Document Type : Scientific Research
Authors
1 Ph.D of Health Psychology, Department of Psychology, Faculty of Psychology and Educational Sciences, University of Tehran, Tehran, Iran
2 Professor, Department of Psychology, Faculty of Psychology and Educational Sciences, University of Tehran, Tehran, Iran.
3 Assistant Professor, Department of Psychology, Faculty of Psychology and Educational Sciences, University of Tehran, Tehran, Iran.
Abstract
Objective: Avoidant/Restrictive Food Intake disorder was added as a new disorder to DSM-5 in 2013 (American Psychiatric Association, 2013). ARFID is a disorder consisting of three distinct and non-exclusive states: (a) selectivity of foods based on sensory characteristics (e.g., food neophobia), (b) limited interest in eating or lack of appetite., desire and (c) fear of bad consequences for eating such as choking, vomiting, or gastrointestinal pain. From an etiological perspective, recent literature in the field of developmental psychopathology framework has emphasized that ARFID is a serious problem in childhood that may be associated with psychological factors such as problems in the child, his mother, as well as low quality of parent-child feeding interaction. In the field of ARFID disorder, it was shown in the study of nutritional interaction that the mother-child couple has specific problems in the fields related to creating a joint activity, interactive mistakes and solving them during the activities, family intimacy, emotional experience of the child and participation. Children had self-regulation (Losserli et al., 2017). Dysfunctional family interactions are a critical issue that emphasizes the importance of detailed diagnostic evaluation in order to target effective treatment. The family drawing test as a useful method allows the specialist to gain children's understanding and awareness of themselves and their parents. Family drawing is considered as an optional tool for examining children's mental representation of attachment to parents and interaction with them, along with the concepts of developmental psychology. Method: The basic issue is investigating the relationship between the components of mother-child interaction in children with avoidant/restrictive eating disorder and the drawing signs of the family drawing test. The statistical population of this research was children aged 4 to 7 years old in Tehran who visited health centers and were diagnosed with ARFID based on DSM-5 criteria. The symptoms of these people were confirmed by the nutritionist and doctor of health centers. After identifying the study subjects under the supervision of experts and confirming the symptoms of ARFID disorder, mother and child interactions were analyzed using family drawings. ARFID symptoms were assessed in these children using the nine-item Parental Screening Scale for Restrictive/Avoidant Eating Disorder (NIAS-PR). The original version has been translated into Persian for the current study and has been approved by psychology professors. After that, the child's parent questionnaire was given to the mother to complete and the child was asked to draw a picture of the family. Also, variables related to family, pregnancy and newborn were measured separately. Results: The symptoms of ARFID disorder were investigated in these children and the results showed that 83% of these children have severe to moderate weight loss and 3 children had normal weight, which has been shown in other studies. In addition, sensitivity to smell and sensitivity to food texture were 61% and 66%, respectively. Also, the two main symptoms of decreased appetite and avoidance of food in these children were 83 and 72%. In the next step, children's drawings were evaluated and coded. In fact, based on Kaplan and Main's (1986) and Fury's (1996) checklists, the semiotics of interaction elements in the painting were examined and then a coding checklist was prepared. The children's drawings were examined based on the prepared checklist and the frequency of the determined codes was determined based on that. The results of the research showed that the relationship between mother-child conflict and exclusion of mother, exclusion of father and exclusion of siblings is positive and significant; This means that the higher the conflict between the mother and the child, the more the child excludes his mother, father or siblings in his drawing. Also, the relationship between the conflict between mother and child and the right to give priority in painting was positive and meaningful; In fact, the child is more likely to paint himself first (in fact, the only member of the family who is painted is the child himself). The two factors of mother's exclusion and father's exclusion had a significant negative relationship with mother-child closeness, in the sense that the less intimate the relationship between mother and child is, the more mother-father exclusion occurs. Finally, the child's dependence on the mother, which was a negative factor in the mother-child interaction, had a significant positive relationship with the removal of the father and the removal of siblings. Conclusion: Dysfunctional family interactions are a critical issue identified for diagnostic evaluation to determine treatment. One of the practical tools that can be used in the study of the child's problems is drawing the family, because the family is the child's world and it shows the problems in the family's problems and behaviors with him in the drawing. In this research, it was shown that the factors related to the mother-child conflict can be seen in children's drawings with the consumption of restrictive-distancing food.Among these factors, I can mention the removal of the mother, the removal of the father, the removal of siblings, not painting the painting, prioritizing oneself in the painting, which was in line with the researches of Prokasia et al. (2014) and Leon et al. (2007). The results of the study by Balaruto et al. (2021) showed that there is a significant relationship between the quality of mother and toddler nutrition interaction and children's weight. Underweight children showed less demand for independence and cooperation than normal weight children. In addition, mothers of underweight children were less sensitive than mothers of normal-weight children to toddlers' cues that they wanted to stop interacting and demands for autonomy. In this research, it was shown that in children with Avoidant/Restrictive Food Intake disorder, the interaction with the mother has deficiencies, and it is suggested to use interaction-based therapy to treat this disorder. In this research, like other researches, there were limitations. It was the first access to samples. The second case was the use of a self-reporting tool, which may have been influenced by the mother. It also included samples from middle to high social strata, which is suggested to be used in future researches from poor socio-economic group as well.
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