PARENT-INFANT INTERACTION: Biobehavioral Regulation, Theory, Research & Assessment

1. PARENT-INFANT INTERACTION: Biobehavioral Regulation, Theory, Research & Assessment Julie Petrie-Thomas, PhD Candidate, IISGP, UBC, Centre for Community Child Health Research, BC Research Institute for Children’s & Women’s Health. David Hayley, Ph.D. Post-Doctoral Fellow, Dept. of Pediatrics, UBC, & Centre for Community Child Health Research, BC Research Institute for Children’s & Women’s Health. J.Petrie-Thomas

2. How the Parent-Infant Relationship Influences Development • Historical overview of some of the major theoretical contributors • Parent-infant interaction • Biobehavioral research and Parent-infant interaction Infant regulation of behavior and physiology: • Attention • Stress • Heart Rate (HR) • Cortisol J.Petrie-Thomas

3. Psychoanalytic Perspective: Consistently Emphasized the Importance of Relationship • Man as a biological organism governed by drives • Reduced tension through the agency of an object • Regulatory role played by the object or person that served the infant’s instincts which was most often mother • In listening to an individual, one was in effect witnessing an internal relationship Freud with mother Amalia J.Petrie-Thomas

4. Developmental Perspective • Extended theory of drive satisfaction to include the role of the parent in structuring the child’s mind • Identified stages of development beginning with biological unity between mother-infant dyad • Psychological disorder examined within the process of developmental evolution, by coming to terms with conflicts as determining the risk of pathology Freud with Daughter Anna 1912 J.Petrie-Thomas

5. Further Inquiry & Theory: Parent-Infant Relationship Mary Ainsworth (1913-1999): Notion of mother as “Secure Base”John Bowlby (1907-1990): Term “Interaction” in “The Nature of the Child’s Tie to His Mother”, 1958). Anna Freud (1895-1992) & Melanie Klein (1882-1960)– Psychoanalytic Theory M. Mahler: 1st to Study Observable Interactions - “Holding Environment” – Mother As Organizer & Regulator (Infant homeostatis), “Physiological” to “Social Symbiosis” D. Winnicott (1896-1971): Importance of Sensitivity, Mirroring “Goodenough Mothering” and Father As Primary Caretaker, Parent-infant “Affective Communication Systems” J.Petrie-Thomas

6. Anna Freud & Renee Spitz Maternal Deprivation (1940’s) • Children deprived of maternal relationship during war or in institutions such as hospitals or foundling homes • Spitz’s classic studies “hospitalization syndrome” • Observed effects of “marasmus” (wasting away for no physiological cause or “anaclytic depression” (reaction to separation from mother) • Anna Freud’s observations of children during WWII “cast a shaft of light on the nature of many forms of psychiatric disturbance” (Bowlby, 1973) • Provided dramatic insight into critical nature of earliest relationship J.Petrie-Thomas

7. Joseph Sandler 1927-1998 (Student of Anna Freud) • Introduced concept of background of safety (1959) • Ego able to maximize security rather than to avoid anxiety • Revolutionary thinking re: infant’s representational world • Relationships viewed as “a set of expectations relating to the mother’s appearance and activities” • Relationships had “shape”, added critical emotional tone to organizing interpersonal experience • Conscious thinking as embedded within a matrix of feeling states that give rise to all adaptation • This set precedent for affect as a basis of infant’s interactions widely acknowledged by many today • E.g. Dante Cicchetti, Robert Emde, Alan Sroufe J.Petrie-Thomas

8. Harlow’s Studies with Rhesus Monkeys – Early 1950’s • Socially isolated newborn monkeys (birth to 1 yr) were severely socially impaired - such vulnerability was not detected when older animals were isolated • Mother-infant tie was built around warmth, protection and security rather than an oral object (Bowlby, 1969) J.Petrie-Thomas

9. Effects of Separation: Maternal Deprivation • Renee Spitz (1945) - In many institutions, despite the best of medical care, 50% of infants died if they had established a good relationship with the mother and then were separated prior to 2 yrs • Anna Freud (1953) - Providing 1 constant mother figure for each group of infants, instead of a rotation of nurses, eliminated many of the infant deaths • Harlow (1958,1979) – Monkeys reared by a terry cloth mother would not mate -one that did batted her infant away when it came to feed J.Petrie-Thomas

10. Balanced by: Ethological Studies • Konrad Lorenz’s work on imprinting (1957) • Led to recognition of infant’s role in “releasing” maternal responses (e.g. by cry) • View of infant as more active participant J.Petrie-Thomas

11. Ethological Studies: Contributions • Identification of “critical periods” – predict developmental trajectories • Naturalistic and detailed analysis - Micro-analytic techniques and timing • Mother/Infant as part of community – social structure can be derived from the variety of interactions between it’s members • Robert Hinde – descriptions of interactions to include not only what but how partners interact (quality of interaction) J.Petrie-Thomas

12. John Bowlby (1907-1990) • Integrated biological concepts and psychoanalytic theory • Viewpoint that early development may set the course for later development (Bowlby, 1973) • Emphasized the importance of reciprocal regulatory control systems that are open to influence by the environment in which development occurs (dyadic system) • Idea that infant attachment behaviors are used to maintain proximity of the primary caregiver (Bowlby, 1958; Bowlby, 1969) • This gave rise to the concept of attachment as a construct that described the mother-infant relationship J.Petrie-Thomas

13. Mary Ainsworth(1913-1999) • Colleague of Bowlby • Also influenced by Harlow’s work • Defined maternal deprivation as lack of interaction • Attachment occurs as a result of child’s activity, rather than through the passive need gratification or external stimulation • Interaction as dyadic - initiated by either member of the pair J.Petrie-Thomas

14. Mary Ainsworth: Canada, UK, Uganda, USA • Established notion of mother as “secure base” • Introduced notion that exploration occurs if infant feels secure • Quality of attachment highly dependant on maternal sensitivity to infant cues “Petero felt much more secure after his mother picked him up." J.Petrie-Thomas

15. Animal Studies: Infant Rat Pups • Maternal regulation of multiple infant systems after birth – mother as hidden “regulator” • Concept of state organization bridged gap between structure and function, and ultimately between biology and psychology • Myron A. Hofer, M.D. J.Petrie-Thomas

16. Barry Brazelton Motivation model of competence inspired work in the area of neonatal assessment – i.e. organisms capacity to interact effectively with environment (accounting for exploratory behavior, manipulation and general activity) • View of infant as competent and active participant provided support for early social engagements as central to development – and form basis of parent infant interaction theory • Viewed the infant’s achievement of homeostatic control and drive to reach out for and incorporate cues from the environment as a biomodal fueling system for energizing development • Differences in state regulation as reflecting neurological integrity and providing an opportunity for diagnosis, prediction and for communicating with and influencing the parent-infant systems for “at-risk” infants J.Petrie-Thomas

17. Developmental Systems View • Coined term " Good enough mother“ • Theorized that there is never just an infant, but an infant-mother pair • Babies gain knowledge about objects from their experiences with the mother • If young children are deprived of a nurturing environment, such as in the case of an alcoholic or abusive parent, infants learn that objects come and go unpredictably D.W. Winnicott, British psychiatrist (1896-1971) J.Petrie-Thomas

18. Louis Sander Influenced by: Erikson & Spitz • Erikson (development/interactions with environment) • Spitz (developmental imbalance resulting from asynchrony of maturational periods of development and object relations) • Recognized that parent-infant interaction varies dramatically as a result of developmental change J.Petrie-Thomas

19. Sander’s 5 Qualitatively Distinct Periods and Developmental Interactive Context • 0 to 2½ months: “Initial Adaptation” Feeding, putting to sleep, parent sensitivity to cue, ability to read infant cues, infant response to soothing • 2½ to 5 months: “Reciprocal Exchange” Face-to-face interaction: maintenance or termination, modulation, termination or avoidance of face-face engagement J.Petrie-Thomas

20. Developmental Periods &Contexts (cont’) • 5 to 9 months “Early Directed Activity” Joint object play, how dyad directs play, timing, attention/focus, elaboration, scaffolding, involvement, organization, intrusiveness or synchrony of parent-infant relationship • 9 to12 months “Focalization on the Parent” Attachment • 12 to18 months “Establishment of Early Autonomy” Control issues, increased mobility, limit setting J.Petrie-Thomas

21. Family Context and Child Development • Ecological systems theories • Transactional theories of development • Family systems theories • ALL emphasize the embeddedness of children in family systems and the family’s importance in development (Bowen, 1978; Brofenbrenner, 1979; Sameroff, 1975; Steinberg & Avenevoli, 2000). J.Petrie-Thomas

22. Concepts & Terminology: Dyadic Interaction • Spitz “Mother-Infant Dialogue” • Bateson (1971) “Protoconversations” • Stern – critical importance of timing, rhythm, structure for the infant to form temporal expectancies, organize attachment, social, self-regulation of affect and state • Trevarthen (1979) “Conversational Negotiation of Emotions” • Papousek & Papousek (late 70’s) rhythmic approach to gaze, vocalization and facial interactions as central to bonding “Intuitive Parenting” J.Petrie-Thomas

23. Dyadic Interaction • Affect regulation as the basis of “Mutual Regulation” (Tronick et al.,1986) “Entrainment” or “Attunement” (e.g. Field, 1994) • Dyadic coordinations = “Co-occurrence”, “Matching”, “Reciprocity”, “Coherence” • Tiffany Field (e.g.1981) emphasized integration of infant arousal, attention and affect as components of early interactions, gaze aversion and changes in HR prior to affect changes J.Petrie-Thomas

24. Neurobiology Perspective • “Neural sculpting” - social and physical environments organize the experiences that shape the networks and patterns of the brain (e.g. Cynader et. al., 1999) • Hofer (1990), Schore (1994) & Trevarthern (1990) have emphasized the 2-way connection between brain maturation and social-emotional development • Changes in brain circuitry are dependent on the the socio-affective context (Sroufe, 1996) • Experience with caretakers interacts with genetic/constitutional factors to produce neural networks that function to regulate affect (Schore) • Communications are fast acting or “hidden” -mother senses and modulates the non-verbal and affective expressions of the infant’s psychobiological state • These neural networks provide the basis for automatic patterning of activity J.Petrie-Thomas

25. Prematurity : High Variability of Outcomes • Heterogeneity of outcomes • Suggests a complex interplay of biological vulnerability and psycho-social influence J.Petrie-Thomas

26. Effects of Maternal Behavior on Preterm Physiology • One premature study has examined the effects of maternal behavior on infant behavior and physiology (Zeskind, O'Grady, & Tremblay, 2001) • Early psychosocial interventions for mothers improved neonatal autonomic regulation (flexibility of behavioural state & temporal organization of heart rate) • Conducted in the neonatal period (NICU)  Aim of Novel Study Parent-Infant interactions influence on: - Behavioural attention - HR response J.Petrie-Thomas

27. Preterm Research:Consistent Responsiveness Maternal responsiveness during infancy and early adolescence: • Faster cognitive growth and higher IQ • Higher arithmetic scores • More positive self-esteem • Teachers reported fewer behavioral and emotional problems J.Petrie-Thomas

28. Preterms More Strongly Influenced by Their Environments • Contextual factors accounted for 40% to 60% of the variance in outcome at 2 years compared to 15-30% for the full-terms • Quality of parent-infant interaction mediates the relation between neonatal risk status and later cognition J.Petrie-Thomas

29. Parent-Preterm Interaction • Infants of more responsive parents are able to tap into a greater source of external regulation (Weinberg, Tronick, Cohn, & Olson, 1999). • Parenting supports nervous system function, regulation and neural feedback systems, which take place within dyadic interaction (Porges, 2002). • Preterm infant’s neuro-regulatory capacity is not developed, thus the caregiver provides this capacity (Porges, 2002). J.Petrie-Thomas

30. Physiological & Behavioral Regulation • Regulation of HR plays a crucial role in infant’s modulation of affect and social behaviour (Bazhenova, Plonskaia, & Porges, 2001). • Recovery of HR rate to challenge linked to higher parent responsiveness (Haley & Stansbury, 2003). J.Petrie-Thomas

31. Parent –Infant Interactions & Cardiac Autonomic Regulation (5-6 months) • Positive link between synchronous patterns of parent-infant interactions and the infants’ physiological regulatory abilities (i.e. greater heart rate variability, parasympathetic regulation) (Porter, 2003) J.Petrie-Thomas

32. Research Measures: Dyadic Interaction • Developmentally appropriate? • Established using specific/special populations? • Reliability and validity? • Appropriate for setting? • Constructs address research/clinical questions? J.Petrie-Thomas

33. Global Mother-infant Interaction Ratings: 8 &18 Months & 3 Years Crnic et al (1983). J.Petrie-Thomas

34. Mother and Infant ratings • Mothers & Infants rated according to their: 1) Gratification from interaction 2) General affective tone (angry, irritated to happy, positive) 3) Mother sensitivity (intrusiveness to synchrony) and Infant Responsiveness (avoidant to active involvement) J.Petrie-Thomas Crnic et al (1983).

35. Mother-preterm Interaction at 8-months Grp 1: High-risk (< 29 weeks; N=29) Grp 2: Lower-risk (30-32 weeks, N=26) Grp 3: Term-borns (N=36) • No differences in mother behaviors across groups (Mother Sensitivity, Gratification and Affect) • Behavioral differences: Infant Responsiveness and Infant Affect for the high-risk premature group only • Mother Affect - highly correlated with all infant behaviors (Responsiveness, Affect and Gratification) for the highest risk preterm group only (r=.48, .53, .69) J.Petrie-Thomas Petrie-Thomas & Grunau, CCCHR, 2004

36. Findings Related to Development? • 2½ to 5 months: “Reciprocal Exchange” Face-to-face interaction: maintenance or termination, modulation, avoidance of engagement • 5 to 9 months “Early Directed Activity” Joint object play, how dyad directs play, timing, attention/focus, elaboration, scaffolding, involvement, organization, intrusiveness or synchrony of relationship J.Petrie-Thomas