Neonatal manual specialization in language and music conditions: Consistency with the hemispheric specialization adult model

The main purpose of this study was to test in neonates the influence of the sound environment, i.e., language versus music, on asymmetric hand movement activity in the presence of a target object. Based on hemispheric specialization, our hypothesis was that infants would use their right hand more in the speech context (left hemisphere) and their left hand more in the music context (right hemisphere). The study involved 19 full-term 3-day-old neonates. An object was presented successively in the two sound environments in counterbalance order for 120 s each. Left and right movements and mouth activity were scored during the target object presentation. Results show that neonates moved their left hand twice as much as their right hand in the music condition than in the language condition, and they moved their right hand a longer time in the language condition than in the music condition. The average number of sucking bursts was significantly higher in the language condition than in the music condition. We discuss the results in terms of manual specialization in relation to the development of hemispheric specialization.

[Validation of the questionnaire for assessing the childbirth experience (QACE) in a French population]

BACKGROUND

A woman's negative perception of her subjective childbirth experience can have consequences on the mother's psychological state and on early mother-baby relationships. To date, there is no validated tool in France allowing to evaluate childbirth experience in a multidimensional way. The aim of this study is to validate the Questionnaire Assessing the Childbirth Experience (QEVA) in a French sample of mothers. This tool was developed in a previous study where the authors combined 25 items into 6 dimensions: representations and expectations, sensory perceptions, feeling of control, perceived social support (medical staff and partner), emotions (positive and negative) and first moments with the baby.

METHODS

The sample included 256 women recruited in a maternity ward. Sociodemographic and obstetric characteristics of our sample were compared to those of the French national perinatal survey. The structure of the QEVA with 17 items was explored by an exploratory structural equation modeling (ESEM). An analysis of the internal consistency was conducted on the sub-scores of the identified factors, and the concurrent validity was assessed with the Peri-traumatic Distress Inventory (PDI) through a correlation and its associated t-test.

RESULTS

The characteristics of our sample and those of the national perinatal survey do not differ on age, marital status, parity, cannabis use, infertility treatment, epidural and baby weight, in favour of the good representativeness of our sample. The study of the QEVA structure revealed a 4-dimensional structure. Analysis of the psychometric qualities showed a good internal consistency, with an observed alpha value ranging from 0.69 to 0.86. The QEVA also shows a good concurrent validity with the peri-traumatic distress scores (r=0.51).

CONCLUSION

To date, the QEVA is the first standardized tool allowing a multidimensional evaluation of the subjective experience of childbirth. It has been validated on a French population using an exploratory structural equation modeling. This tool, which is simple to use and well accepted by mothers, enables health professionals not only to screen mothers experiencing difficult childbirth and in need of support, but also to adapt health care according to the dimensions of the birth experience and its associated difficulties (emotions during the birth, interactions with health professionals, first moments with the baby, or post-partum emotions).

Should we use the Parental Stress Index-Short Form in parents of children with ASD? A French validation study

BACKGROUND

Parents of children with Autism Spectrum Disorder (ASD) exhibit higher levels of parental stress than parents of typically developing children. The most frequently used tools to assess parental stress is the Parenting Stress Index (PSI) or its Short Form (PSI-SF).

AIMS

This study was designed to test the validity of the PSI-SF in French parents of children with ASD (N = 370).

METHODS AND PROCEDURES

First, a confirmatory factor analysis was conducted to test the initial 3-factor structure (36 items) which indicate a poor model fit. Then, an exploratory factor analysis was performed and convergent validity was assessed.

OUTCOMES AND RESULTS

A 3-factor structure (21 items) explaining 44 % of the variance was observed. Dimensions were moderately correlated and exhibited good internal consistency. Convergent validity was checked through the PSI-SF association with anxiety and depression (HADS), quality of life (WHOQOL-Brief) and appraisal of being a parent of a child with ASD (ALES).

CONCLUSIONS AND IMPLICATIONS

Future research should use the full version of the PSI-SF and examine its factor structure. More studies on the factor structure of the PSI-SF are needed to find out if it is a suitable tool for measuring stress in parents of children with ASD in France.

The impact of education, country, race and ethnicity on the self-report of postpartum depression using the Edinburgh Postnatal Depression Scale

BACKGROUND

Universal screening for postpartum depression is recommended in many countries. Knowledge of whether the disclosure of depressive symptoms in the postpartum period differs across cultures could improve detection and provide new insights into the pathogenesis. Moreover, it is a necessary step to evaluate the universal use of screening instruments in research and clinical practice. In the current study we sought to assess whether the Edinburgh Postnatal Depression Scale (EPDS), the most widely used screening tool for postpartum depression, measures the same underlying construct across cultural groups in a large international dataset.

METHOD

Ordinal regression and measurement invariance were used to explore the association between culture, operationalized as education, ethnicity/race and continent, and endorsement of depressive symptoms using the EPDS on 8209 new mothers from Europe and the USA.

RESULTS

Education, but not ethnicity/race, influenced the reporting of postpartum depression [difference between robust comparative fit indexes (∆*CFI) 0.01), but not between European countries (∆*CFI < 0.01).

CONCLUSIONS

Investigators and clinicians should be aware of the potential differences in expression of phenotype of postpartum depression that women of different educational backgrounds may manifest. The increasing cultural heterogeneity of societies together with the tendency towards globalization requires a culturally sensitive approach to patients, research and policies, that takes into account, beyond rhetoric, the context of a person's experiences and the context in which the research is conducted.

The Still-Face: A Greater Challenge for Infants of Mothers With Borderline Personality Disorder

The main aim of this study was to ascertain whether infants as young as 3 months of age, whose mothers suffer from borderline personality disorder (BPD), are already at risk of greater dysregulation than infants of mothers without BPD when faced with a minor stressful experience. Nineteen mothers diagnosed with BPD and 41 controls with no history of psychopathology and their 3-month-old infants were observed using Tronick's Face-to-Face Still-Face paradigm. The authors found that infants whose mothers have BPD express less positive vocalizations and less nonautonomic self-regulation than infants of mothers with no psychopathology. The stress of the Still-Face episode affects their gaze and self-regulation behaviors more strongly than those of infants of controls. The Reunion episode seems particularly challenging for mothers with BPD, who show fewer smiles and an increase in intrusive behavior. Because infants and their mothers with BPD are already dysregulated at 3 months postpartum, envisaging very early intervention seems warranted.

Kangaroo supported diagonal flexion positioning: New insights into skin-to-skin contact for communication between mothers and very preterm infants

OBJECTIVE

Skin-to-skin contact shows benefits in the relationship developed between a mother and her premature infant. In the skin-to-skin session, face-to-face exchanges are impossible in vertical infant positioning. We therefore undertook an observational, prospective, single-center study using kangaroo "supported diagonal flexion" (SDF) positioning. The first aim was to evaluate the safety of kangaroo SDF positioning compared to the usual vertical positioning. The second aim was to evaluate SDF positioning on early communication between the mother and her infant and to improve their well-being.

PARTICIPANTS AND SETTING

Fifteen mothers and their very premature infants (birth 26<32 weeks' gestation) were assigned to one of the two kangaroo positioning modes, either the current vertical positioning (n=7) or SDF positioning (n=8).

DESIGN

Physiological variables and critical events were recorded before, during, and after ten successive skin-to-skin contact sessions. The first and last sessions were videotaped to allow later behavioral measurements. Mothers' risk for depression and feelings about the way they experienced communication with their infant were assessed through questionnaires.

RESULTS

In terms of the infant's physiology, no negative effects were associated with SDF positioning in comparison with the usual vertical positioning. SDF positioning led to fewer disorganized gestures, negative vocalizations, and drowsiness, in favor of more deep sleep. SDF led to more mother-infant eye-to-eye contact as well as maternal vocalizations, smiles, and caressing, although these differences did not reach significance. The score for the risk of postnatal depression decreased significantly between the first and the last session in the SDF group, whereas it did not change in the vertical positioning group.

CONCLUSION

These results support the idea that the kangaroo SDF positioning technique is physiologically safe, has obvious immediate benefits on mothers' infant-directed communicative behaviors, and respects the baby's naturally flexed and asymmetrical tonic neck posture. It is an innovative, inexpensive, easy-to-use technique in daily practice, by all healthcare professionals working in a neonatal intensive care unit. These data suggest that the current kangaroo positioning technique could be improved. More studies are needed to confirm the benefits and safety of the kangaroo SDF positioning in larger groups of preterm infants.

Études longitudinales sur les enfants de mères aux pathologies limites/borderline : réflexions sur les mécanismes d’une possible transmission des pathologies limites

Les résultats d’une étude constituant un suivi longitudinal prospectif d’une cohorte de dyades de mères présentant une pathologie borderline/limite avec leur enfant, dans une approche comparative avec une population témoin de dyades avec des mères sans trouble psychique apporte des pistes de réflexion sur les mécanismes d’une possible transmission de ces pathologies. Les interactions précoces à 3 mois au Still-face permettent d’appréhender comment les bébés peuvent précocement présenter des difficultés en lien avec des particularités du fonctionnement intrapsychique et interpersonnel maternel impactant la régulation émotionnelle dyadique. La grossesse, crise identitaire et narcissique, ébranle l’identité de ces mères aux pathologies limites déjà fragilisée par un narcissisme défaillant. Le bébé, par la relation de dépendance qu’il lui impose, réactive les particularités du fonctionnement interpersonnel de cette dernière et propre à cette pathologie. Les interactions précoces reflèteraient l’incapacité maternelle à s’accorder aux rythmes propres et aux mouvements affectifs et émotionnels de leur enfant. La notion de partage intersubjectif troublé éclaire la façon dont nous pouvons envisager les difficultés maternelles à aider le bébé à réguler ses émotions. Cette étude, par l’utilisation du protocole de la situation étrange, donne également un éclairage sur la manière dont les comportements d’attachement de ces enfants, à 13 mois, s’ancrent dans la particularité de ces dysfonctionnements interactifs. L’évaluation des représentations d’attachement et de la narrativité des enfants, entre 4 et 8 ans, met en lumière différentes évolutions dans la qualité de leur attachement. Ces différents résultats soulèvent, d’une part, la question de la transmission intergénérationnelle des modalités d’attachement – avec l’importance de sa qualité et des capacités de fonction réflexive maternelles – et d’autre part, celle de la désorganisation de l’attachement dans les pathologies limites. Enfin, une approche psychodynamique des narratifs des enfants au test des histoires à compléter éclaire les particularités de leur fonctionnement psychique.

Confabulation, but not executive dysfunction discriminate AD from frontotemporal dementia

We examined confabulation and performance on frontal/executive tasks in Alzheimer's disease (AD) patients and patients with a diagnosis of probable frontotemporal dementia (FTD). Twenty-two patients with probable AD, 10 patients with probable FTD and 32 normal control subjects entered the study. Executive functions were assessed with the Modified Card Sorting test; a verbal fluency test; the Cognitive Estimation test; and the Stroop test. Confabulations were assessed with a modified version of the Confabulation Battery. The Confabulation Battery included 10 questions tapping each of the following domains: Episodic Memory (memories of personal past episodes), Semantic Memory (knowledge of famous facts and famous people), and Personal Future (personal plans). The results revealed that both AD patients and FTD patients were clearly and equally impaired on tests of executive functions. Both patients' groups confabulated across the three tasks of the Confabulation Battery, but FTD patients confabulated significantly more than AD patients on Episodic Memory and Personal Future. The results failed to provide any evidence of a correlation between the performance on frontal/executive tasks and the tendency to produce confabulatory reports. According to our results, confabulation, more than a deficit of frontal/executive functions, discriminate between AD and FTD. Therefore, screening for confabulation and, possibly, for other types of memory distortions may constitute a useful additional clinical tool in order to discriminate AD from FTD.