More and more often we as child psychiatrist and psychologists have to deal with mentally disordered parents. On the other hand, we are requested to assess developmental disorders in young children. In order to unfold the ‘still mysterious unfolding of early psychopathology’, as Peter Fonagy states it, we have to assess the development of the child and its symptomatology, the mental health of both parents and the parent infant relationship. The key point is to assess the different dimensions of functioning in the child, as well as their mutual influences and to assess independently the development of the child, the parent child relationship and the parental caregiving abilities, without inferring one from the others.
Social withdrawal behavior in the young child is therefore an important alarm signal to acknowledge for, as it appears to be the response of the child to the difficulty to maintain synchrony within the relationships (Ruth Feldman). This may stem from the child – (ASD, Pain, sensory difficulty, genetic disorder..) from the relationship with parents (post natal depression, lack of synchrony, failure of repair, improvable or violent relationships). The ADBB scale may be useful to screen for social withdrawal behavior in infants.  Three situations are presented in which there is a definite risk for parental distress and for difficulties in parent infant synchronization: prematurity, Prader-Willy syndrome, Palate cleft syndromes. Studies with infants in those situations show high levels of social withdrawal behavior, as well as high levels of parental stress and depression, but highlight the fact that the majority of infants and parents still succeed in resisting to those adverse conditions, through a phase of difficult adaptation. Early intervention may prove very helpful to increase resiliency in parent and infants.

View or download the original presentation by Antoine Guedeney (pdf, 35 slides).