Stressed parents: a dyadic perspective on perceived infant temperament

The study employed the actor–partner interdependence model (APIM) to test whether one parent's experiences of recent life events as more stressful (the PSS) are associated with the same parent's own (the actor effect) and the other parent's (the partner effect) perceptions of the infant temperament as more negatively and/or less positively tuned (the IBQ; n=584 parents, 292 dyads). The results indicated that the more stress one parent reported the more negatively tuned were the same parent's own, and the other parent's perceptions of the infant. Perceptions of the infant temperament were least positive for members of parent dyads who were more, relative to less, similar in the experienced stress. The associations were independent of the parent gender and the parent‐reported level of trait anxiety. The findings augment prior knowledge on the factors that steer parental perceptions, and suggest that the dyadic perspective may offer valuable insight into the dynamics of interacting within a family consisting of two biological parents and an infant. Copyright © 2006 John Wiley & Sons, Ltd.     

Infantile defences in parent‐infant psychotherapy: The example of gaze avoidance

Findings from parent‐infant observational research have stimulated the development of intersubjective models of psychotherapeutic action. These models have brought out the infant as an interactive partner with the parent. Conversely, interest in describing the individual psyche of the baby has decreased, especially the unconscious levels of his/her experiences and representations. In parallel, clinicians and researchers have been less prone to apply classical psychoanalytic concepts when describing the internal world of the infant. The author argues that this is inconsistent with the fact that psychoanalytic theory, from its inception, was founded on speculations of the infant's mind. He investigates one such concept from classical theory; the defence. Specifically, he investigates if selective gaze avoidance in young babies may be described as a defence or even a defence mechanism. The investigation links with Selma Fraiberg's discussion of the phenomenon and also with Freud's conception of defence. The author also compares his views on the baby as a subject with those suggested by infant researchers, for example, Stern and Beebe. The discussion is illustrated by vignettes from a psychoanalytic therapy with a 3 month‐old girl and her mother.     

Observer Influences on Fathers and Mothers: An Experimental Manipulation of the Structure and Function of Parent – Infant Conversation

From studies over the past 20 years four contrasting hypotheses can be made about the nature of parent–infant communication: (1) mothers and fathers display similar skills to their infants and do not exert a differential influence on their development; (2) fathers are less sympathetic to their infants' level of development and therefore inadvertently stretch the child's development more than mothers; (3) both parents differentially socialize their sons' and daughters' early communicative skills; (4) any apparent differences between parents reflect their expectations about being observed. To examine these hypotheses together, this experiment records the communication of 10 mother–infant and 10 father–infant dyads in two conditions: when an observer was present or absent. The analysis revealed two patterns. Firstly, in keeping with most research on parent–child communication, mothers and fathers both simplified their speech to their infants in similar ways. Secondly, both the structure and function of parental communication showed differences between the two conditions and many of these differences were moderated by interactions between condition and sex of parent or child. The data thus provide more support for the first and fourth hypotheses cited above. It is suggested that analyses of parent–infant interaction should move away from simple assumptions about parental ‘influences’ upon children's development to consider the subtleties of different parental styles in different settings.     

Perceptions of infant boys' behavior and mental health: Relation to infant attachment

Two studies were conducted to determine the impact of infants' attachment classifications and behaviors on naive adults' impressions of their behavior and mental health. In Study 1, three groups of 44 adults viewed a videotape of episode 8 of the Strange Situation for either an avoidant, a resistant, or a secure male infant. After viewing the videotape, they made judgments about aspects of the infant's mental health. Adults viewed the resistant baby as less socially competent and more negative in affect than the other two babies and the secure baby as the least independent of the three babies. Parents rated babies as more intelligent than did nonparents. In Study 2, 15 parents were matched on race and gender with 15 nonparents. All adults viewed a videotape of the reunions of two secure, two avoidant, and two resistant male infants. Avoidant babies were viewed as more socially competent and independent than secure babies and the C2 baby was viewed as the least intelligent, least independent, least socially competent, and most affectively negative of the infants. Results are interpreted as underscoring the need to educate parents and paraprofessionals about the importance of infant distress and physical contact with parents.     

Issues in the identification and long-term management of Munchausen by Proxy Syndrome within a clinical infant service

Munchausen by Proxy Syndrome is a version of Munchausen's Syndrome whereby a parent, usually the mother, simulates or fabricates disease in one or more of her children in order to seek medical attention. Because this disorder is usually identified in pediatric settings, current literature focuses on identification of the syndrome, with little discussion of treatment issues or management strategies other than confrontation of the parent and removal of the child from the home. With the increased availability of infant mental health services, infant clinicians are likely to be called on to evaluate and treat cases of this disorder. This paper reviews the Munchausen by Proxy literature for infant clinicians and describes the identification and long-term management of one Munchausen by Proxy case within the context of an infant home-visiting service. Pertinent issues that emerged included the difficulties inherent in documenting the mother's pathological behavior, the clinical tension between preventing flight from treatment but limiting harmful behavior, the need for a long-term collaborative relationship with a designated pediatrician, and the importance of further education of protective service workers about this syndrome.     

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.     

Traumatic stress and quality of attachment: Reality and internalization in disorders of infant mental health

This article describes the interface between the fields of attachment and child trauma, their respective contributions to an understanding of infant mental health disturbances, and the clinical applications of an integration between attachment theory and trauma‐informed treatment and research. The organizing theme is that a dual attachment and trauma lens must be used in the assessment and treatment of infants and toddlers with mental health and relationship problems. The quality of attachment is an important factor in children's capacity to process and resolve traumatic experiences. At the same time, traumatic events often have a damaging effect on the quality of existing attachments by introducing unmanageable stress in the infant–parent relationship. It is argued that trauma in the first years of life needs to be assessed and treated in the context of the child's primary attachments. Reciprocally, the etiology of attachment disturbances should include an assessment of possible exposure to trauma in the child and in the parents. Current conceptualizations of attachment and trauma are reviewed from this perspective, and a clinical illustration is presented to highlight how a traumatic stressor can trigger behaviors reminiscent of disorganized attachment.     

Transferences in parent–infant psychoanalytic treatments

In parent–infant treatments, babies sometimes exhibit symptoms such as screaming, clinging, and fearful gaze avoidance of the analyst. The paper investigates if such phenomena may be regarded as transference manifestations, and if so, if they appear both in younger and older infants. Based on three case presentations, it is concluded that some babies are capable of forming both brief and enduring transferences. The term “indirect infant transference” refers to when a baby reacts emotionally to the analyst as long as the parent's transference remains unresolved. “Direct transference” refers to when a baby reacts in a non‐mediated way to the analyst. The necessary tool of investigation for discovering these phenomena is a psychoanalytic method with an explicit, though not exclusive, focus on the baby. Discerning them in the clinical encounter may help us understand the baby's predicament and when and how to address the baby or the parent. These treatments constitute an empirical field awaiting more extensive clinical and theoretical investigation. Already now, they suggest that transference may be rooted in, and may appear during, very early developmental stages. The paper's positions are compared with those put forward by other parent‐infant clinicians.     

The father's role in the socialization of his infant

Although research on fathers and infants increased dramatically during the past decade, it did so largely in a theoretical vacuum. Theories of development emphasize mother-infant relationships, with little attention, if any, given to father-infant relationships. As a result, studies of father-infant interactions tend to replicate procedures that have been used in mother-infant research. While useful, mimicking mother-infant research paradigms may blind investigators to salient aspects of development that are unique to and critical for father-infant relationships. In traditional families, study of mother-father-infant triadic interactions may reveal more useful information about the father's role in infant socialization, than the study of father-infant dyadic interactions. However, the study of triadic interactions may yield little useful information about father-infant interaction in the single parent family. Until a number of methodological issues are resolved, the literature on the father's role in the socialization of his infant must be interpreted cautiously.     

Infant–mother and infant–father synchrony: The coregulation of positive arousal

To examine the coregulation of positive affect during mother–infant and father–infant interactions, 100 couples and their first‐born child were videotaped in face‐to‐face interactions. Parents' and infant's affective states were coded in one‐second frames, and synchrony was measured with time‐series analysis. The orientation, intensity, and temporal pattern of infant positive arousal were assessed. Synchrony between same‐gender parent–infant dyads was more optimal in terms of stronger lagged associations between parent and infant affect, more frequent mutual synchrony, and shorter lags to responsiveness. Infants' arousal during mother–infant interaction cycled between medium and low levels, and high positive affect appeared gradually and was embedded within a social episode. During father–child play, positive arousal was high, sudden, and organized in multiple peaks that appeared more frequently as play progressed. Mother–infant synchrony was linked to the partners' social orientation and was inversely related to maternal depression and infant negative emotionality. Father–child synchrony was related to the intensity of positive arousal and to father attachment security. Results contribute to research on the regulation of positive emotions and describe the unique modes of affective sharing that infants coconstruct with mother and father. ©2003 Michigan Association for Infant Mental Health.     

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.     

The function of language in parent‐infant psychotherapy

Parent‐infant psychotherapy, a rather new field in psychoanalysis, raises questions of how to conceptualize the clinical process. Previous publications have used semiotic concepts to account for the therapist's non‐verbal communication and investigated the countertransference, including what the baby might grasp of its variations. The present paper focuses on another argument for using verbal interventions to a baby in therapy; they present him with a symbolic order that differs from that of the parent. The qualitative difference between the parent's and the analyst's address is conceptualized by Dolto's term parler vrai. The therapeutic leverage is not the analytic interventions' lexical content but their message that words can be used to expose conflicts. Thereby, one can transform warded‐off desires into demands that can be negotiated with one's objects. The reasons why this address catches the baby's attention are discussed. A prerequisite for such attention is that the infant brain is prewired for perceiving words as a special communicative mode. Relevant neuroscientific research is reviewed in regard to this question. The presentation relies on concepts by Dolto, Lacan and Winnicott and findings from neuroscience and developmental psychology. It also briefly discusses Chomsky's linguistic concepts in relation to these therapies.     

Moving into tummy time,together: Touch and transitions aid parent confidence and infant development

“Back to sleep” messages can reduce prone practice for infants, with potential for motor delay and cranial deformation. Despite recommendations for “tummy time,” young infants fuss in prone, and parents report uncertainty about how to help infants tolerate prone positioning. We hypothesized that a Child'Space Method lesson, teaching proprioceptive touch and transitions to prone, would facilitate prone tolerance, parent behavioral support, and parent self-efficacy. This randomized study recruited parents (N = 37) of 2- to 5-month-old infants. On two visits, parents answered questions about infant behavior and parent experience, and played with their infant. Lesson group parents had the lesson following the first free play. One week later, lesson parents reported that infants tolerated more prone time and that parents showed more supportive behaviors in bringing infant to prone, as compared to waiting parents. Lesson parents’ efficacy, and infant behavior during play, trended in the hypothesized direction. The study demonstrated how a lesson in preparatory touch, and gradual transitions, promoted infant prone tolerance and also parent support of rolling, side-lying, and prone positioning. The lesson could be incorporated in parent education and early pediatric visits, helping infants and parents negotiate the prone challenge and setting the stage for further parent support of infant development.     

Infant crying and parent–infant interaction: Theory and measurement

Infant crying is frequently quantified as a primary dependent variable in studies where the goal is to understand and soothe infant crying within the context of the parent–infant relationship. Through a historical review and an examination of studies and measurement techniques, the utility of quantifying infant crying is discussed. Although duration and timing of infant crying may be a practical concern for families and health professionals, the effectiveness of soothing interventions may not be best examined by attempts to measure unit reductions in infant crying. Rather, developing an understanding of infant crying within the context of parent–infant relationships may have more utility. Understanding infant crying in context may provide direction to the selection of soothing interventions and to more appropriate measures of the effectiveness of such interventions. ©1999 Michigan Association for Infant Mental Health.     

Parent Anxiety and Infant Pain During Pediatric Immunizations

Infants’ procedural pain and parents’ treatment room anxiety has been largely ignored in the research and clinical domains. To understand and manage infant procedural pain, it is essential to examine the correlates and potential predictors of this pain. Given that parent anxiety is a strong predictor of preschoolers’ procedural anxiety and pain, it is likely that parents play a role in infants’ distress during medical procedures. The purpose of this study was to thoroughly examine parent anxiety and its effects on infant procedural pain for 37 parent-infant dyads. Results demonstrated that only parent self-report measures were intercorrelated and several measures of parent distress correlated with measures of infant distress. Treatment implications and recommendations for future research are discussed.This article is based on the master's thesis of the first author under the direction of the second, at West Virginia University.     

The interaction approach to early intervention

A brief summary of research, supportive of the idea that quality of parent-infant interaction has a powerful effect on infant development, introduces an early intervention model based on that proposition. Also, central to the interaction model is the knowledge that (1) parent and infant both contribute to what happens between them and that (2) a multitude of factors, environmental and internal to parent and infant, affect the parent, the infant, and their interaction. Ten sets of principles and strategies that convey the essence of the interaction model constitute the core of this article. The principles and strategies address the importance of identifying sources of support and stress in the family, of developing relationships with both parents, and of supporting positive interactions between parents and the infant's siblings. The limitations of this model are also addressed, especially in cases where the parent is the primary risk factor. The infant's exposure to nurturing adults in quality day care programs and a more clinical approach with the parent and infant, such as Selma Fraiberg's model, may be more effective with such families.     

Attachment and sensitivity in family context: the roles of parent and infant gender

This study examined the role of child gender in fathers' and mothers' sensitivity to and attachment relationships with their infants from a family systems perspective. Eighty‐seven 1‐year‐olds participated in the Strange Situation with each parent. Parental sensitivity was examined during a competing demands task. Results indicated that fathers and mothers were equally sensitive to sons, but fathers were less sensitive than mothers to daughters, and mothers were more sensitive to daughters than to sons. Although mothers and fathers within the same families were similarly sensitive to daughters and sons, daughters' attachment security with fathers and mothers was similar whereas sons' was not. Further analyses revealed that fathers were more sensitive to sons with an insecure relationship with their mothers. Results of this investigation suggest that child gender is relevant for parent–infant, especially father–infant, attachment relationships. Copyright © 2006 John Wiley & Sons, Ltd.     

The Michigan infant mental health home visiting model

Selma Fraiberg's pioneering work with infants, toddlers, and families over 40 years ago led to the development of a field in which professionals from multiple disciplines learned to work with or on behalf of infants, very young children, their parents, and the relationships that bind them together. The intent was to promote social and emotional health through enhancing the security of early developing parent–child relationships in the first years of life (Fraiberg, 2018). Called infant mental health (IMH), practitioners from fields of health, education, social work, psychology, human development, nursing, pediatrics, and psychiatry specialize in supporting the optimal development of infants and the developing relationship between infants and their caregivers. When a baby is born into optimal circumstances, to parents free of undue economic and psychological stressors and who are emotionally ready to provide care and nurturing for an infant's needs, an IMH approach may be offered as promotion or prevention, with the goal of supporting new parent(s) in developing confidence in their capacity to understand and meet the needs of the tiny human they are coming to know and care for. However, when parental history is fraught with abandonment, loss, abuse or neglect, or the current environment is replete with economic insecurity, threats to survival due to interpersonal or community violence, social isolation, mental illness, or substance abuse, the work of the IMH therapist may require intervention or intensive treatment and becomes more psychotherapeutic in nature. The underlying therapeutic goal is to create a context in which the baby develops within the environment of a parent's nurturing care without the psychological impingement that parental history of trauma or loss or current stressors such as isolation, poverty, or the birth of a child with special needs, can incur.     

Adding “Circle of Security – Parenting” to treatment as usual in three Swedish infant mental health clinics. Effects on parents’ internal representations and quality of parent‐infant interaction

This study presents effects of adding Circle of Security‐Parenting (COS ‐P) to an already established comprehensive therapeutic model for early parent‐child intervention in three Swedish infant mental health (IMH ) clinics. Parents’ internal representations and quality of parent‐infant interaction were studied in a clinical sample comprised of 52 parent‐infant dyads randomly allocated to two comparable groups. One group consisted of 28 dyads receiving treatment as usual (TAU ) supplemented with COS ‐P in a small group format, and another group of 24 dyads receiving TAU only. Assessments were made at baseline (T1), 6 months after inclusion (T2) and 12 months after inclusion (T3). Changes over time were explored in 42 dyads. In the COS ‐P group, the proportion of balanced representations, as assessed with Working Model of the Child Interview (WMCI ), significantly increased between T1 and T3. Further, the proportion of emotionally available interactions, as assessed with Emotional Availability scales (EA ), significantly increased over time in the COS ‐P group. Improvements in the TAU ‐group were close to significant. Limitations of the study are mainly related to the small sample size. Strength is the real world character of the study, where COS ‐P was implemented in a clinical context not otherwise adapted to research. We conclude by discussing the value of supplementing TAU with COS ‐P in IMH treatment.