Part II of Lynne Murray at IPMH
Cognitive Development: IQ and School Achievement
The overall findings for poor outcome in cognitive development in Murray’s Cambridge longitudinal study and other recent studies show that PND is associated with a significant risk for poor outcome, but mainly in the context of high risk (families with multiple risk factors such as poverty and social disadvantage), persistent depression, and possibly being a male child.
What are the maternal behaviors that are associated with poor outcome in PND? Multiple studies suggest general reduced responsiveness (Murray et al, 1993, Milgrom et al, 2004), lack of contingency and learning (Tronick & Weinberg, 1997), and modulation of input to sustain attention (Kaplan et al, 2011).
What do these behaviors look like and how do they exert a negative effect?
It is not hard to imagine that depressed mothers would have a generally reduced responsiveness to their children. However, in the newborn period the child is particularly sensitive to communications – particularly emotional communication – from the caregiver, so that reduced responsiveness exerts a powerful influence at this time in life. Nothing demonstrates this fact more than Tronick’s still face experiment. We have described this research in earlier blog postings. In essence, the mother is instructed to play with her baby in a face-to-face situation with the baby in a baby seat and the mother facing him or her. At a signal, the mother is supposed to assume a nonresponsive pose and hold it (for 1-2 min) until another signal alerts her to resume playing. The infant’s response is powerful. She will usually begin with various bids for the mother’s attention – gazing at the mother, giving her an inviting facial expression, smiling, gesturing, or vocalizing. When persistent bids for connection are unsuccessful, the infant looks increasingly distressed, attempts to self-soothe in various ways, and finally may become acutely dysregulated; some infants even lose postural tone and slump down in their seats.
This experiment does not actually simulate the situation with a depressed mother, but corresponds in terms of the reduction in general responsiveness.
Depressed mothers tend to fall into two different patterns (although these are rough generalizations). Some tend to primarily withdraw, and others tend to be intrusive and controlling (Tronick & Weinberg, 1997). The particular style a depressed mother takes will depend at least in part on her own history of caregiving experiences with her own mother and on her personality style. Both of these problem patterns interfere with the way a mother a mother wants to be with her infant. What are some ways that the PND mother can correct some problem patterns and give her baby what she wants to give him or her?
The first step is to find a supportive family member, friend, or therapist. This is important not only to combat depressive thoughts that pull the mother down further into unhappiness – such as, “I am a failure”, “I can’t do anything right” – but also to gain assistance in reading the baby’s cues. A mother who feels like a failure may easily misinterpret her infant’s gaze aversion as a rejection of her, rather than the communication, “I need a break; I will be right back.” Videotapes of mother and infant interacting can be particularly helpful. Often the videotape will reveal missed opportunities for positive engagement, when for example, the infant is gazing at the mother’s face and she is looking away. After viewing the videotape with a friend or therapist, the mother is more likely to be on the lookout for her baby’s invitations to “be together”. It is important to note that whereas medication may relieve the mother’s depressive symptoms, it does not seem to change problematic interactional patterns in PND mothers. In addition, therapy with the mother alone does not seem to be as effective as therapy that includes mother and infant together. In my opinion, videotape intervention therapy is the most effective for PND of all the alternatives.
Beebe B, jaffe J, Markese S, Buck K, Chen H, Cohen P, Bahrick L, Andress H, Feldstein S (2010). The origins of 12-month attachment: A microanalysis of 4-month mother-infant interaction, Attach Hum Dev. 12(0):3-141.
Kaplan PS, Danko CM, Diaz A, Kalinka CJ (2011). An associative learning deficit in 1-year old infants of depressed mothers: Role of depression in duration, Infant Behavior and Development, 34(1):35-44.
Milgrom J, Westley D, Gemmill AW (2004). The mediating role of maternal responsiveness in some longer-term effects of postnatal depression on infant development. Infant Behavior & Development, 27:443-454.
Murray L, Kempton C, Woolgar M, Hooper R (1993). Depressed mothers’ speech to their infants and its relations to infant gender and cognitive development, Journal of Child Psychology and Psychiatry 34(7):1083-1101.
Tronick EZ & Weinberg MK (1997). Depressed mothers and infants: Failure to form dyadic states of consciousness. In L Murray and PJ Cooper (Eds.), Postpartum depression and child development (pp. 54-81). New York: Guilford Press.