Expulsion prevention: Framework for the role of infant and early childhood mental health consultation in addressing implicit biases

Young children of color—especially boys—are at disproportionate risk for suspension and expulsion from early care and education settings. Infant and Early Childhood Mental Health Consultation (IECMHC) is an approach associated with lower than expected expulsion rates, but the mechanisms through which it may influence preschool expulsion are unknown. This paper reflects on the parallels between IECMHC and interventions created to reduce implicit bias. Based on interviews with leaders in IECMHC practice, implementation, and evaluation, a theoretical framework was created to articulate how IECMHC is hypothesized to affect expulsion by first reducing the influence of implicit bias on disciplinary decisions. Implications for practice and research are provided.     

Infant illness severity and family adjustment in the aftermath of NICU hospitalization

Up to 15% of parents have an infant who will spend time in a neonatal intensive care unit (NICU). After discharge, parents may care for a medically fragile infant and worry about their development. The current study examined how infant illness severity is associated with family adjustment. Participants included parents with infants who had been discharged from the NICU 6 months to 3 years prior to study participation (N = 199). Via a Qualtrics online survey, parents reported their infants’ medical history, parenting stress, family burden, couple functioning, and access to resources. Multivariable regression analyses revealed that more severe infant medical issues during hospitalization (e.g., longer length of stay and more medical devices) were associated with greater family burden, but not stress or couple functioning. Infant health issues following hospitalization (i.e., medical diagnosis and more medical specialists) were associated with greater stress, poorer couple functioning, and greater family burden. Less time for parents was associated with increased stress and poorer couple functioning. Surprisingly, parents of infants who were rehospitalized reported less stress and better couple functioning, but greater family burden. Family-focused interventions that incorporate psychoeducation about provider−patient communication, partner support, and self-care may be effective to prevent negative psychosocial sequelae among families.     

Post-discharge outcomes for mothers and the mother–infant relationship following admission to a psychiatric Mother–Baby Unit

Mother–Baby Unit research has focussed on maternal psychopathology over the course of an admission. Less is known about the baby's well-being, the shared relationship, or the mother's recovery. In an initial sample of 45 women, we describe discharge and post-discharge outcomes for maternal psychopathology (using maternal report and the Global Assessment of Function, GAF) and the mother–infant relationship (using the Child and Adult Relational Experimental Index, CARE Index). Three months post-discharge, one third of women described themselves as “completely recovered,” one third were experiencing significant deterioration and 17% were readmitted to inpatient care. Poorer GAF scores were associated with a clinical diagnosis of comorbid personality disorder, antenatal presence of the index illness, partner illicit substance use, maternal perception of her bond, infant social withdrawal, and child protection concern. Post-discharge, the mother–infant relationship results were concerning. Only 17% were regarded as adequate. Improvement was observed across this period in 56% but relational deterioration occurred for 35%. Maternal and relational outcomes were weakly correlated at discharge (r² = 0.29, p = 0.07) but this was lost post-discharge (r² = 0.03, p = 0.89). The shared relationship and infant mental health should both be targets for intervention; both during MBU admission, and post-discharge.     

Validation of the AMBIANCE-brief: An observational screening instrument for disrupted caregiving

Resulting from a community-identified need for a well-validated indicator of caregiving difficulties for use in practice settings, a brief form of the Atypical Maternal Behavior Instrument for Assessment and Classification System (AMBIANCE) was developed for use as a screening instrument. Prior to its dissemination, this study aimed to assess the feasibility, reliability, and validity of the AMBIANCE-Brief. Adolescent mother–infant dyads (N = 69) participated in the Strange Situation Procedure, as well as play sessions with and without toys. Maternal disrupted caregiving was coded from the play sessions using the AMBIANCE and AMBIANCE-Brief. The AMBIANCE-Brief demonstrated convergent validity with the AMBIANCE in the play session with toys (r = .65, p < .001) and without toys (r = .61, p < .001). Concurrent validity of the AMBIANCE-Brief was also demonstrated in relation to infant attachment disorganization in the play session with toys (r = .36, p < .05) and without toys (r = .32, p < .01). These findings suggest a shorter protocol for assessing disrupted caregiving may be feasible and valid for use in community settings. Future studies are in progress to train community practitioners in the use of the AMBIANCE-Brief and to evaluate their reliability.     

Sleep arrangements and night waking at 6 and 12 months in relation to infants' stress‐induced cortisol responses

The objective of this short‐term longitudinal study was to examine the concurrent and prospective associations of infants' sleep arrangements and night waking with cortisol responses to an inoculation at 6 and 12 months, controlling for several key covariates. To our knowledge, this was the first study to concurrently and prospectively link proximity in sleep arrangements and night waking to physiological stress reactivity. A sample of 92 mother–infant dyads participated in the study when the infants were 6 and 12 months of age, although sample sizes were reduced for some analyses. Both proximal cosleeping arrangements and more frequent night wakings' were associated concurrently with an increased cortisol response to inoculations at both ages. Night waking at 6 months also was associated with a slightly increased cortisol response to inoculation at 12 months. Results aimed at exploring the direction of influence suggested that cosleeping and night waking may influence infant stress physiology rather than the reverse. Adaptive and maladaptive implications of infants' nocturnal experiences and greater stress‐induced cortisol responses are discussed. Copyright © 2009 John Wiley & Sons, Ltd.     

Development of chromatic induction in infancy

The perception of colour in an embedded field is affected by the surround colour. This phenomenon is known as chromatic induction. In the present study we investigated whether the colour perception by infants aged 5–7 months could be affected by the surround colour. In Experiments 1 and 2 each stimulus was composed of an array of six squares in tandem. The colour appearance of the array in the familiarization stimulus was established by chromatic induction. In Experiment 1 we used familiarization stimuli that were perceived as two‐colour array with a two‐colour surround. In Experiment 2 we used a familiarization stimulus that was perceived as a uniform‐colour array with a two‐colour surround. In the test phase, the uniform‐colour array and the two‐colour array were presented on a white uniform‐colour surround in both experiments. The results showed that in Experiment 1 the 5‐ and 7‐month‐old infants had novelty preference for the uniform‐colour test array. This suggested that the infants' colour perception could be affected by surround colour. The results of Experiment 2 showed that the 7‐month‐olds showed a novelty preference for the two‐colour test array, but the 5‐month‐olds showed no novelty preference. This suggested that 7‐month‐olds' colour perception could be affected by surround colour, but that of 5‐month‐olds could not. We discuss the contradiction of the results between Experiments 1 and 2. Copyright © 2007 John Wiley & Sons, Ltd.     

Cultural Differences in Physical Contact Between Hispanic and Anglo Mother–Infant Dyads Living in the United States

This is a study of differences in physical contact and tactile interpersonal behaviours between Hispanic and Anglo mothers and infants living in the United States. Infants were 9 months old and 52 mother–infant dyads, 26 Hispanic and 26 Anglo, were videotaped during free play without toys in a university laboratory playroom. Coders judged the interpersonal distance, physical contact and affectionate touch from the videotapes and mothers responded to a questionnaire about the importance of physical contact and affectionate touch in their relationship with their infant. From questionnaire data we found that Hispanic and Anglo mothers both touch their infants on a daily basis, although Hispanic mothers report touching more frequently, being more affectionate with their infants and having more skin-to-skin contact. From videotaped observations we found that there were no overall differences in mother–infant touch between the two cultures; however, the Hispanic mothers showed more close touch and more close and affectionate touch compared to Anglo mothers, who showed more distal touch. The results are discussed in terms of the role of touch in infant development and cultural differences in the evaluation of close physical contact and touch.     

Observer Influences on Fathers and Mothers: An Experimental Manipulation of the Structure and Function of Parent – Infant Conversation

From studies over the past 20 years four contrasting hypotheses can be made about the nature of parent–infant communication: (1) mothers and fathers display similar skills to their infants and do not exert a differential influence on their development; (2) fathers are less sympathetic to their infants' level of development and therefore inadvertently stretch the child's development more than mothers; (3) both parents differentially socialize their sons' and daughters' early communicative skills; (4) any apparent differences between parents reflect their expectations about being observed. To examine these hypotheses together, this experiment records the communication of 10 mother–infant and 10 father–infant dyads in two conditions: when an observer was present or absent. The analysis revealed two patterns. Firstly, in keeping with most research on parent–child communication, mothers and fathers both simplified their speech to their infants in similar ways. Secondly, both the structure and function of parental communication showed differences between the two conditions and many of these differences were moderated by interactions between condition and sex of parent or child. The data thus provide more support for the first and fourth hypotheses cited above. It is suggested that analyses of parent–infant interaction should move away from simple assumptions about parental ‘influences’ upon children's development to consider the subtleties of different parental styles in different settings.     

The influence of infant irritability on maternal sensitivity in a sample of very premature infants

The relationship between maternal sensitivity and infant irritability was investigated in a short‐term longitudinal study of 29 very preterm infants. Infant irritability was assessed at term with the Brazelton NBAS, the Mother and Baby Scales (MABS) and the Crying Pattern Questionnaire (CPQ). Maternal sensitivity was assessed by nurses' ratings in the neonatal care unit and at three months during mother–infant interaction observation. Cross‐lagged panel analysis indicated that neonatal irritability did not influence sensitivity at 3 months nor did maternal sensitivity in the newborn period lead to reduced irritability at 3 months. Both irritability and maternal sensitivity showed moderate stability over time (r = 0.55 and r = 0.60, respectively). It is concluded that in early infancy maternal sensitivity shows little influence on infant irritability in very preterm infants. Copyright © 2003 John Wiley & Sons, Ltd.     

Crib death: a biobehavioral phenomenon?

In developed countries, more children under 1 year of age die of crib death (sudden infant death syndrome, SIDS) than of all other causes combined. Researchers and clinicians have proposed many possible causes of SIDS, but the abrupt, unexpected death of some babies remains mysterious and frightening. Although infant behavior may explain some of these deaths, scant attention has addressed behavioral characteristics of babies who die without medical explanation. Any explanation of SIDS must account for the fact that most SIDS deaths occur at 2 to 5 months of age, acknowledging that a protective mechanism appears to spare babies before 2 months but then disappears. The respiratory occlusion reflex serves as an initial defense against smothering and can provide such an explanation. Infantile reflexes wane, after providing opportunities for learned responses to be acquired. During this well-documented neurobehavioral transition from subcortical to cortically mediated responding, some babies, viable for the first 2 months, may become especially vulnerable if they fail to acquire sufficiently strong defensive behaviors needed to prevent occlusion after the waning of the life-preserving reflex. Recent success of back-to-sleep directives, urging that babies sleep on their backs to avoid smothering, supports this hypothesis.