Nighttime maternal responsiveness and infant attachment at one year

Maternal Depression and Sleep Problems in Early Childhood: A Meta-Analysis

Both prenatal and postnatal maternal depression have been associated with increased sleep problems in early childhood. However, this association is less consistent for postnatal depression, and the strength of the association remains unclear. The aim of the current study was to provide a quantitative synthesis of the literature to estimate the magnitude of the association between maternal depression and sleep problems in early childhood. Medline, PsycINFO, PsycARTICLES, Web of Science, and Scopus were searched for prospective longitudinal studies from 1970 to December 2022. Of 117 articles screened, 22 studies met the inclusion criteria. Both prenatal depression (OR = 1.82; 95% CI = 1.28-2.61) and postnatal depression (OR = 1.65; 95% CI = 1.50-1.82) were associated with increased likelihood of sleep problems in early childhood. The heterogeneity between the studies was significant and high both for prenatal (Q = 432.323; I2 = 97.456, P < .001) and postnatal depression (Q = 44.902, I2 = 65.594, P < .001), which mean that conclusions are tentative and need to be considered within the possible influence of unmeasured confounding. However, mitigating depression symptoms in mothers both during pregnancy and in the postnatal period would be an effective strategy for reducing sleep problems in children.

Sources of attitudes towards parent-child co-sleeping and their effects: A systematic scoping review

Parent-child co-sleeping is a common practice in many cultures, although in Western countries, families who engage in parent-child co-sleeping can encounter attitudes about co-sleeping that feel critical from the people around them, as it is not commonly accepted and often stigmatized. This systematic scoping review examined and synthesized the available literature on the attitudes about parent-child co-sleeping that people encounter, their origins, and their effect on parents' own attitudes and behaviors. A total of 9796 abstracts were screened, and 33 studies were included. While the scope of the literature on this topic was narrow, this review demonstrated that parents/caregivers mostly encounter encouraging attitudes about co-sleeping from their extended family members and within their culture and discouraging attitudes from healthcare professionals. Findings suggest that encouraging attitudes enhance the likelihood of parents engaging and continuing with co-sleeping behavior, while discouraging attitudes can lead to the avoidance of parents discussing sleep with their healthcare professionals and can cause conflicts with other family members, including partners. Based on these findings, we conclude that further research is needed in several areas related to co-sleeping in Western culture, most specifically in how external attitudes influence the decision to co-sleep, as well as other behaviors and cognitions such as engagement with healthcare professionals, family satisfaction, parental self-efficacy, and overall mental health.

A longitudinal study of breastfeeding relationships at home during the COVID-19 pandemic: A grounded theory method

AIMS

To describe the process of breastfeeding relationships among stay-at-home mother and infant dyads at 1, 3, 5 and 6 months.

DESIGN

A longitudinal qualitative online survey design was used.

METHODS

Data were obtained at 1, 3, 5 and 6 months from 26 breastfeeding mothers who stayed home with their infants and directly breastfed at least once a day for the first 6 months between June 2022 and August 2023. Mothers' written responses to 3 open-ended questions were analysed to assess breastfeeding experiences at home, thoughts/comments while directly breastfeeding and breastfeeding concerns/problems and strategies they used. Based on grounded theory, inductive content analysis was used to analyse the data. Trustworthiness of results was established by coding to consensus, formal peer debriefing and maintaining an audit trail.

RESULTS

'Breastfeeding Relationships at Home,' the core construct, was identified and organized the process of breastfeeding relationships into 5 domains: (1) mothers' emotional well-being while breastfeeding, (2) infant-led feeding, (3) alternatives to breastfeeding, (4) evaluation of breastfeeding and (5) changes in breastfeeding as infants grow older.

CONCLUSION

Breastfeeding is not simply about feeding breast milk but also involves nurturing and developing a relationship between mother and infant. Across the domains, mutual responsiveness, a central element of the breastfeeding relationship was clear. Mothers who were committed to breastfeeding with embedded infant suckling reached emotional well-being in return for their engagement which has potential to reduce maternal stress and prevent postpartum depression.

IMPACT

Findings from the current study add to nurses' knowledge about the relationship building process between stay-at-home mothers and their infants in the first 6 months of breastfeeding during the COVID-19 pandemic. Nurses must remain sensitive to aid the development of breastfeeding relationships in the home environment to maximize mutual responsiveness.

PATIENT OR PUBLIC CONTRIBUTION

No patients or public involved.

Instrument development and an intervention to increase parents' self-efficacy regarding their infant's sleep

OBJECTIVE

Many Swedish parents experience that their infant has sleeping problems. Parents' self-efficacy regarding their infants' sleep may play an important role in how they perceive these problems. This pilot study aimed to develop an instrument measuring parents' self-efficacy regarding their infant's sleep and to examine if parents' self-efficacy was affected by an intervention focusing on parental education.

METHOD

Mothers and fathers, at a maternity unit in Sweden, were drawn into either an intervention (n = 46) or a control (n = 42) group. The intervention group received a home visit from a nurse who provided information about infant sleep; the importance of attachment; and advice regarding sleep, breastfeeding and bed sharing, including guidelines for safe bed sharing. Three months later, the participants answered questions on background data, breastfeeding, sleep and self-efficacy.

RESULTS

The 11-item two-factor Uppsala Parental Self-Efficacy about Infant Sleep Instrument (UPPSEISI) was constructed to measure parents' perceived self-efficacy. In adjusted analyses, being in the intervention group was associated with a higher self-efficacy (P = 0.035), as were being a mother (P = 0.003) and being satisfied with one's own sleep (P = 0.007), while parents' own sleeping problems were associated with a lower self-efficacy (P = 0.015).

CONCLUSION

Importantly, parental education may increase parents' self-efficacy regarding their infant's sleep.

From co-regulation to self-regulation: Maternal soothing strategies and self-efficacy in relation to maternal reports of infant regulation at 3 and 7 months

This study, conducted in Germany, examines the role of maternal soothing strategies to explain the association of maternal self-efficacy with infant regulation (crying and sleeping behavior). Questionnaire data of 150 mothers, living in Germany, with mixed ethnic and educational backgrounds were collected when infants were 3 and 7 months old. Two types of maternal soothing strategies were distinguished: close soothing, involving close physical and emotional contact, and distant soothing, involving physical and emotional distancing from the infant. A cross-sectional SEM at 3 months indicated that maternal self-efficacy is associated with reported infant regulation through distant soothing strategies. Low maternal self-efficacy was associated with frequent maternal use of distant soothing, which in turn was related to reported infant regulation problems, that is, non-soothability and greater crying frequency. Frequent use of close soothing was associated with reported infant sleeping behavior, that is, frequent night-time awakenings. A longitudinal SEM further indicated that the effects of close soothing persisted at least until the infants' age of 7 months. The study showed how low maternal self-efficacy, increased use of distant soothing, and reported early infant regulation problems are intertwined and that, due to their persisting positive effect on infant soothability, close soothing better supports infant development.

Contextual considerations in infant sleep: Offering alternative interventions to families

Infant sleep problems are one of the commonly reported reasons parents seek professional help, yet what constitutes a "sleep problem" depends on the models used to explain the development of infant sleep. The current models are based on research conducted in the western context where infant solitary sleeping is the norm. Parent-child co-sleeping is the norm in many cultures around the world. We argue that the primary focus of current research on parent-child interactions as the mediating context for the development of infant sleep problems has inherently made these models and ensuing interventions less sensitive and applicable to infant sleep problems in the context of co-sleeping families. When families present for help with infant sleep difficulties, extinction based behavioral interventions or interventions focused on reducing parental presence at bedtime are commonly recommended. These recommendations may not always align with cultural values and parenting practices of all families, therefore precluding these families from getting necessary help. In attempting to provide families with choices that depart from behavioral based interventions, this paper draws on research and adapts current models to propose an alternative to conceptualize perceptions of infant sleep problems that may be sensitive to and applied across various cultural and personal contexts. We attempt to provide a rationale for interventions that are inclusive and sensitive to families where reduced parental nighttime responsiveness may not be a preferred choice.

The relationship between perinatal circadian rhythm and postnatal depression: an overview, hypothesis, and recommendations for practice

Postnatal depression (PND) is an important public health problem with far-reaching consequences for mothers, families, and society. Current treatment approaches tend to focus on the depressive symptoms of the mother. We propose the need for a shift in the conceptualisation of PND and its management, by focusing on circadian rhythm as an early manifestation of mother-infant synchrony. We have reviewed the relevant interdisciplinary literature to formulate a hypothesis and suggest recommendations for practice. We hypothesise that, after a mother’s circadian rhythm becomes ‘desynchronised’ immediately following birth, persistence of this disruption is implicated in the development of PND. This has important implications for novel treatment strategies in the critical and vulnerable postnatal period, for example the use of outdoor-based interventions and light.

Using complexity science to understand the role of co-sleeping (bedsharing) in mother-infant co-regulatory processes

Human infants spend most of their time sleeping, but over the first few years of life their sleep becomes regulated to coincide more closely with adult sleep (Galland et al., 2012; Paavonen et al., 2020). Evidence shows that co-sleeping played a role in the evolution of infant sleep regulation, as it is part of an ancient behavioral complex representing the biopsychosocial microenvironment in which human infants co-evolved with their mothers through millions of years of human history (Ball, 2003; McKenna 1986, 1990). This paper is a conceptual, interdisciplinary, integration of the literature on mother-infant co-sleeping and other mother-infant co-regulatory processes from an evolutionary (biological) perspective, using complexity science. Viewing the mother-infant dyad as a "complex adaptive system" (CAS) shows how the CAS fits assumptions of regulatory processes and reveals the role of the CAS in the ontogeny of mother-infant co-regulation of physiological (thermoregulation, breathing, circadian rhythm coordination, nighttime synchrony, and heart rate variability) and socioemotional (attachment and cortisol activity) development.

Effect of Play2Sleep on mother-reported and father-reported infant sleep: a sequential explanatory mixed-methods study of a randomized controlled trial

STUDY OBJECTIVES

This study evaluated the effect on infant sleep of a novel intervention (Play2Sleep) that combined infant sleep information with self-modeled video feedback on parent-infant interactions.

METHODS

An explanatory sequential mixed-methods design consisting of a randomized controlled trial with 63 mother-father-infant triads randomized to Play2Sleep or comparison home visit interventions was used. We used repeated measures analysis of covariance to detect changes in infant night wakings, nocturnal wakefulness, and sleep durations and Wilcoxon signed rank test to evaluate changes in perception of infant sleep problems. Family interviews (n = 20) were used to explain the quantitative findings and analyzed qualitatively using thematic analysis.

RESULTS

Play2Sleep was effective in reducing maternal-reported infant wakefulness, F(1,55) = 5.33, P = .03, partial η² = .09, and the number of paternal-reported naps, F(1,58) = 4.90, P = .03, partial η² = .08. Parents in the Play2Sleep group reported significant improvements in problematic infant sleep that were not observed in the comparison group; however, Play2Sleep was not effective in reducing the number of parent-reported night wakings. Information overwhelm, learning infant cues, and working together with a subtheme of father involvement were key qualitative themes developed to explain the quantitative results. Unplanned exploratory analyses revealed a significant improvement in maternal depression symptoms in the Play2Sleep group.

CONCLUSIONS

This study suggests Play2Sleep could improve infant sleep by promoting parental awareness of infant cues and father involvement and improving maternal depression. Additional research is needed to determine the optimal number and timing of sessions.

CLINICAL TRIAL REGISTRATION

Registry: ClinicalTrials.gov; Name: Play2Sleep: Using Play to Improve Sleep; URL: https://clinicaltrials.gov/ct2/show/NCT02742155; Identifier: NCT02742155.

CITATION

Keys EM, Benzies KM, Kirk VG, Duffett-Leger L. Effect of Play2Sleep on mother-reported and father-reported infant sleep: a sequential explanatory mixed-methods study of a randomized controlled trial. J Clin Sleep Med. 2022;18(2):439-452.

Reasons mothers bedshare: A review of its effects on infant behavior and development

Bedsharing is controversial for nighttime caregiving in the U.S. today, as in most of the West. However, from the standpoint of evolutionary pediatrics, anthropology, and cultural psychology, bedsharing is not controversial at all, representing the context for human infant evolution and conferring a host of physiological benefits to the infant as well as the mother. In an effort to understand the rise in Western bedsharing in recent decades (and following Ball, 2002; McKenna & Volpe, 2007), Salm Ward (2015) systematically reviewed the literature on mother-infant bedsharing and identified ten reasons why mothers choose to bedshare: (1) breastfeeding, (2) comforting for mother or infant, (3) better/more sleep for infant or parent, (4) monitoring, (5) bonding/ attachment, (6) environmental reasons, (7) crying, (8) cultural or familial traditions, (9) disagree with danger, and (10) maternal instinct. The current paper offers the "review behind the review," highlighting the scientific evidence behind the reasons mothers give for their decision to bedshare, focusing on how mothers' decisions about infant sleep location influence infant behavior and development.

Developmental trajectories of infant nighttime awakenings are associated with infant-mother and infant-father attachment security

This longitudinal study examined developmental trajectories of infant sleep problems from 3 to 24 months old and investigated associations with infant-parent attachment security and dependency. In a sample of 107 Israeli families, number and duration of infant nighttime awakenings were measured at 3, 6, 9, and 24 months old, using mothers' and fathers' reports on the Brief Infant Sleep Questionnaire (BISQ). Infant-parent attachment security and infant-parent dependency was assessed at 24 months old, using the observer Attachment Q-Sort procedure (AQS) with both parents. Latent growth curve models showed a non-linear decline in number and duration of infant nighttime awakenings over time. A higher number and longer duration of infant nighttime awakenings at 3 months were associated with higher infant-father attachment security at 24 months. In contrast, longer infant nighttime awakenings at 3 months were predictive of lower infant-mother attachment security at 24 months. A steeper decrease in duration of infant nighttime awakenings was associated with higher infant-father attachment security and lower infant-mother attachment security. As a potential mechanism, paternal involvement in nighttime caregiving was explored in relation to infant-father attachment security. Results of our post-hoc analyses revealed no significant associations between paternal involvement in nighttime caregiving and infant-father attachment security. Our results highlight the need to examine potential mechanisms explaining the divergent associations of infant sleep problems with infant-mother and infant-father attachment security in future research.

Parental Use of "Cry Out" in a Community Sample During the First Year of Infant Life

OBJECTIVE

The primary objective was to identify the characteristics of parents and infants and parenting practices associated with delayed responsiveness to infant crying during the first year of infant life. A secondary objective was to evaluate, in a subsample of maternal-infant pairs, the associations between delayed responsiveness to infant crying and observational measures of maternal-infant interaction and infant-maternal attachment.

METHOD

This is a secondary analysis of the data from a community sample of pregnant women recruited to the Alberta Pregnancy Outcomes and Nutrition study. Mothers completed questionnaires during the first year of infant life (n = 1826), and a convenience subsample of maternal-infant pairs (n = 137) participated in laboratory assessments of maternal-infant interaction at 6 months of age and infant-maternal attachment at 20 months.

RESULTS

Parental use of "cry out" as a strategy to deal with a crying infant was associated with parental characteristics (being white and having a relatively higher income), infant characteristics (higher problematic behavior at 3 months and reduced problematic behavior at 12 months), sleep ecology (infants sleeping alone), and parental soothing strategies (less frequently taking the infant into the parent's bed, cuddling, or carrying the crying infant). Cry out was not associated with observational measures of maternal sensitivity or infant-maternal attachment.

CONCLUSION

When used selectively and in response to the specific needs and characteristics of the infant, delayed responsiveness may reduce problematic behavior and does not harm the infant's socioemotional development.

The School Attachment Monitor-A novel computational tool for assessment of attachment in middle childhood

Background

Attachment research has been limited by the lack of quick and easy measures. We report development and validation of the School Attachment Monitor (SAM), a novel measure for largescale assessment of attachment in children aged 5–9, in the general population. SAM offers automatic presentation, on computer, of story-stems based on the Manchester Child Attachment Story Task (MCAST), without the need for trained administrators. SAM is delivered by novel software which interacts with child participants, starting with warm-up activities to familiarise them with the task. Children’s story completion is video recorded and augmented by ‘smart dolls’ that the child can hold and manipulate, with movement sensors for data collection. The design of SAM was informed by children of users’ age range to establish their task understanding and incorporate their innovative ideas for improving SAM software.

Methods

130 5–9 year old children were recruited from mainstream primary schools. In Phase 1, sixty-one children completed both SAM and MCAST. Inter-rater reliability and rating concordance was compared between SAM and MCAST. In Phase 2, a further 44 children completed SAM complete and, including those children completing SAM in Phase 1 (total n = 105), a machine learning algorithm was developed using a “majority vote” procedure where, for each child, 500 non-overlapping video frames contribute to the decision.

Results

Using manual rating, SAM-MCAST concordance was excellent (89% secure versus insecure; 97% organised versus disorganised; 86% four-way). Comparison of human ratings of SAM versus the machine learning algorithm showed over 80% concordance.

Conclusions

We have developed a new tool for measuring attachment at the population level, which has good reliability compared to a validated attachment measure and has the potential for automatic rating–opening the door to measurement of attachment in large populations.

Sleep Consolidation, Sleep Problems, and Co-Sleeping: Rethinking Normal Infant Sleep as Species-Typical

Infants evolved in the context of close contact (including co-sleeping). Evolutionary context is rarely considered in psychological infant sleep research, and Western sleep researchers make assumptions about what optimal "normal" infant sleep is and how to achieve early, deep, infant sleep consolidation and avoid infant sleep problems. However, an evolutionary and anthropological view of infant sleep as species-typical recognizes that human evolution likely prepared the infant brain for optimal development within its evolutionary context - co-sleeping. Thus, "normal" infant sleep, sleep consolidation, and sleep problems should all be understood within the framework of co-sleeping infants, not the historically new-phenomenon of solitary-sleeping infants. Much work needs to be done in order to understand "normal" infant sleep as species-typical and how adaptive infants are to environments that stray from their evolutionary norm.

Is 4-month-old infants' night waking affected by mothers' responses to them? A cross-sectional survey in Japan

OBJECTIVE

To investigate the association between night waking frequency in 3- to 4-month-old infants and mothers' response to them.

DESIGN

Cross-sectional survey.

SAMPLE

We examined 663 mothers of infants aged 3-5 months who attended regular health checks for 4 months at 7 public health centres in Japan between September 2006 and March 2007.

MEASUREMENTS

Mother-reported questionnaires were used, measuring the frequency of infants' night waking and four types of responses by mothers. Using multiple regression, the association between number of wakings and each response was evaluated adjusting for covariates, that is mother's (e.g. feelings of worry and bed-sharing) and infant's (e.g. age and sex) demographic variables.

RESULTS

The number of wakings was related to "immediately feeding and/or checking diapers" (β = 0.16, p = .002).This response to infants' night waking may be associated with night waking frequency.

CONCLUSION

Modifying caregiver responses to infants' night waking by reducing immediate feeding or diaper checks could improve infants' night waking frequency.

Dynamics of frontal alpha asymmetry in mother-infant dyads: Insights from the Still Face Paradigm

The parent-infant dynamic has a foundational role in emotion regulation development. Electroencephalography (EEG) hyperscanning from mother-infant dyads can provide an unprecedented window into inter-brain dynamics during the parent-infant exchange. This potential depends on the feasibility of hyperscanning with dyads in emotionally taxing contexts. We sought to demonstrate feasibility of hyperscanning from 10 mother-infant dyads during the Still Face Procedure (SFP). We measured frontal alpha asymmetry (FAA) to elucidate ongoing regulatory dynamics and considered maternal caregiving quality as a window into dyads' history. Results showed dyads exhibited a rightward shift in FAA over the course of SFP, indicating growing negative emotionality and desire to withdraw. Results also showed growing variability in FAA for infants over the course of SFP, indicating less active emotional control as stress ensued. Variability was especially low for mothers during periods when asked to be emotionally unavailable, suggesting active control to match the task demands. Dyads with a more responsive mother exhibited higher (more left) FAA relative to dyads with a less responsive mother, which might reflect a more positive emotional experience overall. We raise important methodological and theoretical questions that hyperscanning during SFP can address, such as the developmental origins of trait-like self-regulatory dispositions.

What Is “Normal” Infant Sleep? Why We Still Do Not Know

The human need for sleep is universal and unquestioned; however, humans vary in their sleep needs according to age, individual differences, as well as cultural and social norms and practices. Therefore, what is “normal” in infant sleep and the development of sleep architecture in humans is highly dependent on biological and sociocultural variables as well as socially constructed assumptions about what infant sleep “should” look like. This paper uses a multidisciplinary approach to review papers from fields including pediatrics, anthropology, psychology, medicine, and sociology to understand “normal” infant sleep. Because human culture and behavioral practice changes much more quickly than evolved human biology, and because human evolutionary history occurred in the context of breastfeeding and cosleeping, new work in the field of infant sleep architecture development would benefit from a multidisciplinary approach. To come to a consensus about what is “normal” infant sleep, researchers must agree on underlying basic assumptions of infant sleep from which to ask question and interpret findings.

Assessing Mothers' Postpartum Depression From Their Infants' Cry Vocalizations

Postpartum Depression (PPD), a condition that affects up to 15% of mothers in high-income countries, reduces attention to the needs of the child and is among the first causes of infanticide. PPD is usually identified using self-report measures and therefore it is possible that mothers are unwilling to report PPD because of a social desirability bias. Previous studies have highlighted the presence of significant differences in the acoustical properties of the vocalizations of infants of depressed and healthy mothers, suggesting that the mothers’ behavior can induce changes in infants’ vocalizations. In this study, cry episodes of infants (N = 56, 157.4 days ± 8.5, 62% firstborn) of depressed (N = 29) and non-depressed (N = 27) mothers (mean age = 31.1 years ± 3.9) are analyzed to investigate the possibility that a cloud-based machine learning model can identify PPD in mothers from the acoustical properties of their infants’ vocalizations. Acoustic features (fundamental frequency, first four formants, and intensity) are first extracted from recordings of crying infants, then cloud-based artificial intelligence models are employed to identify maternal depression versus non-depression from estimated features. The trained model shows that commonly adopted acoustical features can be successfully used to identify postpartum depressed mothers with high accuracy (89.5%).

Data Set License: CC-BY-NC

Infant crying problems and symptoms of sleeping problems predict attachment disorganization at 18 months

This longitudinal study examined the associations among infant crying, symptoms of sleeping problems, and attachment while considering the influence of maternal sensitivity and depressive symptoms. One hundred and five healthy full-term infants (42.9% female) were assessed for crying and symptoms of sleeping problems at 3 and 18 months via parental interview. Maternal sensitivity was measured through researcher observation, and attachment was measured at 18 months using the Strange Situation procedure. It was found that infant crying and symptoms of sleeping problems were not linked to the organized patterns of secure or insecure (avoidant versus resistant) attachment. However, when the disorganized attachment was considered, there were direct links found from infant crying and symptoms of sleeping problems at 3 months (β= .22, p< .05) and 18 months (β= .21, p< .05). Thus, crying and symptoms of sleeping problems as early as 3 months may indicate a disruption in the coherence of infants' relationship to their caretakers.

Trajectories of mothers' emotional availability: relations with infant temperament in predicting attachment security

The present study examined observations of parenting quality (mothers' emotional availability - EA) during infant bedtimes at 4 points across the infants' first year, assessing relations between levels and trajectories of EA and infant attachment at 12 months and the role of infant temperament in moderating these associations. The sample (N = 128) was predominantly Euro-American (82.5%) and at low socioeconomic risk. Latent growth curve modeling with latent basis coefficients indicated substantial individual differences in initial levels and slopes in EA trajectories across the first year. Both levels of maternal EA and EA trajectories across the first year predicted 12-month infant attachment security. Although maternal EA tended to decrease across the first year in the full sample, EA trajectories that showed a "bounce-back" between 6 and 12 months, suggesting more successful maternal adaptation to an expanding infant developmental repertoire, predicted greater infant security at 12 months. In addition, linkages between latent EA trajectories and 12-month attachment were moderated by 3-month infant temperamental reactivity and regulation. These findings indicate that infant attachment security is sensitive to both static and dynamic aspects of parenting quality across the first year, and that infant temperament can interact with both in predicting infant attachment.

Response to Infant Cry in Clinically Depressed and Non-Depressed Mothers

BACKGROUND

Bowlby and Ainsworth hypothesized that maternal responsiveness is displayed in the context of infant distress. Depressed mothers are less responsive to infant distress vocalizations (cry) than non-depressed mothers. The present study focuses on acoustical components of infant cry that give rise to responsive caregiving in clinically depressed (n = 30) compared with non-depressed mothers (n = 30) in the natural setting of the home.

METHODS

Analyses of infant and mother behaviors followed three paths: (1) tests of group differences in acoustic characteristics of infant cry, (2) tests of group differences of mothers' behaviors during their infant's crying, and (3) tree-based modeling to ascertain which variable(s) best predict maternal behaviors during infant cry.

RESULTS

(1) Infants of depressed mothers cried as frequently and for equal durations as infants of non-depressed mothers; however, infants of depressed mothers cried with a higher fundamental frequency (f0) and in a more restricted range of f0. (2) Depressed mothers fed, rocked, and touched their crying infants less than non-depressed mothers, and depressed mothers were less responsive to their infants overall. (3) Novel tree-based analyses confirmed that depressed mothers engaged in less caregiving during their infants' cry and indicated that depressed mothers responded only to cries at higher f0s and shorter durations. Older non-depressed mothers were the most interactive with infants.

CONCLUSIONS

Clinical depression affects maternal responsiveness during infant cry, leading to patterns of action that appear poorly attuned to infant needs.

The Maternal (Non) Responsiveness Questionnaire: Initial Factor Structure and Validation

The purpose of this paper was to examine the reliability, stability, and convergent and predictive validity of the newly developed Maternal Responsiveness Questionnaire (MRQ). Participants were 224 first-time mothers. Mothers completed the MRQ when their infants were 6 and 14 months old. Convergent validity was examined in relation to mother-reported personality, depressive symptoms, and emotion socialization practices and observed maternal sensitivity. Predictive validity was examined in relation to mother-reported child behavior problems and social competence, infant attachment security assessed via the Strange Situation, and observed child dysregulation. Three MRQ factors emerged based on exploratory factor analysis and were confirmed via confirmatory factor analysis: responsiveness, non-responsiveness and delayed responsiveness. All three scales demonstrated good internal consistency reliability and significant stability from 6 months to 14 months. Consistent evidence emerged for convergent and predictive validity of the non-responsiveness subscale, but not the other subscales. The potential utility of the non-responsiveness subscale of the MRQ is discussed.

Viii. Attachment and sleep among toddlers: disentangling attachment security and dependency

Many scholars have proposed that parent-child attachment security should favor child sleep. Research has yet, however, to provide convincing support for this hypothesis. The current study used objective measures of sleep and attachment to assess the longitudinal links between mother-child attachment security and subsequent sleep, controlling for child dependency. Sixty-two middle-class families (30 girls) were met twice, when children were 15 months (Wave 1; W1) and 2 years of age (Wave 2; W2). At W1, mother-child attachment was assessed with the observer version of the Attachment Q-Sort. At W2, children wore an actigraph monitor for 72 hr. Results indicated that children more securely attached to their mothers subsequently slept more at night and had higher sleep efficiency, and these predictions were not confounded by child dependency. These findings suggest a unique role for secure attachment relationships in the development of young children's sleep regulation, while addressing methodological issues that have long precluded consensus in this literature.

The role of the father in child sleep disturbance: child, parent, and parent-child relationship

The majority of studies on child sleep problems focus primarily on mothers, neglecting paternal influences. Guided by the transactional framework, we explored how child temperament, paternal and maternal stress, and the parent-child interactions differ between families having children with sleep disturbances and a selected comparison group. The role of paternal involvement in child caregiving as a moderator of these differences was assessed. The sample consisted of 51 children (1-3 years old) and their mothers and fathers. Data were collected during home visits, when mothers and fathers completed questionnaires and were interviewed. In addition, mother-child and father-child interactions were videotaped. Results indicate that compared to the comparison group, fathers rated children with sleep disturbances as fussier, both their mothers and fathers experienced higher levels of stress, and reported using more bedtime interactions that interfere with child's sleep-wake self-regulation. In addition, their fathers were less sensitive during father-child interaction and less involved in child caregiving. Finally, paternal involvement moderated the group differences seen in maternal stress, suggesting that high paternal involvement acted as a buffer to protect parents of children with sleep disturbances from experiencing parental stress. The important role of fathers in families having children with sleep disturbances is discussed.

Negative emotionality moderates associations among attachment, toddler sleep, and later problem behaviors

Secure parent-child relationships are implicated in children's self-regulation, including the ability to self-soothe at bedtime. Sleep, in turn, may serve as a pathway linking attachment security with subsequent emotional and behavioral problems in children. We used path analysis to examine the direct relationship between attachment security and maternal reports of sleep problems during toddlerhood and the degree to which sleep serves as a pathway linking attachment with subsequent teacher-reported emotional and behavioral problems. We also examined infant negative emotionality as a vulnerability factor that may potentiate attachment-sleep-adjustment outcomes. Data were drawn from 776 mother-infant dyads participating in the National Institute of Child and Human Development Study of Early Child Care. After statistically adjusting for mother and child characteristics, including child sleep and emotional and behavioral problems at 24 months, we found no evidence for a statistically significant direct path between attachment security and sleep problems at 36 months; however, there was a direct relationship between sleep problems at 36 months and internalizing problems at 54 months. Path models that examined the moderating influence of infant negative emotionality demonstrated significant direct relationships between attachment security and toddler sleep problems and between sleep problems and subsequent emotional and behavioral problems, but only among children characterized by high negative emotionality at 6 months. In addition, among this subset, there was a significant indirect path between attachment and internalizing problems through sleep problems. These longitudinal findings implicate sleep as one critical pathway linking attachment security with adjustment difficulties, particularly among temperamentally vulnerable children.

Sleep and Attachment in Preterm Infants

Infants born preterm are at elevated risk for social emotional difficulties. However, factors contributing to this risk are largely understudied. Within the present study, we explored infant sleep as a biosocial factor that may play a role in infant social emotional development. Within a prospective longitudinal design, we examined parent-reported sleep patterns and observed parenting quality as predictors of infant-mother attachment in 171 infants born preterm. Using structural equation modeling, we examined main effect and moderator models linking infant sleep patterns and parenting with attachment security. Sleep patterns characterized by more daytime sleep and positive/responsive parenting predicted infant attachment security. Parent-reported nighttime sleep patterns were unrelated to attachment in this sample of infants born preterm. These results indicate that daytime sleep and parenting quality may be important for emerging attachment relationships in infants born preterm.

Maternal sensitivity to infants in various settings predicts harsh discipline in toddlerhood

In a longitudinal study with 73 mothers and their second-born child, stability and main-level differences between measures of maternal sensitivity across settings and over time were examined. Furthermore, the predictability of harsh discipline by these different maternal sensitivity measures was studied. Maternal sensitivity was assessed at three and six months during bathing, free play on mother's lap and the baseline and reunion episode of the Still Face Paradigm (SFP; Tronick, Als, Adamson, Wise, & Brazelton, 1978 ). Harsh discipline was observed during three home visits in the second year of life. Results showed a single underlying factor for all maternal sensitivity settings at both time points and significant stability over time. Harsh discipline was predicted by maternal sensitivity at three months, which was fully mediated by maternal sensitivity at six months. Early failure to respond appropriately to infant signals is an important indicator of risk for future harsh parenting.

Study of mother-infant attachment patterns and influence factors in Shanghai

BACKGROUND

In contrast to the considerable volume of international research on infant attachment development, significantly less research has been conducted in China.

AIM

The present study was designed to identify the patterns of mother-infant attachment in Shanghai and to explore the influence factors.

STUDY DESIGN AND SUBJECTS

The subjects included 160 healthy infant-mother dyads. Infant attachment and temperament were assessed with the Strange Situation Procedure and Carey's temperament questionnaire, respectively; the mother's personality, maternal sensitivity and marital satisfaction were assessed with Eysenck's personality questionnaire, Maternal Behavior Q-sort Manual Version 3.1 and Olson's marital questionnaire, respectively. A self-formulated questionnaire of family environment factors was completed by the infant's mother.

RESULTS

Of the 160 infants, 68.2% were rated as securely attached (B) and 31.8% as insecurely attached. Of those infants rated as insecurely attached, 7.5% were characterized as avoidant (A), 21.8% as resistant (C) and 2.5% as disorganized (D). Maternal sensitivity and marital satisfaction as well as the approachability dimension of infant temperament, were significantly different between securely attached infants and insecurely attached infants. From a temperament perspective, resistant infants showed higher-level intensity of reaction than avoidant infants. Moreover, multiple caregivers in the family and infant's sleeping with other caregivers at night were more likely to be associated with insecure mother-infant attachment.

CONCLUSION

There exist certain cultural characteristics in mother-infant attachment patterns in Shanghai. The influence factors are related with the high involvement of non-mother caregivers as well as maternal sensitivity, marital satisfaction and infant's temperament characteristics.

Attachment and infant night waking: a longitudinal study from birth through the first year of life

OBJECTIVE

: Night wakings are common in infancy. Although a link between infant night wakings and attachment to the primary caregiver has been previously proposed, empirical support is limited so far. The aim of this longitudinal study was to examine the early history of night waking in infants who were later classified as securely or insecurely (avoidantly, resistantly, or disorganized) attached.

METHODS

: Participants in the study were 193 infants and their mothers. Information on infant night wakings was collected with the use of daily sleep diaries for the first 6 months of life and again for 2 weeks at 12 months of age. Infant-mother attachment was assessed using the Strange Situation (Ainsworth et al, Patterns of Attachment: A Psychological Study of the Strange Situation. New York: Hillsdale; 1978) when the infants were 12 months of age.

RESULTS

: Longitudinal regression analyses showed that, after controlling for many covariates, infants with an insecure-resistant attachment at 12 months of age awoke more during the night in their first 6 months of life than the other infants. Furthermore, infants with different attachment classifications developed different patterns of night wakings over the first 6 months, with the insecure-avoidant infants waking the least toward the end of the 6 months. Hierarchical multiple regression analyses showed no associations between attachment and night wakings at 12 months of age.

CONCLUSION

: This study is the first in showing that attachment at 12 months of age is related to infant night waking patterns in the first 6 months of life. Patterns of infant night wakings early in life apparently reflect the emerging attachment relationship.

Maternal sensitivity: within-person variability and the utility of multiple assessments

In this study, we examined within-person variability in maternal sensitivity among a culturally diverse sample of high-risk mother-infant dyads (N = 25). We also examined incremental increases in effect sizes between maternal sensitivity and two related variables, attachment state of mind and child removal from the home, as a function of increasing observations of maternal sensitivity. The dyads were videotaped during 10 1-hour-long home visits and maternal sensitivity was coded using the abbreviated (25-item) version of the Maternal Behavior Q-Sort (MBQS). Attachment state of mind was assessed using the Adult Attachment Interview (AAI). Within-person variability in maternal sensitivity was greater for nonautonomous mothers compared to autonomous mothers. Mothers who were relatively low in maternal sensitivity were more likely to be nonautonomous and also more likely to have their child removed from their home by child protective services. Results from data sampling trials showed incremental increases in these effect sizes as the number of observations of maternal sensitivity increased. Fewer observations of maternal sensitivity resulted in systematic underestimates of effect sizes between maternal sensitivity and related variables. We discuss the implications for maltreatment researchers and interventionists.

The impact of attachment insecurity and sleep disturbance on symptoms and sick days in hospital-based health-care workers

OBJECTIVE

Adult attachment insecurity is associated with many health outcomes and may be associated with sleep disturbance. The purpose of this study was to test the hypothesis that sleep disturbance mediates the relationship between attachment insecurity and three measures of health (perceived general health, physical symptoms and sick days) in a group that is at high risk of sleep disturbance: hospital based health-care workers.

METHODS

One hundred thirty-one nondepressed female hospital workers completed self-report measures of adult attachment, sleep disturbance, depressive symptoms (excluding sleep-related items) and health outcomes. The hypothesis of mediation was tested with sequential regression analyses.

RESULTS

Both attachment anxiety and attachment avoidance were significantly associated with impairment in global sleep quality (ρ=.20 and .19, respectively, P<.05) and physical symptoms (ρ=.21 and .19, P<.05). Attachment anxiety was also associated with depressive symptoms (ρ=.33, P<.001) and sick days (ρ=.21, P<.05). For both physical symptoms and sick days, mediation analyses were consistent with global sleep quality acting as a partial mediator of the relationship between attachment anxiety and physical health. Non-sleep-related depressive symptoms were a stronger mediator.

CONCLUSIONS

This study corroborates evidence that attachment insecurity is associated with sleep disturbance and extends this association to the occurrence of physical symptoms and time off work due to sickness among workers in a high-stress occupation.