Refining the assessment of disrupted maternal communication: Using item response models to identify central indicators of disrupted behavior

Evaluating the use of the AMBIANCE-Brief measure in clinical settings: Assessing acceptability, feasibility, and utility of the AMBIANCE-Brief

Community agencies and practitioners around the globe seek opportunities to learn various assessment tools and interventions rooted in attachment theory. However, information regarding the feasibility of implementation and sustainability of these tools once participants have been trained to use them, is limited. This study investigated the perceived acceptability, feasibility, utility, relevance, fidelity, and sustainability of the Atypical Maternal Behavior Instrument for Assessment and Classification-Brief (AMBIANCE-Brief) among practitioners who had taken a training. Practitioners (N = 59) who attended a virtual AMBIANCE-Brief training originating from Canada between June 2020 and November 2021 completed an online follow-up survey. Practitioners reported that they primarily used the AMBIANCE-Brief for case conceptualization (68%). Additionally, 95% agreed that the AMBIANCE-Brief was relevant to their clinical practice, 98% agreed it was useful for their clinical work, 76% agreed that it was feasible to implement into their clinical work, and 59% found it easy to incorporate into their treatment planning with clients. Findings suggest that the AMBIANCE-Brief may be acceptable, feasible, and useful for practitioners. Avenues for continuing to evaluate the AMBIANCE-Brief include cross-cultural validity, coder drift, and booster sessions. Additional work clarifying how practitioners integrate the measure into practice would be valuable.

Negative versus withdrawn maternal behavior: Differential associations with infant gray and white matter during the first 2 years of life

Distinct neural effects of threat versus deprivation emerge by childhood, but little data are available in infancy. Withdrawn versus negative parenting may represent dimensionalized indices of early deprivation versus early threat, but no studies have assessed neural correlates of withdrawn versus negative parenting in infancy. The objective of this study was to separately assess the links of maternal withdrawal and maternal negative/inappropriate interaction with infant gray matter volume (GMV), white matter volume (WMV), amygdala, and hippocampal volume. Participants included 57 mother-infant dyads. Withdrawn and negative/inappropriate aspects of maternal behavior were coded from the Still-Face Paradigm at four months infant age. Between 4 and 24 months (M age = 12.28 months, SD = 5.99), during natural sleep, infants completed an MRI using a 3.0 T Siemens scanner. GMV, WMV, amygdala, and hippocampal volumes were extracted via automated segmentation. Diffusion weighted imaging volumetric data were also generated for major white matter tracts. Maternal withdrawal was associated with lower infant GMV. Negative/inappropriate interaction was associated with lower overall WMV. Age did not moderate these effects. Maternal withdrawal was further associated with reduced right hippocampal volume at older ages. Exploratory analyses of white matter tracts found that negative/inappropriate maternal behavior was specifically associated with reduced volume in the ventral language network. Results suggest that quality of day-to-day parenting is related to infant brain volumes during the first two years of life, with distinct aspects of interaction associated with distinct neural effects.

Latent profiles of maternal disrupted communication: Relations to affect and behaviour in early infancy

Few studies have examined how mothering is organized in the first months of infancy, especially regarding risk-related interactions. Person-centred approaches, including latent profile analysis (LPA), add valuable insights about early parenting by identifying distinct profiles of interaction. First, this study aimed to identify profiles of disrupted maternal interaction during the Still-Face Paradigm among 181 mothers and their 3- to 8-month-old infants. Second, the study assessed how each maternal profile was related to infant affect and interactive behaviour. The LPA identified four profiles of maternal interaction: optimal, negative/intrusive, withdrawing and pervasively disrupted. The pervasively disrupted profile, in particular, has not been identified in past research. Each profile was associated with specific aspects of infant affect and behaviour. Recognition of disrupted behavioural profiles among at-risk mothers and infants in the early months could facilitate more precise tailoring of early interventions to the needs of mothers and infants with differing profiles of interactive risk.

Effects of maternal trauma and associated psychopathology on atypical maternal behavior and infant social withdrawal six months postpartum

Maternal psychopathology given a history of maltreatment and domestic violence exposure increases the risk for child psychopathology. Infant social withdrawal is one warning sign of adverse developmental outcomes including child anxiety and depression. It remains unclear how maternal trauma-related psychopathology might affect infant social withdrawal six-months postpartum.

METHODS

One-hundred ninety-five women and their six-month-old infants were studied in an at-risk community sample. Maternal trauma history, posttraumatic stress (PTSD) and major depressive (MDD) disorders were assessed. Maternal and infant behaviors were coded from videotaped interactions.

RESULTS

Maternal trauma was correlated with atypical maternal behavior (AMB) and infant social withdrawal (p ≤ .001). PTSD and MDD, and comorbid PTSD/MDD predicted increased AMB (p ≤ .001) but only maternal MDD was predictive of infant social withdrawal (p ≤ .001). Effects of maternal MDD on infant withdrawal were mediated by AMB.

CONCLUSIONS

At six-months postpartum, maternal MDD was associated with infant withdrawal. AMB is an important target for early intervention.

Developmental costs associated with early maternal withdrawal

Neglect is the most prevalent form of maltreatment, but it has been understudied relative to abuse. Additionally, developmental outcomes associated with early maternal withdrawal have been understudied relative to outcomes associated with harsh treatment. However, a large body of studies on rodents has documented the causal effect of low maternal care on altered stress responses in offspring. Other evidence from human studies links early maternal withdrawal to clinical levels of neglect. Studies of both rodents and humans suggest that, rather than the aversive responses (e.g., fight, flight, freeze) modeled in relation to threat of attack or harsh treatment, early maternal withdrawal is associated with increased calling and contact seeking to mothers. Moreover, two longitudinal studies indicate that early maternal withdrawal, but not negative-intrusive interaction, contributes to adolescent borderline psychopathology. The field needs prospective studies with well-operationalized constructs of maternal withdrawal to delineate the distinct developmental pathways that may be associated with neglect.

Feasibility of training service providers on the AMBIANCE-Brief measure for use in community settings

The Atypical Maternal Behavior Instrument for Assessment and Classification-Brief (AMBIANCE-Brief) was developed to provide a clinically useful and psychometrically sound assessment of disrupted parenting behavior for community practitioners. With prior evidence of this tool's reliability and validity in laboratory settings, this study aimed to determine whether providers from family service agencies could become reliable in the use of the level of disrupted communication following a brief training. Providers (N = 46) from three agency sites participated in a 2-day AMBIANCE-Brief training and, at the end of the training, coded eight videotaped mother-child interactions. Novice participant coding was compared to expert consensus ratings using intraclass correlations. On average, participants' interrater agreement was good (ICC_mean  = .84, SD = 0.10), with 89% meeting the reliability standards of ICC ≥ .70. In response to queries, 100% of participants indicated that they would recommend the AMBIANCE-Brief training to their colleagues, 85% reported that the AMBIANCE-Brief measure would be useful or very useful for their clinical practice, and 56% of participant clinicians believed that parents would find the measure acceptable or very acceptable for integration into intervention or support planning. Altogether, these findings speak to the feasibility of using the AMBIANCE-Brief in community settings. Future studies are needed in diverse clinical and community contexts to evaluate whether use of this assessment tool can inform more targeted interventions tailored to the specific needs of families.

Intervening with Attachment and Biobehavioral Catch-Up to decrease disrupted parenting behavior and attachment disorganization: The role of parental withdrawal

This randomized controlled trial investigated the efficacy of Attachment and Biobehavioral Catch-up (ABC; Dozier, Bick, & Bernard, 2011) in reducing disrupted parenting behavior (affective communication errors, role/boundary confusion, fearful/disoriented, intrusive/negativity, and withdrawal) and its association with disorganized attachment. Participants were 105 mother-child dyads randomized to receive either ABC or a control intervention (a 10-session home-visiting intervention focused on improving children's cognitive abilities, gross and fine motor abilities, and language development). At the time of study enrollment, mothers were approximately 26.7 years old (SD = 7.8) and predominantly Black or African American (73.9%). At the first follow-up visit, children were approximately 20.7 months old (SD = 6.3) and most were identified as Black or African American (61.9%). Fifty-two percent of children were male (n = 55). Assessments of disrupted parenting behavior and child attachment quality were assessed approximately 7 months postintervention (SD = 5.8). A one-way analysis of variance revealed that parents who received ABC demonstrated lower levels of parental withdrawal than parents who received the control condition. A structural equation model revealed a significant indirect effect of intervention group on attachment quality through lower levels of parental withdrawal. Results add to the efficacy of the ABC intervention and identified parental withdrawal as a mediator of change.

Intervening with Attachment and Biobehavioral Catch-Up to decrease disrupted parenting behavior and attachment disorganization: The role of parental withdrawal

This randomized controlled trial investigated the efficacy of Attachment and Biobehavioral Catch-up (ABC; Dozier, Bick, & Bernard, 2011) in reducing disrupted parenting behavior (affective communication errors, role/boundary confusion, fearful/disoriented, intrusive/negativity, and withdrawal) and its association with disorganized attachment. Participants were 105 mother-child dyads randomized to receive either ABC or a control intervention (a 10-session home-visiting intervention focused on improving children's cognitive abilities, gross and fine motor abilities, and language development). At the time of study enrollment, mothers were approximately 26.7 years old (SD = 7.8) and predominantly Black or African American (73.9%). At the first follow-up visit, children were approximately 20.7 months old (SD = 6.3) and most were identified as Black or African American (61.9%). Fifty-two percent of children were male (n = 55). Assessments of disrupted parenting behavior and child attachment quality were assessed approximately 7 months postintervention (SD = 5.8). A one-way analysis of variance revealed that parents who received ABC demonstrated lower levels of parental withdrawal than parents who received the control condition. A structural equation model revealed a significant indirect effect of intervention group on attachment quality through lower levels of parental withdrawal. Results add to the efficacy of the ABC intervention and identified parental withdrawal as a mediator of change.