Early, typical, and late talkers: an exploratory study on predictors of language development in the first two years of life.

Background: The consensus in scientific literature is that each child undergoes a unique linguistic development path, albeit with shared developmental stages. Some children excel or lag behind their peers in language skills. Consequently, a key challenge in language acquisition research is pinpointing factors influencing individual differences in language development. Methods: We observed children longitudinally from 3 to 24 months of life to explore early predictors of vocabulary size. Based on the productive vocabulary size of children at 24 months, 30 children met our sample selection criteria: 10 late talkers and 10 early talkers, and we compared them with 10 typical talkers. We evaluated interactive behaviors at 3, 6, 9 and 12 months, considering vocal production, gaze at mother's face, and gestural production during mother-child interactions, and we considered mothers' report of children's actions and gestures and receptive-vocabulary size at 15 and 18 months. Results: Results indicated early precursors of language outcome at 24 months identifiable as early as 3 months in vocal productions, 6 months for gaze at mother's face and 12 months for gestural productions. Conclusions: Our research highlights both theoretical and practical implications. Theoretically, identifying the early indicators of belonging to the group of late or early talkers underscores the significant role of this developmental period for future studies. On a practical note, our findings emphasize the crucial need for early investigations to identify predictors of vocabulary development before the typical age at which lexical delay is identified.

Exploring mothers' metaphorical sensemaking of dyslexia.

Through a reflexive thematic analysis of a large online support group for dyslexia and a sensemaking lens, this study investigated how mothers made sense of their child's dyslexia through metaphors. Mothers used metaphors to characterise their feelings surrounding dyslexia, their school-based interactions and their identity as advocates. The language mothers use offers a generative, textured way to understand the lived experiences of supporting a child with learning differences. Whilst mothers articulated much frustration and anger, they also voiced encouragement, advice-giving, empathy and hope, illustrating how their sense of agency was both threatened and empowered by the experience of having a child with dyslexia. There is much mothers must process, understand and navigate surrounding their child's dyslexia and the findings underscore the need for early school-based screening, support and intervention.

Exploring perceptions of genetic risk and the transmission of substance use disorders.

BACKGROUND: Substance use disorders (SUDs) have been consistently shown to exhibit moderate intergenerational continuity (1-3). While much research has examined genetic and social influences on addiction, less attention has been paid to clients' and lay persons' perceptions of genetic influences on the heritability of SUD (4) and implications for treatment. METHODS: For this qualitative study, twenty-six structured Working Model of the Child Interviews (WMCI) were conducted with mothers receiving inpatient SUD treatment. These interviews were thematically analyzed for themes related to maternal perceptions around intergenerational transmission of substance use behaviours. RESULTS: Findings show that over half of the mothers in this sample were preoccupied with their children's risk factors for addictions. Among this group, 29% spontaneously expressed concerns about their children's genetic risk for addiction, 54% shared worries about their children's propensity for addiction without mentioning the word gene or genetic. Additionally, 37% had challenges in even discussing their children's future when prompted. These concerns mapped onto internal working models of attachment in unexpected ways, with parents who were coded with balanced working models being more likely to discuss intergenerational risk factors and parents with disengaged working models displaying difficulties in discussing their child's future. CONCLUSION: This research suggests that the dominant discourse around the brain-disease model of addictions, in its effort to reduce stigma and self-blame, may have unintended downstream consequences for parents' mental models about their children's risks for future addiction. Parents receiving SUD treatment, and the staff who deliver it, may benefit from psychoeducation about the intergenerational transmission of SUD as part of treatment.

Comparative analysis of general and pregnancy-related prenatal anxiety symptoms: progression throughout pregnancy and influence of maternal attachment.

Pregnancy-specific anxiety (PSA) has been differentiated from general anxiety (GA) to better account for the heterogeneity of prenatal anxiety and possible measurement bias. A longitudinal study was conducted to determine the evolution of maternal anxiety symptoms during pregnancy, distinguishing PSA and GA, and the influence of maternal attachment A sample of 155 women (mean age 32.5, SD 3.88) were enrolled in their first trimester of pregnancy (T1) in one center and follow throughout their pregnancy. The Relationship Scales Questionnaire (RSQ), the State-Trait Anxiety Inventory (STAI), and the Pregnancy-Related Anxiety Questionnaire (PRAQ) were completed at T1, and, for the last two, at the second (T2) and third trimesters of pregnancy (T3). Multi-level model found significant decreases in the PRAQ total score and the STAI total score between T1 and T3, but only the PRAQ total score decreased from T1 to T2. Preoccupied maternal attachment was independently associated with higher PRAQ and STAI total scores at T1, T2, and T3. Considering the progressive decline of the levels of PSA and GA during pregnancy, interventions should focus on pregnant mothers with risk factors for a persisting course of anxiety such as preoccupied attachment.

Early Family Experiences and Neural Activity in Rural Pakistani Children: The Differential Role of Gender.

Adversity within low- and middle-income countries (LMICs) poses severe threats to neurocognitive development, which can be partially mitigated by high-quality early family experiences. Specifically, maternal scaffolding and home stimulation can buffer cognitive development in LMIC, possibly by protecting underlying neural functioning. However, the association between family experiences and neural activity remains largely unexplored in LMIC contexts. This study explored the relation of early family experiences to later cognitive skills and absolute gamma power (21-45 Hz), a neural marker linked to higher-order cognitive skills. Drawing data from the PEDS trial, a longitudinal study in rural Pakistan, we examined maternal scaffolding at 24 months and home stimulation quality at 18 months as predictors of verbal IQ, executive functions, and absolute gamma at 48 months for 105 mother-child dyads (52 girls). Maternal scaffolding interacted with gender to predict absolute gamma power, such that higher maternal scaffolding was related to higher gamma more strongly for girls. Maternal scaffolding also interacted with absolute gamma to predict executive functions, such that higher gamma was related to better executive functions only when maternal scaffolding was average to high. Individual differences in early family experiences may partially buffer the neural underpinnings of cognitive skills from adversity in LMIC.

Perinatal intimate partner violence among teen mothers and children's attachment disorders in Rwanda: potential mediating factors.

Background: The alarming prevalence of teen mothers' exposure to perinatal intimate partner violence (IPV, 8.3-67%) and attachment disorders (ADs) among their children is a global concern, especially in sub-Saharan Africa with high teenage pregnancy rates. This study, therefore, aimed to examine the link between teen IPV and AD in their offspring. We sought also to explore the mediating roles of postpartum depression symptoms, maternal sensitivity, parenting stress, and perceived social support in the relationship between perinatal IPV and children's ADs.Method: This cross-sectional study selected a random sample of 309 teen mothers from Nyanza district. This sample size was determined using Yamane's formula, with random sampling. Various instruments were used for data collection, including questionnaires on intimate partner violence, social support, maternal sensitivity, postpartum depression symptoms and parenting stress and early trauma-related disorders. The data was analysed using SPSS, with mediation analyses performed using the PROCESS macro (version 4.1).Results: IPV was found to be significantly associated with attachment disorders. Simple mediation models showed that parenting stress completely mediated these relationships, while postpartum depression, perceived social support, and maternal sensitivity partially mediated the relationship between IPV and children's ADs. In parallel mediation model, the combined roles of all mediators fully mediated the associations between IPV and ADs.Conclusion: These findings offer valuable insights in designing or strengthening the appropriate interventions to prevent and mitigate the perinatal intimate partner violence and its detrimental impact on children's attachment disorders. Combating intimate partner violence in post-conflict situations is challenging in teen mothers, however, our results suggest that efforts to address maternal mental health and parenting practices may protect children from attachment disorders.

Parenting stress was identified as a significant mediator, fully mediating the relationship between perinatal IPV and children's attachment disorders.Postpartum depression, perceived social support, and maternal sensitivity partially mediated the link between perinatal IPV and children's attachment disorders.The study underscores the necessity for multifaceted support programmes for adolescent mothers to address IPV, alleviate parenting stress, and enhance maternal mental health and social support, promoting better attachment outcomes for their children.

Trait mindfulness during pregnancy and maternal-infant bonding: Longitudinal associations with infant temperament and social-emotional development.

Maternal love and caregiving are pillars for optimal child development and may affect infant outcomes from pregnancy onwards. The present study aimed to examine whether maternal trait mindfulness during pregnancy and pre- and postnatal maternal-infant bonding were associated with maternal perceptions of infant temperament and social-emotional development. In total, 408 Dutch women (Mage = 31.33, SD = 3.59) participated in a prospective perinatal cohort study and completed questionnaires on trait mindfulness, prenatal bonding, postnatal bonding, infant temperament, and infant social-emotional development at 20 and 28 weeks of gestation, and 10 weeks, 6 and 12 months postpartum, respectively. Path analyses demonstrated that higher levels of the trait mindfulness facet non-judging (i.e., refraining from judgments about own feelings and thoughts) were associated with more pre- and postnatal maternal bonding and fewer social-emotional problems as perceived by the mother. Adopting an accepting and non-judgmental attitude may promote positive feelings of bonding and benefit the infant in terms of having fewer social-emotional problems in the first year of life. Mindfulness interventions may be offered to pregnant women in order to enhance maternal bonding and improve infant outcomes after birth.

Maternal heart rate variability at 3-months postpartum is associated with maternal mental health and infant neurophysiology.

Previous research has demonstrated a critical link between maternal mental health and infant development. However, there is limited understanding of the role of autonomic regulation in postpartum maternal mental health and infant outcomes. In the current study, we tested 76 mother-infant dyads from diverse socioeconomic backgrounds when infants were 3-months of age. We recorded simultaneous ECG from dyads while baseline EEG was collected from the infant; ECG heart rate variability (HRV) and EEG theta-beta ratio and alpha asymmetry were calculated. Dyadic physiological synchrony was also analyzed to better understand the role of autonomic co-regulation. Results demonstrated that lower maternal HRV was associated with higher self-reported maternal depression and anxiety. Additionally, mothers with lower HRV had infants with lower HRV. Maternal HRV was also associated with higher infant theta-beta ratios, but not alpha asymmetry. Exploratory analyses suggested that for mother-infant dyads with greater physiological synchrony, higher maternal HRV predicted increased infant theta-beta ratio via infant HRV. These findings support a model in which maternal mental health may influence infant neurophysiology via alterations in autonomic stress regulation and dyadic physiological co-regulation.

Family Therapy for Kosovar Mothers Who Experienced Conflict-Related Sexual Violence and Their Children in Postwar Times: A Pilot Randomised Waitlist-Controlled Trial.

Women who have experienced conflict-related sexual violence report significant long-term effects, including posttraumatic stress disorder (PTSD), depression and relationship difficulties. Research has demonstrated that maternal trauma is associated with children's behavioural difficulties and challenges in family functioning, such as impaired communication and harsh parenting. This pilot study is aimed at evaluating the preliminary effectiveness of family therapy for Kosovar mothers who experienced conflict-related sexual violence in 1998-1999 and later developed PTSD and their children in improving family functioning and reducing behavioural difficulties in postwar times. Sixty-four mothers were randomised to an intervention group or a waitlist control group. Data was collected during a screening phase, at baseline before intervention initiation, after the intervention group completed family therapy and once the waitlist control group received the intervention. Generalised linear mixed models were used to analyse group differences in family functioning and children's behaviours over time. At follow-up, mothers in the intervention group reported improved family functioning. However, mothers in the waitlist control group reported significantly fewer behavioural difficulties than mothers in the intervention group before the control group had started family therapy. There was no significant interaction between group condition and time for child-rated family functioning. Overall, this pilot study suggests that family therapy could be effective in reducing the effects of intergenerational trauma related to PTSD and conflict-related sexual violence. Future research should evaluate the long-term effects of family therapy to assess if immediate effects were maintained.

Bidirectional Relations Among Maternal Positive Emotion, Infant Positive Emotionality, and Infant Physiological Regulation Across the First 18 Months of Life.

Respiratory sinus arrhythmia (RSA), a marker of self-regulation, has been linked to developmental outcomes in young children. Although positive emotions may have the potential to facilitate physiological self-regulation, and enhanced self-regulation could underlie the development of positive emotions in early childhood, the relation between positive emotions and physiological self-regulation in infancy has been relatively overlooked. The current study examined the bidirectional associations among maternal positive emotion, infant positive emotionality, and infant resting RSA across the first 18 months of life. We used data from the Longitudinal Attention and Temperament Study (LanTs; N = 309 in the current analysis) to test the within- and between-person relations of study variables over time using a random-intercepts cross-lagged panel model. We found that infants with higher overall levels of positive emotionality also displayed greater resting RSA, and their mothers exhibited higher levels of positive emotion. However, there were negative cross-lagged associations within-person; higher than average infant positive emotionality predicted lower levels of infant resting RSA at the subsequent timepoint during early infancy, whereas higher than average infant RSA subsequently predicted decreased levels of infant positive emotionality later in infancy. Results highlight the importance of considering transactional relations between positive emotion and physiological self-regulation in infancy.

Rearrest is associated with heightened callous-unemotional traits: No moderating effect of maternal relationship quality.

OBJECTIVE: The presence of callous-unemotional (CU) traits in adolescence predisposes youth to negative behavioral and social outcomes and may be particularly damaging to youth involved in the justice system. Whereas research has shown that CU traits predict later arrest, it remains unknown whether rearrest predicts changes in CU traits and whether these associations may be modified by maternal relationship quality. The present study assessed whether being rearrested predicted changes in CU traits and whether these associations varied by maternal warmth and maternal hostility. HYPOTHESES: We hypothesized that self-reported CU traits would increase at data collection time points following rearrest. Further, we hypothesized that maternal warmth would buffer the negative effects of rearrest, whereas maternal hostility would not have a significant moderating effect on the associations. METHOD: Hypotheses were tested using a large, multisite longitudinal data set of 1,216 justice-involved male youth (Mage = 15.82 years at baseline; 47% Latino, 38% Black/African American, 15% White). Data from a series of nine interviews (across a 7-year period) were used to determine associations between rearrest at one-time point and CU traits at the subsequent time point. RESULTS: Rearrest is associated with a significant increase in CU traits. However, these associations are not moderated by either maternal warmth or maternal hostility. CONCLUSIONS: Rearrest predicts increases in a known risk factor for healthy socioemotional development among justice-involved youths (CU traits). Moreover, the way rearrest is associated with CU traits does not change depending on maternal warmth; rearrest is associated with increases in CU traits irrespective of the quality of a youth's relationship with their mother. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Facing infant cuteness: How nurturing care motivation and oxytocin system gene methylation are associated with responses to baby schema features.

Baby schema features are a specific set of physical features-including chubby cheeks, large, low-set eyes, and a large, round head-that have evolutionary adaptive value in their ability to trigger nurturant care. In this study among nulliparous women (N = 81; M age = 23.60, SD = 0.44), we examined how sensitivity to these baby schema features differs based on individual variations in nurturant care motivation and oxytocin system gene methylation. We integrated subjective ratings with measures of facial expressions and electroencephalography (EEG) in response to infant faces that were manipulated to contain more or less pronounced baby schema features. Linear mixed effects analyses demonstrated that infants with more pronounced baby schema features were rated as cuter and participants indicated greater motivation to take care of them. Furthermore, infants with more pronounced baby schema features elicited stronger smiling responses and enhanced P2 and LPP amplitudes compared to infants with less pronounced baby schema features. Importantly, individual differences significantly predicted baby schema effects. Specifically, women with low OXTR methylation and high nurturance motivation showed enhanced differentiation in automatic neurophysiological responses to infants with high and low levels of baby schema features. These findings highlight the importance of considering individual differences in continued research to further understand the complexities of sensitivity to child cues, including facial features, which will improve our understanding of the intricate neurobiological system that forms the basis of caregiving behavior.

Children's oppositional defiant disorder symptoms and neural synchrony in mother-child interactions: An fNIRS study.

Interpersonal neural synchrony (INS) between mothers and children responds to the temporal similarity of brain signals in joint behavior between dyadic partners and is considered an important neural indicator of the formation of adaptive social interaction bonds. Parent-child interactions are particularly important for the development and maintenance of oppositional defiant disorder (ODD) in children, but the underlying neurocognitive mechanisms are unknown. Therefore, in the current study we measured INS between mothers and children in interactions by using simultaneous functional Near-infrared Spectroscopy (fNIRS), and explored its association with ODD symptoms in children. Seventy-two mother-child dyads were recruited to participate in the study, including 35 children with ODD and 37 healthy children to be used as a control. Each mother-child dyad was measured for neural activity in frontal, parietal, and temporal lobe regions while completing free-play as well as positive, and negative topic discussion tasks. We used Phase-locked value to calculate the synchrony strength and then used the K-means algorithm and k-space based alignment tests to confirm the specific patterns of parent-child synchrony in different brain areas. The results showed that, in free-play (right MFG and bilateral SFG), positive (left TPJ and bilateral SFGdor), and negative (bilateral SFGmed, right ANG, and left MFG) topic discussions, the mother-child pairs showed different patterns of INS. These specific INS patterns were significantly lower in the ODD group compared to the control group and were negatively associated with ODD symptoms in children. Network analyses showed that these INS patterns were connected to different nodes in the ODD symptom network. Our findings suggest that ODD mother-child dyads exhibit lower neural synchrony across a wide range of parent-child interactions. Neural synchrony in the context of interpersonal interactions provides new insights into understanding the neural mechanisms of ODD and can be used as an indicator of neural and socio-environmental factors in the network of psychological disorder symptoms.

The effect of cognitive reappraisal on emotion recognition in mothers of children with special needs.

Intrinsic family dynamics are an important factor in the development of children with special needs, and mothers' emotion regulation ability influences children's development to some extent. This study examined the intrinsic mechanism of cognitive reappraisal of emotion regulation strategies affecting the emotion recognition ability of mothers of children with special needs. Results indicated that mothers of children with special needs recognized negative emotions significantly faster than typically developing child mothers. After receiving cognitive reappraisal emotion regulation strategies, they significantly improved emotional recognition of surprise and reduced attention bias towards anger. Overall, mothers of children with special needs may have obvious attention bias towards negative emotions, and cognitive reappraisal can target negative emotions to help them to better improve emotional resilience.

Characterization of dyadic interaction features between fathers and mothers playing with their autistic children.

BACKGROUND: Socio-communicative difficulties are a core symptom of autism that deeply impact interaction with others. Despite that, research on bidirectional caregiver-child interaction variables has been notably scant and predominantly focused on autistic children's interactive differences and the consequences on parenting behaviors. AIM: The study aimed to assess parent-child interaction in the context of autism through observational validated instruments that consider qualitative and structural features in a complementary way to obtain a comprehensive characterization of the exchange within the dyad. METHODS AND PROCEDURES: This study involved 56 paired parent-child dyads of 28 autistic children (mean age = 38.60 months, sd = 9.50) playing with their mothers and their fathers for 10 min. The video-recorded sessions were coded through the Emotional Availability Scales (EAS) and the Interpersonal Synchrony (IS) coding system. OUTCOMES AND RESULTS: Fathers and mothers do not show significant differences in ISexcept for mother widenings, which are more frequent and successful, and in Emotional Availability. Further, dyads present moderate levels of Emotional Availability, indicating that parents may struggle with structuring, sensitivity, and interactive abilities with their autistic children, which in turn present low levels of responsiveness and involvement. Further, we explored an association between IS and EA characteristics. CONCLUSION AND IMPLICATIONS: This study suggests the need for interventions to target interaction considering both caregivers, ultimately targeting both interaction structure and affect features. Research that includes fathers fosters strategies for individualization and treatment optimization.

Maternal adverse childhood experiences, child resilience factors, and child mental health problems: A multi-wave study.

BACKGROUND: Research suggests that maternal ACEs have intergenerational consequences for offspring mental health. However, very few studies have investigated moderators of this association. OBJECTIVES: The objective of this longitudinal study was to examine whether child resilience factors moderated the association between maternal ACEs prior to age 18, and child-reported symptoms of anxiety, depression, hyperactivity, and inattention. PARTICIPANTS AND SETTING: The current study used data from 910 mother-child dyads. Participants were recruited in pregnancy from 2008 to 2010 as part of a longitudinal cohort study. METHODS: Mothers had previously completed an ACEs questionnaire and reported on their child's resilience factors at child age 8-years. Children completed questionnaires about their mental health problems (symptoms of anxiety, depression, hyperactivity, and attention problems) at ages 10 and 10.5 years. Four moderation models were performed in total. RESULTS: Results revealed that maternal ACEs predicted child-reported symptoms of anxiety (ß = 0.174, p = .02) and depression (ß = 0.37, p = .004). However, both these associations were moderated by higher levels of perceived child resilience factors (ß = -0.29, p = .02, ß = -0.33, p = .008, respectively). Specifically, there was no association between maternal ACEs and child mental health problems in the context of moderate and high levels of child resilience factors. CONCLUSIONS: Children who have the ability to solicit support from internal and external sources (e.g., being creative, setting realistic goals, making friends easily) may be buffered against the consequences of maternal ACEs on anxiety and depression. Thus, the effects of maternal ACEs on child mental health problems are not deterministic.

Infants' cortisol reactivity and infant-mother cortisol synchrony in urban Chinese families: The role of maternal control strategy.

Maternal control strategy refers to a mother's practices used to impel, inhibit, guide, or shape their children's behaviors during mother-child interaction. The present study examined control strategies used by Chinese urban mothers and how they associated with infants' cortisol trajectory and infant-mother cortisol synchrony during a separation task. Participants were 115 infant-mother dyads. Maternal control strategy was assessed during mother-infant free-play when the infants were 6 months (T1) and 1 year (T2) old. Salivary cortisol samples were collected from both infants and mothers during a stress-inducing task at T2. The results indicated that mothers most frequently adopted the moderate power control strategy, at both T1 and T2. T1 maternal low control strategy significantly predicted infants' cortisol response curve, namely infants of mothers who predominantly adopted a low power control strategy had a more dynamic reactivity and recovery in their cortisol response to the separation task. Positive cortisol synchrony was observed between mothers and infants during the separation stress condition. In addition, T2 maternal high power control strategy accounted for inter-individual variations in infant-mother cortisol synchrony, such that mothers who predominantly adopted a high power control strategy exhibited a heightened level of cortisol synchrony with their infants. Our findings suggest that targeted training in maternal control strategies could help mothers calibrate their infants' adrenocortical regulation.

Influence of stress on self-injury among Chinese left-behind adolescents is not cast in stone: Synergistic roles of family protective factors.

BACKGROUND: Left-behind adolescents are vulnerable to stressful life events and often engage in nonsuicidal self-injury (NSSI), which is a growing public concern in China. However, little is known about the synergistic protective effect of family resources on the relationship between stressful life events and NSSI in these adolescents. OBJECTIVE: Based on theories of family socialization and resilience, the aim of this study was to examine the synergistic protective role of maternal knowledge and mother-child cohesion in buffering the effect of stressful life events on NSSI in father-absent left-behind adolescents. METHODS: This study used two-wave longitudinal data. The analytical sample included 673 adolescents (Mage = 13.47 ± 1.11 years, 48 % male) who were enlisted from 4 junior high schools in rural China. Respondents completed questionnaires on stressful life events, parental knowledge, parent-child cohesion, and NSSI at two-time points. RESULTS: The effects of stressful life events on NSSI were significant in father-absent left-behind adolescents. Additionally, maternal knowledge moderated the associations between stressful life events and NSSI in father-absent left-behind adolescents. Moreover, maternal knowledge and mother-child cohesion were found to play synergistic protective roles in the relationship between stressful life events and NSSI. In father-absent left-behind adolescents, only high maternal knowledge and high-quality mother-child cohesion could eliminate the negative effect of stressful life events on NSSI. CONCLUSION: The findings underscore the synergistic protective roles of maternal knowledge and mother-child cohesion in buffering the negative effect of stressful life events on NSSI in father-absent left-behind adolescents. Both maternal knowledge and mother-child cohesion should be considered in interventions aimed at reducing NSSI in these adolescents.

A comparative evaluation of the role of olfaction in attachment.

Olfactory information plays an important role in the attachment and bonding processes for both humans and non-human animals. Odor cues obtained via individual body odor facilitate attachment and bonding processes across species with regard to both mate selection and mother-infant bonding. The purpose of the present paper is to summarize the role of odor as it pertains to bond formation and maintenance in the mother-infant bond for human infants and non-human animal infants, and for mate selection among human adults and non-human animals. We then synthesize this summary with literature on attachment and existing evidence for the relationships between olfaction and attachment processes. Finally, we suggest avenues for areas of future research.

Giving Back What the Patient Brings: On Winnicott's "Mirror-Role of Mother and Family in Child Development".

The author offers a creative reading of Winnicott's (1967) "Mirror-role of mother and family in child development." Winnicott presents the idea that a pivotal experience in the process of the infant's coming into being as himself is the mother's communicating to the infant, by the look in her eyes, what she sees there when she looks at him. In the absence of the experience of being seen, the infant's capacity to feel real and alive atrophies. The author fleshes out Winnicott's thinking by suggesting that just as the infant comes more fully into being as he sees himself in his mother's eyes, so too, the mother comes more fully into being as a mother as she sees herself in the infant's eyes. The paradigm shift that Winnicott has contributed to psychoanalysis is reflected in the clinical work he presents: (1) the goal of psychoanalysis is no longer the enrichment of the patient's self-understanding; rather, the analytic goal is the patient's coming more fully alive to himself; and (2) the analyst helps the patient achieve this end not by making astute interpretations but by allowing the patient to experience the pleasure of making discoveries of his or her own.