Atypical maternal behavior toward feeding‐disordered infants before and after intervention

The display of atypical behaviors and disrupted communication during parent–infant interactions, as assessed by the Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE), has been linked to disorganized infant attachment, which, in turn, has been linked to psychopathology. The present study examined the usefulness of the AMBIANCE as an indicator of the efficacy of two brief interventions in reducing atypical behaviors and disrupted communication during play interactions. Twenty‐eight mother–infant dyads participated (14 per intervention). All infants had feeding problems. One intervention, Interaction Guidance, focused on training caregivers to respond sensitively to their infants (play‐focused intervention). The other intervention focused on training mothers to use new feeding techniques (feeding‐focused intervention). Results showed a significant decrease in AMBIANCE scores in the play‐focused group from pre‐ to postintervention, but not in the feeding‐focused group. There was a significant decrease in the level of disrupted communication from pre‐ to postintervention sessions in the play‐focused group but not in the feeding‐focused group. 73% of mothers from the play‐focused group and 17% of mothers from the feeding‐focused group initially classified as “disrupted” attained a classification of “nondisrupted” at the postintervention session. Some limitations of the study include small sample size, differences in timing of assessment for each intervention, and use of samples of convenience. Nonetheless, these findings provide preliminary evidence both of the usefulness of AMBIANCE as an instrument for assessing clinical efficacy and the efficacy of Interaction Guidance. ©2001 Michigan Association for Infant Mental Health.     

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.     

A randomized controlled trial of mother–infant psychoanalytic treatment: II. Predictive and moderating influences of qualitative patient factors

A randomized control trial was performed on 75 dyads in Stockholm, Sweden, with infants under 1½ years. It recruited mothers who worried about the babies, themselves as mothers, and/or the mother–baby relationship. Two groups of mother–infant dyads were compared. One received only Child Health Centre care (the “CHCC” group) while the other received mother–infant psychoanalytic treatment plus CHCC (the “MIP” group). Significant treatment effects were found on mother‐reported depression, interviewer‐rated dyadic relationship qualities and externally rated maternal sensitivity, and near‐significant effects on mother‐reported stress, all in favor of MIP. The objective of this study is to investigate the predictive and moderating influences on outcomes by qualitatively assessed maternal and infant characteristics. The qualitative factors covered maternal suitability for psychoanalysis, and “ideal types” of mother and child, respectively. Outcome measures from two interviews with a 6‐month interval were depression (Edinburgh Postnatal Depression Scale (J. Cox, J. Holden, & R. Sagovsky, 1987 ), stress (Swedish Parental Stress Questionnaire (M. Östberg, B. Hagekull, & S. Wettergren, 1997 ), distress (Swedish Symptom Checklist‐90 (SCL‐90; L.R. Derogatis, 1994 ; M. Fridell, Z. Cesarec, M. Johansson, & S. Malling Thorsen, 2002 ) and infant social and emotional functioning (Ages and Stages Questionnaire: Social–Emotional (J. Squires, D. Bricker, K. Heo, & E. Twombly, 2002 ), relationship qualities (Parent–Infant Global Assessment Scale (PIR‐GAS; ZERO TO THREE, 2005), and videotaped interactions (Emotional Availability Scales, Z. Biringen, J.L. Robinson, & R.N. Emde, 1998 ). Suitability for psychoanalysis predicted outcome only on the PIR‐GAS. Two overarching maternal ideal types were created, reflecting their attitude to the psychoanalytic process: “Participators” and “Abandoned.” The Participators benefited more from MIP than they did from CHCC on maternal interactive sensitivity. A contrasting, but nonsignificant, pattern was found among the Abandoned mothers. Two ideal types of babies emerged: those “Affected” and “Unaffected” by the disturbance, respectively. Among Affected babies, dyadic relationships and sensitivity among their mothers improved significantly more from MIP than they did from CHCC. The superior effects of MIP applied especially to Participator mothers and Affected infants. For Abandoned mothers and Unaffected infants, CHCC seemed to be of equal value.     

Infants of “depressed” mothers interact better with their nondepressed fathers

To determine whether infants of “depressed” mothers interact better with their nondepressed fathers, twenty-six 3- to 6-month-old infants were videotaped during face-to-face interactions with their parents. The “depressed” mother group consisted of twelve 3- to 6-month-old infants and their “depressed” mothers and nondepressed fathers. The control group was composed of 14 nondepressed mothers and nondepressed fathers and their 3- to 6-month-old infants. In the “depressed” mother group, the nondepressed fathers received better interaction ratings than the “depressed” mothers. In turn, the infants received better interaction ratings when they interacted with their nondepressed fathers than with their “depressed” mothers. In contrast, nondepressed fathers and mothers and their infants in the control group did not differ on any of their interaction ratings. These findings suggest that infants' difficult interaction behaviors noted during interactions with their “depressed” mothers may not extend to their nondepressed fathers. The data are discussed with respect to the notion that nondepressed fathers may “buffer” the effects of maternal depression on infant interaction behavior.     

Infant communication and the mother–infant relationship: The importance of level of risk and construct measurement

Infants' emerging communication skills are understood to be associated with the maternal relationship, particularly for children experiencing high levels of social risk. This study attempts to determine the extent to which this association is influenced by (a) the mental health risk of the dyad and (b) different operational definitions and measurement of both the dyadic relationship and the construct of “communication.” Ninety‐six infants (10–30 months) and their mothers were recruited: A total of 46 were at‐risk dyads referred to a mental health clinic for relationship‐based emotional and/or behavioral difficulties, and 50 were nonrisk dyads not seeking mental health services and served as a normative reference or comparison group. Several factors were assessed: (a) developmental competence, (b) maternal psychopathology, (c) quality of mother–infant interaction during play, (d) attachment security classification, (e) prelinguistic and social‐affective communication, and (f) linguistic communication. In all infants studied, the quality of mother–infant interaction during play, rather than the attachment security classification, was associated with infants' prelinguistic and social‐affective communication abilities, but not with linguistic communication. Different aspects of mother–infant interaction predicted prelinguistic communication for clinic and comparison infants whereas only infant age predicted linguistic communication. All infants displayed communication abilities in the normal range, but the statistically poorer performance demonstrated by clinic‐referred infants could become clinically meaningful in later childhood. Best practices should include communication screening of infants presenting with attachment problems and screening for relational difficulties in infants presenting with communication delays. ©2004 Michigan Association for Infant Mental Health.     

Effects of the Early Prevention Program “Keiner FÄllt Durchs Netz” (“Nobody Slips Through the Net”) on Child,Mother, and Their Relationship: A Controlled Study

The study investigated the effects of a German family‐supporting prevention program “Keiner fällt durchs Netz” (KfdN; “Nobody Slips Through the Net”) after the child's first year in the sample of 152 psychosocially stressed mothers and children who took part in this program and 150 mothers and children from comparison‐group families. The improved level of development posited in the children after intervention as compared to children from the comparison group was confirmed in the social development area (d = .35). In addition, mothers in the KfdN group judged their 1‐year‐old children to be less “difficult” compared to the assessments of the mothers in the comparison group (d = .24). Due to the intervention, the dysfunctionality of the mother–child interaction was reduced (mothers’ self‐assessment, d = .27). No intervention effects were found in for degree of maternal stress. The expected intervention effects in maternal sensitivity were not empirically confirmed. The results suggest that the KfdN intervention exerted a direct positive influence on childhood traits such as social development and temperamental “difficulty” and also positively influenced the mothers’ perceptions or attitudes toward their children's conduct.     

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.     

Emotional availability and psychosocial correlates among mothers in substance‐abuse treatment and their young infants

Emotional availability (EA) was investigated among low‐income mothers enrolled in substance‐abuse treatment and their young infants (n = 21) compared with a demographically matched group of mother–infant pairs who, by self‐report, were not at risk for substance abuse (n = 27). The mother–infant dyads in the treatment group generally demonstrated poorer EA functioning than those in the comparison group, but few differences between the groups on individual dimensions of EA were significant. This finding was notable considering that mothers in treatment reported significantly higher levels of depressive symptoms and psychological stress. Treatment effects may have buffered the negative impact of depression and psychological stress on mothers' EA scores. The clinical implications of the findings are discussed as they relate to substance‐abuse‐treatment services for pregnant and parenting women.     

MATERNAL INTERACTION QUALITY MODERATES EFFECTS OF PRENATAL MATERNAL EMOTIONAL SYMPTOMS ON GIRLS’ INTERNALIZING PROBLEMS

The role of mother–infant interaction quality is studied in the relation between prenatal maternal emotional symptoms and child behavioral problems. Healthy pregnant, Dutch women (N = 96, M = 31.6, SD = 3.3) were allocated to the “exposed group” (n = 46), consisting of mothers with high levels of prenatal feelings of anxiety and depression, or the “low‐exposed group” (n = 50), consisting of mothers with normal levels of depressive or anxious symptoms during pregnancy. When the children (49 girls, 47 boys) were 23 to 60 months of age (M = 39.0, SD = 9.6), parents completed the Child Behavior Checklist (T.M. Achenbach & L.A. Rescorla, 2000 ), and mother–child interaction quality during a home visit was rated using the Emotional Availability Scales. There were no differences in mother–child interaction quality between the prenatally exposed and low‐exposed groups. Girls exposed to high prenatal emotional symptoms showed more internalizing problems, if maternal interaction quality was less optimal. No significant effects were found for boys.     

MOTHER–CHILD AND FATHER–CHILD PLAY INTERACTION: THE IMPORTANCE OF PARENTAL PLAYFULNESS AS A MODERATOR OF THE LINKS BETWEEN PARENTAL BEHAVIOR AND CHILD NEGATIVITY

Based on the premise that father–child play is an important context for children's development and that fathers “specialize” in play, similarities and differences in the role of playfulness in the father–child and mother–child relationship were examined. Participants in this study included 111 families (children's age: 1–3 years). Father–child and mother–child play interactions were videotaped and coded for parental playfulness, sensitivity, structuring, and nonintrusiveness as well as child negativity. Results indicated that mothers and fathers did not differ in playfulness and that mothers and fathers who were higher in playfulness had children with lower levels of negativity. However, playfulness differently moderated the links between parents’ and children's behaviors for mothers and fathers. A double‐risk pattern was found for mothers, such that the links between child negativity and maternal sensitivity, structuring, and nonintrusiveness were significant only for the subgroup of mothers with low levels of playfulness. When mothers had high levels of playfulness, these effects were negligible. For fathers, a double‐buffer pattern was revealed, indicating that the links between child negativity and paternal sensitivity and structuring were significant only for fathers with high levels of playfulness. When fathers had low levels of playfulness, these effects were negligible. These findings demonstrate the important role that parental playfulness has on parent–child interaction as well as the need to examine moderation patterns separately for fathers and mothers.     

Effects of maternal inattentiveness on infant social referencing

The aim of the study was to clarify the meaning of infant looking behaviour when the infant is confronted with an ambiguous situation in order to disentangle the two processes social referencing and attachment. Ninety‐six 12‐month‐olds, presented with an ambiguous or an unambiguous toy, were assigned to one of four conditions; mother inattentive, mother conveyed positive information, and mother conveyed negative information about the ambiguous toy. In the fourth condition (control condition), an unambiguous toy was presented (mother inattentive). The ambiguous situation elicited more referencing looks than the unambiguous situation. During the presentation of the ambiguous toy, infants with inattentive mothers referenced the experimenter more than infants whose mothers provided guidance. In the following free‐play situation, infants in the inattentive group referenced mother to a higher degree than did the other infants. They played less with the toy than infants who had received positive information and infants in the control group, and were less eager to explore the surroundings than infants in the other three groups. When mother turned attentive the infants ceased referencing her and showed an interest in exploring. Copyright © 2003 John Wiley & Sons, Ltd.     

Fathering activities during early infancy

Fathering activities of 16 fathers of firstborns were surveyed via questionnaire to assess their involvement in physical caretaking, affective interaction and support of mother through participation in household tasks. Results indicated that student fathers who had previous infant care experience, whose infants were unplanned and whose wives were either employed or attending school spent the most time interacting with their infants. Other variables explored which had little effect on father's interaction time included: formal education, attendance at prenatal clases, infant's sex and method of feeding, family isolation. Fathers spent more time in affective interaction than in physical caretaking. Time spent by fathers in affective interaction was nearly equal to that of mothers, while time spent in physical caretaking was much greater for mothers.     

The Chances for Children Teen Parent–Infant Project: Results of a pilot intervention for teen mothers and their infants in inner city high schools

Adolescent motherhood poses serious challenges to mothers, to infants, and ultimately to society, particularly if the teen mother is part of a minority population living in an urban environment. This study examines the effects of a treatment intervention targeting low‐income, high‐risk teen mothers and their infants in the context of public high schools where daycare is available onsite. Our findings confirm the initial hypothesis that mothers who received intervention would improve their interactions with their infants in the areas of responsiveness, affective availability, and directiveness. In addition, infants in the treatment group were found to increase their interest in mother, respond more positively to physical contact, and improve their general emotional tone, which the comparison infants did not. Importantly, these findings remain even within the subset of mothers who scored above the clinical cutoff for depression on the Center for Epidemiological Studies‐Depression Scale (CES‐D; L. Radloff, 1977), confirming that it is possible to improve mother–infant interaction without altering the mother's underlying depression. The implications of these findings are significant both because it is more difficult and requires more time to alter maternal depression than maternal behavior and because maternal depression has been found to have such devastating effects on infants.     

Expression of negative affect during face‐to‐face interaction: a double video study of young infants' sensitivity to social contingency

The purpose was to assess infants' sensitivity to social contingency, taking affective state into account, during face‐to‐face interaction with the mother in a double video set‐up. Infants' behaviour during three sequences of live face‐to‐face interaction were compared to two sequences where the interaction between the infant and the mother was set out of phase, by presenting either the infant or the mother with a replay of their partners' behaviour during earlier live interaction. We found a significant negative correlation between the infant's degree of negative affect and the average time of looking at the mother during the live sequences. A median split was calculated to separate the infants into a high‐negative‐affect group and a low‐negative‐affect group on the basis of their emotional responses during the experiment. The low‐negative‐affect infants looked significantly more at their mothers than other foci during the live but not the replay sequences, while the high‐negative‐affect infants did not show this difference. The results suggest that 2–4‐month old infants are able to distinguish between experimental distortion of contingent aspects in live and replay sequences, but that this effect of the replay condition may not be shown by moderate to highly distressed infants. Our findings underline the importance of taking infants' emotional state into account in experiments intended to assess their capacity for intersubjective communication. Copyright © 2006 John Wiley & Sons, Ltd.     

Home‐based intervention after discharge for Latino families of low‐birth‐weight infants

A home‐based intervention designed for impoverished Latino families of low‐birth‐weight infants was implemented, and the efficacy assessed for infants and mothers. Specially trained public health nurses visited the participants' homes for 4 months for the “short” and 12 months for the “extended” intervention groups. Mothers received support and training in infant care. A third group did not receive the intervention. Assessments were at 4‐ to 6‐month intervals from 1 to 24 months. Although the extended visitation group showed no benefits from the intervention, the short visitation group had higher scores on maternal confidence at one month, and on the Bayley Mental Scores at four months than the group receiving no intervention and extended intervention. The nonvisitation group scored significantly higher than both intervention groups on the HOME scores and on the Mother–Infant Interaction and Feeding scores at three different assessment periods. These data suggest that for poor Latino families home intervention is not beneficial across the board. Instead, efforts should be made to identify families that could benefit from intervention and to tailor the program to the specific needs of Latino families. © 2000 Michigan Association for Infant Mental Health.     

Infant sensitivity to negative maternal emotional shifts: Effects of infant sex,maternal postnatal depression,and interactive style

This study examined the effects of infant sex, maternal postnatal depression, and maternal interactive style on infant sensitivity to maternal negative emotional shifts. Face‐to‐face interactions of 68 mother–infant dyads were analyzed at 8 and 18 weeks. Twenty‐five (28%) mothers had postnatal depression. Interactions were analyzed in terms of overall maternal interactive style: “sensitive,” “anxious,” “intrusive,” and “sad.” Episodes of negative shifts in maternal emotional expression were recorded, along with expressions of infant sensitivity to these changes. Daughters of depressed mothers showed higher rates of sensitivity to maternal negative emotion whereas their sons showed lower rates, in comparison to both girl and boy infants of well mothers. While maternal interactive style had no effect on 8‐week infant sensitivity to maternal negative emotional shifts, high rates of 18‐week infant sensitivity were predicted by both an 8‐week and a concurrent, “sad” maternal interactive style. The findings are discussed in relation to theories of emotional and interpersonal development.     

The Effect of Maternal Depressed Mood on Infant Emotional Reaction in a Surprise‐Eliciting Situation

The purpose of this study is to examine the claim that an infant's ability to respond appropriately to an emotional situation varies according to the emotional state of the mother. Surprise expressions in mother and child were examined both in terms of paralinguistic aspects of surprise vocalizations as well as facial expressions. Seventy‐two infants and their mothers (mean age=8 months, range=5–11 months) were video‐ and audiotaped in their homes. Half of the infants, matched for age and gender, had mothers who reported depressed mood. Infants of mothers with depressed mood showed significantly fewer components of facial expressions of surprise compared with infants of nondepressed mothers. Mothers with depressed mood exclaimed surprise with a significantly lower pitch (mean F₀=386.13 Hz ) compared to nondepressed mothers (mean F₀=438.10 Hz ). Furthermore, mothers with depressed mood showed fewer associations between elements of emotional expression than the nondepressed group. Infants' expressions of surprise are influenced by maternal mood, resulting in reduced expression of the emotion in infants of mothers with depressed mood. These results are discussed in terms of coordination of vocal parameters in mother–infant dyadic interaction.     

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.     

Shared minds: How mothers and infants co-construct early patterns of choice within intentional communication partnerships

The qualitative research method of case study inquiry is employed to investigate different patterns observed in early communicative interactions between two infants and their mothers. These mothers and babies were similar in significant ways: Both mothers were observed to be competent, well-functioning adults and reported no communicative or parenting dysfunction: both infants were evaluated as developing normally in terms of their cognitive level and acquisition of communication behaviors. However, a difference was observed between the dyads in their effectiveness in contributing to the infants' development as intentional communicators. The extent to which an infant and mother “share minds” is proposed as accounting for the observed difference. This phenomenon of “shared minds” is examined by observing the process of choice co-construction engaged in by mothers and infants during communication. It is concluded that characteristics of these early co-constructions influence the way in which the young child begins to act with intention and to interpret him- or herself and others as intentional communicative beings. © 1997 Michigan Association for Infant Mental Health