Affect Expression and Self-Regulation Capacities of Infants Exposed in utero to Psychotropics.

This study explored the affect expression and self-regulation capacities of 8-month-old infants exposed in utero to psychotropic medications. This was a continuation of our previous study conducted on the same cohort when the infants were 3 months old. Psychotropics implicated included selective serotonin reuptake inhibitors (SSRIs), and a benzodiazepine derivative anxiolytic (clonazepam). The three comparison groups were: control (n = 23; infants not exposed to psychotropics in utero), SSRI-alone (n = 22; infants exposed to SSRIs only and having mothers who had a primary diagnosis of depressive disorder without having comorbid anxiety disorder), and SSRI+ group (n = 15; infants gestationally exposed to SSRIs and clonazepam and having mothers that had both clinical depression and anxiety disorder). Using the Parent-Child Early Relational Assessment Scale, infants were assessed in a dyadic context during free play and a structured task. There were significant differences in psychotropic exposed and non-exposed dyads regarding infant negative affect management. There were significant associations between the SSRI+ group of mothers and infant negative affect. This group of mothers also showed significant associations with infants' averting and avoiding behaviors in both play situations. The SSRI-alone group was similar to the control group and showed variable associations with infant's positive, negative, and sober moods unlike the SSRI+ group. There were no differences in infants' capacity for self-regulation in psychotropic exposed and non-exposed groups. Increased awareness of these vulnerable subgroups (SSRI-alone and SSRI+) is needed, in order to safeguard these dyads through better support systems and improved management.

The role of pharmacotherapy in the management of self-regulation difficulties in young children.

OBJECTIVE: To review adjunctive pharmacotherapeutic options in the management of self-regulation difficulties in young children. METHODS: Review of available literature and clinical experience pertaining to use of psychiatric medications in preschool aged children (under age 6). RESULTS: Relatively few medications are approved for use in preschool aged children. Pharmacotherapy in this age group may include melatonin for sleep disorders, psychostimulants for Attention Deficit/Hyperactivity Disorder (ADHD), selective serotonin reuptake inhibitors (SSRI), second-generation antipsychotics, mood stabilizers and alpha-agonists. Medication efficacy and adverse effects in this age group are poorly characterized and limited by lack of age-appropriate monitoring scales and published clinical experience. CONCLUSION: As an adjunctive measure, pharmacotherapy is sometimes warranted in young children who are unable to self-regulate their physiological, emotional and behavioural responses.