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[Maternal stress among mothers of children with Williams-Beuren syndrome, Down's syndrome and mental retardation of non-syndromal etiology in comparison to mothers of non-disabled children].

OBJECTIVES: This study assesses the quantity of stress in mothers of children with mental retardation of different etiologies (Williams Syndrome--WS, Down Syndrome--DS, mental retardation of different etiologies--MR) and in mothers of non-disabled children (MA). METHODS: 85 mothers were asked to complete the Parenting Stress Index (PSI) and the Child Behavior Checklist (CBCL). The groups were matched according to the children's age, sex, and verbal comprehension as assessed by the WISC-R. Data on the child's mental age (WISC-R) and the family's socio-economic level were collected. RESULTS: Significant differences were found in the Child Domain, but not in the Parent Domain of the PSI. According to the Child Domain, mothers of children with WS and DS scored significantly higher on the acceptance and demandingness scales, while mothers of children with MR scored higher on the acceptance scale than did mothers of children with MA. Moreover mothers of children with WS displayed the highest scores on the hyperactivity, mood and adaptability scales. Groups did not differ on the level of experienced reinforcement from their child. No significant differences were found in the Parent Domain according to the subscales attachment and social isolation. Mothers of children with DS scored higher than the other groups on the scales: depression, sense of competence and parent health. Mothers of children with MR scored lower on restriction of their role as a parent and relationship to their spouse. The degree of the children's mental retardation as well as conspicuous behavior correlated positively with maternal stress but not the familial socio-economic level or the age of the children. CONCLUSIONS: Generally, mothers of children with mental retardation, regardless of its etiology, find it more difficult to accept their child than do mothers of non-disabled children. Specific behavior problems associated with the behavioral phenotype of a syndrome also influence the level of maternal stress.

Adolescent↗

Mother's early perception of her infant's difficult temperament, parenting stress and early mother-infant interaction.

The current study investigated factors contributing to mother's early perception of her infant's difficult temperament. One hundred and twenty-four mother-infant dyads participated in the study. Mother's perception of the infant's temperament was assessed with the Infant Characteristics Questionnaire (ICQ). The influence of mother-infant interaction, mother's mental health and parenting stress were investigated. Mother-infant interaction was videotaped during a face-to-face interaction and analysed using the Global Rating Scale. Mother's mental health was assessed through a structured interview (Structured Clinical Interview for DSM-IV, SCID) and parenting stress was examined by a questionnaire (Parenting Stress Index). First, the difficulty scale of the ICQ was used as a continuous variable and factors contributing to mother's perception of her infant's temperament as more or less difficult were examined. Secondly, infants were categorized into difficult and non-difficult, and factors increasing the infant's risk of being perceived as difficult were examined. The model including mother's mental health and parental distress accounted for 24% of the variance in perceived infant difficulty, with parental distress in particular being an influential contributor. When infants categorized as difficult were examined, mother's intrusiveness and infant's poor interactive behaviour in early mother-infant interaction as well as parental distress significantly increased the infant's risk of being perceived as difficult.

Adult↗

Infant massage improves mother-infant interaction for mothers with postnatal depression.

BACKGROUND: Postnatal depression can have long term adverse consequences for the mother-infant relationship and the infant's development. Improving a mother's depression per se has been found to have little impact on mother-infant interaction. The aims of this study were to determine whether attending regular massage classes could reduce maternal depression and also improve the quality of mother-infant interaction. METHOD: Thirty-four primiparous depressed mothers, median 9 weeks postpartum, identified as being depressed following completion of the Edinburgh Postnatal Depression Scale (EPDS) at 4 weeks postpartum, were randomly allocated either to an infant massage class and a support group (massage group) or to a support group (control group). Each group attended for five weekly sessions. Changes in maternal depression and mother-infant interaction were assessed at the beginning and the end of the study by comparing EPDS scores and ratings of videotaped mother-infant interaction. RESULTS: The EPDS scores fell in both groups. Significant improvement of mother-infant interaction was seen only in the massage group. LIMITATION: The sample size was small and had relatively high dropout. It was not possible to distinguish which aspects of the infant massage class contributed to the benefit. CONCLUSION: This study suggests that learning the practice of infant massage by mothers is an effective treatment for facilitating mother-infant interaction in mothers with postnatal depression.

Adolescent↗

The caregiving system in mothers of infants: a comparison of divorcing and married mothers.

This study was designed to investigate (1) the construct validity of a measure of the mother's internal representation of herself as a secure base in samples of married and divorcing mothers and infants, and (2) the relative contribution to infant security of this measure and a second representational measure, termed Psychological Protection, which focused specifically on the mother's responsiveness to the infant in the context of father visitation. There were 144 mothers and their first-born infants, age 12 to 20 months, who participated in the study. Of these, 51 dyads were from intact families; 93 were from families who had never married, had recently separated, or were in the process of divorce. Divorcing families were further divided into those in which the infant was participating in overnight timesharing arrangements with the father (n = 44) and those in which the infant was not (n = 49). Mothers completed questionnaires, they participated with their infants in the Strange Situation, and an hour-long, semi-structured Caregiving Interview was administered to them. Ratings of mothers on the Secure Base and Psychological Protection scales were based on verbatim transcripts of this interview. As predicted, mothers of securely attached infants in all family groups were discriminated from mothers of insecurely attached infants on the basis of Secure Base scores. Within the group of divorcing mothers, Secure Base scores were correlated with a rating of the mother's Psychological Protection of the infant in the context of visitation and both measures made independent contributions to infant attachment security. These findings are interpreted in terms of a more general model of the caregiving system. The manner in which the divorce context can disrupt the mothers' caregiving behavioral strategies and representations is also discussed.

Child Custody↗

Depression in mothers of children presenting for emergency and primary care: impact on mothers' perceptions of caring for their children.

CONTEXT: Maternal mental health conditions may influence how mothers utilize emergency health care for their children. However, little is known about the prevalence of depression among mothers of children presenting for emergency health care and how maternal depression affects a mother's perception of how difficult it is to care for her children. OBJECTIVES: To screen for maternal depression and to examine whether mothers with depressive symptoms perceive that these symptoms interfere with their roles in caring for their children. DESIGN: Cross-sectional survey. SETTING: An urban, tertiary-care, children's hospital. PARTICIPANTS: Mothers bringing their children, aged 6 months to 18 years, to an emergency department for low-acuity illness (n = 243) or to a pediatric primary care clinic (n = 249) for well-child care. MAIN OUTCOME MEASURE: Positive screening tests for depression using the Prime MD Patient Health Questionnaire. RESULTS: The prevalence of positive screening tests for depression was similar in both emergency and primary care settings, with 18% of mothers having either major (9%) or subthreshold (9%) depression and 5% percent having suicidal ideation. Seventy-six percent of mothers with a positive screen for major depression and 17% of those with a negative screen for depression reported that their mental health symptoms made it difficult to care for their children. Mothers with a positive screen for depression reported poorer health status for themselves (P =.014) but not for their children (P =.37). CONCLUSIONS: Screening questionnaires in both primary care and emergency care settings with sociodemographically similar groups of mothers produced similar rates of depression. The high rates of depressive symptoms and of mothers' reports that these symptoms cause them difficulty in caring for their children indicate that resources to screen for and address depressive symptoms in mothers should receive higher priority in pediatric health care settings.

Adolescent↗

[The behavior of mothers during dental treatment for their handicapped children. 1. Relationship between mothers' behavior and child patients' factors].

The purpose of this study was to find out factors which determine whether or not mothers of handicapped children chose to be with their children while receiving dental care. The subjects were 46 pairs consisting of a handicapped child and his or her mother who came to the pedodontic clinic of Aichi-Gakuin University Dental School. Such factors of the patients as the various abilities of the patients, their behavior and other items were surveyed with a behavior evaluation. These factors are considered to be related to determining the behavior of the mothers. The results of the survey are summarized as follows: 1. Patients whose mothers chose to be with them tended to be slightly inferior in basic language use and mouth rinsing ability, when compared with patients whose mothers chose to stay in the waiting room. 2. Patients who were autistic more often had mothers who chose to be with them than patients with other disabilities. 3. Patients whose mothers chose to be with them got higher Behavior Evaluation Scores in all dental care situations so that they tended not to adapt to dental care, when compared with patients whose mothers chose to stay in waiting room. 4. From the analyses of Quantification Type II, a height correlation ratio was obtained in the distinction efficiency of the mothers' behavior. Also the behavior of the mothers could be predicted by the factors of the children. 5. There were four factors present in those handicapped children which are considered to have determined their behavior of the mothers: the kind of disability, verbal expression ability, mouth rinsing ability and adaptation to dental care.

Adult↗

Determinants of mother-infant interaction in adolescent mothers.

Mother-infant interactions of adolescent and nonadolescent mothers are compared, and the impact of maternal age, ego development, education, and child care support on these interactions is examined. Thirty primiparous, white, lower- to middle-class mothers (half less than or equal to 17 years) and their healthy full-term infants (8 months) were studied. Interactions were videotaped during face-to-face interactions and teaching sessions. Child care support and ego development were assessed. During face-to-face interactions, only one difference was found between adolescent and nonadolescent mothers: nonadolescent mothers showed more positive affect toward infants. During teaching, nonadolescent mothers talked more, showed more positive affect toward infants, and demonstrated tasks more often. Individual differences during face-to-face interactions were more related to mothers' ego development and support whereas teaching interactions were mostly associated with maternal age. Thus, maternal age was a stronger predictor of interactive style during teaching. This may partially explain noted cognitive deficits in infants of teenage mothers. However, individual differences among all mothers in ego development, education, and support were significantly related to interactions. Thus, teenage mothers with less education and support and lower ego development may represent a higher risk subgroup of adolescent mothers providing less optimal care-giving environments for their infants.

Adolescent↗

Childhood asthma: mothers' affective attitude, mother-child interaction and children's compliance with medical requirements.

Maternal critical attitude (CA) and negative mother-child verbal interaction in families with an asthmatic child and in controls were investigated in the present study. Twenty-eight children with bronchial asthma (6-13 yr) and 23 healthy children with their mothers participated in the project. Mothers were asked to describe their child (Five Minute Speech Sample; FMSS). Mother and child were then asked to discuss a mutual problem (Problem Discussion; PD). Tape recordings were taken. The mothers' responses during the FMSS were used to assess CA. Negative verbal behavior during PD was coded by means of a reliable coding system for dyadic interaction. Significantly more mothers of the asthmatic children than of the controls showed CA during the FMSS. Mothers of the asthmatic children made significantly more critical remarks and offered more negative solutions during the PD. Within the asthma group mothers who made more critical remarks had to make more effort to have their child comply with the medical requirements. Additionally, mothers showing a higher total amount of negative verbal behavior had children with rather high IgE levels. There was no systematic difference between children having CA mothers with high vs low face-to-face contact.

Adaptation, Psychological↗

Trustful bonds: a key to "becoming a mother" and to reciprocal breastfeeding. Stories of mothers of very preterm infants at a neonatal unit.

A preterm birth and subsequent hospitalization of an infant at a neonatal unit (NU) implies an extraordinary life situation for mothers, in which the maternal role and breastfeeding begin and evolve in a medical and unfamiliar setting. Descriptions of how women experience "becoming a mother" and breastfeeding in such a situation are sparse and this question was addressed in the present study. In this qualitative study, inspired by the grounded theory approach, in-depth interviews were conducted with 25 mothers whose very preterm infants had been cared for in seven NUs in Sweden. Findings indicated the importance of quality in social bonds with the infant, father, staff and other mothers at the NU, for "becoming mothers" and experiencing mutually satisfying breastfeeding. Three themes comprised a structure for descriptions of experiences, social bonds and mediated emotions: (1) 'loss' of the infant and the emotional chaos--"putting life on hold"; (2) separation--a sign of being unimportant as a person and mother; and (3) critical aspects of becoming more than a physical mother. The qualities were described as trustful or distrustful, characterized by accompanying feelings of pride/trust or shame/distrust. Social bonds were affected not only by the interpersonal interplay but also by the public environment and care routines. In conclusion, the contextual setting and distrustful social bonds impaired the ability to "become mothers" and the sensation of reciprocity i.e. breastfeeding becoming dutiful and not mutually satisfying. As breastfeeding is an intimate interplay and a personal choice it was considered that the best breastfeeding support would seem to be provision of a favorable environment that enhances the mother's confidence in herself. The contextual setting should be modeled such as to create conditions for a trustful and reciprocal mother-infant bond.

Adult↗

Comparison of child-rearing problems between mothers with multiple children who conceived after infertility treatment and mothers with multiple children who conceived spontaneously.

The purpose of this study was to clarify the characteristic child-rearing problems for mothers of multiple children who conceived after infertility treatment as compared to mothers of multiple children who conceived spontaneously. The subjects were 990 mothers of multiple children: 359 who conceived after infertility treatment and 631 who conceived spontaneously. Mothers who conceived after infertility treatment were more delighted when informed of a multiple pregnancy than those who conceived spontaneously. In addition, with respect to anxiety during twin pregnancies, mothers of twins who conceived after infertility treatment showed lower rates of anxiety about nursing the infants and economic concerns than those of twins who conceived spontaneously. However, after delivery, mothers who conceived after infertility treatment showed a higher rate of depressive symptoms than those who conceived spontaneously. After adjusting for each associated factor using logistic regression, the risk of depressive symptoms in mothers who conceived after infertility treatment was significantly associated with disabled multiple children and the methods for alleviating stress. The odds ratio indicated that mothers with at least one disabled child were twice as likely to have depressive symptoms as mothers with no disabled children. Furthermore, the odds ratio indicated that mothers who used no methods for alleviating stress were twice as likely to have depressive symptoms than those who did.

Adult↗

Mothers with breast cancer and their adult daughters: the relationship between mothers' reaction to breast cancer and their daughters' emotional and neuroimmune status.

OBJECTIVES: The objectives of this study were to assess the associations between psychologic distress of patients with breast cancer and of their adult daughters; and to assess the associations between mothers' psychologic distress and daughters' psychologic distress, stress hormone levels, natural cytotoxic activity (NCA), and Th1 cytokine secretion. METHODS: Eighty mothers with breast cancer and 80 adult daughters participated in the study. They completed the Symptom Check List (SCL-90R) questionnaire. In addition, daughters completed a set of questions on their health status and habits and on the effects of their mothers' disease on their own lives. Thirty milliliters of heparinized venous blood and a first early-morning urine sample were collected from daughters between 8:00 and 9:00 am. Spontaneous and interleukin-2 (IL-2)-induced NCA, in vitro IL-2 and IL-12 secretion, and levels of plasma cortisol and urinary catecholamines were tested in daughters. Forty-seven healthy women, age- and education- matched to daughters, completed the psychologic, immunologic, and hormonal tests, and served as a control group. RESULTS: Psychologic distress of mothers and daughters was highly correlated. However, mothers experienced a higher level of distress than daughters. Mothers with advanced disease and their daughters were more distressed than mothers with primary disease and their daughters. Daughters' distress was also related to their subjective caregiving burden and the frequency of meetings with mothers. Higher distressed daughters had lower IL-2-induced NCA and decreased in vitro IL-2 and IL-12 secretion. Norepinephrine secretion level mediated the relationship between daughters' level of distress and their immune functions. Cortisol mediated only the relationship between daughters' distress and IL-2 secretion. CONCLUSIONS: This initial study shows that the psychologic distress of mothers with breast cancer and that of their adult daughters are similar. Stress hormone secretions and immune functions of daughters are related to both their own and their mothers' psychologic distress.

Adult↗

Pregnancy loss in mothers of multiple births and in mothers of singletons only.

We compared pregnancy loss in mothers of multiple births and in mothers of singletons only. The index of pregnancy loss used for purposes of the present analysis is: the ratio of total pregnancies to total maternities consisting of live births. Mothers of one set of like-sexed twins and mothers of one set of unlike-sexed twins had greater pregnancy loss than did mothers of singletons only. Women who had higher-order multiple births comprised only 5% of our sample; in terms of their pregnancy loss these women were similar to mothers of singletons only. Data on whether women ever had difficulty becoming pregnant, and the type of therapy received to aid in conception showed that mothers of twins had greater difficulty becoming pregnant than did mothers of singletons. Among women with difficulty becoming pregnant, pregnancy loss was greater than among those who reported no difficulty. In our sample, 4.3% of mothers of multiple births and 3.4% of mothers of singletons only received hormonal therapy, some of which included FSH or clomiphene citrate.

Abortion, Spontaneous↗

Cohort comparison study of children whose mothers have acquired immunodeficiency syndrome and children of well inner city mothers.

The virus or viruses (human immunodeficiency virus) associated with the acquired immunodeficiency syndrome may be transmitted in utero or perinatally from an infected mother to her baby. Infected adults may remain asymptomatic for months to years, during which time a mother could transmit the virus. It is not known to what degree a mother may transmit the virus perinatally or whether postnatal transmission is possible. We studied a cohort of children whose mothers had been reported to have acquired immunodeficiency syndrome, comparing human immunodeficiency virus-seropositive with seronegative children as well as a cohort of inner city children with similar socioeconomic characteristics whose mothers are well. Three (12%) of 25 children whose mothers have acquired immunodeficiency syndrome were seropositive compared with none of 44 children whose mothers were well. The seropositive children had lower T4A:T8 lymphocyte ratios than children in the other groups. Nine children of affected mothers were young enough to have been born within their mother's incubation period and were seronegative and well. When compared with seronegative children the seropositive children did not have greater contact with their ill mothers, either in types of physical interaction or in length of time lived together. Although this study cannot preclude the possibility of postnatal nonsexual transmission, it does present evidence against it.

Acquired Immunodeficiency Syndrome↗

[PreS/S gene mutations in HBV in children infected through mother-to-infant transmission and in their mothers].

OBJECTIVES: To investigate the characteristics of mutations in PreS/S gene of HBV in children infected through mother-to-infant transmission and in their mothers with different degree of viremia. METHODS: There were 15 pairs of child and mother in this study. Mothers of all children were chronic asymptomatic HBsAg carrier (ASC) before pregnancy and the children were not inoculated against HBV after birth. Anti-HBV medicine was never administrated to all subjects. The serological markers of hepatitis A, B, C, D and E virus were tested and the titers of serum HBV DNA were quantitated. PreS/S gene was amplified by PCR and cloned into pGEM-T vector with T-A cloning technique. The recombinant plasmid pGEM-PreS/S was confirmed by digestion with restriction enzyme ApaI and SacI. Two clones were selected to be sequenced from each patient. RESULTS: According to the degree of viremia in every pair of mother and child, 15 pairs of child and mother were divided into three groups: group A (both children and mothers had high viremia with HBeAg-positive), group B (high in children and low in mothers with anti-HBe positive), and group C (low in children and high in mothers), and there were 5 pairs in each group. The subtype of each pair was the same. There were 4/5 pairs of HBV with B/adw2 and 1/5 pair of HBV with C/adrq+ in each group. It was shown that there were no difference among the four high viremia groups or between the two low viremia groups in the number of mutations and the number of mutational positions. However, there was significant difference between high viremia group and low viremia group. The mutation was not related to age. There were 56 mutational positions and there was no mutational hotspot in high viremia patients. In two low viremia groups (the mothers in group B and the children in group C), there were 113 mutational positions and 85 mutational positions were hotspots (owned by 5/8 clones in each) which could make 37 amino acids changed. Most of mutational amino acids were located within T and B cell epitopes of envelope protein or/and located in the surrounding regions. CONCLUSIONS: There are many differences in HBV with different degree of viremia, even if it comes from the same strain. There are some regular patterns in the mutations of HBV after HBeAg seroconversion happened.

Adult↗

Comparison of severe life stress in depressed mothers and non-mothers: do children matter?

Given the high rates of maladjustment among children of depressed mothers, parenting is likely to cause significant life stress in this population, potentially worsening the course of mothers' depression. The present study is a comparison of severe life stress in 38 mothers and 62 non-mothers receiving treatment for recurrent major depression. Life stress was assessed using the Life Events and Difficulties Schedule [Brown and Harris, 1978a]. We hypothesized that mothers would evidence a greater number of severe life events and marked difficulties both in the year prior to the onset of their depressive index episode and in the time period following the onset of their current depressive episode. Prior to depression onset, mothers reported a significantly greater number of entrapping difficulties, but not marked difficulties, severe events, entrapping events, or humiliating events. However, following the onset of depression, mothers experienced a significantly greater number of severe events, entrapping events, marked difficulties, and entrapping difficulties, but not humiliating events. Mothers' elevated levels of stress were attributable to child-related stress, predominantly related to children's psychological and behavioral problems. Our findings suggest that comprehensive treatment for mothers with major depression needs to address their parenting style and any psychological problems experienced by their children.

Acute Disease↗

Mothers' representations of relationships with their children: relations with mother characteristics and feeding sensitivity.

OBJECTIVE: To examine parenting representations and feeding interactions of mothers and their children with cerebral palsy (CP) and the extent to which mothers' representations predict their feeding behavior beyond other mother and child characteristics. METHODS: Fifty-eight mothers of children with mild to severe CP ages 16 to 52 months were interviewed with an adapted form of the Parent Development Interview (PDI). Correlation and regression analyses examined relations between representations (compliance with parental requests, achievement, secure base, enmeshment, worry about the child's future, and emotional pain), demographic characteristics, diagnostic severity, and developmental status. RESULTS: Mothers with more compliance-related concerns showed less sensitivity, acceptance, and delight during feeding. Mothers experiencing more emotional pain displayed more hostility. Mothers reporting worries about the child displayed sensitivity and delight. Representations of compliance-related experiences and worry about the child's future accounted for significant increments in explained variance in mothers' feeding behavior, after we controlled for children's skills and abilities. CONCLUSIONS: Findings suggest maternal representations of relationships are associated with caregiving behavior for mothers of children with CP apart from other child and maternal characteristics and may be a useful focus for research and practice related to parenting children with special needs.

Adaptation, Psychological↗

Infants of depressed mothers exhibit atypical frontal electrical brain activity during interactions with mother and with a familiar, nondepressed adult.

Previous studies have shown that infants of depressed mothers exhibit atypical frontal brain electrical activity when they are interacting with their mothers. Whereas typically developing infants exhibit greater left versus right frontal brain activity, infants of depressed mothers have been found to exhibit reduced relative left frontal activity. The left frontal brain region has been associated with the expression of positive emotions. In the present study, the question of whether the atypical pattern of brain activity found in infants of depressed mothers generalizes to situations not involving mother was addressed. Brain electrical activity was recorded from 13- to 15-month-old infants of depressed (N = 59) versus nondepressed (N = 40) mothers during a baseline condition, and during several social conditions that included a playful social interaction with a familiar experiments. Infants of depressed mothers exhibited reduced left relative to right frontal activity during the baseline condition, and during interactions with their mothers and with the familiar experimenter. The present results suggest that the atypical pattern of electrical brain activity found in infants of depressed mothers generalizes to a variety of situations, including positive interactions with nondepressed adults.

Adult↗

Good mothers never wane: mothering at menopause.

Due to recent feminist scholarship, we know a considerable amount about women's mothering identities and activities, as well as the impact of mothering ideology on individual women. Nonetheless there are gaps in our knowledge about motherhood. For instance, we know mostly about experiences of mothers with young children, and an implicit assumption is that mothers are also fairly young themselves. Yet, what about mothers at midlife and beyond? What about menopausal mothers? This paper represents an initial attempt to explore motherhood experiences of middle-aged menopausal women. Findings presented in this article are based on 45 in-depth interviews with middle-class, heterosexual menopausal women in a midwestern state in 2001. Findings suggest that motherwork and the maintenance of "good" mothering ideology are still primary activities of women at menopause despite assumptions that menopausal women have completed mothering experiences and are now grandmothers (if caregivers at all). In analyzing menopausal mothers, I encourage broader explorations of women's experiences of both motherhood and menopause.

Adult Children↗