Association between parent-infant interactions in infancy and disruptive behaviour disorders at age seven: a nested, case-control ALSPAC study.

BACKGROUND: Effective early intervention to prevent oppositional/conduct disorders requires early identification of children at risk. Patterns of parent-child interaction may predict oppositional/conduct disorders but large community-based prospective studies are needed to evaluate this possibility. METHODS: We sought to examine whether the Mellow Parenting Observational System (MPOS) used to assess parent-infant interactions at one year was associated with psychopathology at age 7. The MPOS assesses positive and negative interactions between parent and child. It examines six dimensions: anticipation of child's needs, responsiveness, autonomy, cooperation, containment of child distress, and control/conflict; these are summed to produce measures of total positive and negative interactions. We examined videos from the Avon Longitudinal Study of Parents and Children (ALSPAC) sub-cohort who attended the 'Children in Focus' clinic at one year of age. Our sample comprised 180 videos of parent-infant interaction: 60 from infants who received a psychiatric diagnostic categorisation at seven years and 120 randomly selected controls who were group-matched on sex. RESULTS: A negative association between positive interactions and oppositional/conduct disorders was found. With the exception of pervasive developmental disorders (autism), an increase of one positive interaction per minute predicted a 15% (95% CI: 4% to 26%) reduction in the odds of the infant being case diagnosed. There was no statistically significant relationship between negative parenting interactions and oppositional/conduct disorders, although negative interactions were rarely observed in this setting. CONCLUSIONS: The Mellow Parenting Observation System, specifically low scores for positive parenting interactions (such as Responsiveness which encompasses parental warmth towards the infant), predicted later psychiatric diagnostic categorisation of oppositional/conduct disorders.

Prediction of 7-year psychopathology from mother-infant joint attention behaviours: a nested case-control study.

BACKGROUND: To investigate whether later diagnosis of psychiatric disorder can be predicted from analysis of mother-infant joint attention (JA) behaviours in social-communicative interaction at 12 months. METHOD: Using data from a large contemporary birth cohort, we examined 159 videos of a mother-infant interaction for joint attention behaviour when children were aged one year, sampled from within the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. Fifty-three of the videos involved infants who were later considered to have a psychiatric disorder at seven years and 106 were same aged controls. Psychopathologies included in the case group were disruptive behaviour disorders, oppositional-conduct disorder, attention-deficit/hyperactivity disorder, pervasive development disorder, anxiety and depressive disorders. Psychiatric diagnoses were obtained using the Development and Wellbeing Assessment when the children were seven years old. RESULTS: None of the three JA behaviours (shared look rate, shared attention rate and shared attention intensity) showed a significant association with the primary outcome of case-control status. Only shared look rate predicted any of the exploratory sub-diagnosis outcomes and was found to be positively associated with later oppositional-conduct disorders (OR [95% CI]: 1.5 [1.0, 2.3]; p = 0.041). CONCLUSIONS: JA behaviours did not, in general, predict later psychopathology. However, shared look was positively associated with later oppositional-conduct disorders. This suggests that some features of JA may be early markers of later psychopathology. Further investigation will be required to determine whether any JA behaviours can be used to screen for families in need of intervention.

Developing Pretend Play in Autistic Children Using the Playboxes Joint Play Approach as Part of Ongoing Practice.

A repeated measures single subject design was used to examine the effectiveness of a joint play approach embedded in professional practice, in supporting pretend play for autistic children. Seven autistic children, aged 5-8 years, with a placement within a specialist educational provision, and who demonstrated restricted play, participated in weekly sessions using the Playboxes approach over a period of 3 months. Pre- and post-approach pretend play abilities were assessed using the Symbolic Play Test and the Test of Pretend Play. Every child gained increased age-equivalent scores on the Test of Pretend Play, ranging from + 8 to + 30 months. Pretend Play abilities can support developmental outcomes and incorporation of this approach into regular practice could be of value for autistic children.

Motor activity at age one year does not predict ADHD at seven years.

We have examined the predictive utility of motor activity in infancy towards diagnosis of attention deficit hyperactivity disorder (ADHD) in later childhood. We conducted a nested case-control study using videos of infants in the Avon Longitudinal Study of Parents and Children (ALSPAC). Sixty videos of children who received any Development and Well-being Assessment (DAWBA) psychiatric diagnosis at age 91 months (including 16 with ADHD) plus two controls per case were selected for data analysis. Body movements were measured at age one year: associations between motor activity-derived variables using factor analysis, and later ADHD diagnoses were sought. No significant association was found between infant motor activity and later ADHD. A positive association between motor activity and inattentive ADHD was found in males. Motor activity at age one year did not predict ADHD at age seven years. The positive association with inattentive ADHD in males requires further investigation.

Inexpensive video cameras used by parents to record social communication in epidemiological investigations in early childhood-A feasibility study.

We tested the feasibility of parents recording social interactions with their infants using inexpensive camcorders, as a potential method of effective, convenient, and economical large scale data gathering on social communication. Participants were asked to record two short video clips during either play or a mealtime, and return the data. Sixty-five video clips (32 pairs) were returned by 33 families, comprising 8.5% of families contacted, 44.6% of respondents and 51.6% of those sent a camcorder, and the general visual and sound quality of the data was assessed. Audio and video quality were adequate for analysis in 85% of clips and several social behaviours, including social engagement and contingent responsiveness, could be assessed in 97% of clips. We examined two quantifiable social behaviours quantitatively in both adults and infants: gaze direction and duration, and vocalization occurrence and duration. It proved difficult for most observers to obtain a simultaneous clear view of the parents and infant's face. Video clips obtained by parents are informative and usable for analysis. Further work is required to establish the acceptability of this technique in longitudinal studies of child development and to maximize the return of usable data.

Sadness in mothers' 'baby-talk' predicts affective disorder in adolescent offspring.

'Baby-talk' is common across cultures. It underpins infant vocal preferences, and helps regulate infant engagement. Its longer-term significance is unclear. In a longitudinal study, we found indications of 'sadness' in postnatally depressed mothers' baby-talk statistically mediated effects of maternal depression on offspring adolescent affective disorder.

Reactive attachment disorder--a theoretical model beyond attachment.

Despite its importance in public health, reactive attachment disorder (RAD) is an under-researched and little used clinical category. Abnormalities of social relatedness have long been documented in children who have been abused, neglected or institutionalised, but there have been more recent efforts to define these behaviours within the psychiatric nosology. There has been an implicit assumption that the central deficit in RAD is in the attachment system, but this has caused controversy and may have blocked research. We propose that RAD is better construed within the framework of intersubjectivity, which has a central role in the development of core brain and social functions and may also have had an important role in the evolution of a key human characteristic-complex social functioning. This broader framework may potentially explain apparently diverse symptoms such as indiscriminate friendliness and negative or unpredictable reunion responses. Finally, we suggest that a change of name may be useful in progressing the field, but accept that this may be difficult until there is better agreement in the clinical and scientific communities about the core features and aetiology of this disorder.