Longitudinal changes in term and preterm infant night wakings: The role of caregiver anxious-depression

Changes in infant night waking during the first year of life are associated with individual (e.g., prematurity) and family (e.g., caregiver psychopathology) factors. This study examined the association between infant night waking and caregiver anxious-depressive symptoms during the first year of life in preterm and term infants. We considered between-person differences and within-person changes in caregiver anxious-depressive symptoms in relation to changes in infant night waking from 2- to 9-months. Racially (30.0% Black, 60.4% White, 9.5% multiracial/other) and socioeconomically (40.0% below median household income) diverse caregivers (N = 445) of full term (n = 258) and preterm (n = 187) infants were recruited from hospitals and clinics in two midwestern states. Caregivers completed measures of anxious-depression and their infant's night waking at four sampling periods (2-, 4-, 6-, and 9-months). Infant night wakings declined from 2- to 9-months. Between-person differences were observed, such that caregivers with higher average anxious-depressive symptoms or infants born full term reported more night wakings. Within-person effects of caregiver anxious-depressive symptoms were not significant. Caregiver anxious-depression is closely associated with infant night wakings. By considering a caregiver's average severity of anxious-depression, healthcare providers can more effectively plan infant sleep interventions. If caregiver anxious-depressive symptoms are ameliorated, night wakings may also decrease.     

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.     

Treating sleep disturbance in infants: What generalizes?

When treating infant sleep problems implementing treatment procedures at bedtime‐only might be easier and more efficient than requiring parents to implement procedures throughout the night, but only if improvements at bedtime generalize to later in the night. This study investigated the immediate and generalized effect of treating bedtime settling problems and later night waking in infants and whether it was parent or child behavior that generalized. Parents recorded sleep problems of seven infants (6–20 months) who exhibited chronic sleep disturbance, then implemented a graduated checking procedure at bedtime‐only (Setting 1). A multiple‐baseline across‐settings and participants design was employed. Immediate (in Setting 1) and any generalized effects (in Setting 2) on wakings and other changes in parent and child behavior were assessed by diary information and all‐night infra‐red video recordings. Clinically significant reductions in sleep problems were evident for five out of seven infants, but these were not consistently observed until parents generalized their use of the procedure throughout the night. There was no evidence that the infants generalized changes in self‐soothing from bedtime to later. It is concluded that changes in infant sleep problems are unlikely to occur unless parents actually alter their management of the problems across all settings in which the problems occur. Copyright © 2008 John Wiley & Sons, Ltd.     

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.     

Attachment security differs by later autism spectrum disorder: A prospective study

Although difficulties with social relationships are key to autism spectrum disorder (ASD), no previous study has examined infant attachment security prior to ASD diagnosis. We prospectively assessed attachment security at 15 months in high‐risk infants with later ASD (high‐risk/ASD, n = 16), high‐risk infants without later ASD (high‐risk/no‐ASD, n = 40), and low‐risk infants without later ASD (low‐risk/no‐ASD, n = 39) using the Strange Situation Procedure. High‐risk/ASD infants were disproportionately more likely to be classified as insecure (versus secure) and more likely to be classified as insecure‐resistant (versus secure or avoidant) than high‐risk/no‐ASD and low‐risk/no‐ASD infants. High‐risk infants with insecure‐resistant attachments were over nine times more likely to receive an ASD diagnosis than high‐risk infants with secure attachments. Insecure‐resistant attachment in high‐risk infants suggests a propensity toward negative affect with the parent in conditions of stress. Insecure‐resistant attachment may prove useful as a potential early index of propensity toward ASD diagnosis in high‐risk siblings, while insecure‐resistant attachment in the context of emergent autism may contribute to difficulties experienced by children with ASD and their families.     

Mothers who are securely attached in pregnancy show more attuned infant mirroring 7 months postpartum

This study contrasted two forms of mother–infant mirroring: the mother's imitation of the infant's facial, gestural, or vocal behavior (i.e., “direct mirroring”) and the mother's ostensive verbalization of the infant's internal state, marked as distinct from the infant's own experience (i.e., “intention mirroring”). Fifty mothers completed the Adult Attachment Interview (Dynamic Maturational Model) during the third trimester of pregnancy. Mothers returned with their infants 7 months postpartum and completed a modified still-face procedure. While direct mirroring did not distinguish between secure and insecure/dismissing mothers, secure mothers were observed to engage in intention mirroring more than twice as frequently as did insecure/dismissing mothers. Infants of the two mother groups also demonstrated differences, with infants of secure mothers directing their attention toward their mothers at a higher frequency than did infants of insecure/dismissing mothers. The findings underscore marked and ostensive verbalization as a distinguishing feature of secure mothers’ well-attuned, affect-mirroring communication with their infants.     

Sleep Architecture in Infants of Substance‐Abusing Mothers

This longitudinal, year‐long study compared sleep–wake state organization in two groups of infants–infants whose mothers abused substances during their pregnancies and nonexposed, typically developing, age‐matched comparison infants–to determine whether differences in sleep–wake state organization existed between the two groups. Seventeen infants of mothers who were participating in a parent–infant residential treatment program for substance abuse were enrolled. Their sleep–wake state organization over the first year of life was compared to that of 17 age‐matched comparison infants. The intent was to follow each infant on five occasions over the first year of life using established methods of time‐lapse videosomnography to record sleep–wake state organization; however, attrition in the substance‐abusing group was problematic. Some sleep–wake variables (i.e., Active Sleep%, Quiet Sleep%, Awake%, number of nighttime awakenings) were similar for both groups of infants at comparable ages across the first year. Total sleep time and the longest sustained sleep period (sleep continuity variables) differed significantly at some of the ages measured. Although overall sleep architecture appears highly resilient and well organized, some indications of sleep fragmentation and shortened nighttime sleep periods were observed in the substance‐exposed infants. More research is needed to explain why sleep‐continuity variables and not sleep‐state proportion variables differed between the two groups.     

“Ghosts in the Nursery:” Infant sleep and sleep‐related cognitions of parents raised under communal sleeping arrangements

In an experiment of nature, a normal cohort of parents who were raised under communal sleeping arrangements (CSA) in Israeli kibbutzim are raising their infants at home under home‐based family sleeping arrangements. The present study focused on exploring the links between the early sleep experiences of CSA parents and their present sleep‐related beliefs and behaviors. In particular, the study assessed whether the cognitions of CSA parents regarding infant sleep differ from cognitions of parents who were raised under home‐based family sleeping arrangements. Furthermore, parental soothing methods and infant sleep patterns were compared. One hundred forty‐one families participated in this study. The children's ages ranged between 4.5 to 30 months. Parental cognitions were evaluated by two questionnaires. Infant sleep was assessed by a questionnaire and by daily parental reports. As expected, CSA parents were more likely than were control parents to: (a) interpret infant night wakings as a sign of distress and (b) actively soothe their infants at bedtime, co‐sleep with them, and report more night wakings of their infants. These findings support the hypothesis that early childhood sleep‐related experiences of parents (“Ghosts in the Nursery”) influence their parental sleep‐related cognitions that in turn affect infant sleep patterns.     

Night waking in 6-month-old infants and maternal depressive symptoms

Relations between night waking in infants and depressive symptoms in their mothers at 6 months postpartum were examined using the data from the National Institute for Child Health and Human Development Study of Early Child Care. Although more depressive symptoms were only weakly correlated with a higher frequency of infant waking, longer wake times, and more total time awake, the rate of clinically significant depression scores was about double in mothers of chronically waking infants in comparison with mothers whose infants did not awaken during the night. The value of comparing subgroups to elucidate relations identified through correlations is discussed.     

Infant carrying as a tool to promote secure attachments in young mothers: Comparing intervention and control infants during the still-face paradigm

Infants of adolescent mothers have a greater risk of developing insecure attachment types and attachment disorders into adulthood. Previous research suggests that skin-to-skin contact predicts secure attachment; however, it is largely unknown whether infant carrying or “babywearing” has similar benefits. We hypothesized that adolescent mothers (Mage=19.1 years, SD = 2.0; 40.6 % Hispanic; 40 %< = 11th grade) who were randomly assigned to an infant carrying condition at 2–4 weeks’ post-partum (n = 16; 1 h daily for 3 months), compared to a control group (n = 17; reading), would be more likely to have securely attached infants at 7 months (M = 29.0 weeks, SD = 3.4). We coded infant gaze orientation, fretfulness, affect, self-soothing behaviors, and vocalizations in the reunion phase of the Still-Face Paradigm, and used an algorithm derived from the infant Global Rating Scales to determine attachment type. Infants in the intervention condition were more likely to have secure attachments and less likely to have disorganized attachments compared to the control condition. Hours spent babywearing was positively correlated with secure attachment, r_pb = .40, and negatively correlated with disorganized attachment, r_pb =−0.36. There were no statistically significant differences between the conditions or babywearing hours for avoidant or resistant attachment types. The results suggest that infant carrying may be an effective tool at promoting secure attachments, particularly for mothers and infants at greater risk for attachment insecurity.     

Adult attachment style and stress as risk factors for early maternal sensitivity and negativity

The current study examined the individual and joint effects of self‐reported adult attachment style, psychological distress, and parenting stress on maternal caregiving behaviors at 6 and 12 months of child age. We proposed a diathesis‐stress model to examine the potential deleterious effects of stress for mothers with insecure adult attachment styles. Data from 137 mothers were gathered by the longitudinal Durham Child Health and Development Study. Mothers provided self‐reports using C. Hazan and P. Shaver's ( 1987 ) Adult Attachment Style measure, the Brief Symptom Inventory (L.R. Derogatis & P.M. Spencer, 1982 ), and the Parent Stress Inventory (R.R. Abidin, 1995 ); observations of parenting data were made from 10‐min free‐play interactions. Consistently avoidant mothers were less sensitive with their infants than were consistently secure mothers; however, this effect was limited to avoidant mothers who experienced elevated levels of psychological distress. Results suggest that the association between insecure adult attachment style and insensitive parenting behavior is moderated by concurrent psychosocial stress. Clinical implications for these findings are discussed.     

Predicting infant attachment classification from multiple, contemporaneous measures of maternal care

This investigation was designed to test whether stylistic differences in maternal caregiving were associated with both secure and insecure mother-infant attachment classifications in a low-income sample. Multiple measures of maternal interactive behavior and care were collected from a sample of 95 urban, low-income mothers and their 12-month-old infants. Contemporaneous relations to attachment were found only at the broad level of composite scores of caregiving. Scores derived from different measures were aggregated to create composites reflecting three caregiver styles—sensitive, controlling, and unresponsive. Mothers of infants with secure attachment classifications showed greater sensitivity and less controlling behavior than mothers of infants with resistant and avoidant attachments, respectively. Mothers of infants with resistant attachments appeared less responsive to their infants' signals than those of infants with avoidant attachments. Group differences were significant, but modest. These results contribute to the growing body of studies relating parental care with infant attachment patterns and indirectly support the more recent conceptual work on intergenerational transmission of attachment. They also raise methodological issues that need to be considered in future work on caregiving and infant-mother attachment.     

AQS security scores: What do they represent? A study in construct validation

In a sample of 129 Dutch 15‐month‐old infants, attachment security was assessed both with the Attachment Q‐Set (AQS; Waters, 1995) and with a short version of Ainsworth, Blehar, Waters, and Wall's (1978) Strange Situation (SSS). Infants classified as secure using the SSS had significantly higher AQS scores than insecure and disorganized infants in particular. At the AQS item level, disorganized infants were described as significantly more noncompliant, fussy, and angry relative to secure infants. When security as assessed using the SSS was controlled, the observed quality of parental interactive behavior, parental ego‐resilience, high levels of infant task orientation and pleasure, and low levels of infant anger proneness were found to explain significant and unique portions of the variance in the AQS security scores. The apparently unfavorable set of characteristics associated with low AQS security scores suggests such scores to predict later developmental problems. ©2004 Michigan Association for Infant Mental Health.     

Motherhood in adolescent mothers: Maternal attachment,mother–infant styles of interaction and emotion regulation at three months

Early motherhood is considered a risk factor for an adequate relationship between mother and infant and for the subsequent development of the infant. The principal aim of the study is to analyze micro-analytically the effect of motherhood in adolescence on the quality of mother–infant interaction and emotion regulation at three months, considering at the same time the effect of maternal attachment on these variables. Participants were 30 adolescent mother–infant dyads compared to 30 adult mother–infant dyads. At infant 3 months, mother–infant interaction was video-recorded and coded with a modified version of the Infant Caregiver Engagement Phases and the Adult Attachment Interview was administered to the mother. Analysis showed that adolescent mothers (vs. adult mothers) spent more time in negative engagement and their infants spent less time in positive engagement and more time in negative engagement. Adolescent mothers are also less involved in play with their infants than adult mothers. Adolescent mother–infant dyads (vs. adult mother–infant dyads) showed a greater duration of negative matches and spent less time in positive matches. Insecure adolescent mother–infant dyads (vs. insecure adult mother–infant dyads) demonstrated less involvement in play with objects and spent less time in positive matches. To sum up adolescent mother–infant dyads adopt styles of emotion regulation and interaction with objects which are less adequate than those of dyads with adult mothers. Insecure maternal attachment in dyads with adolescent mothers (vs. adult mother infant dyads) is more influential as risk factor.     

Culturally sensitive assessment of attachment in children aged 18–40 months in a South African township

The objective of our work is to study the possible relevance nonwestern cultural traditions have on the concordance of attachment patterns assessed in mothers and their young children. The attachment of 46 toddlers and their mothers, living in a black township in Johannesburg, South Africa, was assessed using scores derived from mother‐child observations in the home (Attachment Q‐Sort) and an interview (Working Model of the Child Interview). Mothers also had a semistructured psychiatric interview. Agreement between home observations and interview ratings was 29% for secure and 71% for insecure attachment when U.S.‐developed scoring criteria for the interview were used. Agreement increased to 81% for secure and 67% for insecure attachment when the same protocols were rescored, using a culturally modified scoring system, developed by local cultural experts. This study suggests that verbal representations of attachment patterns are more influenced by cultural traditions than are actual parent‐child interactions.     

Dyadic synchrony in parent–child interactions: A link with maternal representations of attachment relationships

The study examined the relation between maternal representations of attachment relationships from childhood and current parent–child interactions with their own preschool aged children. Thirty-six mother–child dyads were recruited from a community sample. The Adult Attachment Interview was converted into a questionnaire (AAIQ) and used to classify mothers as either “secure” or “insecure.” The mother–child dyads then engaged in a 20-min, videotaped play interaction task. The quality of maternal representations of attachment relationships was related to the degree of dyadic synchrony, as well as maternal affect and style of relating. Secure mothers and their children engaged in a more fluid, synchronous process of give-and-take than insecure mothers and their children. In addition, secure mothers expressed more warmth and affection, and their style of relating was less intrusive and more encouraging of child autonomy than insecure mothers. Children of secure mothers sought closer contact and were more compliant than children of insecure mothers. These interaction patterns were uniquely related to maternal representations of attachment, independent of maternal age, education and SES. There were no differences in these patterns of relating between mothers who had experienced loving relationships in childhood (continuous secure) and mothers who had come to terms with unloving and painful childhood relationships (earned secure). Therefore, rather than the quality of childhood histories, it was the manner in which these early experiences were mentally organized and integrated in adulthood that was significantly related to current parent–child interaction patterns. Finally, these differences in parent–child interaction patterns that were apparent on the observational measure were in contrast to information obtained from a maternal self-report measure. © 1997 Michigan Association for Infant Mental Health     

Maternal well-being and sleep–wake behaviors in infants: An intervention using maternal odor

The development of an organized sleep–wake cycle in young infants is influenced by characteristics of both the infant and the parent, and by the nature of their dyadic interaction. Sleep–wake state organization is influenced first by homeostatic biological regulation, and later by socioemotional regulation. This report describes a feasibility study using an olfactory intervention designed to bridge the transition from physiologic to social regulation in sleep–wake state organization. A sample of 21 mother–infant dyads participated in an one year longitudinal study, after random assignment to either an experimental condition with a maternal odor-laden sleepaid, representational sleepaid (RSA) or a control condition with a neutral sleepaid, Sham Control (SC). Self-report questionnaires measured maternal psychological well-being, and video taping recorded infant sleep–wake behaviors repeatedly throughout the first year. RSA mothers reported significantly better levels of well-being throughout the year. At six and twelve months, mothers who reported more depressive feelings exhibited different nighttime interaction patterns. Infant sleep–wake state organization and sleepaid use changed significantly during the first year but were not altered by the intervention. © 1997 Michigan Association for Infant Mental Health     

Intrinsic and extrinsic factors associated with night waking in 9-month-old infants

This study examined relations between infant night waking and both daytime behaviors reflective of poor behavioral and emotional regulation (intrinsic factors) and parent behaviors that may contribute to infant night waking (extrinsic factors) in 41 infants. Mothers completed questionnaires and an infant sleep and crying diary. More time awake at night was related to separation distress, frequent daytime crying, dysregulation, co-sleeping with parents, breast feeding, and being put to bed asleep. More frequent waking was related to separation distress, frequent daytime crying, co-sleeping, and breast feeding. The combination of intrinsic and extrinsic factors predicted night waking better than behaviors from one category alone. Implications for parenting are discussed.     

Early Temperament and Attachment Security with Mothers and Fathers as Predictors of Toddler Compliance and Noncompliance

This longitudinal study (n = 106) examined associations between temperament, attachment, and styles of compliance and noncompliance. Infant negative temperamental reactivity was reported by mothers at 3, 5 and 7 months. Infant attachment was assessed (Strange Situation) at 12 (mothers) and 14 months (fathers). Toddlers' styles of compliance/noncompliance were measured using two laboratory contexts (clean‐up/delay) at 20 months. Results indicated that temperament and attachment predicted toddler behaviour. Toddlers who were secure with mothers and low in temperamental negative reactivity showed more committed compliance than those who were insecure and low in negative reactivity or secure and high in negative reactivity. In addition, interactions revealed that relations between infant–mother attachment and defiance depended on infant–father attachment security, temperament and context. Findings highlight the differential and complex roles of temperament and attachment as potential precursors of later social competence. Copyright © 2013 John Wiley & Sons, Ltd.     

Affect Attunement and Maternal Attachment: A Pilot Study

The notion that individual differences in mothers' representations of their own early childhood attachment relationships impede or facilitate the recognition of an infant's experiences and needs was investigated. Women were classified as secure, dismissing, of preoccupied in relation to attachment on the basis of the Adult Attachment Interview (George, Kaplan, & Main, 1985) and then videotaped in a laboratory setting with their 10- to 13-month-old babies. Maternal attunement behaviors and fantasies about the babies during the attunement moment were recorded and examined in light of individual differences in maternal attachment. The findings reveal that securely attached mothers are more attuned to their babies than are those mothers who are insecurely attached. Secure mothers attune to a range of infant affect, whereas insecure mothers attune to particular affects and not to others. Specifically, dismissing mothers tended not to attune to negative affect, whereas preoccupied mothers randomly attuned to both positive and negative affect states. Qualitative analyses suggest that insecure mothers misattune to infant affects that threaten their internalized attitudes toward attachment. The findings support the hypothesis that the nature of a mother's internal affective experience powerfully influences the affects she acknowledges and attunes to in her child.