Randaline Ayoub

Introduction: Autism Spectrum Disorder (ASD) is a neurodevelopmental condition requiring long-term, coordinated, and multidisciplinary care. Although ASD services in Tunisia have improved, coordination across health, education, and social sectors remains limited, affecting equitable access and continuity of care. This study aimed to develop a national, evidence-based clinical practice guideline for the screening, diagnosis, and management of children and adolescents with ASD adapted to the Tunisian healthcare context. Assessment of guideline development and practice implications: The guideline was developed by the Tunisian Society of Child and Adolescent Psychiatry and accredited by the National Authority for Evaluation and Accreditation in Health. Using the ADAPTE framework, a multidisciplinary panel adapted international ASD guidelines to the Tunisian context. After systematic searches and AGREE II appraisal, the 2023 Singapore ASD guideline was selected as the main source document. Recommendations were adopted, adapted, or newly developed according to contextual relevance and applicability. An additional literature search was performed to incorporate high-level evidence published between June 2023 and January 2025. Actionable recommendations: The final guideline includes 96 evidence-based recommendations and 87 good practice points organized into ten chapters, covering the screening, diagnosis, intervention, and follow-up of autism spectrum disorder in children and adolescents across all levels of care in Tunisia. This article summarizes the key practice-oriented recommendations across these chapters. Conclusion: This first Tunisian ASD guideline aims to harmonize practices, improve the quality of care, and strengthen integrated care pathways.

Introduction: Internet addiction can negatively affect adolescents’ daily life, relationships, and mental health. Prevention programs implementation is essential to promote healthy digital habits. Our study aims to assess the impact of implementing a psychosocial skills training program on the prevention of internet addiction among Tunisian adolescents. Method: We conducted a pilot randomized controlled study among adolescents aged 15–16 from a high school in the Monastir region during the 2023–2024 school year. Participants were randomly assigned to an intervention group or a waiting-list group. The program focused on developing psychosocial skills with before and after assessments using validated tools: Young’s Internet Addiction Test and Internet Gaming Disorder Scale to assess internet addiction behaviors, Child Behavior Checklist to evaluate emotional and behavioral disorders, Rosenberg Self-Esteem Scale to measure self-esteem, and the Child and Youth Resilience Measure to assess resilience. Self-report questionnaires were completed anonymously, while parent-reported CBCL data were collected using unique participant codes to allow pre- and post-intervention matching while maintaining confidentiality. Results: A total of 58 adolescents participated in this study, including 27 in the intervention group and 31 in the waiting-list group. The sample comprised 25 boys and 33 girls. The mean age of the participants was 15.53 ± 0.50 years. Adolescents in the intervention group (n = 27) showed significant reductions in Internet addiction and Internet Gaming Disorder scores (p = 0.004, p = 0.003, respectively), as well as in both internalizing and externalizing behavioral problems (p = 0.001, p = 0.003, respectively), with increased self-esteem levels (p = 0.005). Resilience scores also improved, although not significantly. In contrast, the waiting-list group (n = 31) either showed no improvement or experienced a worsening in these areas. Intergroup comparisons favored the intervention group, particularly regarding addiction and behavioral regulation. Conclusion: Our results suggest that a school-based psychosocial skills training program may reduce internet addiction and improve emotional and behavioral functioning among adolescents. Larger randomized controlled trials with longer follow-up periods are warranted to confirm these findings.

Given that resilience is the ability to cope with adversities, and impulsivity is characterized with rapid reactions without foresight, we aimed to explore the pathways between intra-familial childhood adversities, resilience, impulsivity and suicidal behaviors among adolescents in Mahdia and Gafsa cities (Tunisia). We conducted a cross-sectional study in secondary schools from January to February 2020. Exposure to intra-familial early life experiences was evaluated by the Adverse Childhood Experiences (ACEs)-International Questionnaire. Resilience and impulsivity were assessed via the Adolescent Psychological Resilience and the Barratt Impulsivity Scale. A total of 3170 students were recruited with a response rate of 74%. About 81.1% of them reported being emotionally abused. The resilience mean score was 86.10 ± 9.85. Impulsivity was screened among 42.2% of them. About 38% of students presented suicidal thoughts, 16.4% had a suicide plan, and 10.8% have made a suicide attempt. We found that exposure to intra-familial ACEs predicts suicidal behaviors through impulsiveness (% mediated = 18% for emotional violence) and interpersonal resilience (% mediated = 24% for emotional violence; % mediated = 20.4% for physical violence). Our results emphasize the need to prevent ACEs, and to seek out a way to promote ACE protective factors among adolescents such as resilience.