[Interactional therapy program for mothers with postpartum mental disorders. First results of a pilot project]

BACKGROUND

The period around delivery frequently causes psychiatric diseases that may disturb maternal competence and influence bonding behaviour with the child. Until now only a few possibilities have existed for inpatient treatment and therapy for these problems. The therapy program developed in Wiesloch, Germany, is especially well suited to such patients.

METHODS

Fifty-three mothers with postpartum disorders (33 depressive, 20 psychotic) were examined before and after therapy. Psychopathologic severity, psychosocial level of functioning, and parameters of the mother-child interaction were assessed and compared.

RESULTS

Overall the results showed clear improvements in the assessed parameters at the end of treatment for both psychotic mothers and those with affective disorders.

CONCLUSION

The interactional treatment program for postpartum mental disorders leads to a significant reduction in psychic/psychiatric severity and the associated psychosocial impairment and disturbed mother-child interaction. Considerations of the effects of therapy were not possible due to the study design.

Infantizid als Folge einer postpartalen Bindungsstörung

Parental killing of their own children in the 1st year constitutes a rare phenomenon. Studies on infanticide show that mothers who kill their children are frequently psychiatrically disturbed. Depression is the most common postpartum disorder and may represent a vital danger for both mother and child. The association between depression and infanticide can usually be explained by maternal psychopathologic symptoms. The importance of a mother's bonding to her infant has not often been examined in respect to infanticide. The present case report underlines the importance of postpartum bonding disorder and its relation to a higher risk of infanticide.

Maternal bond and mother-child interaction in severe postpartum psychiatric disorders: is there a link?

Mothers in the puerperium are vulnerable to a wide spectrum of postpartum psychiatric disorders. One of the central psychological processes of the puerperium is the development of an emotional relationship with the baby. The bond to the infant as well as the interaction with the baby are two aspects of the mother-infant relationship that can be disturbed by mothers with postpartum psychiatric disorders. Dysfunctional maternal cognitions may also influence the development of an emotional bonding and the establishment of a positive interaction with the child. The aim of this study is to investigate differences in the self-perceived experience of bonding and the observed mother-child interaction of severely ill postpartum depressive and psychotic mothers. In addition the association between subjective experience of bonding and objective measurement of mother-child interaction will be described. Results show that depressive mothers perceived their bonding to the baby more negatively than psychotic mothers. No differences could be found in the objective interactional behaviour of the mothers in both groups, with the exception that the infants of psychotic mothers showed more eye contact avoidance towards their mothers. The subjective experience of motherhood clearly influences the maternal interactional behaviour with depressive mothers as well as with psychotic mothers.

Early motherhood and disruptive behaviour in the school-age child

AIM

To determine the significance of young maternal age, family adversity and maternal behaviour during mother-toddler interaction in the prediction of child disruptive behaviour at age eight.

METHODS

From an ongoing longitudinal study of infants at risk for later psychopathology (n = 362), 72 young mothers aged between 15 and 24 y (median 22 y) at first birth were compared with 197 primiparous older mothers ranging in age from 25 to 41 y (median 29 y). Family adversity at childbirth was assessed using a modified version of Rutter's Family Adversity Index (FAI) and measures of child disruptive behaviour at age eight were obtained using Achenbach's Teacher Report Form (TRF). An observational procedure was used to assess maternal behaviour during mother-child interaction at the age of 2 y.

RESULTS

Young mothers encountered more adverse family characteristics and were more inadequate, restrictive and more negative during interaction with their toddlers. Their school-aged children showed higher scores on all disruptive behaviour scales of the TRF. Hierarchical regression analyses revealed that family adversity and maternal behaviour during toddler interaction could account for most of the association between early motherhood and child disruptive behaviour.

CONCLUSION

The impact of young motherhood on child mental health is not confined to teenage mothers and is mainly attributed to psychosocial and interactional factors.

Mutter-Kind-Interaktion und externalisierende Störungen bei Kindern im Grundschulalter

Zusammenfassung: Fragestellung: Das Verhalten von achtjährigen Kindern mit externalisierenden Störungen (hyperkinetische Störung und Störung des Sozialverhaltens) in der Interaktion mit ihren Müttern wurde untersucht. Methodik/Ergebnisse: Im univariaten Vergleich waren Mütter in der Interaktion mit ihren hyperkinetischen Kindern restriktiver, abwertender und weniger angemessen als Mütter unauffälliger Kinder, während sich die Kinder unaufmerksamer und impulsiver sowie weniger assertiv und hilflos verhielten. Kinder mit einer Störung des Sozialverhaltens waren in der Interaktion mit ihren Müttern abwertender, aggressiver und provokativer als unauffällige Kinder, während die Mütter mehr Ungeduld zeigten. Schlussfolgerung: Eine Interaktion zwischen aggressivem Kindverhalten und Restriktivität der Mutter trug zu vermehrten dissozialen Symptomen bei. Eine höhere Zahl hyperkinetischer Symptome wurde durch die Interaktion zwischen impulsivem Kindverhalten und mütterlicher Aversivität begünstigt.

[Mother-child interaction and externalizing disorders in elementary schoolchildren]

OBJECTIVES

The behavior of eight-year-old children with externalizing disorders (ADHD and CD) in interaction with their mothers was examined.

METHODS/RESULTS

Mothers of ADHD children were more restrictive and negative towards their children and showed less adequate control than did mothers of normal children. ADHD children paid less attention, were less assertive and helpless, and were more impulsive than controls. CD children were more negative towards their mothers, and were more aggressive and provocative than normal children, while their mothers were more impatient.

CONCLUSIONS

An interaction between aggressive child behavior and maternal restrictiveness contributed to increased conduct problems. Hyperactivity was enhanced by the interaction between the impulsive behavior of the child and the aversive maternal response.