Diagnostic boundaries between regulatory and multisystem developmental disorders: A clinical study

The association of infant crying, feeding, and sleeping problems and inhibitory control with attention regulation at school age

Regulatory problems in infancy and toddlerhood have previously been associated with an increased risk of developing attention problems in childhood. We hypothesized that early regulatory problems are associated with attention problems via reduced inhibitory control. This prospective study assessed 1,459 children from birth to 8 years. Crying, feeding, and sleeping problems were assessed at 5 and 20 months via parent interviews and neurological examinations. At 20 months, inhibitory control was tested with a behavioral (snack delay) task. Attention regulation was assessed at 6 and 8 years using multiple instruments and informants. Detrimental effects of crying, feeding, and sleeping problems on attention regulation were partly mediated by children's ability to inhibit unwanted behaviors (β = -0.04, p = 0.013). Accounting for cognition diminished this indirect effect (β = -0.01, p = 0.209). Instead, the effects of crying, feeding, and sleeping problems on attention regulation were fully mediated by children's cognitive functioning (β = -0.10, p < 0.001). These results support that inhibitory control abilities partly mediate effects of crying, feeding, and sleeping problems. However, these effects may be accounted for by children's general cognitive abilities. Early regulatory problems may set infants on a course of under control of behavior into school age, and such trajectories are highly associated with general cognitive development.

The role of sensory modulation deficits and behavioral symptoms in a diagnosis for early childhood

To contribute to the validation of the sensory and behavioral criteria for Regulation Disorders of Sensory Processing (RDSP) (DC:0-3R, 2005), this study examined a sample of toddlers in a clinical setting to analyze: (1) the severity of sensory modulation deficits and the behavioral symptoms of RDSP; (2) the associations between sensory and behavioral symptoms; and (3) the specific role of sensory modulation deficits in an RDSP diagnosis. Based on clinical observations, 78 toddlers were classified into two groups: toddlers with RDSP (N = 18) and those with "other diagnoses in Axis I/II of the DC:0-3R" (OD3R; N = 60). The parents completed the Infant Toddler Sensory Profile and the Achenbach Checklist. The results revealed that the RDSP group had more severe sensory modulation deficits and specific behavioral symptoms; stronger, although not significant, associations between most sensory and behavioral symptoms; and a significant sensory modulation deficit effect. These findings support the validity of RDSP.

Regulatory disorders in early childhood: Correlates in child behavior, parent-child relationship, and parental mental health

According to the guidelines published by the German Society of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (2007), regulatory disorders of early childhood are characterized by a symptom triad, including (a) behavioral symptoms such as excessive crying, sleeping, or feeding problems; (b) a disturbed parent-child relationship; and (c) parental psychopathology. On the basis of a clinic-referred sample of 162 children, we examined whether children with and without regulatory symptoms differed in the quality of parent-child relationship and parental mental health, and how often the criteria of the symptom triad were fulfilled in the group of children with regulatory symptoms. In addition, emotional and behavior problems were compared in children with and without regulatory symptoms. Children with regulatory symptoms and children with other psychiatric symptoms did not differ with respect to child-parent relationship quality. However, parents of children with regulatory symptoms scored higher on the Symptom Checklist 90 Items-Revised (G.H. Franke, 2002) than did the other parents. On the Child Behavior Checklist (T.M. Achenbach & L.A. Rescorla, 2000), children with regulatory symptoms tended to show more somatic problems, but they showed significantly less withdrawn behavior than did the other children. Of the 67 children with regulatory symptoms, only 11 (16.4%) fulfilled all three criteria of a regulatory disorder.

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.