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Postpartum depression, maternal sensitivity, and infant associative learning

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Postpartum depression, maternal sensitivity, and infant associative learning
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Burgess, Aaron P
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Children of depressed persons -- Education ( lcsh )
Postpartum depression ( lcsh )
Sensitivity (Personality trait) ( lcsh )
Paired-association learning ( lcsh )
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bibliography ( marcgt )
theses ( marcgt )
non-fiction ( marcgt )

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Includes bibliographical references (leaves 50-59).
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by Aaron P. Burgess.

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POSTPARTUM DEPRESSION, MATERNAL SENSITIVITY, AND INFANT
ASSOCIATIVE LEARNING: by
Aaron P. Burgess
B.A., Michigan State University, 1997
A thesis submitted to the University of Colorado at Denver and Health Sciences Center in partial fulfillment of requirements for the degree of Master of Arts Clinical Psychology 2006
r
!A'


This thesis for the Master of Arts degree by Aaron P. Burgess has been approved by

Peter S.. Kaplan
Amanda Moreno


Burgess, Aaron P. (M.A.., Clinical Psychology, University of Colorado at Denver and Health Sciences Center)
Postpartum Depression, Maternal Sensitivity, and Infant Associative Learning Thesis directed by Professor and Department Chair Peter S. Kaplan
ABSTRACT
Children of depressed mothers may be at particular risk for a number of social, emotional, behavioral, and cognitive problems. The quality of the early mother-child relationship in the context of depression, rather than depression itself, has been identified as a mechanism for adverse child outcome. Women who are depressed are less likely to adequately provide the arousal modulation and optimal stimulation required for child socioemotional and cognitive development. In previous research using a conditioned attention paradigm, 5 to 13-month-old infants of depressed mothers failed to learn that either a segment of their own mothers infant-directed (ID) speech, or high-quality ID speech produced by an unfamiliar non-depressed mother, signaled a slide of a smiling face after repeated pairings (Kaplan, P.S., Dungan, J.K., Zinser, M.C., 2004). In the current study, 6 to 13-month-old infants of depressed and non-depressed working-to-middle class mothers received pairings of their own mothers ID speech followed by a slide of a smiling female face, and associative learning was measured in a post-conditioning summation test. To measure the quality of the mother-infant relationship the dyad participated in a 10-minute free play interaction which was assessed according to the Emotional Availability Scales


(EAS: Infancy to Early Childhood Version; Biringen, Robinson, & Emde, 1993). Ratings of maternal sensitivity from the play interaction accounted for a significant proportion of the variance in infant associative learning after depression diagnosis and the correlates of depression had been taken into account. These results indicate that maternal sensitivity in working-to-middle class mothers may be a stronger predictor of infant associative learning than either depression itself or the adversity that often occurs with depression. The role of maternal sensitivity as a mediator or moderator of the effect of postpartum depression on infant cognitive development is explored.
This abstract accurately represents the content of the candidates thesis. I recommend its publication.
Signed


DEDICATION
I dedicate this thesis to Michelle Burgess for her patience, to Rick, Kris, Erik, and Scott Smith for always being there, to John Burgess and Michael Teixeira for encouraging exploration, and to all of my Grandparents.


ACKNOWLEDGEMENT
Thanks to Peter S. Kaplan for the opportunity, learning experience, and thesis support. Additional thanks to: Jessica Sliter for EAS and SCID data, and for help in the lab; Amanda Moreno for EAS training and statistical help; Kevin Everhart for general support, child psychopathology and child assessment courses; Michael Zinser for SCID training and an adult psychopathology course; and Allison Bashe for thesis advising.


CONTENTS
Figures.......................................................ix
Tables........................................................x
CHAPTER
1. INTRODUCTION..............................................1
Maternal Depression and Mother-Infant Interactions....3
Maternal Depression and Child Cognitive Development...7
Mediating and Moderating Variables............10
Infant Directed (ID) Speech..........................13
Conditioned Attention Studies and Infant Associative Learning......................................15
Depression and ID Speech......................16
CHAPTER
2. METHOD..................................................20
Participants.........................................20
Assessment of Depression.............................21
Structured Clinical Interview for DSM-Diagnosis.21
Beck Depression Inventory-II (BDI-II).........22
Maternal ID Speech Samples...........................23
Audio Recording...............................23
Acoustic Analysis.............................24
Assessment of Mother-Infant Interaction..............24
vii


Emotional Availability Scales (EAS).........24
Video-taped Coding..........................27
Apparatus..........................................27
Procedure..........................................28
CHAPTER
3. RESULTS
Demographics and Diagnostic Data...................30
Infant Associative Learning Score...........32
Mean Fundamental Frequency Fo Range.........33
Emotional Availability Scale Ratings........34
Stepwise Linear Regression..................37
Tests of Mediation and Moderation...........40
CHAPTER
4. DISCUSSION............................................43
REFERENCES
50


FIGURES
Figure
3.1 Mean infant difference score from the post-conditioning test as a
function of maternal depression diagnosis..........................32
3.2 Mean fundamental frequency F0 range of maternal ID speech as a
function of depression diagnosis...................................35
3.3 The association between infant learning score and maternal
sensitivity rating with each infants mothers diagnosis labeled...37
3.4 The association between infant learning score and maternal Sensitivity rating with each infants mothers diagnosis labeled
and fit lines added................................................40
3.4 Infant learning score means as a function of maternal depression
Diagnosis and maternal sensitivity rating category.................41


TABLES
Table
3.1 Demographic and Diagnostic Data.............................31
3.2 Mean EAS Ratings for Depressed and Non-depressed Mothers and
Their Infants................................................35
3.3 Inter-Item Correlations for EAS Ratings and Maternal Depression
Diagnosis....................................................36
3.4 Zero-Order Correlations Among Demographic, Diagnostic, and
Infant Learning Variables....................................38
3.5 Step-Wise Linear Regression Data............................39
x


CHAPTER 1
INTRODUCTION
Depression in the postpartum period is an important health and social problem for women and their families, occurring in approximately 10% of women of childbearing age (OHara & Swain, 1996; OHara, 1997). Depression produces personal suffering for women, and has been linked to adverse consequences for the mother-child relationship and for child social, emotional, and cognitive developmental outcome (OHara, 1997). Children of depressed mothers are at a greater risk for later socioemotional (Radke-Yarrow, 1998; Teti, Gelfand, Messinger, & Isabella, 1995) and behavioral problems, as well as childhood psychopathology (Downey & Coyne, 1990; Gelfand & Teti, 1990; Radke-Yarrow, 1998). Studies show that school-age children of depressed mothers have more peer difficulties (Zahn-Waxler, Ianotti, Cummings, & Denham, 1990), lower IQ scores (Hay, Pawlby, Sharp, Asten, Mills, & Kumar, 2001) and lags in attaining school readiness (NICHD Early Child Care Research Network, 1999).
One mechanism that has been implicated in adverse child outcomes is disordered mother-infant interactions. Mothers with depression, compared to non-depressed mothers, have been reported as less responsive to their infants cues, more critical, more irritable, and less active (Gelfand & Teti, 1990). In face-to-face interactions, depressed mothers and their infants display less positive and more negative behavior, and are more likely to be withdrawn or intrusive than non-depressed dyads (Cohn, Campbell, Matias, & Hopkins, 1990; Field, 1984; Field,
1


Healy, Goldstein, & Guthertz, 1990). Mothers who are depressed are less likely to provide adequate emotional regulation and optimal arousal which, in turn, may affect cognitive development (Femald, 1984; Hay, 1997; Kaplan, Jung, Ryther, & Zarlengo-Strouse 1996; Murray, 1992).
Infant directed (ID) speech is used by caregivers during interactions to regulate infant state and attention, and to promote infant learning (Femald, 1984). The pitch and contour of ID speech provide naturally potent stimulation for infants that occur in conjunction with certain actions, events, and stimuli. These contingencies form the basis for the learning of associations. Mothers who are currently depressed have been found to lack expanded fundamental frequency contours in their ID speech which may lead to less infant arousal and therefore may not promote learning about contingencies in the environment (Kaplan, Bachorowski, Smoski, & Hudenko, 2001). The infants response to ID speech is hypothesized not only to be related to the perceptual salience of the voice but also to the prior mother-infant relationship history associated with her voice (Kaplan, Dungan, & Zinser, 2004). Maternal responsiveness and sensitivity have been linked to attachment security and have been shown to moderate (NICHD, ECCRN, 1999; Campbell, Brownell, Hungerford, Spieker, Mohan, & Blessing, 2004) or mediate (Milgrom, Westley, & Gemmill, 2004) the impact of depressive symptoms on infant cognitive development. This study will assess the quality of the mother-infant interaction in currently depressed and non-depressed mothers, and the relative strength of associative learning by the infant in response to his or her own mothers ID speech.
2


Maternal Depression and Mother-Infant Interactions
The symptoms of postpartum depression are more prolonged than the baby blues, and serious enough to interfere with daily functioning (OHara, Neunaber, & Zekoski, 1984). Depressive episodes in the postpartum period show the full spectrum of clinical features including irritability, poor concentration, anxiety, and depressed mood and thoughts (Murray, 1992). Depressive symptoms typically exert a profound effect on interpersonal relations, and thus may prevent mothers from interacting in a sensitive or psychologically available manner with their baby (Martins & Gaffin, 2000; Murray, 1992). Murray and Cooper (1997a) suggests that the effect of depression on interpersonal functioning may interfere with normal infant engagements with the mother and therefore with necessary social interaction and learning.
In addition to the effects of depression on maternal behavior, the behavior of children of depressed mothers has been rated lower on measures of state, fussing, physical activity, facial expressions, and vocalizations (Field, Healy, Goldstein,
Perry, Bendell, & Schanberg et al., 1988). Infants of depressed mothers display fewer vocalizations, look away more, protest more, and show fewer positive facial expressions (Field, 1995). Two-year-old infants of depressed women were less content, more stressed, and fussed more during testing relative to infants of non-depressed mothers (Whiffen & Gotlib, 1989).
Murray, Fiori-Cowley, Hooper, and Cooper (1996) found that infant negative
3


affect was followed by maternal negations which in turn were followed by infant disruptions, and maternal affirmations were preceded by infant positive expression. Difficult infant temperament may be a biological disposition or may result from exposure to a depressed mother, but in either case the infants behavior is likely to exacerbate the mothers negative mood and perceptions of inefficacy when the mother is depressed (Whiffen & Gotlib, 1989).
Postpartum depression is a marker, but not a mechanism, for child developmental risk. Studies increasingly identify a specific risk mechanism to be the quality of early mother-child relationship (Stanley, Murray, & Stein, 2004). In typical mother-infant interactions the mother adjusts her behavior to the behavior of the infant to provide arousal regulation and optimal stimulation (Field, 1994). Mothers with depressive symptoms spend less time looking at their infants, touching and talking to them, display more negative and less positive facial expressions (Field, 1995), and may show withdrawal or intrusiveness (Cohn, Matias, Tronick, Connell,
& Lyons-Ruth, 1986). The resulting distress shown by infants is hypothesized to hinder the internalization of emotional regulation and may produce wariness in response to new situations, which in turn may have an impact on socioemotional and cognitive development (Cohn & Tronick, 1986).
Cohn and Tronick (1983) utilized a still-face paradigm to test infants response to depressed affect in face-to-face interactions. The researchers asked women to appear neutral with their infants which resulted in lower activity level and flat affect by the mother, and distressed behavior by the infant. Infants showed an alternating pattern of fussing, crying and turning away, or looking at the mother
4


warily. When mothers were asked to return to their usual behavior, infants continued to show distressed behavior.
Field (1984) observed that women with elevated, self-reported depressive symptoms were rated as less positive and more negative with their 3-month-olds in a face-to-face interaction. In a second interaction, all mothers were asked to look depressed which produced distress in the infants of mothers who were not normally depressed. Infants whose mothers were actually depressed showed little change in response to their mothers facial expression.
In a study by Cohn, Matias, Tronick, Connell, and Lyons-Ruth (1986) mothers with elevated depressive symptoms displayed withdrawn or intrusive behavior in face-to-face interactions with their 6-7-month-old infants and matched negative expressions more. The mothers who were depressed and their infants showed less turn-taking or mutual responsiveness to changes in the others behavior.
Field, Healy, Goldstein, Perry, Bendell, Schanberg et al. (1988) reported that 3-6-month-old infants and their mothers, who endorsed elevated depressive symptoms, were rated lower on all behaviors in a face-to-face interaction relative to non-depressed dyads. Infants of depressed mothers were less engaged and more negative in interactions, not only with their mother, but also with a friendly stranger.
Campbell, Cohn, and Myers (1995) found that mothers diagnosed with depression did not display high levels of negative, rejecting, or intrusive interaction prominent in high-risk samples demonstrated by Cohn et al. (1986) and Field et al.(1984; 1988). They did report however that the mothers who were depressed were less sensitive and less responsive than optimal. In a middle-class sample of mothers
5


who met diagnostic criteria for depression and their two-month-olds, Murray, Fiori-Cowley, Hooper, and Cooper (1996) found that mothers were less sensitive to their infants cues, and were less affirming and more negating, however they didnt observe the severe disturbances prominent in high-risk samples. Murray et al. did find that in the non-depressed group, women who had experienced recent adversity were significantly less sensitive in a play interaction. Stanley, Murray, and Stein (2004) concluded that in studies using diagnostic criteria to indicate depression, and where psychosocial risk factors are minimal, similar although less extreme results have been observed between depressed and non-depressed mothers and their infants. In the current study a diagnostic interview was utilized to provide more specificity in recognizing depressive symptoms that fulfill diagnostic criteria, and demographic factors were considered in addition to depression when predicting infant associative learning.
Field (1994) indicates that the early mother-infant interaction provides the context for infant behavioral and physiological organization and is the basis for later self regulation. When infants are not in homeostatic balance or are emotionally distressed, as may occur with a depressed caregiver, infants must devote their resources to state regulation and thus are less able to take agency and act on the world(Tronick & Weinberg, 1997, p. 56). An inability to regulate and direct attention may interfere with an infants information processing and storage and thus later cognitive development (Hay, 1997). The mothers role consists of reading the infants signals and providing optimal stimulation which helps the infant remain organized in state and therefore able to be attentive, alert, and receptive to stimulation
6


(Field, 1994). Thus, the infant is able to explore and balance the need for closeness and support with the need to explore and learn (Biringen, 2000).
Maternal Depression and Child Cognitive Development
In a recent review, Grace, Evinder, and Stewart (2003) found that the strongest effects of postpartum depression are on cognitive development such as IQ, language, and in Piagets object concept tasks. Contextual factors that correlate with depression as well as differences in infant gender (i.e. poorer performance in boys; Murray, 1992; Sharp, Hay, Pawlby, Shmucker, Allen & Kumar, 1995) have been noted.
Egeland and Sroufe (1981) examined the impact of maternal psychological unavailability, which is frequently observed in depressed mothers, on infant cognitive development in a low SES group. Infants with mothers who were psychologically unavailable showed lower cognitive development on the Bayley Scales of Infant Development at 24 months with a large decline between 9 and 24 months (Bayley, 1969). Similarly, Lyons-Ruth, Zoll, Connell, and Grunebaum (1986) found that increased maternal depression was significantly related to poorer scores at one year for infants on the mental and motor development on the Bayley Scales.
Cogill, Caplan, Alexandra, Robson, and Kumar (1986) followed up a sample of low-risk women who had been identified as depressed in the first postpartum year. Four-year-old children whose mothers had been depressed at some point in the childs first year of life scored significantly lower on the General Cognitive Index (CGI) of the McCarthy Scales of Childrens Abilities (McCarthy, 1972) compared to
7


those whose mothers had not been depressed in the first postpartum year (i.e. including mothers who were depressed during pregnancy and those who were currently depressed). Hay and Kumar (1995) further analyzed the Cogill et al. sample and found that the greatest impact on the childrens CGI score was on the Perceptual and Performance scale. In addition, higher relative maternal education was found to be a protective factor, but only for boys. Hay (1997) hypothesized that lower scores on perceptual and performance scales may be developmentally specific, in that the infants experience of a depressed mother in the first year occurred at a time when perceptual learning was taking place.
Sharp, Hay, Pawlby, Shmucker, Allen, & Kumar (1995) found that in a high-risk sample, mean CGI scores at 46-months for all infants were significantly lower when compared to the middle-to-upper class sample in Hay and Kumar (1995). The Perceptual and Performance subscales of the McCarthy scales as well as verbal performance scores were significantly lower, but only for boys in working-class homes, when their mothers were depressed in the first year postpartum.
Murray (1992) found in a large sample of first-time mothers that infants of mothers who had been screened and diagnosed with depression at 6 weeks performed poorer on an object concept series (Piaget, 1954) at 12 and 18 month follow-up. At 12 months, infants whose mothers had their first major depressive episode after childbirth were significantly more likely to fail on the Stage IV object concept task than infants whose mothers had a previous history of depression. At 18 months, infants whose mothers had suffered from depression after childbirth were more likely to fail Stage V than infants whose mothers had never been depressed. In contrast to
8


the object permanence tasks, postnatal depression had a significant effect on standardized assessments of mental development and language only in combination with low social class.
A study by Cichetti, Rogoshch, and Toth (2000) found that Toddler-Parent Psychotherapy was effective in fostering cognitive development in a low-risk sample of children whose mothers were depressed. At baseline, scores on the Bayley Mental Development Index (MDI) did not differ between three groups; depressed mothers and their infants who were randomly assigned to the treatment group, depressed mothers and their infants who were randomly assigned to the nonintervention group, and a control group of infants whose mothers had no history of depression. At follow-up (age 3 years) the depressed nonintervention group showed a relative decline in IQ. The depressed intervention and the control group remained equivalent, each having higher WPPSI-R Full Scale with the strongest differences emerging in Verbal IQs. The worst performance was found in children whose mothers had subsequent depressive episodes. Cichetti et al. (2000) suggest that the treatment strives to reduce maternal negative attributions about the child and to establish more positive affective expression and communication, thereby increasing self efficacy which increases exploration of the environment and learning.
Hay (1997) suggests that direct measures of attentional ability and memory recognition in infancy have been found to predict later IQ. Children assessed at 11 years whose mothers were depressed postpartum, were found to have lower IQ, more difficulty in mathematical reasoning, and more attention problems than children whose mothers had not been depressed (Hay, Pawlby, Sharp, Asten, Mills & Kumar,
9


2001).
For infants, attention to contingencies in the environment occurs when an action is closely followed by a reliable response or event. Depressed mothers have been shown to respond less immediately to their infants (Murray, Fiori-Cowley, Hooper, & Cooper, 1996) which may adversely affect an infants ability to understand order in the environment (Hay, 1997). This association, along with the failure on search tasks found by Murray et al. (1996) suggests that maternal depression early on may disrupt social learning processes that normally lead to increased capacity for attention and thus perceptual learning (Hay, 1997).
Mediating and Moderating Variables
Stanley, Murray, and Stein (2004) found in a face-to-face interaction that 3-month-old infants in a low-risk sample of depressed mothers were less affectively attuned and less contingent in their interactions. A measure of maternal responsiveness predicted infant performance in an instrumental learning task and postnatal depression did not. This demonstrates that maternal responsiveness may mediate the effect of postnatal depression or may even be a stronger predictor of cognitive development.
Milgrom, Westley, and Gemmill (2004) adapted a rating scale to obtain a measure of maternal responsiveness in a 15-minute play interaction with mothers diagnosed with moderate depression and non-depressed mother-infant dyads at 6 and 42 months postpartum. Responsiveness was operationally defined as the mothers sensitivity in responding to the infants cues particularly toward minimal verbal and
10


non-verbal messages. At 42 months the children of depressed mothers scored significantly lower on the WPPSI-R full scale IQ as well as on performance subtests of geometric design and arithmetic. Lower cognitive performance was more pronounced in boys which is consistent with other studies (e.g. Murray, 1992; Sharp et al., 1995). In the overall Cognitive/Language Profile, children of depressed mothers scored significantly lower on expressive and receptive language, language conceptualization, and basic school skills. Importantly, maternal responsiveness as measured at 6 months of age mediated the relationship between WPSSI full scale IQ and maternal depression.
Mothers who are sensitive to their infants affective signals respond promptly and optimally to adjust infant arousal (Field, 1994). This view of sensitivity inspired by Ainsworth, Blehar, Waters, and Wall (1978) includes an awareness of timing, flexibility, and clarity of perception which allows a prompt and accurate response (Biringen, 2000). Biringen and Robinson (1991) emphasized the role of emotion in their conceptualization of sensitivity within an emotional availability (EA) framework. Maternal sensitivity includes appropriate reception and expression of emotions by the mother, and whether the mothers response is successful as indicated by the child response. In a large study comparing women who never reported symptoms of depression to women who had, women with chronic symptoms of depression were rated as least sensitive when observed playing with their children from infancy through 36 months (NICHD, ECCRN, 1999). Children whose mothers reported more symptoms of depression but who were rated as highly sensitive were buffered from depressive symptoms while children whose mothers were depressed
11


and rated as insensitive during play were at additional risk cognitively and socially.
Mothers who are high in sensitivity and responsiveness are more likely to have children who are securely attached (Campbell, Brownell, Hungerford, Spieker, Mohan, & Blessing, 2004). Maternal depression has been considered a risk factor for insecure attachment because symptoms of depression may be experienced by infants as unresponsive, rejecting, inconsistent, or unavailable (Campbell et al., 2004; Martins & Gaffin, 2000).
Murray, Fiori-Cowley, Hooper, and Cooper (1996) found at an 18-month follow-up that infants whose mothers had been depressed at 2 months were more likely to be insecurely attached, even after accounting for social or personal adversity. In addition, the quality of the infants communication and degree of active engagement was determined by the mothers sensitivity.
Campbell et al. (2004) demonstrated that maternal depressive symptoms were associated with lower levels of maternal sensitivity and higher attachment insecurity. After controlling for demographic variables, the course and timing of depressive symptoms interacted with maternal sensitivity to predict attachment insecurity. High sensitivity moderated the impact of late, intermittent, or chronic symptoms of depression on insecurity, and therefore sensitivity may be a protective factor for the infant in the context of depressive symptoms (Campbell et al., 2004; NICHD, ECCRN, 1999).
Murray and Cooper (1997b) concluded that the mechanism that mediates the association between postpartum depression and adverse infant and child development is the impaired patterns of interaction occurring between mother and child in the
12


context of depression, rather than the childs exposure to depressive symptoms per se (pg. 257).
Infant-Directed (ID) Speech
Not only has depression been linked to less sensitive and less contingently responsive behavior, mothers who are depressed have been found to take longer to respond vocally and to lack the expanded contours in their voice which modulate attention and arousal (Bettes, 1988).Adults modify their vocalizations when speaking to infants. Infant directed (ID) speech or motherese, is simplified and intonationally different than adult directed (AD) speech used among adults. In infants, hearing develops earlier than other senses, is perceptually dominant, and highly discriminatory (Katz, Cohn, & Moore, 1996; Femald & Kuhl, 1987). Since infants under one year of age have limited linguistic competence, caregivers use paralinguistic communication such as vocal prosody and facial expression (Katz et al., 1996). Femald and Simon (1984) acoustically analyzed ID speech and discovered that when directed to their newborn, mothers spoke with higher pitch, wider pitch excursions, longer pauses, increased rhythmicity, more repetition, and shorter utterances than when speaking to another adult. These features of ID speech are used naturally and particularly by caregivers of pre-linguistic infants to highlight objects or actions and to convey meaning. For example, mothers were found to use high, rising pitch to engage and arouse their infants, and sinusoidal and bell-shaped contours were used when the infant was gazing and smiling at the mother and the mother attempted to maintain the infants positive affect and gaze (Stem, Spieker, &
13


MacKain, 1982). Papousek, Papousek, & Bornstein (1985) discovered that mothers also use low, falling contours to soothe their distressed infant. The exaggerated prosodic features of language spoken to children, has been identified across cultures and appears similar in particular contexts such as when the caregiver is approving or disapproving (Femald & Simon, 1984; Papousek, Papousek, & Symmes, 1991).
Several studies demonstrate that infants attend more to ID than AD speech throughout the first year of life (see Cooper & Aslin, 1994). In an operant auditory preference design, Femald and Kuhl (1987) found that 4-month old infants preferred ID speech to AD speech. In a head-turn procedure, in which a head-tum to one side produced a recorded sample of ID speech and a head-tum to the other side produced AD speech, infants preferred to listen to ID speech. Werker and McLeod (1989) discovered that infants from 4-9 months showed a preference for looking at a video recording of a male or a female adult speaker when they read a script using ID speech as compared to an identical AD speech script.
The exaggerated features of ID speech used across cultures by caregivers provides highly salient information for infants which serves possible developmental functions including; eliciting and maintaining infant attention, modulating arousal and affect, highlighting relevant features of language and the environment, and providing initial access to feelings and intentions of others (Femald, 1984; Femald, 1992).
14


Conditioned Attention Studies and Infant Associative Learning
Associative learning is a basic form of learning for young infants that can be assessed through changes in responding to the signaling stimulus as a function of conditioned stimulus-unconditioned stimulus (CS-UCS) pairings (Rovee-Collier, 1986). In associative learning models, conditioning involves a CS-UCS connection in which a signaling stimulus (CS) precedes and predicts a biologically or socially reinforcing stimulus (UCS). Learning is evident when the CS retrieves a representation of the UCS and establishes an expectation (Kaplan, Fox, and Huckeby, 1992; MacKintosh, 1983).
Kaplan, Fox, and Huckeby (1992) found that a tone (conditioned stimulus, CS) presented to infants in a forward pairing arrangement, preceding a slide of a smiling adult female face (unconditioned stimulus, UCS), acquired the ability to enhance looking at a novel checkerboard pattern in a subsequent summation test. In forward, backward, random, and no-tone control conditions, the amount of time spent looking at the face during the test trials did not differ significantly among groups, indicating that baseline looking was similar. The tone failed to enhance looking when it reliably followed the face or when presented randomly. Analysis of the no-tone control condition showed that the switch from a face to a checkerboard pattern did not itself cause visual fixation on the first checkerboard presentation. In the summation test, only the forward pairing arrangement of a tone that preceded and predicted a novel checkerboard pattern acquired the ability to increase looking.
Kaplan, Jung, Ryther, and Zarlengo-Strouse (1996) utilized an identical
15


conditioning paradigm in which infant-directed (ID) and adult-directed (AD) speech samples (CS) were recorded and presented in forward and backward conditions with the slide of the smiling adult female face (UCS) in the pairing phase and with a novel checkerboard pattern in the post-conditioning test. Infants who had received forward pairings of ID speech and the smiling face demonstrated CS-UCS associations as evidenced by significantly greater difference scores in the post- conditioning test than those in the backward pairing or AD speech conditions. Kaplan et al. (1996) hypothesized that ID speech produces greater arousal which allows infants to process the auditory-visual association more effectively and thus may promote better learning about the world.
Depression and ID Speech
Kaplan, Bachorowski, and Zarlengo-Strouse (1999) utilized a conditioned attention paradigm (described above) with speech segments recorded from mothers who varied in depressive symptoms as the CS for the smiling face UCS in tests with infants of non-depressed mothers. Speech from non-depressed mothers was effective in eliciting the voice-face association whereas infants who received pairings with a depressed mothers ID speech failed to acquire the voice-face association.
Kaplan, Bachorowski, Smoski, and Hudenko (2001) investigated the effects of maternal depression on the learning promoting qualities of their own ID speech directed to their infants. When a segment of their own mothers ID speech signaled a slide of a smiling female face, and when a segment of an unfamiliar non-depressed mothers ID speech was the signal, infants of non-depressed mothers learned the
16


voice-face association as evidenced by visual fixation in the post-conditioning test. Infants of non-depressed mothers however, failed to learn when an unfamiliar depressed mothers ID speech signaled the face. Infants of clinically depressed mothers failed to acquire the association when their own mothers ID speech segment was paired with the face but they did learn when an unfamiliar non-depressed mothers ID speech was the signal. In addition infants of depressed mothers looked more in response to an unfamiliar depressed mothers ID speech than when their own mothers ID speech was the signal. This result indicates that younger infants of depressed mothers, although not engaged by their own mothers voice, are able to learn the association between a voice and a face when high quality ID speech indicates the stimulus. Kaplan et al. (2004) hypothesized that low perceptual salience or prior non-reinforcement may be responsible for infants of depressed mothers failure to learn in response to their own mothers voice.
Kaplan, Dungan, and Zinser (2004) using this paradigm found that 5 to 13-month-old infants of depressed mothers failed to acquire associations when their own mothers or an unfamiliar non-depressed mothers voice was used as the conditioned stimulus. The infants did however learn the association when a non-depressed fathers voice signaled the face. The authors hypothesized that infants may benefit from a paternal caregiver who is relatively more responsive when the mother is depressed. Another possibility is that poor maternal care by depressed mothers may be generalized to other females, including female ID speech.
Infants of depressed mothers failed to acquire associative learning in response to their own mother at 4 months (Kaplan et al., 2002), and to an unfamiliar
17


non-depressed mother at 5-13 months (Kaplan et al., 2004). Infants of depressed mothers may be responding to a prior history of maternal behavior that lacks sensitivity to infant cues and that is less actively engaged. Thus, the ID speech of depressed mothers may be low in perceptual as well as emotional salience, and/or not correlated with positive results, and therefore might impair learning about environmental stimuli and stimulus interrelations (Kaplan et al., 2002; 2004)
Maternal depression has been associated with lower fundamental frequency Fo modulation in the voice (Bettes, 1988; Kaplan et. al, 2001), and disordered mother-infant interactions. The current study will consider both, the F0 of the infants own mothers ID speech and the quality of the relationship. Kaplan et al. (2001) in a sample of 50 mothers found that maternal depression diagnosis was significantly related to AF0. Deficits in ID speech by depressed mothers may have an impact on infant attention and arousal thereby leading to potential deficits in cognitive development. Bettes (1988) suggests that infants of depressed mothers are at a disadvantage in their attempt to interact due to maternal response latency and noncontingent vocalization. Mothers low in sensitivity and responsiveness to infant behavioral and affective cues are less likely to have securely attached infants, which has been implicated in socioemotional and cognitive development.
In this study, 6-12 month olds were tested in a conditioned attention paradigm with a segment of their own mothers ID speech (i.e. same as Kaplan et al., 2002; 2004). Kaplan et al. (2004) hypothesized that 5-13 month-olds of depressed mothers failed to learn the CS-UCS contingency using their own mothers ID speech due to a prior history of non-reinforcing maternal response or engagement. To test
18


the quality of the current mother-infant interaction, mother-infant dyads were assessed in a dyadic free-play interaction using the Emotional Availability Scales (EAS; Biringen & Robinson, 1991). Maternal sensitivity, which is a measurable subscale of the EAS, has been found in previous studies to be negatively associated with maternal depression and positively related to child cognitive development (Milgrom, Westley, & Gemmill, 2004; NICHD, ECCRN, 1999). No previous research has attempted to demonstrate an association between maternal sensitivity and infant associative learning in response to ID speech. Infants who show poorer learning in response to their own mothers ID speech may associate the voice with less responsive and less affectively attuned prior interactions and thus attend less readily to it. We tested the hypothesis that an infants learning in response to his or her own mothers ID speech can be predicted by qualities currently present and measurable in a mother-infant interaction, particularly maternal sensitivity.
j
19


CHAPTER 2
METHOD
Participants
Participants were 44 mothers and their 6- to 13-month-old infants. Mothers were recruited from an advertisement in Colorado Parent, a free local parenting magazine available at supermarkets and newsstands, and were paid for their participation. The mean infant age at the time of testing was 274 days (SD = 66; range: 180 to 395 days). Eighteen (41%) were boys and 26 (59%) were girls. The mean age for mothers was 29.8 years (SD= 5.6; range: 16 to 41 years). Twenty-five (57%) of the mothers were white, 11 (25%) were Latina, 5(11%) were African-American, 2 (5%) were Asian, and 1 (.02%) was Native American. For analyses, due to small numbers in cells, ethnic groups were combined categorically to represent the presence (n = 19) or absence (n = 25) of minority status. Demographic data for depressed and non-depressed mothers are presented in Table 3.1 in Results.
Assessment of Depression
Structured Clinical Interview for DSM-IV
Each mother was interviewed by M.A.-level clinical psychology graduate students using the Structured Clinical Interview (CV; i.e. clinical version) for DSM-IV Axis-I diagnosis (SCID-CV; First, Sptizer, Gibbon, & Williams, 1997). The SCID
20


is a semi-structured clinical interview in which DSM-IV criteria are used to systematically examine for various current and past mental disorders. Graduate student training involved intensive coursework, video demonstrations, and practice interviews. Interviews lasted about 30 to 60-min. Interviewers were supervised by Michael Zinser and Kevin Everhart.
Downey and Coyne (1990) suggest that the use of diagnosis rather than symptom checklists appear to be more specific in discerning high self-report symptoms that may not meet threshold criteria for clinical diagnosis. Diagnostic interviews may be more specific in identifying clinical depression particularly in the postpartum period when physical symptoms and anxiety are more likely to occur as a result of bodily changes.
Mothers who were included in the depressed group received a DSM-IV (fourth edition of the Diagnostic and Statistical Manual of Mental disorders; American Psychiatric Association, 1994) Axis I diagnosis of either major depressive disorder (MDD; n = 8), depressive disorder not otherwise specified (DDNOS; n = 3), bipolar I disorder (BP-I; n = 2), double depression (DBLD; n = 1), or depression due to a general medical condition (GMC; n = 1). Of mothers diagnosed with MDD, 3 were rated as mildly, and 5 were rated as moderately depressed. Four of the 8 mothers with MDD had postpartum onset (i.e. onset within 4 weeks postpartum). The mean duration of the current depressive episode was 7.6 months (SD = 3.7; range = 2-13 months).
Mothers included in the non-depressed group did not currently meet DSM-IV criteria for a major depressive spectrum disorder. Of the non-depressed mothers
21


19 reported no history of depressive spectrum disorder, 8 were in full remission from a major depressive disorder, and 2 were in partial remission from major depressive disorder. Two participants in the non-depressed group reported significant symptoms of anxiety. Since there were only 2 participants in partial remission, a t-test was conducted between participants with no history of depression and those in full remission. Results revealed no significant differences between groups for infant learning score, or maternal fundamental frequency as a function of not currently depressed status. Additionally a 2 (never depressed vs. full remission) x 5 (EAS subscales) univariate ANOVA revealed a non-significant result. Thus the 3 groups (i.e. never depressed, full remission, and partial remission) were collapsed into the non-depressed group representing mothers that were not currently depressed.
Beck Depression Inventorv-II (BDI-II)
All mothers were administered the Beck Depression Inventory-II (BDI-II; Beck, 1996). The BDI-II is a 21 item, self report questionnaire that reflects the cognitive, emotional, behavioral, and physiological symptoms of depression. Participants are asked to indicate on a 3 point scale the presence or absence of depressive symptoms, including their severity, during the past 2 weeks.
The mean BDI score for the sample was 14.3 (SD = 11.6; range = 0-51). The mean BDI score for the depressed and non-depressed groups was 25.4 (SD = 9.9; range = 16-51) and 8.6 (SD = 7.6; range = 0-31), respectively. In the non-depressed group 21 out of 29 (72%) scored below the recommended threshold of 13
22


on the BDI, with only 2 above a BDI of 17. The mean BDI score for the depressed group was 25.4 (SD = 9.9; range = 16-51) and each participant scored higher than 13.
Maternal ID Speech Samples
Audio Recording
Infant-directed (ID) speech samples were recorded from mothers in a 3-min play session. Mothers held infants on their laps and were asked to talk to their infants as they normally would. After 2 min, mothers were given a stuffed toy gorilla and asked to interest their infant in it using the phrase pet the gorilla. For the remaining 1 min mothers were instructed to both ask and tell their infants to pet the gorilla. A hand-held SONY microphone and a SONY TCM 5000EV tape recorder/player were used to collect speech samples. The speech stream was edited so that the first two interrogative and the first declarative pet the gorilla phrases were retained and repeated once (e.g., Will you pet the gorilla? Can you pet the gorilla?
Pet the gorilla). This allowed for a 10-s ID speech segment with approximately the same linguistic content across mothers
Acoustic Analysis
Mean fundamental frequency Fo range was calculated and averaged for gorilla utterances. F0 range consists of the range between the high and low sound in each utterance measured in Hz. Each pet the gorilla sample was analyzed using SpeechStation2 software (Sensimetrics Corporation, Somerville, MA), which was
23


previously used in the Kaplan et al. (2001) study. The gorilla utterance accounted for a majority of the voiced speech in the pet the gorilla utterance and thus was used for the calculation of F0 range.
Assessment of Mother-Infant Interaction Mother-infant play interaction was assessed using the Emotional Availability Scales (EAS 2nd edition; An Abridged Infancy/Early Childhood Version; Biringen, Robinson, & Emde, 1993). The reliability and validity of the EAS has been documented in many studies including convergent validity with Strange Situation classifications and ratings on Attachment Q-sort (Biringen, Robinson, & Emde, 2000, Ziv, Aviezer, Gini, Sagi, & Koren-Kafie, 2000) Mothers were supplied with two crates of toys and a blanket and were asked to interact with their infant as they usually would at home. The 10-min free-play interaction was videotaped through a one-way mirror and later coded by two independent observers.
Emotional Availability Scales (EAS)
The Emotional Availability Scales (EAS) consist of five measures geared specifically to research for understanding the quality of the parent-child interaction with particular emphasis on the emotional features. Emotional availability (EA) from the parent side emphasizes parental emotional signaling and parental understanding of the childs signaling (Biringen, 2000). Parental, or in this case, maternal behavior is assessed by three scales: Maternal Sensitivity (10-point scale), Maternal Structuring/Non-Intrusiveness (9-point scale), Maternal Non-Hostility (5-point
24


scale). Childrens EA to the parents is manifest in the childs affective interactions with the parent and in secure base behavior which indicates the balance between connectedness and autonomy (Biringen, 2000). Childs behavior is assessed by two scales: Child Responsiveness to Mother (9-point scale), and Child Involvement of Mother (9-point scale). These scales use a relational coding approach in which scoring of one dyadic member cannot be determined independent of the others behavior. Ratings incorporate the target behavior of one member while considering the behavior of the other (Ziv, Y., Aviezer, O., Motti, G., Sagi, A., & Koren-Karie, N., 2000). The scales are also global in that they incorporate the whole context of the interaction rather than discrete counts of behavior.
Maternal Sensitivity refers to the appropriateness and authenticity of maternal affect, and the ability to accurately read and respond to childs communications, smoothly negotiate conflict, soothe in distress, be flexible, and find stimulating and creative ways to play. A highly sensitive mother is also characterized by authentic and spontaneous positive affect. In this scale a rating of 9 indicates an optimal score while a rating of 10 indicates hyper-sensitivity in which the interaction is overly contingent and may appear anxious. A rating below 9 reflects noncontingent responsiveness, disconnected affect, and harshness.
Maternal Stucturing/Non-Intrusiveness refers to the degree to which the mother appropriately structures the childs play, follows the childs lead, and sets limits for appropriate behavior. An optimal rating of 5 indicates that the mother is providing a supportive framework from which the child may autonomously explore and lead the interaction. Ratings above 5 indicate mother too frequently sets the pace
25


and/or is over-stimulating or intrusive. Ratings below 5 indicate that mother is inconsistent, passive, or does not set limits, which leaves the child without adequate emotional scaffolding.
Maternal Non-Hostility is rated from not hostile (optimal rating of 1) to overtly hostile (rating of 5) which indicates abrasive/demeaning facial or vocal behavior, physical punishment, or threatening behavior. Scores in between 1 and 5 may indicate covert hostility such as discontent, boredom, or sarcasm with an edge, or more overt hostility such as abrasive teasing.
Child Involvement of Mother reflects the degree to which the child attends to and involves mother in play. An optimal rating of 7 indicates that the child displays balance between autonomous play and involvement of mother, and actively integrates mother into the flow of play. A higher rating indicates an over-involvement where the child displays a sense of neediness and anxiety. A rating lower than 7 indicates that the child is more balanced toward autonomous play rather than involvement of mother.
Child Responsiveness to Mother reflects the extent to which the child shows pleasure and eagerness in attending to mother, but without a sense of urgency. Optimal responsiveness is indicated by a rating of 7. A higher rating indicates a sense of diminished autonomy by the child since the child is overly responsive to mother. A rating lower than 7 reflects less pleasure and eagerness in attending to mother.
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Videotape Coding
Videotapes were coded by observers, blind to maternal BDI-II score or SCID diagnosis, using the criteria for scoring the Emotional Availability Scales (EAS 2nd edition; An Abridged Infancy/Early Childhood Version, Biringen, Robinson, & Emde, 1993). Two graduate students in the M.A. clinical psychology program were trained for the project by Amanda Moreno over a 4 month period. Practice videotapes were assigned and checked for inter-rater reliability.
Coding reliability was determined by intraclass correlation coefficients (ICCs; McGraw & Wong, 1996) which were tabulated for 15 of 44 (34%) current tapes between Amanda Moreno and two trained graduate student coders. Cronbachs alphas for the subscales were: Sensitivity = .94; Structuring/Non-intrusiveness = .67; Non-hostility = .97; Child Responsiveness = .84; Child Involvement = .60. The maternal sensitivity subscale, used in this analysis to measure maternal interaction quality shows excellent reliability.
Apparatus
Infants were placed in a car seat located in front of a large flat-black board. This apparatus was the same as that used in previously published conditioned-attention studies (Kaplan et al., 1999; 2002; 2004). A 4-in square translucent Plexiglas projection screen was situated in the board at eye level. The infants face was recorded by a video camera located 1.9 cm to the infants left of the projection screen. Two independent observers in separate rooms viewed a full face-view of the infant on 48.3-cm video monitors. Auditory stimuli were presented to infants using a
27


SONY TCM 5000EV tape player. A speaker was situated 10 cm below and 33.5 cm behind the infants head to ensure that looking was not simply the infant orienting toward the sound. The distance from the infants head to the projection screen was on average approximately 42 cm. An achromatic slide of a smiling adult female face and an achromatic 4x4 checkerboard pattern were presented using two computer-controlled slide projectors with shutters.
Procedure
Upon arrival mothers were briefed by experimenters about the activities and informed consent was obtained. Next, a 3-min audio recording session was completed (described above). An experimenter then edited the speech into a 10-s ID speech stimulus for use in the infant conditioned-attention test. Meanwhile another experimenter video-taped the mother and infant in a 10-min play interaction (described above) in the adjacent room. After the play session, and as soon as the speech stimulus was edited, the infant was placed in the conditioned-attention test apparatus (described above).
Each infant heard a 10-s pet the gorilla speech segment while the projection screen was uniformly illuminated. Following the speech segment, the infant received a 10-s presentation of an achromatic photographic slide of a smiling adult female face. A 10-s inter-stimulus interval (ISI) followed the termination of the slide and the projection screen was uniformly illuminated. Each infant received six contiguous speech segment-face pairings. Following a 10-s interval the postconditioning test began in which infants viewed four 10-s presentations of a 4x4
28


achromatic checkerboard pattern. The same pairing phase speech segment was presented simultaneously with the first and fourth checkerboard presentations. The second and third checkerboard presentations occurred with only background noise measured at 58 dB. Durations of infant looking at the projection screen during the 10-s speech, face, and checkerboard trials was signaled by two independent observers when the reflection of the visual stimulus was centered on the infants pupils. A second observer was present for all tests. Reliability was tabulated for 23 of 44 (52%) infant tests yielding a mean inter-observer reliability coefficient of .96 (range = .56-.98)
Following the infant test, each mother filled out the BDI-II (see above), and the Denver Maternal Stress, Behavior, and Personal Support Questionnaire for demographic information. Finally, mothers were administered the Structured Clinical Interview for DSM-IV diagnosis (SCID; see above for details).
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CHAPTER 3
RESULTS
Demographic and Diagnostic Data
Demographic and diagnostic data for the currently depressed and non-depressed mothers and their infants are displayed in table 3.1. Depressed mothers differed significantly from non-depressed mothers in years of education (M = 4.9, SD = 1.8; M = 6.1, SD = 1.8), F(l, 42) = 4.89,p = .03, rj2 = .10, and family income (M = 4.9, SD = 2.7; M = 6.7, SD = 2.0), F(l, 42) = 6.20, p = .02, tj2 = .13. Fisher Exact tests revealed that depressed mothers were significantly less more likely to be of minority ethnic status and less likely to be married, p<.01. BDI-II scores for depressed mothers were significantly higher than those of non-depressed mothers (M = 25.5, SD = 9.9; M= 8.6, SD = 7.6), F( 1, 42) = 39.83, p = .001, rf= .49. Infant age, maternal age, and infant gender were not significantly different as a function of maternal depression diagnosis.
30


Table 3.1
Demographic and Diagnostic Data
Variable Depressed Non-depressed
N 15 29
Maternal age (years) 29.6 (6.6) 30 (5.1)
Infant age (days) 295 (60) 264 (67)
Ethnicity
White 4 (26.7%) 21 (72.4%)
Latina 8 (53.3%) 3 (10.3%)
African-American 3 (20.0%) 2 (6.8%)
Asian 0 2 (6.8%)
Native American 0 1 (3.4%)
Percent married 47% 90%**
Mothers education 4.9 (1.8) 6.1 (1.8)*
Family income 4.9 (2.7) 6.7 (2.0)*
Number of children 1.7 (88) 1.6 (.83)
BDI score 25.5 (9.9) 8.5 (7.6)**
Note: Education, 3.0= no high school degree, 4.0= high school degree, 5.0= 2-year degree, 6.0= 4-year college, 8.0= advanced degree; Income (family yearly), 1.0= under $6,000, 2.0= $6,000-10,000, 3.0= $11,000-20,000, 4.0= $21,000-25,000, 5.0= $26,000-30,000, 6.0= $31,000-40,000, 7.0= $41,000-50,000, 8.0= above $50,000. Parentheses indicate standard deviations. Ethnicity is a categorical variable in the remainder of the analyses (0 = absence of minority status, 1 = presence of minority status). p <.05, ** p <.01.
31


Infant Associative Learning Score
Complete data were provided for conditioning trials by 23 of 29 infants of non-depressed mothers (82%) and 13 of 15 infants of depressed mothers (87%). Data for 8 infants was not available due to excessive crying. The mean difference score (i.e. the mean duration of looking during post-conditioning summation tests on checkerboard-plus-speech segment test trials minus duration of looking on checkerboard alone test trials) was lower for infants of depressed mothers, M = .20 (SD = 2.27), compared to infants of non-depressed mothers, M = 1.17 (SD = 1.98), although the results were not significant, F(l, 42) = .191,/? = .16, tj2 = .05.
2.00-
a> 1.50-
c
-1.00-
-1.50 -1-----------1----------------------1-------------
Not Depressed Depressed
Mom Depression Diagnosis
Figure 3.1 Mean infant difference (i.e. associative learning) score from the postconditioning test as a function of maternal depression diagnosis. Error bars represent +1-2 standard errors.
32


Gender has been associated with infant learning in some studies demonstrating adversity for boys in cognitive tasks when their mothers had been depressed postpartum (Murray, 1992, Sharp, Hay, Pawlby, Schumacker, Allen, & Kumar, 1995). With a larger proportion of girls in the depressed group (i.e. 12 girls and 3 boys) it is possible that increasing the proportion of boys could diminish the overall mean in the depressed group. A gender effect however has not been found in past conditioned attention studies
Mean Fundamental Frequency Fn Range
Figure 3.2 shows the mean fundamental frequency F0 range averaged across gorilla utterances as a function of maternal depression diagnosis. The mean F0 range for the depressed mothers was slightly lower M = 123 Hz (SD = 69.4), compared to the non-depressed mothers M = 156 Hz (SD = 73.1), although not significant, F(l, 41) = 2.05, p = .16, rj2 = .05. This result is not entirely consistent with prior studies by Kaplan et al. (1999; 2002; 2004) where significant differences in F0 were found between the two groups. Mean fundamental frequency F0 range was not significantly correlated with infant learning score.


i
V
O)
c
(0
oc
>.
o
c
a>
3
C
0)
re
+*
c
a>
£
re
TS
C
3
LL
200.00
150.00
100.00
50.00
0.00
Not Depressed
Depressed
Mom Depression Diagnosis
Figure 3.2 Mean fundamental frequency Fo range Hz of maternal ID speech as a function of depression diagnosis. Error bars represent +1-2 standard errors.
Emotional Availability Scale Ratings
Table 3.2 displays the mean ratings on the Emotional Availability Scales (EAS) for each subscale as a function of maternal depression diagnosis. A 2 (mother depressed vs. not depressed) x 5 (EAS subscales) univariate ANOVA indicated a marginal although non-significant overall effect, F(5, 44) = 2.10, p = .086. However, a significant between-groups effect was found for maternal sensitivity, hostility, and child responsiveness. Consistent with a-prior hypothesis ANOVA revealed that mothers who were depressed were rated as significantly less sensitive F( 1, 43) = 10.53, p = 02, tj2 = .20, and more hostile F(l, 43) = 5.07, p <.03, rf = .11, than non-depressed mothers. Infants of depressed mothers were also rated as less responsive F(l, 43) = 5.06, p = .03, rf = .11, compared to infants of non-depressed mothers.
34


Mean rating differences were not significant for the maternal structuring/intrusiveness scale and were marginal for child involvement of the mother, F( 1, 42) = 1.79, p = .08, rf = .07.
Table 3.2
Mean EAS Ratings for Depressed and Non-depressed Mothers and Their Infants
Variable Depressed Non-depressed
N 15 29
Sensitivity 6.7(1.2) 7.7(.82)**
Structuring/intrusiveness 5.5(1.0) 5.5(1.0)
Hostility 1.3(.54) 1.0(.19)*
Responsiveness (Child) 5.6(1.3) 6.3(.71)*
Involvement (Child) 5.4(1.2) 6.0(.90)
Note: Numbers in parenthesis are standard deviations. The ranges are as follows: Sensitivity (4-9), Structuring/Non-intrusiveness (3.5-9), Hostility (1-3), Child Responsiveness (3-7.5), and Child Involvement (3.5-7.5). Not all variables are measured on the same scale. Refer to Method for descriptions. p <.05, ** p <.01.
EAS ratings were highly inter-correlated (see table 3.3). Maternal depression diagnosis was significantly negatively correlated with ratings on maternal sensitivity, r = -.45, p<.01, and child responsiveness, r = -.33, p<.05; and positively correlated with maternal hostility, r = .33, p<.05. Maternal sensitivity ratings were significantly negatively correlated with maternal hostility, r = -.70, p <.01; and significantly positively correlated with child responsiveness, r = .74, p <.01, and child
35


involvement, r = ,69,p<.01. Maternal hostility ratings were significantly negatively correlated with child responsiveness, r = -.64, p<.01, and child involvement, r = -.44,
p<.01.
Table 3.3
Inter-Item Correlations for EAS Ratings and Maternal Depression Diagnosis
Variable Dep Sens Struc Host Resp Invo
Depression -.45** .01 .33* -.33* -.27
Sensitivity -.26 i o * 74** .69**
Structuring .23 -.31* -.37*
Hostility . 64** _ 44**
Responsiveness .84**
Involvement
Note: Responsiveness and Involvement are child scales. *p<.05, **p<.01
Of the subscales only maternal sensitivity was significantly correlated with infant learning score, r = .37, p = .03 (see figure 3.3). Infant involvement was marginally positively correlated, r = .28, p = .09.
S
36


Maternal Sensitivity Rating
Figure 3.3 The association between infant learning score and maternal sensitivity rating with each infants mothers diagnosis labeled.
Stepwise Linear Regression
Table 3.5 shows the zero-order correlations among the demographic and diagnostic predictors and the infant learning variable to be entered as the outcome variable in a regression equation.
37


Table 3.4
Zero-Order Correlations Among Demographic, Diagnostic, and Infant Learning Variables
Variable Eth Mar Edu Inc Med Dep Sen Lear
Minority Status -.39** -.53** -.58** -.02 .18 -.13 -.01
Marital Status .50** .52** -.05 -.47** .29 -.02
Education .73** -.25 -.32 .23 -.03
Family Income -.08 -.36* .30 -.08
Medication Use .29 .04 .01
MatemalDepression -.45** -.22
Maternal Sensitivity .37*
Infant Learning
Note: See table 3.1 for income and education coding. Ethnicity, marital status, and depression are categorical (0 = absence of minority status, 1 = presence of minority status; 0 = not married, 1 = married; 0 = not depressed, 1 = depressed; 0 = no medication use, 1 = medication use). p <.05, ** p <.01
A stepwise linear regression was used (See table 3.6) to assess the relative contributions of demographic variables, depression diagnosis, and maternal sensitivity as predictors of infant learning scores in response to the infants mothers ID speech (i.e. difference scores shown in figure 3.1). The first 4 variables entered are correlates of maternal depression and have been found to play an important contextual role in the association between depression and adverse infant outcome (Downey & Coyne, 1990). Maternal medication use is included as the 5th variable because it is a correlate of depression and may influence maternal functioning.
38


Minority status was entered first followed by, marital status, education, family income, medication use, and maternal depression diagnosis in steps 2-6, and maternal sensitivity rating in step 7. Zero-order correlations are shown in table 3.4 and regression results are shown in table 3.5. After the demographic and diagnostic variables were accounted for, maternal sensitivity rating was responsible for a significant increment in variance accounted for in infant learning score, AR2 = .186, p = .012. Maternal depression was marginally significant, AR2 = .093, p = .095, after demographic variables were entered, and may account for significant variance increment with a larger sample size. The overall model was not significant F(l, 27) = 2.08, p =.13. The only predictor of infant learning in response to ID speech produced by the infants own mother that resulted in a significant coefficient ft was maternal sensitivity, t{21) = 2.71,/z = .012.
Table 3.5
Stepwise Linear Regression Data
Step Variable Standardized P AR2 AF dfl df2 Sig. AF
1 Minority Status -.520 .010 .346 1 33 .560
2 Marital Status -.252 .007 .229 1 32 .636
3 Education -.091 .013 .420 1 31 .522
4 Family income -.360 .006 .196 1 30 .661
5 Medication Use .167 .002 .050 1 29 .824
6 Maternal Depression -.127 .093 3.00 1 28 .095
7 Maternal Sensitivity .547 .186 7.34 1 27 .012
39


Tests of Mediation and Moderation
Maternal sensitivity could not be tested as a mediating variable (Baron & Kenny, 1986) because the relationship between maternal depression diagnosis and infant associative learning was not significant in step one, standardized ft = -.223, t(34) = -1.33, p = .19.
As depicted in figure 3.4, the significant positive correlation for infant learning score and maternal sensitivity, when fit with regression lines for the depressed and non-depressed group displays an interaction.
Mom Depression Diagnosis
O Not Depressed # Depressed
%
Not Depressed \ Depressed
R Sq Linear = 0.313 R Sq Linear = 0.014
Figure 3.4 Association between infant learning score and maternal sensitivity rating with each infants mothers diagnosis labeled. Fit lines represent the R2 linear relationship for the depressed (/?2 =.31) and non-depressed (/?2=.01) groups.
40


To test for an interaction effect maternal sensitivity rating was categorized as high and low with a cutoff of 7. An EAS score of 7 represents an average, nonspectacular interaction, in which the mother is considered a good enough mother. Those included in the low sensitivity group (n = 9) received scores of 6.5 or below and those scoring 7 or above where included in the high sensitivity group (n = 27). The mean infant learning score for the low sensitivity group (M = -.25; SD = 1.94) was marginally lower, although not significantly different than the high sensitivity group (M = 1.18; SD = 2.07), F(l, 35) = 3.32, p = .08, tf = .09.
Maternal
Sensitivity Rating Low High
Figure 3.5 Infant learning score means as a function of maternal depression diagnosis and maternal sensitivity rating category.
41


In order to test for an interaction effect a 2 (depressed vs. non-depressed) x 2 (low sensitivity vs. high sensitivity) univariate ANOVA was conducted with infant learning score as the dependent variable. Results revealed no significant overall effects, including a non-significant depression diagnosis x sensitivity rating category interaction, F(2, 33) = 2.57, p = .12. It should be noted however that the small number of subjects in the low sensitivity group (n = 9) may have affected the power of the analysis.


CHAPTER 4
DISCUSSION
In this investigation, Emotional Availability Scales (EAS) ratings of maternal sensitivity, obtained using videotapes of a 10-min dyadic free-play interaction, were a significant predictor of infant associative learning in response the infants own mothers ID speech. Demographic variables that have been linked to adverse child cognitive outcome in previous studies (see Downey & Coyne, 1990; Sharp, Hay, Pawlby, Shmucker, Allen & Kumar, 1995) were significantly correlated with depression, but none were predictive of infant associative learning. In contrast to prior studies by Kaplan et al. (1999; 2002; 2004), maternal depression diagnosis was only a marginal predictor of infant learning in response to his or her own mothers ID speech; and, the mean extent of maternal pitch modulation was not significantly associated with depression diagnosis or infant learning. Maternal sensitivity ratings were negatively correlated with depression diagnosis and positively correlated with infant learning score, but did not significantly mediate or moderate the relationship. Indeed, maternal sensitivity rating was a better predictor of infant learning score than maternal depression diagnosis or socioeconomic variables. These findings support the hypothesis that the quality of the current mother-infant interaction is related to associative learning in response to the infants own mothers ID speech.
Maternal sensitivity as measured by the EAS provides a barometer of the parent-child relationship quality that can be conceptualized as a sample of the behaviors that typically occur within the dyad. From this perspective, the EAS
43


provides an index of the current interaction quality as a proxy of the overall relationship quality, which is composed of a prior history of interactions. This prior history is also hypothesized to be related to an infants response to his or her own mothers ID speech in previous conditioned attention studies (2002; 2004)
Kaplan et al. hypothesized that ID speech is a salient stimulus for infants, not only due to acoustic properties (1999), but also because an infants own mothers ID speech carries prior meaning (2002; 2004). This socioemotional meaning may be responsible for attention and arousal, and thus learning (Femald, 1994). When depressed, a mothers ID speech may be associated with the non-optimal mother-infant interactions that have been demonstrated in many studies (Cohn, Campbell, Matias, & Hopkins, 1990, Murray, 1992; Murray, Fiori-Cowley, Hooper, & Cooper, 1996; NICHD, 1999). In this study, mothers who were depressed were rated as less sensitive. If an infants experience with his or her mother is associated with less responsiveness, less positive affect, more hostility, or other non-reinforcing experiences, then an infant may respond less to cues associated with his or her mother, such as to her ID speech. In fact, in a prior study (Kaplan et al., 2002), infants of chronically depressed mothers did not respond to high quality ID speech produced by an unfamiliar non-depressed mother, but did respond to a non-depressed fathers ID speech, suggesting the possibility of a diminished response to maternal cues in general. In this study, infants whose mothers were rated as less sensitive, regardless of depression diagnosis, may have been less optimally aroused and stimulated, perhaps because their mothers ID speech is not associated with reinforcing events.
44


An alternative explanation for lower associative learning scores in the conditioned attention test is that the infant is affected by state dysregulation or negative affect. Infants of less sensitive mothers may be affected cognitively by negative affect associated with his or her mothers ID speech or by difficulty regulating emotional state during testing (Field, 1997; Tronick & Weinberg, 1997; Whiffen & Gotlib, 1989). However, although not specifically measured, profound negative affect or state dysregulation was not evident in this sample. In addition, this hypothesis is inconsistent with a prior conditioned attention study (Kaplan et. al, 2004) where infants of chronically depressed mothers did not responded to maternal ID speech but had supernormal learning in response to unfamiliar male ID speech. This demonstrates that infant state in the depressed group was most likely regulated enough for learning, although interaction quality was not measured. Therefore, negative affect and state dysregulation cannot be ruled out, and may be relevant to a relatively more disadvantaged sample, it did not appear that infant attention and learning were adversely affected by difficulty with state regulation. It is more likely that the infant did not experience optimal arousal in response to his or her mothers ID speech, which presumably is related to the infants prior experiences. Therefore, it is hypothesized that less sensitive mothers may be less optimally stimulating which is evidenced by less infant response to the contingency of CS-UCS pairing.
The data in this sample of diverse working-to-middle-class mother-infant dyads revealed that when mothers were high in sensitivity their infants responded with more looking in response to their mothers voice. Mothers rated as highly sensitive in other studies have show high positive affect sharing and responsiveness
45


contingent on infant signals. Infants, in turn, respond with more positive affect, comfort, and interest in the environment (Milgrom, Westley, and Gemmill, 2004; Murray, Fiori-Cowley, Hooper & Cooper, 1996). In this study infants of mothers who were low in sensitivity learned to associate the pairing of voice-face stimuli less well regardless of their mothers depression diagnosis. Maternal sensitivity has been shown in other studies to mediate (Milgrom, Westley, & Gemmil, 2004) or moderate (NICHD, ECCRN, 1999) the association between depression and outcome.
Criteria required to infer mediation (Baron & Kenny, 1986) were not met in this study because depression diagnosis was not significantly associated with infant learning score; a result consistent with recent findings by Stanley, Murray, and Stein (2003). Stanley et al. (2003) found that maternal positive contingent responsiveness was a significant predictor of infant performance at 3-months on an Instrumental Learning task, while postpartum depression diagnosed at 2-months did not significantly predict performance. Stanley et al. hypothesized that everyday experience of social contingency, at a time when the infant has little control over goal directed motor activity, may facilitate later learning of contingent relationships in the environment (p. 13). The result that maternal positive contingent responsiveness in the Stanley et al. study and maternal sensitivity in the current study predicted learning tasks that require the recognition of contingencies, while maternal depression did not, is interesting. In this study infants of more sensitive mothers may have learned from prior experience that responsiveness to his or her signals is timely, flexible, and positive, and therefore when her ID speech is presented it receives attention. This response may be due to the infants positive association with the voice
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itself and/or the infants perception and understanding that contingencies exist in the world, which represents prior learning in response to his or her mother.
Besides increased responsiveness, mothers who were high on sensitivity displayed more positive affect and positive affect sharing. Neither instances of exaggerated maternal withdrawal or intrusiveness, nor infant negative affect were specifically measured in this study, however it is likely that interactions rated higher on sensitivity included more positive affect. Since negative affect has been shown to hinder memory and cognitive performance (see Tonick & Weinberg, 1997) it is possible that positive affect is involved in learning. Further research should consider the role of positive affect along with contingent responsiveness on infant arousal, capacity for attention, and interest in the world.
The quality of the interaction may be differentially affected by the presentation of symptoms within the depressed group. Vegetative symptoms, such as difficulty sleeping and low energy may decrease contingent responsiveness and involvement, whereas symptoms of anxiety or irritability may increase intrusiveness and hostility. Infants show different behavior when mothers are withdrawn vs. intrusive. Infants respond to withdrawal with protest, fussiness, and wariness (Cohn & Tronick, 1986; Field, 1988), and to intrusiveness by looking away in order to reduce stimulation (Cohn & Tronick, 1986). Although extreme withdrawal and intrusiveness were not noted in this sample, depression may influence the mother-infant interaction differently depending on the symptom presentation.
Sensitivity may be rated as low on the EAS for a number of reasons. Since the EAS is dyadic, the caregiver may be rated as low when the infant is displaying
47


less interest or pleasure. It may be important in research to deconstruct sensitivity in order to discover what particular behaviors may be more or less associated with infant attention and arousal.
Milgrom, Westley, & Gemmill (2004) found that maternal responsiveness mediated the association between maternal depression and WPPSI total IQ, and performance subtests of arithmetic and geometric design. In contrast, maternal depression was a significant predictor of performance on the Cognitive Language profile, but the result was not mediated by maternal responsiveness. By increasing sample size, as has been found in previous conditioned attention studies, depression may be predictive of infant learning. Since depression has been shown to affect various aspects of maternal care, it is a likely hypothesis that the mother-infant interaction plays a meditating role. Further research in conditioned attention should continue to consider this possibility.
Infant associative learning in response to ID speech has not yet been linked to future cognitive performance. Infants whose mothers are low on sensitivity in the first year of life may perform worse on later tests of cognitive ability, particularly tasks that require perceptual skills (Hay, 1997). A cognitive or performance test concurrent with this test of conditioned attention, or a longitudinal design with a follow-up measure, may provide additional information about the relationship between associative learning and cognitive performance.
Sensitivity in this sample was a stronger predictor of infant learning than depression. Low maternal sensitivity in the context of maternal depression may predict lower learning scores in this paradigm which would suggest sensitivity may
48


act as a protective factor (see NICHD, 1999). Some evidence was present for moderating effect of sensitivity although this effect should be considered as preliminary due to the small number of participants in the low sensitivity group. Alternatively, maternal depression could produce associative learning deficits through its detrimental impact on sensitive and responsive caregiving. In either case, the mother-infant interaction, rather than maternal depression itself, appear to be a mechanism for adversity in associative learning in response to the infants own mothers ID speech. It is probable that a larger sample size will provide a more accurate picture of the relationship between the three variables.
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Full Text

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Demographic and Diagnostic Data p P <.01.

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f).R2 f).R2 p 2.08, p fJ t(27) P Stepwise Linear Regression Data

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Patterns of attachment: A psychological study of the Strange Situation. Diagnostic and statistical manual of mental disorders (4th ed). Journal of Personality and Social Psychology 51, The Bayley scales of infant development. BDI-J/. Child Development, Manualfor scoring the Emotional A vailability Scales: Infancy to early childhood version. American Journal of Orthopsychiatry, 70(1),

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Attachment and Human Development, Developmental Psychology, Postpartum depression and child development Development and Psychopathology, Journal of Abnormal Child Psychology, British Medical Journal, Developmental Psychology,

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New directions for child development: Maternal depression and infant disturbance Child Development, Child Development, 65, Psychological bulletin, New Directions for Child Development, The origins and growth of communication The adapted mind: Evolutionary psychology and the generation of culture Infant Behavior and Development, 279-293 Developmental Psychology, 20, 104-113

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Infant Behavior and Development, Psychobiology of attachment Infant Behavior and Development, Monographs of the Society for Research in Child Development, Developmental Psychology, Child Development, Developmental Psychology, Structured Clinical Interview for DSM-IV Axis I Disorders. Clinician version (SCID CV).

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Clinical Psychology Review, 10, 329-353. Archives of Women's Mental Health, Postpartum depression and child development Child Psychiatry and Human Development, Journal of Child Psychology and Psychiatry, Psychological Science Infancy,

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Child Development, 70(3), 560Developmental Psychology, 40, 140-148. Developmental Psychobiology, 25, Infant Behavior and Development, Developmental Psychology, Child Development, Maternal

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depression and Infant disturbance. The psychology of animal learning. Journal of Child Psychology and Psychiatry, McCarthy Scales of Children's Abilities. Psychological Methods, Infant Behavior and Development, Journal of Child Psychology and Psychiatry, Postpartum depression and child development. Postpartum depression and child development. Psychological Medicine, Child Development,

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Developmental Psychology, Journal of Abnormal Psychology, International Review of Psychiatry, Postpartum depression and child development Social perception in infants. Journal of Psycholinguistic Research, Infant Behavior Development, 13, The construction of reality in the child

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Children of depressed mothers: From early childhood to maturity. Advances in infancy r e search Journal of Child Psychology and Psychiatry, Development and Psychopathology, Developmental Psychology, Developmental Psychology, Maternal depression and infant disturbance: New Directionsfor Child Development.

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Postpartum depression and child development Wechsler Preschool and Primary Scale of Intelligence-Revised Manual. Canadian Journal of Psychology, Journal of Abnormal Psychology, 98, Development and Psychopathology, Attachment and Human Development, 2,