INFANT REGULATORY PROBLEMS

Question 1

EARLY DEVELOPMENTAL TASKS FOR SURVIVAL?

Answer 1

• PRE-PROGRAMMED/BIOLOGICALLY DETERMINED

FIRST 3 MONTHS:

• EARLY COMMUNICATION FOR SURVIVAL; CRYING/FUSSING
• STAYIING ALIVE AND GROWING THE BRAIN; SLEEPING
• NUTRITION INTAKE FOR SURVIVAL; FEEDING

Question 2

THE CRYING CURVE?

Answer 2

Many studies have shown that during the first three months of life, the crying of babies follows a developmental pattern. This pattern is called the crying curve. Crying begins to increase at two or three weeks of age, PEAKS AT AROUND 6 WEEKS to eight weeks of age, and gradually declines to the age of 12 weeks

• HUGE DIFFERENCES AMONG BABIES

Question 3

% OF FUSSING AND CRYING IN 0-3 MONTHS OLD BABIES WHICH IS INCONSOLABLE? (CANNOT BE COMFORTED)

Answer 3

40%

Question 4

BIOLOGICAL REGULATION; CRYING (0-3 MONTHS OLDS)

Answer 4

• NORMAL ADAPTATION PROCESS
• 40% OF FUSSING AND CRYING IS INCONSOLABLE
• DECREASES AFTER 3 MONTHS AND BECOMES INSTRUMENTAL (I.E. REINFORCED BY ATTENTION)
• NO IMPACT ON LATER BEHAVIOURAL PROBLEMS

Question 5

ESTABLISHING SLEEPING PATTERNS IN NEWBORNS?

Answer 5

NEWBORN: SLEEP PERIODS OF 2-4 HOURS EQUALLY DISTRIBUTED ACROSS THE DAY (MULTIPHASIC)

• BETWEEN 2-4 WEEKS OF AGE SLEEPING BECOMES MORE REGULAR
• WHEN THE INFANT STARTS SLEEPING THROUGHOUT THE NIGHT VARIES WIDELY (SOME IN THE FIRST 6 WEEKS, OTHERS NOT UNTIL 6 MONTHS)
• ‘SLEEPING THROUGH THE NIGHT’ DEFINED AS UNINTERRUPTED SLEEPING FOR 6 HRS, FROM MIDNIGHT TO 6AM

Question 6

% OF BABIES WHO WON’T ACQUIRE ABILITY TO SLEEP THROUGH THE NIGHT (DEFINED AS UNINTERRUPTED SLEEPING FOR 6 HRS, FROM MIDNIGHT TO 6AM) IN THEIR FIRST YEAR OF LIFE?

Answer 6

20-25%

Question 7

% OF INFANTS THAT SLEEP >5 HRS IN ONE PIECE AT 3 MONTHS OF AGE?

Answer 7

45%

Question 8

CAN INFANT RESETTLE THEMSELVES TO SLEEP AFTER WAKING UP DURING NIGHT, AND HOW?

Answer 8

• INFANTS ARE CAPABLE OF RESETTLING THEMSELVES TO SLEEP IN THE FIRST 3 MONTHS OF AGE
• THE MAJOR SELF REGULATORY STRATEGY IS SUCKING FINGERS

Question 9

BASIC SLEEP ORGANISATION IN INFANTS RESEMBLES THAT OF ADULTS BY WHICH MONTH OF AGE?

Answer 9

BY 6 MONTHS (RESEMBLES IN THE SENSE THAT IT’S PHASIC, BUT THEY HAVE MUCH MORE REM SLEEP)

Question 10

HOW MUCH OF INFANT WAKING TIME IS SPENT FEEDING?

Answer 10

1/3

Question 11

INFANT WEIGHT IN THE FIRST MONTHS OF DEVELOPMENT?

Answer 11

INFANTS DOUBLE THEIR WEIGHT IN THE FIRST 3-6 MONTHS; TREBLE (x3) IT BY 12 MONTHS

Question 12

NIGHT FEEDING IS NEEDED FOR INFANTS IN THE FIRST…

Answer 12

3 MONTHS OF LFIE

Question 13

WHEN ARE SOLIDS INTRODUCED INTO INFANTS’ DIETS?

Answer 13

3-6 MONTHS (WHO RECOMMENDS 6)

Question 14

SENSITIVE WINDOW FOR SOLIDS?

Answer 14

• 4-8 MOTNHS OF AGE
• SALT PREFERENCE
• AFTER THE 8TH MONTH VERY DIFFICULT TO INTRODUCE SOLIDS

Question 15

CULTURALLY COMMON MATERNAL BIOLOGICAL RESPONSES TO INFANT CRY?

Answer 15

• SAME ACTIVATION PATTERNS IN SPECIFIC BRAIN REGIONS (SUPERIOR TEMPORAL AND INFERIOR FRONTAL)
• MOST COMMON BEHAVIOUR IS TO: TALK, PICK UP THE BABY, AND THEN FEED THE BABY
• SOUND OF CRYING LEADS TO RELEASE OF OXYTOCIN FROM THE POSTERIOR PITUITARY GLAND AND PROLACTIN FROM INTERIOR PITUITARY GLAND, LEADING TO MILK FILLING UP THE BREASTS AND BEING RELEASED

Question 16

INFANT REGULATORY PROBLEMS (RPs)?

Answer 16

PERISTANCE OF INHIBITION PROBLEMS BEYOND PERIOD OF ADAPTATION (3-6 MONTHS)

(INFANT REGULATION MEANS INHIBITING A CURRENT RESPONSE AND RETURNING TO A PREVIOUS BEHAVIOURAL STATE)

Question 17

% OF INFANTS WHO HAVE MULTIPLE REGULATORY PROBLEMS?

Answer 17

UP TO 15%

Question 18

% OF INFANT WHO HAVE PERSISTENT REGULATORY PRROBLEMS (LASTING BEYOND THE FIRST 12 MONTHS OF LIFE)

Answer 18

10%

Question 19

WHAT ARE THE INFANT REGULATORY PROBLEMS AT 3-9 MONTHS?

Answer 19

CRYING: INABILITY TO STOP CRYING: EXCESSIVE CRYING > 3 MONTHS

FEEDING: FOOD REFUSAL, THE INABILITY TO OVERCOME NEOPHOBIA: E.G. INABILITY TO ACQUIRE FOOD ACCEPTANCE

SLEEPING; SLEEP ONSET AND NIGHT WAKING PROBLEM, THE INABILITY TO SETTLE BACK TO A PREVIOUS STATE: E.G. INABILITY TO PERFORM NIGHT SETTLING

Question 20

BIO BEHAVIOURAL SHIFTS? WHEN DO REGULATORY PROBLEMS OCCUR?

Answer 20

1st: 3-6 MONTHS OLD
2nd: 9-12 MONTHS OLD
- REGULATORY PROBLEMS OCCUR WHEN REGULATION IS NOT ACCOMPLISHED AFTER THE 1ST BIO-BEHAVIOURAL SHIFT

Question 21

IS IT MORE COMMON FOR INFANT REGULATORY PROBLEMS TO COME ALONE/BE INDIVIDUALISTIC OR THAT THERE IS CO-MORBIDITY OF REGULATORY PROBLEMS?

Answer 21

• MORE COMMONLY AN INFANT WILL HAVE MULTIPLE REGULATORY PROBLEMS (I.E. ‘MULTIPLE REGULATORY PROBLEMS’)

Question 22

MULTIPLE/PERSISTENT REGULATORY PROBLEMS IN INFANCY AND ATTENTION TRAJECTORY IN ADULTHOOD?

Answer 22

A STUDY FOUND:

• THOSE WITH MULTIPLE/PERSISTENT RPs IN THE FIRST 2 YEARS OF LIFE WERE 3 TIMES MORE LIKELY TO HAVE ATTENTION PROBLEMS (PARENT-REPORTED) IN ADULTHOOD

THEY WERE ALSO 0.5x AS LIKELY TO HAVE HIGH ATTENTION SPAN (TESTER/INDIVIDUALS-REPORTED)

• INCREASED AMOUNT OF ADHD DIAGNOSIS, (AT CHILDHOOD AND IN ADULTHOOD)

Question 23

SUMMARY OF LONG TERM CONSEQUENCES OF RPs?

Answer 23

• STRONG EVIDENCE THAT RPs ARE ASSOCIATED WITH INCREASED BEHAVIOUR AND EMOTIONAL PROBLEMS IN CHILDHOOD
• THE ASSOCIATIONS ARE WITH TOTAL, EXTERNALISING AND INTERNALISING PROBLEMS IN CHILDHOOD
• INCREASING EVIDENCE FOR ADHD TYPE PROBLEMS
• THERE IS EMERGING EVIDENCE THAT MULTIPLE OR PERSISTENT RPs ARE ASSOCIATED WITH PERSISTENT ADULT
  BEHAVIOUR, EMOTIONAL, SOCIAL AND ADHD PROBLEMS
• RPs ARE ASSOCIATED WITH ALTERATIONS OF BRAIN ACTIVITY PATTERNS, ESPECIALLY IN THE DEFAULT MODE NETWORK (The default mode network (DMN) is a network of interacting brain regions that is active when a person is not focused on the outside world, measurable with the fMRI technique), AND THIS MEDIATES BETWEEN RPs AND ANXIOUS AVOIDANT PERSONALITY

Question 24

ROLE OF PARENTING IN REGULATORY PROBLEMS?

Answer 24

• PARENTING VERY LOOSELY RELATED TO INITATION OF THE PROBLEMS (CPARENTING ISN’T THE CAUSE)
• BUT PARENTING BEHAVIOUR CAN REDUCE THE EFFECTS ON MENTAL HEALTH

Question 25

INSECURE VS DISORGANISED ATTACHMENT?

Answer 25

Infants with insecure/resistant attachment are extremely distressed by the separations and cannot be soothed at reunions, essentially displaying much distress and angry resistance to interactions with the caregiver.

Disorganized attachment develops from a parent’s consistent failure to respond appropriately to their child’s distress, or by a parent’s inconsistent response to their child’s feelings of fear or distress. For example, a child might be distressed to be left with a new babysitter or unfamiliar caregiver. Characterised by not having an organised strategy dealing with separation and reunions.

Question 26

A STUDY LOOKING INTO ATTACHMENT STYLE AND INFANT REGULATORY PROBLEMS, FINDINGS?

Answer 26

CRYING AND SLEEPING PROBLEMS & INSECURE ATTACHMENT AT 18 MONTHS:

• crying and sleeping problems at 3 months WERE NOT significantly associated with insecure attachment at 18 months
• maternal sensitivity was the significant predictor for insecure attachment

CRYING AND SLEEPING PROBLEMS & DISORGANISED ATTACHMENT AT 18 MONTHS:

• crying and sleeping problems WERE SIGNIFICANTLY associated with increased disorganised attachment at 18 months; sensitive parenting had no bearing on disorganised attachment
• crying and sleeping problems also influenced maternal depressive symptoms, which contribute to disorganised attachment

Question 27

DEVELOPMENTAL CASCADE MODEL?

Answer 27

In developmental cascade models, risk factors assessed in early childhood are hypothesized to foster increased exposure to risk processes assessed in early, then later middle childhood, and ultimately to adolescent behavior.

(E.G. REGULATORY PROBLEMS CAUSE A CASCADE OF EVENTS IN ADOLESCENCE AND ADULTHOOD, THEY OPERATE ACCORDING TO A CASCADE MODEL —> THE EARLIER WE INTERVENE WITH RPs THE MORE LIKELY WE REDUCE THE RISK ON DYSREGULATION AND LONG TERM COMSEQUENCE I.E. WE CONTROL THE CASCADE BETTER)

Question 28

EARLY MRPs (MULTIPLE/PERSISTENT REGULATORY PROBLEMS) EFFECTS IN CHILDHOOD AND ADOLESCENCE?

Answer 28

• MRPs DIRECTLY AND INDIRECTLY ASSOCIATED WITH ADOLESCENT DEPRESSION
• EARLY MRPs PUT CHILDREN ON A TRAJECTORY OF DYSREGULATION WHICH INCREASES THE RISK OF SEVERAL PSYCHOPATHOLOGIES
• MRPs ARE EARLY INDICATORS OF A VULNERABILITY TOWARDS DYSREGULATION THAT CAN PERSIST INTO ADULTHOOD

Question 29

1 IN HOW MANY CHILDREN HAS A DIAGNOSIBLE MENTAL HEALTH DISORDER?

Answer 29

1/5