• By Laura Whybra
  • Posted on Tuesday 20th May, 2014

Hope for stressed out mothers with irritable babies

strong>Shortly after you bring your bundle of joy home, you discover that the magical moments you expected disappear and hard reality hits. The baby you’ve waited 40 weeks to hold cries all the time. You’ve tried everything you can think of to comfort her, yet nothing works. Is there hope for either of you? Researchers testing a home visiting program for irritable infants from economically stressed families may have an answer.For low-income families, welcoming a new baby into the world comes with its own set of challenges even under the best circumstances. If that new baby is also highly irritable, the challenges may be so great that mother and baby struggle to develop a healthy attachment – and this failure to form an emotional bond can have a lasting impact on the baby’s well being. Researchers from the University of Maryland and Pennsylvania State University were curious about whether attachment interventions could help mothers and babies in such high-stress situations. So they developed and tested a brief attachment-based intervention that appears to be effective in helping some mothers and babies, though not all. The program improved the attachment levels of infants who were highly irritable, but it had no effect on moderately irritable infants. What is the attachment-based program?The Circle of Security – Home Intervention (COS-HV4) was developed specifically for irritable infants from economically stressed families. The intervention consists of four home visits. The core of COS-HVA4 occurs in three 1-hour home visits taking place every three weeks when the infant is between six and nine months of age. The day before the home visit, mothers are asked to videotape themselves and their babies for half an hour as they go about their normal routine. Home visits are timed for when the baby is awake and rested. Except for the initial session, each visit begins with a review of the previous session. The home visitor and mother then watch and discuss clips from the videotapes. Mothers are also given “homework” between sessions – for instance, to explain their infant’s needs to a friend, or to try to observe their baby’s needs during daily interactions.About two weeks after the last 1-hour visit, a brief, final visit occurs when the home visitor gives the mother copies of the videotapes and answers any remaining questions or addresses any lingering issues. How did they test its effectiveness?COS-HV4 was tested in a randomized controlled trial of 174 mother-baby pairs living in a large US metropolitan area. Mothers and babies were considered for inclusion in the study if they met very specific criteria. First, the families had to be considered economically stressed. Mothers were considered economically stressed if they met one of two criteria: (a) earned less than $41,000 or (b) if living with the baby’s father, had a combined income of less than $45,000. However, most families in the study had incomes above the US federal poverty line. Second, babies had to be first-born children who were otherwise healthy, and their mothers had to be at least 18 years old and fluent enough in English to participate in the intervention and respond to questionnaires.Finally, if the first two sets of criteria were met, babies were screened for irritability based on the Neonatal Behavioral Assessment Scale (NBAS), a standardized measure of infant temperament. Only infants rated as highly to moderately irritable were included in the study. In total, 220 mother-baby pairs met these criteria and agreed to participate in the study, of whom 174 completed the study. Half of the participants were randomly assigned to receive COS-HV4. The other half were assigned to a control group that received home visits that included readings from popular press materials about parenting. The study measured changes in infant irritability using the NBAS and changes in infant attachment using the commonly used “Strange Situation” procedure. The mothers’ attachment styles were measured using a self-report measure of adult attachment that classifies mothers into one of four categories: secure, fearful, dismissing, and preoccupied. These attachment styles are based on two factors: the degree of discomfort with closeness and intimacy, called “attachment avoidance,” and the intensity of worries about rejection and abandonment, called “attachment anxiety.”Who did it help?The results, the researchers state, provide “…important new insights into ‘what works for whom’ with regard to attachment-based intervention” because not all of the mothers and babies in the study responded to the intervention. This was not surprising to the authors, who expected that mothers would respond differently to their babies based on the child’s irritability, and differently to the intervention depending upon their own attachment style.Overall, highly irritable infants tended to benefit from the intervention. In contrast, moderately irritable infants were largely unaffected by the intervention. Highly irritable children had an 89% probability of being secure with intervention, compared to a 62% chance in the control group. For moderately irritable infants, there was no effect of treatment.The mothers’ attachment style also made a difference for the effectiveness of the program. The benefits were greatest for highly irritable babies whose mothers were either “secure” (low anxiety and low avoidance) or “dismissing” (low anxiety and high avoidance). In the case of “dismissing” mothers, the researchers speculate, there may be a mismatch between the mother’s dismissing attachment style and her baby’s highly irritable temperament. Mothers who are highly dismissing tend to become less responsive when their babies show more distress – and highly irritable babies show a great deal of distress, pushing their mothers to become less and less responsive. This mismatch may help to explain why the program worked so well for this group: highly irritable infants with more dismissing mothers had a 96% of becoming secure with the intervention, compared to a 45% probability in the control group.What do the results mean for other mothers and babies?The study included a very specific group of just 174 mother-baby pairs. The study included only infants rated as highly or moderately irritable from economically distressed, US families. As such, the results may not translate to other populations. On average, the intervention had no effect. Improvements in some groups, especially those with highly irritable babies, were offset by zero improvements in other groups. The authors argue, however, that for particular types of mother-baby pairs who are at increased risk of infant insecure attachment, the COS-HV4 intervention can be a very great help. **************References: Cassidy, J., Woodhouse, S.S., Sherman, L.J., Stupica, B., and Lejuez, C.W. (2011). Enhancing infant attachment security: An examination of treatment efficacy and differential susceptibility. Development and Psychopathology, 23, 131-148. doi:10.1017/S0954579410000696

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