PARENTINFANT INTERACTION Biobehavioral Regulation Theory Research Assessment Julie

PARENT-INFANT INTERACTION: Biobehavioral Regulation, Theory, Research & Assessment Julie Petrie-Thomas, Ph. D 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. May 13, 2004 J. Petrie-Thomas

How the Parent-Infant Relationship Influences Development 1. Historical overview of some of the major theoretical contributors 2. Parent-infant interaction 3. Biobehavioral research and Parent-infant interaction Infant regulation of behavior and physiology: • • May 13, 2004 Attention Stress Heart Rate (HR) Cortisol J. Petrie-Thomas

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 May 13, 2004 J. Petrie-Thomas

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 May 13, 2004 J. Petrie-Thomas

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: 1 st 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” May 13, 2004 J. Petrie-Thomas

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 May 13, 2004 J. Petrie-Thomas

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 May 13, 2004 J. Petrie-Thomas

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) May 13, 2004 J. Petrie-Thomas

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 May 13, 2004 J. Petrie-Thomas

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 May 13, 2004 J. Petrie-Thomas

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) May 13, 2004 J. Petrie-Thomas

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 May 13, 2004 J. Petrie-Thomas

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 May 13, 2004 J. Petrie-Thomas

Mary Ainsworth: Canada, UK, Uganda, USA • Established notion of mother as “secure base” • Introduced notion that exploration occurs if infant feels secure “Petero felt much more secure after his mother picked him up. " May 13, 2004 • Quality of attachment highly dependant on maternal sensitivity to infant cues J. Petrie-Thomas

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. May 13, 2004 J. Petrie-Thomas

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 May 13, 2004 J. Petrie-Thomas

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 May 13, 2004 J. Petrie-Thomas D. W. Winnicott, British psychiatrist (1896 -1971)

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 May 13, 2004 J. Petrie-Thomas

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 May 13, 2004 J. Petrie-Thomas

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 to 12 months “Focalization on the Parent” Attachment • 12 to 18 months “Establishment of Early Autonomy” Control issues, increased mobility, limit setting May 13, 2004 J. Petrie-Thomas

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). May 13, 2004 J. Petrie-Thomas

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” May 13, 2004 J. Petrie-Thomas

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 May 13, 2004 J. Petrie-Thomas

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 socialemotional development • Changes in brain circuitry are dependent on 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 May 13, 2004 J. Petrie-Thomas

Prematurity : High Variability of Outcomes • Heterogeneity of outcomes • Suggests a complex interplay of biological vulnerability and psycho-social influence May 13, 2004 J. Petrie-Thomas

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 May 13, 2004 J. Petrie-Thomas

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 May 13, 2004 J. Petrie-Thomas

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 May 13, 2004 J. Petrie-Thomas

Parent-Preterm Interaction May 13, 2004 • 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 neuroregulatory capacity is not developed, thus the caregiver provides this capacity (Porges, 2002). J. Petrie-Thomas

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). May 13, 2004 J. Petrie-Thomas

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) May 13, 2004 J. Petrie-Thomas

Research Measures: Dyadic Interaction • Developmentally appropriate? • Established using specific/special populations? • Reliability and validity? • Appropriate for setting? • Constructs address research/clinical questions? May 13, 2004 J. Petrie-Thomas

Global Mother-infant Interaction Ratings: 8 &18 Months & 3 Years Crnic et al (1983). May 13, 2004 J. Petrie-Thomas

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) May 13, 2004 J. Petrie-Thomas Crnic et al (1983).

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) May 13, 2004 J. Petrie-Thomas & Grunau, CCCHR, 2004

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 May 13, 2004 J. Petrie-Thomas