Underinvolved Relationship Disorder and related factors in a sample of young children Omer Faruk Akca a, ⁎, Cagatay Ugur b , Mehmet Colak b , Oya Ozalp Kartal b , Aynur Sahin Akozel b , Gonul Erdogan b , Runa Idil Uslu b a Samsun Psychiatry Hospital, Child and Adolescent Psychiatry division, Samsun, Turkey b Ankara University Faculty of Medicine Child and Adolescent Psychiatry division, Ankara, Turkey abstract article info Article history: Received 21 April 2011 Received in revised form 6 August 2011 Accepted 6 September 2011 Keywords: Infant mental health DC:0–3R Underinvolved relationship Infant–caregiver relationship Background and aims: The interaction between the infant and the caregiver is stated to be very important in the development of a child. When there is inadequacy of interaction, several emotional and developmental problems can emerge. We aimed to investigate the socio-demographic and clinical features of children diag- nosed with Underinvolved Relationship Disorder according to the DC:0–3R classification system. Study design and methods: Four hundred and fifty seven children aged between 1 and 59 months, who had been admitted to an infant mental health clinic were assessed using the DC:0–3R classification system and the whole sample was divided into two groups, the group in which Underinvolved Relationship Disorder be- tween the child and the caregiver had been detected (URD), and the group in which this had not been detected (NURD). These two groups were compared with regard to socio-demographic features, reasons for referral, primary diagnoses, relational disorders, medical/developmental conditions, psychosocial stressors and the Parent–Infant Relationship Global Assessment Scale (PIRGAS) scores of children. Results: Language delay, insufficient social interaction and aggression were found to be significantly more fre- quent reasons for referral in URD. Disorders of Relating and Communicating (equivalent to the Pervasive De- velopmental Disorders in DSM IV) and Deprivation/Maltreatment Disorder were more frequent primary diagnoses, Verbally or Physically Abusive Relationship Disorder was significantly more frequent relational disorder in URD. Mild and moderate mental retardation were significantly more frequent in URD, and social environment, educational/child care and health-care access challenges were found to be more frequent psy- chosocial stressors in the parents of URD. The Mean PIRGAS scores were significantly lower in URD connoting that the parent–infant relationship is poorer. Conclusions: The diagnosis of Underinvolved Relationship Disorder according to the DC:0–3R classification system is related to some developmental and psychosocial problems. © 2011 Elsevier Ireland Ltd. All rights reserved. 1. Introduction Humans, like all other species, develop within a “normal range” when reared within an average expectable environment [1,2]. For in- fants, the expectable environment includes protective, nurturant care- givers and a larger social group to which the child will be socialized. When environments fall outside the expectable range, normal develop- ment is impeded. Especially in the early years, the parent–infant rela- tionship provides the scaffolding necessary for the infant to develop. On the other hand, according to the attachment theory, a secure at- tachment between the infant and the caregiver plays an important role in normal development of a child [3–5] and is associated with longer term positive child outcomes in social and mental development [6–10]. Conversely, insecure attachment is related to increased later problem behaviors and mental health problems [11–20]. Early socio- emotional relationship experiences, especially warm, caring, sensitive and responsive interactions between adults and their infants are crucial contributors to promote secure attachment [21,22]. Likewise, maternal sensitivity to the infant's signals affects the nature of the attachment pattern with the parents; a significant amount of consistent, sensitive and responsive care contributes to the formation of secure attachments [23]. With other possible ethiological factors, researches indicate that an insecure attachment is closely related with social deprivation and ne- glect [24,25] which can usually be seen in institutionalized children [26]. More specifically, institutional rearing environments for young children tend to provide markedly minimal socioemotional relationship experiences, and perhaps as a partial consequence of this deprivation, such children tend to be substantially underdeveloped and to have higher rates of behavioral problems [27–33]. Thus, it may be concluded Early Human Development 88 (2012) 327–332 ⁎ Corresponding author at: Samsun Ruh Sağlığı ve Hastalıkları Hastanesi, Samsun, Turkey. Tel.: +90 530 697 21 02; fax: +90 362 431 78 55. E-mail address: dromerakca@gmail.com (O.F. Akca). 0378-3782/$ – see front matter © 2011 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.earlhumdev.2011.09.004 Contents lists available at SciVerse ScienceDirect Early Human Development journal homepage: www.elsevier.com/locate/earlhumdev