Infant Mental Health Journal

Published by Wiley
Online ISSN: 1097-0355
Publications
Article
Effects on a family of a child with chronic illness have been described. The Impact on Family Scale (IOF) was developed to measure these effects. The impact of extremely low birth weight (ELBW) infants with neurodevelopmental impairment on families is unknown. This study determined IOF scores for families of ELBW infants with increasing degree of impairment at 18 months and identified factors that increase vulnerability to impact. A total of 3,849 ELBW infant survivors born at the 16 centers of the National Institute of Child Health and Human Development Neonatal Research Network between January 1993 and February 2001 were assessed at 18 to 22 months. Infants were divided into four groups by degree of impairment. IOF scores were analyzed by impairment group. Multivariate analyses assessed effects of impairment, social/demographic factors, unmet service needs, and resource utilization on the IOF. A total of 1,624 (42.2%) infants had moderate/severe impairment. Increasing severity of impairment was associated with higher IOF scores. Severity of impairment contributed 6% of variance to the IOF scores. Twenty-one percent of variance was contributed by additional medical needs, low socioeconomic status (SES), and lack of social support. Although increasing severity of impairment impacts families of ELBW infants, significantly more impact is contributed by additional medical needs, low SES, and lack of social support.
 
Article
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.
 
Demographic Description of Sample (N = 15) Variable n % 
Article
Maternal substance abuse is a risk factor for child maltreatment, child attachment insecurity, and maladaptive social information processing. The aim of this study was to conduct a quantitative exploratory evaluation of the effectiveness of an attachment-based parent program, Circle of Security-Parenting (COS-P; G. Cooper, K. Hoffman, & B. Powell, 2009), with a community sample of 15 mothers in residential treatment for substance abuse. Participants attended nine weekly group sessions and were given three measures at pretest and posttest: the Emotion Regulation Questionnaire (J.J. Gross & O.P. John, 2003), the Parent Attribution Test (D. Bugental, ), and the Parenting Scale (D.S. Arnold, S.G. O'Leary, L.S. Wolff, & M.M. Acker, 1993). The results indicate that mothers who attended the majority of group sessions showed greater improvements on all three variables. Participants who attended some of the sessions showed some improvements on the measures, but participants who did not attend the group sessions had no improvements, and on some measures, declined significantly. Further analyses of demographic data indicates that participants with more education, no personal history of child maltreatment, less time in the residential program, and lower social desirability scores demonstrated more positive outcomes. These findings suggest that the COS-P may positively impact parental risk factors associated with child maltreatment and maladaptive social information processing in the context of residential substance-abuse treatment. © 2015 Michigan Association for Infant Mental Health.
 
Article
A residential treatment program has been developed specifically for substance-abusing pregnant and parenting women in Finland, focusing on simultaneously supporting maternal abstinence from substances and the mother-baby relationship. The aims of the study are to explore maternal pre- and postnatal reflective functioning and its association with background factors, maternal exposure to trauma, and psychiatric symptoms, postnatal interaction, child development, and later child foster care placement. Participants were 34 mother-baby pairs living in three residential program units during the pre- to postnatal period. We employed self-report questionnaires on background, trauma history, and psychiatric symptoms (Brief Symptom Inventory: L.R. Derogatis, 1993; Edinburgh Postnatal Depression Scale: J.L. Cox, J.M. Holden, & R. Sagovsky, 1987; Traumatic Antecedents Questionnaire: B. Van der Kolk, 2003), videotaped mother-child interactions coded for sensitivity, control, and unresponsiveness (Care Index for Infants and Toddlers: P. Crittenden, 2003); a standardized test of child development (Bayley Scales of Infant Development-II: N. Bayley, 1993); and semistructured interviews for maternal reflective functioning (Pregnancy Interview: A. Slade, E. Bernbach, J. Grienenberger, D.W. Levy, & A. Locker, 2002; Parent Development Interview: A. Slade et al., 2005). Pre- and postnatal maternal reflective functioning (RF) was on average low, but varied considerably across participants. Average RF increased significantly during the intervention. Increase in RF level was found to be associated with type of abused substance and maternal trauma history. Mothers who showed lower postnatal RF levels relapsed to substance use more often after completing a residential treatment period, and their children were more likely to be placed in foster care. The intensive focus on maternal RF is an important direction in the development of efficacious treatment for this very high risk population.
 
Article
Substance abuse during early motherhood has become a significant problem and has led to accelerated efforts to develop specific treatment facilities for these mothers and children. Despite the often intensive treatment efforts in residential settings, there is surprisingly little evidence of their efficacy for enhancing the quality of caregiving. The situation of these mother-child pairs is exceptionally complex and multilevel, and has to be taken into account in the content and structuring of treatment. Intensive work in the "here and now" focusing on the mother-child relationship from pregnancy onwards in an effort to enhance maternal reflective capacity and mindedness is considered a key element for better treatment prognosis, in terms of both abstinence and quality of parenting. Pioneering work with such a focus is described in this article.
 
Article
This case-study presents in detail the clinical assessment of a 29-year-old mother and her daughter who first presented to infant mental health specialists at age 16-months, with a hospital record suggesting the presence of a dyadic disturbance since age 8-months. Data from psychiatric and neurological assessments, as well as observational measures of child and mother are reviewed with attention to issues of disturbed attachment, intergenerational trauma, and cultural factors for this inner-city Latino dyad. Severe maternal affect dysregulation in the wake of chronic, early-onset violent-trauma exposure manifested as psychogenic seizures, referred to in the mother's native Spanish as "ataques de nervios," the latter, an idiom of distress, commonly associated with childhood trauma and dissociation. We explore the mechanisms by which the mothers' reexperiencing of violent traumatic experience, together with physiologic hyperarousal and associated negative affects, are communicated to the very young child and the clinician-observer via action and language from moment to moment during the assessment process. The paper concludes with a discussion of diagnostic and treatment implications by Drs. Marshall, Gaensbauer, and Zeanah.
 
Article
Adolescent and nonadolescent mothers were visited weekly by trained and supervised child development paraprofessionals. The mothers were taught parenting skills, child development, and were linked to community services. Repeated measures multivariate analysis of variance (MANOVA) was used to determine group by time effects. After 6 months of intervention, the mothers significantly improved their knowledge of (1) infant development; (2) empathic responsiveness; and (3) child and parent roles in the family. In addition, the safety of their homes improved significantly and their involvement with agencies in the community increased significantly. The adolescent mothers scored significantly lower than the nonadolescent mothers at baseline on only two measures: knowledge of infant development and understanding of child and parent roles; however, after 6 months of intervention, their scores were not significantly different from the nonadolescent mothers. The model described in this paper seems to help adolescent and nonadolescent mothers even when the adolescent mothers begin the program with less information on child development and parenting than that of nonadolescent mothers. © 1998 Michigan Association for Infant Mental Health.
 
Article
This study evaluated the new online Emotional Attachment and Emotional Availability (EA2) Intervention for use with adoptive families in enhancing parent-child EA, parental perceptions of EA, child attachment behaviors, parent-child emotional attachment, and reducing parent-reported child behavioral problems and parenting-related stress. Participants in this study were adoptive parents and their adopted children ages 1.5 to 5 years old (N = 15 dyads). Participants were placed in an immediate intervention group (IG) or a delayed intervention group (DG) that would receive the 6-week EA2 Tele-Intervention after the IG. Results revealed significant differences in the IG in child behavioral problems, parent-child EA, parental perceptions of EA, and parent-child emotional attachment, improvements not seen in the DG. Analysis of effects of the DG after receiving the EA2 Tele-Intervention revealed significant differences over time also in most of these qualities. © 2015 Michigan Association for Infant Mental Health.
 
Article
Recent high-risk longitudinal studies have documented a unique contribution of the quality of the early mother-child relationship to diverse forms of psychopathology in young adulthood, even with family economic status, later traumatic experiences, and some genetic factors controlled. In addition, measures of attachment-related deviations in caregiver-infant interaction predict more than measures of infant attachment behavior alone. This article reviews those findings in the context of cross-disciplinary thinking on the importance of shared subjectivities in human evolution and development and in the context of recent studies beginning to map the intersection between processes of interaction and the development of the child's propensities to share mental states with others.
 
Article
Maternal mental health and prenatal stress are linked with neurobehavioral differences in the offspring. The majority of studies documenting this effect have been conducted using either predominantly European American infants or minority infants exposed to teratogens in utero. In this study, we focus on healthy African American women from low-income environments to investigate the earliest individual differences in biobehavioral regulation, including resting heart rate and variability (HRV). In 87 neonates, HRV was significantly lower in those born to mothers reporting past major depressive disorder (p = .01). The number of maternal life stressors also was associated with lower neonatal HRV (p = .03). Obstetrical complications were not associated with significant differences, but breast- versus bottle-feeding in the first few days of life was related to higher HRV (p = .04). Early variation in physiological regulation may be linked to subsequent individual differences in response to stress. Thus, identifying the earliest point in development when such differences can be reliably measured may result in opportunities for prevention of later deficits in regulating response to stress.
 
Article
This study examined the association between paternal alcoholism and 12-month infant temperament and 18-month behavior problems. The role of associated parental psychopathology and maternal drinking in exacerbating risk for maladaptive behavioral outcomes was also examined. Participants were 213 families (102 control families, 94 paternal alcoholic families, and 17 families with alcoholic fathers and heavy drinking mothers) who were assessed when their child was 12 months old and reassessed again when their child was 18 months old. Infants of alcoholics displayed marginally more stubborn/persistent temperaments at 12 months of age, but significantly more internalizing problems at 18 months. Analyses suggested that internalizing problems in the infants of alcoholics could be attributed to the paternal depression concomitant with paternal alcoholism. In addition, an interaction was observed, indicating that paternal alcohol problems predicted 18-month externalizing problems among families with low maternal depression, but not among families with high maternal depression. Children of depressed mothers exhibited uniformly higher externalizing scores, but were not further impacted by paternal alcohol problems. However, children of nondepressed mothers were adversely affected by fathers' drinking as reflected by higher externalizing behavior scores. The results highlight the necessity of addressing the overall contextual risks that occur with paternal alcoholism in studies of the development of children in alcoholic families.
 
Moderation Effect of Father English Proficiency on the Association between Coparenting Conflict (Mother) and Father Engagement in Caregiving  
Moderation Effect of Father English Proficiency on the Association between Coparenting Conflict (Father) and Father Engagement in Caregiving  
Article
The present study examined associations between parents' levels of acculturation depressive symptoms, family support, and couple relationship quality with coparenting conflict. We also explored the effects of coparenting conflict on parenting and infant social development in a sample of low-income Mexican American (n=735) infants (age 9 months) and their parents. Results indicated that couple conflict was the strongest predictor of coparenting conflict. Coparenting conflict had a significant effect on mother-infant interaction and father engagement. The effects of coparenting on father caregiving varied by father's level of acculturation; when there is high coparenting conflict, more acculturated fathers engaged in more caregiving than less acculturated fathers. Coparenting conflict was not predictive of infant social development.
 
Article
Few studies have evaluated the separate contributions of maltreatment and ongoing quality of parent-child interaction to the etiology of antisocial personality features using a prospective longitudinal design. 120 low-income young adults (aged 18-23) were assessed for extent of ASPD features on the Structured Clinical Interview for Diagnosis-Axis II, for presence of maltreatment on the Conflict Tactics Scale, Traumatic Experiences Scale, and Adult Attachment Interview, and for referral in infancy to parent-infant clinical services. Fifty-six of these families had been studied longitudinally since the first year of life. In infancy, attachment disorganization and disrupted mother-infant interaction were assessed; in middle childhood, disorganized-controlling attachment behaviors were reliably rated. In kindergarten and second grade, behavior problems were assessed by teacher report. In cross-sectional analyses, maltreatment was significantly associated with ASPD features but did not account for the independent effect of early referral to parent-infant services on ASPD features. In longitudinal analyses, maternal withdrawal in infancy predicted the extent of ASPD features twenty years later, independently of childhood abuse. In middle childhood, disorganized attachment behavior and maladaptive behavior at school added to prediction of later ASPD features. Antisocial features in young adulthood have precursors in the minute-to-minute process of parent-child interaction beginning in infancy.
 
Article
The objective of this study was to assess whether a mediated model of change could account for the long-term effects of infant home-visiting services observed at ages 5 and 7 years in a high-risk cohort. Participants were 41 mothers and infants from low-income families who were referred to parent-infant home-visiting services during the first 9 months of life due to concerns about the caretaking environment. Services ended when infants reached 18 months of age. Families received between 0 and 18 months of weekly home visits based on infant age of entry into the study. During childhood (ages 5 and 7 years), teachers rated children's behavior problems using standardized instruments. Early home-visiting services accounted for positive child outcomes at 18 months, 5 years, and 7 years of age; however, earlier positive outcomes related to intervention did not account for intervention-related effects at later ages. Further inspection of the data revealed that two additional principles, one of escalating morbidity among less intensively served groups and one of generalized family problem-solving skills, were needed to account for the pattern of effects over time. We conclude that the "domino models" assessed by mediational analyses may be too simple to capture the intervention-related change processes occurring in high-risk cohorts over time.
 
Sample Characteristics (N = 47) Demographic Data M (SD)
Article
Parenting and emotion regulation are two known, and potentially interrelated, areas of impairment among substance-abusing mothers. In this study, we examine substance -abusing mothers' (positive and negative) emotion language word use during their discussion of negative parenting experiences on the Parent Development Interview for its association with reflective functioning (RF), recent substance-use history, and sensitivity to child cues. Within a sample of 47 methadone-maintained mothers, we evaluate the hypothesis that linguistic evidence of emotional avoidance (more frequent positive feeling words and less frequent negative emotion words) will be associated with lower RF, more recent substance use, and more insensitive parenting. Further, we evaluate whether language use mediates the association between self-focused RF and insensitive parenting. Results of hierarchical regressions suggest that more frequent positive feeling word use, but not negative emotion word use, is associated with lower RF, more recent substance use, and lower sensitivity to child cues. Positive feeling word use partially mediates the association between self-focused RF and insensitive parenting. Results are discussed in the context of their contribution to the literature on emotion and parenting in substance-abusing populations.
 
Maternal caregiving behavior, Total Score.
Child behavior, Total Score.
Results of Analyses of Covariance Controlling for Baseline Scores, Marital Status, Child Age, and Child Gender Estimated M (SD)
Article
Previously, we reported posttreatment findings from a randomized pilot study testing a new attachment-based parenting intervention for mothers enrolled in substance-use treatment and caring for children ages birth to 3 years (N.E. Suchman, C. DeCoste, N. Castiglioni, T. McMahon, B. Rounsaville, & L. Mayes, 2010). The Mothers and Toddlers Program (MTP) is a 12-session, weekly individual parenting therapy that aims to enhance maternal capacity for reflective functioning and soften harsh and distorted mental representations of parenting. In a randomized pilot study, 47 mothers who were enrolled in outpatient substance-abuse treatment and caring for children between birth and 3 years of age were randomized to the MTP versus the Parent Education Program (PE), a comparison intervention that provided individual case management and developmental guidance. At the end of treatment, mothers in the MTP condition demonstrated better reflective functioning, representation quality, and caregiving behavior than did mothers in the PE condition. In this investigation, we examined whether the benefits of MTP at posttreatment were sustained at the 6-week follow-up. Recently, we also identified two components of parental reflective functioning: (a) a self-focused component representing the parent's capacity to mentalize about strong personal emotions (e.g., anger, guilt, or pain) and their impact on the child and (b) a child-focused component representing the parent's capacity to mentalize about the child's emotions and their impact on the mother (N. Suchman, C. DeCoste, D. Leigh, & J. Borelli, 2010). In this study, we reexamined posttreatment outcomes using these two related, but distinct, constructs.
 
Article
Although it has been well-documented that parents and children who experience homelessness often have compromised health and well-being, few studies have examined the potential implications of homelessness on the process of parenting young children. In this review, we consider how parents of young children might function under the circumstances of homelessness. We begin with a brief overview of the psychological, social, and medical characteristics of homeless mothers and their young children. Using a developmental attachment perspective, we next briefly review the central tasks of parenting during the first 5 years of life, including emotion regulation and fostering of child autonomy, with an eye toward how homelessness may compromise a mother's ability to complete these tasks. Finally, we provide suggestions for further research that incorporate a developmental attachment perspective and other relevant viewpoints. Because of the paucity of research in this area, our review seeks to provide a heuristic framework for future research, intervention development, and policy.
 
Article
Although randomized controlled trials examining the efficacy of attachment-based interventions have been increasing in recent years, adequate measurement of treatment integrity, integrity-outcome associations, and mechanisms of change has been rare. The aim of this investigation was to conduct a rigorous test of proposed mechanisms of change in the Mothers and Toddlers Program (MTP) treatment model, a 12-session, attachment-based individual therapy for substance-using mothers of children birth to 3 years of age. The MTP aims to improve maternal reflective functioning (RF) and representation quality (RQ) to bring about second-order change in maternal caregiving behavior. Following guidelines from M.K. Nock (2007), it was hypothesized that (a) therapist adherence to unique MTP treatment components would uniquely predict improvement in RF and RQ and that (b) improvement in RF and RQ would function as unique mechanisms of change (when compared with other potential mechanisms-reduction in depression and increase in abstinence from drug use) in the improvement of caregiving behavior. Findings supported each hypothesis, confirming the proposed mechanisms of the treatment model. However, improvement in maternal depression also uniquely predicted improvement in caregiving behavior. Results underscore the potential value of attachment-based parenting interventions for improving mother-child relations and the importance of providing these interventions in clinic settings where mothers have access to comprehensive care (e.g., psychiatric services).
 
Conceptual model of main effect (a) and moderating (b) pathways linking sleep and parenting to infant–mother attachment security.
Family Demographic and Infant Neonatal Health Characteristics (n = 171)
Article
Infants born preterm are at elevated risk for social emotional difficulties. However, factors contributing to this risk are largely understudied. Within the present study, we explored infant sleep as a biosocial factor that may play a role in infant social emotional development. Within a prospective longitudinal design, we examined parent-reported sleep patterns and observed parenting quality as predictors of infant-mother attachment in 171 infants born preterm. Using structural equation modeling, we examined main effect and moderator models linking infant sleep patterns and parenting with attachment security. Sleep patterns characterized by more daytime sleep and positive/responsive parenting predicted infant attachment security. Parent-reported nighttime sleep patterns were unrelated to attachment in this sample of infants born preterm. These results indicate that daytime sleep and parenting quality may be important for emerging attachment relationships in infants born preterm.
 
Article
Cost-efficient prenatal assessments are needed that have the potential to identify those at risk for parent/infant relational problems. With this goal in mind, an additional attachment style description was added to the Relationship Questionnaire (Bartholomew & Horowitz, 1991), an established self-report attachment measure, to create the Relationship Questionnaire: Clinical Version (RQ-CV). The additional description represents a profoundly-distrustful attachment style: "I think it's a mistake to trust other people. Everyone's looking out for themselves, so the sooner you learn not to expect anything from anybody else the better." The RQ-CV was applied to a sample of 44 low-income mothers who had participated in a previous study of the impact of family risk factors on infant development. After first controlling for demographic risk factors and for other insecure adult attachment styles, mother's profound-distrust was associated with three independent assessments of the quality of maternal interactions with the infant assessed 20 years earlier. In particular, profound-distrust was related to more hostile, intrusive, and negative behaviors toward the infant. The results are discussed within the framework of attachment theory.
 
Article
Infants in foster care need sensitive, responsive caregivers to promote their healthy outcomes. The current study examined the effectiveness of the Attachment and Biobehavioral Catch-up Intervention, a short-term, targeted, attachment-based intervention program designed to promote sensitive caregiving behavior among foster mothers. Ninety-six foster mother-infant dyads participated in this study; 44 dyads were assigned to the Attachment and Biobehavioral Catch-up Intervention, and 52 dyads were assigned to a control intervention. Results of hierarchical linear modeling indicated that foster mothers who were assigned to the Attachment and Biobehavioral Catch-up Intervention showed greater improvements in their sensitivity from pre- to postintervention assessment time points when compared with foster mothers who were assigned to the control intervention. We conclude that a short-term, targeted, attachment-based intervention is effective in changing foster mothers' responsiveness to their foster infants, which is critical for foster infants' healthy socioemotional adjustment.
 
Article
Taylor and colleagues (2000) proposed that males tend to display fight or flight responses to threat while females are more likely to display affiliative "tend or befriend" responses. In light of this hypothesis, gender differences in infant attachment behaviors were examined in a sample of 65 low-income mother-infant dyads, half of whom were referred to a home-based intervention service because of concerns about the quality of caregiving. Attachment behaviors were assessed in the Ainsworth Strange Situation when infants were 18 months old, and maternal behaviors were coded both for frightened or frightening behaviors, using the Main and Hesse (1992) coding inventory, and for disrupted affective communication using the Atypical Maternal Behavior Instrument for Assessment and Classification assessment tool (AMBIANCE; Lyons-Ruth, Bronfman, & Parsons, 1999). Results indicated that as maternal behavior became more frightening, female infants tended to approach their mothers more than male infants. These gender differences in response to maternal frightening behavior also were evident in the clinically referred subsample. The results suggest that gender-based differences in tendencies to show affiliative behaviors to threat may complicate interpretation of attachment behavior in clinical contexts.
 
Article
In this article, recent research on parenting behaviors associated with infant attachment disorganization is summarized and applied to a parent-infant psychotherapy case. Both hostile/self-referential and helpless-fearful patterns of parentingare described and viewed theoretically as alternate aspects of a single hostile-helpless internal working model of attachment relationships. The case material focuses on the more subtle and harder to identify manifestations of a helpless-fearful parental stance. Some attachment-related treatment guidelines for working with a hostile-helpless parenting stance are suggested, including challenging the hostile-helpless model implicitly in the qualities of the therapist's approach to the parent, explicitly articulating the hostile-helpless bind with the parent, increasing the parent's openness to a wider range of affective experience, differentiating attachment-related needs from other communications of the baby, and developing new skills for balancing the needs of the self and the needs of the other in interaction with the baby.
 
Article
Disorganized/controlling attachment in preschool has been found to be associated with maternal and child maladjustment, making it of keen interest in the study of psychopathology. Additional work is needed, however, to better understand disorganized/controlling attachment occurring as early as age three. The primary aims of this study were to evaluate risk factors and outcomes associated with disorganized/controlling behavior at age three and to evaluate the risk factors and outcomes differentiating the four subtypes of disorganized/controlling attachment. Analyses were conducted with the first two phases of the NICHD Study of Early Child Care and Youth Development, a prospective study of 1,364 children from birth. At 36 months of age, across the attachment-relevant domains of maternal well-being, mother-child interactions, and child social adaptation, the disorganized/controlling group evidenced the most maladaptive patterns in comparison to both secure and insecure-organized groups. At 54 months of age, the disorganized/controlling group displayed the highest levels of internalizing and externalizing behavior problems, as rated by mothers and teachers, and the lowest quality relationships with teachers. Significant differences found among the disorganized/controlling subtypes indicated that the behaviorally disorganized and controlling-punitive subtypes had more maladaptive patterns across variables than did the controlling-caregiving and controlling-mixed subtypes.
 
Article
This study explored the use of a brief experimental intervention that integrates principles of infant-parent psychotherapy, videofeedback, controlled exposure to child distress in the context of parental posttraumatic stress disorder (PTSD), and stimulation of parental reflective functioning (RF). The Clinician Assisted Videofeedback Exposure Session (CAVES) was applied to 32 interpersonal violence-exposed mothers of very young children (8-50 months) with respect to change of maternal perception of her child. While we found no significant reduction over two videotaped assessment visits with a mental health professional, we did find a significant reduction in the degree of negativity of maternal attributions towards her child following the videotaped visit focused on the CAVES (p<.01). Maternal RF, a mother's capacity to think about mental states in herself and her child, accounted for 11% of the variance in reduction of maternal negativity after accounting for baseline levels of negativity. Clinician-assisted videofeedback appears to support emotional self-regulation of mothers with violence-related PTSD. Focusing with a therapist on videofeedback of child separation distress exposes mothers to avoided mental states of helplessness and perceived loss of protection. Negative maternal attributions may mark violent trauma-associated emotion dysregulation and projected self-representations of the maltreated mother.
 
Descriptive Frequencies Frequency %
Results of moderated mediation path analysis.
Article
Childbirth is a major experience in a woman's life, but the relation between childbirth experiences and later mother-infant outcomes has been understudied. This study examined the relation between mode of delivery and subjective birth experience (e.g., perception of control, social support during labor and delivery), and mothers' descriptions of their babies and their maternal self-esteem, both powerful predictors of maternal caregiving behavior. This study had three questions: (a) Do mode of delivery and subjective birth experience predict mothers' descriptions of their babies and maternal self-esteem? (b) Are the effects of mode of delivery on mothers' descriptions and maternal self-esteem mediated by subjective birth experience? (c) Does infant age moderate any of these pathways? The sample consisted of 269 mothers of full-term, healthy infants who gave birth in the year prior to the study. Mode of delivery showed a direct effect on how mothers describe their babies, but not maternal self-esteem, which was not mediated by subjective birth experience. Subjective birth experience had direct effects on both outcomes. Infant age did not moderate any of these pathways. Results point to the subjective aspects of childbirth as important components of women's experience of labor and delivery. Implications are discussed. © 2015 Michigan Association for Infant Mental Health.
 
Article
In this paper we focus on the first wave of outcomes in a pilot phase randomized control trial of a home-based intervention for infants and their families, Minding the Baby® (MTB), an interdisciplinary, mentalization-based intervention in which home visiting services are provided by a team that includes a nurse practitioner and a clinical social worker. Families are recruited during mother's pregnancy and continue through the child's second birthday. Analyses revealed that intervention families were more likely to be on track with immunization schedules at 12 months, had lower rates of rapid subsequent childbearing, and were less likely to be referred to child protective services. In addition, mother-infant interactions were less likely to be disrupted at 4 months when mothers were teenagers, and all intervention infants were more likely to be securely attached, and less likely to be disorganized in relation to attachment at one year. Finally, mothers' capacity to reflect on their own and their child's experience improved over the course of the intervention in the most high-risk mothers.
 
Article
This study examined the association between foster parents' commitment to their young foster children and the delight they showed in their interactions with children. Seventy foster parent-child dyads were included as participants. The dyads were videotaped during a play interaction when children were between 9 and 28 months, with delight coded on the basis of foster parents' responses to children. Caregivers were interviewed with the "This Is My Baby" Interview (B. Bates & M. Dozier, 1998), with commitment coded as the extent to which parents expressed interest in enduring relationships with their foster children and the extent to which they thought of them as their own. Regression analyses revealed that commitment was a significant predictor of foster parent delight. Foster parents who were more highly committed to their foster children showed greater delight in their children than did foster parents who were less highly committed. These results suggest an important way in which caregiver commitment is transmitted to foster children.
 
Article
Premature birth has been associated with a number of adverse maternal psychological outcomes that include depression, anxiety, and trauma as well as adverse effects on maternal coping ability and parenting style. Infants and children who were premature are more likely to have poorer cognitive and developmental functioning and, thus, may be harder to parent. In response to these findings, there have been a number of educational and behavioral interventions developed that target maternal psychological functioning, parenting and aspects of the parent-infant relationship. Since the last comprehensive review of this topic in 2002, there have been a significant number of developments in the quality of the studies conducted and the theoretical models that address the experience of parents of premature infants. In the current review, eighteen new interventions were identified and grouped into four categories based on treatment length and the target of the intervention. Findings suggest a trend towards early, brief interventions that are theoretically based, specifically target parent trauma, and utilize cognitive behavioral techniques. Although it is difficult to generalize study findings, conclusions from the review suggest that targeted interventions may have positive effects on both maternal and infant outcomes.
 
Article
Shared pleasure (SP) was analyzed in fifty-eight 2-month-old infants and their mothers in face-to-face interaction (T1, at 2 months). The association of SP with child's emotional and behavioral outcome at 2 years (T2) was examined. SP as a possible protecting factor in the presence of parental psychopathology also was studied. Mean duration of SP moments (SP-MD) was related to subsequent socioemotional outcome of the child: Infants of dyads with longer SP-MD showed fewer internalizing and externalizing problems 2 years later. In hierarchical linear regressions, SP-MD uniquely and significantly contributed to internalizing problems after adjusting for infant and maternal factors and mother's interactive behavior. SP protected the child against the influence of parental psychopathology. Father's mental health problems during the follow-up increased the child's risk for higher externalizing and internalizing problems, but only among children with short SP-MD at T1. Internalizing symptoms at T2 increased when moving from the category "no mental health problems" to "mental health problems in one parent" and further to "mental health problems in both parents," but this increase was found only among those with short SP-MD at T1. SP in parent-child interaction is an important feature that fosters positive psychological development and moderates the health effects of other risks such as parental psychopathology. © 2015 Michigan Association for Infant Mental Health.
 
Article
"Ghosts in the nursery." "Visitors from the unremembered past." Fraiberg, Adelson, and Shapiro's (1975) words convey the relational "intruders" that they perceived while working with mothers and infants. A mother's unresolved past is a driving force within the treatment of mother-infant dyads. Working with these families, the therapist strives to process and metabolize the distress of the dyad while enabling the mother to contain the infant more fully. This article proposes that Fraiberg et al.'s metaphor may be newly elaborated utilizing Bion's (1962) original theoretical conceptualization of the "container and contained." He posited that an infant projects distressing affective states upon the mother, who contains the experience, transforms the feelings, and then enables the infant to reintroject a more tolerable experience. This lays the foundation for the relational experience of being known by another and facilitates the infant's development of self-knowledge and emotional regulation. We utilize Fraiberg et al.'s original case material to identify ways in which ghosts in the nursery disrupt the processes of the container and contained. Bion's ideas may help enrich our understanding of how the therapeutic relationship enables cycles of containment, transitioning the material "ghosts" from being contained by the infant to being contained by the therapist, and to ultimately being transformed so that the mother can reattribute them to the past. © 2015 Michigan Association for Infant Mental Health.
 
Interaction between maternal depression slope (DS) and prematurity–neonatal health risks (PNH) on toddler opposition.
Article
Although children born preterm or low birth weight (PT LBW) are more likely to exhibit behavior problems compared to children born at term, developmental and family processes associated with these problems are unclear. We examined trajectories of maternal depressive symptoms in relation to toddler compliance and behavior problems in families with PT LBW infants. A total of 177 infants (93 boys, 84 girls) and their mothers enrolled in the study during the infant's NICU stay. Data were collected at five time points across 2 years. Assessments of maternal depressive symptoms were conducted at all time points, and toddler compliance and opposition to maternal requests and behavior problems were assessed at 2 years. Toddlers born earlier with more health problems to mothers whose depressive symptoms increased over time exhibited the most opposition to maternal requests during a cleanup task at 24 months, consistent with multiple risk models. Mothers with elevated depression symptoms reported more behavior problems in their toddlers. The study has implications for family-based early intervention programs seeking to identify PT LBW infants at highest risk for problem behaviors.
 
Article
This article takes a human rights perspective with a view to articulating the infant's perspective when the infant has been subjected to abuse, neglect, or both and is reliant on the state to ensure his or her health and well-being. When a young child is removed from parental care, important and often difficult decisions have to be made about subsequent contact between child and parent. We consider a number of dilemmas which may arise for practitioners when they are assisting child welfare decision makers in relation to contact, and acknowledge the limited empirical follow-up studies of the impact of child welfare practice and legal decisions on infant outcomes. We draw on the significant and substantive evidence base about infant emotional and cognitive development and infant-parent attachment relationships as well as infant mental health to illuminate the infant's subjective experience in these practice dilemmas. We describe innovations in practice from various countries, which seek to shed light on the challenges often associated with contact.
 
Article
Toddlers in child welfare often have a dysregulated stress response. We tested whether toddlers with caregivers randomized to a 10-week attachment-based intervention, Promoting First Relationships (PFR; Kelly, Sandoval, Zuckerman, & Buehlman, 2008) would show post-intervention change in stimulated salivary cortisol patterns during a research home visit involving a separation-reunion procedure, compared to a condition including child development and resource advice, but no attachment strategies. At baseline and post intervention, toddlers with a caregiver change within 7 weeks of enrollment (n=48, age 10-25 months) provided 4 saliva samples during a 1.5-hour research visit, and samples the next morning. The categorical dependent variable was the pattern of cortisol activity during the course of the post-intervention research visit: Flat, Decreasing, Increasing. Multinomial logistic regression was used to test for post-intervention group differences in cortisol patterns, controlling for time of day, child's age, morning cortisol level, and baseline cortisol pattern. At baseline and post-intervention 92% of children demonstrated atypically low morning cortisol (< .21 ig/dL); Post-intervention, Flat, Decreasing and Increasing patterns were exhibited by 70%, 15%, and 15% of the sample, respectively. Significantly more children in the PFR condition showed an Increasing pattern. This may signal an intervention effect on separation-based stress response physiology.
 
Article
This paper reports the construction and pilot reliability, validity, and psychometric properties of a new caregiver-child rating scale that emphasizes caregiver-child social-emotional interactions and relationships. While the scale was developed and studied in the context of orphanages for young children, it potentially could be used in non-residential early care and education settings as well as for parent-child interactions in the home. The intent was to assess a few dimensions that comprehensively cover the range of caregiver-child social-emotional interactions and relationships but could be administered in a relatively short period of time in a variety of situations and would not require extensive coder training, manuals, or materials. Results showed that the scale can be reliably administered even using observation periods as short as five minutes, reliability was replicated over seven different coders working in three different orphanages, and ratings of caregivers were similar across different types of caregiving activities (i.e., feeding, dressing/bathing, free play) and for caregivers attending to children birth to 4 and 4 to 8 yrs. of age. In the orphanage context, factor analyses showed the scale primarily reflects caregiver-child mutual engagement and relationship with subordinate components of caregiver punitiveness and caregiver- vs. child-directed behaviors and intrusiveness.
 
Article
The primary goal of this study was to examine sleep problems in a sample of cocaine-exposed 7-month-old infants and to determine if maternal psychopathology mediated any existing association between substance exposure and sleep behaviors. We also examined the differences in sleep behaviors of cocaine-exposed infants in parental custody and cocaine-exposed infants in nonparental custody. Participants were 65 cocaine-exposed and 53 nonexposed infants and their primary caregivers who were recruited at delivery and assessed at 7 months of infant age. As expected, women who used cocaine during pregnancy had more psychiatric symptoms than nonusers. Prenatal exposure to heavier amounts of cocaine was significantly related to more severe sleep difficulties, and maternal anxiety mediated this association. Approximately 28% of cocaine mothers lost custody of their infants by 7 months of age. Nonmaternal caregivers had significantly fewer symptoms of psychopathology than the cocaine-using women who retained custody of their children. Infants who were in nonparental care at 7 months of age also had less severe sleep problems than did infants who remained in parental care.
 
Article
Research on teenage parenting together with medical and behavioral research related to child development is reviewed in an effort to determine causal factors related to reported developmental deficits among children of teenage parents. 4 general conclusions are suggested: 1) several researchers agree that children of teenage parents show poor social and intellectual competence when compared with children on non-teen parents. However, the amount of sound empirical data to support this view is minimal. For example, there are few published studies of the longterm effects of teenage parenting or of actual behavioral interactions of teenage mothers and their children. 2) It is unlikely that research along the lines of the "continuum of reproductive casualty" will lead to identification of causal factors sufficient to account for developmental deficits in children of teenage mothers. 3) Research along the lines of "the continuum of caretaking casualty" suggest numerous behavioral and environmental variables that may be related to the development of children of teenage mothers. 4) Research designs applied to the study of teenage parenting must shift from linear models to complex multivariate models that permit simultaneous analysis of organismic, environmental, and behavioral determinants of development. Finally, mental health specialists, government agencies, and researchers alike, must be willing to entertain the hypothesis that much of our knowledge of the childrearing skills of teenage mothers is based on myth rather than empirical fact. 1 such myth may be that below 19 years of age, maternal age in and of itself is an important determinant of infant development and parent-infant interaction. Poor social-economic status, family support systems, marital stability, nutrition and prenatal care may be far more important determinants of development for these children than the age of their mothers.
 
Article
Temperament among children (N = 111 20-month-olds) from three cultural backgrounds in the United States (Latin American, Japanese American, and European American) was investigated. In accord with a biobehavioral universalist perspective on the expression of early temperament, few significant group differences in child temperament were found, regardless of cultural background. However, factors associated with maternal reports of child temperament differed by cultural group. The findings provide insight into the nature of child temperament generally and temperament of children in immigrant families specifically as well as parenting in immigrant families.
 
Descriptive Data for "Who Does What" Measures Mothers Fathers M SD Range M SD Range
Significant Correlations Between Magnitude of Wish Violations About Specific Childcare Tasks and Family Adaptation at 3 Months Postpartum
Predicting 3-Month Outcomes From Division of Labor and Wish Violations
Article
Prior research has indicated that expectant parents overestimate the extent to which fathers will take part in the "work" of parenting, with mothers often becoming disenchanted when these expectations are violated following the baby's arrival. In this study, we examine the role of violated wishes concerning childcare involvement in accounting for variability in maternal and paternal marital satisfaction, and in early coparenting behavior as assessed during family-interaction sessions. The results indicate possible negative effects of violated wishes on the enacted family process and confirm previous findings regarding the effects of marital satisfaction. In addition, we uncovered differences in the way that violated maternal wishes are related to coparenting during playful and mildly stressful family interactions.
 
Article
Emotion-related regulation is a topic of increasing interest among researchers, yet there is little agreement on ways to measure emotion regulation in young children. In this paper, we first consider important conceptual distinctions in regard to the different types of emotion-related regulation and control. Next, we describe a number of ways researchers have assessed children's regulation. We also present data from the Toddler Emotional Development project, in which laboratory-based measures of effortful regulation were used. In this section, we highlight the measures that show promise (and those that did not work well). Future directions for research on the measurement of effortful regulation are presented.
 
Order of appearance of gesture categories as measured by the average age at which each gesture category was first observed to be used by each child.  
Results of Binomial Statistics Testing Whether Children's Emotion, Feeling, and Time Gestures Were Imitations of Adults' Gestures Binomial Test Results
Article
Do infants explicitly recognize feelings and emotions in themselves and others? What would preverbal children say about internal states if they had the words? Investigation of infants' emotional understanding is limited by the challenge of understanding infant mental states before the onset of speech. I examined the use of symbolic gestures by normally hearing, preverbal children to discover whether infants and toddlers represent emotion concepts such as sad and scared, and feeling words such as sleepy. Participants were 22 children (5-28 months) in a childcare program where caregivers modeled symbolic gestures. Gesture use by children and caregivers were videotaped and coded to determine context, characteristics, and frequency. Twenty of 22 children used symbolic gestures; of these, 6 used emotion gestures, and 5 used feeling gestures. These gestures were not imitations of adult gestures, and qualitative data reveal their context and significance. Symbolic gestures reveal the sophistication of infants' internal worlds and their ability and desire to communicate thoughts and feelings. Symbolic gestures are a promising methodology for investigating early explicit mental processes. As a therapeutic communication tool, symbolic gestures may help children express emotions, participate in conversations about emotion, and construct their own understanding of internal states.
 
Article
People become subject to political and social violence when governments fail to give priority to basic health care or education. Attempts to meet foreign obligations also produce severe economic recessions which further impede efforts to improve the general quality of life of disadvantaged populations. Since multiple factors contribute to violence, a multidisciplinary approach is best suited to address the problem. For example, poverty and its associated risks are linked to violence, but living in poverty does not necessarily engender violence. Living in poverty may, however, fuel high rates of child mortality, illiteracy, malnutrition, excessive population growth, street children, and familial disintegration. An integrated action program was developed in Brazil for at-risk individuals and their families based upon the idea of building and reinforcing family ties and intergenerational togetherness. Undernourished infants, street children, the handicapped, women subjected to violence, and neglected senior citizens received special interventions in the program described in the text.
 
Article
An estimated 8-million children, mostly birth to approximately 6 to 8 years of age, live in institutions worldwide. While institutional environments vary, certain characteristics are common, including relatively large groups; high children:caregiver ratios; many and frequently changing caregivers; homogeneous grouping by age and disability status; periodic graduations to new groups of peers and caregivers; and an "institutional style of caregiving" that minimizes talking, provides rather dispassionate perfunctory care, and offers little warm, sensitive, contingently responsive caregiver-child interactions. The development of children in residence is usually delayed, sometimes extremely so, in every physical and behavioral domain. Although efforts are being made in many countries to care for children without permanent parents in family environments (e.g., domestic adoption, foster and kinship care, reunification with biological parents), it is not likely that transitions to family alternatives will be completed in all countries in the near future; thus, institutions are likely to exist for many years, if not decades. But institutions need not operate in the current manner; they can be modified to be substantially more family-like in structure and in the behavior of caregivers. Research has indicated that when such changes are made, the development of children, both typically developing and those with special needs, is improved substantially. Based on the available literature and the authors' experience, this article describes steps that can be taken to implement such changes in residential institutions for infants and young children.
 
Article
During the first months of life, infants switch from a preference for perfect contingent feedback to a preference for less-than-perfect contingent feedback of their own movements. This is an indicator of increasing social interest since others provide less-than-perfect contingent feedback whereas the self provides perfect contingent feedback. We presented 117 6-month-olds with real-time and delayed video feedback of self-performed leg movements and asked parents about difficulties in various socioemotional domains. It was hypothesized that the more infants prefer real-time and therefore perfect contingent feedback over 7 s delayed and therefore perceived noncontingent feedback, the more difficulties parents will report in interaction and communication with their child. Preference for real-time feedback was related to difficulties in interaction, but not to difficulties in communication. Implications of this finding for infants' socioemotional development and health are discussed. © 2015 Michigan Association for Infant Mental Health.
 
Article
This study investigated the effects of infant and maternal sensory processing on sleep, fussing, and crying in a sample of 55 firstborn, 4- to 7-month-old infants and their mothers. Mothers completed self-report questionnaires to assess maternal and infant sensory processing styles and a 4-day diary of infant behavior, including sleep, fussing, and crying. Higher levels of infant Sensation Avoiding were associated with less sleep, more fussing, and more crying whereas higher levels of Sensory Sensitivity were associated with less sleep and more fussing. The positive association between infant Sensation Avoiding and crying was strengthened by lower levels of Low Registration in mothers. The effect of infant Sensory Sensitivity on reducing total sleep also was strengthened by lower levels of maternal Low Registration. Assessment of infant sensory processing as well as the moderating effect of maternal sensory processing on the relationship between infant sensory processing and infant regulatory capacities need to be considered when assessing and designing interventions for families in which infant regulation is problematic. © 2015 Michigan Association for Infant Mental Health.
 
Article
The present study evaluated the interactive behavior of three groups of mothers and their 3-month-old infants in the Face-to-Face Still-Face paradigm. The mothers had either a clinical diagnosis of major depressive disorder (MDD, n = 33) with no comorbidity, a clinical diagnosis of panic disorder (PD, n = 13) with no comorbidity, or no clinical diagnosis (n = 48). The sample was selected to be at otherwise low social and medical risk, and all mothers with PD or MDD were in treatment. The findings indicated that (a) infants of mothers with PD or MDD displayed the traditional still-face and reunion effects described in previous research with nonclinical samples; (b) the 3-month-old infants in this study showed similar, but not identical, gender effects to those described for older infants; and (c) there were no patterns of maternal or infant interactive behavior that were unique to the PD, MDD, or control groups. These results are discussed in light of mothers' risk status, receipt of treatment, severity of illness, and comorbidity of PD and MDD.
 
Article
Maternal parenting self-efficacy (PSE) is a potential target for infant mental health interventions because it is associated with a number of positive outcomes for children and mothers. Understanding the development of maternal PSE under conditions of increased parenting stress, such as parenting an infant who is easily distressed and difficult to soothe, will contribute to providing more effective interventions. This study examines the development of maternal PSE in mothers of infants with high negative emotionality (NE). The Neonatal Behavioral Assessment Scale (NBAS; T. Brazelton, 1973) was administered twice to 111 infants to select a sample of irritable (n = 24) and nonirritable (n = 29) infants for a prospective study comparing the development of PSE in mothers of infants differing in neonatal NE. Consistent with our hypotheses and previous research, at 8 weeks' postpartum, mothers of irritable infants have significantly lower domain-specific PSE than do mothers of nonirritable infants. Contrary to our predictions, mothers of irritable infants exhibit a significant increase in domain-specific and domain-general PSE from 8 to 16 weeks' postpartum. The implications of these results for infant mental health screening, infant mental health interventions, and research on self-efficacy theory are discussed.
 
Article
The purpose of this study is to investigate the effects of a relational intervention (the Getting Ready intervention) on parenting behaviors supporting the parent-infant relationship for families enrolled in Early Head Start home-based programming. Two-hundred thirty-four parents and their children participated in the randomized study, with 42% of parents reporting education of less than a high-school diploma. Brief, semistructured parent-child interaction tasks were videotaped every 4 months over a16-month intervention period. Observational codes of parent-infant relationship behaviors included quality of three parental behaviors: warmth and sensitivity, support for learning, and encouragement of autonomy; two appropriateness indicators: support for learning and guidance/directives; and one amount indicator: constructive behaviors. Parents who participated in the Getting Ready intervention demonstrated higher quality interactions with their children that included enhanced quality of warmth and sensitivity, and support for their children's autonomy than did parents in the control group. They also were more likely to use appropriate directives with their children and more likely to demonstrate appropriate supports for their young children's learning. Results indicate an added value of the Getting Ready intervention for Early Head Start home-based programming for families of infants and toddlers.
 
Article
The concept of maternal reflective functioning (RF) has been gaining increasing interest as a possible intermediate mechanism in associations between a wide range of psychosocial risk factors and poor child outcomes. The purpose of the present study was to determine which psychosocial risk factors are linked to prenatal RF in a high-risk (HR) group of primiparous women. Differences in prenatal RF between the HR group and a low-risk (LR) control group also were examined. The sample consisted of 162 women (M = 22.22 years, SD = 2.39; 83 classified as HR). RF was coded from the Pregnancy Interview (A. Slade, 2007a). Risk status was assessed by means of the Mini-International Neuropsychiatric Interview-plus (M.I.N.I.-plus; D.V. Sheehan et al., 1997) and several questionnaires. HR women demonstrated significantly lower RF quality than did the LR group. Regression analyses indicated that maternal education, size of social support network, and substance use during pregnancy were the strongest predictors of prenatal RF for the HR group. The results suggest that maternal RF potentially could be an important target for those prevention and intervention programs that aim to reduce adverse psychosocial development in offspring of HR mothers. © 2015 Michigan Association for Infant Mental Health.
 
Article
Despite prompts from the field of family therapy since its inception, contemporary infant mental health theory and practice remain firmly rooted in and guided by dyadic-based models. Over the past 10 years, a groundswell of new empirical studies of triadic and family group dynamics during infancy have substantiated that which family theory has contended for decades: looking beyond mother-infant or father-infant dyads reveals a myriad of critically important socialization influences and dynamics that are missed altogether when relying on informant reports or dyad-based interactions. Such family-level dynamics emerge within months after infants are born, show coherence through time, and influence the social and emotional adjustment of children as early as the toddler and preschool years. This report summarizes key findings from the past decade of empirical family studies, highlights several areas in need of further conceptual development and empirical study by those who work with infants and their families, and outlines important implications of this body of work for all practicing infant mental health professionals.
 
Top-cited authors
Phillip R Shaver
  • University of California, Davis
Jude Cassidy
  • University of Maryland, College Park
Allan Schore
Charles H Zeanah
  • Tulane University
Peter Fonagy
  • University College London