Sleep Architecture in Infants of Substance‐Abusing Mothers

This longitudinal, year‐long study compared sleep–wake state organization in two groups of infants–infants whose mothers abused substances during their pregnancies and nonexposed, typically developing, age‐matched comparison infants–to determine whether differences in sleep–wake state organization existed between the two groups. Seventeen infants of mothers who were participating in a parent–infant residential treatment program for substance abuse were enrolled. Their sleep–wake state organization over the first year of life was compared to that of 17 age‐matched comparison infants. The intent was to follow each infant on five occasions over the first year of life using established methods of time‐lapse videosomnography to record sleep–wake state organization; however, attrition in the substance‐abusing group was problematic. Some sleep–wake variables (i.e., Active Sleep%, Quiet Sleep%, Awake%, number of nighttime awakenings) were similar for both groups of infants at comparable ages across the first year. Total sleep time and the longest sustained sleep period (sleep continuity variables) differed significantly at some of the ages measured. Although overall sleep architecture appears highly resilient and well organized, some indications of sleep fragmentation and shortened nighttime sleep periods were observed in the substance‐exposed infants. More research is needed to explain why sleep‐continuity variables and not sleep‐state proportion variables differed between the two groups.     

Maternal adjustment and infant outcome in medically defined high-risk pregnancy.

Biological and psychosocial risk factors in high-risk pregnancy and their relation to infant developmental outcomes were explored in a sample of 153 pregnant Israeli women who had pregestational diabetes mellitus, gestational diabetes mellitus, or were nondiabetic. Questionnaires on coping and resources as well as well-being and distress during the 2nd trimester were administered. Estimates of maternal fuels (HbAlc and fructosamine) were obtained throughout pregnancy. At 1 year, offspring were administered the Bayley Scales of Infant Development and mother-infant interactions were observed. Infants of mothers in the diabetic groups scored lower on the Bayley Scales and revealed fewer positive and more negative behaviors than did infants of mothers in the nondiabetic group. Infant outcomes in the maternal diabetic groups were associated with maternal metabolism. Maternal coping and resources differed in the 3 groups and differentially predicted infant development.     

Longitudinal Assessment of Sleep–Wake Regulation and Attachment Security with Parents

The development of sleep–wake regulation occurs within the context of the infant–parent relationship. The present study investigated (1) patterns of change in night waking across infancy and attachment to parents and (2) if dependency, a characteristic of secure subgroup B4 and insecure‐resistant infants, accounted for differences in night waking. Forty‐six families reported on the number of infant night wakings at 7, 12, and 14 months of age. Attachment was measured at 12 (infant–mother) and 14 (infant–father) months. Findings suggest that infants with a secure (including the dependent‐secure, B4) pattern of attachment with mothers decreased in the number of night wakings over time, whereas infants with an insecure‐resistant pattern of attachment with mothers continued to wake at night into the second year. Attachment dependency did not account for differences in night waking. These findings are important to understanding the mechanism(s) underlying the relation between attachment and sleep–wake regulation. Copyright © 2012 John Wiley & Sons, Ltd.     

Cardiac physiological regulation across early infancy: The roles of infant surgency and parental involvement with mothers and fathers

High baseline respiratory sinus arrhythmia (RSA) and infant temperament are associated with a child’s ability to self-regulate, but moderators of this association have not been thoroughly examined in the literature. Parents who are more involved might have more opportunities to interact with and soothe their children. The current study examined whether parental involvement moderated the association between infant temperament and baseline RSA with mothers and fathers across early infancy. Participants included families (n = 91) assessed at 4 and 8 months of age. Infant temperamental surgency and parental involvement were measured via parent-report when infants were 4 months old, and infant baseline RSA was measured at 4 and 8 months of age. Results revealed differences in mother versus father predictors of infant baseline RSA. A significant Infant Surgency X Maternal Play interaction was revealed; infants of mothers who were low involvement increased in their baseline RSA as their surgency increased. A significant main effect of father care was found; infants with highly involved fathers had higher baseline RSA. In conclusion, mothers and fathers may differentially influence their infant’s cardiac physiological regulation based on their specific type of involvement.     

Depressed mothers' assessments of their neonates' behaviors

Neonates were assessed at delivery and again at 1 month by examiners and by their depressed or nondepressed mothers. Examiner assessments were conducted using the Brazelton Neonatal Behavioral Assessment Scale (NBAS). Maternal assessments were conducted by mothers using a simplified version of the NBAS, the Mother's Assessment of the Behavior of her Infant (MABI). Examiners rated neonates of depressed mothers lower than infants of nondepressed mothers on state organization. At delivery, newborn infants of depressed mothers were given lower state regulation scores by their mothers than by the examiners and, 1 month later, examiners’ state regulation ratings were as negative as those of the depressed mothers. Conversely, infants of nondepressed mothers were given higher social interaction scores by their mothers than by the examiners, and 1 month later, examiner ratings of social interaction were as positive as those of the nondepressed mothers. These findings suggest that infants of depressed mothers may be placed at risk by prenatal influences and by risks associated with maternal perceptions. Perceptions of infants appear to be colored by maternal depression status as early as the immediate postpartum period and, though “subjective,” these perceptions are predictive of infant outcomes.     

The role of attachment security,temperament, maternal perception,and care‐giving behavior in persistent infant sleeping problems

This study investigates the relationship of etiological factors to infant sleeping problems during the first year, and at follow‐up during the second year of life. The relevant factors for concurrent sleeping problems (in order of importance) were problematic maternal cognition concerning setting limits on the infant, fussy–difficult infant temperament, maternal anxiety–depression, ambivalent attachment, and certain maternal care‐giving behaviors involving the use of active physical comforting (cuddling to sleep, settling on sofa or in parental bed, and giving a feed). High initial levels of sleeping problems largely explained the continuity in infant sleeping problems over time. However, this continuity was significantly mediated by the influence of both problematic maternal cognition and infant temperament on the parental use of active physical comforting to settle infants to sleep. In addition, ambivalent attachment had a small but significant independent contribution to persistent problems. Regarding discontinuity in infant sleeping problems over time, infants who developed sleeping problems were those whose parents used high levels of active physical comforting, whereas those infants whose sleeping problems recovered were more likely to have mothers with low depression–anxiety. The significance of these results is discussed with respect to developmental models of infant sleeping problems, and the assessment and treatment of infant sleeping problems. ©2003 Michigan Association for Infant Mental Health.     

Mother and infant affective involvement states and maternal depression

This study shows two different dimensional types of maternal depression, one dull and slow, the other stressed and irritable. When the quality of the infant attachment to mother is assessed, it is noted that the dimensional aspect of the maternal depression can be of some importance in the quality of the attachment. In fact, children are more inclined to develop an insecure–ambivalent attachment to their stressed depressed mothers, while children of slow depressed mothers are more insecure–avoiding. Thus, the dimensions of maternal depression can be an indicator of the type of insecure attachment of the infant at one year of age. We have also found that insecure children of depressed mothers express very little joy in the course of face-to-face interactions. A parallel can be established between the characteristics of the different affective dimensions of the maternal depression, the affective involvement state level of the partners, their synchrony or non-synchrony, the affective expression of the baby, and the type of insecure attachment to the mother. Thus, affective interaction may be an indicator of the child's development, both to assess the interaction and to evaluate the type of attachment shown by the child, indicating that previous interactive patterns have been internalized. © 1997 Michigan Association for Infant Mental Health     

Maternal experience of their infants’ crying in the context of war trauma: Determinants and consequences

We examined, first, how prenatal maternal mental health and war trauma predicted mothers’ experience of their infant crying, indicated by emotions, cognitions, and behavior; and second, how these experiences influenced the mother–infant interaction and infant development. Participants were 511 Palestinian mothers from the Gaza Strip, reporting their war trauma, symptoms of posttraumatic stress disorder (PTSD), depression, and perceived stress during pregnancy (Time 1). They reported experiences of infant crying at 4 months (Time 2), and the mother–infant interaction and infant sensorimotor and language development at 12 months of infants’ age (Time 3). Results revealed that maternal mental health problems, but not war trauma, were important to experiences of infant crying. A high level of PTSD symptoms predicted negative emotions evoked by infant crying, and high depressive symptoms predicted low active and positive responses to crying. Unexpectedly, high prenatal perceived stress predicted high active and positive responsiveness. Concerning the consequences, mothers’ sensitive interpretation of infant crying predicted optimal infant sensorimotor development, and mothers’ active and positive responses predicted high emotional availability in mother–infant interaction. Crying is the first communication tool for infants, and mothers’ sensitive responses to crying contribute to infant well-being. Therefore, reinforcing mother's optimal responses is important when helping war-affected dyads.     

Mother–child interaction and sleep regulation in one‐year‐olds

The regulation of sleep–wake states is controlled not only by biological mechanisms but by care‐giving context as well. In this study the association between mother–child relationship and the infant's sleep was examined. Thirty‐seven 12‐month‐olds and their mothers participated in a 10‐minute laboratory play episode. The dyadic interaction was coded with the Early Parent–Child Relational Assessment (Clark, 1985) and with the Emotional Availability scales (Biringen, Robinson, & Emde, 1993). The child's sleep was measured at home with a small‐computerized activity monitor. Although mothers' behavior was not related to the child's sleep, infants who were more responsive in the play episode woke up more frequently compared to infants who were less involved in the interaction. The link between social‐emotional competency and fragmented sleep, among nonrisk infants, could be an age‐related phenomenon. ©2001 Michigan Association for Infant Mental Health.     

Motherhood in adolescent mothers: Maternal attachment,mother–infant styles of interaction and emotion regulation at three months

Early motherhood is considered a risk factor for an adequate relationship between mother and infant and for the subsequent development of the infant. The principal aim of the study is to analyze micro-analytically the effect of motherhood in adolescence on the quality of mother–infant interaction and emotion regulation at three months, considering at the same time the effect of maternal attachment on these variables. Participants were 30 adolescent mother–infant dyads compared to 30 adult mother–infant dyads. At infant 3 months, mother–infant interaction was video-recorded and coded with a modified version of the Infant Caregiver Engagement Phases and the Adult Attachment Interview was administered to the mother. Analysis showed that adolescent mothers (vs. adult mothers) spent more time in negative engagement and their infants spent less time in positive engagement and more time in negative engagement. Adolescent mothers are also less involved in play with their infants than adult mothers. Adolescent mother–infant dyads (vs. adult mother–infant dyads) showed a greater duration of negative matches and spent less time in positive matches. Insecure adolescent mother–infant dyads (vs. insecure adult mother–infant dyads) demonstrated less involvement in play with objects and spent less time in positive matches. To sum up adolescent mother–infant dyads adopt styles of emotion regulation and interaction with objects which are less adequate than those of dyads with adult mothers. Insecure maternal attachment in dyads with adolescent mothers (vs. adult mother infant dyads) is more influential as risk factor.     

Infant Emotion Regulation Strategy Moderates Relations between Self‐Reported Maternal Depressive Symptoms and Infant HPA Activity

Children of mothers with depressive symptoms often have high cortisol levels. Research shows that various child characteristics (e.g., attachment pattern, internalizing behaviours, and temperament) moderate this association. We suggest that these characteristics share common variance with emotion regulation strategy. Therefore, we examine infant emotion regulation strategy as a moderator of the association between maternal depressive symptoms and infant hypothalamic–pituitary–adrenal (HPA) function. We hypothesize that infants who utilize more independent emotion regulation strategies and have mothers who report higher depressive symptoms will exhibit elevated cortisol levels. Participants were 193 mothers and infants (15 months old) recruited from the community. Self‐reported maternal depressive symptoms were assessed. Infant independent regulatory behaviours (withdrawal, wandering away, distraction, scanning, orienting to another object) were coded in the context of a Toy Frustration Task. Infant cortisol was collected via saliva samples at baseline, +20, and +40 minutes. Results indicate that infant emotion regulation strategy moderates the relation between mothers' self‐reported depressive symptoms and infant total cortisol output (AUC_G) and cortisol reactivity (AUC_I). Infants who employed more independent regulatory behaviours and have mothers with higher depressive symptoms experience greater cortisol secretion. We discuss the findings in relation to parent‐infant interactions and the adaptive nature of emotion regulation strategies, as they relate to HPA regulatory capacities. Copyright © 2015 John Wiley & Sons, Ltd.     

Music therapy enhances preterm infant’s signs of engagement and sustains maternal singing in the NICU

Hospitalized preterm infants are exposed to stressful stimuli and early parental separation, which can undermine their long-term development and mother-infant bonding. Family-centered music therapy can enable positive mother-infant interactions, mediated by maternal infant-directed singing. This study aimed to investigate the effects of music therapy on preterm infant’s signs of engagement, namely Eye Opening (EO) and Smiling (SM), and maternal vocalizations. Participants were 30 mother-preterm infant dyads in a Brazilian Neonatal Intensive Care Unit (NICU), divided into a Music Therapy Group (MTG) and a Comparison Group (CG). The MTG participated in 6 sessions of the Music Therapy Intervention for the Mother-Preterm Infant Dyad (MUSIP), with the aim of supporting maternal singing with the infant. Prior to discharge, all mothers were filmed during a Non-singing (NS) and Singing (S) interactional condition; in the S condition, mothers were explicitly asked to address their infants by singing. Results of video and audio analysis showed that infants in the MTG displayed greater Eye Opening (EO) frequency compared to CG, but only when they were in an initial awake state at test, suggesting that music therapy can potentialize infants’ alertness, by increasing their disposition and chances of being engaged in the interaction with the mother. Non-religious mothers appeared to sing significantly more in the MTG than in the CG. These preliminary findings indicate that music therapy in the NICU could promote infant’s signs of engagement during interactions and can sustain maternal singing, especially with non-religious mothers in Brazil.     

Clinical Interview for high‐risk Parents of premature infants (CLIP) as a predictor of early disruptions in the mother–infant relationship at the nursery

The relations between mothers' narrative regarding the infant and the premature birth and the quality of mother–infant interaction were examined in mothers of 47 very low birth weight (<1650 g) premature singletons prior to discharge. Maternal representations were assessed with the Clinical Interview for high‐risk Parents of premature babies (CLIP), a semistructured interview that explores mothers' experiences of the pregnancy, delivery, hospitalization period, thoughts and feelings about the infant, and impending discharge. Ten minutes of mother–infant interaction were videotaped, and global and microanalytic codes were used to define three interactive variables: maternal adaptation, maternal touch, and infant withdrawal. Factor analysis of the CLIP items identified two factors with eigen values of 2.00 and above, termed Readiness for Motherhood and Maternal Rejection. Regression analyses were used to predict the three interactive variables by the infant's medical condition, maternal anxiety and depression, and the CLIP factors. Maternal adaptation to the infant's signal and maternal positive touch were each uniquely predicted by the mother's readiness for the maternal role, and were each negatively related to maternal depression. The infant's interactive withdrawal was independently predicted by maternal rejection. The clinical implications of the findings and the potential use of the CLIP for routine detection of early disruptions in the mother–infant relationship are discussed. ©2003 Michigan Association for Infant Mental Health.     

Consistency in infant sleeping arrangements and mother–infant interaction

This study examined the association between infant sleeping arrangements (i.e., habitual co‐sleeping, inconsistent co‐sleeping, and non‐co‐sleeping) and quality of mother–infant interaction during play in a sample of mothers, each with a typically developing infant (N=70). Mother–infant dyads who experienced consistency in infant sleeping arrangements in a typical week at 6 months (i.e., habitual co‐sleeping or non‐co‐sleeping) were characterized by more positive maternal and infant behavior and dyadic quality of interaction at 9 months compared with dyads who experienced inconsistency in sleeping arrangements. Additionally, a greater amount of co‐sleeping per week was associated with an increased duration of breastfeeding, mothers working fewer hours, less infant temperamental intensity, and less maternal depression. This study underscores the advantages of empirically based studies that consider consistency in infant sleep experience as a factor that is associated with more positive mother–child interaction.     

Infant colic and maternal depression

The combined impact of infant colic and maternal depression on infant, parent, and family difficulties was examined. The sample included 93 consecutive patients seen at an outpatient Colic Clinic. Most mothers had private insurance and completed high school. Infants were approximately 2 months of age. Questionnaires completed by the mother prior to treatment onset were used to measure depressive symptoms in the mothers, infant cry, sleep and temperament, characteristics, parenting stress, maternal self‐esteem, social support, and family function. Moderate to severe depressive symptoms were reported by 45.2% of the mothers. More severe depressive symptoms in the mothers were related to fussy/difficult infant temperament, more parenting stress, lower parental self‐esteem, and more family‐functioning problems. Pediatric health care providers need to be aware that the combined effects of colic and maternal depression can be problematic for the family. ©2005 Michigan Association for Infant Mental Health.     

Affect expression in prenatally psychotropic exposed and nonexposed mother–infant dyads

This prospective study examined infant, maternal, and dyadic affective profiles at three months postpartum in infant–mother dyads that were exposed to psychotropic medications in utero compared with nonexposed control dyads. Control dyads of nondepressed mothers and their infants showed many similarities in affect expression with mother–infant dyads who were exposed to selective serotonin reuptake inhibitors (SSRIs) alone for treatment of maternal depression. In contrast, mothers who received SSRIs and Rivotril (Benzodiazepine derivative) for treatment of depression and anxiety expressed both positive and negative affect towards their infants. Clinical implications regarding use of psychotropic medications such as SSRIs alone or in combination with other drugs for treatment of maternal anxiety and depression during pregnancy are discussed. Clinicians should be aware of the possible differential response in maternal–infant interaction in a mixed diagnosis group (i.e., depression and anxiety) regarding infant temperament, possibly suggesting latent behavioral teratogenicity with psychotropics. ©2002 Michigan Association for Infant Mental Health.     

Six‐month follow‐up of two mother–infant psychotherapies: Convergence of therapeutic outcomes

Fifty‐eight mothers and infants participating in two infant–mother psychotherapeutic interventions in a comparative infant–mother clinical intervention study were followed six months after treatment ended. One treatment was an infant‐led psychotherapy, Watch, Wait, and Wonder (WWW). The other was a more traditional mother–infant psychodynamic psychotherapy (PPT). Infants ranged in age from 10 to 30 months at the outset of treatment, which took place in weekly sessions over approximately five months. Results indicated that positive effects observed from the beginning to the end of treatment in both treatment groups in infant symptoms, parenting stress, and mother–infant interaction were maintained or improved further at six‐month follow‐up. Additionally, decreased maternal depression, gains in infant cognitive development and emotion regulation, and improved infant–mother attachment security or organization had been observed posttreatment only in the WWW group. Interestingly, between the posttreatment to follow‐up period the PPT group also showed such gains. Thus, for these variables it would be more accurate to say that the outcomes were similar for the two treatment groups but change emerged at a different pace. Nevertheless, an advantage persisted in the WWW group in relation to mothers' comfort dealing with infant behaviors and their ratings of parenting stress which improved more in this group from the end of treatment to follow‐up. The direct inclusion of the infant as an initiator in WWW was set forth as an explanation of differentially timed treatment effects. ©2002 Michigan Association for Infant Mental Health.     

Maternal sensitivity and infant response to frustration: The moderating role of EEG asymmetry

Two hundred and thirty-three 5-month-old infants and their mothers participated in a study designed to examine the influence of maternal sensitivity and infant neurophysiology, as well as interactions between these, on infants’ regulatory behavior and reactivity to emotional challenge. Maternal sensitivity was measured during two mother–child free-play episodes prior to the challenge task. Infant neurophysiology was derived from a measure of resting EEG asymmetry collected during a baseline episode. Infant regulatory behaviors (mother orienting and distraction) and reactivity to challenge (negative affect) were assessed during an arm restraint procedure. Maternal sensitivity predicted mother-orienting behavior for all infants, regardless of baseline EEG asymmetry. Maternal sensitivity also predicted more distraction behaviors for infants with left frontal EEG asymmetry at baseline. In contrast, maternal sensitivity predicted more negative affect for infants with right frontal EEG asymmetry at baseline. These findings lend support for the hypothesis that maternal sensitivity and infant neurophysiological functioning interact to predict regulatory behavior and reactivity and are discussed in terms of the significance for understanding infant regulatory development in the first year of life.     

Maternal avoidance,anxiety cognitions and interactive behaviour predicts infant development at 12 months in the context of anxiety disorders in the postpartum period

BackgroundFew studies have examined the relation between anxiety disorders in the postpartum period and cognitive as well as language development in infancy.AimsThis longitudinal study investigated whether anxiety disorder in the postpartum period is linked to infant development at twelve months. A closer look was also taken at a possible link between maternal interaction and infant development.Study designSubjects were videotaped during a Face-to-Face-Still-Face interaction with their infant (M = 4.0 months). Specific maternal anxiety symptoms were measured by self-report questionnaires (Anxiety Cognition Questionnaire (ACQ), Body Sensations Questionnaire (BSQ), Mobility Inventory (MI)) to check for a connection with infant development. The Bayley Scales of Infant and Toddler Development-III (Bayley-III) were used to assess infant language and cognitive development at one year of age.Subjectsn = 34 mothers with anxiety disorder (SCID-I; DSM-IV) and n = 47 healthy mothers with their infant.Outcome measuresInfant performance on Bayley-III language and cognitive scales.ResultsInfants of mothers with anxiety disorder yielded significantly lower language scores than infants of controls. No significant group differences were found regarding infant cognitive development. Exploratory analyses revealed the vital role of “maternal avoidance accompanied” in infant language and cognitive development. Maternal neutral engagement, which lacks positive affect and vocalisations, turned out as the strongest negative predictor of cognitive development. Maternal anxiety cognitions and joint activity in mother-infant interaction were the strongest predictors of infant language performance.ConclusionsResults underline the importance to also consider the interaction behaviour of women with anxiety disorders to prevent adverse infant development.     

Attachment,culture, and the caregiving system: The cultural patterning of everyday experiences among Anglo and Puerto Rican mother–infant pairs

This investigation focuses on cultural differences in the relationship between maternal sensitivity, emotional expression, and control strategies during the first year of life and infant attachment outcomes at 12 months. Participants were middle‐class Puerto Rican and Anglo mother–infant pairs (N = 60). Ratings of physical control, emotional expression, and maternal sensitivity during mother–infant interactions in five everyday home settings, videotaped when the infants were 4, 8, and 12 months old, were examined in combination with 12‐month Strange Situation classifications. Results suggest that physical control shows a different pattern of relatedness to maternal sensitivity, emotional expression, and attachment outcomes among the Puerto Rican compared to the Anglo mothers in this study. These findings have implications for practitioners and researchers interested in normative parenting among diverse cultural groups. ©2003 Michigan Association for Infant Mental Health.