Jaqueline Wendland

Depression During Pregnancy: Is the Developmental Impact Earlier in Boys? A Prospective Case-Control Study

OBJECTIVE Animal studies have shown sex differences in the impact of prenatal maternal stress on the offspring. The aim of this prospective case-control study was to assess the effect of prenatal depression on newborn and 1-year-old infant characteristics as related to gender, controlling for confounding variables. METHOD We screened 205 pregnant women from April 2004 to November 2006 for depressive symptoms. Inclusion in the prenatal depression group (n = 34) was based on meeting DSM-IV criteria for major depressive episode. We excluded postnatal depression from the control group (n = 79) by routine screening at 2 and 6 months. Newborn and 1-year-old infant characteristics were evaluated with the Neonatal Behavioral Assessment Scale (NBAS) and the Infant-Toddler Social and Emotional Assessment, respectively. RESULTS Despite our use of numerous exclusion criteria (eg, at-risk pregnancy, preterm delivery), prenatal depression highly correlated with anxiety and stress scores. Male newborns of mothers with prenatal depression had lower scores than controls on the motor skills and regulation of states NBAS clusters (P = .03 and P = .026, respectively). At 1 year, infants of prenatally depressed mothers presented higher scores on generalized anxiety (P = .002), particularly in males (P = .009); activity/impulsivity (P = .042); and sleep problems (P = .023) than controls. CONCLUSIONS As in animal studies, depression during pregnancy may affect infant development in a way that is related to gender. Early gender differences observed to be associated with depression, stress, and anxiety during pregnancy may be a key to understanding the higher prevalence in males of child psychiatric disorders.

PHENOMENOLOGY, PSYCHOPATHOLOGY, AND SHORT-TERM THERAPEUTIC OUTCOME OF 102 INFANTS AGED 0 TO 12 MONTHS CONSECUTIVELY REFERRED TO A COMMUNITY-BASED 0 TO 3 MENTAL HEALTH CLINIC

Infants ages 0 to 1 year consecutively referred for psychiatric treatment during the year 2005 were followed, and variables associated with diagnosis and short-term outcome were assessed. Infants were evaluated using the Psychiatric Infant Navigator Chart and Evaluation that includes nosological diagnoses [Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood, (DC 0-3), Zero to Three, 1994] as well as risk and protective factors, treatment procedure, and outcomes. Seventy-six percent of the infants had an Axis I diagnosis, with anxiety disorders and a mixed disorder of emotional expressiveness being the most frequent. Twenty-five percent had an Axis II diagnosis. Multiple correspondence analyses showed that two dimensions corresponding grossly to DC 0-3 Axes I and II emerged. They emphasized three clinical profiles characterized by (a) good infant functioning, parents awareness of their own difficulties, and a good outcome; (b) moderate child symptoms, overinvolved relating, and a good/intermediate outcome; (c) severe child symptoms, underinvolved relating, and a less favorable short-term outcome, signaling the risk for developmental disorders. Among the associated risk factors were cumulative parental stress, maternal psychopathology, and family dysfunction. Clinical implications of these findings indicated that infants under the age of 1 year who are referred for mental health evaluation and intervention are a heterogeneous group in terms of both severity and prognosis. Clinicians should differentiate subgroups of young children to detect those infants at risk for persistent psychopathology.

French Version of the Brief Infant-Toddler Social and Emotional Assessment Questionnaire–BITSEA

OBJECTIVE The aim of the present study was to examine the psychometric properties of the French version of the Brief Infant-Toddler Social and Emotional Assessment (BITSEA). METHODS The sample consisted of 589 low-risk infants aged 12-36 months and their parents. Parents completed the BITSEA, the Child Behavior Checklist 1½-5 (CBCL - 18 months to 5 years version), and the Parenting Stress Index - Short Form (PSI-SF). RESULTS Multitrait-multimethod and confirmatory factor analyses revealed adequate psychometric properties for the French version of the BITSEA. Scores on the BITSEA Problem scale were positively correlated to all CBCL and PSI-SF subscales, whereas negative correlations were found between BITSEA Competence scale and CBCL and PSI-SF subscales. The BITSEA Problem score significantly increased with level of parental worry, examined through a single-item question that is part of the BITSEA. CONCLUSION Findings support the validity of the French version of the BITSEA. However, additional work on the clinical validity of the BITSEA, including with at-risk children, is warranted.

Maternal Burnout Syndrome: Contextual and Psychological Associated Factors

Background: Becoming a parent is one of the most significant experiences in a woman’s life. Including substantial and long-lasting mental, social, and physical charge, the parenting experience may also be a potentially stressful and overwhelming task. Since the eighties, the notion of parental burnout syndrome has gained increasing attention, but its contextual and psychological factors need to be better identified. Aims: To investigate a large array of contextual and psychological factors associated with maternal burnout syndrome in a French community-based population in order to contribute to better operationalize the notion of parental burnout and to explore its determinants. Method: A total of 304 French-speaking mothers (mean age = 34.8 years, SD = 6.72) completed a set of questionnaires including a sociodemographic form (in order to gather general information about the mothers, their spouses, and children living at home). The Perceived Stress Scale, the Maslach Burnout Inventory adapted to parents (MBI-parental), the Hospital Anxiety and Depression Scale, the Parental Stress Index-Short Form and the Ways of Coping Checklist were used in this study. Results: Multivariate linear regression analyses revealed that scores on the MBI-parental version were strongly and positively associated with depressive and anxiety symptoms, as well as with perceived stress related to parenthood and parenting stress levels. Moreover, using the task-oriented coping style in parenthood was strongly and positively associated with personal accomplishment. Conversely, some sociodemographic characteristics were found to be negatively associated with maternal burnout: being employed, working full time and being a mother living without a coparent. Conclusion: The construct of maternal burnout syndrome seems to be linked to a conjunction of psychological and contextual factors associated with maternal exhaustion. The implication of the results for prevention and intervention strategies are discussed.

Protecting the child while preserving the relationship: Using baby’s relational withdrawal to gauge the effect of parental visitation

The impact of children’s interactions with parents in the context of out-of-home placements is receiving much-needed cross-disciplinary attention. However, the paucity of instruments that can reliably represent young children’s experiences of such interactions precludes a nuanced evaluation of their impact on wellbeing and development. In response to this empirical gap, the present study investigates children’s relational withdrawal as a clinically salient, easily observable and conceptually valid measure of infants’ and toddlers’ responses to parents. Relational withdrawal, challenging behaviors and salivary cortisol were assessed before, during and after parental visits. Conceptually, the findings suggest that observations of relational withdrawal correlate meaningfully with measure of neurobiological reactivity. Clinically, three profiles of cross-variable responses in children appeared, distinguishing between groups that experience increased, decreased or unchanged levels of stress in response to parental visits. Taken together, the findings lend empirical support to systematic observations of relational withdrawal to bolster evaluations of young children’s experience of parental visitation during out-of-home placements.

Mother–child interactions in young children with excessive physical aggression and in typically developing young children

Background: Among the multiple risk factors, the emergence of conduct problems in young children may be linked to harsh parenting and child’s temperamental difficulties, leading to a reciprocal early discordant relationship. Little is known about the characteristics of early parent–child interactions in young children with physical aggression. Objective: The purpose of the current study was to evaluate the characteristics of mother–child interactions in dyads referred for excessive physical aggression in young children under 5 years of age compared to mother–child interactions in typically developing young children. Method: Mother–child interactions were assessed during a free-play session in both a clinical sample (N = 70, child mean age = 3.5 years) and a nonclinical sample (N = 80, child mean age = 3.5 years) by using the Rating Scale of Interaction Style (Clark and Seifer, adapted by Molitor and Mayes). Results: Significant differences were found between several interactive features in clinical and nonclinical dyads. In clinical dyads, mothers’ behaviors were often characterized by intrusiveness and criticism toward children, and poor facilitative positioning. Children with excessive aggressive behavior often displayed poor communication, initiation of bids, and poor responsiveness toward the mother. They displayed fewer sustained bouts of play than typically developing children did. In clinical dyads, strong positive correlations were found between child responsiveness and maternal interest in engagement (r = .41, p < .001), while the child displaying sustained bouts of play was negatively correlated with the mother’s attempts to intrude on the child’s activity (r = .64, p < .05). Conclusions: These data show that children with excessive aggressive behavior develop disrupted mother–infant interactions from a very young age. Several negative interactive features and correlations between child behavior and maternal behavior were found in clinical samples. The effects of these features add up and probably strengthen each other, thus leading to interactive difficulties from a very young age. More attention should be paid to early parent–child interactions in case of child behavioral problems. The recognition of these interactive dysfunctions is discussed in terms of clinical implications for therapeutic interventions.

Ambulatories Cares: Parent–Infant Psychotherapy in Perinatal Mental Health

The peripartum is a time of huge and sometimes overwhelming biological, psychological, and social upheaval for the parents and, in particular, for the future mother. Perinatal disorders affect not only the mother but also the developing child, the infants’ father and, to some extent, the whole family. Prevention and intervention strategies need therefore an integrated and shared work involving both adult and child perinatal health practitioners. Several types of preventive and therapeutic perinatal and parent–infant interventions have been developed over the past 40 years. Some of them aim at improving the quality of parenting and of the mother/parent–infant relationship, others at preventing or treating maternal perinatal distress/mental disorders (in particular depression) and its effects on the child, and others at dealing with infant early behavioral, somatic, and developmental symptoms or delays. In this chapter, we focus on general principles and different models of parent–infant psychotherapy, including psychodynamic and psychoanalytic, attachment-based, cognitive–behavioral, interaction-oriented, and infant-centered approaches, as well as manualized treatments and parent–infant co-therapy.