St James-Roberts Ian, Llewellyn Clare
Thomas Coram Research Unit, University College London, London, United Kingdom.
Research Department of Behavioural Science and Health, University College London, London, United Kingdom.
Front Child Adolesc Psychiatry. 2024 Mar 26;3:1322962. doi: 10.3389/frcha.2024.1322962. eCollection 2024.
The term Regulatory Disorders (RDs) refers to infants and young children who cry a lot, have poorly organised sleep-waking, or whose feeding is impaired. The characteristic they share is a failure to acquire autonomous self-control of these key behaviours, which most children develop in the first postnatal year. The concept of RDs is helpful in highlighting this question of how infant self-regulation is, or isn't, accomplished, in drawing these characteristics together and distinguishing them from others, and in focusing research and clinical attention on a common, but relatively neglected, set of concerns for families. The main focus for research into RDs has been on the nature and causes of the infant behaviours involved. Here, the aim is to highlight the part played by parents, since that is central to the provision of clinical services for RDs. Three points are made. (1) The contributions of parents include: detection and monitoring of RDs; generating the resulting healthcare service costs; maintaining their own wellbeing, since that is in their infant's best interest; delivering interventions to help infants and families, which are almost always provided by parents. Parenting may be involved in maintaining RDs in some cases. (2) Substantial differences exist between infant RD cases in the behaviours involved, the age at which they present, the complexity and severity of the RD, and in their persistence over time and age. Most cases have one, rather than all three RDs, making them the most common type seen by clinicians. Evidence is summarised that interventions tailored to fit the RD involved can be effective in these cases. Multiple and sustained RDs are much rarer, but associated with greater risk of long-term psychological and behavioural impairments. They are a priority, but less is known about the contributions of parenting and child factors to these cases. (3) The focus on parents with infants requires joined-up paediatric and adult mental health services. After summarising three main requirements for such services, an example designed to fulfil these requirements is described to illustrate what a service for supporting families with RDs might look like.
调节障碍（RDs）这一术语指的是那些经常哭闹、睡眠 - 觉醒节律紊乱或喂养困难的婴幼儿。他们共有的特征是无法自主控制这些关键行为，而大多数儿童在出生后的第一年就会发展出这种能力。调节障碍的概念有助于突出婴儿自我调节是如何实现或未实现的问题，将这些特征归纳在一起并与其他特征区分开来，以及将研究和临床关注聚焦于一系列常见但相对被忽视的家庭问题。调节障碍研究的主要重点一直是所涉及的婴儿行为的性质和原因。在此，目的是强调父母所起的作用，因为这对于调节障碍的临床服务提供至关重要。提出了三点。（1）父母的贡献包括：发现和监测调节障碍；产生由此带来的医疗服务成本；维持自身的幸福感，因为这符合婴儿的最大利益；提供几乎总是由父母实施的干预措施以帮助婴儿和家庭。在某些情况下，养育方式可能与调节障碍的持续存在有关。（2）婴儿调节障碍病例在所涉及的行为、出现的年龄、调节障碍的复杂性和严重程度以及随时间和年龄的持续性方面存在很大差异。大多数病例只有一种而非全部三种调节障碍，这使其成为临床医生最常看到的类型。有证据表明，针对所涉及的调节障碍量身定制的干预措施在这些情况下可能有效。多种且持续的调节障碍则要少见得多，但与长期心理和行为障碍的风险更高相关。它们是优先关注对象，但对于养育方式和儿童因素对这些病例的影响了解较少。（3）关注有婴儿的父母需要联合儿科和成人心理健康服务。在总结了此类服务的三个主要要求后，描述了一个旨在满足这些要求的示例，以说明支持有调节障碍家庭的服务可能是什么样的。
