Assessment of early mother–child relation in infants with oesophageal atresia

Fifteen one-year old infants with oesophageal atresia and their parents were used to demonstrate how the Parent–Child Early Relational Assessment (PCERA) can be used to explore the mother–child interaction in a clinical sample of children. The infants and their mothers were videotaped for 5-min episodes during feeding and free play, and the quality of the mother–infant interactions was assessed by PCERA. The results showed areas of strength regarding most of the maternal, infant and dyadic components. There was concern about maternal positive physical contact, maternal quality of verbalizations to or about the child, maternal social initiative, infant's communicative competence and infant's visual contact with mother. This concern of social proximity between infants and their mothers was most prominent in the feeding situation. The present study indicates that oesophageal atresia in infants may constitute stressors impinging on the parent–infant relationship. PCERA was found to be an adequate assessment tool with acceptable reliability to evaluate the mother–infant interaction.     

Offspring of women with nonorganic psychosis: mother-infant interaction and fear of strangers during the first year of life

Mother-infant interaction characteristics at six ages during the first year of life were studied in relationship to the development of the infant's fear of strangers (FOS) during the first year. Among 46 offspring of women with psychosis history, a failure to develop the expected FOS was associated with antecedent negative qualitative aspects of interaction such as increased maternal tension, reduced harmony in feeding and increased infant crying. Among 80 low-risk control infants, a failure to develop FOS was associated with an antecedent quantitative reduction in social contact within the mother-infant pair. At a case level, an absence of FOS overlapped little with anxious attachment to the mother, and these two developmental phenomena bear partially different relationships to the mother-infant interaction characteristics.     

Offspring of women with nonorganic psychosis: mother-infant interaction at one year of age

Mother-infant interaction during feeding and in an unstructured play situation was studied in the home at 1 year of age in 46 index mother-infant pairs in which the mother had a history of nonorganic psychosis and in 80 demographically similar control pairs. As was true at the five previous observation ages, some aspects of the interaction were significantly more negative in index than control pairs. Index mothers showed increased tension and uncertainty regarding the infant's needs, increased physical contact during feeding and a discrepancy between the intonation and content of the mother's verbal contact with the infant. Index infants did not differ from controls in behavior in interaction. Across the entire first year, the Cycloid and Schizophrenic mothers deviated most frequently from controls, while the Affectives' interaction was more negative than controls' for the first time at the 1-year observation.     

The neural correlates of maternal sensitivity: An fMRI study

Research on maternal neural response to infant distress highlights circuits that may underlie differences in quality of maternal behavior. However, it is far from clear which circuits are relevant to maternal sensitivity, as opposed to other maternal behavioral dimensions, particularly after the early postpartum. This study examined maternal sensitivity, intrusiveness, and mother-infant dyadic harmony as correlates of mothers' neural responses to the cries of their own infants. Twenty-two primiparous mothers were observed during an interaction with their infants at 18 months postpartum. In a separate functional neuroimaging session, mothers were exposed to their own infant's cry sound, as well as unfamiliar infant's cry and control sounds. Mothers who displayed more sensitive behaviors with their infant exhibited greater activation to their own infant's cry compared to that of an unfamiliar infant in the right frontal pole and inferior frontal gyrus. Mothers who displayed more intrusive behaviors with their infant showed greater activation in the left anterior insula and temporal pole, while mothers who had more harmonious interactions with their infant displayed greater activation in left hippocampal regions. The roles of these areas in the regulation of maternal emotion and stress, self and other awareness, and empathy are examined.     

Offspring of women with nonorganic psychosis: mother-infant interaction at three and six weeks of age

Mother-infant interaction during feeding and in an unstructured play situation was studied in the home at 3 weeks and 6 weeks of age in index mother-infant pairs in which the mother had a history of nonorganic psychosis (n = 42 and 51 at 3 and 6 weeks, respectively) and in demographically similar control pairs (n = 60 and 78). At both ages, interaction was significantly more negative in index than control cases, index mothers showing increased tension and a lack of harmony, decreased social contact, and reduced sensitivity to the infant's needs. Fewer significant differences were found between index and control infants. Mothers in the Schizophrenic, Cycloid and Nonendogenous groups evidenced more negative interaction characteristics than did their matched controls, but the Affective group was not in any way more negative than its controls.     

Offspring of women with nonorganic psychosis: mother-infant interaction at three days of age

Mother-infant interaction during a feeding was studied at about 3 days of age in 51 index mother-infant pairs in which the mother had a history of nonorganic psychosis and in 73 demographically similar control pairs. Interaction was significantly more negative and deviant in index than control cases, index mothers establishing a significantly more negative emotional climate and less harmony in feeding, evidencing more tension and uncertainty, and showing less social contact toward the infant. Index infants showed significantly less social contact toward the mother and index pairs less reciprocal visual contact than did controls. While the Schizophrenic, Cycloid and Nonendogenous Psychoses groups each differed from their matched controls on a number of variables, the Affective group was not in any way more negative than its controls on interaction.     

Offspring of women with nonorganic psychosis: mother-infant interaction at three-and-a-half and six months of age

Mother-infant interaction during feeding and in an unstructured play situation was studied in the home at 3.5 and 6 months of age in index mother-infant pairs in which the mother had a history of nonorganic psychosis (n = 48 and 52 at 3.5 and 6 months, respectively) and in demographically similar control pairs (n = 80 and 79). Interaction was significantly more negative in index than control cases at both ages, index cases showing decreased maternal and infant social contact and reduced maternal sensitivity to the infant's needs. Schizophrenic and Cycloid groups evidenced more negative interaction characteristics than did their matched controls, while the Affective group was not generally more negative than its controls.     

THE EFFECTS OF MATERNAL EPIDURAL ANESTHESIA ON NEONATAL BEHAVIOR DURING THE FIRST MONTH

The effects of maternal epidural anesthesia with bupivacaine on the infant's performance on the Neonatal Behavioral Assessment Scale (NBAS) over the first month of life were examined. 20 non-medicated infants were matched for biomedical and demographic variables with 20 infants delivered with bupivacaine epidural anesthesia. The NBAS was administered on days 1, 3, 7 and 28. The epidural group showed poorer performance on the orientation and motor clusters during the first month of life. Epidural mothers reported spending less time with their infants while in the hospital; post hoc analyses showed that they had longer labor, more forceps deliveries and a greater amount of oxytocin. Controlling for the effects of these medical variables, a dose effect was found for the mean orientation and motor cluster scores. The results are discussed in terms of possible effects of the infant's early disorganization on the mother-infant interaction.     

Borderline personality disorder, mother-infant interaction and parenting perceptions: preliminary findings

OBJECTIVE: Parents diagnosed with borderline personality disorder (BPD) are likely to find the emotional aspects of parenting challenging. Research into the difficulties that these parents experience, however, is lacking. The aims of the present study were to (i) gain an understanding of the interactional patterns of mothers with BPD and their infants and (ii) to explore the parenting perceptions of mothers with BPD. METHOD: Two groups of mother-infant dyads were recruited: mothers with BPD and their infants; and community mothers and their infants. Groups were compared on mother-infant interaction patterns and on maternal self-perceptions of parenting. RESULTS: Mothers with BPD were found to be less sensitive and demonstrated less structuring in their interaction with their infants, and their infants were found to be less attentive, less interested and less eager to interact with their mother. Furthermore, mothers with BPD reported being less satisfied, less competent and more distressed. CONCLUSIONS: Early intervention needs to be provided to mothers with BPD to promote maternal sensitivity and maternal perceptions of competence.     

CHILD SEXUAL ABUSE: SOUTH AFRICAN RESEARCH ON INCIDENCE,PREVALENCE AND INTERVENTION (1984–1990)

Abstract

This paper is based on an invited presentation in a symposium on “Identifying Universals in Human Development” held at the Biennial Meeting of the International Society for the Study of Behavioural Development, Amsterdam (28 June–2 July 1994)

There is a wide agreement that mothers and their infants under 5–6 months of age engage in intense interpersonal interaction, and that this interaction is composed of performances by both adult and child in the domains of visual attention, vocalization and touch. Some stylistic differences in the interpersonal behaviour of mothers and young infants have been reported between Western dyads and dyads from other social and cultural groups. In particular, it has been suggested that African mothers behave differently with their infants from Western mother-infant dyads. These observed differences have raised questions about the universality of early infant development and the nature of the interpersonal experience in adult-infant interactions necessary to sustain normal social and cognitive development.

These issues are considered, several observational studies of urban South African mothers and their infants, as well as a review of the relevant literature. The presented material raises a number of methodological and theoretical considerations, including: the central processes involved in early adult-infant interactions and how are they constrained by infant and adult capacities; the degree to which stylistic differences in maternal-infant behaviour reveal individual, social and/or cultural factors; and the extent to which reports of attentuated maternal behaviour, particularly from Africa, reflect constraints introduced during the process of research rather than the operation of cultural regulators on maternal behaviour.     

Mother's early perception of her infant's difficult temperament, parenting stress and early mother-infant interaction

The current study investigated factors contributing to mother's early perception of her infant's difficult temperament. One hundred and twenty-four mother-infant dyads participated in the study. Mother's perception of the infant's temperament was assessed with the Infant Characteristics Questionnaire (ICQ). The influence of mother-infant interaction, mother's mental health and parenting stress were investigated. Mother-infant interaction was videotaped during a face-to-face interaction and analysed using the Global Rating Scale. Mother's mental health was assessed through a structured interview (Structured Clinical Interview for DSM-IV, SCID) and parenting stress was examined by a questionnaire (Parenting Stress Index). First, the difficulty scale of the ICQ was used as a continuous variable and factors contributing to mother's perception of her infant's temperament as more or less difficult were examined. Secondly, infants were categorized into difficult and non-difficult, and factors increasing the infant's risk of being perceived as difficult were examined. The model including mother's mental health and parental distress accounted for 24% of the variance in perceived infant difficulty, with parental distress in particular being an influential contributor. When infants categorized as difficult were examined, mother's intrusiveness and infant's poor interactive behaviour in early mother-infant interaction as well as parental distress significantly increased the infant's risk of being perceived as difficult.     

Reflections on stillness: mothers' reactions to the still-face situation

The still-face procedure, in which mothers maintain a neutral face and are noninteractive with their infants, has been used to study the effects of maternal withdrawal on the mother-infant interaction. In this study, 56 mothers' reactions to their own experience during a still-face procedure were explored using an open-ended interview. The associations between the mothers' reported experience, the infants' behavior during the procedure, and the mothers' behavior during subsequent play were examined. Over half of the mothers reported experiencing discomfort during the session and were more likely to report discomfort if their infants protested their affective absence. Mothers reporting discomfort were significantly more likely to pick up their infants and continue to reflect verbally on their own feelings after the still-face ended. These results are discussed in terms of their clinical implications for understanding the early development of the social dialogue between mother and infant.     

Fathers of children born to adolescent mothers and their interactive behavior

Adolescent mothers and their children received much scientific attention in the past. Some studies also looked at characteristics of the interaction between mother and child. However, little is known about the interaction between children of adolescent mothers and their fathers, as research to date has focussed on paternal psychosocial aspects. The present study examines 19 partners of adolescent mothers in the interaction with their four-months-old infants. Results indicate that fathers of this sample--despite a sufficiently large intuitive repertoire--mainly relate to their infants with tactile stimulation and behaviours that facilitate eye contact. Most fathers succeed in adjusting their behaviour to their child's state. Fathers who are able to adjust their behaviour to their child's state show a larger repertoire of intuitive capacity. The infant's readiness to interact is associated with successful paternal adjustment. We discuss implications for involving fathers in the clinical work with children of adolescent mothers.     

Specifying the neurobiological basis of human attachment: brain, hormones, and behavior in synchronous and intrusive mothers

The mother-infant bond provides the foundation for the infant's future mental health and adaptation and depends on the provision of species-typical maternal behaviors that are supported by neuroendocrine and motivation-affective neural systems. Animal research has demonstrated that natural variations in patterns of maternal care chart discrete profiles of maternal brain-behavior relationships that uniquely shape the infant's lifetime capacities for stress regulation and social affiliation. Such patterns of maternal care are mediated by the neuropeptide Oxytocin and by stress- and reward-related neural systems. Human studies have similarly shown that maternal synchrony--the coordination of maternal behavior with infant signals--and intrusiveness--the excessive expression of maternal behavior--describe distinct and stable maternal styles that bear long-term consequences for infant well-being. To integrate brain, hormones, and behavior in the study of maternal-infant bonding, we examined the fMRI responses of synchronous vs intrusive mothers to dynamic, ecologically valid infant videos and their correlations with plasma Oxytocin. In all, 23 mothers were videotaped at home interacting with their infants and plasma OT assayed. Sessions were micro-coded for synchrony and intrusiveness. Mothers were scanned while observing several own and standard infant-related vignettes. Synchronous mothers showed greater activations in the left nucleus accumbens (NAcc) and intrusive mothers exhibited higher activations in the right amygdala. Functional connectivity analysis revealed that among synchronous mothers, left NAcc and right amygdala were functionally correlated with emotion modulation, theory-of-mind, and empathy networks. Among intrusive mothers, left NAcc and right amygdala were functionally correlated with pro-action areas. Sorting points into neighborhood (SPIN) analysis demonstrated that in the synchronous group, left NAcc and right amygdala activations showed clearer organization across time, whereas among intrusive mothers, activations of these nuclei exhibited greater cross-time disorganization. Correlations between Oxytocin with left NAcc and right amygdala activations were found only in the synchronous group. Well-adapted parenting appears to be underlay by reward-related motivational mechanisms, temporal organization, and affiliation hormones, whereas anxious parenting is likely mediated by stress-related mechanisms and greater neural disorganization. Assessing the integration of motivation and social networks into unified neural activity that reflects variations in patterns of parental care may prove useful for the study of optimal vs high-risk parenting.     

Offspring of women with nonorganic psychosis: antecedents of anxious attachment to the mother at one year of age

Mother-infant interaction characteristics at six ages during the first year of life were studied in relationship to the development of the infant's anxious vs. secure attachment to the mother at 1 year of age. The same antecedent maternal characteristics, notably less harmony during feeding and less consideration for the child's needs in play, were associated with anxious attachment in both index and control groups. In contrast, control infants' behaviors were totally unrelated to the development of anxious attachment, while index infants developing anxious attachment evidenced reduced social contact toward the mother and increased crying prior to 1 year, suggesting either vulnerability to negative maternal influence or initial deviations in these index offspring.     

Schizophrenia, mental state, and mother-infant interaction: examining the relationship

OBJECTIVE: The aim of this study is to examine the role that disturbance of mental state of hospitalised mothers with a postpartum schizophrenic illness plays in determining the quality of mother-infant interactions. METHOD: We examined the relationship between the nature and severity of symptomatology in mothers with schizophrenia and the quality of her interactions with her infant in a sample of 15 mother-infant dyads admitted to a psychiatric Mother-Baby Unit. Data were obtained at admission and discharge. RESULTS: Mothers with florid positive symptoms and prominent negative symptoms of schizophrenia and their infants were identified as being at particular risk of displaying disturbed interactions. The adverse contribution of negative symptoms was often not evident until after the positive symptoms had resolved. CONCLUSIONS: Given that negative symptoms are often treatment resistant, optimal care of mothers with schizophrenia and their infants needs to involve ongoing therapeutic intervention which specifically addresses disturbances of mother-infant interaction. Further research is required to identify which interventions are likely to be of greatest benefit.     

Interaction of mothers with their infants who are mentally retarded, retarded with cerebral palsy, or nonretarded

Mother-infant interaction was observed during 15 minutes of free play in the homes of 40 families with 8- to 36-month-old infants from the following groups: mentally retarded, both retarded and cerebral palsied, nonretarded MA-matched, nonretarded CA-matched. One-way, repeated measures analyses of variance followed by Tukey multiple range tests for the paired contrasts indicated that mothers of both groups of developmentally disabled infants were more directive than the mothers of the nonretarded infants. Developmentally disabled infants were more compliant than both groups of nonretarded infants. They also demonstrated an overall lower level of behavior and engaged in less verbal interaction than the nonretarded CA-matched infants. Physical contact was more frequent for cerebral palsied infants and their mothers than for all other mother-infant groups. The communicative patterns reported for these groups were interpreted according to Bell's (1971) limiting control strategy, which predicts that mothers tolerate infant behavior within their expectations and actively attempt to keep their infants' behavior within these boundaries.     

The relationship of maternal and child HIV infection to security of attachment among Ugandan infants

This study was designed to examine the relationship of maternal and child human immunodeficiency virus (HIV) infection to the security of attachment of Ugandan infants. The attachment patterns of two groups of Ugandan mother-infant pairs: 35 HIV-positive mothers and their infants and 25 HIV-negative mothers and their infants were compared. We tested the hypothesis that infants of HIV-positive mothers would demonstrate less secure attachment as measured by the Waters Attachment Q-set than infants of HIV-negative mothers. No differences were found in the security of attachment of infants of HIV-positive versus HIV-negative mothers. Infants of HIV-positive mothers with Acquired Immunodeficiency Syndrome (AIDS) were less securely attached than infants of mothers without AIDS. These findings underscore the relationship of infant security of attachment to maternal HIV infection in the presence of AIDS-related symptoms but not to asymptomatic maternal HIV infection.     

Sleep patterns of co-sleeping and solitary sleeping infants and mothers: a longitudinal study

ObjectiveControversies exist regarding the impact of co-sleeping on infant sleep quality. In this context, the current study examined: (a) the differences in objective and subjective sleep patterns between co-sleeping (mostly room-sharing) and solitary sleeping mother–infant dyads; (b) the predictive links between maternal sleep during pregnancy and postnatal sleeping arrangement; (c) the bi-directional prospective associations between sleeping arrangement and infant/maternal sleep quality at three and six months postpartum.MethodsThe sample included 153 families recruited during pregnancy. Data were obtained in home settings during the third trimester of pregnancy and at three and six months postpartum. Mothers were asked to monitor their own sleep and their infants' sleep for five nights using actigraphy and sleep diaries. Questionnaires were used to assess sleeping arrangements, feeding methods, socio-demographic characteristics, and maternal depressive and anxiety symptoms.ResultsMothers of co-sleeping infants reported more infant night-wakings than mothers of solitary sleeping infants. However, none of the objective sleep measures was significantly different between co-sleeping and solitary sleeping infants, after controlling for feeding techniques. Co-sleeping mothers had significantly more objective and subjective sleep disturbances than mothers in the solitary sleeping group. Moreover, poorer maternal sleep during pregnancy and at three months postpartum predicted higher levels of co-sleeping at six months.ConclusionMothers of co-sleeping infants report more infant night-wakings, and experience poorer sleep than mothers of solitary sleeping infants. The quality of maternal sleep should be taken into clinical consideration when parents consult about co-sleeping.     

Antenatal mental representations about the child and mother–infant interaction at three months post partum

OBJECTIVE: To study the predictive value of antenatal maternal mental representations about the child for mother-infant interaction at three months after birth. PROBANDS: A total of 73 pregnant women attending a routine ultrasound examination during the third trimester, who agreed to return with their baby for the interaction study. METHODS: Antenatally a questionnaire for assessing maternal representations about the child was given to the mothers. Also, depression and pregnancy risk were assessed. At three months, mother and infant were video-taped during a 4-phase interaction. Interaction analysis was performed using the Munich Communication Diagnostic Scale. RESULTS: Overall maternal regulatory ability was predicted by a compound factor comprising the antenatal representations. Maternal interactive behavior was not predicted by antenatal representations about the child. Infant overall eye contact was predicted by maternal representations as was interaction readiness during the still-face period. Significant covariates were maternal age, education, parity and the Pregnancy Optimality Score as well as neurologic optimality of the infant. CONCLUSION: Antenatal maternal representations about the child predicted parental regulatory ability and infant interaction behavior especially during the still-face period.