IMPACT OF PARENTAL BINGE EATING DISORDER: EXPLORING CHILDREN'S EMOTIONAL/BEHAVIORAL PROBLEMS AND THE QUALITY OF PARENT–CHILD FEEDING INTERACTIONS

This study examines psychopathological problems in children of parents with binge eating disorder (BED), particularly the effect of parental diagnosis on their offspring's psychopathology and the mediating power of the quality of parent–infant feeding interactions. Two hundred parents and their offspring were administered a questionnaire for the assessment of their children's psychopathology at 18 (T1) and 36 (T2) months of age. An observational measure to evaluate feeding interactions was administered at T1. Children with both parents with BED showed the highest affective, anxiety, oppositional/defiant, and autism spectrum problems, but no influence of paternal diagnosis was found on the offspring's psychopathology. Maternal BED had an influence on children's affective and autism spectrum problems, and diagnosis of BED in both parents had an effect on infants’ affective problems. Paternal BED had an effect on oppositional/defiant problems through the quality of father–infant interactions, and maternal BED had an effect on the offspring's affective and anxiety problems through the mediation of mother–infant interactions. These results suggest the importance of intervention programs focusing both on parental psychopathology and on mother–child and father–child feeding interactions in families with parents with BED.     

EXPANDING INFANT MENTAL HEALTH TREATMENT SERVICES TO AT‐RISK PRESCHOOLERS AND THEIR FAMILIES THROUGH THE INTEGRATION OF RELATIONAL PLAY THERAPY

The expansion of infant mental health (IMH) to at‐risk preschoolers and their families has contributed to the integration of relational play therapy (RPT) into IMH treatment services for this population. Integrating RPT allows access to specialized play and expressive techniques specific to preschool and family development, which improves the clinical ability to meet the multiple and complex needs of at‐risk parent–child dyads and their families. This article will examine the RPT literature and explore the similarities and differences between IMH and RPT. In addition, two case studies will highlight a five‐phase, integrative clinical‐treatment process and provide insight into how IMH clinicians are integrating RPT models and maintaining adherence to the IMH treatment approach.     

INTERFACING INFANT MENTAL HEALTH KNOWLEDGE: PERSPECTIVES OF SOUTH AFRICAN SUPERVISORS SUPPORTING LAY MOTHER–INFANT HOME VISITORS

This article is part of a project investigating the interfacing of clinically and research‐generated knowledge in the field of infant mental health (IMH) with local cultural models of child care and development. The article explores the experiences and challenges reported by psychology‐trained supervisors in supervision with local, lay, trained home visitors. Supervisors and supervisees were drawn from two early intervention programs which apply relational IMH mental health models in socioeconomically deprived townships in South Africa. Literature that considers supervisors’ experiences of conducting supervision with lay counselors has been limited, and even more so in settings where there are marked cultural and contextual differences between supervisors and supervisees. These differences pose particular challenges regarding the finding of a shared theoretical understanding of the work as well as to the establishment of a secure working alliance. While it was found that psychoanalytic and attachment‐informed theories of infant development are applicable in these South African settings, differences in race, language, education, socioeconomic status, and culture between supervisors and supervisees challenge the supervisor–supervisee relationship and require psychological processing and creative solutions to ensure integrity in the application of the model.     

MATERNAL TRAUMA AFFECTS PRENATAL MENTAL HEALTH AND INFANT STRESS REGULATION AMONG PALESTINIAN DYADS

We examined how diverse and cumulated traumatic experiences predicted maternal prenatal mental health and infant stress regulation in war conditions and whether maternal mental health mediated the association between trauma and infant stress regulation. Participants were 511 Palestinian mothers from the Gaza Strip who reported exposure to current war trauma (WT), past childhood emotional (CEA) and physical abuse, socioeconomic status (SES), prenatal mental health problems (posttraumatic stress disorder and depression symptoms), and perceived stress during their secondtrimester of pregnancy as well as infant stress regulation at 4 months. While all trauma types were associated with high levels of prenatal symptoms, CEA had the most wide‐ranging effects and was uniquely associated with depression symptoms. Concerning infant stress regulation, mothers’ CEA predicted negative affectivity, but only among mothers with low WT. Against hypothesis, the effects of maternal trauma on infant stress regulation were not mediated by mental health symptoms. Mothers’ higher SES was associated with better infant stress regulation whereas infant prematurity and male sex predisposed for difficulties. Our findings suggest that maternal childhood abuse, especially CEA, should be a central treatment target among war‐exposed families. Cumulated psychosocial stressors might increase the risk for transgenerational problems.     

DC:0–5: DIAGNOSTIC CLASSIFICATION OF MENTAL HEALTH AND DEVELOPMENTAL DISORDERS OF INFANCY AND EARLY CHILDHOOD

The significant growth in the clinical literature on early childhood psychopathologysince the publication of the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Zero to Three–Revised (DC:0–3R; ZERO TO THREE) in 2005 necessitated substantial revisions to the manual, which resulted in the publication of the DC:0–5: Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Zero to Five (ZERO TO THREE) in 2016. In addition to the decision to extend the early childhood diagnoses to include children through age 5 years, significant revisions were made to many diagnoses, and new diagnostic categories were added such as the Relationship Specific Disorder of Infancy/Early Childhood. Other additions, such as guidance for the development of a Cultural Formulation for the young child and his or her family and the inclusion of functional impairment criteria also contribute to making the DC: 0–5a substantially more comprehensive and robust diagnostic framework than its predecessor.     

IMPLEMENTATION OF AN EVIDENCED‐BASED PARENTING PROGRAM IN A COMMUNITY MENTAL HEALTH SETTING

The process of mental health intervention implementation with vulnerable populations is not well‐described in the literature. The authors worked as a community‐partnered team to adapt and pilot an empirically supported intervention program for mothers of infants and toddlers in an outpatient mental health clinic that primarily serves a low‐income community. We used qualitative ethnographic methods to document the adaption of an evidence‐based intervention, Mothering from the Inside Out, and the pilot implementation in a community mental health clinic. Seventeen mothers and their identified 0‐ to 84‐month‐old children were enrolled in the study. Key lessons from this implementation include (a) the importance of formative work to build community relationships and effectively adapt the intervention to meet the needs of the therapists and their clients, (b) the importance of designing plans for training and reflective supervision that fit within the flow of the clinic and can tolerate disruptions, and (c) that use of an interdisciplinary approach is feasible with the development of a plan for communication and the support of a trained reflective clinical supervisor. These key lessons advance the scientific knowledge available to healthcare managers and researchers who are looking to adapt mental health clinical interventions previously tested in clinical trials to implementation in community settings.     

CULTURAL MODELS OF INFANT EMOTIONS AND NEEDS AMONG THE GAMO PEOPLE OF SOUTHERN ETHIOPIA

How mothers perceive their infants’ emotions and their subsequent responses are influenced by cultural values and beliefs. Mothers who live in particularly harsh environments may have perceptions about their infants’ emotions that reflect not only cultural values but also constraints of the environment. In this qualitative study, 29 Gamo mothers living in rural Ethiopia were interviewed about perceptions of their infants’ emotions, how they felt about these emotions, and what they believed their infants needed in response. Through constant comparative analysis and thematic coding, several patterns emerged in mothers’ perceptions about their infants’ emotions and what constituted appropriate responses. Mothers said that their infants’ negative emotions were possibly related to illness and that appropriate responses were focused mostly on breastfeeding, complementary food, and needing to be held. Mothers also discussed their work demands and how they conflicted with their desire to respond to their infants; however, many mothers said that they relied on their older children to help. Mothers’ responses were centered on a parenting strategy aimed at promoting infant health and survival, which is consistent with research on parents living in rural environments who subsist by farming and have relatively high risk for infant mortality.     

SAFE START: AN EARLY CHILDHOOD MENTAL HEALTH PROGRAM IN A TERTIARY HEALTHCARE SETTING—A CRITICAL REVIEW

Early childhood mental health programs are vital for the current and future mental health and brain development of infants, toddlers, and preschoolers. Founded in 2014, Safe Start is the only early childhood mental health program in Beirut, Lebanon. It aims at being the prototype of such services at the national level. A retrospective analysis of the outcomes of the first year of operations has resulted in important findings about the age of the participants, their diagnoses, previous therapies that the participants have undergone, types of referrals recommended, and the number of participants who were lost to follow‐up. This first analysis pointed at the need for more in‐depth research to encompass the gaps and benefits of such services. It shows the pivotal importance of designing awareness strategies about the importance of early childhood mental health services and care; to move from a diagnostic seeking behavior to commitment to psychotherapy and follow‐up interventions.     

TOP‐DOWN AND BOTTOM‐UP: THE ROLE OF SOCIAL INFORMATION PROCESSING AND MINDFULNESS AS PREDICTORS IN MATERNAL–INFANT INTERACTION

The cross‐generational transmission of attachment appears to reflect a complex interplay of factors, which have been challenging to identify. The current longitudinal study explored the maternal cognitive model of relationships through language use, maternal mindfulness, and attachment style assessed prenatally, as predictors of maternal response to distress and infant behavior at 6 months’ postpartum. Infant behavior to the mother also was examined to provide an understanding of the evolving relationship. Thirty‐two females were interviewed prenatally regarding social and family experiences. At 6 months’ postpartum, each mother participated in a video‐recorded session where she was asked to teach her infant a developmentally appropriate task. Videos were analyzed using the NCAST Teaching Protocol. Language use prenatally as well as the mindfulness facets (acting with awareness and describing) predicted the mothers’ ability to respond to infant distress, indicating greater attunement. Infant's response to mother and clarity of cues also were predicted by maternal pronoun use. The study highlights the role of internal working models reflective of interpersonal beliefs, cognitive models, and current‐moment awareness in maternal behavior. The effect of maternal language on infant behavior arguably indicates the infant's integration of maternal internal working models.     

THERAPISTS’ EXPERIENCES OF MOTHER–INFANT PSYCHOANALYTIC TREATMENT: A QUALITATIVE STUDY

As part of a larger research project in Sweden, a qualitative study investigated psychotherapists’ experiences of mother–infant psychoanalysis (MIP). A randomized controlled trial compared two groups of mother–infant dyads with psychological problems. One had received Child Health Center care, and the other received MIP. Previous articles on long‐term effects have found that mothers who had received MIP were less depressed throughout a posttreatment period of 3½ years, and their children showed better global functioning and psychological well‐being. The present study's objectives were to describe the therapist's experiences of MIP and deepen the understanding of the MIP process. Six months after treatment began, all therapists were interviewed. Transcribed interviews with therapists from 10 (of 33 total) MIP treatments were randomly selected and analyzed in detail by thematic analysis. Therapists worked successfully with mother and infant together and found different ways of cooperation during MIP sessions. Therapists reported overall positive experiences; however, in cases where mothers needed more personal attention, it would be important to adapt the method to them.     

FOOD NEGLECT AND INFANT DEVELOPMENT

The impact of food insecurity on child development in the general U.S. population is well‐established, yet little is known about the harm of food neglect relative to other types of maltreatment. Due to the harmful physiological impact of inadequate nutrients and the social impact of food‐related stress, it was hypothesized that food neglect would be more likely to impair infant cognitive and language development than physical abuse, sexual abuse, and other forms of neglect. Families of infants (N = 1,951) investigated by Child Protective Services were studied using the second cohort of the National Survey of Child and Adolescent Well‐Being (NSCAW II; NSCAW Research Group, 2002). Results from multivariable logistic regression models that controlled for likely confounding variables showed that the odds of impairment in cognition and language were significantly greater when food neglect was the most serious form of maltreatment. Considering that both food insecurity and child neglect are associated with poverty and parental mental health problems, it will be important for child welfare and mental health professionals to work collaboratively to better the health of these vulnerable children.     

POSTPARTUM BONDING DIFFICULTIES AND ADULT ATTACHMENT STYLES: THE MEDIATING ROLE OF POSTPARTUM DEPRESSION AND CHILDBIRTH‐RELATED PTSD

Despite decades of research demonstrating the role of adult attachment styles and early mother–infant bonding in parenting behaviors and maternal mental health, these constructs have seldom been studied together. The present study aimed to investigate the relationship between attachment styles and specific bonding difficulties of mothers. In addition, as postpartum depression and childbirth‐related posttraumatic stress symptoms have been associated with both constructs, we explored their possible mediation effect. One hundred fourteen mothers, 4 to 12 weeks’ postpartum, completed a demographic questionnaire, the Adult Attachment Style Questionnaire (M. Mikulincer, V. Florian, & A. Tolmacz, 1990), the Postpartum Bonding Questionnaire (L.F. Brockington, C. Fraser, & D. Wilson, 2006), the Modified Perinatal Posttraumatic Stress Disorder Questionnaire (J.L. Callahan, S.E. Borja, & M.T. Hynan, 2006), and the Edinburgh Postnatal Depression Scale (J.L. Cox, G. Chapman, D. Murray, & P. Jones, 1996), using an online survey system. As predicted, insecure attachment styles were associated with bonding difficulties wherein anxious/ambivalent attachment was associated with greater infant‐focused anxiety, mediated by postpartum depression but not childbirth‐related PTSD symptoms. In contrast, greater avoidant attachment style was associated with greater rejection and anger, mediated by childbirth‐related posttraumatic stress disorder (PTSD), but not depression symptoms. The current study confirmed the association of different attachment styles with bonding as well as the mediating roles of childbirth‐related PTSD and postpartum depression symptoms. Future psychological interventions may utilize such evidence to target interventions for bonding disorders in accordance with individual differences.     

A THERAPEUTIC PLAYGROUP FOR DEPRESSED MOTHERS AND THEIR INFANTS: FEASIBILITY STUDY AND PILOT RANDOMIZED TRIAL OF COMMUNITY HUGS

Symptoms of depression negatively impact on mother?infant relationships and child outcomes. We evaluated a novel, 10‐session mother?infant therapeutic playgroup—Community HUGS (CHUGS)—which combines cognitive and experiential components through psychoeducation, play, music, and movement. Participants were mothers experiencing a range of postnatal mental health difficulties, including depression, with infants ≤12 months of age. However, the aim was not to treat maternal depression but to ameliorate associated problems in the mother?infant interaction. In the feasibility study, all participants received CHUGS. In the pilot randomized controlled trial (RCT), participants were randomized between intervention and a wait‐list. Outcomes were the Parenting Stress Index (PSI; R.R. Abidin, 1995), Parenting Sense of Competency Scale (Self‐Efficacy subscale; J. Gibaud‐Wallston & L.P. Wandersman, 1978), and the Depression, Anxiety, Stress Scales (P.F. Lovibond & S.H. Lovibond, 1995). In the feasibility study (n = 74), PSI scores dropped on all subscales, all ps < .01. Depression, p < .001, anxiety, p = .01, stress, p = .01, and self‐efficacy, p < .001, all showed improvements, as did observer‐rated mother?infant interactions, p < .001. In the RCT, depression, p < .001, anxiety, p = .005, and stress, p < .001, symptoms were significantly reduced for intervention participants (n = 16), as compared to wait‐list participants (n = 15). The CHUGS program had high participant satisfaction and produced improvements in self‐efficacy, depression, anxiety, stress, and mother?infant interactions that supported the program's acceptability and the utility of further rollout.