Infant Psychiatry-Its Scope, Coherence and Clinical Utility

Article excerpt

Abstract: Background: Infant psychiatry claims to be a separate discipline within psychiatry. This article sets out to test that claim. Goals were to establish whether the field had meaningful boundaries; whether its practice related to a coherent body of research; and whether its assessments and syndromes had clinical utility. Methods: A descriptive, conceptually based review of the literature was undertaken. Established opinion was taken from authoritative textbooks and reviews, and compared with other articles from both keyword and citation-based literature searches. Results: Infant psychiatry is defined by three components. It focuses on children young enough to be socially absorbed primarily in the relationship with their main caretaker. It privileges these relationships, attempting to predicate psychopathology and treatment upon them. It then applies this basis to specific syndromes, their assessment and treatment. This approach has been conceptually and practically effective. Limitations include inadequate distinctions between the normal range of individual differences and psychopathology, and poor integration of constitutional hypotheses about infant difficulties. Conclusions: Infant psychiatry can support its claim to be a separate discipline, with an approach that is both distinctive and useful. Further advances in the field would benefit from collaborative research that would expand its interactionist perspective, and link differences to psychopathology.

Introduction: Definitions & Development

As a discipline, Infant Psychiatry is relatively recent. The first "Medline" citation using the term was in 1979 (1), and the first world conference with proceedings in 1980 (2). However, the same body of knowledge is also organized into other psychiatric disciplines that include infancy, e.g., developmental or perinatal psychiatry. In these circumstances, it is important to establish whether Infant Psychiatry is more than a "distinction without a difference." We need to know if the field has meaningful boundaries; whether its practice relates to a coherent body of research; and whether its assessments and syndromes have clinical utility.

In the first introductory textbook, Minde and Minde (3) authoritatively defined the scope of the field. It is clear from the text that their concerns extended at least to toddlerhood (around two to three years) and occasionally even older. Why then use the term "infant," which refers to a child of less than twelve months, before the acquisition of language? It is because their proposal for infant psychiatry is centrally concerned with the development and disturbances of mother-child interaction, from the perspective of the child. Their chapter on historical perspectives refers largely to child care. In considering emotional development, they largely reference research on mother-child interaction, with little reference to individualistic (temperament) data on emotions. They even observe that true infants require less individual assessment than older children (3, p. 60). Thus, despite the titular use of a term referring to chronological development, their view of infant psychiatry may be best conceptualized as the psychiatry of that period of social development when the child's interactions with its primary caretaker are paramount. The field having been defined, the next stage was to attempt to identify syndromes within it. The Mindes proposed five main groups of syndromes: Pervasive Developmental Disorders; Reactive Attachment Disorders of Infancy; Eating Disorders of Infancy; Sleep Disorders; and Disorders in Behavioral Organization.

In considering this proposal, we need to understand those aspects of normal development that relate to this field, both to assess the rationale of considering "infant psychiatry" a separate field, and to evaluate any classification of syndromes.

Development in Infancy & Early Childhood: Becoming a Social Animal

Consider some broad classes of symptoms of psychiatric concern: unhappiness; inappropriate elation; aggression; anxiety; indifferent isolation; expressions of an isolated view of reality; failure to use shared language appropriately. …