Le rôle spécifique de la sensibilité maternelle comme facteur associé au risque de diagnostics cooccurrents chez l’enfant d’âge préscolaire

Abstract

IntroductionCo-occurrence of mental health diagnoses (dx) refers to the presence of two or more dx in the same child and may imply a more complex profile of symptoms and be more difficult to treat. Treatments for children with co-occurring dx often appear successful for some of the symptoms, while other symptoms persist with clinical efforts. Although it is well documented that an early onset of disorders in the preschool period is associated with numerous adverse outcomes in the middle childhood or adolescence periods (e.g., antisocial behavior, peer rejection), little is known about risk and protective factors associated with the co-occurrence of psychopathological disorders in preschool children. ObjectiveTo better identify intervention leverages for the treatment of these children, this study examines whether the quality of the family environment (maternal sensitivity, stress and depressive symptoms) is associated with the presence of co-occurring psychiatric dx among preschool age children. ParticipantsDuring four years, parents and children (1–5 years old) were approached at a specialized psychiatric clinic at the Sainte-Justine University Hospital Center in Montreal. An assessment and observation protocol was administered to a third of these families. Our study comprises the 54 children and their parents who participated to this protocol. In this sample, 37% of the children were diagnosed with an attention deficit hyperactivity disorder, 24% with a disruptive disorder, 39% with an oppositional defiant disorder and 46% with an anxiety disorder. Overall, 42 children (78%) were diagnosed with two or more dx. MethodMaternal sensitivity was observed during the very well-validated Strange Situation Procedure. Mothers completed questionnaires on parental stress and their depressive symptoms. Children were diagnosed by the clinic's psychiatrists. ResultsAnalyses showed clinical level difficulties of sensitivity (39%), stress (67%) and depression (43%) in a significant portion of the mothers. Parental stress and depression were not associated with co-occurring dx in children; however, less sensitive mothers were more likely to have children with more than one dx. Precisely, children of less sensitive mothers were more than twice as likely to present co-occurring disorders as children with more sensitive mothers. ConclusionsParental sensitivity, i.e., the ability to observe, interpret correctly and respond in a timely and appropriate manner to the child needs, is more problematic in mothers of children with a more complex symptomatology. This study highlights the importance of parental involvement in the treatment of these preschool children. Parent–child dyadic interventions, such as the Attachment Video feedback Intervention (AVI), to optimize parental sensitivity are discussed.