry consultation department of Sfax is 4%. Most of the patients were either the youngest (36.25% of cases) or seniors (35% of cases).

Personal history of speech disorder had been reported in 8 children (10% of cases). Family history of speech disorder was reported in 33.75% of cases. These disorders had been kind of stuttering in 60.66% of cases, speech delay in 18.52% of cases and sound speech disorder in 7.41% of cases.

The parent–child relationship is marked by a parental rigidity in 18.6% of cases. The existence of triggering factor was noted in 37.5% of cases: traumatic situation (30% of cases), the birth of a younger sibling (22% case).

The emergence and evolution of stuttering depend on predisposing, precipitating and chronicisants factors. Identifying these factors and adopting a favorable parental attitude contribute to the fight against stuttering in children and, at least, avoid aggravation and chronicity of this disorder.

The authors have not supplied their declaration of competing interest.

However, impulsivity is more likely to be present in externalizing disorders, little focus seems to have been made on the research of impulsivity in depression.

On this study, we sought to investigate impulsivity among adolescent with Depressive disorder compared to a control sample.

Employing a matched case-control study, participants included 100 adolescents divided into two groups: 30 adolescents (12 to 17 years) with depressive disorder and a control sample of 70 adolescents. Participants were recruited during a period of 2 years (2015, 2016). Depressive disorder patient were drawn from the consultation unit or inpatient unit of the department of child psychiatry in Sfax, Tunisia. Controls were recruited from two secondary schools and they haven’t depressive symptoms according to the child depression inventory (CDI). Impulsivity was evaluated in the two groups by the Barratt Impulsiveness Scale (BIS-11), an instrument designed to measure trait impulsivity.

Adolescents with depressive disorder displayed significantly higher total BIS-11 impulsivity scores than controls (71.6 ± 16 vs 61.6 ± 9; P = 0.003). They scored significantly higher than the controls on motor (P = 0.0001) and attentional impulsivity (P = 0.006). There was no difference in non-planning Impulsivity between the two groups. Motor impulsivity was high in adolescents with history of suicide attempt.

Our findings suggest that trait impulsivity is increased among adolescents with depressive disorder. Impulsivity seems to be a risk factor for suicide attempts, so it that should be systematically evaluated in depressive disorder.

The authors have not supplied their declaration of competing interest.

The aim of our study was to investigate and compare the quality of life of parents of children with ADHD and parents of children within psychiatric troubles.

We conducted a cross sectional and comparative study, on 20 families of children with ADHD, followed in child and adolescent psychiatry department of Sfax, Tunisia, and 20 control families. We used the Short Form Health Survey (SF 36) translated and validated in Arabic to evaluate the quality of life of the parents of the two groups.

The average age of the patients of our survey was 9 years 8 months with a predominance of boys. We objectified a significant difference between the overall scores of the quality of life of parents of children with ADHD and the control sample. A highly significant difference was noted in the following areas: mental health, bodily pain and social functioning. The difference was significant in vitality score. The difference was not significant in 4 scores: general health, physical functioning, role physical, and role emotional.

Families with a child with ADHD have many challenges which impact certainly in their quality of life. As a child and adolescent's psychiatrics, we should be aware of these consequences in order to help the parents to improve their quality of life.

The authors have not supplied their declaration of competing interest.

Persistent encopresis is part of a fairly specific pathologic complex including personality, and familial factors. To a very large extent, interest in encopresis issues has revolved around the mother–child relationship.

In this study, we aimed to assess the psychological profile and the counter attitudes of encopretic children's mothers.

We led a retrospective and descriptive study carrying on 91 medical records of children with encopresis, followed in the outpatient child psychiatry department of the Hédi Chaker university hospital of Sfax over a period of seven years, going from January 1st, 2000 till December 31st, 2006.

In our study, emotional deprivation was noted in 62.2% of cases. Besides, repeated separations from mothers were noted in 26.4% of cases with 2.2% cases of prolonged separations. Our study also revealed that 19.8% of mothers have obsessive personality traits while 14% have rather anxious traits. Furthermore, 6.6% of encopretic children's mothers were found to have anxio-depressive spectrum disorders according to the DSM-IV-TR. Mothers’ intolerance towards encopresis was estimated at 53.3%. This intolerance was mainly reflected in physical punishment, depreciation, blame and humiliation. Toilet training was rigid in more than half of cases (62.2%).

Childhood encopresis can be viewed as a result of a maternal-child conflict. In fact, the mother–child relationship appears to be directly involved in the genesis of encopresis. Nevertheless, the role of the own child neurodevelopmental state in response to the family system should not be ignored.

The authors have not supplied their declaration of competing interest.