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Normality: a clinically useless concept. The case of infant crying and colic
1Department of Pediatrics, Montreal Children's Hospital, QC, Canada.
Insights
Excessive infant crying and colic often lack clear disease indicators. Shifting focus from a symptom to a behavior with functional consequences offers a new perspective for developmental problems.
Area of Science:
- Developmental Pediatrics
- Behavioral Science
- Clinical Psychology
Background:
- Assessing infant crying and colic presents significant diagnostic challenges.
- Crying as a primary complaint rarely signifies underlying disease in infants.
- Established clinical norms for normality and abnormality lose relevance once organic disease is excluded.
Purpose of the Study:
- To challenge the conventional approach to diagnosing infant crying and colic.
- To propose a conceptual shift from viewing crying as a symptom to a behavior.
- To explore the implications of this behavioral perspective on developmental and behavioral problem assessment.
Main Methods:
- Conceptual analysis and argumentation.
- Review of diagnostic challenges in infant crying and colic.
- Proposal of an alternative framework focusing on behavior and its consequences.
Main Results:
- Arbitrary 'cut-off' points for abnormal crying are clinically unhelpful and theoretically unsound.
- Crying should be viewed as a behavior an infant 'does,' not a symptom of a condition.
- This behavioral framing highlights functional or dysfunctional consequences for the infant and caregiver.
Conclusions:
- The proposed behavioral framework may offer new insights into managing infant crying and colic.
- This perspective could be applicable to other developmental and behavioral issues like enuresis and ADHD.
- Rethinking 'abnormal' behavior as context-dependent actions, rather than disease indicators, is crucial.
Abstract:
To summarize, it has been argued that: 1. The assessment of complaints about crying and colic present particular diagnostic problems. 2. The crying brought as a complaint seldom indicates disease. 3. Once clinical disease has been ruled out, the clinical meanings of normality and abnormality no longer apply. 4. At that point, one should not try to determine a "cut-off" point for abnormal crying, because (a) it is unhelpful clinically, (b) it is wrong in principle, and (c) it is not likely that any specific amount of crying is normal or abnormal, independent of context. 5. As a possible alternative, it is proposed that we should think of the behavior not a symptom of something the infant "has," but as something the infant "does." This behavior may have consequences that are functional or dysfunctional for the infant, the caregiver, or the infant-caregiver interaction. If this argument has merit, it may have some interesting and important implications for the way we think about, treat, and investigate developmental and behavioral problems including (but not limited to) infant crying and colic. First, what holds true for crying and colic may also hold for bedwetting and enuresis, overactivity and attention-deficit hyperactivity disorder, and abdominal pain and recurrent abdominal pain syndrome, to name just a few. As a brief test of their applicability, one might ask how often organic disease is found in these entities, or how often patients are investigated and treated because an arbitrary amount of these behaviors is taken to be "excessive" or abnormal.(ABSTRACT TRUNCATED AT 250 WORDS)