Loredana Lucarelli

Maternal psychopathology and child risk factors in infantile anorexia.

OBJECTIVE This study examines a transactional and multirisk model for Infantile Anorexia (IA) and investigates the contributions of the parent, the child, and dyadic interactional variables related to this feeding disorder. METHOD The sample consisted of 371 mother-child pairs (children aged 6-36 months), of which 187 pairs of mothers and normally developing children (ND-group), and 184 mothers and IA children. All dyads were videotaped during feeding; mothers completed questionnaires assessing their psychological profiles and eating attitudes, as well as their childrens temperament and emotional/ behavioral functioning. RESULTS Analyses revealed that the IA-group showed higher scores in symptomatic characteristics both of the mother and of the child, and dysfunctional interactions during feeding as compared with the ND-group. Further analyses revealed that both child and maternal characteristics are significant predictors of dyadic interactional conflict. DISCUSSION Results confirm that a multidimensional assessment is critical in the evaluation of IA.

Parenting stress, mental health, dyadic adjustment: A structural equation model

Objective: In the 1st year of the post-partum period, parenting stress, mental health, and dyadic adjustment are important for the wellbeing of both parents and the child. However, there are few studies that analyze the relationship among these three dimensions. The aim of this study is to investigate the relationships between parenting stress, mental health (depressive and anxiety symptoms), and dyadic adjustment among first-time parents. Method: We studied 268 parents (134 couples) of healthy babies. At 12 months post-partum, both parents filled out, in a counterbalanced order, the Parenting Stress Index-Short Form, the Edinburgh Post-natal Depression Scale, the State-Trait Anxiety Inventory, and the Dyadic Adjustment Scale. Structural equation modeling was used to analyze the potential mediating effects of mental health on the relationship between parenting stress and dyadic adjustment. Results: Results showed the full mediation effect of mental health between parenting stress and dyadic adjustment. A multi-group analysis further found that the paths did not differ across mothers and fathers. Discussion: The results suggest that mental health is an important dimension that mediates the relationship between parenting stress and dyadic adjustment in the transition to parenthood.

Perinatal Parenting Stress, Anxiety, and Depression Outcomes in First-Time Mothers and Fathers: A 3- to 6-Months Postpartum Follow-Up Study

Objective: Although there is an established link between parenting stress, postnatal depression, and anxiety, no study has yet investigated this link in first-time parental couples. The specific aims of this study were 1) to investigate whether there were any differences between first-time fathers’ and mothers’ postnatal parenting stress, anxiety, and depression symptoms and to see their evolution between three and 6 months after their child’s birth; and 2) to explore how each parent’s parenting stress and anxiety levels and the anxiety levels and depressive symptoms of their partners contributed to parental postnatal depression. Method: The sample included 362 parents (181 couples; mothers’ MAge = 35.03, SD = 4.7; fathers’ MAge = 37.9, SD = 5.6) of healthy babies. At three (T1) and 6 months (T2) postpartum, both parents filled out, in a counterbalanced order, the Parenting Stress Index-Short Form, the Edinburgh Postnatal Depression Scale, and the State-Trait Anxiety Inventory. Results: The analyses showed that compared to fathers, mothers reported higher scores on postpartum anxiety, depression, and parenting stress. The scores for all measures for both mothers and fathers decreased from T1 to T2. However, a path analysis suggested that the persistence of both maternal and paternal postnatal depression was directly influenced by the parent’s own levels of anxiety and parenting stress and by the presence of depression in his/her partner. Discussion: This study highlights the relevant impact and effects of both maternal and paternal stress, anxiety, and depression symptoms during the transition to parenthood. Therefore, to provide efficacious, targeted, early interventions, perinatal screening should be directed at both parents.

Prenatal and postnatal maternal representations in nonrisk and at-risk parenting: exploring the influences on mother-infant feeding interactions.

The aim of this study was to investigate the mother-infant relationship in depressive, psychosocial, and cumulative-risk parenting by assessing prenatal and postnatal maternal representations and mother-infant interactions during feeding at 4 months of age. The sample consisted of 167 mother-infant pairs: 41 nonrisk women, 40 depressive-risk women, 40 psychosocial-risk women, and 46 cumulative-risk women. During pregnancy, the women were interviewed about psychosocial-risk variables. Maternal representations and depressive symptoms were evaluated during pregnancy and again when the infants were 3 and 4 months old, respectively. All mother-infant pairs were observed in 20-min video recordings during breast-feeding. Maternal Integrated/balanced representations were more frequent in the nonrisk group whereas the maternal Nonintegrated/ambivalent category was more represented in the cumulative-risk group during pregnancy and after the infants birth. At 4 months, the cumulative-risk group of mothers and infants showed a lack of reciprocity, conflictual communicative exchanges, and higher food refusal behavior. Moreover, at 4 months, differences between the quality of mother-infant feeding interactions and the quality of prenatal and postnatal maternal representations emerged, showing less adequate maternal scaffolding in the Nonintegrated/ambivalent and Restricted/disengaged women. This study has rich implications for intervention to support the affective and communicative caregiving system and to prevent infant feeding problems and mother-infant relational disturbances in childhood.

Mother–Infant and Extra-Dyadic Interactions with a New Social Partner: Developmental Trajectories of Early Social Abilities during Play

Mother–infant interactions during feeding and play are pivotal experiences in the development of infants’ early social abilities (Stern, 1985, 1995; Biringen, 2000). Stern indicated distinctive characteristics of mother–infant interactions, respectively, during feeding and play, suggesting to evaluate both to better describe the complexity of such early affective and social experiences (Stern, 1996). Moreover, during the first years of life, infants acquire cognitive and social skills that allow them to interact with new social partners in extra-dyadic interactions. However, the relations between mother–child interactions and infants’ social skills in extra-dyadic interactions are still unknown. We investigated longitudinally the relations between mother–child interactions during feeding and play and child’s pre-verbal communicative abilities in extra-dyadic interactions during play. 20 dyads were evaluated at T1 (infants aged between 9–22 months) and 6 months later, at T2. The interdyadic differences in mother–infant interactions during feeding and play were evaluated, respectively, with the “Feeding Scale” (Chatoor et al., 1997) and with the “Play Scale” (Chatoor, 2006) and the socio-communicative abilities of children with a new social partner during play were evaluated with the “Early Social Communication Scales” (Mundy et al., 2003). We distinguished the dyads into two categories: dyads with functional interactions (high dyadic reciprocity, low dyadic conflict) and dyads with dysfunctional interactions (lower dyadic reciprocity, higher dyadic conflict). At T1, infants belonging to dyads with dysfunctional interactions were significantly lower in “Initiating Joint Attention” and in “Responding to Joint Attention” in interaction with a new social partner compared to the infants belonging to dyads with functional interactions. At T2, infants belonging to dyads with dysfunctional interactions were significantly lower in “Initiating Social Interactions” with a new social partner compared to the infants belonging to dyads with functional interactions. There were significant correlations between the quality of mother–infant interactions during feeding and infants’ social abilities in interaction with a stranger both at T1 and at T2. This study showed a stable relation over time between mother–child interactions and child’s social communicative skills in extra-dyadic interactions.

Infantile Anorexia and Co-parenting: A Pilot Study on Mother–Father–Child Triadic Interactions during Feeding and Play

Infantile Anorexia (IA), defined by the Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood Revised (DC: 0-3R, Zero To Three, 2005), occurs when the child (a) refuses to eat adequate amounts of food for at least 1 month, and shows growth deficiency, (b) does not communicate hunger and lacks interest in food, and (c) the child’s food refusal does not follow a traumatic event and is not due to an underlying medical illness. IA usually emerges during the transition to self-feeding, when the child issues of autonomy are played out daily in the feeding situation. Studies evidence that the feeding interactions between children with IA and their mothers are characterized by low reciprocity, greater interactional conflict and negative affects (Chatoor et al., 2000; Ammaniti et al., 2010, 2012). Moreover, these studies pointed out that maternal depression and eating disorders are frequently associated with IA (Cooper et al., 2004; Ammaniti et al., 2010; Lucarelli et al., 2013). To date, research has focused almost exclusively on the mother–child dyad, while fathers’ involvement, co-parental and family interactions are poorly studied. The current study is a pilot research that investigated mother–father–child triadic interactions, during feeding and play, in families with children diagnosed with IA, in comparison to families with normally developing children. Until now, at the study participated N = 10 families (five with a child with IA diagnosis and five with lack of child’s IA diagnosis, matched for child’s age and gender). The parents–child triadic interactions were assessed in feeding and play contexts using the Lausanne Trilogue Play (Fivaz-Depeursinge and Corboz-Warnery, 1999), adapted to observe father-mother-infant primary triangle in the feeding context, compared to the play context (Lucarelli et al., 2012). Families of the IA-group showed difficulties in expressing and sharing pleasure and positive affects, and in structuring a predictable and flexible context. Children showed little autonomy and difficulty in being actively engaged and tune with parents. Dysfunctional family interactions are a critical issue for IA that affects co-parental and family subsystems, stressing the importance of an articulated diagnostic assessment in order to target effective treatment approaches.

Comorbidity in specific language disorders and early feeding disorders: mother-child interactive patterns

OBJECTIVE: This empirical study has its main object in highlighting the role of mother-child interactive experiences in the development of affective and communicative exchanges in infancy. METHODS: The study analyzed four groups of mother-child couples with children who presented a Specific Language Disorder (SLD) the first, a Feeding Disorder (FD) the second, the third an association of SLD and FD, and a fourth non clinical group. Diagnostic assessments were done through: a specific linguistic protocol, the Italian version of the Feeding Scale-Observational Scale for Mother-Infant Interactions during Feeding, specific psychodiagnostic questionnaires for mothers and children. CONCLUSION: A distortion in the communication area can significantly weigh upon the quality of infant-caregiver relationship: our data on mothers of children with a SLD/FD comorbidity confirm this finding by describing their children as prone to isolation and withdrawal, thus directing their efforts and worries to a specifically communicative and relational factor.

Fear of childbirth in primiparous Italian pregnant women: The role of anxiety, depression, and couple adjustment

BACKGROUND The prevalence of fear of childbirth in pregnant women is described to be about 20-25%, while 6-10% of expectant mothers report a severe fear that impairs their daily activities as well as their ability to cope with labour and childbirth. Research on fear of childbirth risk factors has produced heterogeneous results while being mostly done with expectant mothers from northern Europe, northern America, and Australia. AIMS The present research investigates whether fear of childbirth can be predicted by socio-demographic variables, distressing experiences before pregnancy, medical-obstetric factors and psychological variables with a sample of 426 Italian primiparous pregnant women. METHODS Subjects, recruited between the 34th and 36th week of pregnancy, completed a questionnaire packet that included the Wijma Delivery Expectancy Questionnaire, the Edinburgh Postnatal Depression Scale, the State-Trait Anxiety Inventory, the Dyadic Adjustment Scale, the Multidimensional Scale of Perceived Social Support, as well as demographic and anamnestic information. Fear of childbirth was treated as both a continuous and a dichotomous variable, in order to differentiate expectant mothers as with a severe fear of childbirth. FINDINGS Results demonstrate that anxiety as well as couple adjustment predicted fear of childbirth when treated as a continuous variable, while clinical depression predicted severe fear of childbirth. CONCLUSIONS Findings support the key role of psychological variables in predicting fear of childbirth. Results suggest the importance of differentiating low levels of fear from intense levels of fear in order to promote adequate support interventions.

Stati mentali materni di ostilità e impotenza e qualità dell’interazione diadica in un gruppo di bambini a rischio di maltrattamento

La ricerca ha coinvolto 20 coppie madre-bambino a rischio di maltrattamento al fine di verificare se stati mentali materni ostili-impotenti influenzano la qualita dei pattern interattivi. Alle madri e stata somministrata l’AAI e ai trascritti e stato poi applicato il Sistema di Codifica degli Stati Mentali di Ostilita e Impotenza (HH); inoltre, e stata effettuata un’osservazione videoregistrata di scambi diadici. I risultati evidenziano una prevalenza di modelli insicuri (55%) e disorganizzati (35%). Il 40% delle madri presenta uno stato mentale ostile-impotente che influenza la qualita interattiva: nella relazione con il figlio, esse mostrano comportamenti intrusivi (t = 2,71; p < 0,01) e affetti negativi (t = 2,68; p < 0,01). I dati confermano che stati mentali ostili-impotenti compromettono la qualita dell’interazione diadica, con importanti implicazioni legate ad una genitorialita di tipo abusivo.

Classificazione e assessment dei disturbi del sonno infantile: studio empirico sui fattori di rischio nella relazione di caregiving e nello sviluppo emotivo-comportamentale del bambino

Nella cornice teorica e di ricerca della Classificazione Diagnostica: 0-3, nella sua ultima revisione, gli Autori presentano uno studio empirico sui disturbi del sonno nella prima infanzia, indagando i fattori di rischio nella relazione di caregiving e nello sviluppo emotivo del bambino. Metodologia: in un gruppo di madri e di bambini con problemi del sonno (N=25) e un gruppo di controllo (N=25) sono state valutate le interconnessioni tra distress e sintomi depressivi materni, qualita dei pattern interattivi madre-bambino al momento dell’addormentamento, problemi del sonno infantile e funzionamento emotivo del bambino. Risultati: i risultati hanno messo in luce dati empirici in linea con le ricerche che evidenziano fattori di rischio co-occorrenti, che includono stili interattivi disfunzionali, affetti depressivi materni e una comorbilita tra problemi del sonno e problemi emotivi che possono essere predittivi di attuali e successive difficolta di adattamento del bambino. Conclusioni: la metodologia di screening proposta offre evidenze empiriche per pianificare programmi di prevenzione e di sostegno allo sviluppo e alla enitorialita.