Infant psychiatric disorders

Infant mental health problems include difficulties to regulate emotions or attention, crying, sleeping or feeding problems as well as aggressive behavior. Early identifications of these problems help to change developmental trajectories and improve developmental outcomes. Psychiatric assessment and classification have to take into account the rapid processes of development as well as the inseparable linkage between symptoms of the infant, psychosocial risks in the family environment, and parent-child relations. The proposed DSM-5 classification system presents a systematic description of mental health disorders which are relevant for infant psychiatry. However, the proposal has provided rather limited attention to developmental differences and parent-infant relations. Therefore, additional classification systems, like the Zero-to-Three (DC: 0-3R), are strongly recommended. In terms of assessment and in accordance with the guidelines of the American Academy of Child and Adolescent Psychiatry, infant psychiatrists have to consider the close relation between somatic and mental health and the interplay between behaviors of the caregiver and the infant. Therefore, the assessment has to be multidisciplinary and relationship based. A standard assessment in infancy includes a clinical interview, behavior observations, caregiver questionnaires, and a pediatric screening. All assessments should pay attention to motor, cognitive, language, and social-emotional development. Because infant development is embedded in the family context, socio-economic factors, parents' mental problems, including drug abuse, domestic violence, and trauma history should be assessed. The treatment has to be oriented toward symptoms and development and has to address underlying medical conditions. The focus should be on parent-child interactions. Evidence-based interventions are based on attachment theory, use social-learning perspectives, and behavioral approache

Cortisol levels in pregnancy as a psychobiological predictor for birth weight

Antenatal maternal stress is thought to negatively affect fetal development, birth outcomes, and infant's development. Glucocorticoids are suggested to be a common link between prenatal stressors and infant's health. However, data on these mechanisms are rare and sometimes conflicting. The objective of this study was to examine the effects of maternal distress during pregnancy on fetal development and birth weight in humans prospectively. This study focuses on cortisol as one mediating the mechanism of the association between maternal distress and birth outcomes. Pregnancy-related and general distress was measured in 81 women with uncomplicated, singleton pregnancies. The rise of salivary cortisol on awakening (CAR) was assessed in weeks13-18 and 35-37 postmenstrual age of pregnancy. Mothers completed a structured interview, the perceived stress scale, a widely used psychological instrument that provided a global measure of perceived stress, as well as the Prenatal Distress Questionnaire, a self-report questionnaire designed to assess worries and anxiety in pregnancy. Pre-, peri-, and postnatal medical risk factors as well as birth characteristics were extracted from medical records routinely kept by the attending obstetricians. Hierarchical multiple regressions indicate that maternal cortisol levels explained 19.8% of the variance in birth weight and 9% of the variance in body length at birth, even after controlling for gestational age, parity, pre-pregnancy BMI, smoking, and infant's sex. Newborns of mothers with higher cortisol levels in pregnancy had lower birth weights and were shorter at birth. An ANCOVA for repeated measures indicated that, after controlling for covariates, pregnancy-related as well as general distress in pregnancy did not influence cortisol levels after awakening (area under the curve). No significant associations between perceived stress and anthrometric measures at birth were found. In conclusion, maternal cortisol levels in pregnancy influence intrauterine growth and may be a better predictor for birth outcome than perceived stres

Inter-rater reliability and acceptance of the structured diagnostic interview for regulatory problems in infancy

Background: Regulatory problems such as excessive crying, sleeping–and feeding difficulties in infancy are some of the earliest precursors of later mental health difficulties emerging throughout the lifespan. In the present study, the inter-rater reliability and acceptance of a structured computer-assisted diagnostic interview for regulatory problems (Baby-DIPS) was investigated. Methods: Using a community sample, 132 mothers of infants aged between 3 and 18 months (mean age = 10 months) were interviewed with the Baby-DIPS regarding current and former (combined = lifetime) regulatory problems. Severity of the symptoms was also rated. The interviews were conducted face-to-face at a psychology department at the university (51.5 %), the mother’s home (23.5 %), or via telephone (25.0 %). Inter-rater reliability was assessed with Cohen’s kappa (k). A sample of 48 mothers and their interviewers filled in acceptance questionnaires after the interview. Results: Good to excellent inter-rater reliability on the levels of current and lifetime regulatory problems (k = 0.77–0.98) were found. High inter-rater agreement was also found for ratings of severity (ICC = 0.86–0.97). Participants and interviewers’ overall acceptance ratings of the computer-assisted interview were favourable. Acceptance scores did not differ between interviews that revealed one or more clinically relevant regulatory problem(s) compared to those that revealed no regulatory problems. Conclusions: The Baby-DIPS was found to be a reliable instrument for the assessment of current and lifetime problems in crying and sleeping behaviours. The computer-assisted version of the Baby-DIPS was well accepted by interviewers and mothers. The Baby-DIPS appears to be well-suited for research and clinical use to identify infant regulatory problems

Maternal adversities during pregnancy and cord blood oxytocin receptor (OXTR) DNA methylation

The aim of this study was to investigate whether maternal adversities and cortisol levels during pregnancy predict cord blood DNA methylation of the oxytocin receptor (OXTR). We collected cord blood of 39 babies born to mothers participating in a cross-sectional study (N = 100) conducted in Basel, Switzerland (2007-10). Mothers completed the Inventory of Life Events (second trimester: T2), the Edinburgh Postnatal Depression Scale (EPDS, third trimester: T3), the Trier Inventory of Chronic Stress (TICS-K, 1-3 weeks postpartum) and provided saliva samples (T2, T3) for maternal cortisol profiles, as computed by the area under the curve with respect to ground (AUCg) or increase (AUCi) for the cortisol awakening response (CAR) and for diurnal cortisol profiles (DAY). OXTR DNA methylation was quantified using Sequenom EpiTYPER. The number of stressful life events (P = 0.032), EPDS score (P = 0.007) and cortisol AUCgs at T2 (CAR: P = 0.020; DAY: P = 0.024) were negatively associated with OXTR DNA methylation. Our findings suggest that distinct prenatal adversities predict decreased DNA methylation in a gene that is relevant for childbirth, maternal behavior and wellbeing of mother and offspring. If a reduced OXTR methylation increases OXTR expression, our findings could suggest an epigenetic adaptation to an adverse early environment

Psychopathologie und elterlicher Stress bei 3- bis 6-jährigen Kindern mit Ausscheidungsstörungen

Objective: Incontinence and functional gastrointestinal disorders are common in young children and are associated with higher rates of psychological symptoms and mental disorders. This article focuses on the mutual association between incontinence and related toilet refusal syndrome, parental stress, and children’s psychopathology especially in young children. Methods: Children’s psychological symptoms, mental disorders, and parental stress levels were assessed in 38 parent-child dyads involving children with incontinence and 42 dyads of typically developing (TD) children. Results: Compared to TD children, patients had higher internalizing and externalizing CBCL scores and higher rates of clinically relevant externalizing problems. However, the rates of clinically relevant internalizing problems and mental disorders did not differ. The parents of children with incontinence reported signifi cantly higher stress levels regarding child-related stress factors (PSI-CD) than did parents of TD children. However, there were no clinically relevant parental stress scores on a group level, which remained below the clinical range (T-value < 60). When simultaneously analyzed, children’s (comorbid) mental disorders but not incontinence had a major impact on parental stress. Conclusions: Despite moderate stress levels, incontinence symptoms, urinary and fecal incontinence are highly prevalent in young children. However, stress among parents of young children was mainly elicited by any (comorbid) mental disorder.Fragestellung: Ausscheidungsstörungen (AS) wie funktionelle Harn- und Stuhlinkontinenz sind sehr häufi ge Störungen im Vorschulalter und sind mit einer erhöhten Prävalenz von psychopathologischen Symptomen und psychischen Störungen bei den betroffenen Kindern assoziiert. Innerhalb der vorliegenden Arbeit wird der wechselseitige Zusammenhang von funktioneller Harn- und Stuhlinkontinenz sowie dem damit in Verbindung stehenden Toilettenverweigerungssyndrom auf die kindliche Psychopathologie und das elterliche Stresserleben speziell bei jungen Kindern untersucht. Methode: Psychopathologische Symptome, psychische Störungen und elterliche Stressbelastung wurden in 38 Eltern-Kind-Dyaden bei Kindern mit vorhandener AS und in 42 Dyaden bei Kindern ohne AS untersucht. Ergebnisse: Kinder mit AS wiesen höhere Werte von internalisierendem und externalisierendem Problemverhalten auf und waren häufi ger von klinisch relevanter externalisierender Symptomatik betroffen. Nichtsdestotrotz war die Prävalenz psychischer Störungen vergleichbar. Eltern von Kindern mit AS berichteten signifi kant höhere kindbezogene Stresslevel. Dennoch zeigte sich auf Gruppenebene kein klinisch bedeutsamer elterlicher Stress und die mittleren Stresslevel lagen unterhalb des Bereichs der klinischen Auffälligkeit (T-Wert < 60). Bei gleichzeitiger Betrachtung des Einfl usses von AS und psychischen Störungen zeigten sich letztere als ausschlaggebend für den elterlichen Stress. Schlussfolgerungen: Trotz moderater Stresslevel konnte eine generell hohe Prävalenz von AS Symptomen bei 3–6-Jährigen aufgezeigt werden. Elterlicher Stress war jedoch bedeutsamer mit einer (komorbiden) psychischen Erkrankung assoziiert

Pharmacotherapeutic intervention in impulsive preschool children: The need for a comprehensive therapeutic approach

Impulsive and aggressive behaviour symptoms often are serious problems in children, even already at preschool age. Thus, effective treatment approaches are requested. In this comment pharmacotherapeutic treatment approaches, first of all risperidone, their limitations and alternative psychotherapeutic approaches are outlined

Exzessives Schreien

Wenn Paare Eltern werden, kann dies, neben all dem Neuen und Schönen, auch eine Reihe von Herausforderungen und Schwierigkeiten mit sich bringen, die bewältigt werden müssen. Regulationsstörungen im Säuglings- und Kleinkindalter zählen zu den am häufigsten auftretenden Problemen in der pädiatrischen Praxis. Papousek et al. (2004) sprechen von etwa jedem vierten bis fünften Kind, welches wegen exzessivem Schreien, Schlaf- und/oder Fütter- und Gedeihstörungen beim Kinderarzt vorgestellt wird. Dabei treten diese Symptome bei der Mehrzahl der Kinder nur passager in den ersten drei Lebensmonaten bzw. in Zusammenhang mit späteren Anpassungs- und Entwicklungsaufgaben auf. Die Bewältigung hängt von der Balance zwischen kindlicher Regulationsfähigkeit und den intuitiven Regulationshilfen der Eltern ab. Wenn sich Eltern jedoch von ihrem Kind völlig überfordert fühlen, ist es schwierig und oft ohne Hilfe kaum möglich das Kind durch Co-Regulation zu unterstützen. Deshalb brauchen sowohl die Eltern als auch das Kind Unterstützung, um ein Persistieren der Regulationsschwierigkeiten und tiefer greifende Störungen der Eltern-Kind-Beziehung zu vermeiden. Im Workshop werden die Symptome der Regulationsstörung in der frühen Kindheit, exzessives Schreien, Schlafstörungen, Fütter- und Gedeihstörungen und Störungen der emotionalen Verhaltensregulation, behandelt. Insbesondere wird auf die Fragen: Wie werden Störungen der frühen Kindheit von &bdquo;normalen Auffälligkeiten" in der Entwicklung abgegrenzt? Wie sieht der Verlauf von Regulationsstörungen aus? Welche Erklärungsansätze und Interventionsmöglichkeiten gibt es? eingegangen. Auf der Basis des aktuellen Wissens der interdisziplinären Frühentwicklungsforschung werden das diagnostische Vorgehen und die Therapie bei Regulationsstörungen vorgestellt. Anhand von videogestützten Fallvignetten werden die Störungsbilder der Frühkindlichen Regulationsstörung und frühe Ansatzpunkte einer Eltern-Kleinkind-Psychotherapie vorgestellt. Ziel dieses Therapie- bzw. Beratungsansatzes ist die Stärkung der Eltern. Mit Hilfe von Videoanalysen der elterlichen Beruhigungsversuche, von Fütter- oder Spielsituationen werden Eltern in ihren intuitiven elterlichen Kompetenzen gefestigt, um wieder entspannte Interaktionen möglich zu machen

Einfluss psychosozialer Stressbelastung während der Schwangerschaft auf die physische und behavioral-emotionale Entwicklung des Kindes

Empirischen Studien zufolge ist die Schwangerschaft eine sensitive Phase in der menschlichen Entwicklung, in der sich ungünstige Umweltbedingungen besonders negativ auf den sich entwickelnden Organismus auswirken können. Früh- und Mangelgeburten, Veränderungen auf neuro-endokriner Ebene sowie Verhaltensauffälligkeiten und Störungen der behavioral-emotionalen Entwicklung werden im Zusammenhang mit pränataler Stressbelastung gesehen. Trotz des großen Interesses an dieser Thematik gibt es bisher nur sehr wenige Humanstudien, die den Einfluss mütterlichen Stresses in der Schwangerschaft auf die Entwicklung prospektiv untersuchen. Die vorliegende Arbeit stellt die Ergebnisse einer längsschnittlichen Humanstudie vor, die den Einfluss psychosozialer Risikofaktoren in der Schwangerschaft auf die vorgeburtliche Entwicklung, den Geburtsausgang sowie das neonatale Verhalten untersuchte. Die Autorin gibt außerdem einen Überblick über aktuelle Literatur zu den Themen der pränatalen Entwicklung, Schwangerschaft und Stress. Dabei finden besonders die psychobiologischen Apekte Beachtung

Ängstliche Eltern, ängstliches Kind?

Kinder - und Jugendpsychologinnnen der Universität Basel zeigen: Die Stimmung der Eltern beeinflusst die Entwicklung der Kinder und kann sogar Angsterkrankungen auslösen

Beyond the technique of calming methods: the role of parent-child relationship and self-regulation skills on infant regulation in early childhood (BECALM)

This anonymous online survey explores the association between parental calming methods on infant behavior (crying, sleeping). Additionally, the moderating role of family relationships (parent-infant bonding, stress coping within the partner-relationship) as well as parental self-regulation skills and beliefs about behavior regulation, is examined