Attachment in preterm infants and their mothers: Neonatal risk status and maternal representations

High‐risk neonatal status, indexed by an intracranial hemorrhage (ICH), and maternal representations of past and present attachment relationships were examined as predictors of infant attachment in a sample of preterm infants. Participants included 50 19‐month‐old infants and their middle‐class, predominantly African American mothers. A maternal‐report questionnaire and a structured interview were used to assess past relationship history with mother and current relationship with infant, respectively. The Strange Situation Paradigm was used to assess attachment security. Multiple logistic regression analyses suggested that maternal representation of the infant—but not ICH or maternal childhood history—significantly predicted infant attachment security. ICH and maternal history of childhood rejection were predictive of disorganized infant attachment. The findings are consistent with previous data that suggest that maternal factors are more important than infant factors in determining infant attachment security. These data also suggest that neurological deficits may contribute to disorganized infant attachment. © 2000 Michigan Association for Infant Mental Health.     

Quality of attachment,perinatal risk,and mother–infant interaction in a high‐risk premature sample

Thirty‐three families, each with a premature infant born less than 33 gestational weeks, were observed in a longitudinal exploratory study. Infants were recruited in a neonatal intensive care unit, and follow‐up visits took place at 4 months and 12 months of corrected age. The severity of the perinatal problems was evaluated using the Perinatal Risk Inventory (PERI; A.P. Scheiner & M.E. Sexton, 1991 ). At 4 months, mother–infant play interaction was observed and coded according to the CARE‐index (P.M. Crittenden, 2003 ); at 12 months, the Strange Situation Procedure (SSP; M.D.S. Ainsworth, M.C. Blehar, E. Waters, & S. Wall, 1978 ) was administered. Results indicate a strong correlation between the severity of perinatal problems and the quality of attachment at 12 months. Based on the PERI, infants with high medical risks more frequently tended to be insecurely attached. There also was a significant correlation between insecure attachment and dyadic play interaction at 4 months (i.e., maternal controlling behavior and infant compulsive compliance). Moreover, specific dyadic interactive patterns could be identified as protective or as risk factors regarding the quality of attachment. Considering that attachment may have long‐term influence on child development, these results underline the need for particular attention to risk factors regarding attachment among premature infants.     

Chaos,danger, and maternal parenting in families: Links with adolescent adjustment in low‐ and middle‐income countries

The current longitudinal study is the first comparative investigation across low‐ and middle‐income countries (LMICs) to test the hypothesis that harsher and less affectionate maternal parenting (child age 14 years, on average) statistically mediates the prediction from prior household chaos and neighborhood danger (at 13 years) to subsequent adolescent maladjustment (externalizing, internalizing, and school performance problems at 15 years). The sample included 511 urban families in six LMICs: China, Colombia, Jordan, Kenya, the Philippines, and Thailand. Multigroup structural equation modeling showed consistent associations between chaos, danger, affectionate and harsh parenting, and adolescent adjustment problems. There was some support for the hypothesis, with nearly all countries showing a modest indirect effect of maternal hostility (but not affection) for adolescent externalizing, internalizing, and scholastic problems. Results provide further evidence that chaotic home and dangerous neighborhood environments increase risk for adolescent maladjustment in LMIC contexts, via harsher maternal parenting.     

Attachment and preschool children's understanding of maternal versus non‐maternal psychological states

There is growing evidence that insecurely attached children are less advanced in their social understanding than their secure counterparts. However, attachment may also predict how individual children use their social understanding across different relationships. For instance, the insecure child's social‐cognitive difficulties may be more pronounced when the psychological states of an attachment figure are being considered. In the current study, forty‐eight 4‐ to 5‐year‐old children were asked about their mothers' emotions and false beliefs, as well as those of non‐attachment figures. The Separation Anxiety Test (SAT) was administered to assess children's attachment representations. Children's SAT scores predicted their overall performance on the false belief and causes of emotion tasks, even after controlling for age and verbal ability. More interestingly, however, children with high scores on the Avoidance dimension of the SAT experienced greater difficulty understanding maternal false beliefs relative to those of an unfamiliar adult female. Thus, although attachment insecurity may hinder social‐cognitive development in general, the findings suggest that there are more specific effects as well. Attachment representations that are characterized by high levels of avoidance appear to interfere with children's ability to fully engage their social‐cognitive skills when reasoning about maternal mental states.     

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.     

Co-occurring risk and protective factors and regulatory behavior of infants living in low-income homes

Early self-regulation is a foundation for lifelong wellness and can be shaped by the interplay among several vital exposures. In this study, we examined the emergence of reliable profiles based upon exposure to risk and protective factors in infancy, determined if sociodemographic resources predict profile membership, and determined if these profiles predict early regulatory behaviors in a sample of infants reared in low-income homes. Data were collected from a sample of primarily Black or White mother-infant dyads living in low-income homes in the Midwest (n = 222) during the infants’ first year of life (mean maternal age at enrollment: 26.29 years; range 18−43 years). Exposures included mother-infant interactions; father support; maternal depression, stress, and self-efficacy; home environment; food security; and breastfeeding duration. Sociodemographic resources included poverty status; economic hardship; maternal education, employment, and age; parental marital status; and infant race and sex. Infant regulatory behaviors were measured with the Infant Behavior Questionnaire-Revised Very Short Form effortful control subscale (mean age 11 months; range 8.5−14.3 months). Latent profile analysis was used to profile infants by risk and protective exposures. Regression was used to differentiate profiles by sociodemographic resources and to predict infant regulatory behavior from profiles. Three profiles emerged: low father support, good maternal mental health, and poor maternal mental health. A married mother, less economic hardship, and working mothers predicted infant exposure to good maternal mental health. Infant regulatory behavior was best when the infant was exposed to the good maternal mental health profile. Implications for future research are discussed.     

Family,friend, and neighbour child care providers and maternal well‐being in low‐income systems: An ecological social perspective

Integrating theory from the family ecological systems and social support literatures with findings from child care research, in this study we develop and test a model relating family, friend, and neighbour (FFN) child care provider characteristics to perceived child care quality (provider reports of caregiving behaviours, mother‐provider caregiving relationship) and maternal well‐being (work‐family conflict, depressive symptoms). Results from phone interviews with 187 FFN providers receiving public subsidies indicated that even after controlling for familial status or household income, caregiver perceptions of higher quality care were associated with higher education levels, greater attachment to child care as a job; and lower provider depressive symptoms. After controlling for familial status, data analysed from a subset of 51 mother‐provider pairs, indicated that mothers using care from providers who reported higher quality parent‐caregiver social relationships reported lower work‐family conflict and depressive symptoms. This study suggests mothers who have providers with whom they have good caregiving interactions may experience positive social support and psychological crossover dynamics associated with mother well‐being.     

Effects of maternal depressive symptoms on sensitivity to infant distress and non-distress: Role of SES and race

The goals of the present study were to examine the extent to which (a) maternal depressive symptoms (prenatal vs. postnatal depressive symptoms) undermine maternal sensitivity toward both infant distress and non-distress; (b) such effects are stronger in the context of socioeconomic risk. SES risk and depressive symptoms interacted such that depressive symptoms, both pre and postnatal, only predicted lower sensitivity among mothers at heightened SES risk. The effects were comparable for sensitivity to distress and non-distress and did not vary by maternal race.     

Withdrawn and intrusive maternal interaction style and infant frontal EEG asymmetry shifts in infants of depressed and non-depressed mothers

The effects of maternal interaction style (intrusive/withdrawn) on the development of brain electrical activity were studied in infants of depressed and non-depressed mothers shortly after birth and again at 3-6 months of age. Infants of depressed mothers exhibited significantly greater relative right frontal EEG activation than infants of non-depressed mothers. Infants of depressed withdrawn mothers exhibited greater relative right frontal EEG activation than infants of depressed intrusive mothers. Furthermore, while infants of depressed mothers with intrusive interaction styles showed a shift towards greater relative left frontal EEG activation from birth to 3-6 months, infants of depressed mothers with withdrawn interaction styles showed a shift towards greater relative right frontal EEG activation.     

When infants talk,infants listen: pre‐babbling infants prefer listening to speech with infant vocal properties

To learn to produce speech, infants must effectively monitor and assess their own speech output. Yet very little is known about how infants perceive speech produced by an infant, which has higher voice pitch and formant frequencies compared to adult or child speech. Here, we tested whether pre‐babbling infants (at 4–6 months) prefer listening to vowel sounds with infant vocal properties over vowel sounds with adult vocal properties. A listening preference favoring infant vowels may derive from their higher voice pitch, which has been shown to attract infant attention in infant‐directed speech (IDS). In addition, infants' nascent articulatory abilities may induce a bias favoring infant speech given that 4‐ to 6‐month‐olds are beginning to produce vowel sounds. We created infant and adult /i/ (‘ee’) vowels using a production‐based synthesizer that simulates the act of speaking in talkers at different ages and then tested infants across four experiments using a sequential preferential listening task. The findings provide the first evidence that infants preferentially attend to vowel sounds with infant voice pitch and/or formants over vowel sounds with no infant‐like vocal properties, supporting the view that infants' production abilities influence how they process infant speech. The findings with respect to voice pitch also reveal parallels between IDS and infant speech, raising new questions about the role of this speech register in infant development. Research exploring the underpinnings and impact of this perceptual bias can expand our understanding of infant language development.     

A pediatric screening instrument to detect problematic infant–parent interactions: Initial reliability and validity in a sample of high‐ and low‐risk infants

The purpose of this study was to determine the initial reliability and validity of a screening instrument developed to detect problematic interactions between infants and parents as part of a pediatric well‐baby exam. Participants included 117 infant–mother dyads (57 preterms and 60 full terms) assessed when infants were 6 to 9 months old. Mothers and infants were observed playing an interactional game such as peek‐a‐boo during the course of the pediatric exam. The game was scored for degree of interactional reciprocity using the Pediatric Infant Parent Exam (PIPE). Acceptable levels of interrater reliability were achieved. As predicted, higher risk infants and their mothers exhibited more problematic interactions than lower risk infants and their mothers. Results indicated that the PIPE was a reliable means of screening for interactional difficulties, that was sensitive to, but not synonymous with, neonatal health indices. ©2001 Michigan Association for Infant Mental Health.     

Influences of maternal postpartum depression on fathers and on father–infant interaction

Maternal postpartum depression (PPD) has been shown to negatively influence mother–infant interaction; however, little research has explored how fathers and father–infant interaction are affected when a mother is depressed. This study examined the influence of maternal PPD on fathers and identified maternal and paternal factors associated with father–infant interaction in families with depressed as compared with nondepressed mothers. A convenience sample of 128 mother–father–infant triads, approximately half of which included women with significant symptoms of PPD at screening, were recruited from a screening sample of 790 postpartum women. Mothers and fathers completed measures of depression, marital satisfaction, and parenting stress at 2 to 3 months' postpartum and were each videotaped interacting with their infants. Results indicate that maternal PPD is associated with increased paternal depression and higher paternal parenting stress. Partners of depressed women demonstrated less optimal interaction with their infants, indicating that fathers do not compensate for the negative effects of maternal depression on the child. Although mother–infant interaction did not influence father–infant interaction, how the mother felt about her relationship with the infant did, even more so than maternal depression. The links between maternal PPD, fathers, and father–infant interaction indicate a need for further understanding of the reciprocal influences between mothers, fathers, and infants.     

Predictors of maternal language to infants during a picture book task in the home: Family SES, child characteristics and the parenting environment

This study investigated the contribution of child characteristics and parenting environment to the relationship between family SES/demographic characteristics and maternal language to infants. 1157 children were drawn from a representative sample of 1292 infants born to mothers in rural Appalachian counties and rural counties in southern minority U.S. communities. Mothers and their 6–8 month old babies were videotaped at home while talking about a wordless picture book. Mothers' language output and complexity were analyzed. Child temperament, age, and parenting environment (knowledge of child development and observed mother–child engagement) were predictors of maternal language. Furthermore, their inclusion reduced the magnitude of the association between demographic characteristics and maternal language. Tests of mediation suggested that the parenting environment partially mediates the relationship between SES/demographic characteristics and maternal language. Findings are discussed with respect to identifying proximal processes that explain how SES may exert its influence on the language of young children.     

The influence of prematurity,maternal anxiety,and infants' neurobiological risk on mother–infant interactions

In this study, we investigated how the birth of a very low birth weight preterm (VLBW) infant influences the mother–infant interaction at 3 months. We also focused on the impact of the infant's neurobiological risk and maternal anxiety, and their interaction. The comparison of the VLBW preterm sample (n = 79) with an external full‐term sample (n = 35) showed mother–infant interactions of the families with the preterm infant to be more vocally responsive during the interaction, but less facially responsive during the interaction. Additionally, higher levels of maternal anxiety were associated with preterm infants being less facially responsive in interaction with their mother. While neurobiological risk of the infant played a part in this association, with higher risk infants also being less facially responsive, the relationship with maternal anxiety and the mother–child interaction was stronger. How these findings may influence therapeutic interventions is discussed.     

Evaluating a home‐based dyadic intervention: Changes in postpartum depression,maternal perceptions,and mother–infant interactions

Psychotherapeutic treatments that focus on improving the relational processes between mothers with postpartum depression (PPD) and their infants, as well as the mother's individual therapeutic needs, have a great potential to positively impact the mother, her infant, and their relationship (K.J. Nylen, T.E. Moran, C.L. Franklin, & M. O'Hara, 2006 ). Utilizing pilot data from an evaluation of a home‐based dyadic therapy for mothers with PPD and their infants, this article reports on a recent academic–community partnership study. The effectiveness of the intervention was examined, specifically regarding changes in mother's mood, parenting experience, and relationship with her infant. In addition, associations were examined among maternal self‐report variables measuring change from pre‐ to posttreatment in PPD, psychological distress, and maternal perceptions of parenting and those variables measuring change in observer ratings of maternal–infant interactions. Results showed improvements in mothers' depression, distress, and perceptions of parenting as well as many ratings of mothers' interactions with their infants. However, only improvements in maternal perceptions of parenting, such as maternal self‐esteem and parenting stress, were associated with better mother–‐infant interactions. Importance of this research for the field of infant mental health as well as clinical implications are discussed.     

The relation between early mother–infant skin‐to‐skin contact and later maternal sensitivity in South African mothers of low birth weight infants

The relation between early mother–infant skin‐to‐skin contact (SSC) and mothers' subsequent sensitivity to their low birth weight infants was investigated in a study of 12 mother–infant dyads who participated in a South African randomized control study of early SSC. The dyads were visited in the home when infants were under 1 year. Amounts of SSC were taken from hospital records and home interviews. Videotapes of mother–infant interactions in the home were scored for maternal sensitivity on the Maternal Behavior Q‐Sort (D.R. Pederson, G. Moran, & S. Bento, 1999) and the Maternal Behavior subscale of the Nursing Child Assessment Teaching Scale (G. Sumner & A. Spietz, 1994). Amount of SSC in infants' first 24 hr correlated with amount of SSC through the first month. Amount of SSC in infants' first 24 hr independently accounted for maternal sensitivity on both measures, indicating that early mother–infant SSC predicted subsequent maternal sensitivity.     

Dispositional Attachment Orientations,Contextual Variations in Attachment Security,and Compassion Fatigue Among Volunteers Working With Traumatized Individuals

In the present article, we report a series of studies examining the links between attachment orientations and compassion fatigue among volunteers working with traumatized individuals. Participants were volunteers in several trauma‐related organizations, ranging in age from 18 to 69 years. In Study 1 (N = 148), we examined associations between self‐reports of attachment insecurities and compassion fatigue. In Study 2 (N = 54), we used a diary design to assess attachment‐related differences in emotional reactions to actual helping encounters over a 2‐month period. In Study 3 (N = 108), we examined the effects of the experimental enhancement of attachment security (security priming) on reactions to a hypothetical helping encounter. As expected, attachment insecurities, either anxiety or avoidance, were associated with heightened compassion fatigue. Moreover, security priming reduced compassion fatigue in response to a hypothetical helping encounter. These findings underscore the relevance of attachment theory for understanding and preventing compassion fatigue.     

Habituation in high‐risk infants: reliability and patterns of responding

We examined both the reliability of infant‐controlled habituation and patterns of responding in a group of high‐risk infants (mean age 16 mos). Good test–retest reliability was found for mean, total, and baseline looking time for one of the stimuli. Classification of infants' pattern of performance yielded two groups: linear (57%) and non‐linear (29%) responders; 14% of cases could not be classified because of cross‐session inconsistencies in performance. Linear responders had shorter total looking times, fewer trials to criterion, and showed more habituation than non‐linear responders, thus validating the linear/non‐linear distinction. Our findings indicate that the infant‐controlled habituation task can be used reliably with infants who are at high risk for developmental disorders. Indeed, we provide evidence that this task is not only reliable, but may also provide meaningful distinctions between infants within the high‐risk population. Discussion focuses on the role of attention in distinguishing between short (linear) and long (non‐linear) lookers. Copyright © 2003 John Wiley & Sons, Ltd.