The application of previewing: Preventive caregiver-infant psychoeducational groups—Part II

This paper proposes a model for caregiver-infant preventive group therapy designed to enhance perceptual skills in the area of development and self-awareness. The model provides for ten sessions involving a group of caregivers with relatively comparable interactional abilities. The initial session is devoted to ascertaining each caregiver's perception of her infant's development and to formulating a diagnostic profile. Subsequently, caregivers are instructed in various representational techniques that serve to enhance awareness of their own perceptions and of diverse infant manifestations. Using these representational skills, the group is then introduced to the techniques of previewing. Previewing refers to interactional sequences during which the caregiver relies upon her perceptions and predictions of imminent development to gradually acquaint the infant with specific maturational changes. Final sessions explore termination issues in terms of the dual forces of separation and intimacy that are encompassed by the developmental processes. This model can benefit highly adaptive caregivers, as well as those whose interaction with their infants is less than optimal.     

Specificity of infants' response to mothers' affective behavior

Mother-infant face-to-face interaction is central to infant socioemotional development. Little has been known about the mechanisms that mediate the mother's influence. Findings are reviewed from a series of laboratory studies that suggest the major functional components of a mother's behavior are its affective quality and its contingent relationship to her baby's behavior. Quality of mother's affective expression accounted for individual differences in the behavior of thirteen 7-month-old infants living in multiproblem families. Infants' response was specific to the type of affective expression mothers displayed. Flat, withdrawn maternal affective expression was associated with infant distress. Intrusive maternal expression was associated with increased gaze aversion. Lack of contingent responsiveness was common to all but four mothers. Findings suggest that withdrawn or intrusive maternal affective expression, together with lack of contingent responsiveness, may in part be responsible for the risk-status of infants in multiproblem families.     

Maternal Depression and Anxiety Across the Postpartum Year and Infant Social Engagement,Fear Regulation,and Stress Reactivity

ObjectiveTo examine the effects of maternal depression on infant social engagement, fear regulation, and cortisol reactivity as compared with maternal anxiety disorders and controls and to assess the role of maternal sensitivity in moderating the relations between maternal depression and infant outcome.MethodsUsing an extreme-case design, 971 women reported symptoms of anxiety and depression after childbirth and 215 of those at the high and low ends were reevaluated at 6 months. At 9 months, mothers diagnosed with a major depressive disorder (n = 22) and anxiety disorders (n = 19) and matched controls reporting no symptoms across the postpartum year (n = 59) were visited at home. Infant social engagement was observed during mother–infant interaction, emotion regulation was microcoded from a fear paradigm, and mother's and infant's cortisol were sampled at baseline, reactivity, and recovery.ResultsThe infants of depressed mothers scored the poorest on all three outcomes at 9 months—lowest social engagement, less mature regulatory behaviors and more negative emotionality, and highest cortisol reactivity—with anxious dyads scoring less optimally than the controls on maternal sensitivity and infant social engagement. Fear regulation among the children of anxious mothers was similar to that of the controls and their stress reactivity to infants of depressed mothers. Effect of major depressive disorder on social engagement was moderated by maternal sensitivity, whereas two separate effects of maternal disorder and mother sensitivity emerged for stress reactivity.ConclusionsPathways leading from maternal depression to infant outcome are specific to developmental achievement. Better understanding of such task-specific mechanisms may help devise more specifically targeted interventions.     

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 difficultness 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 difficultness, 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.     

The emergence of psychopathology in a previously adaptive mother-infant dyad

A mother and her six-week-old infant began attending group therapy sessions designed to raise awareness of developmental events. The mother consistently displayed a high degree of responsiveness and sensitivity to the infant's needs; in fact, her behavior served as a model of adaptive interaction for the entire group. After six months of sessions, when the infant manifested full-blown weaning patterns, the mother reported symptoms indicating a major depressive episode, such as pervasive dejection and rejection, listlessness, and anxiety attacks. After several individual sessions, during which discussion focused on the etiology of these emotions, the depression remitted and the mother was able to resume previous adaptive interaction designed to promote the infant's development. This case study reveals that highly adaptive parents may be susceptible to depression when developmental events that signify imminent separation from their infants or a similar dramatic change in their relationship occur.     

Handling newborn monkeys alters later exploratory,cognitive, and social behaviors

Touch is one of the first senses to develop and one of the earliest modalities for infant-caregiver communication. While studies have explored the benefits of infant touch in terms of physical health and growth, the effects of social touch on infant behavior are relatively unexplored. Here, we investigated the influence of neonatal handling on a variety of domains, including memory, novelty seeking, and social interest, in infant monkeys (Macaca mulatta; n = 48) from 2 to 12 weeks of age. Neonates were randomly assigned to receive extra holding, with or without accompanying face-to-face interactions. Extra-handled infants, compared to standard-reared infants, exhibited less stress-related behavior and more locomotion around a novel environment, faster approach of novel objects, better working memory, and less fear towards a novel social partner. In sum, infants who received more tactile stimulation in the neonatal period subsequently demonstrated more advanced motor, social, and cognitive skills—particularly in contexts involving exploration of novelty—in the first three months of life. These data suggest that social touch may support behavioral development, offering promising possibilities for designing future early interventions, particularly for infants who are at heightened risk for social disorders.     

Neural mechanisms of joint attention in infancy

One of the key transitions in early cognitive development is from participating in face-to-face interactions to engaging in joint attention exchanges. It is known that the ability to jointly attend with another person to an object is essential for the development of abilities such as language in later life. Strikingly, little is known about the function of joint attention in infants in the first year. We developed a novel interactive-live paradigm to assess the neural mechanisms of joint attention in 9-month-old infants. An adult interacted with each infant, and infants' electrical brain activity was measured in two contexts. In the joint attention context, a live adult gazed at the infants' face and then to a computer displayed novel object. In the non-joint attention context the adult gazed only to the novel object. We found that the negative component of the infant event-related potential (ERP), a neural correlate indexing attentional processes, was enhanced in amplitude during the processing of objects when infants were engaged in a joint attention interaction compared to a non-joint attention interaction. These results suggest that infants benefit from joint attention interactions by focusing their limited attentional resources to specific aspects of the surrounding environment.     

MOTHER-INFANT RELATIONS, CONFLICT, STRESS AND ILLNESS AMONG FREERANGING CHIMPANZEES

In a naturalistic study in the Gombe National Park, Tanzania, five chimpanzee mothers with offspring under 24 months of age were observed. Earlier studies have shown that young chimpanzees pass through distinct periods of developmental reorganization and that these episodes are characterized by regressive behaviour. The episodes in turn trigger changes in the mother and mother-infant conflict, which then lead to the infant developing a new level of independence. Monthly observations were made of mother-infant interactions before and during the illness of two infants. Using a measure of the attachment system which controls the regulation of proximity between mother and infant, it was possible to quantify a stressor in the mother-infant interaction when this proximity-control system was overstretched. When a labile developmental transition period occurred in addition to this stress, two of the infants became ill. The curve quantifying the proximity-control system seems to be self-corrective. Illness occurred between the age at which the discrepancy from the 'target curve' was maximal and the age at which the curve returned to the normal range.     

Comparative anatomical assessment of the piglet as a model for the developing human medullary serotonergic system

Because the piglet is frequently used as a model for developmental disorders of the medullary serotonergic (5-HT) system in the human infant, this review compares the topography and developmental profile of selected 5-HT markers between humans in the first year of life and piglets in the first 60 days of life. The distribution of tryptophan hydroxylase-immunoreactive 5-HT neurons in the human infant medulla is very similar, but not identical, to that in the piglet. One notable difference is the presence of compact clusters of 5-HT neurons at the ventral surface of the piglet medulla. While it lacks these distinctive clusters, the human infant medulla contains potentially homologous 5-HT neurons scattered along the ventral surface embedded in the arcuate nucleus. Each species shows evidence of age-related changes in the 5-HT system, but the changes are different in nature; in the human infant, statistically significant age-related changes are observed in the proportional distribution of medullary 5-HT cells, while in the piglet, statistically significant age-related changes are observed in the levels of 5-HT receptor binding in certain medullary nuclei. Analyses of 5-HT receptor binding profiles in selected nuclei in the two species suggest that the equivalent postnatal ages for 5-HT development in piglets and human infants are, respectively, 4 days and 1 month, 12 days and 4 months, 30 days and 6 months, and 60 days and 12 months. Collectively, when certain species differences are considered, these data support the use of the piglet as a model for the human infant medullary 5-HT system.     

Intervention for Infants at Risk of Developing Autism: A Case Series

Theory and evidence suggest the potential value of prodromal intervention for infants at risk of developing autism. We report an initial case series (n = 8) of a parent-mediated, video-aided and interaction-focused intervention with infant siblings of autistic probands, beginning at 8–10 months of age. We outline the theory and evidence base behind this model and present data on feasibility, acceptability and measures ranging from parent-infant social interaction, to infant atypical behaviors, attention and cognition. The intervention proves to be both feasible and acceptable to families. Measurement across domains was successful and on larger samples promise to be an effective test of whether such an intervention in infancy will modify emergent atypical developmental trajectories in infants at risk for autism.     

Previewing: a preventive strategy that promotes adaptive development

The phenomenon of previewing, evident from observations of mother-infant interaction, represents a unique process for understanding the evolution of relational patterns in individuals. Previewing refers to the process whereby mothers first anticipate developmental acquisitions in their infants and subsequently convert these expectations into behaviors designed to acquaint the infant with the experience of new maturational skill and the implications these skills will have on the dyadic relationship. Previewing signifies a distinctive means of approaching the etiology of human behavior because it integrates the subjective perceptions experienced by the mother with the objective behaviors that are an outgrowth of these internal representations. Understanding the previewing process may offer therapists a new technique for diagnosing, treating, and preventing psychopathology. The diagnostic potential of previewing lies in the fact that the therapist can contrast the mother's subjective perceptions with her behavioral manifestations and with the objective developmental changes exhibited by the infant. In addition, by encouraging the mother to predict how upcoming developmental events will affect the interpersonal relationship she shares with the infant, the therapist gains access to unrehearsed material that has not yet been subjected to the defensive operations. As a treatment technique, previewing fosters the predictive capacities of both mother and infant, thereby instilling feelings of mastery over the interpersonal challenges posed by developmental change.     

Parent-infant interaction in infant siblings at risk of autism

Recent models of the early emergence of autism spectrum disorder (ASD) propose an interaction between risk susceptibility and the infant's social environment, resulting in a progressively atypical developmental trajectory. The infant's early social environmental experience consists mostly of interaction with caregivers, yet there has been little systematic study of early parent-infant interaction in infants at risk of ASD. This study examined the global characteristics of parent-infant interaction in 6- to 10-month-old infants with an older sibling diagnosed with ASD (at-risk sibs), in comparison with a group of infants with no family history of ASD (low-risk sibs). As part of the British Autism Study of Infant Siblings (BASIS), 6-min videotaped unstructured play interactions of mother-infant dyads (45 at-risk sibs and 47 low-risk sibs) were rated on global aspects of parent-infant interaction, blind to participant information. Differences in global characteristics of interaction were observed in both infant and parent contributions in the at-risk group compared to low-risk controls. In analyses adjusted for age and developmental level, at-risk sib infants were less lively, and their parents showed higher directiveness, and lower sensitive responding (as a trend after adjustment). Level of infant liveliness was independent of other interactive behaviour. Consistent with reports in previous literature in older children with autism and in other neurodevelopmental disorders, our findings may suggest that infants at genetic risk are exposed to a more directive interactive style relatively early in infancy. We discuss possible explanations for these findings and implications for further developmental study and intervention.     

Responses to infant-directed singing in infants of mothers with depressive symptoms

This study explored responses to infant-directed (ID) singing in infants of mothers with and without depressive symptoms under two conditions: mother sings to infant, and stranger sings to infant. Sixteen, 3–9-month-old infants of mothers with depression were matched by age and gender to sixteen infants of mothers without depression. Infant gaze responses toward each singer were coded from video and ranged from most negative to most positive, in the order of roaming, averted, neutral, intermittent and sustained. Mothers’ depression status had no effect on infant gaze response toward ID singing from mother or stranger. During ID singing from mother, infants displayed high levels of either neutral or sustained gaze. In response to ID singing from strangers, infants demonstrated sustained gazes more than any other gaze type. Infants also showed significantly more roaming and neutral gaze toward mother than stranger, and used significantly more averted and sustained gaze with stranger than mother. Findings indicate that infants of depressed mothers did not display a depressed interaction style with their mother or with a stranger during ID singing. Additionally, infants in both groups appeared capable of discriminating their mother from a stranger. ID singing appears to enhance face-to-face interaction such that infants can experience self-regulation, even when mothers have depression. Findings support the idea of combining ID singing and interaction coaching as a therapeutic intervention for mothers with depression and their infants.     

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.     

The availability of normative data for the Developmental Behaviour Checklist for Adults

There are measurable differences in the information processing abilities of babies during the first year. Some at-risk infants show pronounced deficits in attention, discrimination and memory processes. Since successful learning relies on skilful information processing, assessment of cognitive functioning during infancy may hold the key to early detection of developmental disabilities, greater accuracy in prediction of later intellectual disability and more specific early interventions. This paper discusses relevant research outcomes in two areas: firstly, experimental studies of perceptual-cognitive development and related work directed to the assessment of infant intelligence, and secondly, naturalistic observation of the exploratory patterns of infants during “free-play”. Controversy has accompanied infant intelligence research, particularly the development of the first standardised infant test based on an information processing approach (the Fagan Test of Infant Intelligence), but empirical support for its predictive validity and clinical usefulness is stronger than for conventional scales of infant development. The techniques used in experimental research and naturalistic observation offer the potential to identify specific processing deficiencies during infancy. The area is promising for those concerned with early identification and intervention with infants at-risk for developmental disability.     

Accentuate or repeat? Brain signatures of developmental periods in infant word recognition

Language acquisition has long been discussed as an interaction between biological preconditions and environmental input. This general interaction seems particularly salient in lexical acquisition, where infants are already able to detect unknown words in sentences at 7 months of age, guided by phonological and statistical information in the speech input. While this information results from the linguistic structure of a given language, infants also exploit situational information, such as speakers' additional word accentuation and word repetition. The current study investigated the developmental trajectory of infants' sensitivity to these two situational input cues in word recognition. Testing infants at 6, 9, and 12 months of age, we hypothesized that different age groups are differentially sensitive to accentuation and repetition. In a familiarization–test paradigm, event-related brain potentials (ERPs) revealed age-related differences in infants' word recognition as a function of situational input cues: at 6 months infants only recognized previously accentuated words, at 9 months both accentuation and repetition played a role, while at 12 months only repetition was effective. These developmental changes are suggested to result from infants' advancing linguistic experience and parallel auditory cortex maturation. Our data indicate very narrow and specific input-sensitive periods in infant word recognition, with accentuation being effective prior to repetition.     

Living the Theory: The Complexity of Being Both a Psychodynamic Psychotherapist and a Mother

Abstract

Psychodynamic psychotherapists through their vocational training, and especially through developmental and psychoanalytic theories, are exposed to intense discursive and theoretical models of ideal motherhood and child development that they use to inform their therapeutic practice. In this article, nine psychodynamic psychotherapist-mothers are interviewed to examine how the identities of psychotherapist and mother shape, enrich, and conflict with one another. The results of these interviews suggest that the identity shifts involved in becoming a mother are continuous and that—alongside the negotiation of the relational demands of an infant—, psychotherapist-mothers experience transitions in their relationships to theory. The voice of theory was found to act as both an analytic and/or anti-analytic third. The experience appears to be one of the constantly evolving re-integration. Overall, the challenge for psychotherapist-mothers is to reflect on their relationships to theory, in order to acknowledge and explore those aspects that feel punitive and those that feel helpful.     

Experimental protocols for investigating relationships among mother-infant interaction, affect regulation, physiological markers of stress responsiveness, and attachment

Gergely and Watson's (1996) social biofeedback theory of parental affect mirroring applies the conditional probability model of contingency perception to parent-child interactions. Infants are first evaluated at birth on neurological and temperament measures. Infants are also evaluated at 6 and 12 months on tasks that study social interactional determinants, infant attachment, and physiological reactions. The Strange Situation is completed at 12-15 months of age. The authors describe how the combination of these experimental and observational procedures allows specific developmental hypotheses to be investigated about the quality of contingent parental affect regulation, sensitivity to internal states, and security of attachment.     

Three physiological responses in fathers and non-fathers’ to vocalizations of typically developing infants and infants with Autism Spectrum Disorder

Children with ASD, even before receiving a formal diagnosis, express atypical patterns of distress vocalizations (namely, episodes of crying). Their cries have higher fundamental frequencies, shorter inter-bout pauses, and fewer utterances. Cries of children with ASD are also perceived differently from other cries, and these perceptual differences may alter parent–infant interaction. This study assessed multiple physiological responses in fathers and non-fathers to atypical distress vocalizations (cries of children with ASD), acoustically matched typical distress vocalizations (cries of typically developing children), and positive vocalizations (laughter of typically developing children). The experimental procedures were designed to measure how components of the autonomic nervous system respond to typical and atypical infant vocalizations. Three convergent methodologies (Galvanic Skin Response—GSR; cardiac dynamics via Inter-Beat Interval—IBI; right hand temperature change—RHTC) were performed on two groups with contrasting caregiving experience: fathers of typically developing children (n = 10) and non-fathers (n = 10). Inferential statistical analysis compared the two groups (fathers, non-fathers) and three stimulus types (ASD cry, typical cry, laughter) for the three measures (GSR, IBI, RHTC). Both fathers and non-fathers showed greater negative responses (increased GSR) to ASD cries compared to typical cries and laughter. Fathers showed higher IBI and greater temperature increases (RHTC) than non-fathers while listening to typical and atypical cries. Fathers and non-fathers showed more emotional arousal mediated by sympathetic activation while listening to cries of children with ASD. Fathers were calmer and acted more promptly than non-fathers while listening to typical cries, perhaps because the fathers had more experience in caring for crying infants. These findings point to similarities and differences in fathers’ and non-fathers’ physiological responsiveness to cries of children with ASD and might guide specific intervention programs for parents of children at risk of ASD.