[Intrafamilial disruptive behaviour disorders in children and adolescents: Present data and treatment prospects].

Child-to-parent violence is a form of family violence that is still a well-kept secret. Abused parents can be victims of different types of abuse. Children can use both physical and psychological violence such as financial threats to take control of the home. In this situation, parents often no longer dare to contradict their children by fear of triggering uncontrollable violence. Although the phenomenon recently drew the attention of the media, there is still little knowledge about its prevalence and clinical characteristics. Most families remain isolated for a long time and, even in case of consulting in a mental health setting, disclosure of the nature of the difficulties is often delayed. This article presents the specificities of these children and their clinical characteristics. It also studies the victimized parents, the entire family, and their relation to the external environment. When observing these young offenders oppositional defiant disorder, conduct disorder and attention deficit hyperactivity disorder are frequently found. The diagnosis of "conduct disorder confined to family context" defined in the ICD 10 is the most appropriate to describe them. But it is regrettable that there has currently been no study to validate it and to determine its specificity. Compared with other young children who have "classic" disruptive disorders, children involved in violence against their parents have more difficulties with affect regulation, impulse control, and interpersonal skills. These children also frequently have low self-esteem and difficulties interacting with their peers. They may be isolated and bullied. They feel more sadness than these other young people and use violence as a way to express their emotions. Within the family both girls and boys commit violence against their parents. Girls will mostly use psychological violence but can also be involved in physical aggression. The first victim of child-to-parent violence is the mother. As mothers are often more present at home and seen by their children as weaker than the father, they are seen as an "easy target". If the "classic" conduct disorder is most frequently encountered in low social status families, intra familial disruptive behavior can be observed in families from all socio economic status. With respect to the parent-child relationship in those families, there are some relevant specificities. First, the quality of communication is bad, parents and children are not intimate and the tension is permanent. Furthermore, children do not respect their parents' authority. They perceive parenting style as permissive and negligent without enough support and control, and they may want to restore a coherent authority in the family. It is important to mention that potential vulnerability factors such as older age, a history of mental illness and social isolation have been described in parents of these children. Thereby, victimized parents have all the more difficulty to stand up against their children or to cleverly adapt their authority to their behavior. Other types of inappropriate education can be the origin of the child-to-parent violence. There is a direct correlation between the high frequency of punishments and violent attitude of the children towards their parents. So, the family dynamic is characterized by an inversion of the family hierarchy, the parents' fear of violent behavior from their child, and shame expressed by the parents with regards to the nature of familial relationships. Their fear and their shame will contribute to ensuring that their child's behavior is kept secret. Finally, several factors can therefore be at the source of the development of child-to- parent violence ; this study aims to raise awareness of clinicians of this impairing and frequently hidden condition. Due to the absence of specific studies, management of intra-familial disruptive disorder is likely to be less than optimal and heterogeneous. The development of a group of targeted parental psychoeducation is a promising management technique. We will describe the basic principles of « active parental control», a programme using techniques of « non-violent resistance» to help parents cope with violence and control children's behavior. The results of this programme are still being evaluated, but preliminary results seem promising since the parents included in the pilot group have described a significant improvement in the feeling of parental competence and, notably, self-control.