Working Model Of The Child Interview Research Articles

Parental Coping, Representations, and Interactions with Their Infants at High Risk of Cerebral Palsy.

The aim of this study is to describe parental coping, representations, and interactions during the time of inclusion in the Small Step early intervention program for infants at high risk of cerebral palsy (CP) in Norway (ClinicalTrials.gov: NCT03264339). Altogether, 11 infants (mean age 4.8 months, SD: 1.5) and their parents (mothers: n = 10, fathers: n = 9) were included. Parental coping was assessed using the Parenting Stress Index-Short Form (PSI-SF) and the Hospital Anxiety and Depression Scale (HADS). Parental representations and parent-infant interactions were assessed using the Working Model of the Child Interview (WMCI) and the Parent-Child Early Relational Assessment (PCERA). Parents' PSI-SF and HADS scores were within normal range; however, 26.7% showed symptoms of stress, 52.6% showed symptoms of anxiety, and 31.6% showed symptoms of depression above the cut-off. WMCI results indicate that 73.7% of the parents had balanced representations. For PCERA, the subscale Dyadic Mutuality and Reciprocity was of concern, while two other subscales were in areas of strength and three subscales in some concern areas. There were no differences between mothers and fathers. Most of the parents had balanced representations, some had mental or stress symptoms and many were struggling with aspects of the parent-infant interaction. This knowledge could be useful when developing more family-centered interventions.

Does interactive ultrasound intervention relieve minor depressive symptoms and increase maternal attachment in pregnancy? A protocol for a randomized controlled trial

BackgroundPerinatal depression, especially minor depression, is common during pregnancy and is likely to continue into the postpartum period. It may impair the mother’s health, the infant’s neurodevelopment, and the mother-infant relationship. Screening for perinatal depression is recommended; however, there is no consensus on how to treat depressive symptoms while simultaneously supporting the mother-infant relationship. Ultrasound examination has been shown to improve maternal-fetal attachment among pregnant women. Our aim is to develop a four-dimensional (4D) based interactive ultrasound intervention and test whether it relieves minor depressive symptoms and improves maternal-fetal attachment. Previous studies show that supporting the mother-infant relationship aids in relieving maternal depression. Until now, few studies have combined pregnancy ultrasound and psychological support.MethodsA controlled randomized setting was designed to assess whether interactive 4D-ultrasound intervention would decrease maternal depressive symptoms, strengthen maternal-fetal attachment, and mother-infant relationship. An obstetrician and a psychologist specialized in infant mental health conduct the interventions. The focus is to jointly observe the behavior of the fetus according to the mothers’ wishes. Altogether, 100 women scoring 10–15 on Edinburgh Pre-/Postnatal Depression Scale (EPDS) and with singleton pregnancy are recruited using a web-based questionnaire. Half of the participants will be randomized to the intervention group and will undergo three interactive ultrasound examinations. The primary outcomes are a decrease in perinatal depressive symptoms assessed with EPDS and an increase in maternal attachment. The maternal attachment was assessed using the Working Model of the Child Interview (WMCI), the Maternal Antenatal Attachment Scale (MAAS), and the Maternal Postnatal Attachment Scale (MPAS). Secondly, we hypothesize that if the intervention decreases prenatal depressive symptoms and improves prenatal attachment, the decrease in depressive symptoms and improvement in mother-infant relationship is seen postnatally.DiscussionUltrasound is widely used during pregnancy. The interactive approach is unique and may be feasible as part of routine screenings and maternity clinic visits. Intervention that decreases depression and simultaneously supports maternal-fetal attachment would be a valuable addition to the treatment of minor depression among pregnant women.Trial registrationClinicalTrials.gov NCT03424642. Registered on January 5 2018.

Measuring mothers' representations of their infants: Psychometric properties of the clinical scales of the working model of the child interview in a low- to moderate-risk sample.

The Working Model of the Child Interview (WMCI) is frequently used to measure parents' representations. Beyond the global categories (balanced, disengaged, distorted), the reliability, factor structure, and validity of all the 15 clinical scales have not previously been studied. The WMCI was administered to 152 Norwegian mothers of infants (mean age=7.3 months) recruited from community well-baby clinics. Interrater reliability was adequate for the global categories and moderate for the clinical scales. Exploratory factor analysis and confirmatory factor analysis yielded three factors with evidence of factorial validity: Factor 1 balanced; factor 2 resentful; factor 3 apprehensive. Factor 1 corresponded with the original category balanced, while factor 2 and factor 3 corresponded with the original category distorted. Concurrent validity was supported as mothers with balanced representation (factor 1) were less stressed and the mother-infant interaction was more positive than that of mothers with resentful representation. Mothers with resentful or apprehensive representations (factor 2 and factor 3) reported more stress. The extracted factors and demographic variables correlated weakly or not at all, confirming discriminant validity. Our findings show that the clinical scales of the WMCI can be used in research with low- to moderate-risk samples.

Maternal Mental Representations of the Child and Mobile Phone Use During Parent-Child Mealtimes.

Qualities of the parent-child relationship have not been explored as predictors of parent mobile device use during parent-child activities. In 195 mother-child dyads enrolled in an ongoing cohort study, maternal mental representations of their child (ability to reflect on their child's characteristics, emotional state, and their parenting role) were evaluated through the Working Model of the Child Interview (WMCI), a validated semistructured interview. WMCI scale scores were examined as predictors of active maternal mobile device use during parent-child eating encounters (videotaped home mealtimes and a structured laboratory-based protocol) in multivariate logistic regression models. Children were aged 5.9 years (SD: 0.7), mothers were aged 31.5 years (SD: 7.4), and 73.3% of mothers were of white non-Hispanic race/ethnicity. During the family mealtime, 47 (24.1%) mothers actively used a mobile device at least once, whereas during the structured eating protocol, 44 (22.6%) mothers used a device. Controlling for maternal race/ethnicity, education level, and child's sex, WMCI subscales were associated with device use during home mealtimes (higher Child Difficulty) and the eating protocol (higher Child Difficulty and lower Richness of Perceptions and Caregiving Sensitivity). Maternal mental representations of their child were significantly associated with using mobile devices during eating encounters. More research studies are needed to understand directionality and longer-term associations between mobile device use and parent-child relationship characteristics.

Adding "Circle of Security - Parenting" to treatment as usual in three Swedish infant mental health clinics. Effects on parents' internal representations and quality of parent-infant interaction.

This study presents effects of adding Circle of Security-Parenting (COS-P) to an already established comprehensive therapeutic model for early parent-child intervention in three Swedish infant mental health (IMH) clinics. Parents' internal representations and quality of parent-infant interaction were studied in a clinical sample comprised of 52 parent-infant dyads randomly allocated to two comparable groups. One group consisted of 28 dyads receiving treatment as usual (TAU) supplemented with COS-P in a small group format, and another group of 24 dyads receiving TAU only. Assessments were made at baseline (T1), 6 months after inclusion (T2) and 12 months after inclusion (T3). Changes over time were explored in 42 dyads. In the COS-P group, the proportion of balanced representations, as assessed with Working Model of the Child Interview (WMCI), significantly increased between T1 and T3. Further, the proportion of emotionally available interactions, as assessed with Emotional Availability scales (EA), significantly increased over time in the COS-P group. Improvements in the TAU-group were close to significant. Limitations of the study are mainly related to the small sample size. Strength is the real world character of the study, where COS-P was implemented in a clinical context not otherwise adapted to research. We conclude by discussing the value of supplementing TAU with COS-P in IMH treatment.

Turkish mothers’ attachment orientations and mental representations of their children

Objective: This study aims to investigate a group of Turkish mothers’ internal working models and their critical correlates, including their self-reported attachment orientations and their children’s problem behaviours. Background: The mental representations that mothers hold for their children are a valuable source of information for caregiving behaviours, yet they have seldom been investigated in non-Western cultures. In order to examine the role of mothers’ mental representations in children’s behavioural outcomes with a cultural perspective, we adapted the Working Model of the Child Interview (WMCI) into Turkish, and then examined its predictive power. Considering culture-specific caregiving characteristics, we expected that the mental representations mothers have for their children would be systematically associated with their attachment avoidance rather than attachment anxiety in the Turkish context. Furthermore, maternal education was also hypothesised to be a critical factor in the mental representations of the mothers. Methods: First, mothers (N = 30) were interviewed using the WMCI by two trained researchers, and then they were asked to complete the measures of adult attachment and child adjustment. Results: The findings supported the validity of the WMCI in Turkey and demonstrated that the distribution of mothers in balanced, disengaged and distorted categories was similar to those found in Western cultures. As expected, mothers’ attachment orientations, especially attachment avoidance, and maternal education were significantly associated with the mental representations they hold for their children. Conclusion: Mothers’ attachment avoidance and low level of maternal education appeared to be the critical risk factors for their mental representations about their children. The findings were discussed considering culture-specific aspects of maternal representations, attachment orientations and caregiving behaviours.

Maternal and paternal infant representations: A comparison between parents of term and preterm infants

ObjectiveResearch on parental attachment representations after preterm birth is limited and inconclusive. The present study is the first in which maternal and paternal attachment representations after term, moderately and very preterm birth are compared. In addition, special attention was directed toward disrupted attachment representations. MethodMothers and fathers of term infants (≥37 weeks of gestational age, n=71), moderately preterm infants (≥32–37 weeks of gestational age, n=62) and very preterm infants (<32 weeks of gestational age, n=56) participated in the present study. Attachment representations (balanced, disengaged, distorted) about their infants were evaluated with the Working Model of the Child Interview (WMCI). To asses disrupted representations the coding of the WMCI was extended with the disrupted scale (WMCI-D). ResultsThe three main classifications of attachment representations were not affected by preterm birth. In addition, there were no gender differences in the rate of balanced representations. In case of non-balanced representations however, maternal representations were more often distorted, whereas fathers showed more often disengaged representations. Results further revealed that maternal disrupted attachment representations were marked by role/boundary confusion or disorientation, whereas paternal disrupted attachment representations were characterized by withdrawal. ConclusionGiven the gender differences it is essential to tailor interventions according to the attachment representations of the parent, in order to be able to alter their non-balanced and/or disrupted attachment representations.

Parental representations: A systematic review of the working model of the child interview.

This review provides an overview of results that have been obtained in studies using the Working Model of the Child Interview (WMCI). The WMCI is a structured interview that assesses parents' internal working models of the relationship with their young children. From the current infant mental health perspective, evaluating the quality of parents' representations about the infant-parent relationship is the main focus in the assessment and treatment of infants and their parents. Empirical quantitative studies (N = 24 articles) in which the WMCI was used for data collection were used for analysis. The distribution of balanced, disengaged, and distorted representations differed among various study populations. Parents' internal representations as reflected in their narratives about their child are affected by various factors such as maternal, child, and demographic characteristics. The WMCI is a valid and useful clinical and research tool that can be used in future studies examining the role of parental representations in infant development.

Maternal attachment representations after very preterm birth and the effect of early intervention

ObjectiveFor very preterm infants the mother–infant relationship may be compromised. Maternal attachment representations 18 (corrected) months after very preterm birth and the effect of the post-discharge Infant Behavioral Assessment and Intervention Program (IBAIP) were studied. The IBAIP is designed to assist parents to support and enhance their infant's regulatory competence and development. The intervention consisted of 6–8 home visits during the first 8 months after birth. MethodSeventy-eight mothers of very preterm infants (<32 weeks and/or <1500g) were interviewed, who participated in a randomized controlled trial: 41 from the intervention group and 37 from the control group. Maternal attachment representations were assessed with the Working Model of the Child Interview (WMCI). The interviews resulted in a classification of the attachment representations into balanced or non-balanced. Results30% of the mothers had non-balanced attachment representations. Qualitative content analysis of the answers showed that negative feelings when first seeing their baby and negative or ambivalent feelings in the first weeks at home with their baby are related to non-balanced attachment representations. The WMCI revealed no differences between the intervention and control group. ConclusionEarly support for mothers of very preterm born infants to develop a healthy mother–infant relationship is recommended especially for mothers who report negative first experiences.

Maternal mental representations of the child in an inner-city clinical sample: Violence-related posttraumatic stress and reflective functioning

Parental mental representations of the child have been described in the clinical literature as potentially useful risk-indicators for the intergenerational transmission of violent trauma. This study explored factors associated with the quality and content of maternal mental representations of her child and relationship with her child within an inner-city sample of referred, traumatized mothers. Specifically, it examined factors that have been hypothesized to support versus interfere with maternal self- and mutual-regulation of affect: posttraumatic stress disorder (PTSD) and maternal reflective functioning (RF). More severe PTSD, irrespective of level of RF, was significantly associated with the distorted classification of non-balanced mental representations on the Working Model of the Child Interview (WMCI) within this traumatized sample. Higher Levels of RF, irrespective of PTSD severity, were significantly associated with the balanced classification of maternal mental representations on the WMCI. Level of maternal reflective functioning and severity of PTSD were not significantly correlated in this sample. Clinical implications are discussed.

Video-taped coding of working model of the child interviews: a viable and useful alternative to verbatim transcripts?

Examined inter-rater reliability in scoring a semi-structured representational interview, the Working Model of the Child Interview (WMCI), using coders who scored either verbatim transcripts or video. Results indicated high levels of inter-rater agreement across methods. Direct coding of attachment-based interviews is an economical alternative to transcripts.

Using the Working Model of the Child Interview to assess postnatally depressed mothers' internal representations of their infants: a brief report

The Working Model of the Child Interview (WMCI) was used to investigate mothers' internal representations of their 3-month-old infants in a clinical sample of eight mothers all of whom had a prenatal history of Major Depressive Disorder. Their representations of their infants were less than half as likely to be classified as balanced (balanced 25%, disengaged 25%, distorted 50%) compared to normative data obtained from non-clinical populations (balanced 52-65%, disengaged 3-24%, distorted 24-32%). This effect was entirely due to the WMCI representations of the six mothers who were depressed after delivery, none of whom had balanced representations of their infants. While these findings need replication in a larger sample, there are important clinical implications given the strong link between mothers' WMCI classifications and infant attachment behaviour at 1 year. The WMCI may be of value as a screening instrument and in the assessment of therapeutic interventions.

Nurses' and Physicians' Assessment of Mother–Infant Mental Health at the First Postnatal Visits

To examine the degree to which physicians and nurses use their first postnatal contact with mothers and babies to learn about their psychosocial strengths and problems. Forty-two consecutively born infants and their mothers were observed during their initial postnatal visit with a public health nurse and their physician in Montreal. Both visits were audiotaped. Tapes were analyzed for the number of physical and psychosocial topics discussed during the visits. Observers also rated the professionals' communication skills. During a later home visit, mothers were given the Edinburgh Postnatal Depression Scale, the Symptom Checklist-90-Revised, and the Working Model of the Child Interview (WMCI). Nurses spent more time with families, discussed more psychosocial issues, and were rated to be more sensitive interviewers than physicians. They were also concerned about the psychological well-being and psychological difficulties of more mothers than were the physicians. In contrast, physicians were more sensitive to pregnancy complications in younger mothers. Mothers' satisfaction correlated with the number of psychosocial issues discussed by both professional groups. WMCI data suggest that recent non-Western immigrants are overrepresented among insecurely attached mothers. Nurses and physicians obtain different data from the same patients and should increase their collaboration.

Failure to thrive: Risk for clinical disturbance of attachment?

This study tests the hypothesis that infants with failure to thrive (FTT) are at risk for a clinical disturbance of attachment (defined as a combination of: (1) nonautonomous caregiver state of mind with respect to attachment, measured by the Adult Attachment Interview (AAI); (2) nonbalanced caregiver representation of the infant, measured by the Working Model of the Child Interview (WMCI); (3) problematic play interactions; and (4) problematic feeding interactions). Participants were 57 infants (30 FTT, 27 non-FTT) and their primary caregivers, recruited from outpatient pediatric clinics. Caregivers were interviewed with AAI and WMCI and observed interacting with their infants during play and feeding. Results show that more infants with FTT than infants without FTT met some of the criteria for risk for a clinical disturbance of attachment —nonautonomous AAI and nonbalanced WMCI classifications, and less dyadic reciprocity during feeding. However, there were no group differences in play. Future directions for research are discussed.

Mothers' representations of their infants assessed prenatally: stability and association with infants' attachment classifications.

The stability and predictive validity of classifications of mothers' representations of their infants as determined by the Working Model of the Child Interview (WMCI) were examined. Concordance between mothers' representations of their infants assessed prenatally and again one year later and infant Strange Situation (SS) attachment classifications at 12 months was also examined. WMCI classifications were stable over 12 months in 80% of mothers, compared to 51% expected by chance alone. Pregnancy WMCIs predicted infant SS classifications in 74% of cases, compared to 54% expected by chance. Concordance between 11-month WMCI and 12-months SS classifications was 73% (vs. 55% expected by chance). Problems with the skewed distribution of the sample, the low concordance between pregnancy and 11 months for one of the three classifications, and future directions for research are discussed.

“Working model of the child interview”: Infant clinical status related to maternal perceptions

Parental perceptions and subjective experience of infants have long been considered important in clinical work with infants and families. Using three different samples of infants, we compare mothers' representations of their infants in clinically referred and nonreferred groups, using the Working Model of the Child Interview (WMCI). Twenty-four mothers of infants with failure to thrive (and 25 matched controls), 17 mothers of toddlers with sleep disorders (and 20 matched controls), and 13 mothers of infants seen in a general infant psychiatry clinic participated. Compared to their nonclinical counterparts, mothers of infants with clinical problems had representations of their infants that were significantly more likely to be classified distorted or disengaged. Infant gender, age, and birth order were independent of maternal classifications. We conclude that the WMCI is a useful structured interview to categorize mothers' perceptions and subjective experience of their infant and relationship with the infant. Mothers' WMCI classifications are associated with the clinical status of the infant. © 1997 Michigan Association for Infant Mental Health