The Changing Family and Child Development

Claudio Violato, Elizabeth Oddone-Paolucci

• Publisher: Taylor & Francis
• Year: 2017
• eBook ISBN: 9781351782791
• Edition: 1
• Topic: Social Sciences
• Subtopic: Social Work
• Index: Social Sciences

This title was first published in 2000: This book is based on selected papers from a major international congress of the same name that was held at the University of Calgary in July 1997. The contributors come from Canada, England, Italy, United States, Hong Kong and New Zealand where they are researchers at major universities. The papers are organized into four sections: 1) Context of Families, 2) Family Adjustment and Transitions, 3) Child and Adolescent Development, and Attachment. The book sets out to bring together advanced research by psychologists, social workers, physicians, sociologists and other social scientists on the interface between society, the family, children, adolescents and other family members.

Section III
Child and Adolescent Development

11
Regulation and Its Disorders

DIANE BENOIT

Abstract

A brief review of self-regulation is presented, in addition to current knowledge about the prevalence, classification, etiology, phenomenology, outcome and treatment of regulatory disorders. The role of the environment as external regulator or dysregulator is also described, in addition to the importance of assessing both internal (within the infant) and external (within the environment) aspects of regulation in infants who have clinical problems. The case of an 11-month-old infant with regulatory disorder is used to illustrate the role of the family environment on the perpetuation of regulatory disorders and the impact of regulatory disorders on the family. Future directions for research are discussed.

Introduction

Most parents who expect a new baby imagine the baby will be healthy, adapt easily to the family’s routines, sleep well, thrive, and be easily comforted when distressed (in other words, the baby will be able to self-regulate). Most parents never imagine that a baby might not enjoy being held and cuddled, might be unhappy and miserable most of the time, might not want to eat enough to keep hydrated and well nourished, might not sleep enough, or might remain inconsolable despite a loving environment and almost heroic efforts to soothe him or her. Yet, there seems to be a growing number of unhappy and inconsolable babies who cannot self-regulate and suffer from regulation disorders. The purpose of this paper is twofold. First, a brief review of self-regulation and regulation disorders will be presented. Second, the case of an infant with regulatory disorder will be used to illustrate the mutual impact regulatory disorders and the family environment have on each other.

Self-regulatioff

Most healthy newborns have the capacity to regulate complex physiological processes (e.g., breathing, cardiopulmonary functioning, thermoregulation, swallowing, digestion). This capacity to self-regulate allows them to maintain physiological homeostasis and ensure their survival (Porges, 1996). As they mature, infants’ self-regulatory capacities also mature and encompass increasingly complex domains such as emotion regulation, self-consoling, sensorimotor integration, motor planning, regulation of sleep-wake cycles and hunger-satiety cycles (Cichetti & Tucker, 1994; Thompson & Calkins, 1996). It is believed that infants must learn to competently regulate physiological processes before they can engage effectively in complex social, behavioral, and emotional interactions with the environment (Porges, 1996). In essence, a well functioning, maturing nervous system (in particular the autonomous nervous system) is essential for self-regulation even though individual differences in self-regulatory capacity may exist in neurologically intact infants (Porges, 1996).

Various internal (within the infant) and external (in the environment) factors influence infants’ self-regulatory capacity (Fox, Schmidt, Calkins, Rubin, & Coplan, 1996; Rogemess & McClure, 1996; Thompson & Calkins, 1996). Examples of internal factors that may negatively influence self-regulatory capacity include prenatal drug and cocaine exposure, prematurity, brain injury, and birth complications (Allessandri, Sullivan, Imaizumi, & Lewis, 1993; Jacobson, Jacobson, Sokol, Martier, & Ager, 1993; Mayes, Bomstein, Chawarska, Haynes, & Granger, 1996; Mayes, Bomstein, Chawarska, & Granger, 1995; Mayes, Granger, Frank, Schottenfeld, & Bomstein, 1993; Porges, 1996; Struthers & Hansen, 1992). External factors that may impair or improve infants’ self-regulatory capacity include the quality of the caregiver’s response to the infant’s signals (Mayes et al., 1996). For instance, a disorganized, unpredictable caregiver who repeatedly fails to feed an infant who shows signs of hunger may interfere with the infant’s ability to establish regular hunger-satiety cycles, to feel hunger and/or to communicate feelings of hunger.

The assessment of both internal and external components of regulation has important clinical implications as it guides intervention (Porges, 1996). For example, when a premature infant cannot achieve thermoregulation (i.e., cannot maintain an appropriate body temperature), heating units can be used in special care units. Similarly, when an infant cannot soothe himself to sleep at bed time and during the night, structured bed time routines and behavioral programs can be used (DeGangi, Craft, & Castellan, 1991; Ferber, 1985; Sadeh & Anders, 1993).

Prevalence and classification

The prevalence of regulatory disorders is unknown. However, given that birth complications and pre-maturity are risk factors for regulatory disorders (Porges, 1996), and given the growing number of seriously ill infants who survive because of advances in medical technology, regulatory disorders could be on the rise. Regulatory disorders are not included in the diagnostic nomenclature of DSM-IV but are included in the Diagnostic Classification: 0-3 (Zero to Three, 1994).

The “diagnosis” of regulatory disorder should not be made in infants younger than 6 months because of the high frequency of transient difficulties with self-regulation (e.g., sleep problems that resolve spontaneously by 5 to 6 months of age (DeGangi, DiPietro, Greenspan, & Porges, 1991). Further, in order for a “diagnosis” of regulatory disorder to be made, behavioral and constitutional (maturational) elements must be present and the difficulties in sensory, sensori-motor, or processing capacities must affect daily adaptation and relationships (DeGangi, 1991; DeGangi, DiPietro, Greenspan, & Porges, 1991; DeGangi, Porges, Sickel, & Greenspan, 1993; Greenspan & Wieder, 1993).

Specific subtypes of regulatory disorders have been described based on clusters of symptoms exhibited by the infant. These include (1) Hypersensitive, (2) Under-reactive, (3) Motorically Disorganized, (4) Impulsive, and (5) Other disorders (Greenspan & Wieder, 1993; Zero to Three, 1994). Severity ratings have also been described, ranging from mild (e.g., elimination problems, sleep difficulties) to severe (e.g., irregular breathing, startles, gagging; Greenspan & Wieder, 1993). Examples of moderately severe regulatory disorders include problems with gross and fine motor activity (e.g., abnormal tonus or posture, jerky or limp movements, poor motor planning), attentional organization (e.g., driven or perseverating on small details) and affective organization, including predominantly negative affective tone and moodiness.

Etiology

Regulatory disorders are believed to be due to dysfunctions in the autonomic nervous system (DeGangi, DiPietro et al., 1991; Greenspan & Wieder, 1993), although they are influenced by the environment (Mayes et al., 1996). Specifically, infants with regulatory disorders have been shown to have higher baseline vagal tone and inconsistent vagal reactivity (i.e., heterogeneous response to sensory and cognitive tasks). These findings suggest that infants with regulatory disorders may have autonomic (parasympathetic) hyperirritability caused by defective central neural programs and mediated via neurotransmitters through the vagus nerve (DeGangi, DiPietro et al., 1991; Porges, 1991). However, more research in the field is clearly needed to replicate these findings.

Phenomenology

Regulatory disorders are characterized by a “difficult” temperament, irritability, moodiness, difficulty self-consoling, and lack of cuddliness (DeGangi & Greenspan, 1988). Infants with regulatory disorders also have difficulty regulating physiological processes so that many have sleep problems (regulation of sleep-wake cycles, difficulty falling asleep, frequent night awakenings), feeding problems (regulation of hunger-satiety cycles, refusal to eat a variety of food textures), and elimination problems (constipation, diarrhea). Many have a history of colic. They may present with impaired attentional capacity, impulsivity, negativism, difficulty in making transitions, and impaired reactivity to sensory stimulation (e.g., auditory, visual, tactile, gustatory, vestibular, olfactory, temperature). Many have impaired integrative and processing capacities in the sensorimotor area, for example, they may have impaired motor tone and motor planning, delays in fine motor skills, and impaired capacity to discriminate or integrate auditory-verbal or visual-spatial stimuli (DeGangi, DiPietro, et al., 1991; DeGangi & Greenspan, 1988; DiGangi, Porges, et al., 1993; Greenspan & Wieder, 1993).

Importantly, many domains requiring self-regulation are closely intertwined so that difficulties in one domain may create difficulties in another. For example, sleep, arousal, affect, and attention are known to be such closely intertwined domains. It is well known that difficulties with inadequate sleep are often associated with symptoms of irritability, emotional lability, difficulty concentrating, and fatigue (Dahl, 1996; Derryberry & Reed, 1994; Derryberry & Tucker, 1994; Posner & Dehaene, 1994; Rothbart, Posner, & Rosicky, 1994). This multi-domain involvement might help to explain why infants with regulatory disorders are so difficult for families to cope with. Indeed, because of the regulatory disordered infant’s sleep problems, the parents are often sleep deprived and have little reserve for dealing with the irritable, unconsolable, and sleep-deprived infant. The fact that many babysitters also cannot cope with many infants with regulatory disorders only compounds the problems as the parents often cannot have respite (DeGangi, Craft et al., 1991).

Outcome

Few studies have examined the outcome of infants with regulatory disorders. One study showed that infants with regulatory disorders who are left untreated are at risk for later developmental, sensorimotor, and/or emotional and behavioral problems (DeGangi, Porges et al., 1993), including problems in the areas of cognitive abilities, attention span, activity level, emotional maturity, motor maturity, and tactile sensitivity. Another study showed that low regulation, negative emotionality, and general and positive emotional intensity predicted behavior problems in elementary school children (Eisenberg, Fabes, Guthrie, Murphy, Maszk, Holmgren, & Suh, 1996).

Role of the environment as external regulator or dysregulator

Clinical experience and findings from research suggest that the caregiving environment plays an important part in helping a child self-regulate or dysregulate. For example, findings from one study showed that compared to mothers of infants without regulatory disorders, mothers of infants with regulatory disorders showed less contingent responses, less physical proximity, more flat affect during play interactions, and had more negative perceptions of their infant (DeGangi et al., 1991; DeGangi, Porges et al., 1993). Findings from these studies do not point to a causal link between suboptimal caregiving and regulatory disorders. Rather, they suggest that the quality of a caregiver’s response to an infant with a regulatory disorde...

Table of contents

• Cover
• Half Title
• Title
• Copyright
• Contents
• List of Figures
• List of Tables
• List of Contributors
• Acknowledgements
• Introduction
• SECTION I: THE CONTEXT OF FAMILIES
• SECTION II: FAMILY ADJUSTMENT AND TRANSITIONS
• SECTION III: CHILD AND ADOLESCENT DEVELOPMENT
• SECTION IV: ATTACHMENT