Crib death: a biobehavioral phenomenon?

In developed countries, more children under 1 year of age die of crib death (sudden infant death syndrome, SIDS) than of all other causes combined. Researchers and clinicians have proposed many possible causes of SIDS, but the abrupt, unexpected death of some babies remains mysterious and frightening. Although infant behavior may explain some of these deaths, scant attention has addressed behavioral characteristics of babies who die without medical explanation. Any explanation of SIDS must account for the fact that most SIDS deaths occur at 2 to 5 months of age, acknowledging that a protective mechanism appears to spare babies before 2 months but then disappears. The respiratory occlusion reflex serves as an initial defense against smothering and can provide such an explanation. Infantile reflexes wane, after providing opportunities for learned responses to be acquired. During this well-documented neurobehavioral transition from subcortical to cortically mediated responding, some babies, viable for the first 2 months, may become especially vulnerable if they fail to acquire sufficiently strong defensive behaviors needed to prevent occlusion after the waning of the life-preserving reflex. Recent success of back-to-sleep directives, urging that babies sleep on their backs to avoid smothering, supports this hypothesis.     

Compulsive buying disorder: a review of the evidence

Compulsive buying disorder is characterized by excessive or poorly controlled preoccupations, urges, or behaviors regarding shopping and spending that lead to subjective distress or impaired functioning. Compulsive buying disorder is estimated to have a lifetime prevalence of 5.8% in the United States general adult population. In clinical settings, most individuals with compulsive buying disorder are women (approximately 80%). This gender difference may be artifactual. Compulsive buying disorder is typically chronic or intermittent, with an age of onset in the late teens or early 20s. Comorbid mood and anxiety disorders, substance use disorders, eating disorders, and other disorders of impulse control are common, as are Axis II disorders. The disorder occurs worldwide, mainly in developed countries with market-based economies, and it tends to run in families with mood disorders and substance abuse. There is no standard treatment for compulsive buying disorder, but group cognitive-behavioral models seem promising, and psychopharmacologic treatments are being actively studied. Other treatment options include simplicity circles, 12-step programs, financial counseling, bibliotherapy, marital therapy, and financial counseling. Directions for future research are discussed.     

Hospital-Treated Psychiatric Disorders in Adults with a Single-Parent and Two-Parent Family Background: A 28-Year Follow-up of the 1966 Northern Finland Birth Cohort

This study investigates the relationship between the family type (two-parent and 4 different single-parent types, mainly divorced) during childhood up to 14 years of age and adult hospital-treated psychiatric disorders in a sample from the unselected, general population Northern Finland 1966 Birth Cohort (N = 11,017). Up to the end of 1994, a total of 387 individuals (3.5%) had a hospital-treated psychiatric disorder, with 3.1% in two-parent families and 5.4% in single-parent families (p < .001). The single-parent family was not associated with the child's schizophrenia or other psychotic disorders. The adjusted odds ratios (OR) for personality disorders were highest among individuals without a father before the age of 14 years (OR 4.8), or at birth only (OR 4.0), or with a history of parental divorce (OR 2.8). Parental divorce was also associated with alcoholism (OR 3.7) and parental death with depressive disorders (OR 3.4). In conclusion, we found an elevated risk of hospital-treated nonpsychotic disorder among individuals from a single-parent family background. It is likely that a combination of the single-parent family and psychosocial and/or genetic risk may influence the development of these disorders.     

Life or Death of Severely Disabled Infants: A Counseling Issue

Due to the death of a severely disabled infant from Bloomington, Indiana, a series of events set in motion by the U.S. Department of Health and Human Services has resulted in cautions to health care providers. The resulting policies and procedures warn hospital personnel against withholding nutritional sustenance or medical treatment from severely disabled infants. This article presents dimensions that might serve as a background for counselors to assist families in considering options related to disabled infants. These dimensions include the meaning of life, cost to benefit ratio, medical options, legal precedent, and a theological perspective. This issue is related to counseling practice through counselor ethics, values, and the need for information that counselors can provide to parents during the decision process.     

Stillbirth, neonatal death and Sudden Infant Death (SIDS): parental reactions

The differences between parental grief reactions following different types of infant losses were investigated. A total of 117 parents (55 couples) from three groups of parents (stillbirth, neonatal death and Sudden Infant Death), 53% women and 47% men, answered a survey on different grief reactions one to four years following the death. Included in the survey were psychometric measures relating to anxiety, depression, impact of event, bodily discomfort, and general wellbeing. The results demonstrated that the three groups differed in their experience of various grief reactions. Sudden Infant Death Syndrome (SIDS) parents reported significantly more anxiety and intrusive thoughts than the other two groups in the early post-loss period, as well as significantly more anger, restlessness, and sleep disturbances than the neonatal group. The SIDS parents also scored significantly higher on some of the measures (experience of recovery, IES intrusion) relating to how they felt at the time of study. While the death being sudden did not show any correlation with the parents experience of recovery or the psychometric measures, the length of time the child had lived showed a strong relationship to these measures. It is emphasized that counselling to parents must be based on increased knowledge about parental reactions, tailored to the individual family's needs.     

Risk,cost-effectiveness and profit: Problems in cardiovascular research and practice

Risk is the probability that within a certain time some expected negative event will take place. In medicine risk can be related to a decision or to some intrinsic factors which are associated with the probability of the occurrence of a disease. Decisions can be necessary in the individual life with respect to the question of visiting a physician or performing a certain diagnostic or therapeutic procedure. The introduction of new pharmaceutical or technical products into medical use are another set of decisions which can generate certain risks. Intrinsic or inherent risk factors are a set of variables or signs and symptoms which indicate the presence of a certain probability that some disease or event, e.g., arteriosclerosis or sudden infant death syndrome, may occur. Risk is always related to judgement. In a decision process cost, effectiveness and profit can be used to estimate the magnitude of the risk to be taken. In a similar way the problems in connection with an inherent risk are primarily related to the recognition of the magnitude of risk and to the possibility of prophylactic measures. In our own area of research, the sudden infant death syndrome (SIDS) is an event where only risk factors can be observed. We point at two facts in this context: Highly complex patterns of symptoms like behaviour can better be classified by intuitive Gestalt perception. A medical procedure like induction of labour can itself become a risk factor.     

Differential Effects of Child Difficulties on Family Burdens across Diagnostic Groups

Children with neurodevelopmental disorders, such as attention deficit hyperactivity disorder (ADHD), autism spectrum disorder (ASD), and intellectual disability (ID), have a variety of difficulties that can place considerable strain on their families. This study investigated the nature of family burdens (i.e., financial burden, need for respite, need for counseling, work changes, and care hours) by examining the effects of child characteristics (i.e., age, gender, and severity of condition), family characteristics (i.e., parent role, education, income, and number of children), and child difficulties (i.e., behavioral, adaptive, emotional, social, learning, and communicative). With representative survey data from parents of children with ADHD (n?=?8252), ASD (n?=?1448), or ID (n?=?949), ranging in age from 2 to 17 years old, we used Χ ², binary logistic regression, linear regression, and univariate analyses to answer our research questions. We found that parents of children with ADHD, ASD, and ID experienced different types and amounts of burdens, families of younger children experienced more burden than those of older children, and families with more income or more children experienced fewer burdens. Adaptive and behavioral difficulties had the greatest relative impact on families. Diagnosis moderated almost all of the relationships between child difficulties and family burden. Overall, these results suggest that providing services and supports that are tailored to the specific needs of each child and family will be necessary for enhancing quality of life.     

Women and anxiety disorders: implications for diagnosis and treatment. Proceedings of a conference, November 19-21, 2003, Chantilly, Virginia, USA

Community studies indicate that 19% of men and 31% of women will develop some type of anxiety disorder during their lifetime. The impact of gender is profound in that it increases the likelihood of developing an anxiety disorder by 85% in women compared to men. Sex difference in prevalence rates are apparent as early as age 6, when girls are twice as likely as boys to have an anxiety disorder. In the National Comorbidity Survey, the prevalence rates for panic disorder in women and men were 5% and 2%, respectively. Agoraphobia, which often coexists with panic disorder, has a lifetime prevalence rate of 7% in women and 3.5% in men. Prevalence of trauma is increased in young women as well, and is experienced earlier in life; 62% of sexual assaults are inflicted on females < or = 18 years of age, and 29% occur in children < 11 years of age. Comorbidity of anxiety in women complicates other medical conditions as well. For example, panic disorder is highly comorbid with CHD, which remains the leading cause of death in women in developed countries. Fluctuations in reproductive hormone levels during the female life cycle is thought to be responsible for modulating anxiety. This is often implicated in the later age of onset, the more sudden and acute symptom emergence, and the more episodic course of OCD in women, and in the high prevalence(47.4%) of PMDD. Pregnancy appears to be a protective period for some anxiety disorders, including panic, while for others, such as OCD, it may be associated with onset. Hormonal changes during pregnancy, such as increased prolactin, oxytocin, and cortisol, may contribute to the suppression of stress response that occurs during this period. Despite a large and growing body of literature on anxiety disorders in general, the available data relating to women and girls falls short of informing aspects of diagnosis, treatment, and prevention that may entail sex differences. Additional work is required to understand the biological and psychosocial causes of these differences.     

Neonatal functioning and the sudden infant death syndrome

A male infant, diagnosed as a Sudden Infant Death Syndrome (SIDS) at 5 months, 3 weeks, had been extensively tested as a part of a larger sample in a longitudinal study. The longitudinal sample was comprised of 137 clinically normal neonates, born to intact upper middle-class families, living in a large metropolitan area. A neonatal assessment consisted of 5 hours of polygraphic recordings of heart and respiratory rate during sleep and waking cycles, and 1 hour of behavioral testing. At 3 months of age the infant was observed for 12 hours in the home. Retrospective analyses of these data suggested that: (a) neonatal respiratory behavior during sleep did not distinguish this infant from a sample of control infants; (b) the infant lacked strength in movements requiring the involvement of shoulder and neck muscles (head lift from a prone position); and (c) informal observations by skilled and experienced observers distinguished this infant from the sample of controls.     

Anxiety and vulnerability in parents following the death of an infant

Empirical data on the subjectively reported anxiety reactions of 117 parents who lost an infant at birth or daring the first year of life are presented. From a retrospective survey conducted 1 to 4 years after the death it was evident that parents experienced a great deal of anxiety following the death of their child. Parents who experienced a sudden death in the home reported the strongest anxiety, but other parents who lost their child in hospital at birth or thereafter also experienced strong anxiety. The anxiety for surviving children and later-born children was extensive. In all areas mothers experienced more anxiety than fathers. More intense and longer grief in one's partner, the perceived lack of support from others, being older, and being a female were significantly correlated with anxiety. The results are interpreted as a confirmation that parents who lose their children experience a fundamental change in their beliefs about their family's future security. Better training of health personnel is required to secure an adequate follow up of families that lose a child.     

Maternal avoidance,anxiety cognitions and interactive behaviour predicts infant development at 12 months in the context of anxiety disorders in the postpartum period

BackgroundFew studies have examined the relation between anxiety disorders in the postpartum period and cognitive as well as language development in infancy.AimsThis longitudinal study investigated whether anxiety disorder in the postpartum period is linked to infant development at twelve months. A closer look was also taken at a possible link between maternal interaction and infant development.Study designSubjects were videotaped during a Face-to-Face-Still-Face interaction with their infant (M = 4.0 months). Specific maternal anxiety symptoms were measured by self-report questionnaires (Anxiety Cognition Questionnaire (ACQ), Body Sensations Questionnaire (BSQ), Mobility Inventory (MI)) to check for a connection with infant development. The Bayley Scales of Infant and Toddler Development-III (Bayley-III) were used to assess infant language and cognitive development at one year of age.Subjectsn = 34 mothers with anxiety disorder (SCID-I; DSM-IV) and n = 47 healthy mothers with their infant.Outcome measuresInfant performance on Bayley-III language and cognitive scales.ResultsInfants of mothers with anxiety disorder yielded significantly lower language scores than infants of controls. No significant group differences were found regarding infant cognitive development. Exploratory analyses revealed the vital role of “maternal avoidance accompanied” in infant language and cognitive development. Maternal neutral engagement, which lacks positive affect and vocalisations, turned out as the strongest negative predictor of cognitive development. Maternal anxiety cognitions and joint activity in mother-infant interaction were the strongest predictors of infant language performance.ConclusionsResults underline the importance to also consider the interaction behaviour of women with anxiety disorders to prevent adverse infant development.     

Personality disorders over time: precursors, course and outcome

Personality disorders cause dysfunction over the course of adult life. A chronic course of disorder tends to be associated with an early onset, and personality disorders are preceded by precursor symptoms in childhood. Long-term outcome varies by personality disorder category: antisocial and borderline personality tend to remit with age, an improvement that is not seen in other diagnoses. The chronicity of personality disorders can usefully guide treatment planning, and psychotherapy for personality disorders can focus on rehabilitation.     

Perinatal indicators of sudden infant death syndrome: A study of 34 Rhode Island Cases

Pre- and perinatal characteristics of 34 victims of Sudden Infant Death Syndrome (SIDS) were compared with those controls matched for sex, race, birthdate, and hospital. Data were collected retrospectively from hospital records. Factors which reliably differentiated the SIDS group from controls included low birth-weight, short second stage of labor, fewer years of maternal schooling, and maternal anemia during pregnancy. The constellation of findings was interpreted as reflecting the interaction of physiological predispositions and environmental “setting conditions”, culminating in sudden and unexpected death. The efficacy of a previously established SIDS risk scale was assessed for these cases. Some issues concerning prediction of outcome from perinatal variables are discussed.     

Sally Beauchamp's career: a psychoarchaeological key to Morton Prince's classic case of multiple personality

By the methods of psychoarchaeology, the identity of Sally Beauchamp, Morton Prince's classic case of multiple personality, has been established. The reconstructed life history has for the first time revealed the roots of the dissociative process. This goal was actually obscured by the tangled web of Prince's rambling 1906 book and his other publications on the case. The determinative events included two instances of sudden infant death during the childhood period of the patient, the earlier of which was apparently never even known to Dr. Prince. Though not mentioned in the patient's autobiography, it probably induced the initial dissociation to defend the integration of the personality. The relevance of the new concept of SIDS (since 1969) is considered. Other disturbing influences were the constant rejection of the patient by her mother, who died at an early age, and probable severe abuse by the widowed father which led her to run away from home (permanently) at age 16. Nine years afterward, therapy with Dr. Prince began and lasted seven years. It is suggested that this case and the parallel one of Breuer and Freud (Anna O.) be comparatively reexamined from the standpoint of modern feminism. The role of the conventional 19th-century woman was not acceptable to either of them, and both probably had an unusually large innate, bisexual endowment. Endogenous conflict, intensified by social demands, produced dissociation as a pseudo-solution until, through opportune therapy and other environmental opportunities, each was able to achieve a productive modus vivendi. The relation of bisexuality to the etiology of personality dissociation in general is considered. An incidental but instructive discovery made in the course of the Prince research was an unknown letter from William James to Morton Prince about The Dissociation of a Personality. This find points up the fact that James's final metaphysic was a form of pluralistic panpsychism derived from both psychical research and the contemporary knowledge about dissociated personality. James postulated a cosmic multiple personality.     

The clinical aspects of newborn screening: importance of newborn screening follow-up

The aim of newborn screening is to identify presymptomatic healthy infants that will develop significant metabolic or endocrine derangements if left undiagnosed and untreated. The goal of ultimately reducing or eliminating irreversible sequelae is reached by maximizing test sensitivity of the primary newborn screening that measures specific analytes by a number of methodologies. Differentiation of true from false negatives is accomplished by the test specificity. This review discusses disorders for which, in general, there are available therapies and that are detected by routine and expanded newborn screening. Recommendations are presented for evaluation by a primary care physician, with confirmation by a metabolic or endocrinology specialist. Disorders are organized in tabular format by class of pathway or analyte, with attention to typical clinical presentations, confirmatory biochemical and molecular tests, and therapies. There are numerous challenges in clinical follow-up, including diagnosis and appropriate understanding of the consequences of the disorders. The data required to meet these challenges can be acquired only by large scale longitudinal comprehensive studies of outcome in children identified by newborn screening. Only with such data can newborn screening fully serve families.     

Distress Tolerance as a Familial Vulnerability for Distress-Misery Disorders

Low perceived distress tolerance (DT), a trait-like individual difference factor reflecting one’s perceived ability to withstand aversive affective states, has been linked with current internalizing and substance use disorders (SUDs). However, perceived DT has not been systematically evaluated as a familial, transdiagnostic vulnerability factor for internalizing and SUDs. The current study tested whether perceived DT runs in families and whether it is reduced among individuals with versus without remitted internalizing/SUD psychopathology. Perceived DT and internalizing/SUDs were measured in 638 individuals (nested within 256 families). Analyses also adjusted for the effects of neuroticism to test whether DT was a specific vulnerability factor independent of temperamental negative affect. Analyses revealed that perceived DT was lower in individuals with remitted distress (i.e., major depression, generalized anxiety disorder, posttraumatic stress disorder) but not fear disorders (i.e., panic disorder, social anxiety disorder, specific phobia, obsessive-compulsive spectrum disorders) relative to healthy controls, and the effect of distress-misery disorder history remained significant when adjusting for neuroticism. Perceived DT was not significantly different among individuals with versus without a remitted SUD. There were no effects for comorbid SUD and distress-misery disorders. Finally, perceived DT was also significantly correlated within families, suggesting that it runs in families. Overall, results suggest that independent of neuroticism, low perceived DT is a familial vulnerability for distress (but not fear or substance use) disorders.     

Motivation to Pursue Genetic Testing in Individuals with a Personal or Family History of Cardiac Events or Sudden Cardiac Death

Genetic testing is becoming increasingly available for cardiac channelopathies, such as long QT syndrome and Brugada syndrome, which can lead to sudden cardiac death. Test results can be used to shape an individual’s medical management and to identify at-risk family members. In our qualitative study, all participants had a personal or family history of a diagnosed cardiac arrhythmia syndrome or sudden cardiac death. Open-ended interviews were conducted individually and in focus groups. Interviews were audio recorded, transcribed verbatim, and analyzed using a qualitative grounded-theory approach. Of 50 participants, 37 described their motivations for pursuing genetic testing for long QT syndrome or another cardiac channelopathy. Participants’ motivations included: to find an explanation for a family member’s sudden death, to relieve uncertainty regarding a diagnosis, to guide future medical management, to allay concern about children or other family members, and to comply with recommendations of physicians or family members. Perceived reasons not to pursue genetic testing included denial, fear, and lack of information. The genetic counseling and informed consent process can be enhanced by understanding and addressing an individual’s internal and external motivations either for or against pursuing genetic testing.     

Predictors of Heart-Focused Anxiety in Patients Undergoing Genetic Investigation and Counseling of Long QT Syndrome or Hypertrophic Cardiomyopathy: A One Year Follow-up

Since Long QT syndrome and Hypertrophic cardiomyopathy are inherited cardiac disorders that may cause syncope, palpitations, serious arrhythmias, and sudden cardiac death, at-risk individuals may experience heart-focused anxiety. In a prospective multi-site study, 126 Norwegian patients attending genetic counseling were followed 1 year with multiple administration of questionnaires, including the Cardiac Anxiety Questionnaire, measuring three distinct symptoms of heart-focused anxiety- avoidance, attention, and fear—in mixed linear analyses. Overall, at 1-year follow-up, patients with clinical diagnosis as compared to patients at genetic risk had significantly higher scores of avoidance (p < .002), attention (p < .005), and fear (p < .007). Sudden cardiac death in close relatives, uncertainty whether other relatives previously had undergone genetic testing, patients’ perceived general health, self-efficacy expectations and procedural satisfaction with genetic counseling were influential in predicting the different symptoms of heart-focused anxiety over time.     

Mothers’ Perspectives on Their Child’s Mental Illness as Compared to Other Complex Disorders in Their Family: Insights to Inform Genetic Counseling Practice

To facilitate the development of a therapeutic alliance in genetic counseling, it is important that the counselor understands how families might perceive the condition that constitutes the reason for the referral. Through training and professional practice, genetic counselors develop a thorough understanding of families' perceptions of the conditions that are common indications for genetic counseling. But, for referral indications that are less frequent, like serious mental illnesses, genetic counselors may feel less confident in their understanding of the family's experience, or in their ability to provide psychosocial support when serious mental illness is reported in a family history. This may impede the establishment of a therapeutic alliance. As research shows that most referrals for genetic counseling related to serious mental illness are for female first-degree family members of affected individuals, we sought to explore how this group perceives serious mental illness. To provide a frame of reference with which genetic counselors may be more familiar, we explored how women perceived serious mental illness compared to other common complex disorders in their family. We conducted semi-structured interviews with women who had a child with a serious mental illness (schizophrenia, schizoaffective disorder, bipolar disorder) and a first-degree relative with another common complex disorder (diabetes, heart disease, cancer). Interviews were transcribed and subjected to thematic analysis. Saturation was reached when nine women had participated. Serious mental illness was perceived as being more severe and as having a greater impact on the family than diabetes, heart disease, or cancer. Themes identified included guilt, stigma, and loss. Some of the most important issues that contribute to mothers' perceptions that serious mental illness is more severe than other common complex disorders could be effectively addressed in genetic counseling. Developing a heightened awareness of how family members experience a relative's mental illness may help genetic counselors to be better able to provide psychosocial support to this group, whether serious mental illness constitutes the primary reason for referral or appears in the family history during counseling for a different referral reason.     

Measures of infant behavioral and physiological state regulation predict 54‐month behavior problems

This study investigated whether measures of infant temperament, regulatory disorders, and physiological reactivity and concurrent measures of family environment were predictors of child behavior problems at 54 months of age. The sample consisted of 23 children–mother dyads. The sample recruitment strategy emphasized testing both typical and fussy/difficult infants at 9 months of age. Children were categorized into low and high behavioral problem groups at 54 months of age. The children in the high behavioral problem group were more likely at 9 months to have been temperamentally difficult, to have been classified as regulatory disordered, and to have displayed respiratory sinus arrhythmia (RSA) regulation difficulties. These children also were more likely to come from families described as less cohesive and providing less focus on active/recreational activities when the children were 54 months old. A logistic regression analysis, including only the 9‐month infant measures (i.e., difficultness, regulatory disorders classification, and RSA regulation), resulted in a significant model with 100.0% accurate classification into high or low behavioral problem groups. Data suggest that infant measures of behavioral and physiological state regulation may be early indicators of child behavior problems, especially internalizing problems.