Poster group
Details of individual items:
poster
Objective and Design. In 1996, O'Boyle & Rothbart published the IRI, the first parent reportinstrument for assessing distress ('negative reactivity') to sensory stimulation in infants. IRIscores between 4 month old infants with and without a 'history' of colic (not operationallydefined) were different in one sample but not another. We report a replication in a controlledprospective comparison of infants with diary confirmed Wessel's colic (n39) and controls(n48) at both 6 weeks and at 4.7 months of age (after colic resolves). Parents completed the IRIand 4-7 days of a previously validated Baby's Day Diary at each age.Results. (1) Four-month IRI mean scores (2.1 & 2.3) and variabilties (SD:0.6 & 0.5) for bothcontrol and prior colic infants (respectively) were very similar to O'Boyle & Rothbart's 4-monthold samples (2.2 +/- 0.6 and 2.5 +/- 0.6). (2) At 6 weeks, infants with colic cried (fuss + cry +unsoothable cry) more frequently (9.6 v 6.6 bouts/day, t3.8;P<0.001) with longer bout lengths(29 v 18 min/bout, t3.9;P<0.001) than controls (total daily duration: 4.6 v 2.0 hrs/day). IRIscores were higher in infants with colic (2.8 v 2.5, t2.8;P<0.01). At 4 months, infants with colicstill cried more frequently 7.3 v 4.7 bouts/day, t3.1;P<0.002) but bout length was similar (18 v16 min/bout, t.8;P0.41) for total daily duration of 2.2 v 1.3 hrs/day. For IRI scores, asignificant effect for age interacted with colic status (F4.1;P<0.5) such that IRI scores were nolonger significantly different (2.3 v 2.1, t1.5; P0.13). (3) Six week to 4 month IRI scores werenot stable for infants with colic (r0.25; P0.18) but were for controls (r0.35; P0.03). (4) Ofthe 10 (of 72) correlations that were statistically significant (all r >0.33) among IRI scores andcrying component measures (fuss, cry, unsoothable cry) in colic and non-colic infants at bothages, 6 involved unsoothable cry measures, 3 fuss measures, and 1 cry measure. Of the 4 (of 36)correlations that were statistically signficant (all r >0.33) between 6 weeks and 4 months, 6-week unsoothable cry or fuss measures predicted 4-month IRI 4 times, but 6-week IRI did notpredict 4-month fuss, cry, or unsoothable cry. Conclusions and Interpretation. In a completely independent sample of North American infants,four month IRI scores are very similar to those in the original study. In diary confirmed infantswith and without colic, IRI scores were greater during colic, but this difference was transient,and not stable in infants with prior colic. IRI scores seem to be predominantly affected byfrequency and/or bout lengths of unsoothable crying. Four month ratings of IRI may be affectedin part by prior crying experience during the normative early increase in crying behavior duringthe first three months.
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Persistent crying has often been cited as a predictor of child abuse.However, only a small percentage of persistent criers is abused. It islikely that parental interpretations of aversive behaviors, rather thanthe simple amount of crying, is a major factor in abuse. Experts viewearly crying as unintentional and reflective of physiological states, butparents typically ascribe intentionality to their infant's behavior frombirth. One purpose of this study was to explore parental perceptions ofintentionality to better understand beliefs that may mediate caregivingstrategies.Middle-class parents of 8 healthy newborns (4 female, 4 male) agreed toparticipate in a grounded theory study of infant crying. Parents wereinterviewed three times (on average) when their infants were between 2weeks and 3 months of age. Parents also completed 24-hour diaries ofcrying, sleeping, and feeding patterns before each interview. Interviewsincluded open-ended questions regarding crying and other communicativebehavior. Transcripts of interviews were coded using NVivo software foranalyzing qualitative data. When the babies were 3 months of age, parentscompleted the Carey Infant Temperament Scale and the Feldman and ResnickInfant Intentionality Interview.Analyses suggested that the infants could be clustered into two groups:infants who were relatively more demanding compared with infants who wererelatively more rewarding. Excessive crying (total crying and fussing for3 or more hours in a 24-hour period) did not differentiate between the twogroups. Rather, the more demanding babies had high cry-to-fuss ratios andparents frequently described these babies as having colic/gas pains orfits of frantic crying, suggesting that parents had difficulty soothingtheir babies. These babies were also more likely to have difficultratings on the temperament scale. Babies who were more rewarding werelikely to have easy temperaments and had low cry-to-fuss ratios. Parentsof rewarding babies also commented frequently on playful behaviors,smiling, and non-cry vocalizations such as cooing.Parents of the more rewarding babies had high beliefs in intentionalitybased on both parental interviews and questionnaire data. They were alsomore likely to comment that their babies had positive intentions ratherthan negative intentions, and to make positive attributions rather thannegative attributions. In contrast, parents of demanding babies had lowerbeliefs in the intentionality of their babies' behavior and they were lesslikely to make attributions (either positive or negative) than parents ofrewarding babies.These data are consistent with a positivity bias in parental perceptions(Miller, 1995), suggesting that parents are likely to be optimists and toattribute intentionality to good behaviors. By contrast, problembehaviors are more likely to be viewed as transitory characteristics ofsituational origin, rather than intentional or dispositional. Thispositivity bias may be a protective factor in buffering demanding infantsfrom abuse in a low risk sample. However, it is hypothesized that parentsunder stress may view their infants' aversive behaviors as intentional andmanipulative. Thus, demanding babies in a sample at risk for abuse may notbe protected by the positive parental distortions observed in this study.
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Several previous studies have assessed how caregiving practices contribute to fussing andcrying levels in young infants. In particular, maternal responsiveness and increased holdinghave received much attention, but have produced contradictory findings. The primary aim ofthe present study was to examine whether maternal response and flexibility attitudes, as wellas caregiving behaviors (particularly holding and feeding), predicted reported amounts of fussing/crying in the first 12 weeks in Danish infants. Randomly selected mothers (2-4 days after delivery) at a major Copenhagen hospital wereinvited to participate in a study about caregiving and infant crying in the first 12 weeks oflife. Inclusion criteria were: Danish mother, GA>37 weeks, singleton birth, no special careadmittance. 150 mother-infant pairs entered the study (55% of those approached).The Crying Patterns Questionnaire (St. James-Roberts & Halil, 1991) was completed at 7-10days, and 24-hour behavior diaries were completed for three consecutive days at 3-, 6- and 12weeks. At all four age points, maternal response attitude was measured using a revisedversion of Crockenberg and Smith's Maternal Responsiveness Questionnaire (1982), andcaregiving flexibility was measured using the Schedule-Demand Inventory (Power, et al.,1990).As expected, the attitude of these Danish mothers was one of prompt response to crying andhigh flexibility in caregiving. Mean holding amounts at all ages were greater than thosepreviously reported for western community samples. At three weeks, mothers reportedholding their infants for 3 hours, 44 minutes in a 24-hour period; 3 hours, 28 minutes at sixweeks; and, 2 hours, 59 minutes at twelve weeks. In comparison, St-James-Roberts et al.(1995) in England reported mean holding amounts of 1 hour, 55 minutes at two weeks; and 2hours, 6 minutes at six weeks.Consistent with previous western findings, infant distress consisted mostly of fussing (80% atall ages), and fussing was shown to be a more stable individual infant characteristic (r.57-.73, p <.001) than crying (r.38-.53, p <.001). Support was found for a decrease in totaldistress (fussing/crying) between 3 and 12 weeks (p <.001), as well as for an eveningfussing peak (p <.001). In contrast to previous western findings, mothers reported substantially lower mean totalcrying and fussing amounts, especially at 6- and 12 weeks (79 mins; 48 mins). Furthermore, mean crying amounts were strikingly lower than previously reported figures (<20 min at 3-and 6 weeks, and <10 min at 12 weeks). No 6-week peak was found. On the contrary, fussingand total distress decreased significantly from 3 weeks to 6 weeks (p.012).Moderately higher levels of holding and prompt maternal response and high flexibilityattitudes in the early weeks may have an impact on infant distress, particularly crying, andmay eliminate the 6-week peak. The higher stability of individual differences for fussing thanfor crying may indicate that fussing is more a characteristic of the infant, while crying ismore a reflection of the interventions of the caregiving environment.ReferencesCrockenberg, S.B. & Smith, P. (1982). Antecedents of mother-infant interaction and infantirritability in the first three months of life. Infant Behavior and Development, 5, 105-119.Power, T.G., Gershenhorn, S. & Stafford, D. (1990). Maternal perceptions of infant difficultness: The influence of maternal attitudes and attributions. Infant Behavior andDevelopment, 13, 421-437.St. James-Roberts, I & Halil, T. (1991). Infant crying patterns in the first year: normalcommunity and clinical findings. Journal of Child Psychology and Psychiatry, 32, 951-968.St. James-Roberts, I., Hurry, J., Bowyer, J., Barr, R.G. (1995). Supplementary carryingcompared with advice to increase responsive parenting as interventions to prevent persistentinfant crying. Pediatrics, 95(3); 381-388.
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Although epidemiological studies have shown a strikingly high prevalence (15-30%) of persistent crying in healthy new-borns, its prognostic evaluation and classification remains a matter of controversy. Thus, excessive crying is viewed as a transient disturbance of normal development, an expression of missing parental competence or, to the extreme, as a psychiatric syndrome (regulatory disorder).Recent epidemiological and clinical studies suggest a relationship between excessive crying and temperamental factors, i.e. hyperreactivity to stimulation, self-regulation capacities, maturation of the neuromotor system, and disturbed regulation of behavioural states, especially a dysregulated sleep-wake organisation. Moreover, parent-infant interaction plays a pivotal role in the regulation of infant states. More research is needed to clarify the significance of transient neurological immaturity, constitutional factors, and quality of parent-infant interaction for the development or maintenance of persistent crying. Especially, it should be focused on infant's individual skills and capabilities independent of situation-specific features and of influences of mother-infant-interaction.Therefore, our objective was to investigate the influence of neurological maturity and of constitutional factors on the infant's regulatory capacities.A group of infants (n3D22, 9 girls) - who were referred to the Munich Interdisciplinary Research and Intervention Program for Fussy Babies because of persistent crying - was examined and compared to a control group of 17 age-matched infants (7 girls) without cry problem. Responsiveness to social, mildly aversive and non-aversive stimuli in visual, auditory, vestibular and tactile modalities was assessed in two standardised contexts. On admission (average age: 2.9 months) a semi-structured paediatric examination and a newly developed sequence of stimuli of the same qualities as above were performed within one week. The same procedures were carried out at an age of eight months (follow-up). To minimize effects of mother-infant-communication the mother was instructed not to interfere during the sessions.Video recordings of these examinations were micro-analysed continuously. A homogeneous category system was developed which is applicable for these two measuring points as well as for both contexts. The event-based coding system includes: a) attentional regulation assessed by the infant's visual orientation, b) vocalizations (from distinct negative to positive), c) motor behaviour (quality as well as intensity items), and d) facial expressions. To receive further information about self-soothing capabilities the amount of soothing needed during the examination was scored. Additionally, the reinforcement value of infant's behaviour and the examiner's persistence were investigated.Besides descriptive statistics, multivariate analysis of variance with and without repeated measurement will be performed to show differences between clinical and control group; subgroups should be identified by sequential analysis.We expect differences between groups as to self-regulatory capabilities and behaviour patterns. Relations to sleep and feeding records or current state will be considered as well. Differences between the two contexts within one measuring point indicate situation-specific features influencing individual performance. Stability of individual self-regulatory capabilities across contexts and measuring points can be interpreted as dispositional factors. Results will be discussed taking into account a systemic model of development, with special emphasis on the infant's temperament.
poster
Epidemiological studies show a fairly high proportion (15-30%) of persistent crying in samples of healthy, mature born newborns. Despite this high prevalence its etiology, pathophysiology and long term risks are among the least well understood. According to recent research excessive crying is associated with sleep-wake organisation, temperament features, i.e. hyperreactivity to stimulation, and problems in self-regulation capacities. These features are closely interconnected with processes of normal postnatal adaptation and maturation, and aspects of mother-infant interaction (Papou9Aek & Hofacker, 1995). More research is needed to clarify the role of different aspects of biobehavioural organisation of persistent crying infants, like distribution of sleeping and waking, their physiological rhythms, state transitions, regulation of arousal and attention. Especially, some insight is needed, whether situation specific abilities, persistent crying is an expression of a more transient regulatory dysfunction and situation specific features, or of difficult temperament independent of dysfunctional mother-infant interaction.To answer this question infants between 1 and 5 month of age (n3D22; 7 girls), who were referred to the Munich Interdisciplinary Research and Intervention Programme for Fussy Babies because of persistent crying, were examined and compared with community based age-matched control sample with no cry problem (n3D17; 9 girls) at time of referral (mean age: 2,9 months) and at the age of 8 months (follow up; same procedures).To gain information about biophysiological organisation of the infants, saliva were collected on three consecutive days four times a day (7am, 11am ,15pm ,19pm) and analysed for cortisol. Cortisol is the most prominent indicator for the stress sensitive HPA-axis, which has a daily rhythm by its own. Sleep-wake organisation, the circadian distribution of sleep, fussiness, and crying were scrutinized by 24h-sleep-wake protocols filled in by the parents for 5 days. The physiological and daily rhythms of sleeping and waking of the clinical and control group were compared and related to findings to self-regulation abilities assessed in two contexts, during a physical examination and a newly developed paradigm, where the infant is exposed to a sequence of aversive and non-aversive stimuli in different sensual modalities by a neutral examiner in order to minimise effects of mother-infant interaction. Behavioural reactivity, modulation of arousal, state organisation and motoric restlessness were scored in both contexts via microanalytical behaviour analyses of the videotapes.We expect differences in sleep-wake organisation between clinical and control group, at least at time of referral. Moreover it should be proved whether these discrepancies have some correspondence in cortisol values, especially are morning values correlated with sleep-wake organisation and/or aspects of self regulatory functioning in one or both contexts and are there changes depending on time.The results will be discussed from a bio-psycho-social perspective.
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Differences between colic and 'normal' crying with regard to their acoustic quality and perceptual ratings have been well established. However, perceptual ratings by clinical groups have rarely been investigated. There are studies demonstrating that mothers of infants suffering from 'colic' rated the crying of their own baby as being more urgent, piercing, grating and arousing and felt more sad than mothers of non-colic-babies did.The objective of the present study was to show (1) that there are differences in perceptual ratings between mothers who have an excessively crying infant and mothers who have not, and (2) that there are differences in their psychophysiological stress responsiveness.Samples enrolled in our study were 2 groups of mothers (n 3D 25 each, all primiparae), one with and one without excessively crying infants. Both groups were matched for maternal age, age of infant and sex of infant. All mothers with an excessively crying baby had received counselling at the Munich Interdisciplinary Research and Intervention Program for Fussy Babies.For perceptual ratings, a semantic differential was used comprising 25 items adapted from former research on cry characteristics (Zeskind & Lester, 1978) and from the Mood-Adjective-Checklist by Frodi et al. (1978). The stimuli (8 different crying sounds) used in our study were recorded during a paediatric examination at the Munich Interdisciplinary Research and Intervention Program. They were 10-second interval recordings of 4 excessively crying and 4 non excessively crying babies when at the highest level of arousal. These recordings were copied to a CD in an endless loop in order to play them to the mothers over headset while filling in the questionnaire (semantic differential). The cries were presented at random. The items of the semantic differential were counterbalanced and randomised as well.Salivary-free cortisol levels were measured 3 times: Once before playing the cries (base-rate), once 15 minutes and once 30 minutes afterwards.We were able to show that mothers who had an excessively crying infant felt more disturbed, but interpreted the crying as being more healthy, clearer and less manipulating than mothers who did not have an excessively crying baby. Interaction effects were found between groups and objective loudness of the cries: Mothers of excessively crying babies evaluated relatively low cries (66,7 dB[A] - 69 dB[A]) significantly less distressing and less urgent, and felt less worried than mothers of the control group. For the louder cries (69,8 dB[A] - 73,9 dB[A]) no differences were found.We conclude from our findings that the mothers with an excessively crying baby had probably acquired effective coping strategies during intervention: When presented with mild cries, mothers with an excessively crying baby assert to be less distressed and bothered than mothers of the control group. Our data on the psychophysiological stress responses, currently being analysed, are expected to further elucidate this issue.