Objective: Breath holding spell (BHS) is a paroxysmal, non-epileptic disorder, which affects 0.1-4.6% of young children. Iron deficiency anemia is one of the causes of BHS. Studies have shown that mothers of children with BHS have more life stresses than those of the mothers of typically grown children. There are only a few studies, which evaluate the mother-child attachment pattern and associated psychopathology in children with BHS. We aimed to investigate the relationship between BHS and mother-child attachment pattern in young children.
Method: 11 children diagnosed with BHS in the Pediatric Neurology clinic were reevaluated in the Child Psychiatry clinic. Blood sample were taken for hemogram, serum calcium, glucose and ferritin levels. Their EEG, EKG and ECHO tests were made. Strange Situation Test (SST) was administered to identify the mother-child attachment pattern. In addition, mothers completed Maternal Attachment Inventory (MAI), Maternal Separation Anxiety Inventory (MSAI) and Child Behavior Checklist for ages 2-3 (CBCL).
Results: Psychiatric assessments and psychometric tests revealed that 4/11 children had insecure (anxious/ambivalent) attachment style. Case 1, Case 2 and Case 3 were boys while case 4 was a girl and their ages were 4, 2, 2.5 and 2 years, respectively. They were all diagnosed as cyanotic BHS. Laboratory test results were normal for case 3 while all the values were normal for case 1, 2 and 4 except for a slightly low Hob and serum Fe++ values, which implicated slight anemia. EEG, EKG and ECHO test results of all the cases were normal. The caretakers were mother and grandmother for case 3 while the only caretaker for others was the mother. Anxious-ambivalent attachment score from MAI (20.5) which was found to be higher than all the other attachment scores showed that all the mothers had anxious-insecure attachment. In accordance with these findings, MSAI total scores of the cases were much higher than cut-off value. Anxiety-depression scores of CBCL were higher than Samsun means in all of the patients (8, 9, and 10, respectively) and they indicated anxiety in a clinical level.
Conclusion: Previous studies reported a significant maturational delay in the brain myelination of BHS patients compared to control subjects. In addition, myelination defects were also shown in child and adult anxiety disorder cases. A possible myelination problem can cause both anxiety and BHS. Higher anxiety that occurs because of a trauma is previously claimed to be an important determiner of breath holding time. The results suggest that the treatment of anxiety could be beneficial for BHS. The association between BHS, maternal anxiety and anxious-ambivalent attachment style of the toddler should be researched in further randomized-controlled studies.