Preterm behavior,maternal adjustment,and competencies in the newborn period: What influence do they have at 12 months postnatal age?

This article examines whether preterm newborns' behavior and their mother's adjustment to the premature birth and infant hospitalization have an influence on subsequent infant development and behavior, maternal adjustment, and mother–infant relationship. The behavioral competencies of 42 well, singleton preterm infants (mean gestational age=31 weeks) were assessed, as were their mothers' adjustment (depression and coping) and competencies (knowledge of child development). At 12 months of postnatal age, child competencies (development and behavior) were assessed, together with maternal adjustment (parenting stress and depression). Mother–infant interaction also was observed. Regression analyses indicated that in the newborn period, maternal positive reappraisal and a planful coping style, more knowledge of child development, and previous experience with baby‐sitting were associated with better infant development (p=.002), maternal adjustment (p=.012), and mother–child relationship (p=.002) at 12 months. Newborn infant muscle‐tone maturity was predictive of better motor quality at 12 months (p=.011), and being a firstborn infant who was more sleepy and drowsy was associated with subsequent higher maternal parenting stress (p=.007). Social and educational support groups combined with an approach that assists mothers to develop problem‐solving coping styles may have a beneficial influence on infant development.     

Separation-individuation as a family transactional process in the transition to parenthood

This is a study of the impact of prebirth level of parental and marital individuation on the course of parent-infant and infant development during the first postnatal year. Support was found for the first hypothesis, namely, that a couple's composite individuation profile, taking into account the prebirth separation-individuation of the father and the mother, and their marriage, would be associated with positive infant development and parent-infant transactions related to separation-individuation and mutuality during the first postnatal year. A second hypothesis, that maternal individuation would most strongly predict infant and parent-infant development at 6 months, while paternal individuation would emerge at 1 year as a strong predictor, was not supported. It was found instead that prebirth maternal and paternal individuation were equally strong predictors at six months, while maternal individuation was the primary predictor at 12 months. Other findings on the direct and indirect associations between prebirth parental and marital individuation and postnatal parent-infant transactions suggest that early separation-individuation processes result from a complex configuration of triadic mother-father-infant transactions.     

Early manifestations of childhood depression: influences of infant temperament and parental depressive symptoms

In this longitudinal study, 83 parents of infants between 3 and 12 months completed questionnaires assessing demographic information, infant temperament, and maternal depression. When these children were at least 18 months of age, parents completed follow‐up questionnaires assessing toddler temperament and depression‐like symptoms. We were primarily interested in the contributions of infant temperament and maternal depression to toddler depressive problems, and the analytic strategy involved controlling for toddler temperament in order to isolate the influence of infancy characteristics. The findings indicated that lower levels of infant regulatory capacity and greater severity of maternal depression were predictive of toddler depression‐like symptoms. Moderator effects of infant temperament were also examined, with the negative affectivity * maternal depression interaction emerging as significant. Follow‐up analyses indicated that the risk for early manifestations of depression was attenuated for children with lower negative affectivity in infancy and parents who reported lower levels of their own depressive symptoms; conversely, children exhibiting higher infant negative emotionality had higher levels of depression‐like symptoms as toddlers, regardless of their parents' level of depression. The present findings further suggest that parental depressive symptoms need not be ‘clinically significant’ to predict toddler affective problems. Copyright © 2008 John Wiley & Sons, Ltd.     

Mothers’ self-reported emotion dysregulation: A potentially valid method in the field of infant mental health

In the current study, we evaluated the extent to which mothers reported emotion dysregulation on the Difficulties with Emotion Regulation Questionnaire (DERS) (a) converged with physiological indices of emotion dysregulation while parenting, (b) correlated with maternal sensitivity, and (c) predicted infant attachment disorganization and behavior problems in a sample of 259 mothers and their infants. When infants were 6 months old, mothers’ physiological arousal and regulation were measured during parenting tasks and mothers completed the DERS. Maternal sensitivity was observed during distress-eliciting tasks when infants were 6 and 14 months old. Infant attachment disorganization was assessed during the Strange Situation when infants were 14 months old and mothers reported on infants’ behavior problems when infants were 27 months old. Mothers who reported greater emotion regulation difficulties were more physiologically dysregulated during stressful parenting tasks and also showed lower levels of maternal sensitivity at 6 months. Mother-reported dysregulation predicted higher likelihood of infant attachment disorganization and more behavior problems. Results suggest that the DERS is a valid measure of maternal emotional dysregulation and may be a useful tool for future research and intervention efforts aimed toward promoting positive parenting and early child adjustment.     

Maternal sensitivity,infant temperament,and the development of early feeding problems

Early feeding problems, assessed in maternal reports about general problems and refusal behaviors, were investigated in a normal sample (n = 115) at the ages of 10 months and 2 years. In a longitudinal design, stability of feeding problems was studied. A model for development of nonorganic failure to thrive proposed by Chatoor (1989: Chatoor & Egan, 1983) was used as a guide in selection of potential antecedents to early feeding problems. The predictive value of parent-rated infant temperament and directly observed maternal sensitivity for explaining variance in feeding problems was explored. The results showed moderate stability for feeding problems. Feeding problems at both ages were predicted by interactions between infant temperament and maternal sensitivity. At 10 months feeding problems were marginally associated with an interaction between sensitivity and infant manageability (degree of negative emotionality); less sensitive mothers with less manageable infants reported more refusal behaviors. At the age of 2 years irregular infants were reported to have more problems if their mothers were less sensitive to their signals. The results are discussed in relation to studies of more severe feeding problems in infancy, and the Chatoor model was found to contribute to an understanding of the development of everyday infant feeding problems in a normal sample. © 1997 Michigan Association for Infant Mental Health     

Effects of Early Parenting Interventions on Parents and Infants: A Meta-Analytic Review

This systematic review evaluates the efficacy of parenting interventions on parent, infant and parent-infant relationship outcome measures for parents of infants under 12 months old. Parent outcomes examined included competence, and confidence; baby outcomes included infant behaviours of crying, settling, and sleeping problems and parent-infant relationship outcomes included parental responsiveness. Systematic searches of five databases were carried out. In total, 36 randomised controlled trials over the past 35 years were included in the meta-analyses, with a total of 4880 participants. Interventions were carried out either during pregnancy or within the first 12 months after birth and involved teaching specific strategies and provision of information on infant development and behaviour. Mean effect sizes were obtained using a structural equation modelling (SEM) approach to meta-analysis. Heterogeneity was found on parent responsiveness and infant sleep. Potential moderator variables were assessed for these two outcomes using the SEM approach. Results showed that early parenting interventions are effective in improving parental responsiveness (d?=?0.77), and improving or preventing infant sleep problems (d?=?0.24), but not crying problems (d?=?0.27) possibly due to low power. No conclusions could be drawn in regards to parental competence or confidence. Moderator analysis showed that for interventions aimed at improving responsiveness, briefer interventions were more effective than longer ones; and studies published more recently reported smaller effects than older studies. No other moderators influenced the assessed intervention outcomes. The findings of this study provide further evidence for the positive effects of early parenting interventions for infants under 12 months of age, however future research is needed to assess intervention effects on parental competence and confidence.     

A randomized controlled trial of mother–infant psychoanalytic treatment: I. Outcomes on self‐report questionnaires and external ratings

Mother–infant relationship disturbances occur in three domains: maternal distress, infant functional problems, and relationship difficulties. They constitute common clinical problems. In Sweden, they are usually handled by nurses as part of public Child Health Centre care. Severe cases are referred to child psychiatry services. This randomized controlled trial compared two groups of mother–infant dyads in a Stockholm sample. One received only Child Health Centre care (the “CHCC” group) while the other received mother–infant psychoanalytic treatment plus CHCC (the “MIP” group). Eighty dyads of mothers and infants under 1½ years of age where the mothers had serious concerns about themselves in their role as mothers, their infants' well‐being, or the mother–baby relationship were randomly selected for either the MIP or the CHCC group. The primary outcomes were mother‐reported depression, mother‐reported infant functional problems, and interviewer‐based relationship assessments, all at 6 months after joining the project. Secondary outcomes were mother‐reported stress and general psychic distress, externally rated video‐recorded interactions, and the consumption of healthcare at the CHC, again all after 6 months. Intent‐to‐treat analyses of Treatment × Time effects significantly favored MIP treatment for maternal depression, mother–infant relationships, and maternal sensitivity. Effects were nearly significant on maternal stress, but nonsignificant on mother‐reported infant functional problems, general psychic distress, maternal interactive structuring and nonintrusiveness, infant responsiveness and involvement, and healthcare consumption. MIP treatment improved mother–infant relationships and maternal sensitivity and depression, all of which are known to influence child development. If effects persist and are reproduced, MIP treatment holds promise for more widespread use.     

Synchrony,complexity and directiveness in mothers’ interactions with infants pre- and post-cochlear implantation

This study investigated effects of profound hearing loss on mother–infant interactions before and after cochlear implantation with a focus on maternal synchrony, complexity, and directiveness. Participants included two groups of mother–infant dyads: 9 dyads of mothers and infants with normal hearing; and 9 dyads of hearing mothers and infants with profound hearing loss. Dyads were observed at two time points: Time 1, scheduled to occur before cochlear implantation for infants with profound hearing loss (mean age = 13.6 months); and Time 2 (mean age = 23.3 months), scheduled to occur approximately six months after cochlear implantation. Hearing infants were age-matched to infants with hearing loss at both time points. Dependent variables included the proportion of maternal utterances that overlapped infant vocalizations, maternal mean length of utterance, infant word use, and combined maternal directives and prohibitions. Results showed mothers’ utterances overlapped the vocalizations of infants with hearing loss more often before cochlear implantation than after, mothers used less complex utterances with infants with cochlear implants compared to hearing peers (Time 2), and mothers of infants with profound hearing loss used frequent directives and prohibitions both before and after cochlear implantation. Together, mothers and infants adapted relatively quickly to infants’ access to cochlear implants, showing improved interactional synchrony, increased infant word use, and levels of maternal language complexity compatible with infants’ word use, all within seven months of cochlear implant activation.     

MATERNAL TRAUMA AFFECTS PRENATAL MENTAL HEALTH AND INFANT STRESS REGULATION AMONG PALESTINIAN DYADS

We examined how diverse and cumulated traumatic experiences predicted maternal prenatal mental health and infant stress regulation in war conditions and whether maternal mental health mediated the association between trauma and infant stress regulation. Participants were 511 Palestinian mothers from the Gaza Strip who reported exposure to current war trauma (WT), past childhood emotional (CEA) and physical abuse, socioeconomic status (SES), prenatal mental health problems (posttraumatic stress disorder and depression symptoms), and perceived stress during their secondtrimester of pregnancy as well as infant stress regulation at 4 months. While all trauma types were associated with high levels of prenatal symptoms, CEA had the most wide‐ranging effects and was uniquely associated with depression symptoms. Concerning infant stress regulation, mothers’ CEA predicted negative affectivity, but only among mothers with low WT. Against hypothesis, the effects of maternal trauma on infant stress regulation were not mediated by mental health symptoms. Mothers’ higher SES was associated with better infant stress regulation whereas infant prematurity and male sex predisposed for difficulties. Our findings suggest that maternal childhood abuse, especially CEA, should be a central treatment target among war‐exposed families. Cumulated psychosocial stressors might increase the risk for transgenerational problems.     

PRENATAL AND POSTNATAL MATERNAL REPRESENTATIONS IN NONRISK AND AT‐RISK PARENTING: EXPLORING THE INFLUENCES ON MOTHER–INFANT FEEDING INTERACTIONS

The aim of this study was to investigate the mother–infant relationship in depressive, psychosocial, and cumulative‐risk parenting by assessing prenatal and postnatal maternal representations and mother–infant interactions during feeding at 4 months of age. The sample consisted of 167 mother–infant pairs: 41 nonrisk women, 40 depressive‐risk women, 40 psychosocial‐risk women, and 46 cumulative‐risk women. During pregnancy, the women were interviewed about psychosocial‐risk variables. Maternal representations and depressive symptoms were evaluated during pregnancy and again when the infants were 3 and 4 months old, respectively. All mother–infant pairs were observed in 20‐min video recordings during breast‐feeding. Maternal Integrated/balanced representations were more frequent in the nonrisk group whereas the maternal Nonintegrated/ambivalent category was more represented in the cumulative‐risk group during pregnancy and after the infant's birth. At 4 months, the cumulative‐risk group of mothers and infants showed a lack of reciprocity, conflictual communicative exchanges, and higher food refusal behavior. Moreover, at 4 months, differences between the quality of mother–infant feeding interactions and the quality of prenatal and postnatal maternal representations emerged, showing less adequate maternal scaffolding in the Nonintegrated/ambivalent and Restricted/disengaged women. This study has rich implications for intervention to support the affective and communicative caregiving system and to prevent infant feeding problems and mother–infant relational disturbances in childhood.     

Maternal and infant touching behaviours during perturbed interactions: Associations with maternal depressive symptomatology and infant crying

Touch is an important means through which mothers and infants co-regulate during periods of stress or perturbation. The present study examined the synchrony of maternal and infant touching behaviours among 41 mother-infant dyads, some of whom were deemed at-risk due to maternal depressive symptomatology. Mothers and their 4-month-old infants participated in the Still-Face (maternal emotional unavailability; SF) and Separation (maternal physical unavailability; SP) procedures. Infant crying was examined across procedures and investigated as a brief period of perturbation. Results revealed that mothers and infants displayed a positive pattern of tactile synchrony (coordinated, analogous changes in touch) during infant crying episodes. However, dyads in the high depression group displayed significantly less affectionate touch during instances of infant crying. Furthermore, more depressive symptoms were associated with less maternal and infant touch and lower rates of infant crying. This group of dyads may be less expressive via touch, be less affected by disruptions in their interactions, have impaired regulatory abilities, or simply require minimal amounts of touch to mutually regulate following social stressors and during brief perturbation periods. These findings enrich our limited knowledge about the dynamic interplay of maternal and infant touch and inform preventative intervention programs for at-risk groups.     

Prospective study of postpartum depression: 4 1/2-year follow-up of women and children

The consequences of maternal postpartum depression for mothers and children were investigated in a 4 1/2-year follow-up study, which included 70 of 99 women who had participated in an earlier study of postpartum depression. Information about maternal adjustment and depression during the follow-up period and child adjustment at age 4 1/2 years was obtained. Women who had experienced a postpartum depression were predicted to be at increased risk for subsequent depression and poor adjustment of their child. Postpartum depression was directly related to subsequent depression but not child problems. Later depression was related to child problems at 4 1/2 years. We concluded that postpartum depression may increase risk for later maternal depression and in turn increases risk for child behavior problems. Intervening with women who have experienced a postpartum depression may reduce likelihood of future depressions and child behavior problems.     

Early tactile experience of low birth weight children: links to later mental health and social adaptation

The purpose of this study was twofold: to determine (1) the degree to which specific qualities of maternal touch may contribute to the low birth weight infant's emotional and behavioural problems as well as social adaptation, and (2) the relationship between maternal touch and a mother's other caregiving behaviour. The sample included 114 socioculturally diverse infants and their mothers who were videotaped during an infant feeding when the baby was 3 months old. This videotape was analysed to assess dimensions of mother–infant interaction, including maternal touch. Data on perinatal risk and the mother's acceptance versus rejection of the infant were also acquired. Social adaptation and emotional/behavioural problems were measured when the child was 2 years of age. Hierarchical regression analyses indicated that maternal touch accounted for 15% of the variance in the likelihood of a child having emotional/behavioural problems at age 2. Children who received more nurturing touch had significantly fewer internalizing problems (such as depression) while children receiving both more frequent touch and harsh touch had more externalizing problems (such as aggressive behaviour). Infants who were less responsive to their caregivers were especially at risk of developing aggressive/destructive behaviour as a result of frequent touch. But less responsive infants also appeared to benefit most from greater use of diverse types of maternal touch, accounting for 6% of the variance in superior adaptive behaviour at age 2. Nurturing touch was the only quality that showed even a modest relationship to other caregiving behaviour, suggesting that touch may play a distinct role in the infant's psychosocial development. Copyright © 2001 John Wiley & Sons, Ltd.     

Maternal speech style with prelinguistic twin infants

The mother–infant communicative speech of a group of mothers of 4‐month‐old first‐born twin infants was compared to the speech of a group of mothers of first‐born singleton infants. Maternal groups were matched on age, education level, mother–infant attachment status and infant gender, and maternal depression was assessed as a control variable. Maternal speech was coded for focus, content, complexity and syntax of mothers' utterances. The findings of earlier studies with toddler age twins, that maternal speech style was more directive and less infant‐focused, were replicated in this prelinguistic period of infancy. Compared to mothers of singletons, mothers of twins used less infant‐focused speech, were less responsive to their infants' cues, and attributed less agency to their infants. Mothers of twins also used fewer questions and requests but did not differ from mothers of singletons in their use of negatives and imperatives. These early differences in the language learning environments of twin and singleton infants may be due to the reduced opportunities that mothers of twins have to establish dyadic communicative routines with their infants and to familiarize themselves with their infants as interactive partners, and may have implications for the early language development of twins. Copyright © 2002 John Wiley & Sons, Ltd.     

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.     

Postnatal depression and infant cognitive and motor development in the second postnatal year: The impact of depression chronicity and infant gender

A large body of literature has investigated the effects of postnatal depression on infant development. However, the particular circumstances in which depression is associated with adverse effects remain unresolved. Factors, such as the nature of depression (e.g., duration and severity) and the context with respect to other risk and protective factors (e.g., socioeconomic status and child gender) have been suggested as moderators of the effects of postnatal depression on infant outcomes. This study examined the impact of brief and chronic depression in a non-poverty sample of 112 mothers and their infants. Infant language development was assessed at 12 months, and at 15 months the Bayley Scales of Infant Development-II were administered. Chronic maternal depression, lasting throughout the first 12 months postpartum and beyond, was associated with lower infant cognitive and psychomotor development, with the effects being similar for boys and girls, while brief depression did not significantly impact the infant performance. Language development and infant behavior during testing were equivalent across the groups. The relatively high rates of motor development delay associated with chronic maternal depression found in this study are discussed along with the methodological issues and models of cumulative risk.     

Stability of maternal postnatal bonding between 3 and 6 months: Associations with maternal mental health and infant temperament

Maternal bonding is key for infant development and well-being. Research to date focused on prenatal bonding experience, with fewer studies looking at the postnatal period. Moreover, evidence suggests significant associations among maternal bonding, maternal mental health, and infant temperament. The joint impact of maternal mental health and infant temperament on maternal postnatal bonding remains unclear, with limited research reporting longitudinal data. Hence, the present study aims (1) to explore the impact of maternal mental health and infant temperament on postnatal bonding at both 3 and 6 months of age, (2) to explore postnatal bonding stability from 3 to 6 months, and (3) to determine which factors are linked with 3-to-6-month changes in bonding. At the infants' 3 months (n = 261) and 6 months of age (n = 217), mothers provided measures of bonding, depressive and anxious symptoms, and infant temperament via validated questionnaires. At 3 months, higher levels of maternal bonding were predicted by lower levels of anxiety and depression in the mothers and by higher infants' regulation scores. At 6 months, lower levels of anxiety and depression predicted higher levels of bonding. Moreover, mothers showing decreases in bonding were characterized by 3-to-6-month increases in depression and anxiety, as well as increased reported difficulties in regulation dimensions of infant temperament. This study highlights the impact of both maternal mental health and infant temperament on maternal postnatal bonding in a longitudinal sample and could offer useful information for early childhood prevention and care.     

The role of oxytocin in early mother-infant interactions: Variations in maternal affect attunement

The aim of the present research was to investigate the relationship between oxytocin and maternal affect attunement, as well as the role of affect attunement in the relationship between oxytocin and infant social engagement during early mother-infant interactions. Forty-three mother-infant dyads participated in the present study when infants were 4 months. They were observed during (1) a situation where no communication took place and (2) a natural interaction between mother and infant. During this procedure, three saliva samples from mothers and their infants were collected to determine their levels of oxytocin at different time points. Maternal affect attunement (maintaining attention, warm sensitivity) and infant interactive behaviors (gaze, positive, and negative affect) were coded during the natural interaction. Results indicated that overall maternal oxytocin functioning was negatively related to her warm sensitivity, while infant oxytocin reactivity together with maternal affect attunement were associated with infant positive social engagement with their mothers. Specifically, infant oxytocin reactivity was significantly related to their gazes at mother, but only for infants of highly attuned mothers. These results point to the complex role oxytocin plays in parent-infant interactions while emphasizing the need to analyze both overall oxytocin functioning as well as reactivity as different indices of human affiliative behavior.     

Precursors of social emotional functioning among full-term and preterm infants at 12 months: Early infant withdrawal behavior and symptoms of maternal depression

This study forms part of a longitudinal investigation of early infant social withdrawal, maternal symptoms of depression and later child social emotional functioning. The sample consisted of a group of full-term infants (N = 238) and their mothers, and a group of moderately premature infants (N = 64) and their mothers. At 3 months, the infants were observed with the Alarm Distress Baby Scale (ADBB) and the mothers completed the Edinburgh Postnatal Depression Scale (EPDS). At 12 months, the mothers filled out questionnaires about the infants’ social emotional functioning (Infant Toddler Social Emotional Assessment and the Ages and Stages Questionnaire-Social Emotional). At 3 months, as we have previously shown, the premature infants had exhibited more withdrawal behavior and their mothers reported elevated maternal depressive symptoms as compared with the full-born group. At 12 months the mothers of the premature infants reported more child internalizing behavior. These data suggest that infant withdrawal behavior as well as maternal depressive mood may serve as sensitive indices of early risk status. Further, the results suggest that early maternal depressive symptoms are a salient predictor of later child social emotional functioning. However, neither early infant withdrawal behavior, nor gestational age, did significantly predict social emotional outcome at 12 months. It should be noted that the differences in strength of the relations between ADBB and EPDS, respectively, to the outcome at 12 months was modest. An implication of the study is that clinicians should be aware of the complex interplay between early infant withdrawal and signs of maternal postpartum depression in planning ports of entry for early intervention.     

Infant screen media usage and social-emotional functioning

There has been little research on whether and how screen media usage affects social-emotional (SE) function prior to two years of age, even though early SE development is understood to be nurtured through interpersonal experience, mainly withthe primary caregiver. This study sought to characterise infant screen media usage and understand how it may link with concurrent SE function by testing associated effects on reducing parent-infant interaction and of parent psychological factors. Questionnaire responses from 327 UK-based parents of infants aged 6–24 months showed diverse usage in the amount of time spent on screen media (‘screen time’) and amount of parental involvement (co-sharing and co-referencing). Infants with possible SE delay experienced more screen time than those at low risk. The study tested three mediation models and found support for the displacement and not distancing hypothesis based on this community sample. While screen time predicted both SE competence and SE problems, reduced parent-infant play partially mediated the effect on SE competence. Parent depressed mood was positively linked with infant SE problems, but there was little evidence that increased screen time mediated this effect. Also, parent reflective function and attitudes toward parent-infant play were unrelated to screen time. Though longitudinal study is warranted, the findings implicate screen media usage as potentially directly and indirectly relevant when addressing infant mental health.