Early mother-infant reciprocity

Clinically defining the opioid-exposed birthing person and infant as a dyad to support bedside care, surveillance, and research

Introduction

An increased incidence of maternal opioid use disorder (OUD) and neonatal abstinence syndrome (NAS) has prompted recommendations supporting a dyadic approach to care for birthing persons and their infants. However, there are no consensus guidelines outlining how the dyad is clinically defined.

Methods

To examine how the opioid-exposed birthing person-infant dyad has been defined for purposes of data collection and research, a literature review applying the RAND/UCLA Appropriateness Method was conducted.

Results

The search yielded 320 abstracts, with 110 articles identified as having a dyadic focus. While no articles included a specific definition for the dyad, 33 (30%) contained a descriptive reference to the birthing person-infant dyad. Thematic analysis revealed eight recurring elements characteristic of the dyad: (1) engagement, (2) communication, (3) bonding, (4) attachment, (5) mutual responsiveness, (6) reciprocity, (7) synchrony, and (8) attunement. Integrating these elements revealed the interactional relationship between the opioid-exposed birthing person and infant as the foundational principle that defines the dyad.

Discussion

This definition shifts the focus of the opioid-exposed dyad from two individual patient populations to an interactional relationship that has broad applicability for clinical use, public health data collection, and research considerations.

Annual Research Review: 'There, the dance is - at the still point of the turning world' - dynamic systems perspectives on coregulation and dysregulation during early development

During development we transition from coregulation (where regulatory processes are shared between child and caregiver) to self-regulation. Most early coregulatory interactions aim to manage fluctuations in the infant's arousal and alertness; but over time, coregulatory processes become progressively elaborated to encompass other functions such as sociocommunicative development, attention and executive control. The fundamental aim of coregulation is to help maintain an optimal 'critical state' between hypo- and hyperactivity. Here, we present a dynamic framework for understanding child-caregiver coregulatory interactions in the context of psychopathology. Early coregulatory processes involve both passive entrainment, through which a child's state entrains to the caregiver's, and active contingent responsiveness, through which the caregiver changes their behaviour in response to behaviours from the child. Similar principles, of interactive but asymmetric contingency, drive joint attention and the maintenance of epistemic states as well as arousal/alertness, emotion regulation and sociocommunicative development. We describe three ways in which active child-caregiver regulation can develop atypically, in conditions such as Autism, ADHD, anxiety and depression. The most well-known of these is insufficient contingent responsiveness, leading to reduced synchrony, which has been shown across a range of modalities in different disorders, and which is the target of most current interventions. We also present evidence that excessive contingent responsiveness and excessive synchrony can develop in some circumstances. And we show that positive feedback interactions can develop, which are contingent but mutually amplificatory child-caregiver interactions that drive the child further from their critical state. We discuss implications of these findings for future intervention research, and directions for future work.

Babies in therapy, psychoanalytic interventions for infants and their parents

Babies in therapy: The study "Psychoanalytic interventions for infants and their parents" conducted on infants through the lens of psychoanalysis and clinical work with both parents and infants all contribute to our knowledge of the nature of early relationship disorders. Psychoanalytic theory's concepts of the depressive position, early defense mechanisms, transference, and psychosomatic reactions to depressive emotions are shown to be crucial in clinical cases, giving therapists new tools for intervention and increasing efficiency. Psychoanalysts have researched the long-lasting effects of early disappointments and the sense of being helplessly abandoned; they emphasize that a disruption in the relationship with the caregiver can produce a psychic economy oriented on the avoidance of anxiety, leaving less energy for development. New parents and their sick infants can benefit from early therapies with therapeutic potential and the possibility of preventing future narcissistic pain issues if they are based on psychoanalytic thinking and knowledge of early symptoms.

Attention Guides the Motor-Timing Strategies in Finger-Tapping Tasks When Moving Fast and Slow

Human beings adapt the spontaneous pace of their actions to interact with the environment. Yet, the nature of the mechanism enabling such adaptive behavior remains poorly understood. The aim of the present contribution was to examine the role of attention in motor timing using (a) time series analysis, and (b) a dual task paradigm. In a series of two studies, a finger-tapping task was used in sensorimotor synchronization with various tempi (from 300 to 1,100 ms) and motor complexity (one target vs. six targets). Time series analyzes indicated that two different timing strategies were used depending on the speed constraints. At slow tempi, tapping sequences were characterized by strong negative autocorrelations, suggesting the implication of cognitive predictive timing. When moving at fast and close-to-spontaneous tempi, tapping sequences were characterized by less negative autocorrelations, suggesting that timing properties emerged from body movement dynamics. The analysis of the dual-task reaction times confirmed that both the temporal and spatial constraints impacted the attentional resources allocated to the finger-tapping tasks. Overall, our work suggests that moving fast and slow involve distinct timing strategies that are characterized by contrasting attentional demands.

Sensory processing disorders in premature infants

Introduction. Children born prematurely have an increased risk of immediate medical complications, as well as socioemotional, cognitive, linguistic and sensory processing disorders later in life. Studies have examined the effects of prematurity on developmental outcomes, such as cognition, however, there is a need for a more detailed examination of sensory processing disorders in preterm infants. Not only is prenatal neurosensory development interrupted in utero, but these children may also experience intense stimulation in the neonatal unit, which can further alter the development and function of the sensory system. Objective. The paper presents an overview of research on sensory processing disorders in premature infants, with special emphasis on the impact of the environment of the neonatal unit. Method. Insight into the relevant literature was performed by specialized search engines on the Internet and insight into the electronic database. Results. Sensory processing disorders affect 39% to 52% of newborns born prematurely, with some evidence to suggest that children born before 32 weeks are most at risk. The literature to date has consistently reported difficulties in sensory modulation of preterm infants, within the tactile, vestibular, auditory, oral, and visual domains. Conclusion. Sensory processing disorders in preterm infants appear to occur as a result of their immature neurological and biological system and being in the environment of a neonatal intensive care unit, which is unable to meet the sensory needs of preterm infants. Altered sensory experiences, during periods of neurodevelopmental vulnerability and fragility, can result in sensory processing disorders, which may include enhanced responses or less response to stimuli (hyper or hyposensitivity).

The implications of face masks for babies and families during the COVID-19 pandemic: A discussion paper

COVID-19 has changed the way that newborn babies are cared for within the neonatal setting due to the introduction of social distancing and wearing of face masks to limit the spread of the infection. Potential implications exist related to the normal development of bonding and connections with others. This paper discusses the importance of face to face interactions for early attachment between babies and parents within the context of relevant underpinning developmental theory. Mask wearing can also potentially impact relational communication, requiring us to change our current ways of working. Decreasing face to face interactions and relational communication, along with key recommendations for both parents and health professionals are further highlighted to mitigate the potential negative effects of masks on long-term development related to human connection and attachment.

Digitized Autism Observation Diagnostic Schedule: Social Interactions beyond the Limits of the Naked Eye

The complexity and non-linear dynamics of socio-motor phenomena underlying social interactions are often missed by observation methods that attempt to capture, describe, and rate the exchange in real time. Unknowingly to the rater, socio-motor behaviors of a dyad exert mutual influence over each other through subliminal mirroring and shared cohesiveness that escape the naked eye. Implicit in these ratings nonetheless is the assumption that the other participant of the social dyad has an identical nervous system as that of the interlocutor, and that sensory-motor information is processed similarly by both agents’ brains. What happens when this is not the case? We here use the Autism Diagnostic Observation Schedule (ADOS) to formally study social dyadic interactions, at the macro- and micro-level of behaviors, by combining observation with digital data from wearables. We find that integrating subjective and objective data reveals fundamentally new ways to improve standard clinical tools, even to differentiate females from males using the digital version of the test. More generally, this work offers a way to turn a traditional, gold-standard clinical instrument into an objective outcome measure of human social behaviors and treatment effectiveness.

Early detection of parenting stress in mothers of preterm infants during their first-year home

Background

Maternal stress following the birth of an infant is well acknowledged. It is particularly so when infants are born prematurely as their mothers cannot fully take on their parenting role until their infant(s) is discharged from neonatal intensive care units (NICUs). In this exploratory study, we examined whether these mothers’ parenting stress would lessen during their first-year reunification with their infant(s) as they settle into motherhood at home.

Methods

Two groups of mothers with infants born between 24- and 33-week gestational age were recruited. A group of 25 mothers were monitored at their infants’ 1-month corrected age (CA) and a second group of 24 mothers were monitored at their infants’ 12-month CA. Subjects completed the long form Parental Stress Index (PSI) ranking how stressful they perceive the individual subscales in the Child and Parent Domains of the self-reported questionnaire (PSI-3; Abidin; PAR Inc). The PSI theorizes that the stress mothers perceive is a resultant of their respective characteristics, interactions with their infant(s), family, and environment. Statistical analyses include descriptive statistics, χ² square analysis, and independent t-test.

Results

There was no significant difference in the levels of perceived stress in the PSI subscales between the two groups of mothers at 1- and 12-month CA. Scores for the majority of respondents fell within the 15th to 80th percentile (% ile) distribution of Abidin’s normative population, with some mothers falling below the 15th % ile.

Discussion/conclusion

The data collected suggest that: 1. the perceived stress experienced by mothers during their first-year reunited with their preterm infants is within the normal range observed in Abidin’s normative population. 2. As the PSI is a self-reported survey, care providers need to be aware that some mothers may downplay their stress responses. 3. With the ability to monitor individual participants, the PSI can be readily offered to mothers at their infants’ first year routine clinical visits to assist in the early identification of parenting issues that may threaten the development of a healthy mother-infant dyad. Early appropriate guidance and social support would help “at-risk” mothers develop more constructive parenting routines.

Preterm and full term infant vocalization and the origin of language

How did vocal language originate? Before trying to determine how referential vocabulary or syntax may have arisen, it is critical to explain how ancient hominins began to produce vocalization flexibly, without binding to emotions or functions. A crucial factor in the vocal communicative split of hominins from the ape background may thus have been copious, functionally flexible vocalization, starting in infancy and continuing throughout life, long before there were more advanced linguistic features such as referential vocabulary. 2-3 month-old modern human infants produce "protophones", including at least three types of functionally flexible non-cry precursors to speech rarely reported in other ape infants. But how early in life do protophones actually appear? We report that the most common protophone types emerge abundantly as early as vocalization can be observed in infancy, in preterm infants still in neonatal intensive care. Contrary to the expectation that cries are the predominant vocalizations of infancy, our all-day recordings showed that protophones occurred far more frequently than cries in both preterm and full-term infants. Protophones were not limited to interactive circumstances, but also occurred at high rates when infants were alone, indicating an endogenous inclination to vocalize exploratorily, perhaps the most fundamental capacity underlying vocal language.

The Interaction between Mothers and their Visually Impaired Infants: An Intersubjective Developmental Perspective

In this article, an intersubjective developmental theory that focuses primarily on the development of the interworld between the caregiver and the infant is used to integrate and interpret the seemingly incoherent and contradictory research findings on the interactions between mothers and their infants with visual impairments. The implications for further research and early intervention practices are presented.

Child and Adolescent Depression: A Review of Theories, Evaluation Instruments, Prevention Programs, and Treatments

Depression is the principal cause of illness and disability in the world. Studies charting the prevalence of depression among children and adolescents report high percentages of youngsters in both groups with depressive symptoms. This review analyzes the construct and explanatory theories of depression and offers a succinct overview of the main evaluation instruments used to measure this disorder in children and adolescents, as well as the prevention programs developed for the school environment and the different types of clinical treatment provided. The analysis reveals that in mental classifications, the child depression construct is no different from the adult one, and that multiple explanatory theories must be taken into account in order to arrive at a full understanding of depression. Consequently, both treatment and prevention should also be multifactorial in nature. Although universal programs may be more appropriate due to their broad scope of application, the results are inconclusive and fail to demonstrate any solid long-term efficacy. In conclusion, we can state that: (1) There are biological factors (such as tryptophan-a building block for serotonin-depletion, for example) which strongly influence the appearance of depressive disorders; (2) Currently, negative interpersonal relations and relations with one's environment, coupled with social-cultural changes, may explain the increase observed in the prevalence of depression; (3) Many instruments can be used to evaluate depression, but it is necessary to continue to adapt tests for diagnosing the condition at an early age; (4) Prevention programs should be developed for and implemented at an early age; and (5) The majority of treatments are becoming increasingly rigorous and effective. Given that initial manifestations of depression may occur from a very early age, further and more in-depth research is required into the biological, psychological and social factors that, in an interrelated manner, may explain the appearance, development, and treatment of depression.

Reducing toxic stress in the neonatal intensive care unit to improve infant outcomes

In 2011, the American Academy of Pediatrics (AAP) published a technical report on the lifelong effects of early toxic stress on human development, and included a new framework for promoting pediatric health: the Ecobiodevelopmental Framework for Early Childhood Policies and Programs. We believe that hospitalization is a specific form of toxic stress for the neonatal patient, and that toxic stress must be addressed by the nursing profession in order to substantially improve outcomes for the critically ill neonate. Approximately 4% of normal birthweight newborns and 85% of low birthweight newborns are hospitalized each year in the highly technological neonatal intensive care unit (NICU). Neonates are exposed to roughly 70 stressful procedures a day during hospitalization, which can permanently and negatively alter the infant's developing brain. Neurologic deficits can be partly attributed to the frequent, toxic, and cumulative exposure to stressors during NICU hospitalization. However, the AAP report does not provide specific action steps necessary to address toxic stress in the NICU and realize the new vision for pediatric health care outlined therein. Therefore, this paper applies the concepts and vision laid out in the AAP report to the care of the hospitalized neonate and provides action steps for true transformative change in neonatal intensive care. We review how the environment of the NICU is a significant source of toxic stress for hospitalized infants. We provide recommendations for caregiving practices that could significantly buffer the toxic stress experienced by hospitalized infants. We also identify areas of research inquiry that are needed to address gaps in nursing knowledge and to propel nursing science forward. Finally, we advocate for several public policies that are not fully addressed in the AAP technical report, but are vital to the health and development of all newborns.

Neonatal Transitions in Social Behavior and Their Implications for Autism

Within the context of early infant-caregiver interaction, we review a series of pivotal transitions that occur within the first 6 months of typical infancy, with emphasis on behavior and brain mechanisms involved in preferential orientation towards, and interaction with, other people. Our goal in reviewing these transitions is to better understand how they may lay a necessary and/or sufficient groundwork for subsequent phases of development, and also to understand how the breakdown thereof, when development is atypical and those transitions become derailed, may instead yield disability. We review these developmental processes in light of recent studies documenting disruptions to early-emerging brain and behavior mechanisms in infants later diagnosed with autism spectrum disorder, shedding light on the brain-behavior pathogenesis of autism.

Breastfeeding Challenges and the Preterm Mother-Infant Dyad: A Conceptual Model

Breastfeeding is an experience that only a mother and her infant(s) can share. Infants who can feed from the breast receive not only the best nutrition but also, due to the close physical contact between mother and child, it is the optimal nurturance they can receive from their mother. When breastfeeding is trouble free, maternal well-being is uniquely heightened. However, breastfeeding remains a challenge for many mother-infant dyads and more so for those whose infants are born prematurely. This article introduces a conceptual model of the breastfeeding challenges facing preterm mother-infant dyads. It distinguishes between a maternal caregiving and an infant growth/development components. Within the maternal component, two primary elements are considered, that is, maternal behavioral and nutritional care. The two primary elements within the infant component include infant non-nutritional and nutritional growth/development. It is proposed that an improved understanding of the factors associated with these four elements and how they interplay with each other within individual dyads will facilitate the identification of the breastfeeding challenges facing these mother-infant entities. Due to the intimate relationships existing between a mother and her infant(s), it is further advanced that breastfeeding studies would be optimized if mother-infant pairs are studied as one entity rather than mother and infant separately. It is proposed that this conceptual model will assist health professionals develop personalized breastfeeding management plans for individual preterm mother-infant dyads, while furthering the development of evidence-based interventions to optimize their breastfeeding experiences.

Differences in Action Style Recognition in Children with Autism Spectrum Disorders

Vitality form is a term, originally introduced by Stern (2010), to describe "how" an action is performed. The capacity to perceive the vitality form of others' actions is a fundamental element of social interactions and a basic way of relating to and understanding others' behaviors. Although vitality forms characterize all human interactions, few studies have addressed their role in social and communicative disorders such as autism. The aim of the present study is to evaluate the ability to recognize different vitality forms during the observation of different motor actions in a group of children with autism spectrum disorders (ASD) compared to typically developing controls (TD). Results show a significant difference between children with ASD and TD in vitality forms recognition. This finding sheds new light on how children with ASD understand others' actions providing new ideas on overall social understanding as well as useful insights for professionals and caregivers alike.

Attachment Avoidance Is Significantly Related to Attentional Preference for Infant Faces: Evidence from Eye Movement Data

Objective: To determine the influence of adult attachment orientations on infant preference. Methods: We adopted eye-tracking technology to monitor childless college women's eye movements when looking at pairs of faces, including one adult face (man or woman) and one infant face, with three different expressions (happy, sadness, and neutral). The participants (N = 150; 84% Han ethnicity) were aged 18-29 years (M = 19.22, SD = 1.72). A random intercepts multilevel linear regression analysis was used to assess the unique contribution of attachment avoidance, determined using the Experiences in Close Relationships scale, to preference for infant faces. Results: Women with higher attachment avoidance showed less infant preference, as shown by less sustained overt attentional bias to the infant face than the adult face based on fixation time and count. Conclusion: Adult attachment might be related to infant preference according to eye movement indices. Women with higher attachment avoidance may lack attentional preference for infant faces. The findings may aid the treatment and remediation of the interactions between children and mothers with insecure attachment.

Mother-Infant Studies: Subject Refusals and Sampling Bias

Do sampling biases introduced in studies requiring a large amount of time make those samples less representative than the samples in studies requiring less subject involvement? This question was explored in the context of mother-infant interaction studies by eomparing maternal attitudes of two groups of mothers: 20 mothers who participated with their infants in 35 hours of observation and testing, and 17 mothers who refused to participate in that study, but did spend 30 minutes completing a questionnaire. These two groups of mothers differ widely in their willingness to be involved in a study. All subjects completed the Pregnancy Research Inventory at the end of the eighth month of pregnancy. There were no significant differences between the two groups on any scale. The importance of developing procedures to assess important biases introduced into studies requiring substantial commitments of time is discussed.

Hyperscanning MEG for understanding mother-child cerebral interactions

Child development is seriously affected by social interactions with caregivers, which may lead to forming social minds in our daily life afterward. However, the underlying neural mechanism for such interactions has not yet been revealed. This article introduces a magnetoencephalographic (MEG) hyperscanning system to examine brain-to-brain interactions between a mother and her child. We used two whole-head MEG systems placed in the same magnetically-shielded room. One is a 160-channel gradiometer system for an adult and the other is a 151-channel gradiometer system for a child. We developed an audio-visual presentation system, which enabled a mother and her child to look at each other in real time. In each MEG system, a video camera was placed behind a half-mirror screen for visual presentation to obtain the subjects' facial expressions. The visual presentation system is capable of displaying not only real-time facial expression but also processed facial expression such as a still face or delayed facial expressions. A projector system displays the side-by-side face images of the mother and child, and the images are divided into each face using splitting mirrors and each face is displayed on the half-mirror screen in front of the other subject. To the best of our knowledge, our system is the first MEG hyperscanning system in a single shielded room, and may contribute to elucidating brain-to-brain interactions not only between a mother and her child but also in general inter-individual, brain-to-brain interactions.

Not all emotions are created equal: the negativity bias in social-emotional development

There is ample empirical evidence for an asymmetry in the way that adults use positive versus negative information to make sense of their world; specifically, across an array of psychological situations and tasks, adults display a negativity bias, or the propensity to attend to, learn from, and use negative information far more than positive information. This bias is argued to serve critical evolutionarily adaptive functions, but its developmental presence and ontogenetic emergence have never been seriously considered. The authors argue for the existence of the negativity bias in early development and that it is evident especially in research on infant social referencing but also in other developmental domains. They discuss ontogenetic mechanisms underlying the emergence of this bias and explore not only its evolutionary but also its developmental functions and consequences. Throughout, the authors suggest ways to further examine the negativity bias in infants and older children, and they make testable predictions that would help clarify the nature of the negativity bias during early development.

What is maternal-infant intervention? The role of infant psychotherapy

Therapeutic prevention and intervention programs for infants, their families, and their communities are now quite numerous across the country (Tjossem 1978). These programs differ in respect to size, target populations, and integration of services, but they all have one underlying premise; if intervention can be carried out while the child is still very young, the probability is considerably increased that the child can reach his or her potential. What these programs have in common is a new and concentrated interest in the psychosocial development of the infant in a context of reciprocal behavior with the primary caretaker. There are, of course, many differences, according to the specialized interests of the starting teams, the populations to be served, the therapeutic services already available, and the level of funding; yet all are bound together by the assumptions of infant psychiatry. In this paper, a context for a discussion of parent-infant intervention will be established. We will first address the assumptions of infant psychiatry and then will review the technique of infant psychotherapy. This technique, which we described in a previous paper (Johnson, Dowling, and Wesner 1980), has been found to be extremely useful in helping mothers and infants to increase mutual adjustment. Finally we describe a community-oriented parent-infant intervention program which used this technique.