Abstract: The emerging field of mother-infant psychotherapy lends itself particularly well to objective measures of change. The improvements are often rapid, involving symptom relief or removal. These improvements can be related to subjective change in mothers and to modifications of various interactive variables. We examined changes due to brief therapy (maximum of 10 sessions) in cases of functional and behavioral disturbances in children less than 30 months old. Evaluations were done before treatment and at 1 week, 6 months, and 12 months after therapy. The outcome measures were changes in the infant's symptoms, the mother's representations, and the behavioral interactions between mother and infant. One group of mothers and infants was seen in a form of psychodynamic brief psychotherapy developed in our Center, and a control group was seen in a noninterpretive form of therapy called interactional guidance. This progress report includes the initial 38 mother-infant dyads who have completed the first three evaluations. Results indicate that the major changes are seen in symptom relief or removal; interactions change in the direction of becoming more “harmonious,” with mothers becoming less intrusive and infants being more cooperative. A better identification between mothers and infants is seen in the measures of the mothers' representations. No major differences between the two forms of therapy have yet appeared. To date, pretreatment predictions show little correlation with actual outcomes. Change proved to be durable, even showing some improvement in the 6-month follow-up evaluations. Results are discussed from the point of view of (1) the challenge of an objective, quantitative evaluation of subjective changes; (2) the issue of specificity of modes of treatment; (3) the difficulties of outcome predictions; (4) the remarkable opportunities for prevention of psychic disturbances in infancy; and (5) the relational nature of early disturbances.

Abstract: A family systems approach provides a context for the development and maintenance of dyadic attachment relationships. An attachment approach provides a focus on the expression of and response to attachment behavior within a family. Uniting the two approaches has implications for both research and intervention. Characteristics of attachment theory and family systems theory are briefly outlined: Both involve systemic thinking. Different styles of interacting at the level of the family as a whole, working models of relationships, and dyadic interactions appear to correspond in a coherent way. Further research is needed in order to identify which dimensions of family functioning are relevant to the development of secure attachments, and how the relevant dimensions may change with age and stage in the family life cycle. This will provide targets for preventive interventions, with the development of secure relationships as a primary goal.

Abstract: This comparative analysis of classic and recent literature explores the developmental and social implications of biracial identity in the U.S. Though specific attention was given to Black-White biracial persons, a broader analysis yielded some surprising insights into the nature and implications of the “biracial personality” and the accompanying differences in interpersonal styles and social relationships.

Abstract: Factors that may adversely affect parenting of low birth weight infants, including infant characteristics, parental emotional responses to premature birth, and patterns of parent-infant interaction, are reviewed. In addition, intervention studies designed to improve infant developmental outcomes through influencing parenting behaviors are examined. There was great diversity in theoretical frameworks, in timing of onset and frequency of interventions, and in measurement of outcomes. The interventions that were most effective in influencing behaviors and infant developmental outcomes were those in which there were multiple long-term contacts with parents and/or those that actively involved them in the intervention. The specific theoretical framework upon which the interventions were based appeared to be of less importance in influencing results. In order to increase our knowledge and ability to provide costeffective programs, there is a need to focus attention and data collection efforts on the process and intermediary steps of intervention as well as on outcome measures. There is also a need to improve our ability to recruit and retain those families who are most at risk for parenting and infant developmental problems including those with very low birth weight infants, those whose infants have serious perinatal complications, and those with indications of high social risk such as poverty-level incomes and problems of substance abuse.

Abstract: Our understanding of the etiology, pathophysiology, sequelae, incidence, and management of colic is hampered by the absence of a standard definition and accepted clinical criteria for colic. In this paper we distinguish colic from excessive crying and offer a set of criteria that can be used in clinical practice to determine if an infant has colic or excessive crying. We also discuss differences between colic and excessive crying from a developmental perspective, including biological and transactional components. We conclude that many components have long-term consequences for the parent-infant relationship, and we briefly consider some directions for colic management.

Abstract: At hospital discharge of their infant from a newborn intensive care unit, 50 mothers and fathers were interviewed and completed questionnaires. There were significant within-couple correlations for appraisals of the harm that ensued from this crisis, perceptions of personal control over the infant's recovery, and expectations about the infant's future health and development. Mothers perceived more personal control, mobilized more social support, and used more escapist coping strategies than did fathers. Mothers and fathers exhibited different patterns of relations between their own coping strategies and emotional well-being. But, neither the coping strategies used by one's spouse nor differences between spouses in the use of individual coping strategies correlated with emotional well-being. Analysis of parents' perceived differences between their own and their partner's coping strategies suggested the possibility of mutually helpful, complementary strategies of coping with this problem.

Abstract: Family narratives provide a window for viewing aspects of past and present family relationships. There appear to be meaningful variations among families with respect to their narrative recounting of family events. This paper describes results of a pilot study designed to elicit family narratives using a structured, multigenerational family interview with parental couples. A structured, multigenerational family interview seems to have clinical utility. The paper will suggest directions for further empirical research using the family genogram interview.

Abstract: Teenage parenting was investigated in different ethnic groups (Cuban and American Black), family constellations (single-parent, nuclear, and extended families), and primary caregiving arrangements (mother versus other). One hundred sixty-four infants born to a representative sample of teenage mothers were observed during interactions with their mothers and were given developmental assessments when they were 12, 18, and 24 months of age. Being a Cuban mother, living in a nuclear family, and being a secondary caregiver were each associated independently with stronger social support systems and more positive child-rearing attitudes and mother-infant play interactions. Despite these early advantages, maternal stimulation and infant performance decreased over the second year of life irrespective of ethnic group, family constellation, and caregiving arrangements.

Abstract: A brief summary of research, supportive of the idea that quality of parent-infant interaction has a powerful effect on infant development, introduces an early intervention model based on that proposition Also, central to the interaction model is the knowledge that (1) parent and infant both contribute to what happens between them and that (2) a multitude of factors, environmental and internal to parent and infant, affect the parent, the infant, and their interaction Ten sets of principles and strategies that convey the essence of the interaction model constitute the core of this article The principles and strategies address the importance of identifying sources of support and stress in the family, of developing relationships with both parents, and of supporting positive interactions between parents and the infant's siblings The limitations of this model are also addressed, especially in cases where the parent is the primary risk factor The infant's exposure to nurturing adults in quality day care programs and a more clinical approach with the parent and infant, such as Selma Fraiberg's model, may be more effective with such families

Abstract: Children in foster placement are often considered clinically in terms of the issues that led to their being separated from their families Placement has been recognized as a powerful intervention in the lives of children and families, with ramifications of its own extending through time Despite the movement towards permanency planning, children continue to be exposed to periods of uncertainty, ambivalence, and ambiguity about the resolution of placement This uncertainty, along with the intrinsic transience and marginal identity connected with the role of “foster child”, reduces the child's sense of stability, attachment, and predictability Children in foster care often feel powerless, and may resort to disruptive behavior in an attempt to influence decisions about their future Other responses include depression, withdrawal, and passivity Future anxiety is a system issue, which needs to be addressed by the adult caregivers in the child's life The reality is that children in foster placement often face chronic loss, and caregivers may resist sharing in the child's experience This dynamic makes the development of a support system to help the caregiver manage feelings about the child and his or her role in the child's life a necessity Four case examples are discussed, illustrating interventions in working with issues of future anxiety

Abstract: “Colic” is an ill-defined but common complaint typically thought to be a sign of an underlying disease process or a clinical entity distinct from the crying that characterizes normal infants. In this paper, an alternative hypothesis is suggested. The general argument is that colic represents the upper end of the spectrum of the crying activity of normal infants. However, it is not the case that all aspects of crying will be increased; rather, that the “excessive” crying in colic is due specifically to prolonged bouts of otherwise normal crying. The results of three studies in normal infants are presented to support this argument. Together, the results support the concept that the crying typical of normal infants reflects a biological predisposition to cry, which is nevertheless affected by sufficiently large changes in the caretaking environment, and that these caretaking changes preferentially affect bout length. If so, then the key to “colic” may be in understanding how biology and behavior interact to produce, not just crying, but prolonged crying bouts.

Abstract: This paper presents the thesis that cultural sensitivity is a special form of interpersonal sensitivity and an indispensable ingredient in successful intervention with members of other cultures. Examples from clinical work, attachment research, case management and professional consultation are provided to illustrate the different settings where this approach can be applied.

Abstract: Families who adopt special needs children require substantial preparation and support, due to their increased risk of adoption difficulties and disruption. Studies of special needs adoptive families indicate that large proportions of parents are dissatisfied with the preparation they receive. Present forms of preparatory and supportive services by adoption agencies are reviewed, followed by descriptions of needed additions to and reemphasis in adoption services. These enhancements, such as more child-specific information, identification of problem areas, behavioral training, information on the impact of sexual abuse, identification of community resources, and availability of services over the life of the family, will help to better recruit and serve adoptive families.

Abstract: The irritable crying that occurs in a cyclic fashion at the end of each day in 80% of infants between 3 and 12 weeks can be stressful for caring parents. In their efforts to alleviate the crying, they may add extra and anxious stimulation to the baby's already overloaded CNS. We studied this process in an effort to understand this period as a normal part of the 24-hour sleep-wake cycle of an immature nervous system. This period acts as a discharge phenomenon that helps to reorganize the overloaded CNS for the next 24 hours. Conveying my understanding to parents in the second or third week can act to prevent their anxious overreaction. Offering them support and a routine for extra carrying and soothing at this time can act as a prevention for “colic.” Colic or disordered crying in the small infant seems to be a psychosomatic disorder of parental anxiety added to the inevitable crying of a hypersensitive infant at the end of a period of coping with environmental stimuli.

Abstract: A growing body of literature indicates that families with adopted children seek mental health care for the adoptive and other family members more frequently and for different reasons than biologically-bound families. This paper addresses the struggles and corrective strategies for adoptive families at various levels of their development.

Abstract: The focus of this paper is to suggest an approach to cultural factors in intervention efforts with child maltreatment cases. General issues as well as issues specific to Black and Hispanic Americans are explored. Various risk factors commonly used to guide intervention efforts are examined from a cultural perspective. Recommendations are provided in four key practice areas; organizational and administrative adaptations, staff recruitment and training, research, and public relations.

Abstract: This article examines female delinquency as a symptom of the primary traumas of physical and sexual abuse and secondary traumas, when the environment responds with blame or disbelief. While social workers are increasingly aware that such a relationship often exists, we have yet to operationalize the relevant implications for assessment, practice, and policy in the juvenile justice system. It will be sugested that delinquency may be an act of disclosure and thus effective intervention entails alleviating primary and secondary trauma at the individual-community interface.

Abstract: Childhood depression as a component of the impact of childhood illness or developmental impairment on the latency age child is studied in relation to three diagnostic groups: children with asthma, cancer, and psychiatric diagnoses of behavioral disorders. The study revealed a range of coping styles to deal with the anxiety, loss and feelings induced by the specific crises. The special dimensions of stress and coping adaptations affected the child's developing self concept, the separation individuation process and the child-parent relationships. Depressive symptoms were variously present within and between the three groups of children.

Abstract: The prematurity stereotype is defined as a set of biased beliefs about infants who are identified as having been born prematurely. This article reviews studies that have explored how this prematurity stereotype may negatively influence adults' perceptions of, expectations for, and behavior toward premature infants. The findings from these studies are considered in the context of more general knowledge about how expectations can influence behavior and result in self-fulfilling prophecies. Recent research designed to investigate how prematurity stereotyping can be reduced also is described and evaluated. Finally, the implications of this program of research for intervention with parents of premature infants and suggestions for future research directions are discussed.

Abstract: In this longitudinal study of mothers, their families, and their infants, both discriminant and regression analyses showed that prenatal reports of family dynamics predicted infant disposition at 8 months with considerable accuracy. The most important predictive component was organization and consistency within the family unit as well as the dependability of other family members. Possible mechanisms by which family dynamics might affect the infant's developing disposition are discussed.

Abstract: Migrant parents who are unable to complete the separation process from their country of origin may do so through their relationships with their young children. Two patterns of distorted early childhood development were identified: failure to integrate cognition with feeling, and serving as a cultural bridge at the expense of reality testing and individuation.

Abstract: Examples are given of research on (a) stressful procedures and assessments in the neonatal intensive care nursery and (b) natural caregiving stimulation and self-comforting behaviors that alleviate these stressful experiences. The data from the studies on stressful procedures and assessments revealed that (a) weaning from mechanical ventilation was associated with increased plasma cortisol levels; (b) heelsticks and tube insertions for gavage feedings were accompanied by decreases in oxygen tension (TcPO2); and (c) Brazelton neonatal behavior assessments were followed by increased cortisol levels and decreased growth hormone levels. To alleviate stress, various interventions were tried including caregiver comforting techniques and giving the neonates opportunities to comfort themselves by sucking on pacifiers. The caregiver intervention studies revealed that (a) a simple placement of hands on the head and abdomen of the NICU neonate resulted in a lesser need for oxygen and (b) massaging the NICU neonate resulted in greater weight gain and earlier discharge. In those studies that explored the infant's self-comforting, nonnutritive sucking behavior, the following results emerged: (a) sucking on pacifiers during heelsticks resulted in less crying and lower heart rate and respiration and (b) sucking on pacifiers during tube feedings resulted in smoother bottle feedings later and in greater weight gain. Thus, it appears that several forms of cost-effective interventions can alleviate these stressful procedures and facilitate infant growth and development.

Abstract: This article presents the theoretical basis, clinical model, and case illustrations of the Family Administered Neonatal Activities (FANA), a specialized application of the Neonatal Behavioral Assessment Scale (Brazelton, 1973), in which parents are guided in eliciting behaviors from their infant within the context of a specific clinical protocol that integrates the practices of short-term, psychotherapeutic interviewing with principles of an empowerment model. The protocol is designed to elicit from parents their initial perceptions of their newborn and then to use the behavior of the baby as the vehicle through which parents can affirm or challenge their initial perceptions. Case examples illustrate the use of the FANA for three purposes: family support, intervention, and assessment.

Abstract: In the present study, the effects of developmental intervention and parent-infant interaction intervention on the social competence and emotional development of preterm infants were assessed. The results suggest that early home intervention focused on the infant's development facilitates social competence and adaptation, whereas intervention focused on the parent-infant interaction resulted in greater emotional security on the part of the infant. Social competence during the second year of life was predicted by social competence at 8 months and emotional security at 12 and 16 months. These findings have implications for early identification of infants at risk of later socio-emotional difficulties and intervention with dysfunctional mother-infant dyads.

Abstract: The study reported in this paper investigated how an adolescent father's relationship with his family of origin affects his relationship with his own child. The dependent variable was parental behavior. The adolescent father's perceived role conceptions of his parents and his feeling and attitudes toward his family were the independent variables. The study included a non-random sample of 43 African-American unwed adolescent fathers. The findings of the study indicated a father's parental behavior was influenced by his perceived role conceptions of his mother and his feelings and attitudes toward his family of origin.