4) the quality of the caregiving relationship, including attachment;. 5) the child's . points allocated, giving a total scale score of 14 for the parent and child each. “false positive affect” in the baby is a form of dissociative behavior, indicating a . A Basic List of Child and/or Parent Assessment Tools. This is by no means a comprehensive list of assessment tools, but these are the ones which I have learned about Clinical Form social functioning in the context of the relationship. They then describe the overall model of infant–parent relationship assessment and elaborate the basic premises that guide their approach.
This study suggests the necessity of clinical development and future research concerning the role of fathers in parent-child interaction interventions. Background Parent-child intervention Finding ways to prevent mental health problems is perceived as an important task within child psychiatry, in concurrence with other authorities and organizations striving to promote the course of children's development.
Since the s the arena of early childhood interventions has been transformed from a modest collection of pilot projects to a multidimensional domain of theory, research, practice and policy [ 1 ]. Such interventions were previously directed towards the children themselves — specifically targeting the needs of disabled children and children growing up in poverty [ 2 ]. The scope and the target group for these interventions have since then broadened and may now include mental health problems at large.
As research in the field of child development has grown, the proliferation of parent-child and family interventions have reflected our increased understanding of the critical and determinative nature of parent-child interaction [ 2 ]. Early childhood intervention has thus experienced a paradigm shift from a child-oriented to a family-oriented approach [ 3 ].
The main theoretical basis generally applied for this type of intervention is attachment theory [ 45 ] which emphasizes the importance of the quality of early relationships [ 2 ].Bowlby's Theory - Attachment
A core feature of this theory is the importance for a child to experience everyday interaction with a reasonably sensitive and sufficiently predictable parent able to provide a "secure base" [ 6 ] from which the child can comfortably engage with the world, balancing inquisitiveness with a need for security. This theory is often complemented by the ecological perspective [ 7 ], which highlights both the interaction of the child as a biological organism within its immediate social environment in terms of processes, events and relationships and the interaction of social systems in the child's social environment [ 8 ].
Within the transactional model [ 9 ] the development of the child is seen as a product of continuous dynamic interactions between the child and his or her family and social context. Among the seminal contributions to the fields of infant development and parent-child treatment, the writings of Daniel Stern [ 16 - 18 ] have offered critical and highly influential new theoretical perspectives.
Stern describes the clinical system shaped during parent-child interventions and emphasizes that the interaction includes the inner representations of the child and the parent as well as their observable behaviour. Stern [ 19 ] stresses the fact that the therapeutic alliance in parent-child treatment must be far more positive and validating than in a traditional psychodynamic therapeutic context.
Studies on the efficacy of interventions The first systematic survey of interventions specifically directed towards the parent-child interaction, based upon attachment theory, was undertaken by van Ijzendorn et al [ 20 ].
This survey, including twelve mother-child interventions, supported the theory that such interventions increased the mothers' sensitivity, but the effect on the children's attachment was surprisingly weak. This result indicated the influence of parental attachment representation on children's attachment through mechanisms other than responsiveness; referred to as "the transmission gap" [ 21 ].
A narrative review by Egeland et al [ 22 ] of 15 attachment-based interventions pointed out that there are many factors at different ecological levels that may interfere with successful intervention. The source of obstacles to a secure parent-child attachment may be found in the child, the caregiver, the care-giving environment, or a combination of all these. In order to meet the participants' needs, the authors recommend flexible broad-based interventions — particularly for high-risk samples, where the parents are often dealing with multiple challenges and barriers in their own lives.
Such comprehensive interventions should be designed to make services available that can meet both the attachment-related and other needs of high risk families; e. This review comprises 70 studies where the intervention started at an average child age of below 54 months. The intervention studies were not restricted to a specific population: The analysis revealed that the interventions had an impact both on the mothers' sensitivity and — to a lesser degree — on the children's attachment.
Interventions with video feedback were found to be more effective than those without. The most effective interventions used a moderate number of sessions and focused on sensitivity in families with, as well as without, multiple problems.
Mother-child bonding assessment tools
These findings were summarized in the title of the article: Only three of the studies included fathers and these studies are all fairly old [ 24 - 26 ] but the conclusion in the review was that interventions including fathers appeared to be significantly more effective than interventions focusing on mothers only. It has thus been shown that early interventions directed towards parent-child interaction may have a positive effect upon parenting [ 23 ], but whether "less is more" or "more is better" is an issue that can only be resolved through further studies [ 27 ].
A critical analysis of interventions based on attachment theory, limited to research that has been peer-reviewed, paid special attention to methodological aspects of the primary studies [ 28 ]. The conclusions, based upon 15 prevention studies published between andrevealed that attachment interventions produce on average weak to moderate effects across caregiver and child outcomes.
In only one of the studies were fathers involved. The authors emphasize that data on treatment integrity or social validity — if the interventions are accepted by key agents e. This is significant since an intervention must be accepted by important participants in order to have high effectiveness under real-world conditions — and not only high efficacy under tightly controlled research conditions.
Egeland et al [ 22 ] ask for more research on interventions based upon the ecological model taking into account such factors as social support and parents' emotional health and well-being.
Bakermans-Kranenburg et al [ 23 ] stress the need for long-term follow-up studies, since sleeper effects — effects that emerge a long time after the intervention — on for example attachment security might otherwise remain undetected. Cultural considerations It is also of great importance to study parent-child interventions within various cultural contexts. Even though the development of such interventions has been considerable for the last thirty years in Sweden as well, only a small number of these have been assessed with regard to outcome [ 2930 ].
There are cultural variations with regard to children's mental health.
Heiervang et al [ 31 ] have shown that the Norwegian prevalence of externalising disorders behavioural and hyperactivity was about half that found in Britain, whereas rates of emotional disorders were similar.
Differences like this offer a rationale for the study of parent-child interventions in different cultural contexts. Research results from the Nordic countries — with their resources in the field of mother and child health care, parental leave, and a well-developed pre-school — may be of specific interest to complement and enhance knowledge about various conditions for these interventions.
The most obvious deficit in this research field hitherto is, however, the almost complete lack of intervention studies that include fathers. A Swedish example of parent-infant intervention approaches This study is based on an intervention programme that has been developed during the last two decades in Sweden. Attachment theory [ 45 ] along with an ecological, transactional perspective [ 79 ] and Stern's theories of development in infancy [ 16 ] and of preconditions for treatment [ 1718 ] provide the theoretical foundation employed at these centres.
Attachment theory, which is usually associated with infants and small children, is also relevant for families with children in their middle childhood 7—12when attachment to the parent s is still salient and important [ 32 ] though with a somewhat altered goal: This gradual development is taken into consideration in the therapeutic work. A salutogenetic [ 34 ] therapeutic approach implies a focus on factors that support a positive development and not only an interest in factors that cause problems.
The work assignment The linchpin of the therapeutic work is the collaborative relationship between the parent s and the therapist. A basic principle is that the goals of intervention should be established through a dialogue between the parents and the therapist based on the parents' own descriptions of the problem with the changes they desire being crucial.
Priority is given to the parents' interpretation of the problem. Received Dec 4; Accepted Mar Publicado por Elsevier Editora Ltda.
Parent-Child Assessment (PCA)
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To identify and describe research tools used to evaluate bonding between mother and child up to one year of age, as well as to provide information on reliability and validity measures related to these tools. Thirteen evaluation research tools were identified concerning mother and child attachment: From all tools analyzed, the Prenatal Attachment Inventory presented the higher validity and reliability measures to assess mother and fetus relation during pregnancy.
Concerning the puerperal period, better consistency coefficients were found for Maternal Attachment Inventory and Postpartum Bonding Questionnaire. Besides, the last one revealed a higher sensibility to identify amenable and severe disorders in the affective relations between mother and child.
The majority of research tools are reliable to study the phenomenon presented, although there are some limitations regarding the construct and criterion related to validity. In addition to this, only two of them are translated into Portuguese and adapted to women and children populations in Brazil, being a decisive gap to scientific production in this area. Mother-child relations, Maternal behavior, Reproducibility of results Introduction The establishment of bonding between mother and child is a physical and psychological need of babies, which provides comfort and protection.
Thus, the mother is considered the safe haven for the establishment of the first emotional attachments of the child, which will reflect on all future social relations. In childhood, these emotional interactions are primarily developed with parents in order to impart comfort, protection, affection, and love.