Clinical Research Related to Infant Mental Health Regulatory Disorders of Attention and Play: Syndrome of „Dysphoric Fussiness and Disinterest in Play“ Excerpts from: Papousek, M. (2008). Dysphoric Fussiness and Disinterest in Play in Infancy: Precursors or Early Manifestations of ADHD? In: Papousek, M., Schieche, M., Wurmser, H. (eds.), Disorders of Behavioral and Emotiuonal Regulation in the First Years of Life. Early Risks and Intervention in the Developing Parent-Infant Relationhsip. Washington, DC, ZERO TO THREE: 317–344. The clinical syndrome described as „Dysphoric Fussiness and Disinterest in Play“ emerges mainly in the context of persistent and pervasive regulatory disorders beginning in early infancy. Among 590 infants and toddlers between the ages of 4 and 30 months who had been consecutively referred to, diagnosed and treated in the Munich Program for Fussy Babies because of disorders of behavioral and emotional regulation, the syndrome was diagnosed in 35% of the cases. These proved to be the most seriously affected in terms of persistence and pervasiveness, and degree of burden on the parents‘ part. More than 90% of the children in this group had already cried excessively in the first months of life. In 80 to 90%, listlessness to play was associated with lengthy sleep disorders, in 40% with feeding disorders, and, in toddlers, with higher rates of defiance and aggressive/oppositional behavior. Overall, this subgroup differed from the rest of the clinical group by a concurrence of particularly strong constitutional risk factors in the area of arousal regulation and sensory processing, more frequent and severe problems of the mother’s psychological state, a higher rate of family conflicts, and increasing risks of perturbed and disordered mother-infant relationships. This chapter describes and summarizes the experiences, targeted videobased observations, and data from our clinical work with families in which infants and toddlers were experiencing disorders of behavioral and emotional regulation. It draws attention to a phenomenon that has to date been relatively overlooked, namely, that an increasing number of infants and toddlers appear to grow up with a striking lack of experience with play. If we assume that infant play as self-regulated learning and integration of experience is one of the fundamental adaptive psychobiological needs and elementary life patterns of the growing child, this phenomenon should be profoundly alarming to child health professionals, particularly in view of the growing number of attentional, learning, and language disorders that are diagnosed at preschool or school age. Unlike attachment, this aspect of early deprivation has not been adequately addressed either in the current discourse around early education or in models of developmental psychopathology in child psychiatry. Potential effects of the present „Zeitgeist“ The phenomenon of listlessness to play, as observed in the context of other regulatory problems seems to be promoted by the way of life and the “Zeitgeist” of our fast-paced, media-oriented, over-stimulating society, which is characterized by a continuous glut of information full of rapid, exciting, and sensational stimuli, hectic and overly booked schedules, and a lack of time for relaxation and leisure. Our lives are built around market-driven consumption and, in relation to children, by pressures to advance their academic achievements. Parents are overwhelmed by an abundance of parenting magazines and books, and an overabundance of noncreative but arousing toys or so-called “educational” toys for even the smallest infants. American authors speak of a "high-speed society" and a "rapid-fire culture" (DeGrandpre, 2002) that favors new forms of fast but superficial communication and information processing via television, computers, cell phones, and the like. These influences have already begun to extend into pregnancy, the postpartum transition, and infancy, making it difficult for parents to adjust to their baby’s slower tempo, receptive capacities, and peculiar needs. Potential risks with regard to ADHD A good one-third of the infants and toddlers with disorders of behavioral and emotional regulation may well be predisposed to develop the syndrome of disinterest in play because of some constitutional disposition, adverse family environment, dysfunctional parent-infant interactions, and persistent pervasive regulatory problems. The syndrome of disinterest in play by itself with its accompanying features – distractibility, “sensory hunger”, dysphoric fussiness, and motor restlessness – and the resulting deprivation of self-initiated play suggest that children with these problems may well form a special risk group with regard to ADHD. The developmental trajectories presented here need to be verified in prospective clinical studies focusing on the early development of attention and play in the context of parent-infant relationships in both clinical and non-clinical populations. The effectiveness of targeted therapeutic interventions should be evaluated as well. In addition, the phenomenon of disinterest in play should lead to interdisciplinary studies involving neurobiologists, molecular biologists, clinical developmentalists and child psychiatrists in order to improve current knowledge about the developmental psychopathology of ADHD, the most frequent psychiatric disorder of childhood. The sooner it becomes possible to identify the mechanisms and processes involved in the origins and maintenance of problems of attention regulation, goal-directed action and impulse control, the easier it will be to develop targeted preventive treatment strategies. Significance of play as a unique resource It is not our intention to pathologize the behavioral syndrome of disinterest in play, or to provide evidence for a diagnosis of early-onset attention deficit hyperactivity disorder (EOADHD). Rather, we wish to draw the attention of specialists and parents to the significance of play as a unique resource for infant development and early parent-child relationships, and to counteract disturbing influences early on. Given the pressures brought about by the current societal “Zeitgeist,” the psychobiological predispositions in infants and parents in favor of the development of play have become precious and threatened commodities. Increasingly missing in modern societies are emotional security, true leisure, and an environment that encourages parents to engage in play, communication and positive relatedness with their infant. In addition, children need to be insulated at an early age from overstimulation, the pressure to become a superbaby, television, and other dangers of fast-paced and technologically-oriented societies. To create a protective space in which play remains an elementary facet of life and learning, and an indispensable right of the child, may well be one of the most important tasks of caregiving and childrearing today. In this regard, a therapeutic approach at the level of parent-child play is one of the most mutually rewarding interventions, and – we hope – one of the most effective forms leading to, long-term preventive outcomes. See also: Infant Play and Creativity back to top