[Early restrictive feeding disorders: Quantitative assessment of parent/infant feeding interactions]. / Troubles du comportement alimentaire restrictif du nourrisson et du jeune enfant : évaluation quantitative des interactions parent/nourrisson pendant le repas.

INTRODUCTION: Interest in the study of early feeding disorders (FD) has steadily increased during recent decades. During this period, research described the importance of the transactional relationships and the complex interplay between caregiver and child over time. On the basis of the previous studies, our study tried to explore the associations between the characteristics of the parents and the temperamental characteristics of the infants with early FD. GOALS: A first aim of the present study was to show if parental perception of child temperament (including ability for arousal self-regulation) and parental characteristics (emotional and eating attitudes) are associated with early FD. A second aim was to identify emotional/behavioral difficulties in children with early FD by comparing children with a normal development and children with a diagnosed FD, and to investigate whether there are any correlations between parental emotional and feeding characteristics and a child's eating and emotional-behavioral development. A final aim was to explore if feeding conflict is bound to both infant ability for arousal self-regulatation and caregiver emotional status during meals. METHOD: Participants: 58 clinical dyads (children aged 1-36 months) and 60 in the control group participated in the study. The sample of 58 infants and young children and their parents was recruited in a pediatric hospital. They were compared to healthy children recruited in several nurseries. PROCEDURE: all parent-child pairs in the clinical sample were observed in a 20-minute video-recording during a meal using the procedure of the Chatoor Feeding Scale. After the videotaping, parents completed a battery of self-report questionnaires assessing their child's and their own psychological symptom status. MEASURES: Child's malnutrition assessment was based on the Waterlow criteria. The Child Behavior Checklist (CBCL 1½-5) was used to assess a child's emotional/behavioral functioning. The Infant Behavior Questionnaire-Revised (IBQ-R), a widely used parent-report measure of infant temperament, was used to identify the structure of infant temperament. The Eating Attitude Test-40, a self-report symptom inventory, was used to identify concerns with eating and weight in the adult population. The Chatoor Feeding Scale was used to assess mother-child feeding interactions during a meal based on the analysis of the videotaped feeding session. RESULTS: Analyses revealed that children with FD did not have a difficult temperament, especially no disability for arousal of self-regulatation, but their emotional-behavioral functioning is characterized by internalizing problems. Analyses of the EAT-40 showed that mothers of the children diagnosed with FD had significantly higher scores than mothers of the control sample; it means these mothers showed more dysfunctional eating attitudes. In addition, meals were characterized by negative effects in parents in the clinical group. When compared to the control sample, the feeding interactions between children with FD and their parents were characterized by low dyadic reciprocity, high maternal non-contingency, great interactional conflict and struggles with food. However, no significant correlation emerged either between the severity of malnutrition in infants or the conflict during feeding. CONCLUSION: Our study confirms the relations established in previous research. Finally, future longitudinal studies are needed to further clarify and investigate others factors that may be involved in early feeding disorders.

Interaction and behaviour imaging: a novel method to measure mother-infant interaction using video 3D reconstruction.

Studying early interaction is essential for understanding development and psychopathology. Automatic computational methods offer the possibility to analyse social signals and behaviours of several partners simultaneously and dynamically. Here, 20 dyads of mothers and their 13-36-month-old infants were videotaped during mother-infant interaction including 10 extremely high-risk and 10 low-risk dyads using two-dimensional (2D) and three-dimensional (3D) sensors. From 2D+3D data and 3D space reconstruction, we extracted individual parameters (quantity of movement and motion activity ratio for each partner) and dyadic parameters related to the dynamics of partners heads distance (contribution to heads distance), to the focus of mutual engagement (percentage of time spent face to face or oriented to the task) and to the dynamics of motion activity (synchrony ratio, overlap ratio, pause ratio). Features are compared with blind global rating of the interaction using the coding interactive behavior (CIB). We found that individual and dyadic parameters of 2D+3D motion features perfectly correlates with rated CIB maternal and dyadic composite scores. Support Vector Machine classification using all 2D-3D motion features classified 100% of the dyads in their group meaning that motion behaviours are sufficient to distinguish high-risk from low-risk dyads. The proposed method may present a promising, low-cost methodology that can uniquely use artificial technology to detect meaningful features of human interactions and may have several implications for studying dyadic behaviours in psychiatry. Combining both global rating scales and computerized methods may enable a continuum of time scale from a summary of entire interactions to second-by-second dynamics.

[Bipolar episodes in adolescents: diagnostic issues and follow-up in adulthood]. / Troubles bipolaires de type I de l'adolescent: controverses et devenir à l'âge adulte.

BACKGROUND: Little is known on the phenomenology and potential prognosis factors of bipolar episodes in adolescents. In particular, very few studies examine this issue on inpatients in the European context of free access to care. OBJECTIVE: To assess the follow-up in adulthood of acute manic and mixed episodes in hospitalized adolescents and the predictive value of psychological testing. METHODS: 80 subjects, aged 12 to 20 years, consecutively hospitalized for a manic or mixed episode between 1994 and 2003, were contacted in 2005-2006 for a follow-up assessment. 5 patients refused, 20 were lost, 55 patients were assessed by direct and complete interview (67%) or by phone and treating psychiatrist (33%). RESULTS: At index episode, the sample was characterized by severe impairment, high rates of psychotic features (N = 50, 62,5%), a long duration of stay (mean = 80,4 days), and an overall good improvement at discharge from hospital (86% very much or much improved). Half had a psychological testing before discharge. At follow-up (mean average 5 years), 35 patients still had a diagnosis of bipolar disorder. Eight changed life-time diagnosis for schizoaffective disorder and 11 for schizophrenia. Mortality and morbidity were severe with one subject who died from cardiac failure, and 91% of patients who had at least one relapse. Patients without relapse (N = 5) and patients showing a good social functioning (N = 19) remained with a diagnosis of bipolar disorder. Using a clinical global impression method, psychological testing (blind with follow-up status) was significantly correlated with transition to schizophrenia spectrum disorder. CONCLUSION: Contrarily to what is seen in less severe sample of bipolar disorder, changes in life time diagnosis can occur during follow-up after a manic or mixed episode in adolescence, as many patients are in the schizophrenia spectrum in adulthood.