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.
BackgroundEffective 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.MethodsWe 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.ResultsA 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.ConclusionsThe 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.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2431-14-223) contains supplementary material, which is available to authorized users.
To establish which social interactive behaviours predict later psychiatric diagnosis, we examined 180 videos of a parent-infant interaction when children were aged one year, from within the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort. Sixty of the videos involved infants who were later diagnosed with a psychiatric disorder at seven years, and 120 were a randomly selected sex-matched control group. Interactive behaviours for both the caregiver and the one year old infant were coded from the videos according to eight holistic categories of interpersonal engagement: Well-being, Contingent Responsiveness, Cooperativeness, Involvement, Activity, Playfulness, Fussiness, and Speech. Lower levels of adult activity and speech in interaction at one year significantly predicted overall diagnosis of child psychiatric disorder.
This article and the four videos linked to this article are a result of the earliest experiences in establishing an international research collaboration among seven countries in the Project Social and emotional experiences in transition through the early years. We draw attention to the complex issues surrounding the many processes, beliefs and attitudes about infants in research that permeated our processes of gaining ethical approval for the international study and which posed many challenges for our project. Through a process of reflective analysis, we have identified a range of ethical tensions and issues which the different countries involved in this international study faced in gaining ethical approval from their institutional ethical committees for their collaborative participation. More specifically, we identify one persistent tension concerning the use of video data in research on young children. This tension is a result of diverse interpretations of international ethical codes, alongside local restrictions and ethics review processes. It illuminates various positions concerning the protection of infants' privacy versus the benefits of using non-anonymous video data both in joint analysis, and even further, in open publishing. Such positions have been widely debated in research with adults, whereupon many of the ethically challenging questions have been dealt with through processes of acquiring informed consents from the participants. In case of infants, however, the role and nature of informed consents is different from research with adults, as is the role of the adult in using infant 'data' in research. For most cases, informed consents are acquired from the parents or the legal guardians that are not necessarily present on a day-to-day basis in the actual data collection process in early years educational settings. The question of children's own assents for study is widely debated and this is no less so in the project we present in this paper. On the basis of the experiences in this international collaboration, and the challenges and tensions identified in between diverse cultural context and ethical review boards and practices, we propose that more dialogue in relation to research ethics on video research is needed within the diverse research communities and (Continued on next page)
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