Abstract
The aim of our study is to report the relation between pathological care and impairment in social interaction, communication, language development, and stereotypical behaviors. Fifteen cases (9 boys, 6 girls) who have the symptoms listed above and who were misdiagnosed with pervasive developmental disorder (PDD), were referred to our clinic for evaluation and treatment. After the cases were evaluated by a semi-structured interview, symptoms related to pathological care were fortified; maternal depressive symptoms associated with child neglect and overexposure to television viewing. The cases and the mothers/primary caretakers were treated in a standardized psycho-educational program of 3 months. After this period improvements were observed in all of the symptom clusters. Twelve cases (80%) had improvements in eye contact. Eleven cases (73.3%) began to engage in reciprocal play and ten cases (66.6%) showed social imitative behaviors. Six cases (40%) began to form sentences. Stereotypic behaviors diminished in six cases (40%) and disappeared in nine cases (60%). According to our findings, although the symptoms of PDD and reactive attachment disorder (RAD) resemble each other, presence of pathological care and good response to treatment in RAD can be important for the differential diagnosis with PDD.
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References
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, 3rd revision. Washington DC, 1980.
Skuse D: Extreme deprivation in early childhood. Theoretical issues and a comperative review. J Child Psychol Psychiat 25(4): 543–572, 1984.
Dennis W: The effect of cradling practices upon the onset of walking in Hopi children. J Genet Psychol 56: 77–86, 1940.
Davis K: Final note on a case of extreme isolation. Am J Sociol 52: 432–437, 1947.
Koluchova J: Severe deprivation in twins; A case study. J Child Psychol Psychiatr 13: 107–114, 1972.
Koluchova J: The further development of twins after severe and prolonged deprivation: A second report. J Child Psychol Psychiatr 17: 181–188, 1976.
Douglas JE & Sutton A: The development of speech and mental processes in a pair of twins; A case study. J Child Psychol Psychiatr 19: 49–56, 1978.
Richters MM & Volkmar FR: Reactive attachment disorders of infancy or early childhood. J Am Acad Child Adolescent Psychiatry 33(3): 328–332, 1994.
Spitz R: Hospitalism; an inquiry into the genesis of psychiatric conditions in early childhood. Psychoanal Study of Child 1: 53–74, 1945.
Bowlby J: Maternal care and mental health. World Health Organisation Geneva, 1951.
Bowlby J: Attachment and loss. Vol I, Attachment. Penguin Books, Harmondsworth, 1969.
Rutter: Maternal Deprivation Reassessed. Penguin Books, London, 1981.
Provence SA: Separation and deprivation. Child Adolescent Psychiatry: A Comprehensive Textbook, ed. Lewis M. Williams & Wilkins, 376–88, 1991.
Minde K: The effect of disordered parenting on the development of children. Child Adolescent Psychiatry: A Comprehensive Textbook, ed. Lewis M. Williams & Wilkins, 394–407, 1991.
Provence SA & Lipton RC: Infants reared in institutions. International University Press, New York, 1962.
Gaensbauer TJ & Sands M: Distorted affective communication in abused/neglected infants and their potential impact on caregivers. J Am Acad Child Adolescent Psychiatr 18: 236–250, 1979.
Richters MM & Volkmar FR: Reactive attachment disorders of infancy or early childhood. Child and adolescent psychiatry, second edition, ed. Williams & Lewis M. Wilkins, 498–502, 1996.
Zeanah CH & Emde RN: Attachment disorders of infancy or childhood. In Child and Adolescent Psychiatry 3rd ed. Rutter M, Hersov L & Taylor L., eds. London, Blackwell, 490–504, 1994.
Alessandri SM: Play and social behaviours in maltreated preschoolers. Development and Psychopathology 3: 191–206, 1991.
Coster WJ, Gersten MS, Beegly M et al.: Communicative function in maltreated toodlers. Development and Psychopathology 25: 1020–1029, 1989.
Skuse D, Bentovim A: Physical and emotional maltreatment. In Child and Adolescent Psychiatry 3rd ed. Rutter M, Hersov L & Taylor L., eds. London, Blackwell, 209–228, 1994.
World Health Organisation: International classification of diseases 10th ed. diagnostic criteria, 1990.
American Psychiatric Association, Diagnostic Statistical Manual of Mental Disorders 4th ed. Washington DC, 1994.
Weinberg MK, Tronick EZ: Maternal depression and infant maladjustment: Failure of mutual regulation. Handbook of Child and Adolescent Psychiatry, vol 1, eds. Greenspan S, Wigder S, Osofsky J. 177–191, 1997.
Field T: Early interactions between infants and their postpartum depressed mothers. Infant Behavior and Development 7: 512–522, 1984.
Murray L, Kempton C, Woogar M, Hooper R: Depressed mothers speech to their infants and its relation to infant gender and cognitive development. J Child Psychology and Psychiatry 34(7): 1083–1101, 1993.
Field T, Healy B, Goldstein S, Guthertz M: Behavior state matching and synchrony in mother-infant interactions of non-depressed versus depressed dyads. Developmental Psychology 26(1): 342–347, 1990.
Lyons-Ruth K: Brodening our conceptual framework: Can we reintroduce relational strategies and implicit representational systems to the study of psychopathology. Developmental Psychology 31(3): 432–436, 1995.
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Mukaddes, N.M., Bilge, S., Alyanak, B. et al. Clinical Characteristics and Treatment Responses in Cases Diagnosed as Reactive Attachment Disorder. Child Psychiatry Hum Dev 30, 273–287 (2000). https://doi.org/10.1023/B:CHUD.0000037154.77861.21
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DOI: https://doi.org/10.1023/B:CHUD.0000037154.77861.21