Disorder and Risk
for Disorder during Infancy
Charles H. Zeanah
Sameroff (1992) has noted that the study of behavior in context was the most significant advance in developmental research in the latter part of the 20th century. This is no surprise to those who study, observe, or treat infants and young children; all of these professionals must be impressed again and again with the extraordinary importance of context for infant development. Increasingly, the infant's relationship with the primary caregiver has been considered the most important context in which to consider infant development and psychopathology (Crockenberg & Leerkes, 2000; Zeanah, Larrieu, Valliere, & Heller, 2000).
Nevertheless, this observation also underscores a major challenge of attempting to conceptualize disorders of infancy. A series of questions challenges our efforts to define these disorders. Can infants be diagnosed as having within-the-person psychiatric disorders or are their symptoms relationship-specific? To what degree should the caregiving contexts of infants' development be considered an integral part of a relationship disorder, as opposed to an associated feature of individual disordered behavior? Are disturbed behaviors in infants indicative of disorder per se, or do they merely indicate risk for subsequent disorder? To what degree are we to take into account here-and-now suffering, or must we also demonstrate links between infant developmental disturbances and subsequent disorders? How we answer these questions may lead us in different directions.
There are, in fact, two major and quite different traditions in infant mental health regarding how to conceptualize psychiatric disturbances in young children. These approaches make different assumptions about disturbances, and seem likely to direct efforts at intervention differently as well.
One tradition (which has dominated research in developmental psychology and developmental psychopathology) suggests that infants may be considered as having a number of specific risk factors increasing, and/or protective factors decreasing, the probability that they will develop a given disorder in later childhood. These risk and protective factors may be biological (intrinsic), social (contextual), or both. Much of contemporary research has been devoted to detecting early “markers” of subsequent disorder, with the aim of delineating developmental pathways or trajectories of at-risk infants.
Another tradition (which has more clinical than empirical roots) suggests that infants may have