A comparison of dyadic interactions and coping with still‐face in healthy pre‐term and full‐term infants

Pre‐term birth has a significant impact on infants' social and emotional competence, however, little is known about regulatory processes in pre‐term mother‐infant dyads during normal or stressful interactions. The primary goals of this study were to investigate the differences in infant and caregiver interactive behaviour and dyadic coordination of clinically healthy pre‐term compared to full‐term infant‐mother dyads and to examine pre‐term infants' capacity for coping with stress using the face‐to‐face still‐face paradigm (FFSF). Fifty mother‐infant dyads, including 25 pre‐term infants and 25 full‐term infants were videotaped during the FFSF. All infants were 6–9 months of age (corrected for gestational age in the pre‐term group). Infant and maternal socio‐emotional expressivity and self‐regulatory behaviours were coded and measures of dyadic coordination (Matching, Reparation Rate, and Synchrony) were calculated. There were no significant differences in infant and caregiver socio‐emotional behaviours between the two groups and both groups demonstrated the still‐face (SF) effect and the reunion effect. There was a difference in self‐regulatory behaviour. Pre‐term infants were more likely than full‐term infants to use distancing (e.g., by turning away, twisting, or arching) from their mothers during the FFSF. Additionally, during the Reunion episode of the FFSF pre‐term infants showed more social monitoring compared to full‐term infants. Regardless of the birth status, the dyads showed less coordination and a slower rate of reparation during the Reunion episode than during the Play episode. The higher proportion of distancing in the pre‐term group and the increase in social monitoring suggest that even in normal interactions pre‐term infants may experience a higher level of stress and have less capacity for self‐regulation compared to the full‐terms and that pre‐term infants appear to use a compensatory strategy of increased social monitoring to cope with the stress of renegotiating the interaction during Reunion. The findings suggest that pre‐term infants have different regulatory and interactive capacities than full‐term infants.     

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.     

Caregiving behavior and interactions of prenatally depressed mothers (antidepressant‐treated and non‐antidepressant‐treated) during newborn acute pain

This exploratory study aimed to examine time‐based measures of the behaviors and interactions of prenatally depressed serotonin reuptake inhibitors (SRI)‐medicated mothers to their infant's pain (n = 10) by comparing them with similar measures obtained from prenatally depressed nonmedicated mothers and their infants (n = 10), and nondepressed mothers and their infants (n = 10). During the second trimester of their pregnancy, the 30 study mothers were assessed for depression and anxiety, with no further measures of maternal mood taken. Maternal and infant interactions were continuously videorecorded while the infant underwent a scheduled heel lance for routine blood screening that occurred when study infants were between the ages of 24 and 60 hr. Maternal behavior and infant cry, for all 30 cases, were coded second‐by‐second for the full duration of each infant's heel lance using a reliable coding system and analyzed using odds ratio and regression analyses. Infants exposed to prenatal SRIs and depressed maternal mood were more likely to have lower Apgar scores and to exhibit weak and absent cry. Even when duration of the heel lance was controlled for, women with depression during the second trimester were more likely to exhibit depressed behavior at 2 days' postpartum despite sustained SRI antidepressant treatment. Both groups of prenatally depressed mothers were more likely to exhibit diminished response to their infants' pain cue although nonmedicated mothers' expressions of depressed behavior were more similar to healthy controls. Comprehensive understanding is essential to optimize the clinical care of mothers and their infants in this complex setting. This study contributes preliminary new findings that warrant prospective and longitudinal studies to clarify further the impacts of prenatal SRI and maternal mental mood (e.g., chronic depression and anxiety) effects on the mother–infant interaction and infant pain and stress reactivity.     

INSIGHTFULNESS AND LATER INFANT ATTACHMENT IN CLINICALLY DEPRESSED AND NONCLINICAL MOTHERS

The aim of this pilot study was to investigate the relationship between maternal insightfulness and sensitivity and subsequent infant attachment security and disorganization in clinically depressed and nonclinical mother–infant groups. Nineteen depressed mothers with infants ages 3 to 11 months participated in this study. Twenty nonclinical mother–infant dyads were matched to the clinical sample according to infant sex and age. Maternal depression was assessed using the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (American Psychiatric Association, 1994), insightfulness using the Insightfulness Assessment (IA), and sensitivity using the Maternal Sensitivity Scales (M.D.S. Ainsworth, 1969). IA classifications and subscales were considered separately. Later infant attachment was assessed by the Strange Situation Procedure (M.D.S. Ainsworth, M.C. Blehar, E. Waters, & S. Wall, 1978). Depressed mothers tended to have less securely attached children than did nonclinical mothers. Within the clinical sample, the insightfulness categories correlated slightly moderately with attachment security, but were not related to attachment disorganization. Within the nonclinical sample, the IA categories were slightly moderately associated with attachment security and with disorganization. On IA subscales, relationship patterns differed in clinically depressed and nonclinical mother–infant dyads. These findings provide the first evidence of the predictive power of the IA categorization and subscales on subsequent infant attachment. They also may allow the development of different foci of intervention for enhancing insightful caregiving.     

A dynamic system analysis of dyadic flexibility and stability across the Face-to-Face Still-Face procedure: Application of the State Space Grid

The Face-to-Face Still-Face (FFSF) paradigm allows to study the mother–infant dyad as a dynamic system coping with social stress perturbations. The State Space Grid (SSG) method is thought to depict both flexibility and stability of the dyad across perturbations, but previous SSG evidence for the FFSF is limited. The main aims were: (1) to investigate mother–infant dyadic flexibility and stability across the FFSF using the SSG; (2) to evaluate the influence of dyadic functioning during Play on infant Still-Face response and of infant stress response in affecting dyadic functioning during Reunion. Forty 4-month-old infants and their mothers were micro-analytically coded during a FFSF and eight SSG dyadic states were obtained. Dyadic flexibility and attractor states were assessed during Play and Reunion. Infants’ stress response was coded as negative engagement during the Still-Face episode. Two dyadic states, “maternal hetero-regulation” and “affective mismatch”, showed significant changes in the number of visits from Play to Reunion. During Play “maternal positive support to infant play” emerged as attractor state, whereas during Reunion a second attractor emerged, namely “affective mismatch”. Dyadic affective mismatch during Play correlated with infants’ negative engagement during Still-Face, whereas infants’ response to Still-Face resulted in minor social matching during Reunion. Findings provide new insights into the flexible, yet stable, functioning of the mother–infant dyad as a dynamic system. Evidence of a reciprocal influence between dyadic functioning and infant social stress response are discussed.     

Affect expression in prenatally psychotropic exposed and nonexposed mother–infant dyads

This prospective study examined infant, maternal, and dyadic affective profiles at three months postpartum in infant–mother dyads that were exposed to psychotropic medications in utero compared with nonexposed control dyads. Control dyads of nondepressed mothers and their infants showed many similarities in affect expression with mother–infant dyads who were exposed to selective serotonin reuptake inhibitors (SSRIs) alone for treatment of maternal depression. In contrast, mothers who received SSRIs and Rivotril (Benzodiazepine derivative) for treatment of depression and anxiety expressed both positive and negative affect towards their infants. Clinical implications regarding use of psychotropic medications such as SSRIs alone or in combination with other drugs for treatment of maternal anxiety and depression during pregnancy are discussed. Clinicians should be aware of the possible differential response in maternal–infant interaction in a mixed diagnosis group (i.e., depression and anxiety) regarding infant temperament, possibly suggesting latent behavioral teratogenicity with psychotropics. ©2002 Michigan Association for Infant Mental Health.     

The co‐construction of joint action between mothers and 2–4‐month‐old infants: the mother's role

The purpose of this longitudinal study was to describe object‐centred interactions between mothers and their 2–4‐month‐old infants, before and during the emergence of reaching and grasping movements. We hypothesized that when reaching movements emerge at around 3 months, mothers alternate between attention stimulation and reaching stimulation, before joint actions between mother and infant develop around objects. Twelve dyads were recorded when infants were 2 months, 3 months and 4 months. The interactive sessions lasted 5 min. Three age‐appropriate toys the infant could handle were available to the mother. A principal component analysis (PCA) was performed on verbal and non‐verbal maternal behaviours, motor infant behaviours and co‐occurrences of those behaviours. The developmental course of prehension in infants when playing with their mother follows similar pathways, as was described when they are observed alone. Mothers appeared to early scaffold prehension skills by verbal and non‐verbal means. Moreover, maternal behaviours change according to the infant's behaviour, and conversely, infant's behaviours influence maternal behaviours: mother plays first an active part in joint action, while later on, the infant achieves joint action when motor skills develop. Copyright © 2000 John Wiley & Sons, Ltd.     

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.     

Maternal representations and emotional availability among drug‐abusing and nonusing mothers and their infants

Both negative and idealized maternal prenatal representations may constitute a risk for mother–infant interaction. This study analyzed the role of maternal prenatal representations and pre‐ to postnatal representational change in predicting mother–infant emotional availability (EA) among 51 drug‐abusing mothers and their infants who participated in either psychodynamic group therapy (PGT) or received psychosocial support (PSS) and among 50 nonusing comparison dyads. Maternal representations of her child, the child's father, her own mother, self‐as‐mother, and self‐as‐woman were measured during pregnancy and at 4 and 12 months' postpartum with the Interview of Maternal Representations (M. Ammaniti et al., 1992 ; M. Ammaniti, R. Tambelli, & P. Perucchini, 1998). EA was measured with the Emotional Availability Scales, fourth edition (Z. Biringen, 2008 ) at 4 and 12 months. The results showed that drug‐abusing mothers had more negative prenatal representations of the self‐as‐woman and of the child's father. Postnatally, PSS mothers tended to first idealize their child, but later to experience disillusionment of idealization. Both negative and idealized prenatal representations of the self‐as‐mother predicted mother–infant EA problems, but only among the PGT mothers. For all mothers, negative representational change was detrimental for the mother–infant EA whereas for drug‐abusing mothers, also increasing idealization from the prenatal period to the postnatal period was harmful. Clinicians working with drug‐abusing mothers should aim at supporting the development of a realistically positive view of motherhood.     

Maternal depression and dyadic interaction: the role of maternal attachment style

Maternal mental health and the contents of her representational world are important determinants of early parent–child relationship. We examined, first, the role of prenatal and postnatal depressive symptoms and maternal attachment style in predicting the quality of mother–child interaction. Second, we analysed whether the secure‐autonomous attachment style can protect the dyadic interaction from the negative effects of maternal depression. The participants were 59 mother–infant pairs examined during pregnancy (T1), 4–5 months postpartum (T2) and when the children were approximately 14 months old (T3). Maternal attachment style was assessed with a modified Adult Attachment Interview ‐procedure, depressive symptoms with Edinburgh Postnatal Depression Scale, and observed mother–child interaction with Care Index. The results show that autonomous mothers were more sensitive and responsive and their children more co‐operative than dyads with dismissing maternal attachment style. As hypothesized, mothers with the combination of both prenatal and postpartum depressive symptoms were highly unresponsive in their dyadic interaction. Further, prenatal depressive symptoms had a stronger impact on maternal unresponsiveness than postnatal symptoms. As hypothesized, mother's autonomous attachment style protected the mother–child interaction from the negative impact of maternal postnatal depressive symptoms, whereas dyads with preoccupied mothers were especially at risk for interaction problems when mothers had postpartum depressive symptoms. Copyright © 2010 John Wiley & Sons, Ltd.     

Effects of maternal postpartum depression in a well‐resourced sample: Early concurrent and long‐term effects on infant cognitive,language, and motor development

This study examined early and long‐term effects of maternal postpartum depression on cognitive, language, and motor development in infants of clinically depressed mothers. Participants were 83 mothers and their full‐term born children from the urban region of Copenhagen, Denmark. Of this group, 28 mothers were diagnosed with postnatal depression three to four months postpartum in a diagnostic interview. Cognitive, language, and motor development was assessed with the Bayley Scales of Infant and Toddler Development third edition, when the infants were 4 and 13 months of age. We found that maternal postpartum depression was associated with poorer cognitive development at infant age four months, the effect size being large (Cohen's d = 0.8) and with similar effects for boys and girls. At 13 months of age infants of clinical mothers did not differ from infants of non‐clinical mothers. At this time most (79%) of the clinical mothers were no longer, or not again, depressed. These results may indicate that maternal depression can have an acute, concurrent effect on infant cognitive development as early as at four months postpartum. At the same time, in the absence of other risk factors, this effect may not be enduring. The main weaknesses of the study include the relatively small sample size and that depression scores were only available for 35 of the non‐clinical mothers at 13 months.     

The importance of maternal state of mind regarding attachment and infant age at placement to foster mothers' representations of their foster infants

Previous research has found that foster mother state of mind with respect to attachment and infant age at placement into foster care influence the developing foster mother–foster child relationship (Dozier, Albus, Stovall, & Bates, 2000; Stovall & Dozier, 2000). This study extends prior research by assessing factors related to foster mothers' representations of their foster infants. Participants were 48 foster mother–foster infant dyads in two mid‐Atlantic cities. We expected that foster mothers' states of mind and infant age at placement would be associated with foster mothers' acceptance of infants, commitment to infants, and belief in their influence on infants' development. Consistent with hypotheses, foster mothers' states of mind interacted with infant age at placement in predicting foster mothers' acceptance of their babies, and the extent to which foster mothers believed they could influence their infants' development. Specifically, autonomous foster mothers of babies placed before 12 months of age were more accepting and more likely to believe they could influence their infants' development compared to autonomous foster mothers of babies placed after 12 months of age, a pattern not seen for nonautonomous foster mothers. These results converge with other findings suggesting that timing of placement in foster care, and foster mothers' states of mind, are important to the developing foster mother–child relationship. ©2002 Michigan Association for Infant Mental Health.     

Impact of mother interactive style on infant affect among babies exposed to alcohol in utero

This study examined the ability of infants prenatally exposed to alcohol to regulate their affect during and after a stressor. Specifically, the Still‐Face Paradigm (Tronick, Als, Adamson, Wise, ' Brazelton, 1978) was used as a stress induction paradigm to assess both mother‐infant interaction and infant self‐regulation. In addition to the mothers' interactive style, the effect of mothers' drinking during and after pregnancy on the infant was explored. Participants were 76 six‐month‐old infants and their mothers. Infant affect and maternal interaction style was coded second‐by‐second for the 6 min of the Still‐Face Paradigm. Results indicated that infants whose mothers made fewer attempts at engaging them during the play portion of the still‐face (e.g., either watched their infant or paid minimal attention to their infant) showed greater negative affect in contrast to infants whose mothers played in an interactive manner. A gender effect was found among female infants. That is, female infants whose mothers drank more during pregnancy showed greater negative affect. The study demonstrates the possibility of early identification of negativity in infants with prenatal alcohol exposure. The impact of mother‐child relationship on emotional regulation of infants prenatally alcohol exposed may be a target of future intervention and further study.     

Association of maternal interaction with emotional regulation in 4- and 9-month infants during the Still Face Paradigm

This study used the Still Face Paradigm to investigate the relationship of maternal interaction on infants' emotion regulation responses. Seventy infant-mother dyads were seen at 4 months and 25 of these same dyads were re-evaluated at 9 months. Maternal interactions were coded for attention seeking and contingent responding. Emotional regulation was described by infant stress reaction and overall positive affect. Results indicated that at both 4 and 9 months mothers who used more contingent responding interactions had infants who showed more positive affect. In contrast, mothers who used more attention seeking play had infants who showed less positive affect after the Still Face Paradigm. Patterns of stress reaction were reversed, as mothers who used more attention seeking play had infants with less negative affect. Implications for intervention and emotional regulation patterns over time are discussed.     

The Effectiveness of an Attachment‐Based Intervention in Promoting Foster Mothers’ Sensitivity toward Foster Infants

Infants in foster care need sensitive, responsive caregivers to promote their healthy outcomes. The current study examined the effectiveness of the Attachment and Biobehavioral Catch‐up Intervention, a short‐term, targeted, attachment‐based intervention program designed to promote sensitive caregiving behavior among foster mothers. Ninety‐six foster mother–infant dyads participated in this study; 44 dyads were assigned to the Attachment and Biobehavioral Catch‐up Intervention, and 52 dyads were assigned to a control intervention. Results of hierarchical linear modeling indicated that foster mothers who were assigned to the Attachment and Biobehavioral Catch‐up Intervention showed greater improvements in their sensitivity from pre‐ to postintervention assessment time points when compared with foster mothers who were assigned to the control intervention. We conclude that a short‐term, targeted, attachment‐based intervention is effective in changing foster mothers’ responsiveness to their foster infants, which is critical for foster infants’ healthy socioemotional adjustment.     

Comparison of Maternal Perceptions of Preterm and Fullterm Infants

We compared maternal attitudes and feelings in two groups of mother–infant dyads: 25 mothers with preterm newborns (M=30.9 weeks of gestational age) and 25 mothers with fullterm newborns (M=39.7 weeks of gestational age). Both groups were matched for infant sex, age (corrected in preterms) and birth order as well as for maternal age and education. Semi-structured interviews were used to collect data on maternal attitudes and feelings about pregnancy and the first contacts with the newborn. Mothers completed rating scales to indicate the specific behavioural problems they perceived in their infants at 6 weeks and 3 months of (corrected) age. Observations of infant responses to visual and/or auditory stimuli were made at 6 weeks and 3 months in a laboratory setting. At 3 months, each infant was administered the Bayley Scale of Mental Development. There were no differences in maternal attitudes and feelings between the two groups of mothers prior to the birth. However, significant differences appeared after birth and indicated increased anxiety in mothers of preterm infants. Significantly more 6-week-old preterm infants were perceived by their mothers as irritable and to cry more than fullterm infants. At the age of 3 months, both groups of infants differed only in terms of irritability. Differences between the two groups of mother–infant dyads, age-related changes in these differences and relationships between maternal evaluations and the laboratory-based assessments are discussed in the context of contrasts in the stability of behavioural regulation in preterm and fullterm infants.     

Six-week postpartum maternal self-criticism and dependency and 4-month mother-infant self- and interactive contingencies

Associations of 6-week postpartum maternal self-criticism and dependency with 4-month mother-infant self- and interactive contingencies during face-to-face play were investigated in 126 dyads. Infant and mother face, gaze, touch, and vocal quality were coded second by second from split-screen videotape. Self- and interactive contingencies were defined as auto- and lagged cross-correlation, respectively, using multilevel time-series models. Statistical significance was defined as p<.05. Regarding self-contingency, (a) more self-critical mothers showed primarily lowered self-contingency, whereas their infants showed both lowered and heightened, and (b) infants of more dependent mothers showed primarily lowered self-contingency, whereas findings were absent in mothers. Regarding interactive contingency, (a) more self-critical mothers showed lowered attention and emotion contingencies but heightened contingent touch coordination with infant touch, and (b) more dependent mothers and their infants showed heightened facial/vocal interactive contingencies. Thus, maternal self-criticism and dependency have different effects on mother-infant communication.