Month: October 2015

Pregnancy has been described as the most difficult period in terms of psychological adjustment for fathers (Condon, Boyce, & Corkindale, 2004; Genesoni & Tallandinin, 2009). Therefore, learning to recognize the importance of their role and ways to engage them during pregnancy into postpartum can be challenging. Early childhood prenatal home visiting programs, in collaboration with the medical model of pregnancy care, can play an important role in supporting fathers.

One reason for fathers’ lack of involvement may be due to perinatal programs, especially in the medical arena, which center on responding to the health needs of the mother–child dyad (Dubeau et al., 2011; deMontigny & Lacharite´, 2012). Fathers report that there are not enough resources to support their education or feelings about fathering (St. George & Fletcher, 2011). Antenatal education’s primary focus is on the mother’s prenatal care and education for labor and birth, casting the father as support person rather than involved as a “triad” in the pregnancy plan of care; it does not address both parents’ transition to the role changes of parenthood (May & Fletcher, 2013; St. George & Fletcher, 2011). For example, one study of fathers who did not meet their partners’ expectations during labor and birth found that one reason cited was they were not prepared for their own distress and did not know how to help themselves (Dellman, 2004). Another study found that some maternity care services viewed fathers as “not-patient and not-visitor” (Steen, Downe, Bamford, & Edozien, 2012) while others found that fathers felt overlooked by staff and that their concerns and emotional needs were often not heard (deMontigny & Lacharite´, 2004). Reasons for this, acknowledged by health care professionals, include staff feeling poorly prepared to meet fathers’ needs (deMontigny, et al., 2011; deMontigny & Lacharite´, 2012; Harvey & Pattison, 2013).

Assessing the psychological well-being of fathers during prenatal health care and diagnosing anxiety and emotional problems among fathers during the perinatal period is also not a common practice (Vreeswijk, Mass, Rijk & van Bakel, 2013). Fathers who experience ongoing mental distress in relation to their parenting roles are less likely to develop and maintain supportive relationships with their partner, and thus are less likely to positively engage with the roles and responsibilities of fatherhood, which may disrupt the development of the father-child attachment relationships (Fletcher, 2011). A study of teen fathers found unrecognized psychological symptomatology of anxiety and depression, suggesting they require services as well as the mothers (Quinlivan & Condon, 2004). Fathers who reported more symptoms of depression or anxiety were found to generally have poorer quality of attachment toward the unborn baby (Vreeswijk, Maas, Rijk & Van Bakel, 2013). These studies support others that suggest that mental health screening of fathers during the perinatal period would be beneficial (Field, Diego, Hernandez-Reif, et al., 2006).

Although the majority of fathering studies have focused on the postpartum period, some are now addressing fathers’ changing sense of identity and paternal-fetal attachment during pregnancy, and suggest that some forms of intervention can effectively promote paternal mental health during this time (deMontigny et al., 2006 a, 2006b; deMontigny and Lacharite´, 2008). Professional awareness of the father’s involvement during pregnancy and his transition to parenthood can create opportunities to provide education and social support (Everett, Bullock, Gage, et al. 2006; Fletcher, May, & St. George, 2014) that may improve outcomes for the family (Alio, Lewis, Scarborough, Harris & Fiscella, 2013).

Engaging Fathers

It has been suggested that a father’s commitment to his unborn baby can be measured through the effect that his behavior has on the health and well-being of the mother (Feltcher, et al., 2014). As much as possible, it is helpful to assess the fathers support by planning home visits when he is home. This helps him know that his presence and feelings are equally important. Use eye contact, directing questions to both the father and the mother. Ask how he is doing and his feelings about the unborn baby. Encourage fathers to attend prenatal visits with the mother if she is open to this. If her relationship with the father is strained, explore what she would be comfortable having a home visitor share, if anything, to help involve her partner.

The emerging field of research on fetal competencies can be a guide for home visitors to engage fathers and provide antenatal education. One study found that the quality of the fathers’ thoughts and feelings about the unborn baby were more important in shaping their representations of the baby than the amount of time spent on thinking about the baby (Vreeswijk & colleagues, 2013). Learning that the unborn baby has the ability to hear by the second trimester and that he/she recognizes the father’s voice can be a powerful motivator to engage him in interacting with the baby during pregnancy, supporting the idea that the unborn baby “already knows him” (O’Leary & Parker, 2009). Encourage fathers to find a book to read to the unborn baby at night, sharing that the baby will then recognize his voice postpartum. Above all, regardless of how active the father might be, let the father know that the baby has an awareness of his voice. When he interacts with the mother he is also interacting with his baby.

Fathers also need to learn that the unborn baby can sense someone’s touch as different from the mother’s. Often when the baby moves he/she stops when the dad puts his hands on the mother’s abdomen. Fathers need to be encouraged talk to the baby with simple words such as “this is your dad,” to wait a few seconds after which the baby will often respond with movements. This will help the baby become more real to a father.

Fathers can also learn the importance of supporting the mother to rest. Discuss tasks he might take over to help the mother find more time to rest, such as grocery shopping, cooking, or caring for older siblings. Teach him that resting helps increase the amniotic fluid around the baby. The amniotic fluid is important for lung development as the baby practices breathing patterns in the uterus when swallowing and peeing the fluid. In a real sense both parents hear the message that resting is “feeding the baby” during pregnancy. When the mother breathes, her abdomen is moving the uterus up and down; a behavior that can be translated to parents as “rocking the baby” during pregnancy. Fathers can learn that after birth, holding the baby in a flex position in their hands close to their chest simulates the same rocking the baby felt inside the mother. Now it’s the father’s turn “to hold the baby” close, something all newborns need in the first months.

Partners’ support is also important for breastfeeding as breastfeeding is most successful when the mother has adequate support, and fathers’ support can be the difference in how long a mother nurses. The State of Kentucky initiated a campaign (Kentucky Dads Support Breastfeeding) that offers helpful tips for dads to support breastfeeding including ways to support the mom, such as helping with positioning and burping the baby after feedings (The Nations Health, 2015, p.9).

A father’s internal working model of attachment and representation of ‘mother’ and ‘father’ are to some extent socially shaped (Condon, Corkindale, Boyce, & Gamble, 2013). It is important to explore what fathering means to him; his relationship with his father; what behaviors he wants to keep and what he wants to change for his baby. Offering a discussion to identify and interpret infant communication, and to explore issues of why babies cry and strategies to employ when feeling overwhelmed can be helpful in identifying areas that may interfere with a partnership in parenting (May & Fletcher, 2013). This will help open the topic of family of origin views on discipline and “spoiling a baby” messages from both parents.

Unexpected Outcomes

It is not just fathers in a low-risk pregnancy whose needs must be recognized but fathers who experience an unexpected outcome. Fathers of preterm babies have also reported lack of support and recognition during the crisis of the labor and birth experience (Harvey & Pattison, 2013; Hugill & Harvey, 2012). Fathers of infants who die have been described as “the forgotten bereaved” (Armstrong, 2001; Côté-Aresenault & O’Leary, 2015; McCreight, 2004; Murphy, 1998; O’Leary & Thorwick, 2006, a & b; O’Leary, Thorwick, & Parker, 2012). During these medical situations, the health care providers’ focus is primarily on the mother and baby’s health, often unintentionally neglecting the needs of the father. In both situations the fathers report feeling helpless and left alone (Hugill & Harvey, 2012; O’Leary & Thorwick, 2006, a & b). Fathers, by default, assume the role of the support person as they become the messenger to family and friends while worrying about the health of the mother and baby. When there is a perinatal loss, the father often has the primary role of informing others about the loss, making the funeral arrangements, and coping with siblings at home. By holding back their own emotions to support the mother and siblings, processing their own trauma can be jeopardized (O’Leary, Thorwick & Parker, 2012).

An unexpected outcome of pregnancy occurs in the medical setting but it is when parents return home that healing begins. A home visitor plays an important role as parents move back into their communities, now profoundly changed people with the trauma of the birth of a preterm baby or perinatal loss embedded in their memory. Parents are rarely given resources at the hospital on how to support children at home and, in their own grief, do not know how to cope themselves (O’Leary, 2007). Providing developmentally appropriate resources for the children can be invaluable to parents (see resources for children’s books).
Most parents want to share what happened so it is important to not be afraid to ask about the story. Parents’ need a listening ear and will often replay the trauma many times over the months. The home visitor may be the first person to ask the father’s viewpoint as most people ask how the mother is doing but not the father (O’Leary & Thorwick, 2006b). Asking about a missing baby can be very healing for families. Parents want all their children, living and deceased, recognized and will want and need to talk about this.

Pregnancy Following Loss

In a pregnancy that follows loss, fathers have a different understanding of an unborn child and prenatal attachment, realizing this may be the only time they have with the baby (O’Leary & Thorwick, 2006 a & b; 2008). Some fathers embrace their parental identity prenatally with more involvement, attending antenatal visits to get as much information as they can. Others avoid prenatal visits and some won’t even drive by the hospital where the death occurred. It is common for fathers to become vigilant about fetal movement, asking the mother many times a day if the baby is moving. It is crucial to assess how and where fathers are getting support for themselves. In an effort to protect the mother, who is often the father’s primary source of support, the father will acknowledge holding back his fear and anxiety that the new baby could die (O’Leary & Thorwick, 2006b). Pregnancy for both parents becomes a complex journey of grieving for one baby while trying to attach to a new unborn baby (O’Leary, et al., 2012).

Education about fetal competencies to help support attachment to the new baby becomes an important intervention to facilitate fathers engaging prenatally. This provides concrete information to help fathers begin connecting with the new unborn baby while also reinforcing the idea that the deceased baby knew him as his/her parent as well. Their parenting role — and continued bond and attachment to a deceased baby — does not go away just because they are in a new pregnancy (O’Leary, et.al., 2012). This prenatal education also can help individualize the two babies as separate people, and will be reinforced again when the new baby is born alive.

Fathers need labor and birth preparation for a new baby, too. The previous birth that resulted in death can bring symptoms of post-traumatic stress, often heightened for a father who felt helpless to protect the mother and baby (O’Leary, et. al., 2012). At a minimum, touring the birthing area of the hospital can help both parents know what might trigger memories and prevent symptoms of PTSD (Côté-Arsenault & O’Leary, 2015). They need to experience the space, the smells, the sounds — anything that may trigger flashbacks to the previous birth. They then can write a birth plan that reflects what they may need for support (O’Leary, et al, 2012). This helps give parents some control to be more fully present for the birth of the new baby.

After the baby is born, demonstrating newborn competencies (Nugent, 2015) to all fathers is a wonderful way to engage men who may not have been invested during pregnancy. If the father has been actively involved, the baby will know his voice and turn to his face. Most important for fathers who have experienced a previous loss, this will show that the baby is alive, healthy and a different baby. In the cases of loss, be aware a new layer of grief will surface because the deceased baby may be heavy on a father’s mind. The full impact of what he lost in the death of that baby will be seen in the healthy development of the subsequent baby (O’Leary, 2004).

Summary

Prenatal infant mental health programs are an important resource to engage fathers and work alongside the medical community in meeting the needs of all childbearing families. Using what home visitors have done for years needs to be translated into intervention for fathers too. Helping fathers recognize their important role in the relationship with the mother and baby can build stronger, healthier families.

References

Alio, A., Lewis, P., Scarborough, K., Harris, K., & Fiscell, K. (2013). A community perspective on the role of fathers during pregnancy: a qualitative study. BMC Pregnancy and Childbirth, 13:60.
http://www.biomedcentral.com/1471-2393/13/60

Armstrong, D. (2001). Exploring fathers’ experiences of pregnancy after a prior perinatal loss. Maternal Child Nursing, 26(3), 147-153.

Condon, J., Corkindale, C., Boyce, P. & Gamble, E. (2013). A longitudinal study of father-to-infant attachment: antecedents and correlates. Journal of Reproductive and Infant Psychology, 31(1), 15-30.

Côté-Arsenault, D. & O’Leary, J. (2015). Understanding the Experience of Pregnancy Subsequent to Perinatal Loss. In: Wright, P., Limbo, R., & Black, (Ed.), Perinatal and Pediatric Bereavement, Chapter 10; 169-181. Springer Publishing, NY, NY.

Dellman, T. (2004). ‘The best moment of my life’: a literature review of Fathers’ experience of childbirth. Australian Midwifery Journal of the College of Midwives 17 (3), 20–26.

Dubeau, D., Devault, A. and Forget, G. (2009). Fatherhood in the 21st century. Quebec, University Press.

deMontigny, F.,Lacharite´ , C.,2004. Fathers’ perceptions of the immediate post-partal period: what do we need to know? Journal of Obstetric, Gynecologic, and Neonatal Nursing, 33:328–340.

deMontigny, F.,Lacharite´ , C.,Devault,A.,(2012). Transition to fatherhood: modeling the experience of fathers of breast fed infants. Advances in Nursing Science,35, E11–E22.

deMontigny, F., Girard, ME Lacharite, C., Dubeau, D., & Devault, A. (2013). Psychosocial factors associated with paternal postnatal depression. Journal of Affective Disorders, 150(1):44-9. http://dx.doi.org/10.1016/j.jad.2013.01.048

Erlandsson K, Linder H, Haggstrom-Nordin E (2010) Experiences of gay women during their partner’s pregnancy and childbirth. Br J Midwifery 18(2): 99–103.
http://www.magonlinelibrary.com/doi/abs/10.12968/bjom.2010.18.2.46407′)

Everett, K., Bullock, L., Gage, J., Longo, D., Geden, E. & Madsen, R. (2006) Health risk behavior of rural low-income expectant fathers, Public Health Nursing 23(4): 297–306.

Field, T., Diego, M., Hernandez-Reif, M., et al., 2006. Prenatal paternal depression. Infant Behavior and Development 29, 579–583.

Fletcher, R., Bimpani, G., Russell, G., & Keating, D. (2008). The evaluation of tailored email and web-based information for new fathers. Child Care Health & Development, 4(4), 439-446.

Fletcher, R. (2011). The Dad Factor: How Father–Baby Bonding Helps a Child for Life. Finch Publishing, Warriewood, NSW.

Fletcher, R., May, C. & St. George, J. (2014). Fathers’ prenatal relationship with ‘their’ baby and ‘her’ pregnancy—implications for antenatal education. The International Journal of Birth and Parent Education, 1(3), 23-27.

Habib, C. & Lancaster, S. (2006). Transition to Fatherhood: Identity and Bonding in Early Pregnancy. Fathering, 4(3), 235-253.

Hugill, K. & Harvey, M. (2012). Fatherhood in Midwifery and Neonatal Practice. Quay Books. London.

May, C & Fletcher, R. (2013) Preparing fathers for the transition to parenthood: Recommendations for the content of antenatal education. Midwifery 29 474–478.

McCreight, B. S. (2004). A grief ignored: Narratives of pregnancy loss from a male perspective. Sociology of Health and Illness, 26(3), 326-350.

McElligott, M. (2001). Antenatal information wanted by first-time fathers. British Journal of Midwifery, 9:556-558.

Murphy, F. (1998). The experience of early miscarriage from a male perspective. Journal of Clinical Nursing, 7(4), 325-332.

Nugent, K. (2015). The newborn behavioral observation (NBO) system as a form of intervention and support for new parents. Zero to Three, 36(1), 2-10.

O’Leary, JM (2004). Grief and its impact on prenatal attachment in the subsequent pregnancy. Archives of Women’s Mental Health, 7(1), 7-18.

O’Leary, J. & Thorwick, C. (2006a). When pregnancy follows a loss: Preparing for the birth of your new baby. O’Leary, JM. Minneapolis, MN

O’Leary, J., & Thorwick, C. (2006b). “It affects me too.” Fathers experience in a pregnancy after loss. Journal of Obstetrics, Gynecologic, and Neonatal Nursing, 35(1), 78-86.

O’Leary, J, & Thorwick, C. (2008). Attachment to the Unborn Child and Parental Representation of Pregnancy Following Perinatal Loss. Attachment: New Directions in Psychotherapy and Relational Psychoanalysis, 2(3), 292-320.

O’Leary, J (2007) Pregnancy and Infant Loss: Supporting parents and their children. Zero to Three, 27(6), 42-49.

O’Leary, J. & Parker, L. (2009). Parenting your baby before birth: Explore the relationship. Thorwick, C. (Ed.) Minneapolis, MN. Self published: O’Leary

O’Leary, J., Warland, J. & Parker, L. (2012). Childbirth Preparation for Families Pregnant After Loss. International Journal of Childbirth Educations, 27(2) 44-50.

O’Leary, J. & Thorwick, C., Parker, L. (2012). The baby leads the way: Supporting the emotional needs of families’ pregnant following perinatal loss. 2nd edition Ragland, K. (Ed.) Minneapolis, MN Self published: O’Leary.
Available at aplacetoremember.com

Quinlivan, J. & Condon, J. (2005). Anxiety and depression in fathers in teenage pregnancy. Australian & New Zealand Journal of Psychiatry, 39:915-920.

Ramchandani, P., Stein, A., Evans, J., et al., 2005. Paternal depression in the postnatal period and child development: a prospective population study. Lancet 365, 2201–2205.

Ramchandani, P., O’Connor, T.G., Evans, J., et al., 2008. The effects of pre- and postnatal depression in fathers: a natural experiment comparing the effects of exposure to depression on offspring. Journal of Child Psychology and Psychiatry 49, 1069–1078.

Ramchandani, P.G., O’Connor, T.G., Heron, J., et al., 2009. Depression in men in the postnatal period and later child psychopathology: a population cohort study. Journal of the American Academy of Child Psychiatry 47, 390–398.

Ramchandani, P.G., Psychogiou, L., Vlachos, H., et al., 2011. Paternal depression: an examination of its links with father, child and family functioning in the postnatal period. Depression and Anxiety 28, 471–477.

Skari, H.,Skreden,M.,Malt,U.F.,etal.,2002.Comparative levels of psychological distress, stress symptoms, depression and anxiety after childbirth—a prospective population-based study of mothers and fathers. BJOG: An International Journal of Obstetrics and Gynaecology109,1154–1163.

The Nations Health: A publication of the American Public Health Association, May/June, p. 9, www.thenationshealth.org

Vreeswik, C., Mass, J., Rijk, C., van Bakel, H. (2013). Fathers’ experiences during pregnancy: Paternal prenatal attachment and representations of the fetus. Psychology of Men & Masculinity 15(2):1-9. DOI:10.1037/a0033070

Resources http://www.beyondblue.org.au/resources/for-me/men/what-causes-anxiety-and-depression-in-men/new-fathers

Resources for children: http://www.aplacetoremember.com or http://www.centering.com

Relationship-based interventions, like infant mental health, target the caregiving relationship as a way to support infant attachment security and social-emotional development.  In theory, IMH therapists support reflective functioning when they provide developmental guidance, speak for the baby, remain curious about both parents’ and infants’ internal experiences and help parents reflect on and re-process experiences and emotions from their own childhood. As such, reflective functioning is an important construct in IMH research and practice.

Reflective functioning is the capacity to reflect upon internal experiences (thoughts, emotions and intentions) in self and others and to link these internal experiences with behaviors (Rosenblum, McDonough, Sameroff, & Muzik, 2008; Sharp & Fonagy, 2008; Slade, 2005).  A small body of research suggests that reflective functioning is the foundation for parenting sensitivity, which is associated with a variety of positive developmental outcomes, including a secure attachment. Secure attachment, in turn, is related to prosocial behavior, emotion regulation, and psychosocial adjustment (for a review, see Thompson, 2008).  Interventions aimed at increasing reflective functioning, beginning as early as in pregnancy, are of interest to research and to clinicians utilizing infant mental health models.

The effectiveness of these interventions is tested by measuring reflective functioning at the beginning of the intervention, in pregnancy, and then again following intervention after the child has been born. The problem with this is that we do not actually know if reflective functioning remains stable across the transition to parenthood or increases as the parent-child relationship develops, the child’s cues become clearer, or the child develops language. Not knowing if reflective functioning increases naturally as a relationship unfolds makes it difficult to determine if interventions are actually successful.

Research Questions

In the Early Relationships Lab at the Merrill Palmer Skillman Institute we are studying reflective functioning in pregnancy and postpartum to better understand a) whether risk factors influence the ability to be reflective (i.e. a history of maltreatment and depression), b) how reflective functioning supports sensitivity and a secure attachment, c) whether IMH services support parents’ reflective capacity and d) factors that influence stability and change in reflective functioning across the transition to parenting.

Overview of Study Methods

All of our studies assess parental reflective functioning with a one-hour semi-structured interview that asks parents to reflect on their own and their children’s internal experiences. The interview is coded for parents’ use of mental state language (language about their children’s internal mental and feeling states such as the parent commenting on what she thinks her child is thinking or feeling), their ability to link mental states to behavior (such as the parent linking her perceptions of the child’s emotions, goals or intentions to the child’s behavior) and their curiosity to understand other’s minds (Slade, 2005). We are assessing reflective functioning in three studies.

Wayne County Baby Court. We are evaluating whether this collaborative approach is effective at improving safety, permanency and well-being.  Parent-infant dyads receiving Baby Court services work with an infant mental health clinician who is part of a collaborative team that includes the DHHS caseworker and the child’s attorney. The evaluation includes a pre- and post-test parent-child interaction task, a developmental assessment, a clinical interview to assess reflective functioning and parents’ report on their child’s social-emotional development.

The PuRPLE Study. We are testing the stability and change in reflective functioning in a subsample of mothers participating in a larger longitudinal study that assesses fetal brain development, parenting and child development across infancy. Our team has spent the last two years collecting data from women beginning during pregnancy and then again when the infant is seven months. We assess reflective functioning at both time points. Parents also complete a variety of self- report measures about mental health, stress, social support, temperament and parenting.  The dyad participates in the still-face procedure and we also test the infants’ development.

The MACY Study. This longitudinal study (PI: Muzik) followed mothers, with and without histories of child maltreatment, and their infants through the preschool period. The study sought to better understand how trauma shapes mental health, parenting representations, parenting behavior and subsequent child biology and attachment. The MACY team interviewed more than 100 mothers using the Parent Development Interview, which was coded by the team in the Early Relationships Lab. Some self-report data was collected via phone when the infant was four months. Dyads participated in home visits when the infant was 6 months, a lab visit at 15 months and mothers were interviewed by phone when the infant was 18 months.

Results

 Risk and Reflection. Our findings from the MACY study suggest that women who have a history of childhood maltreatment demonstrate a wide range of reflective functioning. Although most women in the study tended to have few demographic risks, for example most were married and college educated, the presence of a single demographic risk factor (low income, low level of education, young or single parent) was associated with lower reflective functioning scores. Contrary to our expectations, maternal reflective functioning was not related to experiencing maltreatment as a child, experiencing multiple types of maltreatment as a child, or having a depression or PTSD Diagnosis (Muzik, et al., 2015; Stacks, et al., 2014).

Reflective Functioning, Parenting and Attachment. Consistent with previous research, our findings from the MACY study suggest that mothers with higher levels of reflective functioning demonstrate more sensitivity and less negativity when interacting with their infants. Further, maternal reflective functioning differed among infant attachment classifications. Mothers of infants classified as secure had higher reflective functioning scores than mothers of infants classified as avoidant or disorganized. The mechanism by which reflective functioning was associated with attachment was through parental sensitivity (Stacks et al., 2014).

The PuRPLE Study is ongoing; however, preliminary findings suggest that mothers with balanced representations of their attachment relationships with their infants have higher prenatal reflective functioning scores than mothers with disengaged representations (Alismail, et al., 2015;).  Further, mothers who had more instances of being reflective throughout their prenatal interview used more attuned mind-minded comments during the still-face procedure, r = .51, p = .02, (Alrajhi, et al., 2015).

Stability and Change in Reflective Functioning. Preliminary results from the PuRPLE study suggest that maternal reflective functioning in pregnancy is highly correlated with postnatal reflective functioning, r  = .74, p  = .001 and that it increases across the transition to parenthood t(30) = -3.80, p = .001. Future analyses will explore factors associated with stability and change. One factor that may support change in RF is IMH treatment. Preliminary findings from 10 Baby Court parents who have completed the pre- and post-test suggest that parental reflective functioning scores increase as a result of treatment, t(9) = -4.81, p = .001.

Conclusions

Across our studies, it appears that parental reflective functioning is related to observed parenting, infant attachment classification, and mother’s working model of her child. Further, mothers who experience maltreatment as children or who have diagnoses of depression and PTSD demonstrate a range of reflective functioning scores. It will be important to understand what factors support parental reflective functioning in the context of these risks that are usually associated with less sensitive parenting. Our findings also suggest that reflective functioning, while generally fairly stable over time, can increase for some parents across the transition to parenthood. One factor that appears to support parental reflective functioning is IMH treatment.

Key Implications for Practice 

• Maternal reflective functioning is associated with parenting quality and attachment.
• Maternal reflective functioning can change over time and IMH treatment may be effective at supporting parental reflective functioning.

 

References

Alismail, F., Wong, K., Villa, A., Antilla, C., Beeghly, M., & Stacks, A. (2015, May).Maternal Attachment Representations of the Infant in the First Year of Life: The Influence of Prenatal Reflective Functioning and Depression.Poster presented at the biennial meeting of the Michigan Association for Infant Mental Health, Kalamazoo, MI.

Alrajhi, N., Costner, S., Stacks, A., Villa, A., Antilla, C. &Beeghly, M. (2015, May). The Role of Reflective Functioning and Maternal Mind Mindedness on Infants’ Language Development in the First Year: Preliminary Findings.  Poster presented at the biennial meeting of the Michigan Association for Infant Mental Health, Kalamazoo, MI.

Muzik, M., Stacks, A. M., Rosenblum, K. L., Huth-Bocks, A., &Beeghly, M. (2015, May).  The Effects of Trauma and Depression on Parenting Representations and Child Outcomes: Findings from the MACY Study. Workshop presented at the biennial meeting of the Michigan Association for Infant Mental Health, Kalamazoo, MI.

Rosenblum, K.L., McDonough, S., Sameroff, A. J. &Muzik, M. (2008). Reflection in thought and action: Maternal parenting reflectivity predicts mind-minded comments and interactive behavior. Infant Mental Health Journal, 29(4), 362-376.

Sharp, C. &Fonagy, P. (2008). The parent’s capacity to treat the child as a psychological agent: Constructs, measures and implications for developmental psychopathology. Social Development, 17(3), 737-754.

Slade, A.  (2005). Parental reflective functioning: An introduction. Attachment and Human Development, 7(3), 269-281.

Stacks, A. M., Muzik, M., Wong, K., Beeghly, M., Huth-Bocks, A., Irwin, J. & Rosenblum, K. L. (2014). Maternal reflective functioning among mothers with maltreatment histories: Links to sensitive parenting and infant attachment security. Attachment and Human Development, 16(5), 515-533.

Thompson, R. (2008). Early attachment and later development: Familiar questions, new answers. In  J. Cassidy & P. R. Shaver (Eds). Handbook of Attachment: Theory, Research and Clinical Applications (pp. 348-365). New York: Guilford.

Wong, K., & Stacks, A. M., Ghrist, F., Vila, A., Antilla, C. &Beeghly, M.  (2015, May). Is Reflective Functioning Stable from Pregnancy to Postpartum: Preliminary Findings? .Poster presented at the biennial meeting of the Michigan Association for Infant Mental Health, Kalamazoo, MI.

 Contact Information

For more information contact: Ann M. Stacks at amstacks@wayne.edu

 

 

Infant mental health specialists recognize the unique strengths and needs of each family. An understanding of variations in child temperament can help clinicians provide developmental information that is specific to each baby.  It can also be used to help parents recognize and foster their children’s individual potential. Research confirms that individuals vary in their degree of sensitivity to environmental influence including being more or less impacted by parenting behaviors. Increased sensitivity may be a disadvantage in an unfavorable environment, but it also allows a child to take full advantage of a positive and supportive environment (Belsky & Pluess, 2009). What is generally referred to as a “difficult” temperament has been shown to be associated with this type of increased sensitivity to parenting (Belsky, Bakermans-Kranenburg, & Van Ijzendoorn, 2007).

At the same time, children with difficult temperaments may present the most challenges to receiving an optimal level of care. A difficult temperament is characterized by heightened reactivity and emotionality. Children may react easily and intensely and are often described as easily upset. Research has shown mixed results in terms of the effect a child’s temperament has on parenting. This is particularly important when it comes to so-called “difficult” or challenging temperaments. Some research indicates that children with more reactive temperaments are more taxing for parents and are more likely to receive harsher or less responsive care (Clark, Kochanska, & Ready, 2000; Jaffee et al., 2004). Still, other studies show this same temperament elicits greater responsiveness and maternal involvement (Kochanska, Friesenborg, Lange, & Martel, 2004; Pettit & Bates, 1984; Sroufe, 1985).  This study examines how children’s temperamental predispositions evoke particular responses from parents and the manner in which parental qualities affect their responses to children’s temperament.

Research Questions

First, we were interested in identifying naturally occurring patterns of child temperament and parental response to that temperament. We expected to see that some parents experience pronounced distress in relation to heightened child negative emotionality while others do not. Second, we examined the relationships between the patterns and parenting quality over time.  We hypothesized that highly emotional children may be more likely to experience negative parenting behaviors from highly distressed parents than their less reactive counterparts or from parents who were more satisfied with the parent-child relationship. As a next step, we examined whether additional parent and child characteristics or behaviors distinguished among patterns that included children high in negative emotionality. The aim was to determine factors that distinguish between parents of children high on negative emotionality experiencing higher levels of distress and dissatisfaction in the parenting role from those who do not in order to inform future interventions for so-called “difficult” children.

Overview of Study Methods

The sample included 2,329 Early Head Start eligible children (1,184 males) and their primary caregivers from the National Early Head Start Research and Evaluation (EHSRE) Project (Love et al., 2005).

At enrollment, caregivers were a mean age of 22.6 (SD = 5.77) years and children were a mean age of 15.02 (SD = 1.48) months. Caregivers were 37% White, 34% African American, and 23% Hispanic/Latino, most with no more than a high school education (74.4%). Annual gross income averaged $9,277 (SD = $8,421).

We measured temperament by parent report using the Emotionality Activity Sociability and Impulsivity (EASI) measure (Buss & Plomin, 1984) at 14 months.  Parental distress and parent-child dysfunctional interaction (dissatisfaction with the parent-child relationship) were assessed via parent report using the Parenting Stress Index (Abidin, 1995). Parental Distress refers to distress related to the parenting role and the Parent-Child Dysfunctional Interaction addresses the parent’s dissatisfaction with the parent-child relationship. Some of the questions have to do with whether the child’s behavior is what the parent expected.

To answer the second research question regarding how parent/child patterns are related to parent behaviors, we looked at parental negative regard toward the child during play using a measure called the “3-bag task”. The 3-bag assessment is a videotaped parent-child semi-structured play task that is then coded by an observer. Parental negative regard included things like expression of anger toward the child or disapproval or rejection of the child. We used ratings of parents collected when children were 24 and 36 months old, and when children were five years old.

Results

Patterns of Child Temperament and Parental Response. Consistent with our hypotheses, analyses (Figure 1) revealed variations in patterns of child temperament and parenting distress and/or dissatisfaction.

Figure 1. Patterns of Child Emotionality and Parental Distress/Dissatisfaction

The first group represents what we would think of as “easy” children. They were low on negative emotionality, and their parents experienced very little parenting distress and little dissatisfaction in the parenting role. This is the largest group and contains 83% of the parent-child dyads. The second and third groups were both high on negative emotionality (the “difficult” children), but what distinguishes the third group is the magnitude of the distress and dissatisfaction in the parent that goes with it.

Parental Negative Regard. For the entire sample taken as a whole, parental negative regard exhibited toward the child in the free play episodes decreases over time from child age 24 months to 5 years. The first set of comparisons evaluated possible group differences in change in parental negative regard between the first group, comprised of temperamentally “easy” children and their parents, and the two remaining groups, comprised of highly emotional children and their parents, together. As seen in Figure 2, children in the groups characterized by heightened emotionality tend to experience significantly higher levels of negative regard at 24 months (1.43) than those with a less reactive disposition (1.52) as well as a significantly slower rate of decrease Δχ²(3, N = 2022) = 28.71, p < .001, over time.

Figure 2. Group 1 compared to Groups 2 and 3 Combined

Those in the “difficult” groups experience more parental negative regard to begin with and that negative regard decreases less by the time children are 5 years old. That is, parents were more negative toward their emotionally reactive children at the first assessment and continued to be more negative over time as compared to parents whose children had a less challenging temperament.

The second set of comparisons evaluated possible differences between the two groups that included children with heightened emotionality. This was done to compare highly emotional children with distressed parents to those whose parents did not experience such distress. As seen in Figure 3, highly distressed parents exhibit significantly higher levels of negative regard (1.70) toward their highly emotional children than parents of similar children who are less distressed and more satisfied in the parenting role (1.49). Results also show significant difference between groups, Δχ²(3, N= 331) = 13.91, p = .003, in the rate of decline in parental negative regard over the study period.

Figure 3. Group 2 compared to Group 3

For parents of highly emotional children, those who are highly distressed show much more negativity toward their children at the first assessment than less distressed parents of equally emotional children. These highly distressed parents show very little, if any, lessening of that negativity over time.

Group Differences on Additional Characteristics. Parents in the highly distressed group tended to perceive more behavior problems, F(2,1348) = 68.20, p < .001, in their children despite no significant differences between groups 2 and 3 on observer rated behavior scales. Parents who are better able to accept and interact with their child’s temperament are characterized by greater knowledge of infant development, F(2,1348) = 24.86, p < .001.

Conclusions

Results highlight the importance of parental perception in shaping the emerging parent-child relationship. Parenting behaviors were not impacted by a challenging child temperament, but rather by the parents’ acceptance and response to that temperament. Parents who experienced substantial distress and who saw their relationship with their child as less satisfying exhibited more and longer lasting negative regard toward their children. However, highly emotional children whose parents did not experience such distress and had more positive perceptions of the relationship showed levels of negative regard similar to parents of “easy” children. A notable difference in these more accepting parents of highly emotional children is that they had greater knowledge of child development.

Key Implications for Practice

• Offering developmental guidance in terms of variations in temperament and reactivity could help parents form accurate expectations and improve their understanding of their unique child’s behavior. This could be especially helpful for parents of children with challenging temperaments.
• IMH specialists could offer interaction guidance regarding effective strategies parents could use to model and facilitate self-regulation in their highly emotional children. This could improve parental self-efficacy. At the same time, it could assist these children in successfully managing their tendency toward increased reactivity and emotional response. Strengthening the parent-child relationship can be particularly advantageous for children who are more sensitive to environmental influence.

References

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Contact Information

For more information contact: Danielle Dalimonte-Merckling at dalimon5@msu.edu.