Is bronchial provocation test positivity associated with blood eosinophil count and cut-off value?

OBJECTIVE

Asthma is characterized by airway hyperresponsiveness due to chronic inflammation in the airways. One of the main cells involved in airway inflammation is eosinophils. In the current study, a bronchial provocation test (BPT) was performed to demonstrate airway hyperresponsiveness. We investigated the relationship between BPT and blood eosinophil count and the cut-off value of blood eosinophil count.

PATIENTS AND METHODS

In this study, we retrospectively evaluated the data of 246 patients who visited our immunology and allergy clinic, a tertiary reference center, with asthma symptoms between May 2017 and March 2020 and underwent BPT with methacholine for the diagnosis of asthma. The cases were grouped according to the level of BPT positivity and negativity.

RESULTS

Of 246 patients, BPT was positive in 90 (36.6%) and negative in 156 (63.4%). The blood eosinophil measurement of the BPT-positive cases was found to be statistically significantly higher than that of the BPT-negative cases (135 vs. 119 cells/µl, respectively, p=0.029). When BPT is grouped according to positivity levels, there was no statistically significant difference in blood eosinophil measurements between subgroups (p=0.174). As a result of the evaluations, the cut-off point obtained for the blood eosinophil count was determined as ≥226 cells/µl. For the blood eosinophil count, for the cut-off value of ≥226 cells/µl, sensitivity was 30.0%, specificity 87.7%, positive predictive value 58.7%, and negative predictive value 68.3%.

CONCLUSIONS

This study shows that BPT positivity is associated with blood eosinophil count. The cut-off value (≥226 cells/µl) determined for blood eosinophil count may be helpful when planning BPT and evaluating the diagnosis of asthma.

Framing the work: A coparenting model for guiding infant mental health engagement with families

When working with families of infants and toddlers, intentionally looking beyond dyadic child-parent relationship functioning to conceptualize the child's socioemotional adaptation within their broader family collective can enhance the likelihood that clinical gains will be supported and sustained. However, there has been little expert guidance regarding how best to frame infant-family mental health therapeutic encounters for the adults responsible for the child's care and upbringing in a manner that elevates their mindfulness about and their resolve to strengthen the impact of their coparenting collective. This article describes a new collaborative initiative organized by family-oriented infant mental health professionals across several different countries, all of whom bring expansive expertise assessing and working with coparenting and triangular family dynamics. The Collaborative's aims are to identify a means for framing initial infant mental health encounters and intakes with families with the goal of assessing and raising family consciousness about the relevance of coparenting. Initial points of convergence and growing points identified by the Collaborative for subsequent field study are addressed.

Parental reflective functioning and coping among parents of toddlers with severe developmental disabilities: An early integrative bio-psycho-social rehabilitative intervention in daycare facilities

BACKGROUND

Parental reflective functioning has a positive effect on parents' wellbeing. It is associated with positive outcomes for their children. However, there is little research on it among parents of toddlers with severe developmental disabilities.

AIMS

We examined an early bio-psycho-social rehabilitative intervention with parents of toddlers with severe developmental disabilities in daycare programs and its contribution to their parental reflective functioning and coping.

METHODS AND PROCEDURES

Seventy parents of children (ages 3 months to two and half years) responded to measures before and after the intervention in their children's daycare programs. Structural equation modeling of the mediation model revealed that the therapeutic inputs were associated with more adaptive coping strategies by increasing parental reflective functioning.

OUTCOMES AND RESULTS

Parents who participated in an intervention of 13 sessions or more significantly increased their reflective functioning. The path analysis showed that parental reflective functioning after the intervention mediated the association between its prior level and the therapeutic inputs, and the parents' proactivity and search for support.

CONCLUSIONS AND IMPLICATIONS

Parental reflective functioning positively affects parents' adaptive coping styles. A bio-psycho-social intervention targeting parental reflective functioning benefits parents of toddlers with severe developmental disabilities.

Factors contributing to continuity and discontinuity in child psychopathology from infancy to childhood: An explorative study

This study examined the psychopathology and socioemotional functioning of school-aged children treated during infancy and a comparison group of children without symptoms or treatment history. Our goal was to identify the factors associated with the continuity of psychopathology from infancy to childhood. The sample comprised 54 Israeli children, 30 with treatment history as infants in an infant mental health clinic and 24 with no treatment history. A 2 × 2 study design, with treatment history (treated/non-treated) and current psychiatric diagnosis (diagnosed vs. non-diagnosed), was used and group differences in children's psychopathology (Development and Well-Being Assessment (DAWBA)), socioemotional functioning (Vineland Adaptive Behavior Scales-Second Edition (VABS-II)), maternal stress (Parenting Stress Index-Short Form (PSI/SF)) and psychopathology (Symptom Checklist-90-Revised (SCL-90-R)), family functioning (Family Assessment Device (FAD)), and mother-child relational patterns (Coding Interactive Behavior (CIB)) were assessed. We found no differences between the previously treated and non-treated groups in the rate of given Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Text Revision (DSM-IV-TR) diagnosis. However, there was an interactive effect of treatment history × current psychiatric diagnosis, with the highest level of maternal stress in mothers of children exhibiting both early and late emotional and/or behavioral symptoms. Implications of these findings for identifying children and families at risk for continued child psychopathology and the importance of early parent-child psychotherapy interventions are discussed.

WAIMH position paper: Infants' rights in wartime

The World Association for Infant Mental Health (WAIMH) decided to compose a position paper on infants' rights in wartime, as there is still a general lack of attention paid to the impact of war-related traumas on infants' development and psychological health. Though there are numerous areas of violent conflicts around the globe, there have been few published studies that relate specifically to infants. Consequently, humanitarian aid programs tend to overlook infants' psychological needs and to pay more attention to those of older children. This position paper first reviews the studies identified through a literature search, about the impact of war-related traumas during pregnancy and postnatal periods, then describes the existing recommendations that have been added to the Children Rights Convention and their implications for infant mental health clinicians.

Comparing the broad socio-cognitive profile of youth with Williams syndrome and 22q11.2 deletion syndrome

BACKGROUND

Numerous studies have assessed the socio-cognitive profile in Williams syndrome (WS) and, independently, in 22q11.2 deletion syndrome (22q11.2DS). Yet, a cross-syndrome comparison of these abilities between individuals with these two syndromes with known social deficits has not been conducted.

METHODS

Eighty-two children participated in four study groups: WS (n = 18), 22q112.DS (n = 24), age-matched individuals with idiopathic developmental disability (IDD; n = 20) and typically developing (TD) controls (n = 20). Participants completed four socio-cognitive tests: facial emotion recognition, mental state attribution, differentiating real from apparent emotions and trait inference based on motives and actions-outcomes.

RESULTS

The current findings demonstrate that children with WS were better in labelling happy faces compared with children with 22q11.2DS, partially reflecting their exaggerated social drive. In the false belief task, however, the WS and IDD groups performed poorly compared with the 22q11.2DS group, possibly due to their difficulty to interpret subtle social cues. When asked to identify the gap between real-negative vs. apparent-positive emotions, the 22q11.2DS group performed similarly to TD children but better than the WS group, possibly due to their anxious personality and their innate bias towards negatively valence cues. Finally, individuals with WS were more willing to become friends with a story character even when the character's motives were negative, reflecting their difficulty to avoid potentially harmful real-life situations.

CONCLUSIONS

Overall, our multi-facet socio-cognitive battery uncovered strengths and weaknesses in social cognition that are syndrome-specific, shared among the genetic syndromes, or common to the three clinical groups compared with healthy controls. Our findings underscore the need to devise age-specific and condition-specific assessment tools and intervention programs towards improving these children's socio-cognitive deficits.

Some Reflections on Infancy-Onset Trichotillomania

Whether infancy-onset trichotillomania is best regarded as a habit, an early sign of obsessive compulsive disorder, a symptom of anxiety, or a sign of severe deprivation has been a topic of continuous debate. In this paper, we describe our clinical experience with nine consecutive cases of infancy-onset trichotillomania and detail the evaluation process and treatment course in one case. A distinct psychosocial stressor was identified in all cases, often accompanied by loss in the parents' histories. Most of the children had no transitional object. In six infants, the symptom resolved after treatment and did not recur, while in three others improvement was partial. Length of treatment varied from four to twenty-one sessions and outcome was unrelated to treatment duration. In all cases, mother-child interactions were characterized by a lack of maternal physical contact and warmth, sharp maternal transitions between under-involvement and intrusiveness, lack of mutual engagement, and no elaboration of symbolic play. The infant's behavior during play was marked by anxiety, irritability, and momentary withdrawal from the interaction. Our cases reveal an impaired affective interpersonal communication between mother and child, often masked by a fair overallfamily instrumental functioning. It is tenta- tively suggested that infancy-onset trichotillomania represents an end-point symptom of several factors, such as a disturbed parent-infant relationship, a low pain threshold in the infant, and a parental hypersensitivity to overt expressions of aggressive impulses and negative affects. Issues related to treatment modalities are also addressed. Discussion focused on our experience that early-onset cases of trichotillomania are often not benign or homogenous in terms of etiology, course, or response to treatment and require much further study.

DIAGNOSTIC CLASSIFICATION OF MENTAL HEALTH AND DEVELOPMENTAL DISORDERS OF INFANCY AND EARLY CHILDHOOD DC:0-5: SELECTIVE REVIEWS FROM A NEW NOSOLOGY FOR EARLY CHILDHOOD PSYCHOPATHOLOGY

The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Revised Edition (DC:0-5; ZERO TO THREE) is scheduled to be published in 2016. The articles in this section are selective reviews that have been undertaken as part of the process of refining and updating the nosology. They provide the rationales for new disorders, for disorders that had not been included previously in the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Revised Edition (DC:0-3R; ZERO TO THREE, 2005), and for changes in how certain types of disorders are conceptualized.

The experience of premature birth for fathers: the application of the Clinical Interview for Parents of High-Risk Infants (CLIP) to an Italian sample

Aim: The study explored fathers’ experience of premature birth during the hospitalization of their infants, analyzing levels of depressive and anxiety symptoms as compared with mothers. Moreover the Italian version of the Clinical Interview for Parents of High-Risk Infant (CLIP) was tested through confirmatory factor analysis.

Methods: Couples of parents (N = 64) of preterm infants (gestational age < 37 weeks) were administered a socio-demographic questionnaire, the Edinburgh Postnatal Depression Scale, the State-Trait Anxiety Inventory and the CLIP after the admission to the Neonatal Intensive Care Unit (NICU).

Results: Significant levels of anxiety and depressive symptoms and high percentages of subjects above the corresponding risk thresholds were found among fathers and mothers with higher scores among the latters. Confirmatory factor analysis of the CLIP showed an adequate structure, with better fit for mothers than for fathers.

Conclusion: Results highlighted the importance for nurses and clinicians working in the NICU to consider not only the maternal difficulties but also the paternal ones, even if these are often more hidden and silent. In addition the CLIP may be considered an useful interview for research and clinical purposes to be used with parents of high-risk infants.

Psychopathology and its Early Impact on Parenting Behaviors in Mothers: The Interface between Adult and Infant Psychiatry

Parenting is, in its essence, the domain where adult mental health and infant's mental and physical health meet in a complex and dynamic interplay. Becoming a parent is a developmental challenge in itself, and often exacerbates an existing mental illness, and in turn, maladaptive parenting impinges on the early parent-infant relationship, and on the infant's socio-emotional development and later functioning. The capacity for mentalization is brought as a bridging concept between adult and infant psychiatry. A few clinical vignettes illustrate the dynamic interplay between very young children's vulnerabilities and needs and their parents' strengths and weaknesses, leading to a complex interaction and often to symptoms in both child and parent. In the light of the compelling data about the impact of parental psychopathology on parenting behaviors and children outcomes, there is an imperative need for a working alliance and on-going communication between child and adult psychiatrists.

Social signal processing for studying parent-infant interaction

Studying early interactions is a core issue of infant development and psychopathology. Automatic social signal processing theoretically offers the possibility to extract and analyze communication by taking an integrative perspective, considering the multimodal nature and dynamics of behaviors (including synchrony). This paper proposes an explorative method to acquire and extract relevant social signals from a naturalistic early parent–infant interaction. An experimental setup is proposed based on both clinical and technical requirements. We extracted various cues from body postures and speech productions of partners using the IMI2S (Interaction, Multimodal Integration, and Social Signal) Framework. Preliminary clinical and computational results are reported for two dyads (one pathological in a situation of severe emotional neglect and one normal control) as an illustration of our cross-disciplinary protocol. The results from both clinical and computational analyzes highlight similar differences: the pathological dyad shows dyssynchronic interaction led by the infant whereas the control dyad shows synchronic interaction and a smooth interactive dialog. The results suggest that the current method might be promising for future studies.

The association of month of birth with atopy in adult patients with asthma and rhinitis in Anatolia, Turkey

BACKGROUND

Exposure to allergens in early life may predispose subjects to develop allergies and diseases related to allergic sensitisation.

OBJECTIVE

To determine the association between month of birth and atopic sensitisation in adult Turkish patients with rhinitis and/or asthma using the diagnostic method of skin prick tests.

METHODS

This prospective cross-sectional study included all adult patients who underwent skin prick testing with rhinitis and asthma from November 2009 to June 2010. Sensitisation was categorised as any sensitisation, pollen sensitisation, and house dust mite sensitisation. Multivariate logistic regression model was employed with the primary predictor being month of birth. Diagnosis (asthma, rhinitis and both), age, gender and family history of atopy were considered as potential confounders in the model. The associations were presented with both unadjusted and adjusted odds ratios (OR) and their 95% confidence interval (CI).

RESULTS

A total of 616 subjects were evaluated. Three-hundred and forty-one subjects had sensitisation to allergens according to skin prick tests. Analyses showed that subjects born in September were less likely to have documented skin test positively with pollen sensitisation [0.27 (0.09-0.84), p=0.023].

CONCLUSION

The results support the hypothesis that being born at the end of the pollen season may protect subjects from pollen sensitisation.

Clinical challenges of adoption: Views from Montreal and Tel Aviv

Adoption is accompanied by well-known risk factors that contribute to unique clinical challenges for children, parents, and clinicians. Adoption also serves to illustrate issues that remain relatively "silent" in the typical transition to parenthood. In this article, the authors review the normal developmental challenges that parents face during adoption, the adoption-related risk factors that may impinge on the child's development and attachment process, and the impact of adoption on the child's development of identity and filiations. We will review and illustrate clinical conditions often associated with adoption. In many countries, adoptive parents are reluctant to consult mental health clinicians during the first year of the adoption. The cases presented here illustrates the need to implement routine clinical programs for early detection and intervention of adoptive parent-infant dyads and triads at risk.

Family functioning and interactive patterns in the context of infant psychopathology

Family functioning and mother-infant relational patterns were examined in 38 clinic-referred infants and 34 matched non-referred infants. Referred infants were diagnosed with the Diagnostic Classification for Zero to Three. On the family level, referred families showed significantly lower family functioning in all domains of emotional and instrumental communication, regardless of the specific infant's diagnoses. On the dyadic level, referred mothers were more intrusive and their infants were more withdrawn during dyadic interactions. Clinic-referred mothers reported higher levels of phobia and depression. Global family functioning was predicted by the infant's clinical status, maternal intrusiveness, and maternal psychopathology. Infant mental health clinicians need to address both family level and dyadic level of functioning, regardless of the reason for the infant's referral.

Maternal representations, infant psychiatric status, and mother-child relationship in clinic-referred and non-referred infants

To examine the relations between maternal representations, infant socio-emotional difficulties, and mother-child relational behavior, 49 clinic-referred infants and their mothers were compared to 30 non-referred controls. Clinic-referred infants' psychiatric status was determined with the DC 0-3-R classification of Zeanah and Benoit (Child Adolesc Psychiatry Clin N Am 4:539-554, 1995) and controls were screened for socio-emotional difficulties. Mothers were interviewed with the parent development interview (Aber et al. in The parent development interview. Unpublished manuscript, 1985) and dyads were observed in free play and problem-solving interactions. Group differences emerged for maternal representations and relational behaviors. Representations of clinic-referred mothers were characterized by lower joy, coherence, and richness, and higher anger experienced in the mother-infant relationship compared to controls. During free play, clinic-referred mothers showed lower sensitivity and higher intrusiveness and provided less adequate instrumental and emotional assistance and support during problem solving. Referred children showed lower social engagement during free play. Associations were found among maternal representations, maternal interactive behavior, child social engagement, and the child's ability to self-regulate during a challenging task. These findings provide empirical support for theoretical and clinical perspectives suggesting a reciprocal link between maternal negative representations and mother and child's maladaptive behaviors in the context of early socio-emotional difficulties and mental health referrals.

Depression in infancy

The evolution of the concept of depression in infancy (0-3 years) is relatively new and follows a path similar to the history of depression in adolescence, then in childhood, and in preschool years. It started with Spitz observation of a depressive clinical syndrome, named anaclitic depression, followed by Bowlby's description of three phases in the development of infants who have been separated from their caregiver. Kreisler linked life-threatening feeding disorders with depression in infancy. This article reviews the different causes of depression in infancy. Clinical vignettes illustrate some of them. The main unanswered question is whether depression in infancy can be primary. Diagnostic criteria, differential diagnoses and prognoses are reviewed, as well as therapeutic concerns specific to infancy.

Sustained withdrawal behavior in clinic-referred and nonreferred infants

To examine the relations between infants' sustained withdrawal behavior and children's mental health status and maternal and child relational behavior, 36 clinic-referred and 43 control infants were evaluated. Families were visited at home, mother-child free play and feeding interactions were videotaped, and mothers completed self-report measures. Interactions were coded for sustained withdrawal using the Alarm Distress Baby Scale (ADBB; Guedeney and Fermanian, 2001) and for global relational patterns with the Coding of Interactive Behavior (CIB; Feldman, 1998). Higher ADBB scores were found for the referred group, with many infants (38.9% ) scoring above the clinical cutoff (vs. 11.6% in the control group). More negative relational patterns were found for the withdrawn group in terms of higher maternal intrusiveness, lower reciprocity, and lower child involvement. Associations were found between maternal and child behavior during play and feeding and child sustained withdrawal behavior at play. Sustained withdrawal also was associated with unpredictable child temperament and lower sense of parental self-efficacy. Maternal depressive symptoms were higher in the referred group and correlated with maternal and child relational patterns. The findings contribute to the construct and discriminant validity of the CIB and the ADBB coding systems, and suggest that sustained withdrawal may serve as a risk indicator for early socioemotional disorders.

Relations between parents' interactive style in dyadic and triadic play and toddlers' symbolic capacity

Play has a major role in the evaluation and treatment of young children referred to mental health clinicians. The present study examined parental correlates of preschoolers' symbolic play during dyadic and triadic play interactions. Boys' play contained more aggressive themes, and girls' contained more nurturing themes. Mothers displayed more caring themes during play with both sons and daughters, and fathers displayed more repair and construction themes. Mothers' and fathers' facilitative- creative interaction style in dyadic play predicted the level of the child's symbolic play. Co-parenting style marked by cooperation and autonomy predicted symbolic play during a triadic family session. Child intelligence predicted symbolic play beyond the parent's style during triadic but not dyadic interactions. The findings have implications for early intervention directed at increasing symbolic play in young children.

Mother-Child touch patterns in infant feeding disorders: relation to maternal, child, and environmental factors

OBJECTIVE

To examine mother and child's touch patterns in infant feeding disorders within a transactional framework.

METHOD

Infants (aged 9-34 months) referred to a community-based clinic were diagnosed with feeding disorders (n = 20) or other primary disorder (n = 27) and were case matched with nonreferred controls (n = 47). Mother-child play and feeding were observed and the home environment was assessed. Microcoding detected touch patterns, response to partner's touch, and proximity at play. Relational behaviors were coded during feeding.

RESULTS

Compared with infants with other primary disorder and case-matched controls, less maternal affectionate, proprioceptive, and unintentional touch was observed in those with feeding disorders. Children with feeding disorders displayed less affectionate touch, more negative touch, and more rejection of the mother's touch. More practical and rejecting maternal responses to the child's touch were observed, and children were positioned more often out of reach of the mothers' arms. Children with feeding disorders exhibited more withdrawal during feeding and the home environment was less optimal. Feeding efficacy was predicted by mother-child touch, reduced maternal depression and intrusiveness, easy infant temperament, and less child withdrawal, controlling for group membership.

CONCLUSIONS

Proximity and touch are especially disturbed in feeding disorders, suggesting fundamental relationship difficulties. Mothers provide less touch that supports growth, and children demonstrate signs of touch aversion. Touch patterns may serve as risk indicators of potential growth failure.

[Attention deficit disorder in the preschool years: its characteristics and course from infancy to toddlerhood]

Diagnosis of Attention Deficit Disorder with/without hyperactivity in school-age children is based on the presence of the three main symptoms: lack of attention, impulsivity and hyperactivity. In infants and toddlers, these symptoms may very well be contingent to their development stage, but may also signify early signs of attention deficit disorder. Diagnosis in the age group of 2-5 years is very challenging, because reliable criteria are still lacking. The cutpoint between normal developmentally-based lack of attention and impulsivity and "true" attention deficit, is often not clear enough. Also, the very young child's condition often reflects the quality of the early parent-child relationship. Diagnostic criteria, differential diagnoses and treatment relevant to this age group, are presented. An 18 month old boy with signs of irritability, sleep problems, and poor attention span, shows the course of these symptoms, from infancy to toddlerhood under treatment, with modalities that changed over time. We suggest adopting an integrative standpoint of the young child and his/her family in the diagnostic as well as the therapeutic process, while keeping in mind the dynamic and development-dependent nature of the clinical presentation.

A case-study of PTSD in infancy: diagnostic, neurophysiological, developmental and therapeutic aspects

Post-traumatic Stress Disorder of Infancy has become accepted as a nosological entity. Assessment guidelines and diagnostic criteria have been defined, taking into account the impact of development on the expression of post-traumatic symptoms. Therapeutic reenactment has been considered the cornerstone of the therapeutic process. The issue of deciding what is the optimal time for therapist-induced reenactment of the trauma remains ill-defined. The less verbal and the more avoidant the traumatized infant is, the more directive the therapist needs to be, meaning he will not necessarily get clues from the infant of his readiness for reenactment. The therapist will need to introduce the trauma, at the risk of provoking a massive "flight or fight" reaction, as is illustrated by the case study of a two-and-a-half-year-old post-traumatic preverbal boy and his mother. Issues relating to conditions under which reenactment stops causing reactivation of the trauma and starts being a process of therapeutic desensitization are raised. We suggest that integration of psychodynamic and neurodevelopmental concepts might be useful in deepening the understanding of the impact of therapeutic reenactment in PTSD of Infancy.

The pediatric team and the consulting child psychiatrist and the hospitalized depressed infant

The link between pediatricians and child mental health professionals is a complex, but fascinating issue. Based on our clinical experience, this paper will discuss the issue of depression in very young children hospitalized for serious illness in a general pediatric ward, and its theoretical implications. We begin with a clinical vignette, followed by a review of several clinical phenomena including anticipated bereavement (either by the parents or the medical team, or both), some high-tech medical conditions specific to neonatology and joint parents-infant hospitalization as well as relating the above to psychoanalytical concepts. The significance and importance of adopting a dual perspective, from both the pediatric and the psychopathological viewpoint, while treating the very sick hospitalized young child and his/her parents, is underlined.

Diagnoses and interactive patterns of infants referred to a community-based infant mental health clinic

OBJECTIVES

To describe the distribution of symptoms and diagnoses in a community-based infant mental health clinic and to compare play and feeding interactions of referred and nonreferred infants.

METHOD

The Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood (DC 0-3) was used to diagnose 113 referred infants (60% were boys). Thirty additional dyads were matched with 30 nonreferred dyads. Feeding, play interactions, and home environment were compared.

RESULTS

Two peaks of referral were found: 0 to 6 and 12 to 18 months. The main reasons for referral were eating problems, sleep problems, aggressive behavior, irritability, and maternal depression. The most common DC 0-3 diagnosis was a combination of primary infant disorder, parent-child relationship disorder, and parental psychopathology. Mothers of referred children provided lower levels of sensitivity, support, and structuring of the interaction, and less optimal home environment. The dyadic relationship showed a lower degree of mutuality and higher negative exchanges. Feeding interactions elicited more negative interactions than play.

CONCLUSIONS

Infants referred by community health workers showed less optimal mother-infant interactions and had less optimal environment, compared with nonreferred dyads. Symptoms of emotional distress in infancy are best apprehended when assessed in multi-institutional contexts and formulated in a multiaxial approach.

[Prematurity as an interplay between psychological and biological risk factors leading to infant psychopathology]

Concepts such as risk factor, vulnerability, protective factor and resiliency have become central in the field of developmental psychopathology. The birth of a very-low-birth weight premature baby can be used as a paradigm of the interplay between these factors. Indeed, prematurity implies for both infant and parents, biological as well as psychological risk factors. They may interact in such a way that the child's emotional, cognitive and social development will deviate from normal. Understanding the psychological impact of premature birth includes reference to both the normal psychological processes that characterize pregnancy that are jeopardized by a premature, often traumatic delivery, and to the special significance of being a parent in the Special Care Nursery. The contrast between the expected appearance of the baby and that of the sick-looking, tiny premature, together with uncertainty about its medical status, often affect the parents' bonding process. In addition, parents must learn quickly to cope with issues such as total dependence on a very busy team, loss of control of the care of their baby, and their unclear roles as parents. Added to these risk factors are the specific neurobehavioral characteristics of premature babies, which often make it hard for parents to read their cues and respond to them properly. A clinical vignette illustrates the chain of psychological and biological events that lead to severe disturbance of the early parent-child relationship. It also brings up the question of psychosocial intervention in the Special Care Nursery, both in terms of early detection of families at risk and the types of intervention.

Assessment of caregiver-child interaction in the context of a preschool psychiatric evaluation

Assessment of the caregiver-child relationship has become an intrinsic part of the preschool child psychiatric evaluation. Normal and abnormal development of relationship is influenced by a myriad of genetic, psychological, cultural, and environmental factors in both the caregiver and the young child. In the past, professionals from different fields, like pediatrics, neurology, development, and social welfare, would understand the child and his or her environment with their own tools. Since then, these parallel lines have converged into a more complementary and integrated view. The need to evaluate the caregiver, the child, the caregiver-child interaction, and the context of the relationship makes the evaluation a challenging multidisciplinary process, in which standardized assessment tools have to be integrated into a sound clinical conceptualization of the evaluated relationship.

Dyadic psychotherapy for early relationship disorders: a case study

Specific treatment modalities, such as dyadic psychotherapies, have emerged, based on the notion that in cases of very early relational disorders, the patient is the parent-infant relationship. The aim of this paper is to present a case study of such a relational disorder which took place as the result of a complex interplay between the infant's biological risk factors and the parents' psychological risk factors. The emphasis is on the technique and the course of the dyadic psychotherapy of the mother and her three-year-old child, where the main goal was to change some of the intrapsychic and interpersonal processes specifically related to pathological motherhood. The theoretical background is briefly presented, while emphasizing the criteria for choosing one approach among the different kinds of dyadic psychotherapy.

[Feeding disorders in infancy: feeding interaction concept in diagnosis and treatment]

In infancy clinical manifestations of psychological distress are mainly somatic. Feeding disorders are one of the most common and nonspecific manifestations of different kinds of disturbed parent-child relationships. These disturbances may have their origins in the baby's constitution and physical status, in the parent's personality structure, or both, as has been conceptualized in the transactional model of normal and abnormal development. Among the daily interactions a baby has with parents, feeding has special inherent impact on the early parent-child relationship because of its psychological meanings. Therefore, feeding disorders, with or without failure to thrive, often reflect various disorders of infancy, still not well recognized in the medical community, such as regulatory disorders, attachment disorders, depression of infancy, disorders of separation-individuation, and post-traumatic eating disorder. 3 clinical cases are brought to increase awareness of psychological distress in the infant, and of feeding disorders as 1 of its manifestations. Each illustrates a different kind of feeding disorder in terms of etiology and pathogenesis. Through these cases we emphasize the need for a multi-disciplinary, integrative approach in diagnosis and treatment. Our conceptual background is based both on the transactional model of development (infant and parental factors impact on each other) in a very dynamic paradigm, and on psychodynamic premises. Intrapsychic conflicts and past representations impact heavily on the parenting characteristics. We emphasize the psychological significance of disturbed feeding interactions, with or without failure to thrive.

[Neuropsychiatric symptoms in systemic lupus erythematosus]

Involvement of the central nervous system in systemic lupus erythematosus is frequent (50-66%). Its manifestations may be either neurological, psychiatric or both. The psychiatric syndrome may appear without physical symptoms, or may accompany severe systemic involvement. In either case psychiatric diagnosis is quite difficult and consequently treatment is often controversial. We review current knowledge and present the case of an 18-year-old male which illustrates the complexity of both diagnosis and treatment of the syndrome.