Infant Psychiatry Research Articles

René Spitz’s Empty Frames: ‘Hospitalism’, Screen Analysis and the Birth of Infant Psychiatry

This article casts light on the origins of infant psychiatry by taking a new, interdisciplinary approach to the work of psychoanalyst and film-maker René Spitz. Focusing on his observations of babies living in orphanages, it argues that by undertaking the difficult, and sometimes paradoxical, task of capturing emotional absence and psychological fragmentation on film, Spitz created a new and influential theory of the infant psyche. It considers how this vision of an indeterminate and potentially ‘empty’ infant subject was generated by the institutional care which he sought to undermine. The particular ways in which the institution emerges as a problem and opportunity for child analysts after World War II propelled Spitz into a surprising range of post-war debates on cultural politics. He is revealed as embedded in a complex, interdisciplinary web of discourse, practices and observational strategies, and at the centre of post-war visual research into the environmental origins of mental illness.

Mothering in the frame: Cinematic microanalysis and the pathogenic mother, 1945–67

This article examines the use of cinematic microanalysis to capture, decompose, and interpret mother–infant interaction in the decades following the Second World War. Focusing on the films and writings of Margaret Mead, Ray Birdwhistell, René Spitz, and Sylvia Brody, it examines the intellectual culture, and visual methodologies, that transformed ‘pathogenic’ mothering into an observable process. In turn, it argues that the significance assigned to the ‘small behaviours’ of mothers provided an epistemological foundation for the nascent discipline of infant psychiatry. This research draws attention to two new areas of enquiry within the history of emotions and the history of psychiatry in the post-war period: preoccupation with emotional absence and affectlessness, and their personal and cultural meanings; and the empirical search for the origin point, and early chronology, of mental illness.

The Treatment of Infants and Toddlers with their Parents in an Outpatient Unit for Infant Psychiatry

The Treatment of Infants and Toddlers with their Parents in an Outpatient Unit for Infant Psychiatry This article presents an integrative treatment model for infants and toddlers between zero to three years and their parents by integrating different complementary psychotherapeutic perspectives. Between 2012 and 2014 a total of 214 children between zero and three years have been treated, the diagnostic and process data of 53 % (N = 113) of the children were evaluable. The parents have been consulted in the beginning, at the end and six months post-treatment with different questionnaires concerning distress of the children and of the parents as well as regarding the social and the emotional behavior of the toddlers. The psychotherapists filled in different instruments at the beginning and at the end of the treatment. Our research demonstrates that a clearly conceptualized intervention has a measurable and persistent positive effect on the symptoms of the children, on the parent-child-relationship and on the wellbeing of the parents.

Educator Argues for Integrating Infant MH in Child Psychiatry Training

Educator Argues for Integrating Infant MH in Child Psychiatry Training

Vulnerable parenting among mothers with substance abuse in their family of origin: a cross-sectional comparative study of mothers in an infant and toddler program.

ObjectiveTo investigate whether women raised in a family with substance abuse constitute a particularly vulnerable group of patients in an infant psychiatry setting and to identify the risk factors of suspected parental malfunctioning in women referred to treatment in an infant and toddler intervention program.BackgroundA history of family substance abuse can severely disrupt the caretaking abilities of parents in ways that can have far-reaching consequences, and children growing up with insufficient parental care may incorporate this deficiency into their own parental behavior.MethodsIn total, 126 mothers completed self-report questionnaires assessing their substance abuse and health problems as well as problems in their family of origin. The index group was defined as women who reported substance abuse in their family of origin (n = 35). The comparison group was defined as women who denied substance abuse in their family of origin (n = 91).ResultsSymptoms of depression and anxiety were overrepresented in the total group of mothers compared with the Swedish norm. The index group had experienced parental divorce and traumatic life events more often and reported earlier substance abuse of their own. They had significantly more depression and ADHD symptoms and were more often single parents. All these factors can have a negative influence, separately or in combination, on the ability to practice sensitive parenting.ConclusionsFemale offspring of substance-abusing parents are an especially vulnerable group of patients. To prevent the intergenerational transmission of alcohol and drug abuse, it is important to identify parents with specific needs and to administer targeted treatment and support at primary health care centers and child psychiatric clinics.

The Block Family Memorial Grant: supporting perinatal and infant psychiatry

The Block Family Memorial Grant: supporting perinatal and infant psychiatry

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 approaches.

Daniel Stern’s Journey in Infant Psychiatry

This interview with Professor Daniel Stern, conducted on February 16, 2012 by Dr. John Talbott, reviews the field of infant psychiatry, the history of which goes back more than 100 years. Sigmund Freud, then Melanie Klein, Anna Freud, Donald Winnicott, and, finally, Margaret Mahler, all psychoanalysts, influenced its development. Direct observation of very young infants and their mothers began in the latter half of the 20th century, and the subsequent course shifted through the influence of developmental psychologists and ethologists. This review concludes with Dr. Stern's predictions and fears about future directions of the field.

Twenty years of exchanges between French and Romanian infant and child psychiatry

Twenty years of exchanges between French and Romanian infant and child psychiatry

Troubles du comportement et troubles fonctionnels du nourrisson : caractéristiques, interactions mère-enfant, alliance et évolution après une psychothérapie brève parent-enfant. Étude pilote

Functional and behavioral disorders are the most frequent reasons for consultation in infant psychiatry, but there are still few studies about the efficacy of parents-child psychotherapies. Functional disorders appear to be easier to treat than behavioral disorders. The aim of this study was: (1) to assess outcome after a brief psychotherapy in a population of 49 infants aged 3 to 30 months, presenting functional or behavioral disorders; (2) to compare characteristics before therapy and outcomes for children with functional disorders and with behavioral disorders, to have a better understanding of the worse outcome of children with behavioral disorders. Two assessments were performed, one before treatment and the second a month after the end of the therapy including the infant's symptoms (Symptom Check-list), parents' anxious and depressive symptoms (Hospital Anxiety and Depression scale) and mother-infant interactions (Crittenden Experimental Index of adult-infant relationship). The therapeutic alliance was assessed by the therapist and the parents after the first consultation (Working Alliance Inventory). The assessments after therapy show complete or partial improvement in the child's symptoms, in the mother's anxious and depressive symptoms and in the father's anxious symptoms. During interaction, the mothers become more sensible, the number of controlling and of unresponsive mothers decrease, while the children become more cooperative and less passive. Initial characteristics and outcome are however different according to the type of the child's disorder. The children with behavioral disorders are older and present an association of several symptoms. The disorder onset is later. Their mothers are, before therapy, more anxious and depressive. The therapeutic alliance is weaker. After therapy, despite the fact that their mothers' affective state and that interactive behavior improves, the mothers are more anxious and less sensible, while the children no longer differ from the group without behavioral disorder from the point of view of opposition (assessed during mother-child interaction). Although this study is limited by the lack of a control group and the sample size, it underlines some particularities of infants and toddlers presenting behavioral disorders and the difficulties involved in their treatment. One can wonder if these characteristics are specific of the behavioral disorders or if they are the result of an older dysfunction, complicated by the developmental evolution of the child and the duration of the difficulties. The small number of cases, among the children with behavioral disorders, presenting a preexistent functional disorder, the absence of difference in the duration of the disorders, and the different disorder's onset plead in favor of the first hypothesis. The behavioral disorders often associate child psychopathology, dysfunctional parents-child-relationships and environmental factors difficult to modify with a brief therapy focused on the relationship. It would appear necessary to develop specific treatments for this population.

Comparison of ICD-10 and DC: 0-3R Diagnoses in Infants, Toddlers and Preschoolers

The purpose of this study was to analyze and compare diagnoses of patients from a special outpatient department for infants, toddlers and preschoolers. Specifically, overlap, age and gender differences according to the two classification systems DC: 0-3R and ICD-10 were examined. 299 consecutive children aged 0-5; 11 years received both ICD-10 and DC: 0-3R diagnoses. All ICD-10 diagnoses were given prospectively at the initial contact. The DC: 0-3R diagnoses were allotted in mutual consensus conferences. The most common ICD-10 disorders were Oppositional Defiant (ODD), Hyperkinetic (HKD) and Emotional Disorders. In DC: 0-3R, nearly half of the children could not be coded adequately ('Other Disorders'). Sleep Behavior Disorders were followed by Feeding Behavior and Regulation Disorders. Both classification systems are needed in infant, toddler and preschool psychiatry. There is a good concordance of the two systems for Feeding, Sleeping, Adjustment and Attachment Disorders, whereas the ICD-10 diagnoses HKD and ODD are not adequately represented in DC: 0-3R.

In This Issue/Abstract Thinking: Back to the Future

In this third installment of the 50th anniversary celebration of the Journal, Dr. Theodore Shapiro, Professor Emeritus and Director of Infant Psychiatry at Weil Cornell Medical College, provides historical perspective on foundational studies in early child development (p. 207). He provides the context through which studies on mother–infant dyads emerged, starting with rudimentary initial observations of infants in typical and stressed conditions and progressing to extensive case observations guided by principles of scientific inference examining the complex interactions between infants and their caregivers over the course of development.

Tyano, S., Keren, M., Herrman, H., Cox, J. (eds). Parenthood and mental health (a bridge between infant and adult psychiatry)

Tyano, S., Keren, M., Herrman, H., Cox, J. (eds). Parenthood and mental health (a bridge between infant and adult psychiatry)

Early intervention: Bridging the gap between practice and academia

Prevention and early intervention have increasingly become a focus of basic and applied research in child and adolescent psychiatry. In recent years, the emergent field of infant psychiatry has made significant progress. Many countries in the world try to invest more in prevention and intervention programs at the beginning of life, in an effort to decrease later health costs related to psychiatric disorders in childhood and adolescence. Child and Adolescent Psychiatry and Mental Health (CAPMH) provides an international forum for addressing important and timely issues in child mental health. In this context, we present a special section on early intervention in infants and preschoolers, in order to give an overview of the latest developments in this field and new research and practical reports from different settings and countries.

Forthcoming WPA publications.

Forthcoming WPA publications.

Les troubles des conduites : approche diagnostique et thérapeutique

The authors have taken advice of numerous theorists and specialists of the French Infantile Psychiatry, in the aim to clarify the management of the conduct disorder in the infant psychiatry sectors. In this view, they first define the conduct disorder concept to understand the resulting care. Statistically, theses sectors are highly concerned by those pathologies, which Educative, Therapeutic and Pedagogic institutes (ITEP) are in charge of, at the adolescence. During the first consultations, the psychiatrists for children have a diagnosis and therapeutic approach vary according to the cross-section of life. The authors have chosen the cross-section of life depending on the education, which reflects quite well the organisation of the care. The main characteristics of the care are individual factors, their adaptability to the capacity and the needs, the pluriprofessionality and the environment resource. Finally, their work implies rich possibilities of research that would set to work the different actors together. To succeed, it would need pilots, collaborations and means of professionals.

Infant psychiatry, its relevance for adult psychiatry

Infant psychiatry, its relevance for adult psychiatry

Perinatal and Infant Psychiatry

Perinatal and Infant Psychiatry

Diagnostik und Klassifikation von Verhaltensauffälligkeiten bei Säuglingen und Kleinkindern von 0-5 Jahren

The Article is working on developmental psychopathology, diagnosis, and treatment of behavioral problems in infants and toddlers age 0 to 5. An overview of the literature about the international discussion is given. In particular diagnostic classification is elaborated by mentioning the revision of "Diagnostic Classification 0-3 (DC: 0-3R)" and "Research Diagnostic Criteria-Preschool Age (RDC-PA)". State of the art and clinical implication is reported on the basis of principal considerations on infant psychiatry. The american practice parameters become adapted and a working title for diagnostic formulation is given. More research should be done against the background of the introduced standards.

Mother–Infant Psychotherapy and Perinatal Psychiatry: Current Clinical Practice and Future Directions

To explore trends in the practice of mother-infant psychotherapy among perinatal psychiatry clinicians based in Melbourne. A cross-sectional survey with a purpose designed self-report questionnaire was used to assess the attitudes and practices of 47 perinatal and infant psychiatry clinicians in their use and understanding of mother-infant psychotherapy. Seventy per cent of clinicians in this field of psychotherapy who responded to the questionnaire subscribe to a psychodynamic model, although cognitive behavioural models are also used. The interventions were mostly used in conjunction with other interventions, would be more accurately described as 'parent-infant psychotherapy', and non-psychiatrists in the area tended to be more likely to be formally trained in psychotherapy, but only 4% were formally trained in specific mother-infant psychotherapy. There was a unanimous request for further clinical training in this area. The emerging field of perinatal psychiatry needs to develop coherent therapeutic models and conduct outcome trials on specific interventions. Specific trainings in these models, in assessment and in diagnostic frameworks are required to enhance clinical efficacy, for research and service development purposes.