“R” Relationship and Affect

“R” Relationship and Affect

Developmental models have evolved from many years of discovery in the field of infant mental health.  Beginning in the 1950s, there was a new understanding of the importance of parent-infant interaction, known as attachment theory.

Bowlby, J. (1951). Maternal care and mental health. World Health Organization (WHO). Monograph Series, no. 51. Geneva: World Health Organization.

Ainsworth, M., Bell, S.M., & Stayton, D. (1974). Infant-mother attachment and social development: Socialization as a product of reciprocal responsiveness to signals. In M. Richards, ed., The Integration of the child into a social world. Cambridge: Cambridge University Press.

Stern, D. (1974). Mother and infant at play: The dyadic interaction involving facial, vocal, and gaze behaviors. In M. Lewis and L. Rosenblum, eds., The effect of the infant on its caregiver. New York: John Wiley & Sons, Inc.

 

Dr. Greenspan and Serena Wieder contributed to the field with their study of the importance of mother-child interactions in high-risk infants.

National Center for Clinical Infant Programs (1987). Infants in Multirisk Families. Case Studies in Preventive Intervention. Stanley I. Greenspan, Serena Wieder, Robert A. Nover, Alicia Lieberman, Reginald S. Lourie, Mary E. Robinson, eds. Clinical infant Reports, Number three. International Universities Press.

 

Other researchers contributed to the appreciation of parent-child interaction for child development:

Mundi, P., Sigman M., Kasari C. (1990). A longitudinal study of joint attention and language development in autistic children. Journal of Autism and developmental Disorders 20:115-128.

Alan Fogel (1993), Developing Through Relationships, The University of Chicago Press. Synopsis available at http://www.press.uchicago.edu/presssite/metadata.epl?mode=synopsis&bookkey=52786

Gernsbacher M.A., (2006). Toward a behavior of reciprocity. Journal of Developmental Processes, 1, 139-152. http://psych.wisc.edu/lang/pdf/gernsbacher_reciprocity.pdf

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“Parent-mediated” or “Parent implemented” interventions are now recognized as evidence based on recent reviews. There are many studies that find correlations between the strength of parental sensitivity and responsiveness and child outcomes, including:

Mahoney, G., Perales, F., Wiggers, B., & Herman, B. (2006). Responsive Teaching: Early Intervention for Children with Down Syndrome and Other Disabilities. Down Syndrome Research and Practice, 11(1), 18-28.

Solomon, R., Necheles, J., Ferch, C., & Bruckman, D. (2007). Pilot study of a parent training program for young children with autism: The PLAY Project Home Consultation program. Autism, 11(3), 205-224.

Siller, M., & Sigman, M. (2008). Modeling longitudinal change in the language abilities of children with autism: Parent behaviors and child characteristics as predictors of change. Developmental psychology, 44(6), 1691.

Ingersoll, B., & Wainer, A. (2013). Initial efficacy of Project ImPACT: A parent-mediated social communication intervention for young children with ASD. Journal of autism and developmental disorders, 43(12), 2943-2952.

Siller, M., Swanson, M., Gerber, A., Hutman, T., & Sigman, M. (2014). A parent-mediated intervention that targets responsive parental behaviors increases attachment behaviors in children with ASD: Results from a randomized clinical trial. Journal of autism and developmental disorders, 44(7), 1720-1732.

Bottema-Beutel, K., Yoder, P. J., Hochman, J. M., & Watson, L. R. (2014). The role of supported joint engagement and parent utterances in language and social communication development in children with autism spectrum disorder. Journal of autism and developmental disorders, 44(9), 2162-2174.

Patterson, S. Y., Elder, L., Gulsrud, A., & Kasari, C. (2014). The association between parental interaction style and children’s joint engagement in families with toddlers with autism. Autism, 18(5), 511-518.

Pajareya, K., Sutchritpongsa, S., & Kongkasuwan, R. (2019). DIR/Floortime® Parent Training Intervention for Children with Developmental Disabilities: a Randomized Controlled Trial. Siriraj Medical Journal, 71(5), 331-338.

Schertz et al. used a qualitative analysis to describe factors affecting parent self-efficacy, showing the value of their involvement.

Schertz, H. H., Lester, J. N., Erden, E., Safran, S., & Githens, P. (2020). Challenges and contributors to self-efficacy for caregivers of toddlers with autism. Autism, 24(5), 1260-1272.

And Liu and Schertz reported parents’ outcomes using JAML, and its effects on child outcomes.

Liu, X., & Schertz, H. H. (2022). Parents outcomes of parent-mediated intervention for toddlers with autism. Topics in Early Childhood Special Education, 42(3), 259-268.

Schertz, H. H., Liu, X., Odom, S. L., & Baggett, K. M. (2022). Parents’ application of mediated learning principles as predictors of toddler social initiations. Autism, 26(6), 1536-1549.

Mahoney and Solomon analyzed how parent’s interaction mediated the effects on children’s outcomes in the study of PLAY Project.

Mahoney, G., & Solomon, R. (2016). Mechanism of developmental change in the PLAY project home consultation program: Evidence from a randomized control trial. Journal of autism and developmental disorders, 46, 1860-1871.

 

In 2020 Mahoney and Solomon again analyzed the 2014 study regarding the effects of parental depression on outcome. They found that levels of parental depression did not affect parents’ interaction or child engagement and that those with more depression at the onset had the greatest improvement in their depression symptoms.

Mahoney, G. J., & Solomon, R. M. (2020). Effects of parental depression symptoms on parents and children with autism spectrum disorder in the play project home consultation program. International Journal of Early Childhood Special Education, 12(1), 28-40. https://doi.org/10.20489/intjecse.722333

 

Karaaslan and Mahony analyze how maternal responsiveness mediated pivotal behaviors, which contributed to outcomes in a program using Responsive Teaching.

Karaaslan, O., Diken, I., & Mahoney, G. (2013). A randomized control study of Responsive Teaching with young Turkish Children and their mothers. Topics in Early Childhood Special Education, 33, 18-27. https://doi.org/10.1177/0271121411429749

Karaaslan, O., & Mahoney, G. (2015). Mediational analyses of the effects of responsive teaching on the developmental functioning of preschool children with disabilities. Journal of Early Intervention, 37(4), 286-299.

 

In 2016, a randomized controlled trial demonstrated a “significant and large effect” of a 12 course of DIR to increase “parental reflexive function capacities.”

Sealy, Julie, and Ira P. Glovinsky. “Strengthening the reflective functioning capacities of parents who have a child with a neurodevelopmental disability through a brief, relationship‐focused intervention.” Infant Mental Health Journal 37, no. 2 (2016): 115-124.

 

In 2020, Leadbitter et al. published a qualitative study showing that parents who participated in PACT experienced improvements in the quality of their relationships and interactions with their children.

Leadbitter, K., Macdonald, W., Taylor, C., Buckle, K. L., & PACT Consortium. (2020). Parent perceptions of participation in a parent-mediated communication-focussed intervention with their young child with autism spectrum disorder. Autism, 24(8), 2129-2141. https://doi.org/10.1177/1362361320936394

 

The following 6 articles are reports about VIPP- Video Interaction to Promote Positive Parenting- VIPP uses video feedback to increase caregivers’ awareness of their infant’s social communication and guide their responses to build infant social engagement and interaction.  These studies illustrate the impact of caregivers’ relationship on the developmental course of high-risk and children with autism. Green et al. (2013) reported an initial pilot case series of iBASIS-VIPP with infants 8-10 months of age at high risk for autism. In 2015, Green et al. (2015) showed broad effects in a RCT using iBASIS-VIPP with high-risk infants, and a follow-up study showed extended treatment effects (Green 2017). In 2015, a RCT reported the effects of a version of VIPP, called VIPP-AUTI, adapted for young children with a diagnosis of autism (Poslawsky et al., 2015). And in 2021, a RCT reported decreased symptom severity with infants showing early signs of autism (Whitehouse et al., 2021).

Poslawsky, I. E., Naber, F. B., Bakermans-Kranenburg, M. J., De Jonge, M. V., Van Engeland, H., & Van IJzendoorn, M. H. (2014). Development of a video-feedback intervention to promote positive parenting for children with autism (VIPP-AUTI). Attachment & Human Development, 16(4), 343-355.

Poslawsky, I. E., Naber, F. B., Bakermans-Kranenburg, M. J., Van Daalen, E., Van Engeland, H., & Van Ijzendoorn, M. H. (2015). Video-feedback Intervention to promote Positive Parenting adapted to Autism (VIPP-AUTI): A randomized controlled trial. Autism, 19(5), 588-603.

Green, J., Wan, M. W., Guiraud, J., Holsgrove, S., McNally, J., Slonims, V., … & BASIS team. (2013). Intervention for infants at risk of developing autism: a case series. Journal of autism and developmental disorders, 43, 2502-2514.

Green, J., Charman, T., Pickles, A., Wan, M. W., Elsabbagh, M., Slonims, V., … & Johnson, M. H. (2015). Parent-mediated intervention versus no intervention for infants at high risk of autism: a parallel, single-blind, randomised trial. The Lancet Psychiatry, 2(2), 133-140.

Green, J., Pickles, A., Pasco, G., Bedford, R., Wan, M. W., Elsabbagh, M., … & McNally, J. (2017). Randomised trial of a parent‐mediated intervention for infants at high risk for autism: Longitudinal outcomes to age 3 years. Journal of Child Psychology and Psychiatry, 58(12), 1330-1340.

Whitehouse, A. J., Varcin, K. J., Pillar, S., Billingham, W., Alvares, G. A., Barbaro, J., … & Hudry, K. (2021). Effect of preemptive intervention on developmental outcomes among infants showing early signs of autism: A randomized clinical trial of outcomes to diagnosis. JAMA Pediatrics, 175(11), e213298-e213298.

Also, an adapted version of Responsive Teaching was reported in 2015 for children at high risk of autism.

Baranek, G. T., Watson, L. R., Turner-Brown, L., Field, S. H., Crais, E. R., Wakeford, L., … & Reznick, J. S. (2015). Preliminary efficacy of adapted responsive teaching for infants at risk of autism spectrum disorder in a community sample. Autism research and treatment, 2015.

 

Increasingly, the emergence of autistic symptomatology is considered to be a process of derailing development with both constitutional and transactional causes.

Klin, A., Micheletti, M., Klaiman, C., Shultz, S., Constantino, J. N., & Jones, W. (2020). Affording autism an early brain development re-definition. Development and Psychopathology, 32(4), 1175-1189. https://doi.org/10.1017/S0954579420000802

Green, J. (2022). Autism as emergent and transactional. Frontiers in Psychiatry, 13, 988755. https://doi.org/10.3389/fpsyt.2022.988755