Miri Keren

Maternal representations, infant psychiatric status, and mother–child relationship in clinic-referred and non-referred infants

To examine the relations between maternal representations, infant socio-emotional difficulties, and mother–child relational behavior, 49 clinic-referred infants and their mothers were compared to 30 non-referred controls. Clinic-referred infants’ psychiatric status was determined with the DC 0-3-R classification of Zeanah and Benoit (Child Adolesc Psychiatry Clin N Am 4:539–554, 1995) and controls were screened for socio-emotional difficulties. Mothers were interviewed with the parent development interview (Aber et al. in The parent development interview. Unpublished manuscript, 1985) and dyads were observed in free play and problem-solving interactions. Group differences emerged for maternal representations and relational behaviors. Representations of clinic-referred mothers were characterized by lower joy, coherence, and richness, and higher anger experienced in the mother–infant relationship compared to controls. During free play, clinic-referred mothers showed lower sensitivity and higher intrusiveness and provided less adequate instrumental and emotional assistance and support during problem solving. Referred children showed lower social engagement during free play. Associations were found among maternal representations, maternal interactive behavior, child social engagement, and the child’s ability to self-regulate during a challenging task. These findings provide empirical support for theoretical and clinical perspectives suggesting a reciprocal link between maternal negative representations and mother and child’s maladaptive behaviors in the context of early socio-emotional difficulties and mental health referrals.

The experience of premature birth for fathers: the application of the Clinical Interview for Parents of High-Risk Infants (CLIP) to an Italian sample.

Aim: The study explored fathers’ experience of premature birth during the hospitalization of their infants, analyzing levels of depressive and anxiety symptoms as compared with mothers. Moreover the Italian version of the Clinical Interview for Parents of High-Risk Infant (CLIP) was tested through confirmatory factor analysis. Methods: Couples of parents (N = 64) of preterm infants (gestational age < 37 weeks) were administered a socio-demographic questionnaire, the Edinburgh Postnatal Depression Scale, the State-Trait Anxiety Inventory and the CLIP after the admission to the Neonatal Intensive Care Unit (NICU). Results: Significant levels of anxiety and depressive symptoms and high percentages of subjects above the corresponding risk thresholds were found among fathers and mothers with higher scores among the latters. Confirmatory factor analysis of the CLIP showed an adequate structure, with better fit for mothers than for fathers. Conclusion: Results highlighted the importance for nurses and clinicians working in the NICU to consider not only the maternal difficulties but also the paternal ones, even if these are often more hidden and silent. In addition the CLIP may be considered an useful interview for research and clinical purposes to be used with parents of high-risk infants.

Family Functioning and Interactive Patterns in the Context of Infant Psychopathology

Family functioning and mother-infant relational patterns were examined in 38 clinic-referred infants and 34 matched non-referred infants. Referred infants were diagnosed with the Diagnostic Classification for Zero to Three. On the family level, referred families showed significantly lower family functioning in all domains of emotional and instrumental communication, regardless of the specific infants diagnoses. On the dyadic level, referred mothers were more intrusive and their infants were more withdrawn during dyadic interactions. Clinic-referred mothers reported higher levels of phobia and depression. Global family functioning was predicted by the infants clinical status, maternal intrusiveness, and maternal psychopathology. Infant mental health clinicians need to address both family level and dyadic level of functioning, regardless of the reason for the infants referral.

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.

Interaction and behaviour imaging: a novel method to measure mother–infant interaction using video 3D reconstruction

Studying early interaction is essential for understanding development and psychopathology. Automatic computational methods offer the possibility to analyse social signals and behaviours of several partners simultaneously and dynamically. Here, 20 dyads of mothers and their 13–36-month-old infants were videotaped during mother–infant interaction including 10 extremely high-risk and 10 low-risk dyads using two-dimensional (2D) and three-dimensional (3D) sensors. From 2D+3D data and 3D space reconstruction, we extracted individual parameters (quantity of movement and motion activity ratio for each partner) and dyadic parameters related to the dynamics of partners heads distance (contribution to heads distance), to the focus of mutual engagement (percentage of time spent face to face or oriented to the task) and to the dynamics of motion activity (synchrony ratio, overlap ratio, pause ratio). Features are compared with blind global rating of the interaction using the coding interactive behavior (CIB). We found that individual and dyadic parameters of 2D+3D motion features perfectly correlates with rated CIB maternal and dyadic composite scores. Support Vector Machine classification using all 2D–3D motion features classified 100% of the dyads in their group meaning that motion behaviours are sufficient to distinguish high-risk from low-risk dyads. The proposed method may present a promising, low-cost methodology that can uniquely use artificial technology to detect meaningful features of human interactions and may have several implications for studying dyadic behaviours in psychiatry. Combining both global rating scales and computerized methods may enable a continuum of time scale from a summary of entire interactions to second-by-second dynamics.

Social signal processing for studying parent-infant interaction

Studying early interactions is a core issue of infant development and psychopathology. Automatic social signal processing theoretically offers the possibility to extract and analyze communication by taking an integrative perspective, considering the multimodal nature and dynamics of behaviors (including synchrony). This paper proposes an explorative method to acquire and extract relevant social signals from a naturalistic early parent–infant interaction. An experimental setup is proposed based on both clinical and technical requirements. We extracted various cues from body postures and speech productions of partners using the IMI2S (Interaction, Multimodal Integration, and Social Signal) Framework. Preliminary clinical and computational results are reported for two dyads (one pathological in a situation of severe emotional neglect and one normal control) as an illustration of our cross-disciplinary protocol. The results from both clinical and computational analyzes highlight similar differences: the pathological dyad shows dyssynchronic interaction led by the infant whereas the control dyad shows synchronic interaction and a smooth interactive dialog. The results suggest that the current method might be promising for future studies.

Mother-Child Interaction as a Window to a Unique Social Phenotype in 22q11.2 Deletion Syndrome and in Williams Syndrome.

Mother-child interactions in 22q11.2 Deletion syndrome (22q11.2DS) and Williams syndrome (WS) were coded for maternal sensitivity/intrusiveness, child’s expression of affect, levels of engagement, and dyadic reciprocity. WS children were found to express more positive emotions towards their mothers compared to 22q11.2DS children and those with developmental delay in a conflict interaction. During the same interaction, dyads of 22q11.2DS children were characterized by higher levels of maternal intrusiveness, lower levels of child’s engagement and reduced reciprocity compared to dyads of typically developing children. Finally, 22q11.2DS children with the COMT Met allele showed less adaptive behaviors than children with the Val allele. Dyadic behaviors partially coincided with the distinct social phenotypes in these syndromes and are potential behavioral markers of psychopathological trajectory.

Maternal Representations and Mother-Infant Relational Behavior Following Parent-Infant Psychotherapy

To examine how relational behavior and maternal representations are manifested before and after parent-infant psychotherapy, mothers’ and infants’ behaviors and maternal narratives were assessed in 45 clinic-referred dyads who participated in psychodynamically informed parent-infant psychotherapy. Pretreatment and posttreatment assessments included observations of mothers’ and infants’ behaviors (CIB; Feldman, 1998) and assessment of maternal representations (PDI; Aber, Slade, Berger, Bresgi, & Kaplan, 1985). Parent-infant psychotherapy consisted of weekly child-mother, child-father, and two parents’ sessions. Following psychotherapy, maternal sensitivity and child engagement showed a significant increase. An increase was also evidenced in the richness of maternal narratives regarding the mother-infant relations. During the pretreatment assessment, maternal intrusiveness was associated with restricted narratives, lack of joyful descriptions, and reduced coherence and child engagement was associated with maternal narratives characterized by incoherence and reduced joy. Maternal reports of high psychological distress were associated with higher maternal intrusiveness and lower maternal sensitivity following psychotherapy. Discussion focuses on the unique opportunities for infants in parent-infant psychotherapy as well as the need for further understanding of the processes underpinning change following this treatment modality.

Application of core concepts in developmental psychopathology to the understanding of pathways of aggression and violence from infancy to adulthood

 Psychiatric disorders can start at a very young age, though prevalence of specific disorders change over time. Consequently, any study of continuities and discontinuities should start in infancy, and core concepts of developmental psychopathology are useful for understanding the data. Violence is a major societal problem, while the most effective intervention is to prevent the developmental, normative aggression in very early childhood, from turning into conduct disorders and antisocial personality disorders later in life. The aims of this study were to apply the core concepts of developmental psychopathology to the understanding of the data about how developmental aggression in infancy may turn into pathological violence and conduct disorders in childhood and then into psychopathology in adulthood.

Does the portal of entry determine our view? Interfaces between dyadic and three‐way assessment of a clinical family transitioning to parenthood

The purpose of this interface was to explore the influences of dyadic and three-way observation on clinical assessment of young families. Three independent clinicians observed a clinically referred family using semistructured play paradigms, each with only a limited view of the family. One had only the data on dyadic interactions, the second only had data on the family triad, and the third observed both the dyads and the triad. Interactions were scored using standardized measures as well as the clinical impressions of the three practitioners. The various ports of entry yielded similar impressions in some instances, but each port also provided a richness of information not available from the other portal. Clinical implications are discussed, including not only the benefits of each port for assessment but also the implications for therapy in this case example.