Mother's attachment representations of their premature infant at 6 and 18 months after birth

The effects of premature birth on attachment have generally been examined from the infant's perspective. There is a lack of data concerning parental attachment representations toward a premature child. Because of the psychological stress engendered in parents confronted with a premature birth, we hypothesized that their attachment representations would be altered during the first months after the hospital discharge. Fifty families with a premature infant (25–33 gestation weeks) and a control group of 30 families with a full‐term infant participated to the study. Perinatal risks were evaluated during hospitalization. To assess mothers' representations of their infant, the Working Model of the Child Interview (WMCI, Zeanah & Benoit, 1995 & Benoit, Zeanah, Parker, Nicholson, & Coolbear, 1997) were administered when their children were 6 and 18 months old. The severity of the perinatal risks was found to have an impact on the mothers' attachment representations. At six months, only 20% of the mothers of a prematurely born infant (30% at 18 months) had secure attachment representations, vs. 53% for the control group (57% at 18 months). Furthermore, mothers of low‐risk premature infants more often had disengaged representations, whereas distorted representations were more frequent in the high‐risk group of premature children. These findings suggest that the parental response to a premature birth is linked to the severity of postnatal risks. The fact that secure attachment representations are affected in mothers of low‐risk infants just as much as they are in mothers of high‐risk infants points to the need to conduct further studies aimed at evaluating whether preventive intervention for both low‐risk and high‐risk premature will be helpful.     

Exploration of the links among fathers' unresolved states of mind with respect to attachment,atypical paternal behavior,and disorganized infant–father attachment

Atypical maternal behavior has consistently been identified as a precursor of disorganized infant–mother attachment, but to date, no research has examined the role of atypical paternal behavior in the development of disorganized infant–father attachment. This study aims to enhance our understanding and conceptualization of infant–father attachment by examining the role of fathers' unresolved states of mind and the display of atypical paternal behavior in the development of disorganized infant–father attachment. Thirty‐one middle‐class couples participated in this study. Maternal and paternal Adult Attachment Interviews (C. George, N. Kaplan, & M. Main, 1996 ) were completed prenatally and at infant age 6 months, respectively. Infant–mother and infant–father dyads participated in the Strange Situation paradigm (M. Ainsworth, M. Blehar, E. Waters, & S. Wall, 1978 ) when the infants were 12 and 18 months of age, respectively. The Atypical Maternal Behavior Instrument for Assessment and Classification (E. Bronfman, E. Parsons, & K. Lyons‐Ruth, 1999 ) was used to assess maternal and paternal behavior during the Strange Situation. Maternal states of mind regarding attachment predicted infant–mother attachment relationships, and paternal states of mind predicted infant–father attachment relationships. Atypical maternal behavior was associated with infant–mother disorganized attachment; however, atypical paternal behavior did not predict infant–father disorganized attachment. Thus, it is possible that other factors, yet to be uncovered, might contribute to the development of infant–father disorganized attachment.     

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.     

Can We Identify Emotion Over‐regulation in Infancy? Associations with Avoidant Attachment,Dyadic Emotional Interaction and Temperament

Emotion over‐regulation in infancy has seldom been the focus of empirical research. This study analysed the specificities of over‐regulation when compared with under‐regulation (maladaptive) and adaptive regulation by testing its association with attachment, dyadic emotional interaction, and temperament. The sample consisted of 52 low‐risk mother–infant dyads. During a home visit, dyadic emotional interaction was assessed in the daily routines and free play of 10‐month‐old infants. The infant's emotion regulation was assessed using the Shape Sorter Task, and a temperament questionnaire was completed by the mother. Attachment was assessed at 12 or 16 months using the Strange Situation. As hypothesized, (i) emotion over‐regulation (versus adaptive regulation) was predicted by a lower quality of dyadic emotional interaction and marginally by avoidant attachment; (ii) over‐regulation (versus under‐regulation) was predicted by avoidant attachment; and (iii) the predictive role of avoidant attachment was substantiated after controlling for another measure of mother–infant interaction. Contrary to expectations, temperament did not distinguish between emotion regulation styles. The link between over‐regulation and lower quality of mother–infant emotional interaction and avoidant attachment was demonstrated. There is empirical support to the claim that it is possible to identify emotion over‐regulation in infancy and that it is a maladaptive style of emotion regulation. Copyright © 2012 John Wiley & Sons, Ltd.     

Maternal perinatal representations and their associations with mother–infant interaction and attachment: A longitudinal comparison of Portuguese and Brazilian dyads

Prior research in Western countries (mostly the US, Canada and northern Europe) indicates that mothers' representations are associated with mother–infant interaction quality and their child's attachment security later in the first year. Fewer studies, however, have evaluated whether these associations hold for mother–infant dyads in other countries, such as Brazil and Portugal. Although these countries share a similar language and culture, they differ on societal dimensions that may affect parenting attitudes and mother–infant relationships, such as economic stress, social organisation, social policy, and the availability of services for young families. In this longitudinal study, we followed two independent samples of Brazilian and Portuguese mother–infant dyads from the perinatal period to 12 months post-partum. We assessed mothers' perinatal representations using semi-structured interviews in the first 48 hours after the infant's birth, and evaluated the associations of these representations with mother interaction quality at 9 months and infant attachment at 12 months. Results were similar in each country, corroborating prior research in single Western countries: Mothers with more positive perinatal representations were more sensitive to their infants during free play at 9 months and were more likely to have infants classified as securely attached at 12 months.     

Attachment in low‐SES rural Appalachian infants: Contextual,infant, and maternal interaction risk and protective factors

Attachment classifications were obtained for 95 low‐socioeconomic‐status (SES) rural Appalachian infants in the Strange Situation procedure at 15 months. The distribution of secure (B) and insecure (A, C, D) infants was similar to other low‐SES samples and significantly different from low‐risk samples. Levels of contextual and infant risk, together with maternal responsiveness to crying and pattern of sensitivity from 4 to 9 months, predicted attachment security. High social support, when examined as a protective factor, related to reduced contextual risk, but not to increased likelihood of security. Exploratory discriminant function analyses showed that infants in secure relationships differed in positive directions on contextual and maternal interactional factors. Insecure‐organized (A and C) infants experienced contextual and maternal interaction risks, while insecure‐disorganized (D) infants were best distinguished by infant characteristics, including greater likelihood of being male and low use of mother as a secure base at 9 months. ©2001 Michigan Association for Infant Mental Health.     

Maternal sensory sensitivity, mother-infant 9-month interaction, infant attachment status: predictors of mother-toddler interaction at 24 months

At 24-months of age, toddlers (N=62) and their mothers were observed in a free-play session to determine the contribution of (a) maternal sensory sensitivity to positive and negative infant facial expressions as measured in a signal detection task at 6 months, (b) maternal behavior and affect, infant behavior and affect, and dyadic interaction at 9 months, and (c) infant attachment status at 12 months in predicting maternal, toddler, and dyadic measures at 24 months. Hierarchical regression analyses revealed that over and above early maternal behavior, which was predictive of later maternal behavior at 24 months, sensory sensitivity to the positive infant expression at 6 months predicted maternal behavior at 24 months and sensory sensitivity to both the positive and negative expression was associated with later maternal affect. Infant attachment status emerged as the variable which predicted toddler behavior and dyadic interaction at 24 months.     

ATTACHMENT IN INFANTS WITH CLEFT LIP AND/OR PALATE: MARGINAL SECURITY AND ITS CHANGES OVER TIME

This study examines the attachment quality and how this changed over time among infants who had cleft lip and palate (CLP), by conducting a prospective longitudinal study addressing the effects of this type of perinatal event on the parent–infant relationship and the emotional development of the infants. At 12 months of age, the Strange Situation Paradigm (SSP; M. Ainsworth, M.C. Blehar, E. Waters, & T. Wall, 1978) was administered to a sample of 38 CLP infants (born between 2003 and 2010) and 17 healthy controls. At 4 years of age, the Attachment Story Completion Task (ASCT; I. Bretherton, D. Ridgeway, & J. Cassidy, 1990) was administered to 32 individuals from the CLP sample and 14 from the control group. As reported in the literature, CLP infants display secure attachment behaviors as frequently as do control infants (55%). However, a more detailed analysis of the attachment scales revealed that CLP infants show more avoidance and less proximity seeking. In addition, a closer examination of the subcategories of attachment styles revealed that most CLP infants (71%) displayed distal attachment strategies such as the B1/B2 or A1/A2 subcategories. At 4 years old, CLP infants clearly displayed more deactivation and less security than did the control sample. Moreover, when detailing the evolution of attachment individually, almost 60% of the CLP children showing distal strategies at 12 months became deactivated or disorganized when they reached 4 years. Indeed, subtle differences in attachment behaviors at 12 months old—which can be considered marginally secure at that age—may reveal attachment vulnerabilities, which seem to be more apparent over the course of development.     

Longitudinal Assessment of Sleep–Wake Regulation and Attachment Security with Parents

The development of sleep–wake regulation occurs within the context of the infant–parent relationship. The present study investigated (1) patterns of change in night waking across infancy and attachment to parents and (2) if dependency, a characteristic of secure subgroup B4 and insecure‐resistant infants, accounted for differences in night waking. Forty‐six families reported on the number of infant night wakings at 7, 12, and 14 months of age. Attachment was measured at 12 (infant–mother) and 14 (infant–father) months. Findings suggest that infants with a secure (including the dependent‐secure, B4) pattern of attachment with mothers decreased in the number of night wakings over time, whereas infants with an insecure‐resistant pattern of attachment with mothers continued to wake at night into the second year. Attachment dependency did not account for differences in night waking. These findings are important to understanding the mechanism(s) underlying the relation between attachment and sleep–wake regulation. Copyright © 2012 John Wiley & Sons, Ltd.     

Psychotherapy groups and individual support to enhance mental health and early dyadic interaction among drug‐abusing mothers

The purpose of this controlled study was to examine the outcome of psychodynamic mother–infant group psychotherapy (PGT) outpatient intervention for drug‐abusing perinatal mother–infant dyads. PGT comprised 20 to 24 weekly 3‐hr sessions with 3 to 5 months of follow‐up. A comparison intervention group was formed of mothers participating in individually tailored psychosocial support (PSS) lasting, on average, 12 months and providing mother–infant support and practical counseling. We hypothesized that positive changes would occur in maternal drug abuse, mental health, and mother–infant interaction, especially in the PGT group due to its more intensive therapeutic focus. Participants were 26 drug‐abusing dyads in PGT, 25 in PSS, and 50 dyads in a non‐drug‐abusing comparison group. Assessments were pre‐intervention and at 4 and 12 months' follow‐up, including maternal depressive symptoms and mother–child interaction assessed by the Emotional Availability Scales (EA). As hypothesized, in dyadic interaction maternal hostility decreased significantly in the PGT group, and intrusiveness decreased in both intervention groups, but especially in the PTG group. However, both interventions showed a general improvement in the quality of mother–infant interaction. They also succeeded in sustaining high maternal abstinence, treatment retention, and alleviating depressive symptoms. The findings are discussed in relation to preventing negative transgenerational interaction patterns in the high‐risk dyads.     

Impact of fathers' alcoholism and associated risk factors on parent–infant attachment stability from 12 to 18 months

This study examined short‐term attachment stability and sought to identify predictors of stability and change within a sample characterized by fathers' alcoholism. Results suggest moderate stability of attachment classifications (60% for mothers, 53% for fathers) from 12 to 18 months. Higher paternal and maternal alcohol symptoms, maternal depression, and maternal antisocial behavior were found in families with stable insecure mother–infant attachment compared to those who were stable secure. Mother–infant stable insecurity was associated with higher levels of maternal negative affect expression during play. Father–infant stable insecurity was associated with lower levels of paternal positive affect expression and decreased sensitivity during play. Stable insecure children also had higher levels of negative affect during parent–infant interactions and higher negative emotionality during other episodes compared to stable secure children. Results indicate that infants who were insecure at both time points had the highest constellation of family risk characteristics.     

Dynamics of the dyad: How mothers and infants co-construct interaction spaces during object play

Studies of dyadic interaction often examine infants’ social exchanges with their caregivers in settings that constrain their physical properties (e.g., infant posture, fixed seating location for infants and adults). Methodological decisions about the physical arrangements of interaction, however, may limit our ability to understand how posture and position shape them. Here we focused on these embodied properties of dyadic interaction in the context of object play. We followed 30 mother–infant dyads across the first year of life (at 3, 6, 9, and 12 months) and observed them during 5 min of play with a standard set of toys. Using an interval-based coding system, we measured developmental change in infant posture, how mothers and infants positioned themselves relative to one another, and how they populated interaction spaces with objects. Results showed that mother–infant dyads co-constructed interaction spaces and that the contributions of each partner changed across development. Dyads progressively adopted a broader spatial co-orientation during play (e.g., positioned at right angles) across the first year. Moreover, advances in infants’ postural skills, particularly increases in the use of independent sitting in real time, uniquely predicted change in dyadic co-orientation and infants’ actions with objects, independent of age. Taken together, we show that the embodied properties of dyadic object play help determine how interactions are physically organized and unfold, both in real time and across the first year of life.     

The risk of low risk: First time motherhood,prematurity and dyadic well-being

Premature birth has a well-documented impact on infants, mothers and their dyadic interactions. First time motherhood in the context of low risk premature birth—relatively unexplored in the literature—is a specific experience that sits at the nexus of premature infancy, motherhood and the processes that underpin dyadic connection. This qualitative study analyzed semistructured interviews with first time mothers of low risk premature babies. Findings were generated in response to research questions concerning mothers’ meaning-making, bonding and identity. Findings demonstrated that maternal meaning-making emerged from a dyadic framework. When mothers or their infants were considered outside of a dyadic context, surplus suffering inadvertently occurred. Findings have important implications for infant mental health practice in medical settings, for postnatal support in the aftermath of premature birth, and for understanding the meaning of risk.     

Interaction between mother and pre-term infant at 34 weeks post-conceptional age

The impact of premature birth and perinatal medical status on early mother–infant interaction was assessed in 75 dyads with pre-term infants divided into three groups. Infants' gestational age at birth and need for neonatal intensive care intervention differentiated the groups: group 1, 23–31 weeks with intensive care; group 2, 32–35 weeks with intensive care; group 3, 32–35 weeks with no intensive care. The methodological approach was based on observations of the dyads performed when the infant reached a post. conceptional age of 34 weeks (4 weeks before estimated due date of delivery). The observations were conducted in the neonatal nursery during cleaning, face-to-face and feeding interactions. Significant group differences were found in infant distress, maternal sensitivity to the infant and dyadic behaviours of positive interaction. Group 1 dyads showed higher scores or more desirable performance than dyads of group 3. Group 2 dyads usually achieved intermediate scores and performed better than dyads of group 3, especially during the feeding situation. We suggest that, in addition to a possible emergence of maternal compensatory mechanisms in the higher-risk groups, the amount of dyadic experience after birth affects the quality of mother–infant interaction at this early stage.     

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.     

Dyadic and triadic skills in preterm and full term infants: a longitudinal study in the first year

This longitudinal study examined dyadic and triadic skills in 26 preterm and 31 full term infants at 3, 6 and 9 months of age. In dyadic interaction, infants engaged with a stranger in face-to-face play interrupted by a still-face episode. In triadic interaction, infants interacted with the adult stranger as she coordinated gaze between the infant and object. Both groups were sensitive for non-contingency in both dyadic and triadic interactions. There were significant group and developmental differences for dyadic and triadic competencies. Compared to full term infants, preterms made less positive elicits during the still-face at 6 months and followed gaze less at 9 months of age. Six-month dyadic skills and 9-month triadic competencies were positively related in preterm and full term infants.     

Maternal sensitivity behavior and infant behavior in early interaction

Maternal sensitivity behavior and infant behavior in early interaction were investigated among 57 Finnish mother–child pairs. Their interaction was video‐recorded at home in free‐play situation when the infants were 3 months and 12 months of age, and evaluated using the Parent–Child Early Relational Assessment Scale (PCERA). Maternal sensitivity behavior was mainly related to infant's positive aspects of mood, social and play behavior, and visual contact, both at 3 months and 12 months of age. Even though maternal sensitivity behavior correlated to infant behavior at 3 months and 12 months, infant behavior at 3 months of age contributed to later maternal sensitivity behavior. ©2001 Michigan Association for Infant Mental Health.     

Consistency in infant sleeping arrangements and mother–infant interaction

This study examined the association between infant sleeping arrangements (i.e., habitual co‐sleeping, inconsistent co‐sleeping, and non‐co‐sleeping) and quality of mother–infant interaction during play in a sample of mothers, each with a typically developing infant (N=70). Mother–infant dyads who experienced consistency in infant sleeping arrangements in a typical week at 6 months (i.e., habitual co‐sleeping or non‐co‐sleeping) were characterized by more positive maternal and infant behavior and dyadic quality of interaction at 9 months compared with dyads who experienced inconsistency in sleeping arrangements. Additionally, a greater amount of co‐sleeping per week was associated with an increased duration of breastfeeding, mothers working fewer hours, less infant temperamental intensity, and less maternal depression. This study underscores the advantages of empirically based studies that consider consistency in infant sleep experience as a factor that is associated with more positive mother–child interaction.     

Attachment,culture, and the caregiving system: The cultural patterning of everyday experiences among Anglo and Puerto Rican mother–infant pairs

This investigation focuses on cultural differences in the relationship between maternal sensitivity, emotional expression, and control strategies during the first year of life and infant attachment outcomes at 12 months. Participants were middle‐class Puerto Rican and Anglo mother–infant pairs (N = 60). Ratings of physical control, emotional expression, and maternal sensitivity during mother–infant interactions in five everyday home settings, videotaped when the infants were 4, 8, and 12 months old, were examined in combination with 12‐month Strange Situation classifications. Results suggest that physical control shows a different pattern of relatedness to maternal sensitivity, emotional expression, and attachment outcomes among the Puerto Rican compared to the Anglo mothers in this study. These findings have implications for practitioners and researchers interested in normative parenting among diverse cultural groups. ©2003 Michigan Association for Infant Mental Health.