Infant mental health and variability of parental depression symptoms.

OBJECTIVE: To examine the course of mothers' depression symptoms in association with child and family functioning beyond that explained by diagnostic status. METHOD: A longitudinal high-risk design with 16 months of course-of-illness follow-up was used. Structured clinical and family interviews, direct observation of child social-emotional competence, and parent reports of child behavior problems were included. RESULTS: Parameters of maternal symptom patterns across time were associated with child and family functioning. Most of these effects remained when presence/absence of major depression diagnosis was covaried. CONCLUSIONS: The trajectory of symptoms over time is important to consider in studies of children at risk and may also help to inform how illness in infancy and early childhood is conceptualized.

Developmental systems and psychopathology.

Efforts to understand the etiology of adult mental disorders by studying children has produced unanticipated changes in our understanding of pathology, individual development, and the role of social context. Among these are the blurring of the division between mental illness and mental health, the need to attend to patterns of adaptation rather than personality traits, and the powerful influences of the social world on individual development. Current developmental views place deviancy in the dynamic relation between individuals and their contexts. At another level, when we view the history of developmental psychopathology, dialectical developmental processes are evident as we trace how patterns of adaptation of researchers, expressed in theoretical models and empirical paradigms. increasingly have come to match the complexities of human mental health and illness.

Environmental risk factors in infancy.

Environment plays an important role in shaping development from the newborn period through adolescence. Many individual environmental risk factors may impinge on development (poverty, mental illness, minority status, and many others), but the most detrimental effects are caused when multiple risk factors act on a single infant. These effects were revealed by the Rochester Longitudinal Study, an ongoing comprehensive investigation of environmental risk factors, summarized in this article.

Academic and emotional functioning in early adolescence: longitudinal relations, patterns, and prediction by experience in middle school.

Adopting a motivational perspective on adolescent development, these two companion studies examined the longitudinal relations between early adolescents' school motivation (competence beliefs and values), achievement, emotional functioning (depressive symptoms and anger), and middle school perceptions using both variable- and person-centered analytic techniques. Data were collected from 1041 adolescents and their parents at the beginning of seventh and the end of eight grade in middle school. Controlling for demographic factors, regression analyses in Study 1 showed reciprocal relations between school motivation and positive emotional functioning over time. Furthermore, adolescents' perceptions of the middle school learning environment (support for competence and autonomy, quality of relationships with teachers) predicted their eighth grade motivation, achievement, and emotional functioning after accounting for demographic and prior adjustment measures. Cluster analyses in Study 2 revealed several different patterns of school functioning and emotional functioning during seventh grade that were stable over 2 years and that were predictably related to adolescents' reports of their middle school environment. Discussion focuses on the developmental significance of schooling for multiple adjustment outcomes during adolescence.

Infant temperament measured by multiple observations and mother report.

Observers and mothers rated infant behavior (n = 50) in the home on dimensions of temperament once a week for 8 weeks. Although week-to-week correlations were modest (intraclass correlations of .14-.36), aggregates of the 8 observations had high reliability for both observers and mothers. Mother reports were tied to our observation sessions by having mothers (a) rate their infants' behavior during the period when our observations were made and (b) use a questionnaire that mirrored the scoring system used for scoring the videotaped observation sessions. When direct observations were compared with mother reports (on the aggregated weekly reports and on 4 widely used questionnaires), little evidence of mother-observer correspondence was found. The interpretation of the large literature that has used maternal report is discussed, as well as the importance of direct observation of infant behavior when temperament is assessed.

Relations among maternal stress, cognitive development, and early intervention in middle- and low-SES infants with developmental disabilities.

Relations between maternal stress and the development of infants with handicaps was examined in 72 middle-SES and 72 low-SES families who attended a weekly early intervention program. Measures of maternal stress and development of infants were obtained 10 months apart. Regression analyses predicted 81% of variance in later developmental level with initial Bayley MA, initial Mental Development Index (MDI), SES, initial stress, early intervention participation, and SES x Initial Stress x Attendance interaction. Subsequent maternal stress was predicted (42% variance explained) by initial stress, attendance, initial MDI, number of intervention agencies and MDI x SES x Attendance. Results were interpreted in terms of a transactional model.

Stability of intelligence from preschool to adolescence: the influence of social and family risk factors.

Intelligence scores of children in a longitudinal study were assessed at 4 and 13 years and related to social and family risk factors. A multiple environmental risk score was calculated for each child by counting the number of high-risk conditions from 10 risk factors: mother's behavior, mother's developmental beliefs, mother's anxiety, mother's mental health, mother's educational attainment, family social support, family size, major stressful life events, occupation of head of household, and disadvantaged minority status. Multiple risk scores explained one-third to one-half of IQ variance at 4 and 13 years. The stability between 4- and 13-year environmental risk scores (r = .77) was not less than the stability between between 4- and 13-year IQ scores (r = .72). Effects remained after SES and race, or maternal IQ, were partialled; multiple risk was important in longitudinal prediction, even after prior measurement of child IQ was accounted for; the pattern of risk was less important than the total amount of risk present in the child's context.

Child and family factors that ameliorate risk between 4 and 13 years of age.

Protective processes in at-risk children between 4 and 13 years of age were examined in a longitudinal study. A multiple risk index was used at 4 years to identify 50 high-risk children and 102 who were at low risk. Cognitive and social-emotional status were measured at each time point. The following indicators of protective processes were related to positive change in cognitive and/or social-emotional function in the high-risk children between 4 and 13 years: mother-child interaction; child perceived competence, locus of control, life events, and social support; and maternal parenting values, social support, depression, and expressed emotion. Many of these factors were also related to improvement in the low-risk children. Some variables showed an interaction effect, where impact was substantially higher in the high-risk group compared with the low-risk group. The utility of multiple risk constructs and process oriented approaches to protective factors are discussed.

Positive effects of interaction coaching on infants with developmental disabilities and their mothers.

Modification of maternal responsivity was attempted in a study of the effects of interaction coaching. Twenty-three mothers and their infants with developmental disabilities participated in an interaction coaching component that consisted of six sessions of providing feedback to mothers about incidence of overstimulation observed on videotapes. Suggestions were given for ways to interact in a more contingently responsive manner. Compared with a control group of 17 mother-infant pairs, the interaction coaching group mothers increased responsibility and decreased stimulation. The infants were less fussy and performed better on standardized developmental assessments.

Family context in pediatric psychology: a transactional perspective.

The degree to which the family is seen as a significant contributor to child health conditions impacts directly on the successful functioning of the pediatric psychologist. A transactional model of family functioning is proposed for pediatric psychology. Development is considered to be the result of a three-part process that starts with child behavior that triggers family interpretation that produces a parental response. Family interpretation is presented as part of a regulatory system that includes family paradigms, family stories, and family rituals. Corresponding to the proposed three-part regulation model, three forms of intervention are discussed: remediation, redefinition, and reeducation. Clinical decision making based on this model is outlined with examples given from different treatment approaches. Implications for the treatment of families in pediatric psychology are discussed.

Intelligence quotient scores of 4-year-old children: social-environmental risk factors.

Verbal IQ scores in a socially heterogeneous sample of 215 4-year-old children were highly related to a cumulative environmental risk index composed of maternal, family and cultural variables. Different combinations of equal numbers of risk factors produced similar effects on IQ, providing evidence that no single factor identified here uniquely enhances or limits early intellectual achievement and that cumulative effects from multiple risk factors increase the probability that development will be compromised. The multiple risk index predicted substantially more variance in the outcome measure than did any single risk factor alone, including socioeconomic status. High-risk children were more than 24 times as likely to have IQs below 85 than low-risk children.

Defining environmental risk: multiple dimensions of psychological vulnerability.

Children participating in a longitudinal study of risk for serious mental disorder were assessed at 48 months of age. Six risk factors were defined: negative life events, e.g., illness/injury to the child; maternal hospitalizations, for all reasons; number of children in the family; maternal psychiatric status; maternal cognitive orientation toward child-rearing; and single-parent family. The results show that the number of risk factors is negatively related to social and intellectual adjustment; a rigid conforming maternal cognitive orientation is associated with diminished intellectual and social performance; maternal psychiatric status is associated with lessened social performance. Additionally, the combination of a rigid conforming maternal cognitive orientation with negative life events is associated with diminished social adjustment. A discussion examines these results in a context defined by developmental and crisis theory.

Familial risk and child competence.

Components of familial risk are examined in the context of a 4-year longitudinal study of children with mentally ill mothers. The risk factors examined are parental mental health, social status, parental perspectives, and family stress. The interactions among the risk factors were found to be complex in nature and different for child cognitive and social-emotional competence. These findings are discussed in the context of a systems approach to development in general, and to the development of children at risk in particular. Parental beliefs, attitudes, and coping abilities are hypothesized to be important mediators between environmental stress and child competencies.

Sociocultural variability in infant temperament ratings.

The interaction between the temperament of children and their caretaking environment is thought to be an important factor in the etiology of childhood behavior deviance. Most recent research in infant temperament has used a maternal questionnaire. Scores from these questionnaires have been subject to low concurrent validity. Also, there have been indications that maternal characteristics such as anxiety level influence child temperament ratings. The present study examined mother characteristics, child behavior, and mother's temperament ratings when their babies were 4 months old. The social status, anxiety level, the mental health status of the mother were all related to temperament ratings on the Carey Infant Temperament Questionnaire. However, child behavior measured in the home and laboratory were sporadically related to temperament, and these relations were of small magnitude. Hierarchical multiple regression analysis demonstrated that mother effects were powerful than child effects. These results supported the notion that individual differences in mothers, rather than differences in infants, may be the major contributor to early ratings of temperament.

IV. Issues in grouping items from the Neonatal Behavioral Assessment Scale.

The various analyses of the NBAS that we have described do not permit any simple understanding of the significance of the scales. We have shown that other variables associated with the scale may have more significance than the scales themselves. Predominant state appears to be one of these variables. When the NBAS scores are correlated with behavior only 4 months later, only tiny relationships are evident, and, what is more, many of these relationships do not make obvious sense. In recent times there has been growing evidence that infant behavior shows little consistency or continuity over time (McCall, Eichorn, & Hogarty 1977). These data from the Brazelton NBAS seem to conform that notion. The message we want to end with is that we have still not reached the point where we can adequately understand the behavior of the human newborn. Simple relations between antecedent and consequent behaviors assessed by simple statistical procedures will not solve our problem. Bridging the gap between our global theorizing about newborn behavior and concrete deomonstrations of those theories will require a complex interplay of common sense and statistical sophistication.

Childbirth education, maternal attitudes, and delivery.

The purpose of this study was to evaluate the effects of a childbirth education program (patterned after the Lamaze procedure) on maternal attitudes and the delivery process. Dependent variables included axniety as measured by the anxiety scale of the IPAT, scores on the Maternal Attitudes to Pregnancy Inventory (MAPI), the duration of labor, and the amounts of premedication and anesthesia administered during delivery. Three groups of pregnant women were used as subjects: 70 primiparous and 48 multiparous women taking a 6 week childbirth education course and 41 multiparous women delivery at the same hospitals but not taking the course. In addition the data on labor duration and amount of medication administered to 1,400 multiparous and 1,015 primiparous patients delivery at one of the same hospitals as the other three groups were examined for comparison purposes. No differences were found between groups on the anxiety measure or on duration of labor. Some differences favoring women who had the childbirth education course were found on the MAPI and the medication and anesthesia measures. It was concluded that the childbirth education course had some beneficial effects.