Development and Assessment of Short and Very Short Forms of the Infant Behavior Questionnaire–Revised

Prenatal alcohol consumption and infant and child behavior: Evidence from the Growing Up in New Zealand Cohort

BACKGROUND

High levels of alcohol exposure during pregnancy can damage developing brains and influence child behavior and learning.

AIM

To examine the effects of lower levels of alcohol and very early exposure to alcohol on infant temperament and child behavior.

STUDY DESIGN, SUBJECTS, AND OUTCOME MEASURES

The Growing Up in New Zealand study involves a prospective birth cohort of 6822 pregnant women of whom 6156 provided information on their child's temperament using the Infant Behavior Questionnaire-Revised (IBQ-R VSF) at 9 months and their child's behavior using the Strengths and Difficulties Questionnaire at 2 years.

RESULTS

A series of adjusted linear regression models controlling for socio-demographic factors found alcohol consumption during pregnancy was most consistently related to Lower Positive Affect, Affiliation/Regulation, and Orienting Capacity temperament scores. Mothers who stopped drinking after becoming aware of their pregnancy, but had an unplanned pregnancy (hence may have a baby exposed to alcohol for longer), also reported infants with lower Orienting Capacity, Affiliation/Regulation, and Fear temperament scores compared to those that did not drink. Children whose mothers drank four or more drinks per week during pregnancy were more likely to report their child as having conduct problems, with higher total difficulties scores at age 2.

CONCLUSIONS

Alcohol consumption during pregnancy has a negative effect especially on infant temperament, even if small amounts of alcohol are consumed. Our findings have implications for men and women who drink, medical professionals, and for the availability of contraception to those who drink, but do not plan to get pregnant.

Prenatal exposure to disaster-related traumatic stress and developmental trajectories of temperament in early childhood: Superstorm Sandy pregnancy study

BACKGROUND

Little is known about the impact of prenatal maternal stress (PNMS) on the developmental trajectory of temperament and few studies have been able to incorporate a natural disaster as a quasi-experimental stressor. The current study investigated PNMS related to Superstorm Sandy ('Sandy'), a hurricane that struck the New York metropolitan area in October 2012, in terms of objective exposure during pregnancy, subjective stress reaction as assessed by maternal symptoms of post-traumatic stress, and their impact on the developmental changes in temperament during early childhood.

METHOD

A subsample of 318 mother-child dyads was drawn from the Stress in Pregnancy Study. Temperament was measured at 6, 12, 18, and 24 months of age.

RESULTS

Objective exposure was associated with greater High-Intensity Pleasure, Approach, Perceptual Sensitivity and Fearfulness, but lower Cuddliness and Duration of Orientation at 6 months. Objective exposure and its interaction with subjective stress reaction predicted developmental changes in temperament. In particular, objective exposure was linked to greater increases in Activity Level but decreases in High-Intensity Pleasure, Approach, and Fearfulness. The combination of objective exposure and subjective stress reaction was also associated with greater increases in Activity Level.

LIMITATIONS

Temperament was measured solely via maternal report. Trimester-specific effects of Sandy on temperament were not examined.

CONCLUSION

This is the first study to examine the effects of prenatal maternal exposure to a natural disaster on trajectories of early childhood temperament. Findings suggest that both objective stress exposure and subjective stress reaction in-utero predict developmental trajectories of temperament in early childhood.

Maternal report of infant negative affect predicts attenuated brain response to own infant

Parent-infant interaction is known to be influenced bidirectionally by parent and infant characteristics. However, it is unclear whether infant temperament affects parents' neural responses to infant stimuli. 85 infants (6-12 months) were filmed in distress-eliciting tasks, which were coded for infants' negative affect. Mothers' reported infant affect was obtained from the Infant Behavior Questionnaire Very Short Form-Revised. Mothers' EEG activity was recorded while passively viewing photos of own, familiarized, and unfamiliar infants. Multiple regression indicated that mothers who reported greater infant negative affect showed a smaller difference in the late positive potential (LPP) response to own infant versus familiarized infant, controlling for researcher-coded infant negative affect. The findings suggest that parents' perceptions of their infant's temperament, but not independent measures of infant temperament, are related to electrocortical indices of emotional attention.

Using Play to Improve Infant Sleep: A Mixed Methods Protocol to Evaluate the Effectiveness of the Play2Sleep Intervention

BACKGROUND

One in four Canadian families struggle with infant sleep disturbances. The aim of this study is to evaluate Play2Sleep in families of infants with sleep disturbances. In addition to parental education on infant sleep, Play2Sleep uses examples from a video-recorded, structured play session with mothers and fathers separately to provide feedback on parent-infant interactions and their infant's sleep-related social cues. The quantitative phase will answer the research question: Does one dose of Play2Sleep delivered during a home visit with mothers and fathers of infants aged 5 months reduce night wakings at age 7 months? The qualitative phase will answer the research question: What are parental perceptions of family experiences, processes, and contexts related to Play2Sleep and infant sleep? The overarching mixed methods research question is as follows: How do parental perceptions of family experiences, processes, and contexts related to infant sleep explain the effectiveness of Play2Sleep?

METHOD AND ANALYSIS

An explanatory sequential mixed methods design will be used. In the quantitative phase, a randomized controlled trial and RM-ANOVA will compare night wakings in infants whose parents receive Play2Sleep versus standard public health nursing information. Sixty English-speaking families (mothers and fathers) of full-term, healthy, singleton, 5-month-old infants who perceive that their infant has sleep disturbances will be recruited. The primary outcome measure will be change in the number of night wakings reported by parents. The qualitative component will use thematic analysis of family interviews to describe parental perceptions and experiences of infant sleep. Mixed methods integration will use qualitative findings to explain quantitative results.

DISCUSSION

Play2Sleep is a novel approach that combines information about infant sleep with personalized feedback on parent-infant interactions and infant cues. Including fathers and mixed methods should capture complex family experiences of infant sleep disturbances and Play2Sleep. If effective, Play2Sleep has possible application for preventing infant sleep disturbance and tailoring for other populations.

CLINICAL TRIAL REGISTRATION

www.ClinicalTrials.gov, identifier: NCT02742155. Registered on 2016 April 23.

Explaining the relationship between temperament and symptoms of psychiatric disorders from preschool to middle childhood: hybrid fixed and random effects models of Norwegian and Spanish children

BACKGROUND

Four explanations for the concurrent and prospective associations between temperament and psychopathology in children have been suggested: predisposition, complication/scar, common cause/continuity, and pathoplasty/exacerbation. Because the confounding effects of common causes have not been ruled out in prior work, the support for the various explanations is uncertain.

METHODS

Screen-stratified community samples of 4-year olds in Trondheim, Norway (n = 1,042), and 3-year olds in Barcelona, Spain (n = 622), were assessed biennially for symptoms of attention-deficit/hyperactivity (ADHD), oppositional defiant (ODD), conduct (CD), anxiety, and depressive disorders through interviewer-based psychiatric interviews across four waves of data collection. The parents completed child temperament ratings. The data were analyzed with random and fixed effects regression adjusted for all time-invariant unmeasured confounders (e.g., genetics, common methods bias, item overlap).

RESULTS

In both Norway and Spain and across ages, negative affect predisposed children to symptoms of all disorders except CD, low effortful control predisposed children to ADHD and ODD-symptoms, and surgency predisposed children to increased ADHD-symptoms. Complication effects were observed in the Spanish children for ADHD-symptoms, which increased surgency and diminished effortful control, and for ODD-symptoms, which decreased surgency. The common cause and pathoplasty/exacerbation explanations were not supported.

CONCLUSIONS

The present results are consistent with the view that temperament plays a causal role in the development of symptoms of psychiatric disorders in children. Because temperament is malleable, interventions targeting the affective, attentional, and behavioral regulatory components of temperament may reduce psychopathology in children.

Pacifier Use and Early Life Weight Outcomes in the Intervention Nurses Start Infants Growing on Healthy Trajectories Study

BACKGROUND

Although widely used by infants, little is known about the long-term effects of pacifiers. We investigated relationships between pacifier use in infancy and appetite, temperament, feeding, and weight outcomes through age 2 years using data from the Intervention Nurses Start Infants Growing on Healthy Trajectories study.

METHODS

Mother-newborn dyads were randomized to a responsive parenting intervention for obesity prevention or a control group. Infants with data on pacifier use (n = 250) were categorized as using a pacifier beyond early infancy (≥4 months of age) or not. Anthropometrics were measured at 6 months, 1, and 2 years with overweight defined as weight-for-length ≥95th percentile at 1 year and BMI ≥85th percentile at 2 years. Mothers completed questionnaires on temperament, appetite, and feeding.

RESULTS

Infants who used a pacifier at 4 months or later (68%) had greater conditional weight gain from birth to 6 months (p = 0.01), weight-for-length z-score at 1 year (p < 0.001), and BMI z-score at 2 years (p < 0.001) than infants who did not. Infants using a pacifier at ≥4 months were more likely to be overweight at ages 1 year (11.7% vs. 1.3%, p = 0.03) and 2 years (20.1% vs. 7.9%, p = 0.03). Pacifier use was associated with shorter breastfeeding duration and less responsive parent feeding styles, but these variables did not mediate the relationship between pacifiers and weight. Parent-reported temperament and appetite were unrelated to pacifier use.

CONCLUSIONS

Pacifier use beyond early infancy is associated with accelerated infant growth and toddler overweight, although the reasons for this relationship are unclear.

Negative affect is related to reduced differential neural responses to social and non-social stimuli in 5-to-8-month-old infants: A functional near-infrared spectroscopy-study

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Blood oxygenation changes in infants’ right posterior temporal cortex reflect processing of social dynamic compared to non-social dynamic stimuli.

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Higher levels of Negative Affect are related to a weaker hemodynamic response to social compared to non-social stimuli in the right posterior-temporal cortex.

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High Negative Affect may contribute to difficulties in social-interactive behavior later in life via reduced cortical specialization for social perception in infancy.

Both social perception and temperament in young infants have been related to social functioning later in life. Previous functional Near-Infrared Spectroscopy (fNIRS) data (Lloyd-Fox et al., 2009) showed larger blood-oxygenation changes for social compared to non-social stimuli in the posterior temporal cortex of five-month-old infants. We sought to replicate and extend these findings by using fNIRS to study the neural basis of social perception in relation to infant temperament (Negative Affect) in 37 five-to-eight-month-old infants.

Infants watched short videos displaying either hand and facial movements of female actors (social dynamic condition) or moving toys and machinery (non-social dynamic condition), while fNIRS data were collected over temporal brain regions. Negative Affect was measured using the Infant Behavior Questionnaire.

Results showed significantly larger blood-oxygenation changes in the right posterior-temporal region in the social compared to the non-social condition. Furthermore, this differential activation was smaller in infants showing higher Negative Affect.

Our results replicate those of Lloyd-Fox et al. and confirmed that five-to-eight-month-old infants show cortical specialization for social perception. Furthermore, the decreased cortical sensitivity to social stimuli in infants showing high Negative Affect may be an early biomarker for later difficulties in social interaction.

Ontogeny of emotional and behavioral problems in a low-income, Mexican American sample

Clinically meaningful behavior problems are thought to be present beginning in the early toddler years, yet few studies have investigated correlates of behavior problems assessed before age 2 years. The current study investigated the direct and interactive contributions of early infant and caregiver characteristics thought to play an important role in the ontogeny of behavior problems. Specifically, the study examined: (a) the links between infant temperamental reactivity and toddler behavioral symptoms, (b) whether maternal sensitivity moderated associations between temperamental reactivity and behavioral symptoms, (c) whether variability in temperamental reactivity was explained by exposure to maternal stressful life events (SLEs) in utero, and (d) whether child sex moderated these pathways. Data were collected from 322 low-income, Mexican American families. Mother reports of SLEs were obtained between 23 and 40 weeks gestation; temperamental negativity and surgency at 6 weeks and 12 months; and internalizing and externalizing behaviors at 18 months. Maternal sensitivity during structured mother-infant interaction tasks at a 12-month visit was assessed by objective raters. Results indicated that significant paths linked maternal prenatal SLEs with 6-week negativity, 6-week negativity with 12-month negativity, and 12-month negativity with 18-month behavioral symptoms. Sex-specific effects were also observed. Maternal SLEs were directly associated with internalizing behaviors for girls only. Surgency and maternal sensitivity moderated the associations of negativity with subsequent externalizing behaviors for girls only. Results suggest that ecological stressors associated with sociodemographic risk factors such as low-income and ethnic minority status begin to exert cascades of influence on children's developmental outcomes even before birth. (PsycINFO Database Record

The association between infantile postural asymmetry and unsettled behaviour in babies

Unsettled infant behaviour is a common problem of infancy without known aetiology or clearly effective management. Some manual therapists propose that musculoskeletal dysfunction contributes to unsettled infant behaviour, yet reported improvement following treatment is anecdotal. The infantile postural asymmetry measurement scale is a tool which measures infantile asymmetry, a form of musculoskeletal dysfunction. The first part of the study aimed to investigate its reliability and validity for measuring infantile postural asymmetry. This study also aimed to investigate whether there was an association between infantile postural asymmetry and unsettled infant behaviour and whether an association was mediated by, or confounded with, the demographic variables of age, sex, parity, birth weight and weight gain in 12- to 16-week-old infants. Fifty-eight infants were recruited and a quantitative cross-sectional observational design was used. An association between unsettled behaviour and infantile postural asymmetry was not found. A significant difference between high and low cervical rotation deficit groups for surgency was detected in female babies and needs further examination.

CONCLUSION

Questions remain regarding the construct validity of the infantile postural asymmetry scale. No association between unsettled infant behaviour and infantile postural asymmetry was found in 12- to 16-week-old infants. The influence of sex on the interaction between infantile postural asymmetry and infant behaviour needs further examination. An association between unsettled infant behaviour and infantile postural asymmetry is still unproven. What is known: • Unsettled infant behaviour has a considerable impact on many family situations. • Identifying a definitive cause has been a source of much examination and research. Many different hypotheses have been suggested yet much is still unknown. What is new: • The association between unsettled infant behaviour and infantile postural asymmetry is still unproven. • The need to validate a reliable tool to measure infantile postural asymmetry, with particular focus on cervical spine rotation deficit, is indicated.

Early development of infants with neurofibromatosis type 1: a case series

Background

Prospective studies of infants at familial risk for autism spectrum disorder (ASD) have yielded insights into the earliest signs of the disorder but represent heterogeneous samples of unclear aetiology. Complementing this approach by studying cohorts of infants with monogenic syndromes associated with high rates of ASD offers the opportunity to elucidate the factors that lead to ASD.

Methods

We present the first report from a prospective study of ten 10-month-old infants with neurofibromatosis type 1 (NF1), a monogenic disorder with high prevalence of ASD or ASD symptomatology. We compared data from infants with NF1 to a large cohort of infants at familial risk for ASD, separated by outcome at age 3 of ASD (n = 34), atypical development (n = 44), or typical development (n = 89), and low-risk controls (n = 75). Domains assessed at 10 months by parent report and examiner observation include cognitive and adaptive function, sensory processing, social engagement, and temperament.

Results

Infants with NF1 showed striking impairments in motor functioning relative to low-risk infants; this pattern was seen in infants with later ASD from the familial cohort (HR-ASD). Both infants with NF1 and the HR-ASD group showed communication delays relative to low-risk infants.

Conclusions

Ten-month-old infants with NF1 show a range of developmental difficulties that were particularly striking in motor and communication domains. As with HR-ASD infants, social skills at this age were not notably impaired. This is some of the first information on early neurodevelopment in NF1. Strong inferences are limited by the sample size, but the findings suggest implications for early comparative developmental science and highlight motor functioning as an important domain to inform the development of relevant animal models. The findings have clinical implications in indicating an important focus for early surveillance and remediation in this early diagnosed genetic disorder.

Human milk cortisol concentration predicts experimentally induced infant fear reactivity: moderation by infant sex

Little consideration has been given to the possibility of human infant development being shaped via lactocrine programming, and by breast milk cortisol levels specifically. Despite animal models indicating that glucocorticoid (GC) exposure via lactation might modify brain development and behavior, only one study has reported that milk cortisol levels were positively associated with infant negative affectivity, especially fearfulness and sadness-early emerging risk factors for internalizing difficulties such as anxiety. The aim of the current study was to investigate whether human milk cortisol is associated with mother-reported fearfulness and experimentally induced infant fear reactivity. Mother-infant dyads (n = 65) enrolled in the FinnBrain Cohort Study participated. Breast milk samples were obtained 2.5 months postpartum, and milk cortisol concentrations were ascertained using validated luminescence immunoassay methodology. Infant fear reactivity was assessed using maternal reports 6 months postpartum and in a laboratory 8 months postpartum. There was a significant interaction between infant sex and milk cortisol such that higher milk cortisol was related to higher infant fear reactivity in a laboratory setting in girls (β = 0.36, p = .04) but not in boys (β = -0.15, p = .40). Milk cortisol was not associated with mother-reported infant fearfulness. Results suggest that higher human milk cortisol concentrations are associated with elevated experimentally induced fear in infancy. Findings support lactocrine programming, and suggest that mothers may "communicate" vital information about stressful environments via cortisol contained in breast milk, shaping girls' early emotional reactivity.

Prenatal Depression and Infant Temperament: The Moderating Role of Placental Gene Expression

Prior research has demonstrated the link between maternal depression during pregnancy (i.e., prenatal depression) and increased neurodevelopmental dysregulation in offspring. However, little is known about the roles of key hypothalamic-pituitary axis regulatory genes in the placenta modulating this association. This study will examine whether placental gene expression levels of 11β-hydroxysteroid dehydrogenase type 2 (HSD11B2), glucocorticoid receptor (NR3C1), and mineralocorticoid receptor (NR3C2) can help elucidate the underlying mechanisms linking prenatal depression to infant temperament, particularly in infants with high negativity and low emotion regulation. Stored placenta tissues (N = 153) were used to quantify messenger ribonucleic acid levels of HSD11B2, NR3C1, and NR3C2. Assessments of prenatal depression and infant temperament at 6 months of age were ascertained via maternal report. Results found that prenatal depression was associated with increased Negative Affectivity (p < .05) after controlling for postnatal depression and psychosocial characteristics. Furthermore, the association between prenatal depression and Negative Affectivity was moderated by gene expression levels of HSD11B2, NR3C1, and NR3C2 such that greater gene expression significantly lessened the association between prenatal depression and Negative Affectivity. Our findings suggest that individual differences in placental gene expression may be used as an early marker of susceptibility or resilience to prenatal adversity.

Digital disruption? Maternal mobile device use is related to infant social-emotional functioning

Mobile device use has become increasingly prevalent, yet its impact on infant development remains largely unknown. When parents use mobile devices in front of infants, the parent is physically present but most likely distracted and unresponsive. Research using the classic Still Face Paradigm (SFP) suggests that parental withdrawal and unresponsiveness may have negative consequences for children's social-emotional development. In the present study, 50 infants aged 7.20 to 23.60 months (M = 15.40, SD = 4.74) and their mothers completed a modified SFP. The SFP consisted of three phases: free play (FP; parent and infant play and interact), still face (SF; parent withdraws attention and becomes unresponsive), and reunion (RU; parent resumes normal interaction). The modified SFP incorporated mobile device use in the SF phase. Parents reported on their typical mobile device use and infant temperament. Consistent with the standard SFP, infants showed more negative affect and less positive affect during SF versus FP. Infants also showed more toy engagement and more engagement with mother during FP versus SF and RU. Infants showed the most social bids during SF and more room exploration in SF than RU. More frequent reported mobile device use was associated with less room exploration and positive affect during SF, and less recovery (i.e., engagement with mother, room exploration positive affect) during RU, even when controlling for individual differences in temperament. Findings suggest that the SFP represents a promising theoretical framework for understanding the impact of parent's mobile device use on infant social-emotional functioning and parent-infant interactions.

The role of sustained attention, maternal sensitivity, and infant temperament in the development of early self-regulation

This study investigated infant predictors of early cognitive and emotional self-regulation from an intrinsic and caregiving environmental perspective. Sustained attention, reactive aspects of infant temperament, and maternal sensitivity were assessed at 10 months (n = 124) and early self-regulation (including executive functions, EF, and emotion regulation) was assessed at 18 months. The results indicated that sustained attention predicted early EF, which provide empirical support for the hierarchical framework of EF development, advocating early attention as a foundation for the development of cognitive self-regulation. Maternal sensitivity and surgency predicted emotion regulation, in that infants of sensitive mothers showed more regulatory behaviours and a longer latency to distress, whereas high levels of surgency predicted low emotion regulation, suggesting both the caregiving environment and temperament as important in the development of self-regulation. Interaction effects suggested high sustained attention to be a protective factor for children of insensitive mothers, in relation to emotion regulation. In addition, high levels of maternal sensitivity seemed to foster development of emotion regulation among children with low to medium levels of sustained attention and/or surgency. In all, our findings point to the importance of both intrinsic and extrinsic factors in infant development of self-regulation.

Maternal anxiety predicts attentional bias towards threat in infancy

Although cognitive theories of psychopathology suggest that attention bias toward threat plays a role in the etiology and maintenance of anxiety, there is relatively little evidence regarding individual differences in the earliest development of attention bias toward threat. The current study examines attention bias toward threat during its potential first emergence by evaluating the relations between attention bias and known risk factors of anxiety (i.e., temperamental negative affect and maternal anxiety). We measured attention bias to emotional faces in infants (N = 98; 57 male) ages 4 to 24 months during an attention disengagement eye-tracking paradigm. We hypothesized that (a) there would be an attentional bias toward threat in the full sample of infants, replicating previous studies; (b) attentional bias toward threat would be positively related to maternal anxiety; and (c) attention bias toward threat would be positively related to temperamental negative affect. Finally, (d) we explored the potential interaction between temperament and maternal anxiety in predicting attention bias toward threat. We found that attention bias to the affective faces did not change with age, and that bias was not related to temperament. However, attention bias to threat, but not attention bias to happy faces, was positively related to maternal anxiety, such that higher maternal anxiety predicted a larger attention bias for all infants. These findings provide support for attention bias as a putative early mechanism by which early markers of risk are associated with socioemotional development. (PsycINFO Database Record

Effectiveness of skin-to-skin contact versus care-as-usual in mothers and their full-term infants: study protocol for a parallel-group randomized controlled trial

BACKGROUND

Twenty-to-forty percent of women experience postpartum depressive symptoms, which can affect both the mother and infant. In preterm infants, daily skin-to-skin contact (SSC) between the mother and her infant has been shown to decrease maternal postpartum depressive symptoms. In full-term infants, only two studies investigated SSC effects on maternal depressive symptoms and found similar results. Research in preterm infants also showed that SSC improves other mental and physical health outcomes of the mother and the infant, and improves the quality of mother-infant relationship. This randomized controlled trial will investigate the effects of a SSC intervention on maternal postpartum depressive symptoms and additional outcomes in mothers and their full-term infants. Moreover, two potential underlying mechanisms for the relation between SSC and the maternal and infant outcomes will be examined, namely maternal oxytocin concentrations and infant intestinal microbiota.

METHODS/DESIGN

Design: A parallel-group randomized controlled trial.

PARTICIPANTS

116 mothers and their full-term infants.

INTERVENTION

Mothers in the SSC condition will be requested to provide daily at least one continuous hour of SSC to their infant. The intervention starts immediately after birth and lasts for 5 weeks. Mothers in the control condition will not be requested to provide SSC. Maternal and infant outcomes will be measured at 2 weeks, 5 weeks, 12 weeks and 1 year after birth.

PRIMARY OUTCOME

maternal postpartum depressive symptoms. Secondary maternal outcomes: mental health (anxiety, stress, traumatic stress following child birth, sleep quality), physical health (physical recovery from the delivery, health, breastfeeding, physiological stress), mother-infant relationship (mother-infant bond, quality of maternal caregiving behavior). Secondary infant outcomes: behavior (fussing and crying, sleep quality), physical health (growth and health, physiological stress), general development (regulation capacities, social-emotional capacities, language, cognitive and motor capacities). Secondary underlying mechanisms: maternal oxytocin concentrations, infant intestinal microbiota.

DISCUSSION

As a simple and cost-effective intervention, SSC may benefit both the mother and her full-term infant in the short-and long-term. Additionally, if SSC is shown to be effective in low-risk mother-infant dyads, then thought could be given to developing programs in high-risk samples and using SSC in a preventive manner.

TRIAL REGISTRATION

NTR5697 ; Registered on March 13, 2016.

Helping the One You Hurt: Toddlers' Rudimentary Guilt, Shame, and Prosocial Behavior After Harming Another

This study explored the role of guilt and shame in early prosocial behavior by extending previous findings that guilt- and shame-like responses can be distinguished in toddlers and, for the first time, examining their associations with helping. Toddlers (n = 32; Mage  = 28.9 months) were led to believe they broke an adult's toy, after which they exhibited either a guilt-like response that included frequently confessing their behavior and trying to repair the toy; or a shame-like response that included frequently avoiding the adult and seldom confessing or attempting to repair the toy. In subsequent prosocial tasks, children showing a guilt-like response helped an adult in emotional distress significantly faster and more frequently than did children showing a shame-like response.

Maternal Distraction During Breast- and Bottle Feeding Among WIC and non-WIC Mothers

OBJECTIVE

To explore the prevalence and correlates of maternal distraction during infant feeding within a sample of mothers enrolled or not in the Special Supplemental Nutrition Program for Woman, Infants, and Children (WIC).

DESIGN

Mothers kept diaries of their infants' feeding patterns.

PARTICIPANTS

Mothers (n = 75) with infants aged ≤6 months.

MAIN OUTCOME MEASURES

Within the diaries, mothers recorded what else, if anything, they did during the feeding. Mothers also completed questionnaires on demographics, feeding styles, and infant temperament and eating behaviors.

ANALYSIS

Mothers' responses were coded into thematic categories. Feedings were classified as distracted when the mothers reported doing something other than feeding and/or interacting with the infant. Logistic regression was used to explore whether mothers exhibited different levels of distraction when breastfeeding (BF) vs bottle feeding. The researchers used multiple stepwise regression to explore associations between distracted feeding and characteristics of mothers and infants.

RESULTS

Distractions were reported during 43% of feedings; 26% involved technological distractors. Mothers who were multiparous and perceived that their infants had greater appetites reported greater levels of any distraction during feeding. Mothers who were of racial/ethnic minorities, adhered to laissez faire feeding style, had younger infants, and perceived their infants to have lower food responsiveness and greater appetite reported greater levels of technological distraction. Being enrolled in WIC was not associated with mothers' levels of distracted feeding.

CONCLUSIONS AND IMPLICATIONS

Mothers reported a wide variety of distractions during both BF and bottle feeding; higher levels of distraction were associated with characteristics of both mothers and infants. Further research is needed to understand whether and how maternal distraction affects feeding outcomes. Awareness of such distractions and their potential impact would be useful to practitioners working with pregnant and postpartum women.

The protective role of maternal posttraumatic growth and cognitive trauma processing among Palestinian mothers and infants

War survivors use multiple cognitive and emotional processes to protect their mental health from the negative impacts of trauma. Because mothers and infants may be especially vulnerable to trauma in conditions of war, it is urgent to determine which cognitive and emotional processes are effective for preventing negative trauma impacts." This study examined whether mothers' high posttraumatic growth (PTG) and positive posttraumatic cognitions (PTC) protected (a) their own mental health and (b) their infants' stress regulation and sensorimotor and language development from the effects of war trauma. The participants were 511 Palestinian mothers and their infants living in the Gaza strip. The mothers were interviewed in their second trimester of pregnancy (T1) as well as when the infant was four months (T2) and twelve months (T3). Mothers reported posttraumatic growth (PTG; Tedeschi & Calhoun, 1996) at T1 and posttraumatic cognitions (PTCI; Foa et al., 1999) at T2. They also reported their exposure to traumatic war events both at T1 and T3 and described their mental health conditions (e.g., PTSD and/or depressive and dissociation symptoms) at T3. The Infant Behaviour Questionnaire (IBQ) was used to measure infants' stress regulation at T2 and sensorimotor and language development at T3. The results, based on regression analyses with interaction terms between trauma and PTG, showed that high levels of traumatic war events were not associated with high levels of PTSD, depressive, or dissociation symptoms among mothers showing high levels of PTG. This suggests that PTG may protect maternal mental health from the effects of trauma. In turn, positive maternal PTCs appeared to protect the infants' stress regulation from the effects of war trauma. The study concludes by discussing ways to develop and implement preventive interventions for mother-infant dyads in war conditions.

Mindful with Your Baby: Feasibility, Acceptability, and Effects of a Mindful Parenting Group Training for Mothers and Their Babies in a Mental Health Context

Many mothers experience difficulties after the birth of a baby. Mindful parenting may have benefits for mothers and babies, because it can help mothers regulate stress, and be more attentive towards themselves and their babies, which may have positive effects on their responsivity. This study examined the effectiveness of Mindful with your baby, an 8-week mindful parenting group training for mothers with their babies. The presence of the babies provides on-the-spot practicing opportunities and facilitates generalization of what is learned. Forty-four mothers with their babies (0-18 months), who were referred to a mental health clinic because of elevated stress or mental health problems of the mother, infant (regulation) problems, or mother-infant interaction problems, participated in 10 groups, each comprising of three to six mother-baby dyads. Questionnaires were administered at pretest, posttest, 8-week follow-up, and 1-year follow-up. Dropout rate was 7%. At posttest, 8-week follow-up, and 1-year follow-up, a significant improvement was seen in mindfulness, self-compassion, mindful parenting, (medium to large effects), as well as in well-being, psychopathology, parental confidence, responsivity, and hostility (small to large effects). Parental stress and parental affection only improved at the first and second follow-ups, respectively (small to medium effects), and maternal attention and rejection did not change. The infants improved in their positive affectivity (medium effect) but not in other aspects of their temperament. Mindful with your baby is a promising intervention for mothers with babies who are referred to mental health care because of elevated stress or mental health problems, infant (regulation) problems, or mother-infant interaction problems.

Infant Behavior Questionnaire-Revised Very Short Form: A New Factor Structure's Associations With Parenting Perceptions and Child Language Outcomes

The Infant Behavior Questionnaire Revised-Very Short Form (IBQ-R VSF; Putnam, Helbig, Gartstein, Rothbart, & Leerkes, 2014 ) is a new publicly available measure of infant temperament measuring positive affectivity/surgency (PAS), negative emotionality (NEG), and orienting and regulatory capacity (ORC). Although the initial psychometric properties of the 3-factor model appear promising, it has not been administered to a large and diverse sample and its predictive validity has not been established. This study administered the IBQ-R VSF to a diverse sample of 5,639 mothers of infants aged between 23 and 52 weeks. Confirmatory factor analysis found that the 3-factor solution did not meet the requirement for satisfactory model fit. Exploratory factor analysis found that a 5-factor solution (PAS, NEG, Orienting Capacity, Affiliation/Regulation, and Fear) was statistically and conceptually the most parsimonious. All 5 temperament dimensions were found to relate to both mother- and partner-reported infant closeness, parenting confidence, and parenting satisfaction, and four of the dimensions (PAS, Orienting Capacity, NEG, and Fear) related to the infants' communication development. Some parental differences were also found. Together these findings suggest that the 5-factor IBQ-R VSF is a promising measure of infant temperament and is related to parenting perceptions and child language development.

A Cross-Cultural Analysis of the Infant Behavior Questionnaire Very Short Form: An Item Response Theory Analysis of Infant Temperament in New Zealand

The Infant Behavior Questionnaire-Revised Very Short Form (IBQ-R VSF; Putnam, Helbig, Gartstein, Rothbart, & Leerkes, 2014 ) is a newly published measure of infant temperament with a 3-factor structure. Recently Peterson et al. ( 2017 ) suggested that a 5-factor structure (Positive Affectivity/Surgency, Negative Emotionality, Orienting Capacity, Affiliation/Regulation, and Fear) was more parsimonious and showed promising reliability and predictive validity in a large, diverse sample. However, little is known about the 5-factor model's precision across the temperament dimensions range and whether it discriminates equally well across ethnicities. A total of 5,567 mothers responded to the IBQ-R VSF in relation to their infants (N = 5,639) between 23 and 52 weeks old. Using item response theory, we conducted a series of 2 parameter logistic item response models and found that 5 IBQ-R VSF temperament dimensions showed a good distribution of estimates across each latent trait range and these estimates centered close to the population mean. The IBQ-R VSF was also similarly precise across 4 ethnic groups (European, Māori, Pacific peoples, and Asians), suggesting that it can be used as comparable measure for infant temperament in a diversity of ethnic groups.

Establishing the Measurement Invariance of the Very Short Form of the Infant Behavior Questionnaire Revised for Mothers Who Vary on Race and Poverty Status

We examined the measurement invariance of the Infant Behavior Questionnaire Revised-Very Short Form (IBQR-VSF; Putnam, Helbig, Gartstein, Rothbart, & Leerkes, 2014 ) in a sample of 470 racially (185 White, 285 African American) and socioeconomically diverse mothers (158 below federal poverty threshold, 296 above federal poverty threshold) of infants. Using multigroup confirmatory factor analysis, we demonstrated configural, full metric, and full scalar invariance demonstrating that the 3-factor structure (negative emotionality, positive affectivity/surgency, orienting/regulatory capacity), pattern of item loadings, and item means were comparable for White and African American mothers, and for poor and not poor mothers. In addition, we demonstrated full error invariance across racial groups and partial error variance invariance across poverty status, demonstrating that item reliability was comparable for White and African American mothers, and both those above and below the poverty line (with the exception of a subset of items). Thus, the IBQR-VSF appears appropriate for use in racially and socioeconomically diverse samples.

Exploratory Factor Analysis With Small Samples and Missing Data

Exploratory factor analysis (EFA) is an extremely popular method for determining the underlying factor structure for a set of variables. Due to its exploratory nature, EFA is notorious for being conducted with small sample sizes, and recent reviews of psychological research have reported that between 40% and 60% of applied studies have 200 or fewer observations. Recent methodological studies have addressed small size requirements for EFA models; however, these models have only considered complete data, which are the exception rather than the rule in psychology. Furthermore, the extant literature on missing data techniques with small samples is scant, and nearly all existing studies focus on topics that are not of primary interest to EFA models. Therefore, this article presents a simulation to assess the performance of various missing data techniques for EFA models with both small samples and missing data. Results show that deletion methods do not extract the proper number of factors and estimate the factor loadings with severe bias, even when data are missing completely at random. Predictive mean matching is the best method overall when considering extracting the correct number of factors and estimating factor loadings without bias, although 2-stage estimation was a close second.

Maternal prenatal stress and infant emotional reactivity six months postpartum

BACKGROUND

Maternal prenatal stress has been related to infant negative affect. However, it is still unclear how different sources of maternal prenatal stress such as depressive, anxiety and pregnancy-specific anxiety symptoms are associated with reactivity outcomes. This study aimed to test the associations between different sources of maternal prenatal stress and the aspects of infant emotional reactivity at six months.

METHOD

Our study population (n=282) was drawn from the FinnBrain Birth Cohort Study. Prenatal stress was measured by questionnaires on maternal depression, general anxiety and pregnancy-specific anxiety at three time points across pregnancy (gwk 14, 24, 34). Based on the symptom scores, the sample was divided into mothers with high stress during pregnancy (n=110) and mothers with low stress during pregnancy (n=172). Mother-reported infant emotional reactivity and its subscales were measured six months postpartum.

RESULTS

After controlling for background variables and maternal postnatal symptoms, overall negative emotional reactivity (β=0.20, p<0.01), and its aspects fearfulness (β=0.15, p=.057) and falling reactivity (β=-0.22, p<0.01), were predicted by only pregnancy-specific anxiety. No significant predictors were found for infant positive reactivity after adjusting for confounders.

LIMITATIONS

Mother reports of both maternal symptoms and infant reactivity were used, which might increase the risk of reporting bias.

CONCLUSIONS

The findings suggest that mothers experiencing stress should be provided intervention during pregnancy, and that screening should have a particular focus on pregnancy-related worries.

Vagal tone during infant contingency learning and its disruption

This study used contingency learning to examine changes in infants' vagal tone during learning and its disruption. The heart rate of 160 five-month-old infants was recorded continuously during the first of two training sessions as they experienced an audiovisual event contingent on their pulling. Maternal reports of infant temperament were also collected. Baseline vagal tone, a measure of parasympathetic regulation of the heart, was related to vagal levels during the infants' contingency learning session, but not to their learner status. Vagal tone levels did not vary significantly over session minutes. Instead, vagal tone levels were a function of both individual differences in learner status and infant soothability. Vagal levels of infants who learned in the initial session were similar regardless of their soothability; however, vagal levels of infants who learned in a subsequent session differed as a function of soothability. Additionally, vagal levels during contingency disruption were significantly higher among infants in this group who were more soothable as opposed to those who were less soothable. The results suggest that contingency learning and disruption is associated with stable vagal tone in the majority of infants, but that individual differences in attention processes and state associated with vagal tone may be most readily observed during the disruption phase.

Frontal Electroencephalogram Asymmetry and Temperament Across Infancy and Early Childhood: An Exploration of Stability and Bidirectional Relations

The stability of frontal electroencephalogram (EEG) asymmetry, temperamental activity level and fear, as well as bidirectional relations between asymmetry and temperament across the first 4 years of life, were examined in a sample of 183 children. Children participated in annual laboratory visits through 48 months, providing EEG and maternal report of temperament. EEG asymmetry showed moderate stability between 10 and 24 months. Analyses revealed that more left asymmetry predicted later activity level across the first 3 years. Conversely, asymmetry did not predict fear. Rather, fear at 36 months predicted more right asymmetry at 48 months. Results highlight the need for additional longitudinal research of infants and children to increase understanding of bidirectional relations between EEG and temperament in typically developing populations.

Mother-Infant Face-to-Face Interaction: The Communicative Value of Infant-Directed Talking and Singing

BACKGROUND

Across culture, healthy infants show a high interest in infant-directed (ID) talking and singing. Despite ID talking and ID singing being very similar in physical properties, infants differentially respond to each of them. The mechanisms underpinning these different responses are still under discussion.

METHODS

This study explored the behavioral (n = 26) and brain (n = 14) responses from 6- to 8-month-old infants to ID talking and ID singing during a face-to-face mother-infant interaction with their own mother. Behavioral response was analyzed from offline video coding, and brain response was estimated from the analysis of electrophysiological recordings.

RESULTS

We found that during ID talking, infants displayed a significantly higher number of visual contacts, vocalizations, and body movements than during ID singing. Moreover, only during ID talking were the number of visual contacts and vocalizations positively correlated with the number of questions and pauses in the mother's speech.

CONCLUSIONS

Our results suggest that ID talking provides infants with specific cues that allow them not only to react to mother stimulation, but also to act toward them, displaying a rudimentary version of turn-taking behavior. Brain activity partially supported that interpretation. The relevance of our results for bonding is discussed.

Toddlers' Differential Susceptibility to the Effects of Coparenting on Social-Emotional Adjustment

The present study tested whether infants high in negative affectivity are differentially susceptible to observed coparenting behavior in relation to their subsequent social-emotional development. Data came from a longitudinal study of 182 U.S. dual-earner, primiparous couples and their infant children. At 9-months postpartum, child negative affectivity was reported by mothers and fathers and supportive and undermining coparenting behavior were assessed from mother-father-infant observations. At 27-months mothers reported on toddlers' externalizing behavior and dysregulation using a clinical assessment tool designed to identify competencies and areas of concern in toddlers' social-emotional development. Hierarchical regression analyses revealed partial support for the differential susceptibility hypothesis. Specifically, infants high in negative affectivity had lower levels of dysregulation when embedded in a more supportive coparenting context, and higher levels of dysregulation when embedded in a less supportive coparenting context. In contrast, supportive coparenting behavior was not relevant for the dysregulation of infants initially low in negative affectivity.

What are mothers doing while bottle-feeding their infants? Exploring the prevalence of maternal distraction during bottle-feeding interactions

The purpose of this study was to describe the extent to which mothers engage in distracting activities during infant feeding. Mothers reported engaging in other activities during 52% of feedings; television watching was the most prevalent activity reported. Further research on the impact of distraction on feeding outcomes is needed.

Effectiveness of a behavioural intervention to prevent excessive weight gain during infancy (The Baby Milk Trial): study protocol for a randomised controlled trial

BACKGROUND

Infancy is a period of rapid growth and habit formation and hence could be a critical period for obesity prevention. Excess weight gain during infancy is associated with later obesity and formula-fed babies are more likely to gain excess weight compared to breastfed babies. The primary trial outcome is a change in the weight standard deviation score from birth to 1 year.

METHODS/DESIGN

We will recruit 650 to 700 parents who introduce formula-milk feeds within 14 weeks of their baby's birth to a single (assessor) blind, parallel group, individually randomised controlled trial. The focus of the intervention is the caregiver (usually the mother), and the focus of the primary outcome is the infant. The intervention group will receive the behavioural intervention, which aims to reduce formula-milk intake, promote responsive feeding and healthy weaning, and prevent excessive weight gain during infancy. The intervention is based on Social Cognitive Theory and action planning ('implementation intentions'). It consists of three components: (1) a motivational component to strengthen parents' motivation to follow the Baby Milk feeding guidelines, (2) an action planning component to help translate motivation into action, and (3) a coping planning component to help parents deal with difficult situations. It will be delivered by trained facilitators (research nurses) over 6 months through three face-to-face contacts, two telephone contacts and written materials. The control group will have the same number of contacts with facilitators, and general issues about feeding will be discussed. Anthropometric outcomes will be measured by trained research staff, blind to group allocation, at baseline, 6 months and 12 months following standard operating procedures. Validated questionnaires will assess milk intake, temperament, appetite, sleep, maternal quality of life and maternal psychological factors. A 4-day food diary will be completed at 8 months.

DISCUSSION

The results of the trial will help to inform infant feeding guidelines and to understand the links between infant feeding, behaviour, appetite and growth.

TRIAL REGISTRATION

ISRTCN20814693 . Registration date 13 January 2011.

Feasibility study and pilot randomised trial of an antenatal depression treatment with infant follow-up

Substantial evidence links antenatal depression, anxiety and stress with negative effects on foetal development, resulting in enduring problems in child development. Despite this, there is a paucity of research on intervention programmes designed to address depression and anxiety, and none that include infant outcomes. We aimed to evaluate the efficacy of a brief treatment for maternal depression and anxiety in pregnancy in a sample of women with a diagnosed depressive disorder. We developed a cognitive behavioural therapy treatment for antenatal depression and anxiety and evaluated it in a feasibility trial. This was followed by a pilot randomised controlled trial (RCT) which collected data on the efficacy of the brief intervention and follow-up data on infants. The feasibility study (n = 25) yielded promising results for adherence, acceptability and improvements in depression and anxiety (Beck Depression Inventory and Beck Anxiety Inventory). The RCT (n = 54) again showed excellent adherence and acceptability and supported the efficacy of the treatment. Strong reductions in anxiety were observed during pregnancy, and improvements in depression were maintained at 9 months representing a moderately large effect size. Nine-month infant outcomes showed several medium to large effects favouring the intervention in domains including problem solving, self-regulation and stress reactivity, which were independent of maternal postnatal mood. Treating severe depression and anxiety during pregnancy with a brief cognitive behavioural therapy (CBT) intervention appears feasible and worthwhile. To reliably detect clinically meaningful effects on infant outcomes, larger RCTs are likely to be required.

Mindless feeding: Is maternal distraction during bottle-feeding associated with overfeeding?

Mindless eating, or eating while distracted by surrounding stimuli, leads to overeating. The present study explored whether "mindless feeding," or maternal distraction during bottle-feeding, is associated with greater infant formula/milk intakes and lower maternal sensitivity to infant cues. Mothers and their ≤24-week-old bottle-feeding infants (N = 28) visited our laboratory for a video-recorded feeding observation. Infant intake was assessed by weighing bottles before and after the feedings. Maternal sensitivity to infant cues was objectively assessed by behavioral coding of video-records using the Nursing Child Assessment Feeding Scale. Maternal distraction was defined as looking away from the infant >75% of the feeding; using a mobile device; conversing with another adult; or sleeping. Twenty-nine percent (n = 8) of mothers were distracted. While differences in intakes for infants of distracted vs. not distracted mothers did not reach significance (p = 0.24), the association between distraction and infant intake was modified by two dimensions of temperament: orienting/regulation capacity (p = 0.03) and surgency/extraversion (p = 0.04). For infants with low orienting/regulation capacity, infants of distracted mothers consumed more (177.1 ± 33.8 ml) than those of not distracted mothers (92.4 ± 13.8 ml). Similar findings were noted for infants with low surgency/extraversion (distracted: 140.6 ± 22.5 ml; not distracted: 78.4 ± 14.3 ml). No association between distraction and intake was seen for infants with high orienting/regulation capacity or surgency/extraversion. A significantly greater proportion of distracted mothers showed low sensitivity to infant cues compared to not distracted mothers (p = 0.04). In sum, mindless feeding may interact with infant characteristics to influence feeding outcomes; further experimental and longitudinal studies are needed.

Infants' neural responses to facial emotion in the prefrontal cortex are correlated with temperament: a functional near-infrared spectroscopy study

Accurate decoding of facial expressions is critical for human communication, particularly during infancy, before formal language has developed. Different facial emotions elicit distinct neural responses within the first months of life. However, there are broad individual differences in such responses, so that the same emotional expression can elicit different brain responses in different infants. In this study, we sought to investigate such differences in the processing of emotional faces by analyzing infants's cortical metabolic responses to face stimuli and examining whether individual differences in these responses might vary as a function of infant temperament. Seven-month-old infants (N = 24) were shown photographs of women portraying happy expressions, and neural activity was recorded using functional near-infrared spectroscopy (fNIRS). Temperament data were collected using the Revised Infant Behavior Questionnaire Short Form, which assesses the broad temperament factors of Surgency/Extraversion (S/E), Negative Emotionality (NE), and Orienting/Regulation (O/R). We observed that oxyhemoglobin (oxyHb) responses to happy face stimuli were negatively correlated with infant temperament factors in channels over the left prefrontal cortex (uncorrected for multiple comparisons). To investigate the brain activity underlying this association, and to explore the use of fNIRS in measuring cortical asymmetry, we analyzed hemispheric asymmetry with respect to temperament groups. Results showed preferential activation of the left hemisphere in low-NE infants in response to smiling faces. These results suggest that individual differences in temperament are associated with differential prefrontal oxyHb responses to faces. Overall, these analyses contribute to our current understanding of face processing during infancy, demonstrate the use of fNIRS in measuring prefrontal asymmetry, and illuminate the neural correlates of face processing as modulated by temperament.

Effects of prenatal factors and temperament on infant cortisol regulation in low-income Mexican American families

Prenatal psychosocial exposures can significantly affect infant health and development. Infants with higher temperamental negativity are theorized to be more susceptible to environmental exposures. We evaluated the interaction of prenatal maternal exposures and infant temperamental negativity to predict infant cortisol response to mildly challenging mother-infant interaction tasks. Participants included 322 Mexican American mother-infant dyads (mother age 18-42; 82% Spanish-speaking; modal family income $10,000-$15,000). Mothers reported depressive symptoms and social support prenatally and infant temperamental negativity at 6 weeks postpartum. Salivary cortisol was collected from infants before and after mother-infant interaction tasks at 12 weeks. Higher prenatal maternal depressive symptoms and lower social support predicted higher cortisol among infants with higher temperamental negativity. Higher infant temperamental negativity predicted an increase in maternal distress and a decrease in social support from prenatal to 12 weeks postpartum. Interactive influences of maternal social-contextual factors and infant temperament may influence the development of infant neurobiological regulation and promote or strain maternal and infant adaptation over time.

Psychosocial predictors of primiparous breastfeeding initiation and duration

BACKGROUND

Many US women fall short of meeting the recommendations on breastfeeding. Whereas prenatal demographic factors have been well researched in relation to breastfeeding, psychosocial maternal characteristics are less understood but could be important predictors of breastfeeding initiation and duration.

OBJECTIVE

This study examined primiparous maternal psychosocial characteristics and temperamentally based negative infant affect as predictors of breastfeeding initiation and duration while accounting for depression and sociodemographic covariates.

METHODS

Prenatally, 237 primiparous women were administered the Adult Attachment Interview and completed a measure of beliefs related to infant crying. At 6 months postpartum, negative infant affect was assessed via mother report. Breastfeeding was assessed at 6 months and 1 year postpartum via mother report.

RESULTS

Results indicated that younger, low income, less educated, single, ethnic minority mothers and mothers with elevated depressive symptoms were less likely to initiate breastfeeding and breastfed for a shorter period than other women. Women who initiated breastfeeding tended to have higher adult attachment coherence scores (more secure attachment) than those who did not initiate breastfeeding (median score of 6.00 vs 4.00). An interaction was observed between negative infant affect and beliefs about crying related to spoiling, such that earlier cessation of breastfeeding was observed among mothers who reported high levels of negative infant affect and strongly endorsed the belief that responding to cries spoils infants (hazard ratio = 1.71, P < .01).

CONCLUSION

Although these psychosocial variables predicted relatively little variation in breastfeeding over and above covariates, the results suggest some novel approaches to promote breastfeeding.

The effects of 'does not apply' on measurement of temperament with the Infant Behavior Questionnaire-Revised: A cautionary tale for very young infants

BACKGROUND

The Infant Behavior Questionnaire-Revised (IBQ-R) is a widely used parent report measure of infant temperament. Items marked 'does not apply' (NA) are treated as missing data when calculating scale scores, but the effect of this practice on assessment of infant temperament has not been reported.

AIMS

To determine the effect of NA responses on assessment of infant temperament and to evaluate the remedy offered by several missing data strategies.

STUDY DESIGN

A prospective, community-based longitudinal cohort study.

SUBJECTS

401 infants who were born>37 weeks of gestation.

OUTCOME MEASURES

Mothers completed the short form of the IBQ-R when infants were 3-months and 6-months of age.

RESULTS

The rate of NA responses at the 3-month assessment was three times as high (22%) as the rate at six months (7%). Internal consistency was appreciably reduced and scale means were inflated in the presence of NA responses, especially at 3-months. The total number of NA items endorsed by individual parents was associated with infant age and parity. None of the missing data strategies completely eliminated problems related to NA responses but the Expectation Maximization algorithm greatly reduced these problems.

CONCLUSIONS

The findings suggest that researchers should exercise caution when interpreting results obtained from infants at 3 months of age. Careful selection of scales, selecting a full length version of the IBQ-R, and use of a modern missing data technique may help to maintain the quality of data obtained from very young infants.