Associations between maternal mind-mindedness and infant attachment security: investigating the mediating role of maternal sensitivity

In the last 20 years, three meta-analyses suggested that the relation between maternal sensitivity and infant attachment security was lesser in magnitude than originally believed. This led to a search for other parental behaviors likely to contribute to the development of attachment security. Based on previous theoretical propositions and empirical findings suggesting that maternal mind-mindedness may contribute to infant attachment security by favoring maternal sensitivity, the aim of this study was to examine whether sensitivity mediates the relation between maternal mind-mindedness and infant attachment security. Fifty mother-infant dyads took part in two home visits (12 months and 15 months), allowing for assessment of maternal sensitivity (T1), mind-mindedness (T1), and infant attachment (T2). The results confirmed that maternal sensitivity mediates the relation between mind-mindedness and infant attachment. The findings are discussed in light of the assessments used in this and previous studies.     

Correlates of therapeutic progress by infants with cerebral palsy and motor delay

A group of 10 infants diagnosed as having cerebral palsy or severe motor delays was administered pre/posttest assessments of both standardized and nonstandardized motor-evaluation instruments. Following 6 mo. of therapeutic intervention provided through neurodevelopmental treatment, the motoric gains of these infants were correlated with age, IQ, infant hours in treatment, hours of parental participation, and degree of involvement. Kendall's tau correlations showed a significant relationship between motoric progress and age, parental participation, and degree of involvement. The dilemma faced by habilitation professionals regarding whether or not to encourage parents to participate in therapeutic intervention programs is noted.     

Assessment of gestational age and neuromaturation

Neuromaturation is the functional development of the central nervous system (CNS). It is by its very nature a dynamic process, a continuous interaction between the genome and first the intrauterine environment, then the extrauterine environment. Understanding neuromaturation and being able to measure it is fundamental to infant neurodevelopmental assessment. Fetal and preterm neuromaturation has become easier to observe with the advent of prenatal ultrasonography and neonatal intensive care units. A number of measures of degree of fetal maturation have been developed and used to estimate gestational age (GA) at birth. The most reliable measures of GA are prenatal measures, especially from the first trimester. Postnatal GA measurements tend to be least accurate at the extremes of gestation, that is, in extremely preterm and post-term infants. Observations of measures of neuromaturation in infants born to mothers with pregnancy complications, including intrauterine growth restriction, multiple gestation, and chronic hypertension, have led to the discovery that stressed pregnancies may accelerate fetal pulmonary and CNS maturation. This acceleration of neuromaturation does not occur before 30 weeks' gestation and has a cost with respect to cognitive limitations manifested in childhood. The ability to measure fetal and preterm neuromaturation provides an assessment of neurodevelopmental progress that can be used to reassure parents or identify at risk infants who would benefit from limited comprehensive follow-up and early intervention services. In addition, measures of neuromaturation have the potential to provide insight into mechanisms of CNS injury and recovery, much-needed early feedback in intervention or treatment trials and a measure of early CNS function for research into the relationships between CNS structure and function.     

Exploring an integrative model of infant behavior: what is the relationship among temperament, sensory processing, and neurobehavioral measures?

Traditionally, developmental psychology, occupational/physical therapy, and behavioral pediatrics view similar infant behaviors from temperament, sensory processing, or neurobehavioral theoretical perspectives. This study examined the relations between similar and unique summary scores of three infant assessments (Early Infancy Temperament Questionnaire - EITQ, the Infant Sensory Profile - ISP, and the NICU Network Neurobehavioral Scale - NNNS) in a healthy sample of 100, one-month-old infants. A Principal Components Analysis of selected subscale scores derived from the three assessments suggested a three-factor model. Temperament and sensory summary scores had the strongest relations on two factors: Sensory-Affective Reactivity and Engagement. A third factor had strong relations between state regulation and motor competence. This new integrative model also validates an existing model and expands explanation of infant behavior across disciplines and methods which have significant implications for assessment, intervention, and management practices.     

Mother–child interaction on video compared with infant observation: Is five minutes enough time for assessment?

In this small‐scale preliminary study, we compared the correlation between assessments based on short videorecordings and infant observation. Five mother–infant dyads were assessed when the child was 1 year of age according to the Parent–Child Early Relational Assessment method (PCERA, 65 items) developed by Roseanne Clark (1985), using both observations covering 1 year and a 5‐min videorecording. The agreement between two video raters was sufficient (κ = 0.41–1.00 or proportion of agreement: 4/5–5/5) in 54 items. In 42 (78%) of these items, there was at least moderate agreement (κ = 0.41–1.00 or proportion of agreement 4/5–5/5), and in another 7 (13%) items fair (κ = 0.21–0.40 or proportion of agreement 3/5) agreement between the video and observation ratings, and both methods revealed the areas of strength and areas of concern of the dyads. Only a few items describing negative interactive style were assessed as identifying concern, but such items identified the dyad which was assessed to have the most constant problems. Most items describing positive interactive style and identifying the areas of concern in the interactive style according to both observation and video assessment were connected with the parental and dyadic engagement in the interaction. Five items with slight or poor (κ ≤ 0.20 or proportion of agreement 1/5–2/5) agreement between video rater and observer gave rise to questions about how the videorecording situation affected the behavior of the dyads, and about the limits of assessment methods and assessment of dyads with children of different ages and dyads from different cultures. ©2005 Michigan Association for Infant Mental Health.     

Limited effects of pre‐existing maternal antisocial behaviours on infant neurodevelopment: A pilot study

Antisocial behaviour disorders (ABDs) are among the most costly and treatment resistant of all psychiatric syndromes. Select neurodevelopmental abnormalities have been labelled a risk factor for ABDs, but it is unknown if maternal ABDs are associated with early neurodevelopmental abnormalities. This study tested whether infants of ABD mothers had more neurodevelopmental abnormalities than mothers with no psychiatric disorder (ND). Thirty‐nine pregnant women (49% with ABDs; 51% no psychiatric disorder) were recruited from the community. Infant neurodevelopment was assessed at ≤1 and 8 weeks using the Neonatal Behavioural Assessment Scale and at 16 weeks of age using the Bayley Scales of Infant and Toddler Development‐III. There was no significant group difference at ≤8 weeks. At 16 weeks, ABD mothers rated their infants higher on the Adapted Behaviours subscale, specifically on the leisure and self‐directed scales, when corrected for substance use and socio‐economic status. This pilot study found higher maternal ratings of Adapted Behaviours at 16 weeks, which may be due to unrealistic expectations about infant development.

Highlights

• Maternal Antisocial behaviour disorders (ABDs) do not impact early infant neurodevelopment at ≤ 8 weeks old as measured by standardized assessment.
• Mothers with ABDs view their infants at 16 weeks as better adapted than women without any psychiatric disorder.
• Specifically, mothers with ABDs reported their infants as better adapted on the leisure and self‐direction subscales of the Bayley Scales of Infant and Toddler Development‐III. This finding may be due to less knowledge about normal infant adaptive behavior.

     

Infant sleep moderates the effect of infant temperament on maternal depressive symptoms,maternal sensitivity,and family functioning

Observed infant temperamental difficulty and infant sleep efficiency and sleep variability were examined as predictors of maternal depressive symptoms, maternal sensitivity, and family functioning. Eight observations at 8-months postpartum were used to assess infant temperament, and actigraphy was used to measure infant sleep for 1-week at the time of the 8-month assessment. Structured clinical interviews were used to assess maternal depressive symptoms between 5 and 12 months postpartum and at 15 months postpartum, and observational assessments were used to assess maternal sensitivity and family functioning at 15 months postpartum. Variability in infant sleep moderated the effect of infant temperament on maternal depressive symptoms, maternal sensitivity, and family functioning. Infant temperament was positively associated with maternal depressive symptoms when variability in infant sleep efficiency was high, but not when variability in infant sleep efficiency was low. Likewise, infant temperament was negatively associated with maternal sensitivity and family functioning when variability in infant sleep efficiency was high, but not when variability in infant sleep efficiency was low. Results underscore the importance of infant sleep for maternal and family health.     

The Assessment of Preterm Infants' Behavior (APIB): furthering the understanding and measurement of neurodevelopmental competence in preterm and full-term infants

The Assessment of Preterm Infants' Behavior (APIB) is a newborn neurobehavioral assessment appropriate for preterm, at risk, and full-term newborns, from birth to 1 month after expected due date. The APIB is based in ethological-evolutionary thought and focuses on the assessment of mutually interacting behavioral subsystems in simultaneous interaction with the environment. The subsystems of functioning assessed include the autonomic (respiration, digestion, color), motor (tone, movement, postures), state organization (range, robustness, transition patterns), attention (robustness, transitions), and self-regulation (effort, success) systems as well as the degree of facilitation required to support reorganization and subsystem balance. The environment is represented by a sequence of distal, proximal, tactile, and vestibular challenges, derived from the BNBAS. The APIB conceptualizes infant competence as the degree of differentiation of subsystem function and degree of modulation of subsystem balance at any stage in infant development. Infants are understood as actively seeking their next differentiation, while counting on good enough environments to assure progressing developmental competence. In the case of interference such as premature birth, the mismatch of expectation and actual experience causes misalignment, which may become developmentally costly. The assessment is a finely tuned dialogue between examiner and infant, which requires training, skill and self-knowledge. The APIB has well established inter-rater-reliability, concurrent and construct validity, and is clinically relevant for behavioral intervention and individually appropriate and supportive care.     

Socio-demographic determinants of infant neurodevelopment at 18 months of age: Mother-Child Cohort (Rhea Study) in Crete, Greece

Studies on determinants affecting child development are still limited in Greece. The aim of the present study was to describe the socio-demographic characteristics associated with neurodevelopment in infants aged 18 months in the Mother-Child Cohort (Rhea Study) in Crete, Greece. A total of 599 (72.9%) mothers agreed to participate in the neurodevelopment protocol and 612 infants (586 singletons and 26 twins) were assessed by means of the Bayley Scales of Infant and Toddler Development (3rd edition). The present analysis includes 605 infants. Multivariable linear regression models were implemented to examine the associations between the Bayley-III standardised scores and different parental and infant characteristics, also adjusting for quality of assessment. Girls were found to have better neurodevelopmental outcomes in cognitive, receptive and expressive communication, fine motor and social-emotional development. Maternal higher education was positively associated to almost all aspects of infant neurodevelopment assessed. Increasing number of older siblings was negatively associated with cognitive development, communication skills and gross motor development. Our results, also, suggest a positive effect of maternal employment on infants' receptive and expressive communication, and gross motor scores. The results of the present study suggest that in the population on Crete social and environmental factors contributed more to infants' neurodevelopment at 18 months than biological factors.     

Relationship assessment in infant mental health

Infant-caregiver relationships are the crucial context for infant development and psychopathology. Considerable evidence suggests that infants may construct qualitatively different relationships with different caregivers. For these reasons, infant-caregiver relationships should be a centerpiece of assessment in infant mental health. We advocate assessing infant relationships with all important caregivers in both clinic based and naturalistic settings. In this article we describe our approach, which attends both to the external component of the relationship, behavioral interaction, as well as the internal component of the relationship, subjective experience. By integrating results from assessments of these two components, we determine both level of relationship adaptation and the specific domains of strengths and weaknesses. © 1997 Michigan Association for Infant Mental Health     

Neurodevelopmental care in the NICU

Neurodevelopmental care, which is any NICU intervention undertaken to improve neurodevelopmental outcome, includes NICU design, nursing routines, nursing care plans, management of pain, feeding methods and, most importantly, encouraging parental involvement with their NICU infant. Recognition that sensory stimulation can overwhelm preterm infants and increase physiologic signs of stress led to attempts to reduce sensory input. More recent approaches judiciously add back soothing sensory input (e.g., therapeutic touch, soft music). Circadian light/dark cycles and physical activity improve preterm growth. Attention to infant positioning and handling affects physiologic variables and joint mobility, if not functional motor abilities. A highly organized system of care for NICU infants is Als' NIDCAP (i.e., Neonatal Individualized Developmental Care and Assessment Program). Although NIDCAP may reduce need for respiratory support and hospital length of stay, it does not significantly influence neurodevelopmental outcome at 2-3 years. Pain management includes benign interventions (e.g., nonnutritive sucking, oral glucose), but the prolonged use of narcotics must be balanced against the consequences of sedation and dependency. The foremost challenge for NICUs remains parent disenfranchisement. Kangaroo care, which involves parent/infant skin-to-skin contact, improves preterm growth, decreases nosocomial infections and may shorten hospital length of stay. A great deal of work needs to be done to identify and demonstrate efficacy of specific interventions and changes that humanize the NICU, encourage parental involvement, support infant development and optimize preterm neurodevelopmental outcomes.     

Screening for Medical and Neurodevelopmental Disorders for the Professional Counselor

This article reviews several assessment factors useful identifying the presence of a possible medical illness or neurodevelopmental disorder contributing to a client's adjustment problems. Use of behavioral observations, record reviews, brief neuro-behavioral screening tests, and the taking of a history are outlined that can assist in raising the index of suspicion for organic influence. Also addressed are issues pertaining to referral for medical and specialty assessments, including neuropsychological evaluation.     

Selecting measures for the neurodevelopmental assessment of children in low- and middle-income countries

Diseases affecting millions of children in low- and middle-income countries (LMICs), such as malnutrition, micronutrient deficiency, malaria, and HIV, can lead to adverse neurodevelopmental outcomes. Thus, a key health outcome in children is neurodevelopmental status. In this paper, the neurodevelopmental screening and testing measures most commonly utilized in LMICs are reviewed, and a matrix is presented to help researchers and clinicians determine which measures may be most useful for various LMIC inquiries. The matrix is based on an Internet literature review of 114 publications for the period January 1998 to February 2016, reporting the psychometric properties of instruments tested in LMIC children. The measures are classified as screening tests or more detailed tests that include both comprehensive batteries of general development and tests of specific domains. For completeness, two experts have reviewed this paper, as well as the authors. An overview of the tests used to date is presented, including the benefits and drawbacks of each test, in order to provide researchers and developmental clinicians with a way to decide which tests may be best suited to their developmental assessment goals. Remarkable progress has been made in neurodevelopmental testing in children in LMICs over the past two decades but there remains a need for additional research in this area to develop new tests, better evaluate and adapt current tests, and assess test validity and reliability across cultures.     

National Study of School Psychologists’ Use of Evidence-Based Assessment in Autism Spectrum Disorder

This study aimed to better understand predictors of evidence-based assessment practices for autism spectrum disorder (ASD). Nationwide, 402 school psychologists were surveyed for their knowledge of and training and experience with ASD on assessment practices, including reported areas of training needs. The majority of school psychologists reported that they did not engage in comprehensive assessment of ASD, which was defined as assessments that consider all areas of development in addition to the use of ASD-specific instruments. Results from logistic regression revealed that experience and training, working with young children with ASD, and geographic location predicted use of evidence-based assessment practices. Experience and training with ASD was the strongest predictor of evidence-based assessment. No differences in training needs were indicated by school psychologists whose practices were consistent with evidence-based assessment and those whose practices were not. Overall, the results identified gaps between best and current practices by school psychologists and highlight areas of need for additional training and professional development.     

What Can Be Known and How People Grow: The Philosophical Stakes of the Assessment Debate

Fierce debates over standardized assessments in teacher preparation have revolved around flaws in implementation and the politics of privatization. While important, this focus obscures the philosophical divide between proponents and opponents of standardized assessments. This article examines how faculty in New York State argue for and against a controversial performance assessment for teacher candidates, the edTPA. Revealing the distinctive ways that teacher educators on opposing sides of this debate understand the nature of knowledge, human development, professionalism, and social justice clarifies what is at stake in debates over how to prepare teachers. Such clarification can deepen the discussion on how to evaluate learning and growth as well as enrich the conversation on how to protect the integrity of educational professions and practices.     

Infectious and immune factors in the pathogenesis of neurodevelopmental disorders: epidemiology, hypotheses, and animal models

Both genetic and environmental factors contribute to the pathogenesis of a wide variety of neurodevelopmental disorders, including autism, mental retardation, and schizophrenia. Some heritable disorders approach 100% penetrance; nonetheless, even in these disorders, subtle aspects of clinical disease expression may be influenced by the environment. In other disorders with genetic influences, exogenous factors, and the timepoint(s) during nervous system development at which they are introduced, modulate expression of disease. Elucidation of the mechanisms guiding this intricate interplay between host response genes, environmental agents, and the neurodevelopmental context within which these interactions occur, is necessary to understand the continuum of clinical outcomes. This chapter will review the evidence that infectious and immune factors may contribute to the pathogenesis of neurodevelopmental disorders, describe an animal model of neurodevelopmental disorders based upon viral infection, identify processes by which neural circuitry may be compromised, and outline areas for future research.     

The Interface Between Attachment and Intersubjectivity: Perspective from the Longitudinal Study of Disorganized Attachment

This article considers the interface between the concepts of attachment and intersubjectivity in light of accumulated research on infant development. Both Tomasello (1999) and Hobson (2002) have argued persuasively that the flexible human capability for sharing mental states with others reframes and revolutionizes our older, more highly channeled primate biological heritage. In contrast to this emphasis on discontinuity from primate to human evolution, attachment theorists have stressed the continuities between human attachment and attachment in other primates. The implication of new work on infant intersubjectivity for reframing aspects of attachment theory is first explored. By the same token, however, the extent to which the infant–caregiver attachment relationship functions to maintain positive engagement and regulate the infant's fearful arousal will have escalating consequences over development for the organization of intersubjectivity. Therefore, attachment research has much to offer in understanding the development of joint attention and the sharing of mental states under conditions of increased emotional arousal. The potential contributions of attachment research for understanding the development of intersubjectivity are discussed in light of recent work from the author's lab on forms of young adult symptomatology associated with deviance in the early intersubjective dialogue between mother and infant. The clinical implication emerging from all these diverse areas of research is that fostering more collaborative forms of communication may lie at the heart of evolutionary change, developmental change, and changes resulting from psychodynamic psychotherapy.     

A novel two-body sensor system to study spontaneous movements in infants during caregiver physical contact

Spontaneous movements, which refer to repetitive limb movements in the absence of any external stimulus, have been found to be reflective of neurodevelopmental status during infancy. These movements are modulated by both individual and environmental factors, including physical contact (holding) with the caregiver. However, it is a challenge to measure spontaneous movements during physical contact because infant-generated movements become coupled with caregiver-generated movements in such contexts. Here, we propose the use of a novel two-body sensor system to distinguish infant-generated movements in the presence of physical contact with the caregiver. Data from seven typically developing infants and their caregivers were recorded during different simulated home activities, which involved different combinations of physical interaction, caregiver’s movement and infant positions. The two-body sensor system consisted of two wearable accelerometers – one placed on the infant’s arm and one on the caregiver’s arm, and we developed a Kalman-filter based algorithm to isolate the infant-generated movements. In addition, video was recorded for qualitative analysis. Results indicated that spontaneous movement activity was higher when there was no physical contact with caregiver. When there was physical contact, spontaneous movements were increased when the caregiver was still and when the infant was held horizontally. These results show that the novel two-body sensor system and the associated algorithms were able to isolate infant-generated movements during physical contact with the caregiver. This approach holds promise for the automated long-term tracking of spontaneous movements in infants, which may provide critical insight into developmental disorders.