Abstract
Infantile Anorexia (IA), defined by the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood Revised (DC: 0-3R, Zero To Three, 2005), occurs when the child (a) refuses to eat adequate amounts of food for at least 1 month, and shows growth deficiency, (b) does not communicate hunger and lacks interest in food, and (c) the child’s food refusal does not follow a traumatic event and is not due to an underlying medical illness. IA usually emerges during the transition to self-feeding, when the child issues of autonomy are played out daily in the feeding situation. Studies evidence that the feeding interactions between children with IA and their mothers are characterized by low reciprocity, greater interactional conflict and negative affects (Chatoor et al., 2000; Ammaniti et al., 2010, 2012). Moreover, these studies pointed out that maternal depression and eating disorders are frequently associated with IA (Cooper et al., 2004; Ammaniti et al., 2010; Lucarelli et al., 2013). To date, research has focused almost exclusively on the mother–child dyad, while fathers’ involvement, co-parental and family interactions are poorly studied. The current study is a pilot research that investigated mother–father–child triadic interactions, during feeding and play, in families with children diagnosed with IA, in comparison to families with normally developing children. Until now, at the study participated N = 10 families (five with a child with IA diagnosis and five with lack of child’s IA diagnosis, matched for child’s age and gender). The parents–child triadic interactions were assessed in feeding and play contexts using the Lausanne Trilogue Play (Fivaz-Depeursinge and Corboz-Warnery, 1999), adapted to observe father-mother-infant primary triangle in the feeding context, compared to the play context (Lucarelli et al., 2012). Families of the IA-group showed difficulties in expressing and sharing pleasure and positive affects, and in structuring a predictable and flexible context. Children showed little autonomy and difficulty in being actively engaged and tune with parents. Dysfunctional family interactions are a critical issue for IA that affects co-parental and family subsystems, stressing the importance of an articulated diagnostic assessment in order to target effective treatment approaches.
Highlights
Assessing Adult–Child Interactions: A Shift toward a Triadic PerspectiveIn the recent years, there has been an increasing interest in the clinical and scientific investigation of interactive contexts which are more complex than the dyadic one
Recent literature highlighted the presence of associations between fathers’ involvement and feeding disorders, indicating the need to move beyond previous theories which focused exclusively on the mother-child dyad to explain the aetiogenesis and the development of child psychopathology (Barriguete et al, 2002; Atzaba-Poria et al, 2010; Hall et al, 2014)
We suggest a model where difficulties in feeding, and more generally in adult–child interactions, might influence and be influenced in a specific way by the functioning of the broader triadic mother–father–child system, beyond the one of the single mother–child and father–child dyadic subsystems
Summary
Assessing Adult–Child Interactions: A Shift toward a Triadic PerspectiveIn the recent years, there has been an increasing interest in the clinical and scientific investigation of interactive contexts which are more complex than the dyadic one. During the interactive exchanges with his/her care-givers, the child gradually becomes more skilled in experiencing “schemas-of-being-with” another person (Stern, 1985) that allow to organize the interactive history into triadic schemas which involve the repeated experience of being simultaneously in interaction with more than one person per time (Fivaz-Depeursinge and Corboz-Warnery, 1999) According to this perspective, the quality of the triadic interactions and the development of triadic competencies are no longer considered as a developmental step subsequent to the acquisition of dyadic interactive competencies. Rather, they appear since early infancy and become already observable during the first months of life (Tremblay-Leveau and Nadel, 1995; Fivaz-Depeursinge and Corboz-Warnery, 1999; TremblayLeveau, 1999)
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