Speaking for the baby: A therapeutic intervention with adolescent mothers and their infants

Adolescent mothers frequently experience problems in mother-infant interaction. However, intervention can be very difficult, particularly when complicated by unresolved conflicts involving relationships in the young woman's past. This article describes a therapeutic intervention, based on the work of Fraiberg, which allows the young mother to learn to interpret her infant's cues while also encouraging her to express her own emotions in the context of the mother-infant relationship. Two case studies are discussed to illustrate the use of the technique as part of a program of mother-infant intervention.     

Mothers who are securely attached in pregnancy show more attuned infant mirroring 7 months postpartum

This study contrasted two forms of mother–infant mirroring: the mother's imitation of the infant's facial, gestural, or vocal behavior (i.e., “direct mirroring”) and the mother's ostensive verbalization of the infant's internal state, marked as distinct from the infant's own experience (i.e., “intention mirroring”). Fifty mothers completed the Adult Attachment Interview (Dynamic Maturational Model) during the third trimester of pregnancy. Mothers returned with their infants 7 months postpartum and completed a modified still-face procedure. While direct mirroring did not distinguish between secure and insecure/dismissing mothers, secure mothers were observed to engage in intention mirroring more than twice as frequently as did insecure/dismissing mothers. Infants of the two mother groups also demonstrated differences, with infants of secure mothers directing their attention toward their mothers at a higher frequency than did infants of insecure/dismissing mothers. The findings underscore marked and ostensive verbalization as a distinguishing feature of secure mothers’ well-attuned, affect-mirroring communication with their infants.     

Mother's prenatal and postpartum depression symptoms and infant's sleep problems at 6 months

Mother's prenatal and postpartum depression have been associated with infant's sleep problems. This study aimed to analyze (a) the effects of mother's prenatal and postpartum depression symptoms, including the effects of prenatal and postpartum anxiety and depression scores of the Edinburgh Postnatal Depression Scale (EPDS), on infant's sleep problems at 6 months, and (b) the interaction effect between mother's prenatal and postpartum depression symptoms and infant's sex on infant's sleep problems at 6 months. The sample was comprised of 164 mother–infant dyads whose mothers completed measures of depression at the third trimester of pregnancy, 2 weeks, 3 and 6 months postpartum and a measure of infant's sleep problems at 6 months (CSHQ-I). Mother's prenatal depression symptoms, specifically depression scores of the EPDS, predicted more infant's sleep anxiety and daytime sleepiness, while mother's depression symptoms at 2 weeks postpartum, specifically anxiety scores of the EPDS, predicted more bedtime resistance and CSHQ-I total scores at 6 months. Boys of mothers with more prenatal depression symptoms presented more sleep anxiety at 6 months. Both mother's prenatal and early postpartum depression symptoms have a negative effect on the emergence of infant's sleep problems. Additionally, boys seem more vulnerable to mother's prenatal depression symptoms.     

Infant's action skill dynamically modulates parental action demonstration in the dyadic interaction

When interacting with infants, human adults modify their behaviours in an exaggerated manner. Previous studies have demonstrated that infant‐directed modification affects the infant's behaviour. However, little is known about how infant‐directed modification is elicited during infant–parent interaction. We investigated whether and how the infant's behaviour affects the mother's action during an interaction. We recorded three‐dimensional information of cup movements while mothers demonstrated a cup‐nesting task during interaction with their infants aged 11 to 13 months. Analyses revealed that spatial characteristics of the mother's task demonstration clearly changed depending on the infant's object manipulation. In particular, the variance in the distance that the cup was moved decreased after the infant's cup nesting and increased after the infant's task‐irrelevant manipulation (e.g. cup banging). This pattern was not observed for mothers with 6‐ to 8‐month‐olds, who do not have the fine motor skill to perform the action. These results indicate that the infant's action skill dynamically affects the infant‐directed action and suggest that the mother is sensitive to the infant's potential to learn a novel action. A video abstract of this article can be viewed at: https://www.youtube.com/watch?v=VNS2IHwLIhg&feature=youtu.be     

A postpartum telephone program of reassurance,information, and early intervention in a family practice

This paper presents a program developed in a family practice office to provide reassurance, guidance, and early detection and intervention for mothers and their new infants in the first month of the infant's life. Telephone calls from an office nurse at 2 weeks of age followed by a written questionnaire demonstrated a dichotomy between the mothers' expressions of their physical and emotional problems. Feeding was the most prominently expressed concern, but we also found that complaints or worries about feeding were also an acceptable way to initiate intervention for more serious problems.     

Newborn behavioral observations system in rural Pakistan: A feasibility and acceptability study

The Newborn Behavioral Observations (NBO) system is a relationship-based tool that helps parents recognize their infant's competencies and learn their behavioral cues, with the goals of enhancing parental responsiveness and satisfaction in the infant-parent relationship. In our study, a pediatrician integrated the NBO into 44 pediatric health care visits of infants in rural Pakistan villages, under the remote guidance of two U.S.-based child psychiatrists. A clinician then gave the mothers a survey about their experience of the NBO and found that the mothers were highly satisfied, reporting greater appreciation of their infant's strengths, greater understanding of their infant's behavioral cues, stronger attachment to their infant, and greater self-confidence as a mother. In their consideration of these results, the authors explore cultural reasons for the mothers’ responses and generate hypotheses to inform an outcome study of a similar intervention. This was a feasibility and acceptability study and was not randomized, had no control group, and did not use objective measures of outcome.     

Strategy instruction for writing composition at school and at home

Abstract

The objectives of this study are 1) to analyze the effectiveness of a writing composition intervention program aimed to increase children's writing performance and other personal variables; 2) to analyze whether implementation in the environment (school and home) or responsible figures (parents and teachers) produced different effects in program effectiveness; and 3) to check whether increasing parental involvement in doing homework was sufficient to improve children's outcomes or whether prior family training is required to enable them to be efficient. The sample consisted of 112 students (5th-6th grade) and their families. 26 of them made up the EFP group (mothers implementing a writing program), 25 of them were assigned to the PAD group (mothers increasing help with writing homework), 35 to the PRO group (teachers applying a writing program) and 26 to the OC group (ordinary curriculum). We analyze the results and present and discuss our conclusions.     

Caregiving behavior and interactions of prenatally depressed mothers (antidepressant‐treated and non‐antidepressant‐treated) during newborn acute pain

This exploratory study aimed to examine time‐based measures of the behaviors and interactions of prenatally depressed serotonin reuptake inhibitors (SRI)‐medicated mothers to their infant's pain (n = 10) by comparing them with similar measures obtained from prenatally depressed nonmedicated mothers and their infants (n = 10), and nondepressed mothers and their infants (n = 10). During the second trimester of their pregnancy, the 30 study mothers were assessed for depression and anxiety, with no further measures of maternal mood taken. Maternal and infant interactions were continuously videorecorded while the infant underwent a scheduled heel lance for routine blood screening that occurred when study infants were between the ages of 24 and 60 hr. Maternal behavior and infant cry, for all 30 cases, were coded second‐by‐second for the full duration of each infant's heel lance using a reliable coding system and analyzed using odds ratio and regression analyses. Infants exposed to prenatal SRIs and depressed maternal mood were more likely to have lower Apgar scores and to exhibit weak and absent cry. Even when duration of the heel lance was controlled for, women with depression during the second trimester were more likely to exhibit depressed behavior at 2 days' postpartum despite sustained SRI antidepressant treatment. Both groups of prenatally depressed mothers were more likely to exhibit diminished response to their infants' pain cue although nonmedicated mothers' expressions of depressed behavior were more similar to healthy controls. Comprehensive understanding is essential to optimize the clinical care of mothers and their infants in this complex setting. This study contributes preliminary new findings that warrant prospective and longitudinal studies to clarify further the impacts of prenatal SRI and maternal mental mood (e.g., chronic depression and anxiety) effects on the mother–infant interaction and infant pain and stress reactivity.     

Maternal recollected anxiety and mother–infant interaction in preterm infants

This study focused on the relationship between maternal recollected anxiety and the quality of mother–preterm infant interaction. In a observational study, 52 mothers and their preterm infants were videotaped at home in a standardized object–play interaction situation, at the infant's age of 6 months. Observations concentrated on different aspects of maternal behavior, including sensitive responsiveness, involvement, level of activity, and intrusiveness. Mothers were interviewed about their experiences during the period of neonatal intensive care and were, on the basis of their answers, divided into high‐anxiety and low‐anxiety mothers. In general, and independent of the infant's current interactive behavior and medical status, high‐anxiety mothers were more intrusive and more active during interaction with their infants than were mothers who recalled little or no anxiety during the postnatal period. ©1999 Michigan Association for Infant Mental Health.     

MARITAL SATISFACTION AMONG MOTHERS OF INFANTS WITH CONGENITAL HEART DISEASE: THE CONTRIBUTION OF ILLNESS SEVERITY,ATTACHMENT STYLE,AND THE COPING PROCESS

This study examined the contribution of illness severity and attachment style to marital satisfaction among mothers of infants with Congenital Heart Disease (CHD) as well as the mediating role of cognitive appraisal and ways of coping with motherhood tasks. Eighty-five mothers of newborns with CHD rated their attachment style 2 weeks after the infant's CHD diagnosis and two physicians rated the severity of the disease. One year later, mothers completed self-reports scales tapping marital satisfaction, appraisal of motherhood tasks, and ways of coping with these tasks. The severity of infant's disease and mothers’ attachment anxiety and attachment avoidance were related to less marital satisfaction. Moreover, whereas illness severity and attachment anxiety had direct effects on marital satisfaction, the negative effects of attachment avoidance were mediated by the appraisal of motherhood in threatening terms and the reliance on emotion-focused coping. The interconnections between attachment style, the process of coping with the stress of a chronic illness, and marital satisfaction were discussed.     

Maternal correlates of infant temperament ratings and of infant-mother attachment: A longitudinal study

This study examined longitudinally correlates of mothers' ratings of their infant's temperament and of the infant-mother attachment relationship. Measures included Carey's Revised Infant Temperament Questionnaire, child-rearing attitudes, psychophysiological responses to an unfamiliar infant's crying pre- and postdelivery, psychophysiological responses to the mother's own infant's crying, and assessments of infant-mother attachment. The results indicated that maternal ratings of infant temperament at 4 months were significantly related not only to concurrent cry responsiveness but also to cry responsiveness and child-rearing attitudes predelivery, as well as to the quality of attachment at 1 year. It is suggested that a differential response pattern of mothers of “easy” and of “difficult” infants, which affects the developing infant-mother bond, may in part originate in maternal dispositions existing prior to parenthood.     

Infant‐holding biases in mothers and affective symptoms during pregnancy and after delivery

Several authors have reported that participants have a leftward bias when holding a newborn or young infant. Our study of mothers met before and after their infant's birth sought to ascertain whether particular combinations of affective symptoms (depression, anxiety) and holding positions (horizontal versus vertical) were related to holding‐side biases. Our results showed that (a) mothers displayed a significant leftward (71%) holding bias, (b) mothers with affective symptoms held their newborn on the right side and more frequently in the vertical position, and (c) hemispheric specialization for perceiving visual emotions had no significant effect on the holding‐side biases of new mothers. These results suggest that maternal affective symptoms have a dominant effect on the determination of holding‐side preferences, when associated with a particular holding position. Copyright © 2008 John Wiley & Sons, Ltd.     

Social referencing in infants of mothers with symptoms of depression

The present study examined the acquisition of social referencing skills in infants of mothers with symptoms of depression (n = 44). We aimed to determine if a short discrimination training could facilitate infants’ social referencing. Mothers were instructed to pose either joyful or fearful facial expressions to cue infants’ approach/avoidance responses toward an ambiguous object. Maternal expressions were correlated with pleasant or unpleasant events occurring after the infant's response. The results showed that after the intervention, infants looked at their mothers more frequently and reached or avoided the ambiguous object based on the preceding maternal expression. The results suggest that discrimination training procedures can establish social referencing in infants of mothers with symptoms of depression.     

Mother–Infant Joint Attention and Sharing: Relations to Disorganized Attachment and Maternal Disrupted Communication

The normative development of infant shared attention has been studied extensively, but few studies have examined the impact of disorganized attachment and disturbed maternal caregiving on mother–infant shared attention. The authors examined both maternal initiations of joint attention and infants’ responses to those initiations during the reunion episodes of the Strange Situation Procedure at 12 and 18 months of infant age. The mothers' initiations of joint attention and three forms of infant response, including shunning, simple joint attention, and sharing attention, were examined in relation to infant disorganized attachment and maternal disrupted communication. Mothers who were disrupted in communication with their infants at 18 months initiated fewer bids for joint attention at 12 months, and, at 18 months, mothers of infants classified disorganized initiated fewer bids. However, the infant' responses were unrelated to either the infant' or the mother' disturbed attachment. At both ages, disorganized infants and infants of disrupted mothers were as likely to respond to maternal bids as were their lower risk counterparts. Our results suggest that a disposition to share experiences with others is robust in infancy, even among infants with adverse attachment experiences, but this infant disposition may depend on adult initiation of bids to be realized.     

The effects of mothers' teasing: Do Japanese infants read their mothers' play intention in teasing?

The focus of this study was whether an infant can understand the playful intention in the mother's teasing behaviour. The mother's teasing behaviour can elicit playful interaction with the infant on the one hand, or can result in the infant's distress. In other words, teasing may function as the turning-point in mother-infant interaction. Thus it was hypothesized that the consequence of mothers' teasing behaviour would be positive or negative depending on the success or failure in communication of both mothers' play intention with play signs and infants' interpretation of the play signs. Subjects were 20 mothers and their infants aged from 10 to 13 months (M = 11 months) who were observed during 10 minutes of free play with toys that evoke minor surprise and/or fearfulness. Results showed that about one-third of mothers' teasing behaviour elicited the infant's enjoyment. Especially, mothers' playful teasing accompanied by a smile or laugh led most successfully to infant enjoyment. In contrast, mothers' pretence teasing elicited no particular response from infants. These data suggest that around their first birthday infants develop some understanding of the play intention latent in mothers' teasing behaviour.     

Self-guided behavioral skills training: A public health approach to promoting nurturing care environments

The World Health Organization identified the promotion of “Nurturing Care Environments” as a global health priority. Responsive caregiving, 1 of 5 domains describing nurturing care, is critical for healthy child development. Relatively little research has evaluated population-level interventions aimed to increase responsive caregiving during the first 1,000 days of an infant's life. In this pilot study, we evaluated an intervention designed for population-level dissemination that targeted responsive caregiving. The self-guided behavioral skills training aimed to teach mothers to imitate infant vocalizations. The intervention was delivered within an on-line asynchronous training. All 3 mothers increased vocal imitative behavior following training without receiving coaching or behavior-specific feedback from an implementer. The results offer a preliminary proof of concept with implications for population-level intervention design and evaluation.     

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.     

Early stages of initiative and environmental response

Research results on the association between maternal response to infant' initiative and the development of such initiatives is being presented. This study is based on 239 feeding situations belonging to 41 mother–infant pairs videotaped at home at 30-day intervals, from the beginning of spoon-feeding until 1 year of age. The results showed that the basic hypotheses of this study were confirmed. There was a clear association between maternal responses to initiatives of the infant and four variables: Initiatives, Attempted Initiatives, Aversive Behavior, and Conflictivity. A favorable maternal response went along with more initiatives, fewer Attempts, less Aversivity, and less Conflictivity. Conflictivity was understood as reciprocal exchange of antipathetic reactions such as opposition, disgust, and hostility. Therefore, conflicts show struggle and confrontation between both members of the interaction. Aversivity is the infant's sole reaction to disgust, distaste, or opposition. As the infant risks confrontations with the care-giver to sustain her initiatives, we can say that, although highly influentiable by maternal response, Initiative is a contribution of the infant to her own development. Thus, in our view, a developing self shows an emerging capacity to initiate actions of his/her own. This becomes a relational issue as soon as the infant's initiative hits the interactional field, causing an environmental response that ultimately will allow or impede initiative. In case of impediments, the strong reaction of the infant will produce an impact upon the progressive stages of construction of the relationship, and certainly will be influential upon the further development of the infant's self.     

Infant Developmental Outcomes: A Family Systems Perspective

The aim of the current study was to examine whether parental mental health, parent–infant relationship, infant characteristics and couple's relationship factors were associated with the infant's development. Forty‐two families took part at three time points. The first, at 3 months postpartum, involved a video recorded observation (CARE‐index) of parent–infant interactions. At 5 months postpartum, in‐depth clinical interviews (the Birmingham Interview of Maternal Mental Health) assessed parental mental health and parental perceptions of their relationship with their infant, their partner and their infant's characteristics. Finally, the Bayley Scales III was carried out 17 months postpartum to assess the infants' cognitive, language and motor development. A higher mother–infant relationship quality was significantly associated with more optimal language development, whilst a higher father–infant relationship quality was associated with more advanced motor development. Additionally, maternal postnatal post‐traumatic stress disorder had a negative impact on the infant's cognitive development, whilst maternal prenatal depression was associated with a less optimal infant's language development. The largest prediction was afforded by parental perceptions of their infant's characteristics. The findings indicate that such perceptions may be crucial for the infant's development and imply that negative internal parental perceptions should be considered when assessing risk factors or designing interventions to prevent negative child outcomes. Copyright © 2013 John Wiley & Sons, Ltd.