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.     

Studying the process of psychoanalytic parent–infant psychotherapy: Embodied and discursive aspects

This paper presents findings from an intensive, mixed methods case study of one session of psychoanalytic parent–infant psychotherapy (PPIP) addressing early relational trauma, and aims to shed light on the multimodal interactive processes that take place in the moment-to-moment exchanges comprising the therapeutic encounter. Different research methods were used on video material from PPIP sessions, including microanalysis of adult–infant interactions, discourse analysis of talk, and coding systems developed to study parent–infant interaction. These different perspectives were brought together with the clinical narrative to illuminate the complex, dynamic processes of parent–infant–therapist interaction. More specifically, the detailed analysis of one interactive episode revealed brief behavioral manifestations of fearful and disoriented states of mind, reflecting dysregulated interaction between mother and infant, which also powerfully affected the therapist. The processes through which the therapist gradually resolves this rupture are also described in detail. Through this pilot study, we were able to show that it is possible to systematically study the process of PPIP. The study contributes to the growing psychotherapy research literature that takes into account both the verbal domain and implicit, interactional processes in therapeutic practice, and underscores the therapist's comprehensive engagement in the therapeutic process.     

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.     

The effects of the Newborn Behavioral Observations (NBO) system in early intervention: A multisite randomized controlled trial

The purpose of this pilot study was to evaluate the effect of an infant mental health intervention, the Newborn Behavioral Observations system (NBO), versus usual care (UC) on infant neurodevelopment and maternal depressive symptoms in early intervention (EI). This multisite randomized trial enrolled newborns into the NBO (n = 16) or UC group (n = 22) and followed them for 6 months. Outcome measures included the Battelle Developmental Inventory (BDI-2), Bayley Scales of Infants Development (BSID-III), and Center for Epidemiologic Studies Depression Scale (CES-D). The CES-D and BSID-III were collected at 3- and 6-months post EI entry and the BDI-2 was collected at EI entry and 6-months post-EI entry. We estimated group differences [95% CI], adjusting for program characteristics. At 6 months, the NBO group had greater gains in Communication (b = 1.0 [0.2, 1.8]), Self-Care (b = 2.0 [0.1, 3.9]), Perception and Concepts (b = 2.0 [0.4, 3.6]), and Attention and Memory (b = 3.0 [0.4, 6.0]) than the UC group. The NBO group also had greater decline in maternal postnatal depressive symptoms (b = −2.0 [−3.7, −0.3]) than the UC group. Infants receiving the NBO infant mental health intervention had greater gains in cognitive and adaptive functions at 6 months than infants receiving UC. Caregivers receiving NBO care had greater improvements in maternal depressive symptoms than caregivers receiving UC.     

Tummy time without the tears: The impact of parent positioning and play

The American Academy of Pediatrics (AAP) recommends that infants spend supervised time in the prone (tummy) position to foster motor development and prevent cranial deformities. However, infants may not tolerate the position, and consequently, caregivers may avoid placing their infants in the prone position. The AAP recommends that caregivers provide toys or interaction during tummy time. We evaluated the individual and combined effects of a play mat and experimenter interaction on negative vocalizations and head elevation during tummy time—positive effects were limited. Next, we evaluated a parent-led intervention wherein mothers interacted with their infants, using a toy, while lying chest-to-chest. This intervention was associated with a reduction in negative vocalizations and an increase in head elevation for the majority of infants. Additionally, mothers rated the effectiveness of the parent-led intervention more favorably than the experimenter-led intervention, suggesting the effects of the parent-led intervention were also socially valid.     

Early manifestations of childhood depression: influences of infant temperament and parental depressive symptoms

In this longitudinal study, 83 parents of infants between 3 and 12 months completed questionnaires assessing demographic information, infant temperament, and maternal depression. When these children were at least 18 months of age, parents completed follow‐up questionnaires assessing toddler temperament and depression‐like symptoms. We were primarily interested in the contributions of infant temperament and maternal depression to toddler depressive problems, and the analytic strategy involved controlling for toddler temperament in order to isolate the influence of infancy characteristics. The findings indicated that lower levels of infant regulatory capacity and greater severity of maternal depression were predictive of toddler depression‐like symptoms. Moderator effects of infant temperament were also examined, with the negative affectivity * maternal depression interaction emerging as significant. Follow‐up analyses indicated that the risk for early manifestations of depression was attenuated for children with lower negative affectivity in infancy and parents who reported lower levels of their own depressive symptoms; conversely, children exhibiting higher infant negative emotionality had higher levels of depression‐like symptoms as toddlers, regardless of their parents' level of depression. The present findings further suggest that parental depressive symptoms need not be ‘clinically significant’ to predict toddler affective problems. Copyright © 2008 John Wiley & Sons, Ltd.     

Playing with reality

The authors explore the interpersonal aspects of the early development of an experience of external reality and the roots of this experience in primary intersubjectivity. They suggest some implications that this has for psychoanalytic work with the patient's experience of external reality. They argue that the external world is not an independently existing 'given', for the infant to discover, as is sometimes implicitly assumed. Infants acquire knowledge about the world not just through their own explorations of it but by using other minds as teachers. The experience of external reality is invariably shaped through subjectivities. The authors argue that at first the infant assumes that his knowledge is knowledge held by all, that what he knows is known by others and that what is known by others is accessible to him. Only slowly does the uniqueness of his own perspective differentiate so that a sense of mental self can develop. In clinical work we frequently observe the undoing of this process of differentiation, and understanding the underlying mechanisms can be helpful in managing the transference and countertransference consequences when the process has been derailed.     

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.     

Parent–infant co‐sleeping: fathers' roles and perspectives

Dyadic co‐sleeping (mother–baby) is a common strategy for night‐time infant care in the majority of world cultures. Triadic co‐sleeping (mother–father–baby) is less common, although still widely practised cross‐culturally. This paper examines triadic co‐sleeping in an opportunistic sample of parents from the North Tees region of England, and explores fathers' expectations and experiences of sleeping with their babies. Using a prospective study design, 36 sets of parents, pre‐ and post‐natally, were interviewed about infant care strategies, particularly at night. Although they did not anticipate sleeping with their infants at the pre‐natal interview, the majority of fathers (81%) had done so by the time of the second interview. First‐time fathers were afraid that they would squash or suffocate the baby in their sleep, and some were concerned that the infant's presence would adversely affect their own sleep. Fathers used a variety of strategies to help overcome their initial fears of co‐sleeping. Among those for whom triadic co‐sleeping became a regular night‐time infant care strategy, the pleasures of prolonged intimate contact with their infant were clearly apparent. It is suggested that the experience of sleeping with their infant ameliorates some of the distancing effects felt by fathers outside the breast‐feeding relationship, and helps encourage paternal involvement in night‐time infant care‐giving. Copyright © 2000 John Wiley & Sons, Ltd.     

Infant observation and the French model

Psychoanalytic training in the French Societies belonging to the International Psychoanalytic Association does not grant any place to the observation of babies as it exists in certain societies of other countries. Infant observation is even the object of sharp critiques by eminent French theoreticians. The reasons given for condemning infant observation and refusing to give it any place in the training programme lie in theoretical positions concerning the very nature of the Freudian discovery and its interpretation, which is more idealistic than empirical. The author discusses these reasons while drawing attention to the frequent confusion between a reference to empiricism and a reference to the experimental. The fear of a psychologizing deviation of metapsychology and of a denial of psychic reality leads, in the French model, to placing the emphasis on personal analytic experience during the candidate's psychoanalysis, prolonged by supervisions. It excludes any academic teaching of metapsychology or of related disciplines. The confusion between the empiricism of Esther Bick's method and the recourse to experimental procedures in developmental research stands in the way of making a place for infant observation and of recognizing its training value, not so much for the acquisition of new knowledge or the validation of metapsychological models, as for its usefulness in developing a mode of psychoanalytic observation and an increase in the candidates' containing capacities.