8^th World Congress
Amsterdam, The Netherlands
Short Abstracts - Day 3, Thursday

#216

MATERNAL TOUCH AND TOUCH THERAPY.

Goldstein-Ferber, S., Kohelet, D., Kuint J., Feldman R., Dollberg S., Arbel E., Weller A. Sackler School of Medicine, Tel Aviv University, ISRAEL.  ferbers@post.tau.ac.il 

The objectives of these studies were to examine maternal demonstration of massage therapy compared to trained professionals unrelated to the infant. 112 mothers and preterm infants were included in two studies (study 1, n=57; study 2, n=55) and assigned to three groups using a random cluster design: one in which the mothers performed the massages for their infants, one in which trained professionals utilized this intervention and one control group. Touch Therapy was adopted from Field et al.(1986). The infants were weighted daily. Calorie intake was calculated by research assistants blind to group allocation (study1).The Trait-State Anxiety Scale and Beck’s depression inventory were filled in by the mothers at the onset of study and one day following the 10 days of the entire treatment. Mother infant interaction was examined at 3 months of age (corrected) and analyzed by factors introduced by Mayes et al. 1997.(study 2).The infants in both treatment groups gained significantly more weight compared to controls. There were no significant differences in calorie intake (study1). Mothers that massaged their infants decreased their trait anxiety more in comparison to the other two groups. Mothers in both treatment groups diagnosed as suffering from mild depression decreased their depression significantly compared to controls. Treated infants scored significantly higher at three months (study 2).

#362

THE INTERGENERATIONAL TRANSMISSION OF TRAUMA: EXPLORATIONS AND INTERVENTIONS.

Coates, S., Schechter, D.S., First, E., Anzieu-Premmereur, C., Fonagy, P., Target, M. Columbia University Parent-Infant Program, New York, NY  10032 USA. swcoates@mindspring.com

Many mediating factors for intergenerational transmission of trauma have been proposed: Parental dissociation, maternal frightening-frightened behavior, intergenerational transmission of attachment patterns, the communication of unconscious fantasy, projective identification.  This panel will explore applicability of these concepts, and demonstrate the utility of Fonagy and Target’s notion of reflective functioning in designing interventions.  Susan Coates’ introduction uses material from a childhood GID case.  Daniel Schechter presents original research on inner-city mothers who have a history of violent trauma exposure and their children (age 8-50 months).  Elsa First and Christine Anzieu-Premmereur will discuss mother/infant psychotherapy cases in which the child evidently held the mother’s trauma in mind.  Peter Fonagy and Mary Target will discuss.

#363

INTERGENERATIONAL LOSS IN A CASE OF EARLY CHILDHOOD G.I.D.

Coates, S.Columbia University Parent-Infant Program, New York, NY 10032 10032 swcoates@mindspring.com.

A case of a three-year old boy with an anxious insecure attachment will be discussed whose presenting symptoms were separation anxiety, a persistent wish to be a girl, and a fear of girls with angry eyes.  The onset of the symptoms occurred in the context of the loss of a girl that precipitated a maternal depression.  Exploration of family dynamics revealed intergenerational issues of loss of girls in three generations, and attempts at reparations that played a role in both the onset and perpetuation of the child’s symptoms. The child’s need to repair the mother’s depression and the derailed attachment relationship also played a significant role.  The need for combined child and family therapy will be addressed.

#364

MATERNAL VIOLENT TRAUMA HISTORY, MENTAL STATES, AND PERCEPTION.

Schechter, D.S., Columbia University Parent-Infant Program, New York, NY 10032, USA. swcoates@mindspring.com.

This study examined the relationship between maternal history of childhood violent trauma, and mother’s perception of her child.  Subjects are 40 inner-city mothers and their children (ages 8-50 mos.), who presented to a clinic treating families with physical and/or sexual abuse and/or domestic violence exposure. Over 2-3 videotaped sessions, mothers were assessed for violent trauma history, psychopathology, reflective functioning (RF), and perception of the child. Change of maternal perception after a video feedback session was then rated.

Preliminary results regarding RF suggest that, while the degree of RF shows no relationship to severity of violent traumatic experience, RF is inversely correlated with severity of maternal depression and posttraumatic stress.  RF is furthermore inversely correlated with the degree of maternal negativity and distortion of perception of the child and is positively correlated with change after feedback.  RF may be a protective factor for trauma transmission.

#365

TRANSMISSION OF MATERNAL TRAUMA IN AN INCONSOLABLY SCREAMING TODDLER. 

First, E. Columbia University Parent-Infant Program, New York, NY 10032. USA swcoates@mindspring.com.

A 16month-old girl twin (with a twin brother) was evaluated for a  persistent sleep disturbance involving severe episodes of inconsolable night screaming.  The mother, who was still nursing her, felt compelled to hold the toddler tightly at the breast while standing for hours in a state of  exhaustion, unable to protect herself by handing the child to the co-parent, her partner in a lesbian marriage.  Mother believed her daughter was being attacked by undiagnosed pains, possibly caused by injury in utero from the twin brother. Mother evidently dissociated during these screaming episodes ,which became linked in psychotherapy with recent and childhood medical trauma in the mother’s life and a childhood chronic trauma of threats of violence from a brother . Material suggested that in these episodes mother experienced the girl toddler as her unprotected child self, and as expressing an inconsolable suicidality. The sleep disorder and screaming remitted within 6 weeks of parent/infant psychotherapy as mother became able to think of daughter in a more differentiated way.

#366

ATTACHMENT DISORDERS IN THREE FEMALE GENERATIONS.

Anzieu-Premmereur, C. Columbia University Parent-Infant Program, New York, NY 10032 USA. Swcoates@mindspring.com.

A four-year-old girl ran away from her mother, thus placing herself in dangerous situations. The grandmother had predicted to this daughter that she would be unable to raise a child, and conveyed that she would be a toxic mother. During psychotherapy, mother discovered that her daughter had been enacting the grandmother’s preoccupation with abandonment.  The repetition through four female generations of the fear of being abandoned and the loss of their sense of continuity had created an insecure attachment between mother and daughter. The child was avoidant, the mother, preoccupied-dependent, the great grandmother and the grandmother, dismissing. The young mother, unable to keep a bond between herself and her children, had abandoned them during a postpartum depression, after having been merged with the infant. These attachment disorders were the cause of narcissistic pathology through generations.

#222

            Abstract not available

#223

REFLECTIVE FUNCTIONING IN THE PARALLEL NARRATIVES OF SEXUALLY ABUSED CHILDREN AND THEIR MOTHERS. 

Target, M., Ensink, K., Normandin, L. and Fonagy, P. Subdept of Clinical Health Psychology, University College London, Gower St., London WC1E 6BT, UK, and Ecole de Psychologie, Université Laval, Quebec, QC, Canada. m.target@ucl.ac.uk. 

This contribution will present the results of a study of fifty 8-11 year old children. Half of the children had been sexually abused some years earlier, and the interviews to be reported were part of a follow-up assessment of their mental health in middle childhood. Within this group, about half of the mothers had also been abused when children. The children were assessed using the Child Attachment Interview (Target, Fonagy, Shmueli-Goetz, Datta and Schneider, 1998) a newly validated measure of parent-child attachment in 8-13 year olds. The mothers have been interviewed using the Parent Development Interview (Aber, Slade, et al., 1985). Both interview narratives will be scored for reflective function, and within each parent-child pair reflective function will be analyzed in the context of the child’s attachment to mother, and the mother's representations of the child.

#224

MATERNAL REFLECTIVE FUNCTIONING: ATTACHMENT AND CAREGIVING. 

Slade, A., Bernbach, E., Grienenberger, J., Levy, D.W., Locker, A. Yale Child Study Center, New Haven, CT 06520, USA, Arietta.Slade@Yale.edu. 

This research examined the links between child attachment security, adult attachment security and maternal reflective functioning.  Parent Development Interviews (Aber, Slade, Berger, Bresgi, & Kaplan, 1984) were administered to 46 mothers of 10 month olds, and were scored for reflective functioning. Results indicate that maternal reflective functioning is predicted by prenatal maternal attachment security; maternal RF is also strongly related to infant attachment security at 14 months. It was determined that RF mediates the link between adult and infant attachment security, suggesting that RF is critical to the intergenerational transmission of attachment representations from mother to baby. The latter half of this presentation will use these research findings to consider some of the ways clinicians may enhance parental reflective functioning in their direct work with parents, infants, and toddlers.

#225

REFLECTIVE FUNCTIONING AND MATERNAL REPRESENTATIONS IN NORMAL AND AT RISK PREGNANCIES.

Ammaniti M., Tambelli R., D’Isidori M., Odorisio F., Vismara L., Università “La Sapienza “ di Roma, Via dei Marsi 78, 00185 Roma, Italy. Massimo.ammaniti@uniroma1.it

The aim of this work is to analyze reflective-functioning (Fonagy & Target, 1995; Fonagy, Steele, Steele, Steele & Target, 1994) during pregnancy.

Thirty women have been enrolled within a longitudinal study whose  main objective is infantile maltreatment prevention. The women have been selected and assigned to three different groups according to psycho-social risk, depressive risk and absence of risk during the first months of pregnancy.

In the 7th-8th month of pregnancy the women were administered the IRMAG (Ammaniti, Tambelli et al., 1995) a semi-structured interview which assesses maternal representations as possible protective or risk factors that concur to predict a functional adaptation of the child in his/her relational context.

The narratives collected through the IRMAG have been coded using the Reflective-Functioning Scale; further a within and between group analysis has been conducted.

Results show lower reflective-functioning scores and less integrated maternal representations among women belonging  to the risk groups compared to the control group.

We may conclude that there is a correlation between the evaluation of reflective-functioning and that of maternal representations, both sensible indexes of the maternal functioning.

#227

RECENT DEVELOPMENTS AND CURRENT ISSUES IN ATTACHMENT-BASED INTERVENTIONS IN INFANCY.

Moran, G. and Pederson, D.R.  Department of Psychology, The University of Western Ontario, London, Ontario, CANADA  N6A 5C2  gmoran@uwo.ca 

Developmental theories agree that substantial disruptions in the first relationship between an infant and caregiver increase the likelihood of problems in social, cognitive, behavioural, and emotional domains. This symposium draws together research groups from the United States, The Netherlands, and Canada to present research directed at better understanding the mechanisms underlying success and failure of early relationship-based intervention programs.  The studies draw participants from a range of at-risk populations and each takes a distinct but complementary perspective on examining the basis of the effectiveness the interventions. It is vital that we be able to design intervention programs optimally matched to a particular mother-infant dyad to maximize the likelihood of success.   These four presentations each address this question by pursuing a more complete understanding of the actual social-developmental mechanisms of the formation of the first relationship.

#228

SENSITIVITY AND ATTACHMENT: HOME-BASED, SHORT-TERM INTERVENTION WITH INSECURE MOTHERS.

 Bakermans-Kranenburg, M., Juffer, F. & van IJzendoorn, M.H. Center for Child and Family Studies, Leiden University, P.O. Box 9555, NL-2300 RB Leiden, The Netherlands bakermans@fswrul.fsw.LeidenUniv.nl

In our study (N=79) we explore whether short-term interventions can break the intergenerational cycle of insecure attachment. First-time mothers who were classified as insecure with the Adult Attachment Interview were provided two types of intervention during four home visits. The first program, Video Intervention to promote Positive Parenting (VIPP), aimed at enhancing maternal sensitive behavior through providing personal video feedback and brochures on sensitive responding in daily situations. The second intervention (VIPP-R, that is, VIPP combined with representational efforts) included additional discussions about past and present attachment, aiming at affecting the mother’s mental representation of attachment. In a subsample (N=30) the interventions resulted in more sensitivity in mothers, but did not affect infant security (Bakermans-Kranenburg, Juffer & Van IJzendoorn, 1998). We now report on findings in the total sample.

#229

A HISTORY OF ABUSE AND MATERNAL UNRESOLVED ATTACHMENT STATUS INTERFERES WITH INTERACTION-BASED INTERVENTIONS.

Moran, G., Pederson, D.R., Krupka, A., and Bailey, H.N.  Department of Psychology, The University of Western Ontario, London, Ontario, CANADA  N6A 5C2  gmoran@uwo.ca. 

Attachment-based interventions focused on the interactions in the first year of life have proven to be effective at increasing maternal sensitivity and promoting secure attachment, however, many fail to benefit from such interventions. This presentation reports on a study of 99 adolescent mothers observed at 6, 12, and 24 months infant-age,  49 of whom were involved in an attachment-based intervention program between 6- and 12-months. Maternal sensitivity was higher and the quality of the attachment relationships were more likely to be Secure in the Intervention group.  However, 41% of the Intervention group developed non-Secure attachment relationships and sensitivity declined in 26%. Mothers classified as Unresolved with respect to abuse in the Adult Attachment Interview were almost certain not to benefit from intervention.  The possible mechanism of this interference of Unresolved state of mind with intervention is discussed with particular reference to Post Traumatic Stress Disorder symptoms and emotional functioning in interaction with the infant.

#230

REDUCING ATYPICAL CAREGIVER BEHAVIOR USING MODIFIED INTERACTION GUIDANCE.

Madigan, S. and Benoit, D., Department of Psychiatry, Hospital for Sick Children, 555 University Avenue, Toronto, Ontario, CANADA M5G 1X8 smadigan@uwo.ca.

Disorganized attachment is a powerful predictor of children’s emotional and behavioral problems. No interventions have yet been directed at eliminating atypical caregiver behavior, documented as a precursor of disorganized attachment. Atypical behavior is associated with disorganized but not with avoidant or resistant attachment; conversely, caregiver insensitivity is associated with avoidant or resistant but not disorganized attachment. The AMBIANCE (Atypical Maternal Behavior Instrument for Assessment and Classification) was used to assess the behavior of 13 mothers of 18month-old infants referred for feeding problems. A 5-session Modified Interaction Guidance successfully reduced atypical behaviors, whereas a more traditional parent training program did not. An examination of change in atypical behavior across the 5-sessions in successful cases (73%) revealed a marked drop in the early stages of treatment, maintained throughout the intervention and at follow-up. Unresolved attachment classification in the caregiver was independent of treatment outcome.

#231

THE ROLE OF PARTNER SUPPORT IN RELATIONSHIP-BASED INTERVENTION WITH AT-RISK FAMILIES.

Heinicke, C. M. UCLA, Child Psychiatry Division, Rm 68-237, NPI, 760 Westwood Plaza, Los Angeles, CA  90024.  USA. cheinicke@mednet.ucla.edu.

An outline of a family systems perspective to relationship-based interventions is presented, which focuses on the role of partner support in the changes in the parent-child relationship and the child’s development reported by two projects intervening with at-risk families:  The Nurse Home Visitor Program and the UCLA Family Development Project.  Heinicke et al. (2001) report parallel changes in the first two years of the intervention in the quality of partner support, mother responsiveness to the needs of her child, and that child’s attachment security.  Olds et al. (2000) found less abuse of the children and various indications of better maternal adaptation such as longer intervals between the birth of the first and second child and a lower rate of adolescent anti-social behavior.  Emphasizing the role of positive partner support, these intervention effects were not found in the presence of domestic violence.

#232

IMPROVING THE STABILITY AND RESPONSIVENESS OF CAREGIVING IN RUSSIAN BABY HOMES. 

McCall, R. B., Nikoforova, N., Groark, C. J., Palmov, O., Muhamedrahimov, R., Osofsky, J. D., Chisholm MacLean, K., University of Pittsburgh, Office of Child Development, Pittsburgh, PA.  mccall2@pitt.edu.

This symposium reports on a unique Russian-US collaborative project to improve the stability and social responsiveness of caregivers in the Baby Homes for children with and without disabilities birth   to 4-5 years in St. Petersburg, Russia. Most other aspects of care in the Baby Homes (e.g., medical, nutritional, caregiver hours, toys and equipment) are adequate. In a quasi-experimental design, both staffing changes and caregiver behavioral training will be implemented in one Baby Home, only the training in a second, and neither intervention in the third. Children and caregivers will be compre-hensively assessed in the Baby Home for up to five years, and parents who adopt children to the USA will be surveyed annually. The project is unusual because the effects of stability and responsiveness are isolated to a greater extent than in other studies, and it is one of the largest follow-up studies of children adopted to the United States from foreign orphanages in which their early environments are well known. Two discussants will put the project into a broader conceptual and practical context.

#233

THE SCIENTIFIC DESIGN, MEASUREMENTS AND EARLY RESULTS OF THE RUSSIAN BABY HOME PROJECT.

McCall, R. B. & Muhamedrahimov, R. J., University of Pittsburgh Office of Child Development, Pittsburgh, PA, USA.  mccall2@pitt.edu.

Both the staffing and training interventions are provided to one Baby Home, only the training to a second, and neither to a third (Ns at any one time=80-120 each). Caregivers are assessed with the HOME Scale to verify the effectiveness of the training intervention, and Baby Home records are used to verify increases in caregiver stability. Questionnaires are administered periodically to caregivers that assess the caregivers’ satisfaction with work, attitudes toward children and caregiving, anxiety and depression, perception of emotions in children, attitudes toward their own childhood and parents, personal values and goals, and training and experience. Children are measured periodically for medical condition; functional abilities; and physical, mental/developmental, and social-emotional development. USA parents adopting children from these Homes both before and after the interventions are assessed annually with a questionnaire that covers parent-child attachment, child development and behavior problems, and family functioning. Results demonstrated the two interventions produced the desired changes, and preliminary results on the effects of the interventions on children may be available by July 2002.

#234

THEORETICAL, HUMANITARIAN, AND PRACTICAL RATIONALE FOR THE RUSSIAN BABY HOME PROJECT.

Groark, C. J., University of Pittsburgh Office of Child Development, Pittsburgh, Pennsylvania, USA.  cgroark@pitt.edu.

Theoretically, two components of the early experience of infants and young children thought to be essential for adequate mental, social, emotional, and physical development of children with or without disabilities are 1) a stable, consistent, and small set of caretakers over a prolonged period of time, and   2) caregivers who provide socially-responsive, developmentally-appropriate caregiving behaviors and interactions with the children. The Baby Homes of St. Petersburg tend to be adequate on all important aspects of early care, except these two. Therefore, this project provides two interventions, one to increase the stability of caregivers and the other to train and promote responsive caregiving, in an attempt to more closely isolate the effects of these two aspects of early caregiving for physical, mental, and social-emotional development. The project attempts to implement these changes in ways that can   be maintained after the project is finished and transferred to other orphanages. Further, the same needs for stable caregivers and adequate training of caregivers of infants and young children exist in many countries, including the USA, especially with respect to home child care and foster care.

#235

THE TRAINING AND STAFFING INTERVENTIONS IN THE RUSSIAN BABY HOME PROJECT.

Groark, C. J., & Palmov, O. I., University of Pittsburgh Office of Child Development, Pittsburgh, PA, USA. cgroark@pitt.edu.

The training intervention promotes socially-responsive and interactive caregiving for young children with and without disabilities. Training covers every aspect of development and care to illustrate how socially responsive caregiving can be implemented throughout the day. A train-the-trainer approach is used in which the professionals of the Baby Home are trained by an experienced American trainer for three weeks. These professionals train caregivers in 12 areas for approximately 60-72 hours plus supervise implementation on the wards. The purpose of the staffing intervention is to promote infant/child-caregiver relationships by reducing the number of different caregivers serving individual children, increasing the number of consecutive days and the amount of time specific caregivers spend with individual children, and structuring the physical environment to promote contact with these caregivers. The intervention changed some caregivers from part-time to 5 days a week for 7-12 hours day so that children saw one of two of these two primary caregivers for 7-12 hours a day, 7 days a week, thus providing substantially fewer and more consistently available caregivers.

#236

THE CHILDREN AND CAREGIVERS IN RUSSIAN BABY HOMES.

Nikoforova, N. V., Baby Home #13, St. Petersburg, Russia.  babyhome13@mail.rcom.ru.

In 1993, there were 253 Baby Homes in Russia with an enrollment of approximately 17,700 children from birth to 3-4 years of age. Baby homes are the largest system of care for children with frank disabilities, for children from social risk environments, and increasingly for children whose parents lack financial resources. In St. Petersburg, most children arrive at the Baby Homes between 2 and 8 months of age, and approximately 40% have diagnosed disabilities. The Baby Homes are operated by the Ministry of Health; so they emphasize health-related aspects of care rather than the social-emotional development or early education of the children. Caregivers in the orphanages have little or no training, and the job is low paying and low status, making hiring difficult and turnover substantial. Caregivers tend to work part-time, and they get 56 days of vacation per year. Moreover, children are moved from one group of caregivers to another every 6 or 12 months. So, a child may have 60-100 different caregivers in the first two years of life, and no caregiver today who was there yesterday. Also, caregiving is performed in a business-like, efficient manner, emphasizing custodial care rather than reciprocal adult-child interactions and mutuality.

#238

VERY EARLY SCREENING OF AUTISM.

C. Bursztejn, J. Buitelaar

There is a consensus among clinicians that early treatment might improve the prognosis in autistic disorders. Several researches have been undertaken to identify very early signs that might be used by nurses and pediatricians to screen infant and toddlers at risk for autism.

The conceptual background, methodology and first results of these studies will be presented and discussed.

#239

EVALUATION OF THE INTEREST TO IDENTIFY VERY EARLY OBSERVABLE SIGNS THAT COULD BE INDICATIVE OF RISK OF AUTISTIC DISORDERS. 

M.C. Laznik, L. Benhabib

In a first time, the paediatricians receive, during tree days, a formation in order to aloud them to be sensitive and able to explore a particular form of communication between the baby and his counterpart. The research turns around the ability of the baby to organise with his mother wath we call "a drive" relation, with a special interest on the gaze as a drive and on the oral drive, both implying the relation with the Other. The babies will be observed at the age of 4, 9 and 18 month, in the context of systematic paediatric examinations. The value of the alert signs will be ascertain by comparison with the C.H.A.T. at 18 month.

#240

ATTENTIONAL SKILLS DURING THE FIRST 6 MONTHS OF AGE IN AUTISM SPECTRUM DISORDER.

F.Muratori, S Maestro, MC Cavallaro

Attentional skills are essential for social and communicative development. The main aim of this study is to identify the quality of early attention in autistic spectrum disorders (ASD) through home movies. 15 home movies, regarding the first six months of life of ASD children, are compared with home movies of 15 normal children. The films of the two groups have been mixed and rated by blind observers through a Grid for the Assessment of Attentional Skills in Infants, composed of 13 items grouped into three developmental areas. Significant differences between the two groups are found for the items in the Social Attention and in the Social Behaviour areas; on the contrary there were no differences in Non-Social Attention. We pose some hypotheses about a specific early-appearing impairment of attention in ASD where children shift their spontaneous attention mainly toward non-social stimuli rather than toward social stimuli. The importance of this finding for early diagnosis and treatment is underlined.

#241

SYSTEMATIC EVALUATION OF INDEXES OF EARLY SOCIAL COMMUNICATION BETWEEN 9 AND 24 MONTH. A POPULATION STUDY.

C.Bursztejn, A. Danion-Grilliat. B. Golse, Hôpitaux Universitaires de Strasbourg - 67000 France

The aim of this study is to identify easily observable signs indicative of risk of autistic disorder. In a large multicentric study, a questionnaire exploring various aspects of early social communication development is currently applied to children aged 9 to 24 month, in the context of systematic pediatric examinations. The value of the alert signs will be ascertain by the population follow up

#242

INFUSING DEVELOPMENTALLY BASED, INTERDISCIPLINARY PERSPECTIVES INTO INFANT MENTAL HEALTH TRAINING & PRACTICE.

Finello, K. M. & Poulsen, M. K. California School of Professional Psychology @ Alliant International Univ., 1000 So. Fremont Ave, Unit 5, Alhambra, CA 91803. kfinello@earthlink.net

This workshop will focus on the critical importance of incorporating developmental and neurobehavioral issues into both pre-service and in-service training for IMH practitioners.  Rigid program structures due to licensure and third party payment restrictions have led to a training conundrum of how to fully integrate comprehensive developmental knowledge, along with necessary interdisciplinary perspectives into pre-service programs training individuals will become “licensed” mental health practitioners. Similar in-service issues exist around re-training needs of mental health practitioners who are interested in providing infant mental health services.  Case examples demonstrating the critical role of developmentally based perspectives in the diagnostic and treatment process will be discussed.  Suggestions will be provided for pre-service and in-service training and for internship and supervision experiences.

#243

ADDRESSING RESEARCH CHALLENGES: STRATEGIES in TRAINING HOME VISITORS.

Culp, A., Eberhart-Wright, A., Griffin, A. & Culp, R.  Dept of Human Development, College of Human Environmental Sciences, Univ. of Alabama, Tuscaloosa, AL 35487-0158  USA   aculp@ches.ua.edu.

When expected outcomes surrounding parent interaction behaviors with their infants are not as strong as predicted, researchers feel challenged to explain why.  Data is presented on two sets of variables at 12 months between intervention and control group outcomes: 1) language behavior (significantly different) and play interactions (nonsignificantly different).  One way to address this challenge is to look at the training of the home visitors, child care workers, and parent educators in the domain of mother infant interaction.  To expect home visitors and child care workers to know how to teach mothers to be "available to their infant", to "respond appropriately and sensitively" requires extensive training.  This workshop will demonstrate a training program that has evolved over ten years by skilled infant clinicians who are using it in the training of childcare workers in Head Start.  One of the five goals is to train home visitors, childcare workers and parents to recognize teachable moments and to experience the joy and the impact of furthering a child's progress through responsiveness that builds new skills. A key tool is the use of a camcorder to capture, reinforce and build on every positive behavior.

#244

DEFINITION AND CLASSIFICATION OF FEEDING DISORDERS: A  PLEA FOR CONSENSUS.

Ramsay, M. The Montreal Children’s Hospital, 2300 Tupper Street, Montreal, Quebec, H3H 1P3, CANADA Maria.Ramsay@mcgill.ca. Lindberg, L. Karolinska Institutet, Stockholm, SWEDEN

There is a universal agreement about infant feeding being a source of satisfaction and pleasure for both parent and infant. However, there is no universal agreement about what goes wrong when the act of ingesting food by the infant becomes a problem. The absence of agreement as to the cause of poor or no ingestion of food by the infants resulted in several different definitions and classification systems over the last decade or so. The intention is to provide a forum for practitioners and researchers where discussions may lead to some consensus and continued work toward an integrated classification system for feeding disorders in order to enhance early detection and promote intervention.

#245

MATERNAL BACKGROUND AND NEONATAL HEALTH IN CHILDREN SUBSEQUENTLY TAKEN INTO CARE.

Kalland, M., Sinkkonen, J., Meriläinen, J., Siimes M.A. Save the Children, PB177 Lapinrinne 2  00181 Finland. mirjam.kalland@pela.fi

This cohort-based retrospective study observed health at birth among children subsequently placed in foster care, to investigate if the relation between medical and social risk may already be observed at the time of birth. The 3 419 children in the study had more neonatal health problems than the population-based controls. The proportion of teen-age mothers was about four times higher and the proportion of single women was twice as high. The odds ratios for subsequent foster care of the child were 8.2 for women that smoked during pregnancy and 5.8 for single mothers. Our findings indicate that social and medical risks are already related in the neonatal period and that foetal neglect may predict subsequent child neglect. The mothers used the maternal welfare clinics during the pregnancy, which provides possibilities for early intervention.

#246

CHILDREN IN POVERTY: USING INFANT MENTAL HEALTH PRINCIPLES TO PROMOTE POSITIVE INTERACTIONS BETWEEN PARENTS AND THEIR CHILDREN. 

Tittnich, E., and Herman V.  Early Head Start, University of Pittsburgh, Pittsburgh, PA 15206 etheltn@pitt.edu.

This video documentation of family work shows changes in a parent’s interactions with an infant after two years in a home-visiting program.  The parent became more sensitive and responsive to the infant’s cues.  This case will illustrate how staff use their relationship with parents to support parent relationships with their children.  The video shows the parent with two of her infants when each is four months of age.  With the first infant the parent seems to treat the baby more as an object, even laying a large inflatable rattle over the infant’s forehead, seemingly unaware she had done so.  This contrasts with the second infant interactions in which the mother is more personable with the infant and elicits vocalizations and responds to infant signals in a positive manner.  The discussion will focus on ways the home-visitor interacted with the mother to help her become more sensitive to her children’s needs.  It will illustrate principles of infant mental health to support a dyadic relationship in a family support model.  It will also focus on the effects of poverty on parent-infant relationships and ways the program deals with these issues.

#247

A CASE STUDY OF TEMPERAMENT AND CONTEXT: AFFECT REULATION PROCESSES OF AN INHIBITED GIRL. 

Appelman, E.  20 Sderot Chen, TelAviv 64166, Israel.  eappelma@caregroup.harvard.edu. 

The temperamental trait of inhibition offers a setting for examining the characteristics of the interplay between intraindividual factors and environmental influences.  This presentation portrays the mechanisms and consequences of this dynamic two-way interchange by examining the processes in which both the individual and the environment are constantly changing and effecting changes in each other.  The possibility of ameliorating shy behavior is inherently intricate and more revealing of the dynamic processes of the nature-nurture interplay.  The portrait presents a unique case of a very inhibited girl, age 3, who, during the co-construction of narratives, gradually shifts from a frozen, fearful and extremely inhibited stance into spontaneous, active behavior.  The major hypothesis is that while the underlying biology of inhibition may remain unchanged, the environmental input creates a possibility for change in both the interpersonal and the interpersonal aspects of behavior.  The concept of emotional apprenticeship, similar to cognitive and social apprenticeship, is instrumental in understanding the processes that facilitate the gradual change in the child’s ability to regulate her affect.  It is argued that during a successful emotional apprenticeship, child and caregiver become jointly attuned to the same aspects of the emotional experience and can thus create a “zone of proximal development” for increasingly charged affective exchanges.  With the adult's careful scaffolding of gradually more complex affective experiences, the dyad's interactions shift the level of emotional difficulty, 'stretching' the child's ability to regulate affect. The stress-buffer function of the adults is also explored.

#252

REVIEWED EXPERIENCE OF TEN YEARS OF PARENT-INFANT PSYCHIATRIC CLINIC.

Le Nestour, A., Danon, G., Bydlowski, M., Rosenblum, O., Squires, C., Heroux, C., Patouillot, I., Laboratoire de Psychopathologie Périnatale, 89 rue d'Assas, 75006 Paris, France. L'Aubier, Centre du Tout Petit, Erasme Hospital. Gisdanap@aol.com.

L'Aubier, a specialized community based parent-infant psychiatric clinic, has worked steadily over the past ten years with a variety of families and in concentration with numerous community based institutions (day-care, community based medical centers, foster family facilities, etc.) and surrounding hospitals (maternity and pediatric wards). Over the years, a population of an average of 200 families has been managed and treated by the clinic's team. Only criteria for receiving care by the clinic was the presence in the family of an infant less than 24 months of age. We emphasize the steady increase of the decrease in age of the infants referred. Infants less than 6 months are now commonly referred and there has been a progressive number of pregnant women referred for future mother-infant care (20% increase each year for the past 5 years). Is this due to an earlier assessment of parental psychopathology by practitioners? Is there an increase in pathology? We discuss it on video presentation.

#253

BABIES AND PARENTS IN A MULTICULTURAL CONTEXT. BUILDING A THERAPEUTIC ALLIANCE.

Moro M.R., Baubet T., Paris 13-University, Avicenne Hospital, Service de psychopathologie de l’enfant, 125, rue de stalingrad 93009 Bobigny cedex, France, marie-rose.moro@avc.ap-hop-paris.fr

An infant on its own doesn’t exist. He/she only exists in the arms of his mother, parents or groups to which the infant belongs : nuclear and extended family, social groups, society. We have learned to recognize an infant’s cultural and social cradle. Later, researchers in intercultural psychology have highlighted the importance of cultural variations on the psychological structuring of infants. We can see now the importance of these observations in clinical work and research in the work with infants and their migrant families in our multicultural changing societies. We will study a research carried out by the Ecole de Bobigny (2001, Paris, France) which shows the importance in clinical work of formulating the cultural representations parents have of their infants in order to create a real therapeutic alliance and to allow the construction of harmonious triadic parent-infant-context interactions. In addition to known levels of interaction (behavioral, affective and phantasmic), it is important to describe the cultural level of interactions, which constitutes the framework of all transmission. We will show an example of therapeutic setting which takes in account the individual and cultural level. An infant clinical history will be analyzed from a multicultural suburb in Europe.

#254

CONSIDERATIONS ABOUT PARENTAL HYPER-CATHEXIS OR ITS WITHDRAWAL IN THE ACQUISITIONS OF PSYCHOTIC AND AUTISTIC CHILDREN UNDER TREATMENT.

Amorim, M.S.B., Correia, J.R.A, Lima, A.M.B., Melo, K.C., Nascimento, E.B., Queiroz, T.C.N. CEMPI -Rua Desembargador Martins Pereira, n. 204, Recife, PE CEP 52050-220, Brazil, ms.bemardes@bol.com.br

The goal of this article is to identify the possibilities of advances and acquisitions in psychotic and autistic children by means of parental discourse and attitudes, considering their libidinal cathexis.  Taking as reference hyper-cathexis/maternal presence and withdrawal of cathexis/maternal absence, the authors try to link parental cathexis, mourning, mourning of an imaginary child, guilt, guilt of ambivalence and death wish.  It is proposed that some kind of hypercathexis represents the cathexis of the imaginary but damaged child as a form of compromise between the impossible ideal and the withdrawal of cathexis from the reality child.  Also, autism, repetitions and phrases interrupted as if to be completed by the adult, as well as angelic bodies that never fall or, on the other hand, the lack of care and hygiene, skin injuries, persistent diarrhea, may be indicators of parental absence or presence imprisonment.  These considerations may be important if they elucidate the direction of the treatment.  Clinical cases i1lustrate these reflections.

#255

THE COMMUNICATIVE USE OF POINTING IN AUTISM: DEVELOPMENTAL AND CLINICAL FACTORS.

Camaioni, L, Muratori, F., Perucchini, P., Parrini, B. & Cesari, A. University of Rome. luigia.camaioni@uniroma1.it

The objective of this study was to examine the heterochrony in the emergence of imperative and declarative pointing, the parallel changes in cognitive and communicative skills, as well as in symptoms severity, and the different developmental profiles in five autistic children (initial age: 3;10-4;3). Testing conditions designed to elicit both production and comprehension of imperative and declarative pointing, were administered to each subject in five subsequent sessions (mean distance: 4,3 months). Concurrently with these sessions, children were evaluated in terms of their cognitive (Griffiths Scale), communicative (QSCL) and clinical (CARS) profiles. The five children examined showed heterochrony in the emergence of different communicative intentions, besides their communicative development seem to be affected both by mental age and by symptom severity. As far as CARS evaluations is concerned, a preliminary conclusion is that the autistic symptomatology may decrease across time, eventhough the rate of decrease varies in different children.

#257

PRELIMINARY FINDINGS OF A SOCIAL-PRAGMATIC, JOINT ATTENTION FOCUSED PARENT TRAINING INTERVENTION STUDY FOR PRE-SCHOOL CHILDREN WITH AUTISM.

Charman, T#., Drew, A. Baird, G., Baron-Cohen, S., Cox, A., Slonims, V., Wheelwright, S., & Swettenham, J.

Behavioural and Brain Sciences Unit, Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, UK. t.charman@ich.ucl.ac.uk

Preliminary findings from an early intervention study for pre-school children with autism are reported. The study contrasted a parent training programme with a home-based applied behavioral analysis programme and children in receipt of locally available services only. Assessments were conducted pre-intervention (24 months) and an interim follow-up was conducted 12 months later. Three main findings emerged: (i) The behavioral group had made greater gains in non-verbal mental age than the two other groups; (ii) The parent training group had made marginally greater gains on parent-report measures of language understanding and production than the two other groups combined, and the parent training and behavioral groups combined had more productive gestures at follow-up compared to the Local services group; and (iii) The behavioral group showed a greater increase in parental self-report of stress than the parent training and local services groups.

#258

THE EVALUATION OF CHILDREN WITH THE SYMPTOMS OF PERVASIVE DEVELOPMENTAL DISORDER (PDD) ACCORDING TO EARLY ADMISSION

Erden, G., Akçakin, M. Medical School of Ankara University, Child Psychiatry Department, Ankara, TURKEY.erdenmgul@yahoo.com

The objective of this study was to examine the development of children who were brought to Child Psychiatry Department some of them under 3 years old and some of them over 3 years old with the complaints of relationship disorders, lack of interests. All children were evaluated by a clinical psychologist using Autism Evaluation Form which is based on DSM IV criteria. The children under the age 3 were evaluated by the Diagnostic Critera 0-3. They were diagnosed as PDD. Furthermore AGTE, a developmental test developed for Turkish children was used to assess their general developmental level. After at least one year of treatment period these two group children were compared each other in terms of their initial symptoms. The result indicated that early diagnosis can be an important variable for symptoms reduction, and lowering the intensity of symptoms. Attending to special education regularly which is another variable of this study, seem to affect the treatment process of children with PDD. The results will be helpful to families and the professionals in the field.

#259

NEONATAL PREDICTORS OF PSYCHOPATHOLOGY, TEMPERAMENT AND COGNITIVE DEVELOPMENT AT AGE 6 YEARS.

Josepa Canals, Joan. D. Fernández-Ballart, Griselda Esparó, Edelmira Domènench. Department of Psychology, Rovira i Virgili University, Crta.Valls s/n, 43007 Tarragona (SPAIN). jcs@fcep.urv.es

The  purpose of this study was investigated early predictors of psychopathology, temperamental traits and cognitive development. Seventy-nine children participated from birth to six years old. They were assessed by the Neonatal Behavior Assessment Scale (NBAS) at three days and four weeks of age. At the same age, both mothers and fathers individually filled in the Neonatal Perception Inventory (NPI). Bayley Scales were administered at four and twelve months of age. At age 6, the WPPSI was administered and the Child Behavior Checklist (CBCL) and Dimensions of Temperament Survey-Revised (DOTS-R) were filled in by parents. The NBAS showed a significant association with several temperamental and psychopathological traits at age 6 (DOTS).  Neonatal motor behavior explained significantly the later aggressiveness. A little relationship was observed between NBAS and cognitive development. There were not significant relation between parental neonatal perceptions and both temperamental and psychopathological dimensions at six years old.

#260

AGGRESSIVE BEHAVIOURS IN THREE YEAR OLDS.

Dorado, M., Jané, M.C., Domènech-Llaberia, E. Facultat de Psicologia, Universitat Autònoma de Barcelona, 08193 Bellaterra. Spain. Edelmira.Domenech@uab.es.

The goal of the present study is the detection of aggressive and disruptive behaviors at the age of three, in order to apply an early appropriate intervention. It is known (Campbell, 1995) that children who have aggressive behaviors at age 3 have approximately 50% of chance, without intervention, of continuing to have problems into adolescence. A clinical sample of 70 children from two urban areas near Barcelona was assessed. These children are the whole population of two geographical areas near Barcelona attending, three times a week, two centers for children with special needs (10 children were missing). Data sources from three different informants: parents, teachers and children themselves were included. Parents and teachers were administered the Spanish version of the Early Childhood Inventory – ECI – (Gadow & Sprafkin, 1996), a screening instrument for 13 psychiatric disorders based on DSM-IV. Children were assessed through a new pictorial instrument created specially for this research. This tool assesses aggressive attributions and strategies. We present here the new pictorial instrument and the results of the externalizing behaviors of these children. The prevalence of disruptive disorders (opposicional desafiant disorder, conduct disorder and TDAH) was approximately 3,5% of the whole sample, The rates are higher in boys than in girls, and the sex differences are significant. The main point of this research is to focus in three-year-olds and the introduction of a new pictorial instrument for the self-assessment of aggressive behaviors.

#261

PEDIATRIC REHABILITATIAON CONSULTATION FOR BEHAVIOR PROBLEMS IN YOUNG CHILDREN WITH CEREBRAL PALSY AND/OR DEVELOPMENTAL DELAY.

Wright, H., McDermott, S., Nagle, R., Leonhardt, T., Wuori, D., Swann, S.  School of Medicine, University of South Carolina, Columbia, SC. 29208. USA.  hhw@gw.mp.sc.edu

Child behavior problems and family concerns are common in families of children with Cerebral Palsy and/or Developmental Delays.  An intervention to reduce the severity and/or the onset of behavior problems in this population was designed to be delivered by rehabilitative therapists utilizing a consultation model.  As a result of the intervention, significant improvement from baseline to one year followup was noted in the Vineland Adaptive Behavior Scale scores and the Questionnaire on Resources and Stress Respondent Attitude subscale scores, but not in the Child Behavior Checklist scores.  The magnitude of the improvement was greatest for children with Mental Development Indices of less than 50.  Implications of the findings are discussed.

#262

THE IRRITABLE INFANT INTERVENTION STUDY.

Jordan, B., Lubitz L., Meehan M., Heine R., & Catto Smith A., Mental Health Service, Royal Children’s Hospital, Flemington Rd., Parkville. Vic. 3052 Australia. jordanb@cryptic.rch.unimelb.edu.au 

This aim of this study was to compare the efficacy of medical therapy of non pathological gastro-oesophageal reflux with an Infant Mental Health intervention for infants under 9 months of age admitted to hospital for the investigation of persistent irritability in the absence of organic disease.  One hundred and three infants completed the randomized placebo controlled treatment trial, with 84 providing complete cry-chart data. Anti-reflux medication was not superior to placebo treatment in reducing the amount of total daily crying, The Infant Mental Health intervention resulted in a statistically significant reduction in the need for mother baby unit admission during the trial, and of clinical significance was the finding that less of the infants in this group were crying more than 3 hours a day at the end of the trial. Neither anti-reflux medication or the Infant Mental Health intervention were superior to placebo in reducing maternal distress.

#263

NEWBORN BEHAVIOR AND TEMPERAMENT.

Nugent, J.K., Kagan, J., Snidman, N., Liske, J., & Bujoreanu, I.S. Brazelton Institute, Children’s Hospital, Boston, MA 02215. kevin.nugent@tch.harvard.edu.

The nature and stability of individual differences among infants and their influence on later personality are issues with serious implications for practice in the field of infant mental health. Significant demonstration of preservation comes from the research of Kagan and Snidman showing that high- versus low-reactivity in four-month infants predicts profiles of shy, withdrawn, or sociable and bold behaviors in later childhood and adolescence (Kagan and Snidman, 1991).  However, little is known about behavioral signs in the period prior to four months that might predict high or low reactivity at four months. The goal of this study is to examine the relation between newborn behavioral characteristics and temperament categories at four months of age.  One hundred healthy full-term newborns were assessed on the second day of life with a new revised standardized behavioral scale, based on the Neonatal Behavioral Assessment Scale (Brazelton and Nugent, 1995).  At four months, a temperament battery (Kagan et al.) measuring behavioral and physiological responses (cardiac function, and EEG power and asymmetry) was administered.  Chi-square analyses of the first 41 infants revealed significant relations between newborn crying and soothability, and patterns of high/low reactive temperament categories at four months. The stability of these profiles suggests that some babies are born with a high threshold for excitability, and others with a low level of reactivity.  Analysis of the total sample will further examine the degree to which these newborn differences persist over time. The implications of these results for future research and clinical practice will be discussed.

#264

THE SLEEP OF THE INFANT: ENVIRONMENTAL AND CULTURAL FACTORS.

Bouden, A., Othman, S., Charfi, F., Bayram, M., Hajji, J., Ben Chaabane, M., & Halayem, M.B. Hôpital Razi, Service de Pédopsychiatrie, la Manouba, Tunis(ie) bouden_asma@yahoo.fr

The goal of this work is to study the environmental factors that surround the sleep of the infant and to research of a possible cultural specificity (Tunisia). A questionnaire evaluating these factors has been submitted to mothers at the opportunity of pediatric consultations. 89 infants (sex-ratio=1) have formed the subject of this preliminary study. The sleep has been described by mothers as globally satisfactory in 61.8% of the cases while a sleep trouble has been found through the questionnaire(difficulty to fall asleep and or several nocturnal awakening) in 68.4%. Concerning the environmental factors, in 91% of cases, the presence of the mother is a necessary condition for the child to fall asleep or to go back to sleep in case of nocturnal awakenings. 91% of children sleep in the parents' bedroom and 31.4% in the parents' bed. 74.2% of children demand the presence of a transitory object (children under 18 months in 72% of cases) and a night-light in 84.3% of the cases. Correlation between troubles of the sleep and factors of recent affective stress, chaotic baby-sitting modes, excessive stimulation, strict bed-time schedule, alimentary forcing, mother's outside job, will be evaluated when the sample size will reach 200.

#265

STRESS REACTIONS IN CHILDREN SUSPICIOUS FOR CHILD PSYCHIATRIC DISORDERS IN THE SOSO PROJECT.

Drs. Naber, F.B.A.,  Dr. Willemsen Swinkels, S.H.N. , Prof. Dr. Buitelaar, J.K.,  Prof. Dr. van Engeland, H..UMC-Utrecht , Heidelberglaan 100, 3508 GA  Pb. 85500, roomnumber B01.201 Department Child and Adolescent Psychiatry. F.naber@azu.nl

It is suggested that stress is linked to the psychopathology and pathogenesis of mood and anxiety disorders

We designed a study to investigate the behavioral and physiological reaction of very young clinically referred children to different kind of stressors.  During two observations, the children were placed in settings in which interaction of the children with the mother and the session-leader was observed. The reaction of children to maternal separation was tested during the Strange Situation Procedure, developed by Marie Ainsworth to investigate attachment classifications. During this procedure stress coping and attachment classifications were analyzed. We also introduced non social stressors like for instance offering children nice toys and forbid them to play with it. During the other setting the children were observed during tasks they had to perform with the session leader and the mother.

A special ethogram to observe stereotyped- and other stress related behaviors under different circumstances was developed and used to observe the children during these settings. Also the heartbeat of the children was measured during these settings using a polar advantage heart beat measure equipment and during each session saliva cortisol was collected using cotton roles which were analyzed using RIA's.

During the poster session results of this study will be presented.

#266

INFANT EMOTIONAL REACTIVITY AND REGULATION IN RESPONSE TO MOTHERS’ STILL FACE. 

Hui-Chin Hsu, Department of Child & Family Development, McPhaul Center, University of Georgia, Athens, GA30602-3622, U.S.A. Hchin@fcs.uga.edu.

Reactivity and self-regulation are two distinct dimensions of individual differences in infant temperamental characteristics. Reactivity refers to the arousability in individuals' behavioral and physiological systems, whereas self-regulation refers to the neural and behavioral processes serving to modulate heightened arousal.  Previous research has been focusing on the form and function of infant negative emotional reactivity and self-regulation in response to nonsocial frustrating events (e.g., toy removal). The present study was designed to examine the form, function, and correlates of 3-month-old infants' emotional reactivity and self-regulation in response to a social stressor, a still face posed by their mothers. Results indicated that these infants exhibited both positive (e.g., smile) and negative (e.g., cry) emotional reactivity to maternal still face. They also employed several self-regulatory strategies (e.g., selective attention, self-soothing).  However, none of these strategies was effective in reducing their negative emotional reactivity.   Furthermore, maternal perceptions of temperamental difficulty and unadaptability were significantly related to infants' negative emotional reactivity, but not self-regulation or baseline heart rate variability.

#267

PREVENTING DISRUPTIVE BEHAVIOR DISORDERS IN TODDLERS:  PILOT STUDY OF A GROUP INTERVENTION FOR PARENTS. 

Niccols, A., & Van Tuyl, M.  Hamilton Health Sciences & McMaster University, Hamilton, Ontario, Canada.  Niccols@hhsc.ca. 

Coping with Toddler Behavior is an innovative group intervention to train parents in effective parenting strategies, improve parent-toddler interaction, and reduce the risk of disruptive behavior disorders in very young children, before parent and child behavior become entrenched. Parents learn skills and strategies in parenting their toddler, such as preventing challenging behaviors (e.g., planning ahead, modifying the environment, using transitional warnings) and responding to challenging behaviors (e.g., setting limits calmly and consistently, redirecting, ignoring inappropriate behavior). An active adult learning model is used. A small pilot study using parent-report measures revealed decreased dysfunctional parent-child interaction, parental distress, and parent perception of their child as difficult and significantly improved knowledge of toddler parenting issues.  High levels of client satisfaction also were reported, and gains were maintained at one-month follow-up.

#268

THE INFLUENCE OF PRENATAL TESTOSTERONE LEVELS ON TEMPERAMENT.

van de Beek, C., van Goozen, S.H.M., Cohen-Kettenis, P.T., Buitelaar, J.K. Department of Child and Adolescent Psychiatry University Medical Center Utrecht, P.O. Box 85500, 3508 GA Utrecht, The Netherlands, C.vandeBeek@psych.azu.nl.

The aim of the study was to investigate the influence of prenatal testosterone levels on temperament in infants in the first year of life. In this prospective longitudinal study testosterone was measured in the amniotic fluids of 158 women of whom 79 were expecting a boy and 79 a girl. Postnatally the child’s behavior was assessed by using a parental questionnaire (Infant Behavior Questionnaire: Rothbart, 1978) administered at 3, 6 and 9 months. The IBQ contains six scales, including Activity level, Distress to Limitations and Fear. Significant sex differences were observed for levels of testosterone, although there was also a considerable overlap between the sexes. Within- and between-sex variability in prenatal testosterone levels could have different effects on the temperamental outcome measures in the children. The poster will present the results and discuss its implications.

#269

REGULATION AND CORRELATED DISORDERS: A STUDY ON 20 CHILDREN.

Collini M., Caruso P., Benini L., Gentili C., Bacchi C., Siboni P., Martelli M.. Centro per la Prima Infanzia, p.zza 2 Agosto 2, Castel Maggiore (BO).ITALY. cprimainfanzia@auslbonord.regione.emilia-romagna.it.

Regulatory ability is, at present, one of the most investigated developmental aspects in infant mental health. Researches in this field have recently shown the correlation between regulatory ability and both care-giving and parents-infant interactions. To understand better the nature and the development of the regulatory disorders, we need to detect different aspects of the relation between constitutional and relational factors through controlled studies. The study  we present was conducted on a sample of 20 children (16 males; 4 females; average age = 29.5 months) who were referred to the Centro per la Prima Infanzia (Bologna -Italy). All the children were diagnosed with DC:0-3 Regulatory Disorders. The results of our study derive from the comparison between the primary diagnosis (I axis), the type, the severity and symptoms of the regulatory disorders, with scores on axis II (relationship classification), the presence of physical, neurological or developmental diagnoses (axis III) and the scores on the BSID- II  (Bayley Scales of Infant Development –II edition, 1993) behavior Rating Scale (BRS).

#270

MATERNAL SENSITIVITY BEHAVIOR AND INFANT TEMPERAMENT IN THE FIRST YEAR OF LIFE.

Kivijärvi, M., Räihä H. & Piha, J. Department of Psychology, University of Turku, 20014 Turku, Finland.  marja.kivijarvi@utu.fi 

The objective of this study was to examine maternal sensitivity behavior and infant temperament in low-risk families. Fiftysix mother-infant pairs were video recorded in their home when the infants were 3 months and 12 months of age. Maternal sensitivity behavior and observed infant temperament behavior were assessed by using the Parent-Child Early Relational Assessment (PC-ERA) scale. In addition, the mothers answered the questions regarding of infant temperament at 6 and 12 months of age. The infants of More Sensitive (MS) mothers had more positive mood than the infants of Less Sensitive (LS) mothers at the both time points assessed by the PC-ERA. Maternal sensitivity behavior did not related to different temperament characteristics assessed by the Revised Infant Temperament Questionnaire (R-ITQ) and by the Toddler Temperament Questionnaire (TTQ). However, we found a tendency that the infants in difficult temperament cluster had more MS mothers than LS mothers.

#271

DAY- TIME REGULATION OF NIGHT-TIME SLEEP PROBLEMS OF INFANTS.

Skúladóttir A. & Thome, M., University Hospital Fossvogur, Iceland. Arna@landspitali.is

Day-time disregulation of infant sleep problems has been found to constitute one of five characteristics that are related to night time sleep problems.  In particular, the length of the time infants wake in the morning before taking their first day nap and the length of waking before falling asleep for the night were found to be critical in correcting night tile sleep problems.  A study was conducted to test the effectiveness of day-time regulation of night sleep problems as a component of an intervention program.  The sample consisted of 194 sleep disturbed infants.  Data were collected by a semi structured interview with both parents before start of the intervention and by a structured follow-up telephone interview with one parent 5 months after its termination. All interviews were analyzed for content and categories elaborated. Results showed that sleep problems were specific for age groups and day-time regulation proved to be effective for all age groups that took day naps. On the contrary, assistance to fall asleep was an intervention component that was limited in its effectiveness to the age groups under 14 months. Results suggest that day-time regulation of infant’s night sleep problems, is an important component of the treatment.

#272

IRRITABLE INFANTS: HOW NURSING CARE CAN MAKE THE DIFFERENCE.

Meehan M. Jordan.B Infant Mental Health Group. Royal Children's Hospital Flemington Road Parkville 3052 meehan@cryptic.rch.unimelb.edu.au

An intervention program for irritable infants in an inpatient setting in Australia, found that many of the positive responses from parents about the admission related to the attitude of staff especially nurses. The joint nursing and psychotherapeutic approach addressed issues of practical baby care and the baby's symptom, as well as internal emotional issues. Keefe talks of the process that parents move through in adapting to the needs of an irritable infant, and that nurses are in and ideal position to help parents make the transition from feeling overwhelmed to understanding and coping with the demands of the baby. However seeking to understand the impact of the experience on the infant, rather than just parent directed advice, gives a broader scope to the nursing care. Parents reported that what was helpful in the admission, was support, understanding validation, advice, reassurance, time spent talking, and observing the baby. This poster will describe how these processes allowed space for the infants’ experience and emotional response to be considered and interpreted, so that the intervention was seen as contributing directly to the infant not just changing parent’s projections.

#273

DISORDERS OF BEHAVIORAL REGULATION IN INFANCY: A 10-YEAR ACCOUNT OF THE MUNICH INTERDISCIPLINARY RESEARCH AND INTERVENTION PROGRAM FOR FUSSY BABIES.

Papoušek, M. & Wurmser, H. Institute for Social Pediatrics and Youth Medicine, University of Munich, Heiglhofstr. 63,D-81377 Munich, Germany cry.kiz@lrz.uni-muenchen.de

Over the past decade, more than 2000 1- to 30-month-old “difficult” infants and their families were referred to the Munich Interdisciplinary Research and Intervention Program for Fussy Babies because of excessive crying, sleeping and feeding disorders, and other problems of behavioral regulation. Clinical data from extensive neuropediatric, psychiatric, and psychological assessments, standardized questionnaires, behavioral diaries, and videobased behavioral observation of parent-infant interactions were documented systematically and analyzed from both systemic and developmental perspectives. The data from 1000 consecutive referrals reveal unexpected commonalities among the behavioral syndromes in question: The syndromes represent (1) extremes of normal behavioral variation; (2) they reside neither in the infant alone, nor in the parent, but show immediate relations to age-specific developmental tasks and co-regulatory failures in everyday parent-infant interactions; (3) they exert distressing demands on the parents’ intuitive competence and psychological condition; (4) individual syndromes exhibit a high degree of concurrent and sequential “co-morbidity”; and (5) long-term risks for disorders of parent-child relationships, attachment and mental health tend to increase with the duration and pervasiveness of dysfunctional interactions, as well as with accumulating biological and psychological risks.

#274

EMOTIONAL AND MOOD DISORDERS IN EARLY LANGUAGE DEVELOPMENT DISORDERS.

Fabrizi A., Giamundo V., Ponticello L., Setaro S.  Università di Roma “La Sapienza”, Via Dei Sabelli, 108 Italia Anna.Fabrizi@uniroma1.it.

Our Clinic and research team is increasingly focusing attention on Developmental Disorders and Psychiatric Disorders in the first years of life. The aim of this study was to investigate the presence and the features of psychiatric disorders in our population of infants with language disorders. We used the multiaxial approach of Diagnostic-Classification 0-3 to define psychopathological diagnosis. Subjects were 90 children aged 24 to 36 months with a delay in language development. The assessment include: cognitive tests; neuropsychological  and neurolinguistic tests; individual play sessions with a trained clinician; observation of parent-child interaction; observation of peer interaction; C.B.C.L. modified version for infant; Functional Emotional Assessment Scale; evaluation of psychosocial stressors. Results of this study are consistent with previous clinical and epidemiological data that show rates of comorbid psychiatric diagnosis among language impaired children as exceeding what would be expected by chance. The presence of receptive or comprehensive language disorders has proven to be the most important consideration: Children with Mixed language Disorders have higher rates of psychiatrics disorders and are at high risk for affective-behavioral disorders.

#275

ARE THERE LINKS BETWEEN INFANT TEMPERAMENT AND COPARENTING PROCESSES AT 3 MONTHS POST-PARTUM?

Berkman, J. M., Alberts, A. E, Carleton, M. E., & McHale, J. P.  Department of Psychology, Clark University, 950 Main Street, Worcester, MA. 01610. USA  jberkman@clarku.edu.

This study sought to examine whether connections exist between the dynamics of the coparenting relationship and indicators of infant temperament.  Observational rating systems were used to assess both infant temperament and triadic family interaction at 3 months post-partum.  Findings indicated that parents whose babies were rated as more negative and inhibited during the temperament assessment had more cooperative interactions with their partners, while also exhibiting higher levels of family warmth during triadic play.  Parents may need to pull together more when faced with a difficult baby, or become more proactive in creating a warm, comforting environment for a child who they sense is particularly cautious or emotionally fragile.  Further examination of temperament and family-level dynamics is needed to fully understand the difficult infant’s earliest environment.

#276

USING THE D.I.R. MODEL TO HELP PARENTS AND PROFESSIONALS UNCOVER EACH CHILD’S UNIQUE SELF-SATEMENT. 

Catalano, C.G., Wolters, P., & Hernandez, P. Montclair State University Demonstration Program, Upper Montclair, NJ. 07043. USA CGC94@aol.com.

This session will present an outline for conducting a series of workshops based on the functional emotional levels of development and the Developmental, Individual Differences, Relationship-Based (D.I.R.) approach to working with children with pervasive developmental delays.  The focus and goal of the workshops is to guide parents and professionals in developing and writing a unique self-statement for each child in order for the adult to view the world from the child’s perspective.  A professional will discuss the use of the workshop for staff training and a parent will share her experience of attending the workshop as well as additional uses of the self-statement.

#277

AN OPEN DROP-IN CLINICAL PROGRAM FOR INFANTS 0-3 AND THEIR PARENTS.

Couetoux, F., Appell, J.R., Garrigue, Marie P., Martin, M., Rabain, D., Mazet, Ph. Unité Petite Enfance Vivaldi – 28 allée Vivaldi 75012 Paris – France  Email : unite0-3ans.vivaldi@psl.ap-hop-paris.fr.

We propose to present a poster about a special program in the Unité Petite Enfance Vivaldi, a « 0-3 » infant psychiatric unit at Salpêtrière Hospital, Paris.

The program is free of charge. A parent can arrive with her or his child on a drop-in basis, without an appointment. On hand is an interdisciplinary team, including pediatric nurses, educators and a psychologist. Some parents hear about the program from other parents. Others are referred by pediatricians or from other institutions. A place of meeting, listening, evaluation and at times therapeutic accompaniment is provided. A gentle support for new processes of infant-to-parent and parent-to-infant communication is given. The emphasis is upon developmental needs of the infant, looked at with an assumption that each infant’s developmental rhythm is unique.

#279

EMPOWERMENT-BASED INTERVENTION IN RELATIONAL PATHOLOGY: AVOIDING THE PITFALLS OF HELPLESS CAREGIVING REPRESENTATIONS.

Schuengel, C., Baartman, H.E.M., Smets, K., Korver, M., & Pontier, C. Dept. Of Orthopedagogy, Free University, Van der Boechorststraat 1, 1081 BT  Amsterdam. The Netherlands C.Schuengel@psy.vu.nl.

Disordered attachment between parents and toddlers may be accompanied by parents’ representation of the caregiving relationships in terms of helplessness and failure to provide adequate protection of the child (George & Solomon, 1996). Home visitors have to resist the ‘pull’ from these parents to be directive, take charge, and take over parental responsibilities. We present an empowerment-based family preservation program in which training of home visitors, intake procedures, content of the program, and monitoring of progress are all geared towards helping parents take up the primary responsibility to protect the child and provide security. This implied a critical reconsideration of existing approaches that use protective daycare, home-visiting and videofeedback training, which may sometimes inadvertently make parents believe that they can never be a secure base to their child. Case examples illustrate the role played by the caregiving representation in the intervention process, and the numerous pitfalls that have to be avoided in working with these parents.

#280

THE INSTITUTION, A PLACE OF DAY TO DAY THERAPY AND OF PREVENTION OF VIOLENCE?

Rasse, M., Mauvais, P Association Pikler Lóczy, 20 rue de Dantzig, 75015 Paris, France. pikler-loczy@wanadoo.fr

Institutions caring permanently for babies and very young children - often suffering from emotional deprivation or victims of previous bad treatments, disorganized by separation from their family - have to face not only the constraints inherent to institutional functioning but also the difficulties and complexities of the caretakers’ task. This context tends to generate violence either open or on the contrary hidden, sometimes not even noticed by caretakers themselves.  We will focus on three main ideas, illustrated by various clinical and videotaped documents:

1. Institutional violence is not unavoidable and professionals can plan their work according to some principles which offer young children a life, relationships and an environment answering to their different individual needs and turning the institution into a “house to grow up in”. In this respect, the experience of the Pikler Institute is a founding reference.

2. The institution can combine the necessary elements for a day to day therapeutic atmosphere.

3. This approach and practice of care, while contributing to develop a feeling of competence in the very young child, that is to say, the capacity of influencing others and acting on the world, contributes to identity construction as well as shaping a specific social behavior that harmonizes the strength of individual reactions with concern for others. They are likely to play an important role in the prevention of violence and deserve all the attention of clinicians and researchers interested in the subject.

#281

BABY DANCE METHOD IN PROMOTING EARLY INTERACTION IN PRIMARY HEALTH CARE.

Markkanen,R., Jouhki, T., Määttänen, K., South-Eastern Community Health Centre, PoB 6300, 00099 CITY OF HELSINKI, Finnland. kirsti.maattanen@soster.hel.fi.

The poster outlines an infant-centred early prevention and intervention programme in Helsinki South-Eastern Community Health Centre. Dialogical Baby Dance Method was adopted into the work of health care nurses as a potential answer to the question: How to give effective practical guidance to parents in order to facilitate their motivation, skills and sensitivity in interaction with their infants? - Baby Dance is a simple method based upon structured use of pre-planned movement sequences in playful interaction between the infant and the care-giver. Optimally it is introduced to the baby's life at the age of two months. The phases of the programme, starting from pre-birth family guidance followed by regular meetings with the family, are described. Experiences in guiding depressed mothers, teenager mothers and infants with developmental risks are summarized.

#282

DIALOGICAL BABY DANCE IN PROMOTING OPTIMAL EARLY DEVELOPMENT. 

Määttänen, K., South-Eastern Community Health Centre, PoB 6300, 00099 CITY OF HELSINKI, Finnland.kirsti.maattanen@soster.hel.fi.

By the age of two months the infant's need for active participation in social interaction comes markedly to the fore. This phase is a formative period for interactional patterns between the infant and the parent and thus may be considered especially malleable. - Dialogical Baby Dance is a method to facilitate joyful interaction between the baby and the parent on a daily basis at home from the age of two months on. It is based upon use of pre-planned movement sequences, which enable the child first to anticipate and then actively to join in.

In the video presentation the Baby Dance Method is demonstrated a) by showing a mother engaged in Baby Dance with her baby (2 min) with a discussion on the basic ideas of the method. b) a video of a mother starting with Baby Dance with her prematurely born baby (2 min) and a recording of their interaction about ten months later. A hand-out/poster of the theoretical background and the basic ideas of Baby Dance is delivered.

#283

THE MODEL OF NURSING IN THE CARE OF EARLY RELATIONSHIP.

Behm-Kostiainen S, Hanhimäki L, Pukuri T & Kaukonen P. Tampere University Hospital P.O.Box 2000 , FIN-33521 Tampere , Finland   palvi.kaukonen@tays.fi

We started early relationship treatment in the child psychiatric department of Tampere University Hospital in 1997. The infant psychiatric outpatient unit, “Baby Team” treats infants with disturbances in emotional and/or behavioral development and infant families with severe problems in family relationships and functions. The team also conducts problem identification and evaluation of parenthood. Our multiprofessional team includes a child psychiatrist, an assistant head nurse, a psychologist and a social worker. The role of nursing is taking care of infant families in an intensive way by making home visits and being available every weekday. The methods of nursing depend on the situation of the baby and of the family and the focus may be on the baby, mother, the whole family or others. However, the main focus is on baby-mother interaction. We work both on the level of representations and on the level of concrete behavior. The main concepts of nursing are 1) safe environment, 2) supportive caring, 3) timing, 4) empowering and 5) identification of possible alternatives. In the future we must co-operate more with professionals in adult psychiatry and we have to be more and more aware of the needs of the baby in our treatment.

#284

PADDLE - THERAPY.

Brunod R., Hôpital de Jour Enfants, CHS de Colson, BP 631, 97261, Fort de France Cédex, Martinique, FWI, regis.brunod@caramail.com.

Motor-inhibition is a very common symptom in young children. It could be associated with a delay in speech or an extra-familiar muteness meeting the criteria for the diagnostic of Disordered Attachment with Inhibition. In the treatment of this condition we use psychomotor therapy and specially activities in a paddling-pool. It could be a single child with one therapist. The therapy consist in sequences of relaxation of the child held in the water by the therapist taking turns with sequences of play with balls or something like that, but specially with a small rubber tubing pouring water. That allows spraying each other. The child is allowed and sometimes encouraged to speak or to shout while playing. More often the mother may attend at the beginning of the treatment but is not allowed to take an active part. It could be also, but in general after, amidst a small group of infants. This therapy works at a somatic (psychomotor) level but also at a symbolic level where the child can exhibit aggressive feelings in a sort of “half-symbolic” way.

#285

HELPING FAMILIES WITH INFANTS: DID THEY GET HELP?

Östring, H., Kinnunen, I. Services for Families with Infants, PL 7411, 00099 Helsinki, Finland helena.ostring@hel.fi

This regional working programme has been in use since 1996 in order to support families in the parent-infant early interaction at risk. The work is carried out by two psychologists, from the Health Care Centre and from the Family Guidance Centre. The families are referred to the programme from various collaborating organizations. The reasons for referral differ: mothers may be depressed, families might live in severely difficult social circumstances or they might have a demanding infant. Because of variety of problems different interventions are needed. In the intensive treatment model the group of four mothers and babies come together twice a week. Each mother has also a weekly therapy session with her infant. The father participates in the family meeting once a month. In autumn 2000 after the treatment period parents were sent a questionnaire including quantitative rating scales and open questions concerning the treatment.  The similar questionnaire was sent also for referring collaborating partners. Effectiveness of this intervention will be evaluated. The results will be presented.

#286

BABIES IN A PSYCHIATRIC MOTHER-BABY CARE UNIT: WHICH THERAPEUTIC FOR THESE HIGH PSYCHIATRIC RISK BABIES ? (I) THEORETICAL APPROACH, CLINICAL EXPERIENCE AND DISCUSSION.

Lafont, V., Barré, C., De Castelnau P. & Taiclet, S. Unité d’Accueil Parent-Bébé, Institut Théophile Roussel, 1, rue Philippe Mithouard, 78360 Montesson, France. veroniquelafont@club-internet.fr.

If the symptoms of the mother are often of primordial interest when mother and baby are hospitalized for psychiatric reasons, the babies are themselves not exempt from suffering. We have developed different ways to specifically take care of the children by referring to the nursery experiences of Loczy, to the observation method according to Esther Bick, to the work of psychomotor specialists and to body techniques such as hydrotherapy. As soon as babies present worrying signs in their psychological development we put forward our experience of these different types of care. We suggest that we discuss the theoretical interest, the difficulties of putting them into place and the results of these therapeutic methods on the development of the babies.

#287

MOTHER – BABY THERAPY IN PSYCHIATRY: VARIOUS TREATMENT CONCEPTS.

Deneke,C., Department of child and adolescent psychiatry, Hamburg University Hospital, Martinistr.52, D 20246 Hamburg, Germany. cdeneke@web.de

Mother-baby therapy is indicated in cases of maternal mental illness and postpartum crises. In this symposium, various concepts of mother-baby therapy for these cases are presented. At first, members of a very engaged adult psychiatric team report their way to establish a small mother-baby unit with a notable therapeutic concept within the means of a general psychiatric ward. The second is a rather comprehensive child psychiatric day care concepts, which shows a variety of therapeutic points of application. The third contribution stems from a very experienced outpatient and day care child psychiatric team, which has developed a number of specialized treatment methods for various maternal pathologies, here for eating disorders. On the whole, this symposium cannot give an overview, but a small choice of different concepts, which may serve as an impulse for further reflections on mother-baby therapy in psychiatry.

#288

CHARACTERISTICS OF INFANTS/CHILDREN AND FAMILIES REFERRED TO A SPECIALIST CLINIC WITHIN THE PUBLIC CHILD HEALTH SERVICE.

Ostberg, M. Children' s Hospital, Specialist Child Health Clinic, Uppsala University Hospital, S751 85 Uppsala, Sweden, Lindberg, L. Karolinska Institutet, Stockholm, Sweden, Dannaeus, M. Uppsala University Hospital, Sweden monica.ostberg@ped.uas.lul.se

The aim of this study was to describe characteristics of infants/children and families referred to a specialist clinic within the public child health services and to compare the characteristics of referred and non-referred infants/children and families.  Questionnaires were used to measure parental stress, caretaking hassles, social support, life events, workload and child temperament, while maternal sensitivity was used to measure interaction.  The problem group included 33 infants/children with feeding or sleeping problems.  Comparisons of these two problem groups did not reveal any significant differences.  Results showed that the problem group differed from the 98 infants/children in the control group regarding parental stress, caretaking hassles, social support, life events and child temperament.  The discussion will be focused on the clinical implications of the results.

#289

THE DEVELOPMENT OF AN AFFILIATE OF WAIMH  - THE HISTORY OF GAIMH. 

Dunitz-Scheer, M., Papousek, M., Klitzing, Kv. Perfrina, F., Fries, M., Psychosomatic unit, Hospital for Children and Adolscence, Univ.-Klinikum, A-8036 Graz, Austria Marguerite.Dunitz@klinikum-gras.at

At the 5th WAIMH World Congress in Chicago 1992 first steps were initiated to start with a German-speaking affiliate within the newly founded WAIMH.  It was Hiram Fitzgerald’s first year and especially Serge Lebovici was supporting the idea.  Mechhild and Hanus Papousek and Pet & Marguerite Dunitz-Scheer were invited to gather interested experts, researchers, as well as clinicians.  A first meeting was held in Munich 1996, first outlines of the proposal of the by-laws were made.  The first election of presidents took place, one from each country.  Mechthild Papousek was first elected president, using her good contacts to WAIMH members supporting the integration of GAIMH into WAIMH at the 6th World Congress in Tampere.  Since then GAIMH has organized annual meetings in Munich (1996), Basel (1998), Graz (1997), Cologne (1999), Zurich (2000), Vienna (2001).  The next annual meeting will be in Berlin, fall 2002.  The affiliate holds 484 members from different professional backgrounds, from all three countries.  The process of organizational development will be described in order to encourage other regions of the world to undertake the same, sometimes strenuous work in order to promote infant mental health.

#290

BEGINNING THE FAMILY DANCE: MOTHER-INFANT AND FATHER-INFANT COMMERCE DURING DIAPER CHANGES AT THREE MONTHS POSTPARTUM.

Chaffe, E., Robertson, L., Lyubchik, A., & McHale, J.  Department of Psychology, Clark University, Worcester, MA.  01610.  USA  Echaffe@clarku.edu.

In this report, we extend research conducted on affect attunement and face-to-face interaction during the past two decades by examining both maternal and paternal exchanges with infants during routine diaper changes at three months postpartum.  Fifty families with first-born infants took part in this study.  After a period of extended rapport-building and familiarization with camera work in their homes, mothers and fathers were filmed separately during diaper change activities.  Videotaped records of these events were rated along dimensions of affect attunement and concern with the baby’s comfort.  Behavioral counts were also obtained of imitative acts, missed opportunities for imitation, social smiling, gazes, verbalizations, and mobility.  Analyses of within-family patterns indicated both families in which mothers exhibited somewhat greater sensitivity during diaper changes than fathers, and families where sensitivity levels shown by the two parents did not differ markedly.  Infant mobility was also linked with parental activity for both mothers and fathers.  Discussion focuses on steps to be taken in cataloging infants’ dyadic and family-level experiences.

#291

GENDER DIFFERENCES IN LATENCY AND DURATION OF FACIAL EXPRESSION IN 7-THROUGH 13-MONTH-OLD INFANTS.

Losonczy, M. E., & Brandt, L. J.  Department of Psychology, Salisbury University, Salisbury, MD.  21801 USA melosonczy@salisbury.edu.

As part of a larger study, infants aged 7 through 13 months were presented with 12 different stimuli.  Their emotional responses were videotaped and later analyzed using the Maximally Discriminative Facial Movement Coding System (MAX), and with a newly constructed measure, which incorporated MAX codes.  The new measure also incorporated items from a temperament measure (Lab-Tab) in order to examine intensity of facial, vocal, and bodily expression.   Eighty-two infants comprised the final sample; 33 infants were male, and 49 infants were female. A time-code generator encoded the time onto the videotape in seconds and frames (1/30 of a second).  Latency was the time code between onset of the stimulus and onset of facial expression.  Duration was the time code between onset and offset of facial expression. Statistically significant sex differences were found in both latency and duration of facial expression.  Females had shorter mean latency than males; females had longer mean duration than males.

#292

MATERNAL SALIVARY CORTISOL MEASURES TO MARK RISK FOR INTERGENERATIONAL VIOLENT TRAUMA?

D.S. Schechter, S.A.Brunelli, C.H. Zeanah, M.M. Myers, S.W. Coates, P. Baca, & M.A. Hofer. New York State Psychiatric Institute, Unit 40, 1051 Riverside Drive, New York, NY 10032, USA  dschechter@psychoanalysis.net 

The aim of this study was to determine if mothers of very young children at high-risk would display HPA-Axis functioning consistent with chronic posttraumatic stress. Subjects were 31 inner-city mothers with violent trauma histories prior to age 16 and their children (ages 8-50 months), who were referred to a parent-infant clinic. Maternal salivary cortisol (SC) levels taken before and after an interaction-procedure with separation-reunions.  We measured maternal trauma history, child protective service involvement, and posttraumatic stress symptoms (PTSS), as well as degree of negative/distorted maternal child-attributions and degree of disturbances of child attachment (DDCA) by maternal report. Child protective service involvement showed negative effects on SC reactivity.  Degree of lifetime PTSS was negatively correlated with SC baseline levels and reactivity after separation-stress.  Negativity/distortion of maternal child-attributions was inversely correlated with baseline SC.   DDCA was significantly inversely correlated with baseline and reactivity of SC. Low baseline values and reactivity of SC is a valid physiologic marker of PTSS in this high-risk population.

#293

CHILDREN AND BOOKS.

Jun-ichi, Ito. Yoko, Ito.  Habilitation Center for Children with Mental Handicap, Taiyo-no-sono, Date, Hokkaido, 052-8585.  JAPAN ito-date@io.ocn.ne.jp.

We studied how many of the children know typical Japanese folktales and some foreign tales in 780 children. We also evaluated the relationship between the preschool experience about reading picture books and later. 30 to 50% of the children in kindergarten or in first grade did not know typical Japanese folktales like `Saru-kani-gassen` (the revenge of crabs), which was superior to 10 to 20% of such foreign tales like `Snow white`. After all 10 to 20% of the children in sixth grade did not know typical Japanese folktales. We found out that children in fourth grade who knew more folktales have read more stories for elderly. One of the most effective ways of giving children both a love of books and basic reading skill might be to read with them from an early age. Although some of the picture books have become more popular in these days, it is regretful to show that our own folktales are rather neglected. We believe that it is necessary for toddlers to be read them repeatedly to handle down our own culture for next generation.

#294

BABIES AND PRESCHOOL SIBLINGS AT PLAY TOGETHER: AN ANALYSIS OF INITIATING BIDS.

Shaw, D., Lauretti, A., McHale, J. Department of Psychology, Clark University, Worcester, MA. 01610 USA DSHAW@CLARKU.EDU

Studies of infants’ early social environments have begun to incorporate an appreciation for the contributions made by older siblings. This area of study is still relatively new, and data on infant-sibling interactions as a function of gender pairings remain in relatively short supply. In this report, we examine both the number and quality of initiating bids by 1-year-olds and their preschool siblings as a function of family context (monitored vs. unmonitored).  Data on 41 preschool-infant siblings pairs reveal strong context effects on the behavior of older siblings toward infants, whereas infant behavior is less reactive to context. Data also indicates that the gender composition of the sibling pairings makes an important difference in the nature of sibling interaction quality across contexts.

#295

TO SHARE OR NOT TO SHARE: A QUALITATIVE STUDY OF THE DEVELOPMENT OF THE INFANT SELF.

De Koeyer, I., & Fogel, A. Department of Psychology, University of Utah, Salt Lake City, UT 84112-0251. USA. ilse.dekoeijer@psych.utah.edu.

This study describes the development of the self in the second half year of life, when infants discover that they have their own subjective experience that may or may not be shareable with others (Stern, 1985). Two mother-infant pairs were videotaped weekly during play. Instances in which the infant's self was highlighted or suppressed were observed. The two infants showed distinct developmental patterns. As Susan is discovering herself, her mother attends to this process and gradually makes herself part of it. The infant's sense of self becomes increasingly complex and shared with mother. In Peter's case, the mother tends to intrude more in the infant's self-dialogue. He appears to increasingly suppress himself, in order to remain connected with his mother. The observations will be discussed in the context of Winnicott's ideas about development of True and False self and models of developmental change.

#296

CHILDREN´S DRAWINGS AS A MEASURE OF ANXIETY LEVEL.

Puura K*, Rorarius M, Puura A, Annila P, Viitanen H , Baer G. University Hospital and University of Tampere, 33014 University of Tampere, Finland.

Sixty three to five year-old children scheduled for adenoidectomy were asked to draw a picture after arrival in the day-case unit, 10 min after premedication and prior to leaving home. The children were randomised into three premedication groups: rectal diazepam 0.5 mg/kg, rectal placebo and no premedication groups. Signs of anxiety were rated from the drawings according to a set of criteria, to form a sum score of anxiety ranging from 0 to 10. An independent assessor familiar with the criteria (KP) assessed all the pictures blinded to the group. The children also rated their own anxiety/fear on a five point face scale. Before venous cannulation the agitation of the children was scored by a nurse and these agitated children were compared to the less agitated children. There were no statistical differences between the premedication groups at any time point, when the anxiety scores of the drawings of the children were analyzed. However, the anxiety score of the drawings of the very agitated children before venous cannulation (n=17) was significantly higher (P=0.029) already at arrival into the hospital compared to other children (n=43). Thus, it may be useful to assess drawings to detect anxiety before operations.

#297

SYMTOMATIC AND RELATIONSHIP DIFFERENCES BETWEEN ONLY AND NOT ONLY CHILDREN AGED 4 AND 5.

Saucier, J.F., Marleau, J., Department of Psychiatry, Ste-Justine Hospital, 3100 Ellendale, Montréal, Québec, H3S 1W3, gallant@justine.umontreal.ca

Objective: To find out the differences between only and not only children, aged 4 and 5, concerning behavior problems and the mother-child relationship.

Methods: The data are from a representative sample of 1284 girls aged 4 and 5 (whose 102 are only children) and of 1306 boys aged 4 and 5 (whose 111 are only children).

Results: Concerning behavior problems, the bivariate analyses show that not only girls are more directly aggressive (p<.01) and do more misbehaviors against property (p<.05) than only girls.  On the other hand, not only boys are more often hyperactive (p<.05) and are also more often directly aggressive (p<.05) than only boys.  Regarding the mother-child interaction, with not only girls, the positive interactions are less frequent (p<.001) whereas mother’s hostile behaviors (p<.05) and punitive behaviors (p.<01) are more frequent than with the only girls.  Also, the mother’s positive interactions with not only boys are less frequent (p<.001) whereas the hostile behaviors are more frequent (p.<05) than with only boys.

#298

SELF CARE IN THE YOUNG CHILD.

Landau. E, & Levy-Shiff. R. Schneider Children’s Hospital, Mental Health Clinic, Kaplan Street,14, Petach Tikva, Israel. eclandau@zahav.net.il.

This research examined the concept of self care in three year old children. For the purpose of this study, self care is defined as a system of functions towards self-protection, and body care. Two measurements (parental questionnaires and child projective measurements) were developed and validated to measure self care. These tests have been adapted from previous standardized tests. Parents also provided reports of children’s injury history. In addition, this study examined variables that are assumed to be correlated with self care; these include, a) predisposing characteristics including temperament, impulse control and externalizing factors; b) physiological measurements (heart rate); and, c) the caretaking environment, which was measured in this study by mother–child interactions. Results showed that children with low self care skills also exhibit lower measurements in self care correlates, including poorer inhibitory control, and a lower resting heart rate. In addition, those children with lower self care skills also exhibited higher levels of injury frequency, impulsivity, activity level and aggression.  The importance of a better understanding of self care and its correlates and its implications for injury prevention are discussed.

#299

DIABETES MELLITUS IN INFANCY: DEVELOPMENTAL CONCERNS.

De Raeymaecker, D. and Bruining, G. Sophia Childrens Hospital, Erasmus University, Rotterdam.

Especially during the first 5 years of life insulin dependent diabetes mellitus is a major clinical problem.  The incidence before age 18 years doubled every 20 years, before age 6 even every 10 years these past decades.  Adequate metabolic regulation is very difficult in the face of frequent intercurrent illnesses, variations in activity and food resorption and emotional upheaval, either following mothers illness or the birth of a sibling.  To better adjust insulin administration to the consequent glucose swings, continuous subcutaneas insuline infusion (CSII or the pump) is used with some success.  This raises questions to the consequences of pumpusages to the development of these young children f.e. concerning body mastery and egocontrol.  The clinical backgrounds of these interactions will be introduced.  First in terms of the neuro-metabolic deviations caused bij treated diabetes by the pediatrician.  Second the psycho-developmental issues involved, with regard to mother-child interactions by the child psychiatrist. Clinical practice is demonstrated through two (or three) case histories.  Systematic interactive communication is aimed for regarding all possible aspects raised by the audience.

#300

TO WHAT EXTENT DOES INFANT SOCIOEMOTIONAL ADJUSTMENT CONTRIBUTE TO PRESCHOOL COGNITIVE COMPETENCE?

St-Amand, P., Boisclair, A., Tessier, R., & Tarabulsy, G. M.  School of Psychology, Université Laval, Ste-Foy, Québec, CANADA, G1K 7P4 pascale.st-amand@psy.ulaval.ca.

The goal of this longitudinal study is to examine the relative contribution of infant socioemotional factors in the cognitive competence assessed during the preschool period. The following variables were measured in infancy and related to intelligence performance at 43 months: attachment security, distress during separations from mother and temperament as perceived by caregiver. Participants were 46 mother-infant dyads. Results indicate that insecure-ambivalent infants obtain the highest scores on the Stanford-Binet Verbal Comprehension Index. Findings also suggest that a high level of distress during the second separation episode of the Strange Situation predicted superior intellectual performance on the Verbal Comprehension and the Nonverbal Reasoning/Visualization factors. Parental evaluation of infant's temperament was not associated with any cognitive measures at 43 months. These results suggest that although insecurity of attachment is related to many forms of later maladaptation, non-optimal mother-infant interactions can help develop certain cognitive strategies and thus favor specific abilities in children.

#301

EXPLORING THE MOTHER-BABY EXPERIENCE THROUGH VISUAL ART.

Xeros-Constantinides, S., ‘Wundeela’, Maroondah Hospital Child & Adolescent Mental Health Service, 21 Ware Cres., Ringwood East, Victoria, 3122, Australia.   rastru@unimelb.edu.au

An Exhibition of Art work exploring women’s experiences around reproduction and early motherhood was held at the University of Melbourne in June 2001, in conjunction with the conference “Women’s Bodies, Women’s History: conversations across time and cultures”.  The works on display explored socio-historical dimensions, personal and family dimensions, and the clinically-reported experiences of women (patients) in the peri-natal period.  The works included drawings, paintings, prints, photography, material collages and embroidery.  As well as referencing the body in its biological/physical dimension, the works alluded to other aspects of women’s experiences – including psychic trauma and loss.  The mother-infant relationship was also variously referenced.  The responses of delegates to the Exhibition were sought during and after the Exhibition.  Many who reported on their experience commented that the Exhibition was both provocative and emotionally moving. The visual arts provide an avenue for discussion and exploration of important reproductive and mother-baby experiences.

#302

COMMUNITY EDUCATION OF INFANT EMOTIONAL NEEDS.

Flory, V. Child and Adolescent Mental Health Service, Maroondah Hospital, Victoria, Australia.  chandler@mira.net.

The objective of this study was to examine the effectiveness of a community education program on infant emotional needs.  26 community mothers with infants aged 1 to 9 months attended 3 workshops conducted by the author.  Self-report on a 5 point scale indicated that mothers had learnt a considerable amount on infant emotional needs, had changed their parenting behavior somewhat and were very satisfied with the workshops.  Parental behavior, affect and attributions were gauged using 2 scenarios from the Parental Empathy Measure.  Mothers imagined their child as a 4 month old crying after a feed and nap, and a preschooler distressed after a sibling's birth and wrote their behavior, affect and attributions for these situations.  Analyses of variance revealed no significant differences between pre and post groups on parental behavior, affect and attributions, but all means were higher for the post group.  Negative correlations existed between behavior, affect and attributions and amount of change in parenting behavior, indicating that mothers who were less empathic made greater changes to their parenting behavior.

#303

THE MATERNAL REPRESENTATIONS AT THE FALSES ACCUSATIONS ABOUT  SEXUAL ABUSE  AT CHILDREN < 4 YEARS OLD.

Ibáñez,M., Petitbó,D., Pou,J., Comas, Ll.,Bassets,J. Unitat Funcional de Abus i Maltractement (UFAM) Hospital Universitari de Sant Joan de Déu de Barcelona, passeig de sant Joan de Déu, 2, 08950 Esplugues (Barcelona) Spain. Maibanez@worldonline.es.

 We will study the maternal representations (“R” interview, Edicode) of 34 mothers that go to the UFAM because they suspect that their ex_parteners (child’s father) abuse the child at the different set visits up by  the parent’s divorce. This abuse is not confirmed by the medical and psychological examinations. The abuse’s fantasies to overturn the psychic, emotional and behavioral interaction between mother and infant.  We consider this relation as a emotional abuse (Whiting 76). Our research questions are: 1- do fantasies of sexual abuse relate to the presence of insecure maternal representations? Does stress adaptative disorder relate to the presence of insecure maternal representations? The clinical group was compared with a control group of non-clinical mothers of infants 30m.o. N=34 and with a clinical group of mothers of abused children N=34. We applied analysis data with Chi2. The results will be discussed in terms of whether the presence of insecure maternal representations are related to presence of fantasies abuse or not and it can clarify this clinical situation.

#304

THE PREVALENCE OF MENTAL HEALTH PROBLEMS IN DANISH INFANTS.

Skovgaard AM, Houmann T, Olsen EM, Christiansen E, Lichtenberg A, Landorph S, Heering K, Kaas-Nielsen S, Samberg V, Jørgensen T.

Child Psychiatric Department, University Hospital of Copenhagen, Glostrup, Denmark  annemetteskovgaard@dadlnet.dk

The prevalence of mental health problems in infancy is studied in a birth cohort of 5560 children born 1.1 – 32.12 2000 in the County of Copenhagen. The children are examined by the public health nurses at 2 weeks, 2-3 months, 4-6 months and 8-10 months of age and items concerning infant mental health are systematically recorded.  The mental health problems of the children are afterwards described in symptom clusters, according to the diagnostic categories of DC 0-3, and prevalence rates of Axis I primary diagnoses are estimated. The physical and psycho-social background factors and associations to developmental problems, problems in mother-infant relationship and specific symptoms are estimated. Results concerning the prevalence, distribution and correlates of developmental problems and problems in mother-infant relation will presented and the implications for preventive intervention discussed.

#305

PROMOTING INFANT MENTAL HEALTH IN PRIMARY CARE.

Almqvist, S., Nurmela , A-E., Salo, S.,  Kinnunen, K. , Valtonen U., Almqvist F. Helsinki University Hospital Lastenlinnantie 2, 00250 Helsinki, FINLAND, and Social- and Health Centre of  Espoonlahti. fredrik.almqvist@hus.fi.

The importance of early interaction and secure attachment stresses the need to develop services for small children and their families at the basic level of health care and social welfare. The PILARI project was carried out in well baby clinics and day care units in the area of Espoonlahti, in co-operation with the Centre for Infant Mental Health at the Helsinki University Hospital. We developed a model for identifying early risks, doing early interventions and supporting the developmental needs of children and parents.  Health nurses, day-care teachers and social workers trained themselves to become aware of early risks, and in supporting children, parents and the interaction between them.  A combination of lectures, pear group supervision, literature studies and reflective networking resulted in: 1) grossly improvement of knowledge on infant mental health, 2) readiness and skills to understand and support development and relationships in well-baby clinics, in day care and in social work, 3) increased co-operation between maternity and well-baby clinics, day-care units, social work, child guidance clinic and child psychiatric services.

#306

EVALUATION OF A RURAL HEALTHY FAMILIES AMERICA PROGRAM: THE IMPORTANCE OF TARGET POPULATIONS.

Whipple, E.E. & Nathans, L.L., Michigan State University, School of Social Work, East Lansing, MI  48824 USA. whipple@msu.edu  

This presentation describes sociodemographic, program involvement, and outcome variables for 115 families involved in a rural HFA program for over 2 years. Measures completed quarterly include: Sociodemographic Questionnaire; Program Involvement Questionnaire; HOME Inventory; Parenting Stress Index/SF; and the Ages & Stages Questionnaire.  HFA-involved families did well in health and developmental outcomes: the mean number of illnesses or accidents was .68, of emergency room visits was .38, number of subsequent pregnancies was .22 , and CPS referrals was .36.  Immunization rates ranged from 95% at 2 months and 67% at 15 months.  Overall, children successfully met developmental milestones, although demonstrated fewer changes over time in regard to stress levels or the home environment than expected.  The most revealing results involved relationships between mother’s sociodemographic characteristics and outcome measures.  The applicability of some HFA program tenets (i.e., persistent outreach in a geographically-dispersed area with families who do not engage, targeting high risk families in rural areas with fewer specialized service providers to rural area are discussed.  Sociodemographic characteristics need be carefully considered to effectively target families who are most likely to benefit from program involvement.