POSTPARTUM DEPRESSION AND INFANT COGNITIVE
B.S., University of Texas at Austin, 2002
A thesis submitted to the
University of Colorado Denver
in partial fulfillment
of the requirements for the degree of
Master of Arts
This thesis for the Master of Arts
has been approved
Diaz, Andres (M.A., Clinical Psychology)
Postpartum Depression and Infant Cognitive Development
Thesis directed by Professor and Department Chair Peter S. Kaplan
Depression in the postpartum period has been associated with behavioral problems,
socio-emotional disturbances and cognitive delay in infants and young children.
The current study tested the hypothesis that depression, as measured by elevated
BDI-II score, would be associated with poor performance on the Bayley-III
cognitive subtest. It was also predicted that caregiver sensitivity, infant security of
attachment to caregiver, and infant performance on an associative learning task
would be positively related to Bayley-III cognitive subtest performance. The main
sample for the current study consisted of 56 mothers and their infants. Data for the
infants fathers was collected for a portion of the main sample (N=39). Results
showed that only infant security of attachment to fathers was significantly
associated with better Bayley-III Cognitive performance. This effect remained
after relevant demographic, father-child relationship and marital satisfaction
variables were taken into account.
This abstract accurately represents the content of the candidates thesis. I
recommend its publication.
Peter S. Kaplan
Thanks to Peter Kaplan for overall support and guidance on this project and
Amanda Moreno and Kevin Everhart for assessment training and feedback. Id
also like to thank Christina Danko and Helene Gotthelf.
TABLE OF CONTENTS
Purposes of the Study....................................1
Postpartum Depression and Infant/Caregiver Interactions..2
Postpartum Depression and Child Cognitive Development....3
Cross Sectional Studies............................6
Security of Attachment..................................10
Role of the Father in Infant Development................11
Associative Learning Task...............................12
Infant Directed (IDS) Speech............................13
Conditioned Attention Paradigm..........................14
Assessment of Matemal/Patemal Depression....................18
Beck Depression Inventory-II (BDI-II)...................18
Structured Clinical Interview for DSM-IV................18
Assessment of Infant Cognitive Development..................19
Bayley Scales of Infant and Toddler Development (Bayley-III)19
Assessment of Infant Associative Learning...................20
Infant Directed Speech Segments.........................20
Assessment of Matemal/Patemal Sensitivity...................23
Assessment of Security of Attachment........................24
Attachment Q-Set (AQS)..................................24
Associative Learning Task...................................24
Bayley-III Cognitive Scores and Maternal Depression.........28
Object Permanence Performance and Maternal Depression.......28
Bayley-III Scores and Paternal Depression...................30
Sensitivity and Cognitive Development.......................31
Security of Attachment and Cognitive Development............32
Infant Associative Learning Score and Cognitive Development.36
LIST OF FIGURES
3.1 Bayley cognitive mean scores as a function of father attachment category...33
LIST OF TABLES
3.1 Demographic and depression data......................................36
3.2 Hierarchical regression data 1........................................43
3.3 Hierarchical regression data 2........................................44
3.4 Correlations for bayley cognitive Scores, maternal and paternal sensitivity,
and infant security of attachment to mother and father...............44
Purposes of the Study
The infants of postpartum depressed mothers have been shown to be at
increased risk for a host of behavioral problems and developmental delays. A
portion of the research investigating the possible adverse affects of depression on
child development has focused on cognitive delays. One of the purposes of the
current study was to examine the relationship between postpartum depression and
infant cognitive development in order to gain a better understanding of how infants
may be affected by exposure to a depressed caregiver. The study also investigated
how caregiver sensitivity and infant security of attachment relate to infant cognitive
development. Lastly, the level of agreement between infant cognitive development
scores and infant performance on an associative learning test was determined in
order to gain insight into the relationship between general cognitive development
and infant associative learning.
Postpartum Depression and Infant/Caregiver Interactions
Postpartum depression is experienced by a substantial percentage of new
mothers and can have a profound impact on the lives of those affected. Minor
mood disturbances, often referred to as postpartum blues, are experienced by
between 50-80% of new mothers. Postpartum depression refers to a more severe
and longer mood disturbance and affects between 10-15% of new mothers (OHara,
Neunaber & Zekoski, 1984). In addition to causing considerable emotional pain to
the parent, mood disturbances during the postpartum period are also associated
with disrupted infant-caregiver interactions. Research has shown disruptions in the
behavior of both depressed mothers and their infants.
Depressed mothers are much slower at responding to their children,
(Campbell, Cohn, Flanagan, Popper, & Meyers, 1992: Murray, Fiori-Cowley,
Hooper, & Cooper, 1996) and tend to be more withdrawn or irritable than non-
depressed mothers (Teti & Gelfland, 1997). When compared to non-depressed
mothers, the speech of depressed mothers during mother-infant play interactions
was less focused on their infant and more focused on their own actions and
concerns (Murray, Kempton, Woolgar, & Hooper, 1993). In face-to-face
interactions with their own depressed mother, 3-6 month-old infants have shown
fewer positive facial expressions (Field, 1984), more drowsiness and fussiness
(Field et al. 1985) and higher levels of withdrawn behavior than the infants of non-
depressed mothers (Cohn, Matias, Tronick, Connell, Lyons-Ruth, 1986). Similar
behavior was observed in 2-3 month-old infants of depressed mothers while
observed interacting with a stranger. These infants demonstrated more problematic
behavior (e.g. excessive crying, negative affect, protest and withdrawn behavior)
and were more tense (Cutrona & Troutman, 1986, Whiffen & Gotlib, 1989) than
the infants of non-depressed mothers.
According to Tronicks Mutual Regulation Model, normal child development
occurs when both the infant and caregiver work together to regulate the infants
physical and emotional state (Tronick, 1997). Hay (1997) proposes that disrupted
patterns of interaction, like those found between depressed mothers and their
children, could inhibit an infants ability to regulate attention and emotion. She
hypothesizes that a disruption in regulating attention can lead to a failure to detect
contingencies in the social and nonsocial environment and can eventually lead to
more general learning deficits including delays in cognitive development.
Postpartum Depression and Child Cognitive Development
The relationship between postpartum depression and child cognitive
development has been explored by several other researchers. Some of these studies
have assessed children in infancy while others have looked at older children.
Although the current study assessed the cognitive development of 11-13 month-old
infants, the findings on both infants and school-age children are discussed here in
order to present a broad picture of the literature. Longitudinal studies are presented
first, followed by cross-sectional studies and then a brief description of how these
finding relate to the current study.
Some of the most prominent findings on this topic have come from a
longitudinal study by Murray and colleagues (Murray, 1992; Murray & Cooper,
1997; Muray, Fiori-Cowley, et al., 1996; Murray, Hipwell, Hooper, Stein, &
Cooper, 1996). This study assessed the cognitive development of the children of
postpartum depressed and non-depressed mothers at 9 months, 18 months and 5
years of age.
In this study, mothers were screened for depression after childbirth using
the Edinburgh Postnatal Depression Scale (EPDS: Cox, Holden, Sagovsky, 1987).
Those with elevated scores at 6 weeks postpartum were administered the Schedule
of Affective Disorders and Schizophrenia (SADS) 2-3 months postpartum in order
to determine any current or lifetime mood disturbances. The cognitive abilities of
these children were later assessed at 9 and 18 months. Results showed that infants
of mothers who had experienced postpartum depression since birth (either minor or
major depression) performed significantly worse than children of non-depressed
mothers on stage IV and V Piagets Object Concept Tasks (Piaget, 1954) at 9 and
18 months of age respectively. Infants of mothers with major depression
performed poorer than those with minor depression. At the 18-month follow-up,
infants general cognitive abilities were also assessed using the Bayley Scales of
infant development (Bayley, 1969) and no overall relationship between maternal
depression and general cognitive delay was found. At the five year follow-up,
infants cognitive abilities were assessed with the McCarthy Scales of Children
Abilities and no significant differences on childrens General Cognitive Index were
found. However, the boys of depressed mothers performed significantly worse
than the boys of non-depressed mothers, indicating that boys exposed to a
depressed caregiver may be at elevated risk for cognitive delay.
Another longitudinal study (Cogill, Caplan, Alexandra, Robson, & Kumar,
1986) was conducted with a low-risk sample of mothers and their young children.
Mothers level of depression during the first year postpartum was assessed by a
semi-structured interview administered by a psychiatrist. The McCarthy scales of
childrens Abilities were used to assess the childrens general cognitive abilities at
4 years of age. The children of mothers who had experienced depression in the first
year postpartum had a significantly lower General Cognitive Index score when
compared with a control group. The findings from Cogill et al. (1986) were
analyzed more closely (Hay and Kumar, 1995) and it was confirmed that a
relationship between postpartum depression and cognitive development at 4 years
A third longitudinal study was conducted with a high-risk sample of
children and their mothers (Sharp et al., 1995). Mothers were assessed using the
Clinical Interview Schedule (CIS) at 3 and 12 months postpartum and children
were first assessed at about 4 years of age on the McCarthy scales. It was found
that only the male children of postpartum depressed women scored significantly
worse than the control group. This sample was followed up again when the
children were 11 years old (Hay et al. 2001). Results showed that the 11-year-old
boys and girls of mothers who were depressed at 3 months postpartum had
significantly lower IQ scores than infants of mothers who had not been depressed.
In line with the assessment at 4 years, boys were more severely affected than girls.
A few cross-sectional studies have also examined the relationship between
postpartum depression and infant cognitive development. A study by Egeland and
Sroufe (1981) assessed a group of economically disadvantaged mothers on their
level of psychological availability during the postpartum period. Infants of
psychologically unavailable mothers performed significantly worse than a control
group on the cognitive portion of the Bayley scales at 24 months with a marked
decrease (mean drop of 38 points) on Bayley developmental quotient from 9-24
months. In a related study, Lyons-Ruth, Zoll, Connell and Grunebaum (1986)
assessed maternal depression directly and found that twelve-month-old infants
whose mothers had elevated levels of depressive symptoms had significantly lower
scores on the mental and motor development portions of the Bayley Scales than
infants of non-depressed mothers.
The topic was also addressed by Whiffen and Gotlib (1989) who used a sample of
two-month-old infants and their mothers. Infants were assessed using the Bayley
scales of infant development and their mothers level of depression was assessed
using the Beck Depression Inventory (BDI; Beck, 1961) and the Schedule for
Affective Disorders and Schizophrenia (SADS; Endicott & Spitzer, 1978). Infants
of depressed mothers performed significantly worse on the cognitive tasks of the
Cicchetti, Rogosch, and Toth (2000) examined the effectiveness of a
Toddler-Parent Psychotherapy intervention for mothers experiencing a Major
Depression in the postpartum period. There were no significant cognitive
differences between the intervention and control groups before treatment at 20
months of age as assessed by the Bayley Scales. Results of the post-intervention
follow-up at 3 years of age revealed that the children in the depressed-
nonintervention group had significantly lower IQ scores than the non-depressed
and depressed-intervention group.
Finally, a low risk sample of mothers and their children were assessed in
order to determine the effects of postpartum depression on infant cognitive
development (Cornish, 2005). Mothers level of depression was assessed using the
composite International Diagnostic Interview (CIDI; World Health Organization,
1997). Children were assessed with the Bayley Scales at 12 and 15 months.
Results showed that chronic postpartum depression lasting throughout the 1st year
and beyond was related to poorer cognitive development. Brief postpartum
depression, defined as lasting less than one year postpartum, showed no significant
effect on infant cognitive development.
In general, cognitive deficits in the infants and children of clinically
depressed mothers have been found. Postpartum depression appears to a have
greater effect on cognitive development when it is chronic and when the child is
male. It should be noted that the association between postpartum depression and
child cognitive development has not always been found. Murray(1992) found that
infants of depressed mothers performed worse on object permanence tasks but
Bayley scores were not affected at 18 months. Cichetti, Rogosch, and Toth (2000)
found cognitive deficits in the children of postpartum depressed mothers at 3 years
of age but not in infancy.
Only two of the studies investigating infants have looked specifically at 12-
month-olds, and both found cognitive deficits related to postpartum depression
(Lyons-Ruth, 1986; Cornish, 2005). The current study addressed the effect of
postpartum depression on 1-year-olds. We predicted that performance would be
poorer for the infants of depressed relative to non-depressed mothers. Based on the
results of past studies (Murray, 1992; Sharp, 1995), we also predicted that the male
infants of postpartum depressed mothers would show greater cognitive deficits than
Some researchers (Hay, 1997) have suggested that specific features of
child-parent interactions, such as caregiver sensitivity, may be as important as
depression itself in predicting child developmental delay. Depressed mothers have
shown low responsiveness and sensitivity with their children during play
interactions when compared to non-depressed mothers (Campbell, Cohn & Meyers,
1995; NICHD, ECRN, 1999). Maternal responsiveness and sensitivity has also
been linked to child developmental problems. A study by Milgrom, Westley, and
Gemill (2004) found that low maternal responsiveness at 6 months mediated the
relationship between postnatal depression and full scale IQ on the Wechsler
Prechool Primary Scale of Intelligence at 42 months of age. The infants of mothers
who were rated high in insensitivity at 2 months postpartum scored significantly
lower on the Bayley Scales at 18 months (Murray, 1996). Low maternal sensitivity
was also found to be more predictive of poor performance on an associative
learning task (Burgess, 2006) and low Bayley cognitive scores (Pound, 2006) than
level of maternal depression. In this study, the role of maternal sensitivity as a
mediator of the effect of postpartum depression on infant cognitive development
was explored. Also, the relationship between maternal and paternal sensitivity and
infant cognitive development was explored regardless of whether depression was
Security of Attachment
The quality of attachment found between infants and their postpartum
depressed mothers has been examined in several studies. A connection between
elevated levels of maternal postpartum depression and insecure attachment has
been found with 12-month-old infants (Lyons-Ruth et al., 1986) and preschool-age
children (Teti, Gelfand, Messinger, & Isabella, 1995). Murray (1992) also found
that the 18-month old infants of mother who had experienced a minor or major
depression episode in the postnatal period were more likely to be insecurely
The possible link between attachment security and child cognitive
development has also been investigated outside of the context of postpartum
depression. A quantitative meta-analysis was conducted on 32 studies in order to
determine whether quality of attachment is associated with cognitive and language
abilities (Van Uzendoom, Dijkstra, & Bus, 1995). Results showed that secure
attachment was significantly related to better cognitive and language abilities,
although a much greater impact was found on language development. In a study by
Spieker, Nelson, Petras and Bernard (2003), children were assessed for security of
attachment at 19 months of age and their cognitive development was assessed at
24, 30 and 36 months. Infants securely attached at 19 months had significantly
higher Bayley Mental Development Index scores relative to insecurely attached
infants at 36 months. The relationships between security of attachment and Bayley
Cognitive score were not significant at 24 or 30 months but mean scores were in
the predicted direction. Although it appears that security of attachment generally
predicts better cognitive outcome very little research has examined the relationship
between attachment security and cognitive development with 12 month-old infants.
The current study investigated this relationship with the intention of learning how
this age group (11-13 month-olds) might be affected.
Role of the Father in Infant Development
Although the vast majority of the research examining the relationship
between caregiver characteristics and child cognitive development has focused on
mother and child, some studies have found an association between father
involvement and positive developmental outcomes for infants and young children.
The Infants (5-6 month-olds) of highly involved fathers had significantly
higher scores on the Bayley Scales than infants experiencing minimal interaction
with their fathers (Pedersen, Rubenstein, & Yarrow, 1979). Father involvement
was also associated with better cognitive functioning, as assessed by the Bayley
scales (Nugent, 1991), and better performance on a problem solving task at 1-year
of age (Easterbrooks & Goldberg, 1984). In a longitudinal study by Yogman,
Kindlon & Earls (1995) infants of low-income families were assessed at different
times from birth to 3-years of age. Infants whose fathers were highly sensitive had
better linguistic and cognitive capacities at 18 months (Yogman, Kindlon, & Earls,
1995) and a high level of father involvement since infancy predicted significantly
higher IQ scores at three years of age than infants of fathers with low involvement.
The relationship between paternal depression and child cognitive
development has not been explored to a great extent. In a study by Cogill et al.
(1986), 4-month-old infants whose fathers had a history of psychiatric problems
were found to have lower cognitive scores. Also, the infants of fathers with
elevated BDI-II scores were significantly worse at an associative learning task
involving their own fathers voice (Kaplan, Sliter and Burgess, 2007). These
findings suggest that it is possible that exposure to a depressed father may disrupt a
childs general cognitive development.
The current study assessed paternal depression, paternal sensitivity, and
childs security of attachment to the father in order to verify the relationship
between these factors and Bayley cognitive performance.
Associative Learning Task
The current study investigated the relationship between infant cognitive
development and infant performance on an associative learning task. Much prior
research in the laboratory has examined the extent to which maternal and paternal
infant-directed speech (IDS) promotes learning in a conditioned attention
paradigm. That research shows that, although IDS normally promotes voice-face
association in infants, IDS produced by depressed mothers and fathers does not. A
key question is the extent to which these learning failures predict later delays in
infant cognitive development. For the sake of clarity, infant directed speech and
the conditioned attention paradigm will be explained separately.
Infant Directed Speech (IDS)
IDS or baby talk is the unique manner in which adults across cultures
tend to speak to infants. When compared to adult-directed speech (ADS), IDS is
characterized by slower speed, exaggerated pitch modulation, higher overall pitch,
hyper-articulated vowel sounds, longer pauses between words, simplified
vocabulary and more repetition (Femald 1984; Femald & Simon, 1989). Several
studies have shown that IDS speech serves important practical functions within the
caregiver-infant relationship during the first year of life (Femald, 1984:1992). IDS
speech is more effective than ADS speech in engaging and maintaining infants
attention, regulating arousal levels, and in conveying emotion. According to
Femald (1994) IDS speech plays a crucial role in infants ability to learn about
others and the world.
Conditioned Attention Paradigm
The conditioned attention paradigm was created as a way to study infant
associative learning (Kaplan, Fox & Huckeby, 1992). This paradigm is based on
the finding that attentional responses can be conditioned. That is, when one
stimulus (SI) is consistently followed by another (S2), attentional responses to SI
are maintained or even increase. This kind of learning is involved with infants
learning what goes with what in their environment.
Early work established that infants could form sound-face associations. The
basic experiment consisted of a pairing phase and a summation test. During the
pairing phase, infants were presented with 6 parings of a tone and an image of a
smiling womans face. Forward pairing (tone preceding the face), backward paring
(tone followed the face), random control (random pairing) and no tone control (no
pairing) conditions were presented to the infants. The pairing phase was then
immediately followed by the summation test. During the summation test, infants
were presented with 4 presentations of a novel black and white checkerboard
pattern. The same tone used in the pairing phase was simultaneously paired with
the first and fourth presentation of the checkerboard pattern and no tone was
presented with the second and third presentations of the checkerboard pattern.
Results showed that only infants in the forward pairing condition increased the
amount of time they looked at the checkerboard pattern indicating that infants
learned to associate the tone with the face during the pairing phase.
Using the same conditioned attention paradigm, researchers (Kaplan, Jung,
Ryther and Strouse, 1996) substituted IDS or ADS stimuli for the tone and studied
forward and backward paring arrangements. In agreement with the prediction of
theorists (Femald, 1984) results showed that infants were significantly better at
learning voice-face associations when listening to IDS speech than ADS.
Subsequent work showed, however, that IDS produced by depressed
mothers and fathers did not promote learning in this paradigm when infants of
either non-depressed or depressed mothers were tested (Kaplan, Bachorowski, &
Zarlengo-Strouse, 1999; Kaplan, Bachorowski, Smoski, & Hudenko, 2002). This
work led to an obvious question: If infants of depressed caregivers are not learning
in response to their parents stimulation, do they eventually exhibit delays in
cognitive development relative to infants of non-depressed caregivers? No
previous study has compared the same sample of infants on their general cognitive
development and their associative learning abilities. The current study made this
comparison with the prediction that infant performance on the two measures would
be positively correlated.
To review, the current study tested a series of hypotheses. We predicted that
the infants of depressed caregivers would perform more poorly than the infants of
non-depressed caregivers on the cognitive subtest of the Bayley-III with greater
deficits associated with maternal versus paternal depression. We also expected that
greater deficits would be found in the male vs. female infants of depressed mothers.
Assuming a significant relationship between maternal depression and Bayley-
III cognitive scores, we predicted that maternal sensitivity would mediate the
relationship between these two variables. We also predicted that infant
performance on the Bayley-III cognitive subtest would be better for the infants of
caregivers who demonstrate optimal sensitivity to their child and for those infants
who are securely attached to their caregiver. Lastly, we predicted that infant
performance on the Bayley-III cognitive subtest would be significantly correlated
with infant performance on an associative learning test.
The participants for this study were 56 mothers and their 1 l-13,h month-old
infants. Participants were primarily recruited from an advertisement in Colorado
Parent but a few were recruited from Kids Pages and three Early Head Start
programs (The Clayton Foundation, Family Star, and Mile High Montessori) in
Denver. Colorado Parent and Kids Pages are free parenting magazines found at
supermarkets and newsstands around the Denver Metropolitan area. All parents
were paid for their participation. The mean infant age at the time of testing was
367 days (SD= 66; range: 319 to 429 days). Thirty of the infants were male (54%)
and 26 (46%) were female. The mean age for mothers was 31 years (SD = 5.2;
range: 20 to 40 years). Thirty-nine (69.6%) of the mothers were white, 10 (18%)
were Latina, 2(2%) were African American, 4 (7.1%) were Asian, and 1(1.8%) was
Native American. Demographic data for elevated vs. non-elevated BDI scores is
available in Table 3.1 in the Results section.
For a sub-sample of the infant and mother participants (N = 39) data was
also collected for the fathers of the infants. Within this sub-sample the mean infant
age at the time of testing was 370 days (SD = 25.73; range: 319 to 420 days).
Twenty of the infants were male (51.3%) and nineteen were female (48.77%). The
mean age for mothers was thirty-one years (SD = 5.1; range: 20 to 40 years) and
the mean age for fathers was thirty-two years (SD = 5.7; range: 23 to 47 years).
Twenty-nine (74%) of the mothers were white, 5 (12%) were Latino and 1(3%) was
African American, and 4 (10%) were Asian.
Assessment of Matemal/Patemal Depression
Beck Depression Inventory-II (BDI-ID
The Beck Depression Inventory-II (BDI-II; Beck, 1996) was administered to
all mothers and fathers participating in the study. The BDI-II is a widely used, 21-
item, self-report measure used to assess severity of depression in adults and
adolescents over the past 2 weeks of their lives. The BDI correlates significantly
with DSM-IV Axis-I depression spectrum diagnoses.
Structured Clinical Interview for DSM-IV
The Structured Clinical Interview for DSM-IV-TR AXIS I Disorders
(Research version)(SCID; First, Spitzer, Gibbon, & Williams, 1997) was used to
diagnose the mothers of 11-13 month-old infants. Masters level clinical
psychology students conducted all SCID interviews. The interviewers were
extensively trained and supervised by Ph.D.-level psychologists. The SCID was
primarily used to determine whether participants met DSM-IV criteria for current
or past Major Depressive Disorder. Participants were also asked general life
history information and were screened for anxiety and psychosis. Each Clinical
interview lasted approximately 45 minutes. Of the 56 mothers in this sample, 3
met criteria for current Major Depressive Disorder, 18 were in full remission from a
Major Depressive Disorder since the birth of their most recent child, and 6 were in
Assessment of Infant Cognitive Development
Bavlev Scales of Infant and Toddler Development (Bavlev-IID
The cognitive subtest of the Bayley Scales of Infant and Toddler
Development, Third Edition (Bayley, 1969) was administered to infants
participating in the study. The Bayley-III is a widely used, individually
administered measure, designed to identify children with developmental delays and
to provide useful clinical information for potential intervention plans. The Bayley-
III assesses the development of young children between the ages of 1 month and 42
months. During the cognitive subtest, children are presented with and asked to
manipulate simple objects (e.g. blocks, a ring on a string) while seated on their
mothers lap. The items on the cognitive portion of the Bayley-III assess
sensorimotor development, exploration and manipulation, object relatedness,
concept formation, memory and other cognitive abilities.
Assessment of Infant Associative Learning
Infant Directed Speech Segments
The speech segments of parents infant directed speech used for the current
study were recorded during a separate but related study. Mothers and fathers of 11-
13 month-old infants were first asked to play freely with their child for about 2
minutes. They were then asked to utter the phrase pet the gorilla in the form of
both a command and a question for approximately 1 minute as they tried to interest
their child in a stuffed toy gorilla. The recording of each parent was subsequently
edited into a 10-second Infant directed speech segment which consisted of the first
two interrogative statements uttered by the parent followed by their first declarative
statement (e.g. Can you pet the gorilla? Will you pet the gorilla? Pet the gorilla)
and then repeated once. The 10-second voice segment was later used during the
associative learning test in the current study. Speech stimuli were presented just
behind the heads of infants with an average intensity level of 68 dB (SPL).
Infants sat on their mothers lap facing a large black board containing an
illuminated Plexiglas projection screen within it. The screen was located
approximately 42cm from the infants face at eye level. A video camera was placed
approximately 1.9 cm to the left of the infant and captured the infants face through
a hole in the black board. Two researchers simultaneously observed the infants
face on two separate video screens in different rooms. Infants were presented with
infant-directed speech segments (Pet the Gorilla) via a tape recorder located
approximately 33.5 cm behind and 10cm below their heads. An achromatic slide of
a smiling womans face and an achromatic slide of a 4x4 checkerboard pattern
were projected onto the screen using two computer controlled slide projectors.
Once mothers and their children arrived to the laboratory researchers briefly
explained the procedure of the study and obtained informed consent. After
completing the BDI-II, the Child Care Activity Questionnaire (CCAQ), and a short
form of the Dyadic Adjustment Scale, infants were placed in the conditioned
attention testing apparatus as described above. Infants were presented with a 10
second voice segment (also described above) of either an unfamiliar non-depressed
mother or an unfamiliar non-depressed father saying, Pet the Gorilla. The
projection screen directly in front of the infant was evenly illuminated while the
voice segment was presented. Immediately following the presentation of the voice
segment an achromatic image of a smiling womans face was projected onto the
screen for 10 seconds. Following the presentation of the face, the projection screen
remained uniformly illuminated for a 10 second inter-stimulus interval. A total of
six voice segment-face pairings were presented to each infant. The pairing phase
was immediately followed by a summation test in which four 10-second
presentations of a 4x4 achromatic checkerboard were projected onto the screen.
The pet the gorilla speech segment was presented with the first and fourth
presentations of the checkerboard pattern and nothing was paired with the second
and third presentations of the checkerboard pattern. Two independent raters in
separate rooms recorded the amount of time each infant spent looking at the
projection screen during the test. Infants were considered to be looking at the
screen when the reflection from the screen was visible in the center of the childs
pupils. After a ten minute break a second conditioned attention test was conducted.
If an unfamiliar mothers voice was used in the first test then an unfamiliar fathers
voice was used for the second test and vice versa. The order of testing was
Following the completion of the association test, the Bayley Scales of Infant
and Toddler Development, Third addition (See above) was administered to all 56
infants. During administration of the Bayley-III infants sat on their mothers laps
while a main examiner presented them with toys and other objects from across a
table. The objects were presented in order to engage infants in age appropriate
tasks and their performance was observed. Items on the cognitive subtest become
increasingly more difficult and testing continued until an infant failed 5 items in a
row. A second examiner, also seated at the table, assisted the main examiner by
preparing testing materials and scoring the test items during the assessment. Each
administration of the Bayley Scales lasted approximately 45 minutes.
For a sub-sample of the infant and mother participants (N = 39), data was
collected for the fathers of the infants. In addition to conducting paternal level of
depression assessments (BDI-II and SCID), assessments were also made for
parental sensitivity, infant security of attachment, and associative learning in
response to infants own parents voices.
Assessment of Matemal/Patemal Sensitivity
Emotional Availability Scales (EAS)
Ten-minute long Parent-child play interactions were videotaped in the
infant lab and later coded by researchers using the Emotional Availability Scales
(EAS; Bringen, Robinson, & Emde, 2000). The Emotional Availability Scales
assess the emotional availability of the parent toward the infant and the infant
toward the parent using five general measures: Parental sensitivity, Parental
structuring/intrusiveness, Parental covert and overt hostility, Childs responsiveness
to parent and Childs involvement of mother/father. The current study assessed the
parental sensitivity of both the mother and father of each infant. Parental
sensitivity refers to the degree to which the parent is responsive to the needs of the
child and also takes into account the authenticity and warmth of parental affect
toward the child.
Assessment of Security of Attachment
Attachment O-Set (AOS)
The Attachment Q-Set, Version 3 (AQS, Walters & Deane, 1985) was used
to assess security of attachment between 11-13 month old infants and their parents.
This assessment measures the secure-base behavior of infants toward an attachment
figure within the dyads natural environment. The AQS consists of 90 descriptions,
which are either characteristic or non-characteristic of a securely attached child and
some filler items. Two researchers visited and observed infants and their parents in
the familys home. Following the home visit each researcher independently rated
the observed child on the 90 descriptions of the Q-Set. The two raters sorts were
then averaged together and a correlation between their score and an experts rating
of an ideal securely attached child yielded the childs attachment security score.
Associative Learning Task
The associative learning task followed the same procedure as mentioned
above with the exception that the voices of infants own father and mother were
used. The complete sample of 56 infants participated in the associative learning
task in response to the voices of unfamiliar parents. The sub-sample of 39 infants
participated in the associative learning task in response to both unfamiliar and
familiar parents voices.
Demographic information for the complete sample of mothers and infants
who participated in the study is presented in table 3.1. Mothers in the elevated BDI
category did not differ significantly from mothers in the non-elevated BDI category
in years of education, family income or minority status. A chi-square test revealed
that mothers in the elevated BDI category were significantly less likely to be
married (x2 = 4.9, p=.027). Maternal age and infant age were not significantly
different as a function of BDI category.
As previously mentioned, a portion of the mothers and infants from the total
sample took part in a related study which also collected data on the fathers of the
infants. The 39 mothers from this sub-sample were separated into elevated (N=12)
and non-elevated BDI (N=27) categories and demographic differences were
examined. Mothers in the elevated BDI group differed significantly from the non-
elevated BDI group in years of education (M= 5.3, SD = 1.48;M= 6.4, SD = 1.4, F
(1,37) = 5.61., p= 003. Family income, paternal education, marital status, maternal
age, infant age, and ethnic minority status were not significantly different as a
function of elevated BDI category.
Table 3.1 Demographic and Depression Data
Variable Elevated BDI Non-Elevated BDI
N 13 43
Maternal Age (years) 31.2 (6.4) 30.4 (4.8)
Infant Age (days) 371.8(29) 365 (31)
Mothers education 5.4 (1.7) 6(1.3)
Family Income 5.3 (2.8) 6.6 (1.9)
White 7 (53.8%) 32 (74.4%)
Latina 4 (30.8%) 6 (14%)
African-American 0 2 (4.6%)
Asian 1 (7.7%) 3 (7%)
Native American 1 (7.7%) 0
Percent married 61.5% 88.4%*
Bavlev-III Cognitive Scores and Maternal Depression
Complete Bayley-III cognitive subtest data was collected for 56 of the 58
infants who participated in the study. The data for 2 infants was not used due to
excessive fussiness. Of the available Bayley-III data, 13 of the infants had mothers
in the elevated BDI-II category and 43 had mothers in the non-elevated group. The
Bayley-III cognitive composite scores for infants of mothers in the elevated
category, (M= 102.3, SD =11.65), were not significantly different from the scores
of infants in the non-elevated category, (M= 99.4, SD = 10.53), F (1, 55) = .715,p
= .40. There was no significant relationship between Bayley-III Cognitive
Composite score and total maternal BDI-II score (r = .066,/? = .63). i
Object Permanence Performance and Maternal Depression
The relationship between BDI-II category and infant performance on object
permanence tasks within the Bayley-III cognitive subtest was investigated. The
rationale for this investigation was partially based on Murrays (1992) finding that
A dichotomous variable was created where 0 = mothers who had experienced a Major Depressive Episode
since conception and were in full remission before the birth of their child, and 1= mothers who had experienced
a Major Depressive Episode since the birth of their child but were currently in full remission. The Bayley-III
Cognitive scores of infants in the MDE since birth group (M= 97.9, SD =10.4) were not significantly different
from those in the no MDE since birth group (M= 101, SD =11), F(l, 54) = .885,/?= .351).
the infants of depressed mothers performed poorly on object permanence tasks
similar to those found in the Bayley-III. Also, Hays (1997) theory that exposure to
a depressed mother may disrupt an infants ability to regulate and direct attention
suggests that deficits in object permanence may be more detectable with this age
group than general cognitive delay. Depending on how well an infant performed
on the Bayley-III cognitive subtest they could potentially be administered a total of
four object concept tasks. Because not all infants had the opportunity to complete
all four tasks only infants who completed the same number of tasks were compared
on object concept performance. Therefore, only infants who reached the second
task were compared with each other, only infants who reached the third task were
compared with each other, and so on. Data for performance on the first object
permanence item was not analyzed because almost all (52 of 56) of the infants
correctly answered that item.
No significant difference was found between the elevated BDI-II category (M
= 1.76, SD = .59) and the non-elevated BDI-II category (M- 1.67, SD = .59) on the
second object permanence task, F (1, 51) = .34,p = .563. There was also no
significant difference between the elevated BDI-II group (M= 2.3, SD = .88) and
the non-elevated BDI-II category (M = 2, SD = .65), F(l, 48) = 1.97, p = .17) on
the third or fourth object permanence tasks. Elevated BDI-II (M= 3.1, SD= .64) vs.
non-elevated BDI-II category (M= 2.5, SD =.68), F (1, 26) = 4.15, p=.052.
Bavlev Scores and Paternal Depression
Paternal depression data was collected for 39 of the 56 Bayley-III participants.
For this sample there were 7 infants whose fathers were in the elevated BDI
condition and 32 in the non-elevated BDI category. Although in the predicted
direction, the Bayley cognitive composite scores for infants in the elevated BDI
category, (M= 95.7, Â£D=10.57) were not significantly different from the scores of
infants in the non-elevated category (M= 100.7, SD=l 1.4), F(l, 38) = 1.16,/? = .28.
There was no significant relationship between Bayley cognitive composite score
and total paternal BDI score (r = -.213, p = .193).
As previously noted, some research has shown that the boys of postpartum
depressed mothers may be at greater risk for cognitive delay than the girls of
postpartum depressed mothers (Murray, 1992). A 2 (elevated BDI vs. non-elevated
BDI) x 2 (Male vs. Female) univariate ANOVA was conducted with Bayley-III
cognitive score as the dependent variable. No significant difference was found
between the Bayley-III cognitive scores of males (M = 102, SD = 13), and females
(M= 103.3, SD 7.63) of mothers in the elevated BDI group, F (1, 55) = .178,p -
.67. However, we should note that there were only 3 females in the elevated BDI
Sensitivity and Cognitive Development
Complete maternal sensitivity data were provided for by 38 of 39
participants (97%) and complete paternal sensitivity data was provided for by 37 of
39 participants (95%). Matemal/patemal sensitivity was categorized as either low
(< 6), optimal (7-9), or overly sensitive (> 9.5). Due to the small number of
participants in the overly sensitive group (2 mothers and 2 fathers) that category
was excluded from the study. The Bayley-III cognitive scores of infants whose
mothers were in the low sensitivity category (M = 103, SD = 13.37) were not
significantly different from infants whose mothers were in the optimal sensitivity
category (M= 98.75, SD =10.45). The Bayley-III cognitive scores of infants whose
fathers were in the low sensitivity category (M= 102.1, SD=\A) were not
significantly different from infants whose mothers were in the optimal sensitivity
category (M= 100, SD = 10.8). When running a correlational analysis with
sensitivity as a continuous variable no significant relationship was found between
maternal sensitivity and Bayley-III cognitive score, r = -.17,/)=.33, or paternal
sensitivity and Bayley-III cognitive score, r-A2,p =.49.
Maternal sensitivity could not be tested as a mediating variable (Baron &
Kenny, 1986) because the relationship between BDI-II category and Bayley-III
cognitive score was not significant in step one, standardized |3= .175, t (35) = 1.05,
p = .29.
Security of Attachment and Cognitive Development
Complete maternal security of attachment score data was available for 38 of
39 participants (97%) and complete paternal attachment data was available for 36
of 39 participants (92%). Attachment data was not available for 4 participants who
did not complete the study. Infants who fell in the lower one-third (AQS security
score < .348 for dads, AQS security score < .309 for moms) of attachment security
scores for their group were labeled insecurely attached and those in the upper two-
thirds were labeled securely attached. This division was based on the work of
researchers Lamb, Thompson, Gardner & Chamov (1985), who found that 67% of
infants were securely attached and 33% were insecurely attached in a normative
sample. Other researchers have also used this finding to create a secure vs.
insecure cutoff point for their own sample (Howes and Ritchie, 1999, Teti and
The Bayley cognitive subtest scores of infants securely attached to their
mothers (M=T00.4, SD= 11.71) were not significantly different from those of
infants in the insecurely attached group (M- 98.07, (SD = 10.71), F (1, 37) =.356, p
= .55. However, as depicted in Figure 3.1, infants securely attached to their fathers
(M= 103.2, SD = 11.03) scored significantly higher than infants who were
insecurely attached to their fathers (M=93.07, SD=9.25), F (35, 1) =, p=.008, r|2=
.189). Correlations between infant Cognitive score, sensitivity and security of
attachment variables are presented in table 3.3.
Insecurely Attached Sectxely Attached
Security of Attachment to Father
Error ban: 05% Cl
Figure 3.1 Bayley Cognitive Score as a function of father attachment category.
A hierarchical linear regression was used (see table 3.2) to assess the
relative contributions of demographic variables and security of attachment to the
father on Bayley-III cognitive score. Minority status was entered first, followed by
education, Income, and Security of Attachment to Father Category. The only
predictor of Bayley cognitive score that resulted in a significant coefficient |3 was
Security of Attachment to the father, t (31) = 2.6, p = .015.
Hierarchical Linear Regression Data 1
Step Variable Standardized P AR2 AF dfl Df2 Sig.AF
1. Minority Status -.069 .005 .164 1 34 .688
2. Education .073 .004 .139 1 33 .712
3. Income .096 .008 .259 1 32 .614
4. Security of Attachment to Father .425 .175 6.70 1 31 .015
A second hierarchical regression was used (see table 3.3) in order to
determine the relative contributions of marital satisfaction, fathers time spent
playing with child, time spent caring for child, and infant security of attachment of
the father on Bayley-III cognitive score. The only predictor of Bayley Cognitive
score that resulted in a significant coefficient p was security of attachment to the
father, t (24) = 2.4,/? = .022.
Hierarchical Linear Regression Data 2
Step Variable Standardized P AR2 AF dfl Df2 Sig.AF
1. Marital Satisfaction -.184 .034 .942 1 27 .340
2. Time spent playing with Child -.309 .094 2.817 1 26 .105
3. Time spent caring for child -.056 .002 .047 1 25 .830
4. Security of Attachment to Father .435 .173 5.970 1 24 .022
Correlations for Bayley Cogntive Scores, Maternal and Paternal Sensitivity and
infant Security of attachment to mother and father
Variable Bay Msen Dsen Maqs Daqs
Bay Cog -.25 -.14 .10 .43**
Msensitivity .27 -.087 -.216
Dsensitivity -.251 -.10
Note: Matemal/Patemal Sensitivity and Security of Attachment to mother and
father are categorical variables (0= Low Sensitivity, 1= Optimal), (0= Insecure
attachment, 1= Secure attachment). p <.05, **p < .01
Infant Associative Learning Score and Cognitive Development
Complete data for associative learning scores in response to an unfamiliar
mothers voice was provided for by 48 of 56 infants (86%) and complete data for
associative learning scores in response to an unfamiliar fathers voice was provided
by 45 of 56 infants (80%). Data for 19 infants was not available due to excessive
fussiness. There was no significant relationship between infant associative learning
in response to an unfamiliar non-depressed mothers voice and Bayley Cognitive
score (r = .03,/? = .80). A non-significant positive correlation between infant
associative learning in response to an unfamiliar non-depressed fathers voice and
Bayley-III cognitive score (r = .247, p = .10) was found.
Complete data for associative learning scores in response to an infants own
mothers voice were provided for by 30 of 39 infants (74%) and complete data in
response to an infants own father was provided for by 29 of 39 infants (70%).
Data for 19 infants was not available to excessive fussiness. There was no
significant relationship between infant associative learning in response to own
mothers voice and Bayley-III cognitive score (r = .16,/? = .37) and no significant
relationship between infant associative learning in response to own fathers voice
and Bayley-III cognitive score (r = .206,/? = .283).
This study hypothesized that infants of depressed caregivers would perform
more poorly on the cognitive subtest of the Bayley-III. It was also predicted that
optimal caregiver sensitivity, secure attachment to a caregiver, and better
performance on an associative learning task, would predict higher Bayley-III
cognitive development scores. For the most part these predictions were not
supported by the findings of this study. However, infants securely attached to their
fathers performed significantly better on the Bayley-III cognitive subtest relative to
infants insecurely attached to their fathers. The positive relationship between
security of attachment to the father and infant cognitive development remained
after fathers ethnicity, family income, and education were taken into account. Due
to the fairly large number of correlations examined in this investigation, it is
possible that the significant correlation between attachment security to the father
and infant cognitive development was due to chance. However, it should be noted
that this relationship was significant at the .01 level.
The significant finding of this study adds to previous work suggesting the
important role of the father in child development. Positive father involvement and
security of attachment have been linked to positive child cognitive outcomes. The
infants of highly involved fathers have higher scores on the Bayley scales at 6 and
12 months (Pedersen, Rubenstein, & Yarrow, 1979; Nugent, 1991) and
demonstrate higher IQ scores at 3 years of age (Yogman, Michael, Kindlon, Daniel;
Earls, & Felton, 1995). Security of attachment has been associated with puzzle
solving skills at 20 months (Easterbrooks & Goldberg, 1984). Some researchers
have explored the pathways by which fathers may contribute to the development of
Fathers are thought to exert their influence on child development by both
direct and indirect pathways (Lamb & Tamis-Lemonda, 2004). Direct pathways of
paternal influence refer to the ways in which fathers directly interact and influence
their children (e.g. caretaking, playing, verbal interaction, etc.). Indirect paternal
influence consists of paternal behaviors directed at other family members, or the
family as a whole (e.g. Financial support, emotional support to the mother and
other family members) that also impact the child.
Direct and indirect pathways of father influence assessed in this study
included a measure of the percentage of time that fathers spend taking care of or
playing with their infant, as reported by the mother and a measurement of marital
satisfaction, as reported by the mother and father. In contrast to previous research,
no significant relationships between marital satisfaction, father involvement
(caretaking and play) and cognitive development were found. Some researchers
have suggested the specific importance of child exposure to father marital discord
in considering the effects of marital quality (Cummings, Goeke-Morey, &
Raymond, 2004) and perhaps future research could take this into account.
An explanation for the possible link between child cognitive development
and secure attachment is found in the attachment-teaching hypothesis (Uzendoom,
Dijkstra, & Bus, 1995). This theory suggests that because any learning situation
causes a certain degree of anxiety about the possibility of failure, it is important for
a child to feel that they can trust the person teaching them. Therefore, securely
attached infants who trust their caregivers and feel free to learn and explore, may
show more optimal cognitive development than insecurely attached children.
The hypothesis that infants of depressed mothers would perform more
poorly on the Bayley-III cognitive subtest was not supported by the results of this
study. No significant relationship was found between maternal BDI category
(elevated vs. non-elevated) and Bayley-III cognitive score. This is inconsistent
with some of the previous findings on the topic (Lyons-Ruth, 1986; Murray, 1992,
Whiffen and Gotlib, 1989, Cornish et al, 2005) that found cognitive deficits in the
children of postpartum depressed mothers. This discrepancy is most likely
attributable to both the limitations of this study and to methodological differences
between this study and past research.
One of the major limitations of the study in regard to investigating the
relationship between postpartum depression and infant cognitive development was
that there were very few clinically depressed mothers (3 of 56) in the sample. Due
to the lack of diagnosable maternal depression, elevated BDI vs. non-elevated BDI
categories were used to make comparisons. However, the number of mothers in the
elevated category remained small (13 of 56) and provided only enough statistical
power to detect a very large effect. Most of the past studies linking postpartum
depression to infant cognitive development created depressed and non-depressed
groups based on clinical diagnoses of depression (e.g. Murray, 1992; Cogill et al.,
1986) and used larger sample sizes. Therefore, it is likely that the number of
mothers in the elevated BDI category was too few and the severity of their
symptoms too low to detect a difference in their infants Bayley Cognitive scores.
The current findings could also be due to the possibility that cognitive
deficits related to postpartum depression do not appear until later infancy or early
childhood and thus would not be detectable in our sample of 11-13 month-olds. A
study by Cicchetti, Rogosch, and Toth (2000) found a significant difference
between the infants of postpartum depressed moms at 3 years of age on the
Wechsler Preschool and Primary Scales of Intelligence-Revised (WPPSI-R;
Wechsler, 1989) but had found no difference with the same group on the Bayley
Scales at 20 months of age.
Another possible explanation for the lack of a relationship between Bayley
score and maternal depression is that the specific symptoms of the mothers in the
elevated BDI category were not taken into account. A distinction has been made in
past research (Jones et al., 1997) between withdrawn vs. intrusive mothers and each
interaction type has been associated with different infant outcomes. The infants of
withdrawn mothers appear to be more negatively affected than intrusive mothers,
and demonstrate less interactive behavior and lower Bayley Mental Scale scores at
12 months of age (Jones et al., 1997). Future research on this topic should take into
account the specific characteristics of each participants depression in their
statistical analyses and thus differentiate between intrusive vs. withdrawn
depressive interaction styles.
Past research (Murray, 1992; Sharp, 1995) has found that the boys of
depressed mothers are at greater risk for cognitive developmental delays than the
girls of depressed mothers. The current study was not able to investigate this
question due to the small number of infants in the elevated BDI-II mom category
(10 males, three females). Future research could address this issue with a larger
sample that has a more even number of males and females.
The prediction that maternal and paternal sensitivity would be associated
with performance on the cognitive subtest of the Bayley-III was not supported by
the results of this study and there are several possible reasons for this. First, almost
all of the previous studies that found an association between sensitivity and
general cognitive delay found deficits in children older (18 to 42 months of age)
than those assessed in the current study. It is possible that the adverse effects
related to parental insensitivity do not manifest until after the childs first year.
It is also important to note that the current study assessed parental
sensitivity and cognitive development within weeks and sometimes days of each
other, when the child was about 1-year-old. Most of the other studies that found
cognitive deficits related to sensitivity had assessed the child in early infancy,
between 2 and 6 months of age (Milgrom, Westley & Gemmill, 2004; Murray,
1992; Pound, 2006) and assessed cognitive development when the child was over 1
year of age. It is possible that low parental sensitivity during earlier infancy may
have a greater impact on infant cognitive development than insensitivity occurring
later in development. As part of a longitudinal study Murray, Fiori-Cowley,
Hooper, and Cooper (1996) found that adverse cognitive outcome at 18 months was
predicted by the quality of mother-infant interaction when the child was 2 months
old. This study and the others previously mentioned point to the possibility of a
sensitive period in infancy (Murray, 1997). Future research addressing the
relationship between parental sensitivity and the cognitive development of 1-year-
old-infants should also take into account parent-child interactions in early infancy.
Previous research suggested that IDS plays an important role in infant
learning and therefore it was predicted that infant performance on an associative
learning scores in response to infant-directed speech and their Bayley-III scores
would show a significant level of agreement. The results of this study did not
support that prediction. Infant Bayley-III cognitive scores were not significantly
related to how well infants learned in response to either their own parents or
unfamiliar parents voices within the conditioned attention paradigm. Although not
significant, infant learning in response to both an unfamiliar and familiar fathers
voice were both positively correlated with Bayley-III cognitive scores, the latter
approaching significance at the .05 level.
Due to the small number of depressed caregivers in our sample we were
not able to address the question of whether caregiver depression is associated with
infant cognitive developmental deficits. Infant security of attachment to the father
was found to be significantly associated with infant cognitive development and this
finding supports previous literature suggesting the important impact that fathers
may have on the development of their children.
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