Friday, 14 January 2005 - 10:00 AM

This presentation is part of: Early Intervention in Children

The Difficult Baby and the Eye of the Beholder: A Role for Social Work in Infant Mental Health

Purpose: Three of the most commonly reported problems that parents of infants bring to the attention of health professionals involve difficulties in excessive crying, sleeping and feeding. An area that is the focus of much debate is whether these reported regulatory difficulties represent real child illnesses or are reflective of early disturbances in caregiver-child relationship quality. Infant sleeping problems and excessive crying, in particular, can pose a significant disruptive influence on family functioning and, through dynamic transactional relationship processes, subsequent child behavioral and mental health outcomes. The question of where intervention efforts are best focused – either at remediating the child’s regulatory difficulty or at reframing the caregivers negative perceptions of their baby’s behavior – necessitates a more complete understanding of the complex processes and mechanisms involved. The current study examined which factor is more important to preschool behavioral outcomes; maternal perception of infant crying and sleeping as problematic or the actual crying and sleeping behavior itself.

Method: The sample consisted of 240 mother-child dyads from the Michigan Family Study, a longitudinal study examining the link between infant regulation problems and mental health outcomes. Observations included a home-visit and laboratory playsession at 7, 15, and 33 months-of-age. The relationship of both maternal perceptions of 7 month-old's crying and sleeping and actual infant behavior to environmental variables and behavioral outcomes in the third year of life was examined.

Results: The mother's perception of crying or sleeping as problematic at 7 months-of-age was more predictive of behavioral outcomes at 33 months-of-age than was the actual amount of infant crying or sleeping. High-crying infants at 7 months whose mothers did not see their crying as problematic went on to have better outcomes than low-crying infants whose mothers saw it as problematic. In addition, the actual amount of sleep at 7 months was not related to later behavioral problems, but negative maternal perceptions of infant sleeping behavior was predictive of later difficulties. Environmental and family factors linked to negative maternal perceptions were also examined.

Implications for Intervention Design: The importance of maternal perceptions of their infant to later outcomes, as compared to actual infant behavior, provides important insight into the transactional nature of these developmental pathways. The analysis also points to the need to adopt an intervention strategy that focuses on the mother's beliefs and representations about her child rather than on the infants' crying or sleeping itself. Two logical ports of entry for intervention are suggested by the current study. Social Work practitioners should work to reframe caregiver expectations about infant behavior and to reduce negative perceptions and the attribution of hostile intent to infant behavior. Our efforts, however, cannot ignore the environmental risk faced by many families and the strong relation between high levels of adversity and stress and subsequent caregiver perceptions.

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