Emotionale, dyadisch-behaviorale & regulatorische Mediationsebenen: Zum Zusammenhang zwischen parentalen Depressionen & Angststörungen im Peripartalzeitraum und beeinträchtigten kindlichen Entwicklungsverläufen

Der Peripartalzeitraum stellt für Eltern und ihre Säuglinge eine bedeutsame Entwicklungsphase dar. Parentale Depressionen und Angststörungen weisen in diesem Zeitraum erhöhte Prävalenzen auf und können die kindlichen Entwicklungsverläufe beeinträchtigen. Die vorliegende Arbeit befasst sich mit potentiellen Mediationswegen zwischen der parentalen Symptomatik und der kindlichen Entwicklung. Hierbei wird die primäre Bezugsperson fokussiert, welche in den meisten Fällen durch die Mutter repräsentiert ist. Einleitend verschafft das Werk einen Überblick über die Symptomatik und die Prävalenzen maternaler peripartaler Depressionen und Angststörungen sowie deren Zusammenhänge mit kindlichen Entwicklungsverläufen. Darüber hinaus werden potentielle Mediationswege zwischen der maternalen Symptomatik und der kindlichen Entwicklung eingeführt. Die Schriften I und II zeigen Zusammenhänge zwischen maternalen Angststörungen im Postpartalzeitraum sowie der Stressreaktivität der Säuglinge und der Bezugsperson-Säuglings-Interaktion auf. Die Schriften III und IV führen das Konzept der maternalen emotionalen Bindung gegenüber dem Säugling ein und stellen Befunde zu Zusammenhängen zwischen maternalen Depressionen und maternaler Bindung dar. Diese Befunde werden schließlich in Schrift V auf maternale Angststörungen im Postpartalzeitraum übertragen und vor allem Zusammenhänge mit der Schrift II hergestellt. Die Ergebnisse werden anschließend in einer Gesamtschau integriert und im Hinblick auf klinische Implikationen diskutiert

What Dyadic Reparation Is Meant to Do: An Association with Infant Cortisol Reactivity

BACKGROUND The latency to reparation of interactive mismatches (interactive repair) is argued to regulate infant distress on a psychobiological level, and maternal anxiety disorders might impair infant regulation. SAMPLING AND METHODS A total of 46 dyads (19 mothers with an anxiety disorder, 27 controls) were analyzed for associations between interactive repair and infant cortisol reactivity during the Face-to-Face-Still-Face paradigm 3-4 months postpartum. Missing cortisol values (n = 16) were imputed. Analyses were conducted on both the original and the pooled imputed data. RESULTS Interactive repair during the reunion episode was associated with infant cortisol reactivity (original data: p 0.23). Additional stepwise regression analyses found that latency to repair during play (p < 0.01), an interaction between distress during the first trimester of pregnancy and latency to repair during reunion (p < 0.01) and infant self-comforting behaviors during the reunion episode (p = 0.04) made independent contributions to cortisol reactivity in the final regression model. CONCLUSIONS This is the first study demonstrating that interactive repair is related to infant psychobiological stress reactivity. The lack of a relation to maternal anxiety disorder may be due to the small sample size. However, this result emphasizes that infants respond to what they experience and not to the maternal diagnostic category

Linking maternal psychopathology to children's excessive crying and sleeping problems in a large representative German sample—The mediating role of social isolation and bonding difficulties

Attaining self-regulation is a major developmental task in infancy, in which many children show transient difficulties. Persistent, clinically relevant difficulties in self-regulation include excessive crying or sleeping disorders. Many families with affected children are burdened with multiple psychosocial risk. This suggests that regulatory problems are best conceptualized as the maladaptive interplay of overly burdened parents and a dysfunctional parent–child interaction. The current study examines whether social isolation and bonding difficulties function as mediating mechanisms linking maternal psychopathology to (1) children's excessive crying and (2) sleeping problems. The sample comprised N = 6598 mothers (M = 31.51 years) of children between zero to three years of age (M = 14.08 months, 50.1% girls). In addition to socio demographic data, the written questionnaire included information on maternal depression/anxiety, isolation, bonding, and children's regulatory problems. Hypotheses were tested with a mediation model controlling for psychosocial risk and child characteristics. As expected, maternal symptoms of depression/anxiety were linked to infants‘ excessive crying and sleeping problems. Social isolation and bonding difficulties mediated this association for excessive crying as well as for sleeping problems, but social isolation was a single mediator for sleeping problems only. The findings provide important insights in the mediating pathways linking maternal psychopathology to children's regulatory problems

Effects of Maternal Anxiety Disorders on Infant Self-Comforting Behaviors: The Role of Maternal Bonding, Infant Gender and Age

Background/Aims: We investigated the links between maternal bonding, maternal anxiety disorders, and infant self comforting behaviors. Furthermore, we looked at the moderating roles of infant gender and age. Methods: Our sample (n = 69) comprised 28 mothers with an anxiety disorder (according to DSM-IV criteria) and 41 controls, each with their 2.5- to 8-month-old infant (41 females and 28 males). Infant behaviors were recorded during the Face-to-Face Still-Face paradigm. Maternal bonding was assessed by the Postpartum Bonding Questionnaire. Results: Conditional process analyses revealed that lower maternal bonding partially mediated between maternal anxiety disorders and increased self-comforting behaviors but only in older female infants (over 5.5 months of age). However, considering maternal anxiety disorders without the influence of bonding, older female infants (over 5.5 months of age) showed decreased rates of self-comforting behaviors, while younger male infants (under 3 months of age) showed increased rates in the case of maternal anxiety disorder. Conclusions: The results suggest that older female infants (over 5.5 months of age) are more sensitive to lower maternal bonding in the context of maternal anxiety disorders. Furthermore, results suggest a different use of self-directed regulation strategies for male and female infants of mothers with anxiety disorders and low bonding, depending on infant age. The results are discussed in the light of gender-specific developmental trajectories. (C) 2016 S. Karger AG, Basel

Theory of Mind in Pre-school Aged Children: Influence of Maternal Depression and Infants’ Self-Comforting Behavior

A milestone of child development is theory of mind (ToM): the ability to attribute mental states, especially beliefs and desires, to other persons and to understand that their behavior is guided by mental states. The learning process about the mental world also takes place in social communication and interaction, beginning in infancy. Infancy is assumed to be a sensitive period for the development of social skills through interaction. Due to limited self-regulatory skills, infants depend on sensitive behavior of their caregivers to regulate affective states and physiological arousal, and in turn, mutually regulated affects allow the infant to gradually acquire the capability to self-regulate negative affective states. Effective and adequate affect regulation is an important prerequisite for environmental interaction and thus for the development of socio-emotional skills. The present study investigated the relation of self-regulatory abilities in infancy and later ToM in pre-school aged children of clinically depressed mothers and healthy controls. The sample comprised of N = 55 mother–child dyads, n = 22 diagnosed with postpartum or lifetime depression according to DSM-IV and n = 33 healthy controls. Mother–infant-interaction was videotaped during the Face-to-Face Still-Face paradigm. At 3 and 42 months postpartum mothers were interviewed with the Structured Clinical Interview for DSM-IV Axis I Disorders (SCID-I) to evaluate maternal psychopathological status according to DSM-IV. At the age of M = 4.0 years, children’s ToM abilities were assessed using content-false-belief and location-false-belief tasks. The results of this study show that contrary to our hypotheses, maternal depression did not impair the development of children’s ToM-abilities per se. Rather, an interaction effect highlights the role of infant’s self-comforting behavior during mother–infant interaction in infancy (3 months postpartum) for ToM-development at pre-school age assessed with the Maxi-task; this association was distinct for female in comparison to male children. The results of this longitudinal study shed light on the discussion, how maternal depression influences child development and point in the direction that self-comforting behaviors in infancy can also be seen as a resource

From Early Micro-Temporal Interaction Patterns to Child Cortisol Levels: Toward the Role of Interactive Reparation and Infant Attachment in a Longitudinal Study

Parental mental disorders increase the risk for insecure attachment in children. However, the quality of caregiver–infant interaction plays a key role in the development of infant attachment. Dyadic interaction is frequently investigated via global scales which are too rough to uncover micro-temporal mechanisms. Prior research found that the latency to reparation of uncoordinated dyadic states is associated with infant behavioral and neuroendocrine regulation. We investigated the hypothesis that this interactive mechanism is critical in predicting secure vs. insecure attachment quality in infancy. We also assessed the predictive quality of infant attachment regarding neuroendocrine reactivity later in childhood. A subsample of N = 58 dyads (n = 22 mothers with anxiety disorders, n = 36 controls) from a larger study were analyzed. At 3–8 months postpartum, maternal anxiety disorders were diagnosed via a structured clinical interview as well as dyadic interaction during the Face-to-Face-Still-Face (FFSF) was observed and coded on a micro-temporal scale. Infant attachment quality was assessed with the strange situation paradigm at 12–24 months of age. In an overlapping subsample of N = 39 (n = 13 mothers with anxiety disorder; n = 26 controls), we assessed child cortisol reactivity at 5 to 6 years of age. Generalized linear modeling revealed that longer latencies to interactive reparation during the reunion episode of the FFSF as well as maternal diagnosis at 3–8 months of age predict insecure attachment in children aged 12–24 months. Cox regressions demonstrated that dyads with infants who developed insecure attachment at 12–24 months of age were 48% less likely to achieve an interactive reparation at 3–8 months of age. Mixed models revealed that compared to securely attached children, children who had developed an insecure attachment at 12–24 months of age had an increased cortisol reactivity at 5 to 6 years of age during free play. The results confirm the hypothesis that the development of attachment is affected by experienced micro-temporal interactive patterns besides diagnostic categories. They also showed that infants of mothers with postpartum anxiety disorders have a more than fivefold increased risk of developing an insecure attachment than the infants of the control group. Moreover, results imply that these patterns may influence neurohormonal regulation even in preschool aged children

Emotional stress during pregnancy - associations with maternal anxiety disorders, infant cortisol reactivity, and Mother-Child Interaction at pre-school age

There is growing evidence that even milder forms of maternal stress or anxiety during pregnancy affect the fetus causing possible long-term consequences for infant and child development. The mechanisms through which prenatal maternal stress may affect the unborn are not yet entirely clarified. Due to limited self-regulatory skills after birth, infants depend on sensitive behavior of their parents to regulate affective states and physiological arousal. Dyadic affect regulation has been linked to various developmental patterns up to adolescence and thereby represents a key element of early social relationships. Aim of the study was to evaluate possible long-term consequences of emotional stress during pregnancy and postpartum anxiety disorders, as well as infant postpartum cortisol reactivity on mother–child-interaction at pre-school age. The sample comprised of N = 63 mother–infant dyads at study entry, n = 28 diagnosed with postpartum anxiety disorders according to the Diagnostic and Statistical Manual of Mental Disorders IV (DSM-IV), n = 35 were healthy controls. Mothers were interviewed with the Structured Clinical Interview for DSM-IV Disorders at an average infant age of M = 4.1 months and filled out a questionnaire regarding emotional stress during pregnancy. Further, they were videotaped during the Face-to-Face-Still-Face paradigm (FFSF), a widely used mild socio-emotional stressor for infants. To determine infant stress-reactivity, infant salivary cortisol was collected before, immediately after and 20 min after the FFSF. Missing values were estimated by multiple imputations. At the age of M = 5.3 years, mother-child-interaction was re-assessed in a follow-up sample of n = 30 dyads via a free-play situation. Moreover, dimensional measures for anxiety were assessed. Mothers in the clinical group reported significantly higher stress scores than the control group. Infant stress reactivity in the early postpartum period and maternal anxiety symptoms at the 5-year follow-up assessment were significantly associated with dyadic interaction quality at pre-school age. Even though maternal stress during pregnancy did not directly predict mother–child interaction quality at pre-school age, it was significantly correlated with infant cortisol reactivity during postpartum period. Nevertheless, caution should be taken when interpreting the results considering the small sample size

Disentangling the Dyadic Dance: Theoretical, Methodological and Outcomes Systematic Review of Mother-Infant Dyadic Processes

Background : During the last decades, the research on mother-infant dyad has produced a great amount of data, methods and theories, which largely contributed to set a revolution in the way we look at developmental changes during infancy and childhood. Very different constructs depict the different aspects of the "dyadic dance" occurring between a mother and her infant;nonetheless, a comprehensive and consistent systematization of these concepts in a coherent theoretical landscape is still lacking. Aim : In the present work, we aim at disentangling the different theoretical and methodological definitions of 9 dyadic constructs and we highlight their effects on infants' and children developmental outcomes Methods : A literature search has been conducted on three databases-PubMed, Scopus, Web of Science. Three different reviews are reported here: (1) a review on the theoretical definitions of dyadic constructs;(2) a review of operational definitions, settings and methods of dyadic processes;(3) a systematic review of dyadic processes' outcomes for infants' and children developmental trajectories. Results : Two constructs emerged as wide meta-theoretical concepts (reciprocity and mutuality) and seven described specific processes (attunement, contingency, coordination, matching, mirroring, reparation, synchrony). A global model resuming the relationships among different processes is reported, which highlights the emergence of two specific cycles of dyadic functioning (i.e., matching-mismatching-reparation-synchrony;contingency, coordination, attunement, mirroring). A comprehensive review of the adopted measures is also provided. Finally, all the processes provided significant contributions to infants' behavioral, cognitive, and socio-emotional development during the first 3 years of age, but limited research has been conducted on specific processes(e.g. reparation and mirroring). Conclusion : The present study provides an original research-grounded framework to consider the different nature of mother-infant dyadic processes within a unified dyadic eco-system. Different levels of evidence emerged for the role of diverse mother-infant dyadic processes on infants' and children development. Open questions and future research directions are highlighted