An invited commentary on mentoring in infant mental health: A symposium commemorating Robert N. Emde.

This paper is based on a symposium on mentoring in infant mental health that took place at the 18th World Association for Infant Mental Health (WAIMH) conference. The symposium commemorated Robert N. Emde who was one of the founders of the field of Infant Mental Health, and devoted much of his career to mentorship. From an IMH perspective, mentoring experiences are best thought of as relationships, significant for both mentor and mentee, with positive mentoring experiences crucial for the development of IMH clinicians and researchers. The symposium participants, two pairs of mentor-mentee dyads, first gave an opening statement about what mentoring meant for them generally and personally, and then addressed three issues: the goodness of fit between mentor and mentee, "light and shadow" in mentoring relationships, and balancing old wisdom with new trends in mentoring. The paper brings the participants' views and personal experiences regarding these issues in their own words, highlighting key personal and professional issues related to mentorship from the perspectives of both mentor and mentee.

Cet article est basé sur un symposium sur le Mentorat en Santé Mentale de la Petite Enfance qui s'est tenu lors de la 18ème conférence de l'Association Mondiale pour la Santé Mentale de la Petite Enfance (World Association Infant Mental Health ­ WAIMH). Ce symposium a commémoré Robert N. Emde qui fut l'un des fondateurs du domaine de la Santé Mentale de la Petite Enfance et a consacré une large partie de sa carrière au mentorat. Du point de vue de la Santé Mentale de la Petite Enfance les expériences de mentorat sont davantage considérées comme des relations, importantes pour à la fois le et le ou la mentoré(e), avec des expériences de mentorat positives et cruciales pour le développement des cliniciens et des chercheurs IMH. Les participants au symposium, deux paires de dyades mentor­mentoré, ont d'abord fait un discours d'ouverture sur ce que le mentorat signifiait pour eux généralement et personnellement, et ont ensuite parlé de trois défis: le bon ajustement entre mentor et mentoré, « la lumière et l'ombre ¼ dans la relation de mentorat et l'équilibre de la vieille sagesse avec les nouvelles tendances dans le mentorat. Cet article récapitule les vues et les expériences personnelles des participants pour ce qui concerne ces défis, avec leurs propres mots, mettant en valeur les défis personnels et professionnels clés liés au mentorat de la perspective d'à la fois le mentor et le mentoré.

Este artículo se basa en un simposio sobre Consejería en el campo de la Salud Mental Infantil que se llevó a cabo en el Decimoctavo Congreso de la Asociación Mundial para la Salud Mental Infantil (WAIMH). El simposio fue dedicado a Robert N. Emde, uno de los fundadores del campo de Salud Mental Infantil, quien dedicó gran parte de su carrera a la consejería y guía profesional. Desde una perspectiva de IMH, la mejor interpretación de las experiencias de consejería es verlas como una significativa relación tanto para el consejero como para el aconsejado, considerando que las positivas experiencias son cruciales para el desarrollo de los profesionales clínicos e investigadores de IMH. Los participantes en el simposio, dos pares de díadas consejero­aconsejado, dieron primero una presentación de apertura sobre lo que significaba para ellos la consejería general y personalmente, para entonces abordar tres asuntos: la bondad de ajuste entre consejero y aconsejado, "Luz y Sombra" en la relación de consejería, así como el equilibrio en la consejería entre la vieja sabiduría y los nuevos acercamientos. El ensayo presenta los puntos de vista y experiencias personales de los participantes sobre estos asuntos en sus propias palabras, subrayando asuntos personales y profesionales claves relacionados con la consejería desde la perspectiva tanto del consejero como del aconsejado.

Maternal and paternal insightfulness and reaction to the diagnosis in families of preschoolers with Autism spectrum disorder: associations with observed parental sensitivity and inter-parent interaction.

Sensitivity among parents of children with Autism Spectrum Disorder (ASD) is based on parental insightfulness and on resolution regarding the child's diagnosis. This has been supported in studies of mothers, and we examined whether the same is true regarding fathers. Also, we asked whether parents' Insightfulness and Resolution tap general mentalization and therefore also be expressed in parent-parent interactions. Eighty preschooler boys with ASD and both of their parents participated. As expected, fathers who were more insightful and mothers who were more resolved were more sensitive. Contrary to expectations, no associations were found between fathers' resolution and mothers' insightfulness and their sensitivity. Associations were found between parental insightfulness and resolution and positive parent-parent interaction. The findings are the first to demonstrate the insightfulness-sensitivity link among fathers of children with ASD. Also, they suggest that both insightfulness and resolution involve general mentalization that is evident both in parent-child and parent-parent interactions.

Positive and challenging themes in parents' perceptions of their relationships with their child with autism: Comparison between mothers and fathers.

LAY ABSTRACT: Most studies of how parents of children with autism see the parent-child relationship used questionnaires completed by the parents and focused on challenges. This study broadened the lens by interviewing parents using open-ended questions that provide an opportunity to raise challenging but also positive experiences. Seventy-five mother-father dyads were interviewed individually about their own and their spouses' relationships with their preschooler, and we found nine relationship themes. In descending order, the themes mentioned most frequently by mothers were "Security and Closeness," "Love," and "Tenderness and Sensitivity," and by fathers were "Pleasure in Joint Activities," "Security and Closeness," and "Guidance." Positive themes were more common than challenging themes. Finally, more mothers mentioned the themes "Love," "Tenderness and Sensitivity," "High Involvement and Care," and "Difficulties" than did fathers, whereas more fathers mentioned the themes "Guidance" and "Pleasure in Joint Activities" than did mothers. The findings portray a nuanced view of the parenting experience of mothers and fathers of preschoolers with autism.

Parental insightfulness is associated with mother-father-child interactions among families of preschoolers with an Autism Spectrum Disorder diagnosis.

BACKGROUND: Parental insightfulness underlies parental sensitive behavior and is associated with secure attachment among Typically Developing (TD) children and also among children with Autism Spectrum Disorder (ASD). Moving beyond the parent-child dyad, a study of TD children and their parents linked mothers' and fathers' combined insightfulness to triadic interactions. The goal of the current study was to examine this association in families with children with ASD. The hypothesis was that the interactions in families in which both parents are insightful will be more cooperative than in families in which only one or neither parent was insightful. METHODS: Eighty preschooler boys with ASD and both of their parents participated in the study. Parental insightfulness was assessed employing the Insightfulness Assessment (IA) and mother-father-child interactions were observed and coded employing the Lausanne Triadic Play (LTP) procedure. RESULTS: As expected, families in which both parents were insightful displayed higher parental coordinated support in the LTP than families in which one or neither parent was insightful, controlling for children's IQ and severity of symptoms. Children's engagement with their parents was associated with their IQ and severity of symptoms but not with parental insightfulness. CONCLUSIONS: The importance of considering paternal, in addition to maternal insightfulness as a foundation for parental coordinated support in family interactions, is discussed, as well as the contribution of the LTP in assessing family interactions with children diagnosed with ASD.

Disrupted maternal communication and disorganized attachment in the Arab society in Israel.

Disrupted maternal communication during mother-infant interaction has been found to be associated with infants' disorganized attachment, but has been studied primarily in North American and European samples and not in Arab samples. To address this gap the study examined the association between disrupted maternal communication and infant attachment in a sample of 50 Arab mothers and their one-year-old infants in Israel. Attachment was assessed with the Strange Situation Procedure (SSP), and disrupted communication with the AMBIANCE. Disrupted communication was higher in mothers of infants with disorganized and ambivalent attachment than in mothers of securely attached infants. The findings support the link between disrupted communication and disorganized attachment in the Arab society in Israel and add to our understanding of maternal behavior associated with ambivalent attachment.

Se ha determinado que la interrumpida comunicación materna durante la interacción madre-infante está asociada con la desorganizada afectividad de los infantes, pero ha sido estudiada primariamente en grupos muestras norteamericanos y europeos, no así en grupos muestras árabes. Con el fin de ocuparse de este vacío, el estudio examinó la asociación entre la interrumpida comunicación materna y la afectividad del infante en un grupo muestra de 50 madres árabes y sus infantes de un año de edad en Israel. Se evaluó la afectividad con el Procedimiento de la Situación Extraña (SSP), y la interrumpida comunicación con AMBIANCE (Lyons-Ruth et al., 1999). La interrumpida comunicación fu mayor en madres de infantes con afectividad desorganizada y ambivalente que en madres de infantes afectivamente seguros. Los resultados apoyan la conexión entre la interrumpida comunicación y la desorganizada afectividad en la sociedad árabe en Israel y también son un aporte a nuestra comprensión del comportamiento materno asociado con la afectividad ambivalente.

On sait que la communication maternelle perturbée durant l'interaction mère-bébé est liée à l'attachement désorganisé des bébés, mais cela a été avant tout étudié chez des échantillons d'Amérique du Nord et européens, et non chez des échantillons arabes. Afin de combler ce fossé l'étude a examiné le lien entre la communication maternelle perturbée et l'attachement du bébé chez un échantillon de 50 mères arabes et leurs bébés d'un an en Israël. L'attachement a été évalué avec la Procédure de Situation Etrange (SSP en anglais) et la communication perturbée a été évalué avec l'AMBIANCE (Lyons-Ruth et al., 1999). La communication perturbée était plus élevée chez les mères de bébés avec un attachement désorganisé et ambivalent que chez les mères de bébés étant attachés de manière sécure. Les résultats soutiennent le lien entre la communication perturbée et l'attachement désorganisé dans la société arabe en Israël et ils s'ajoutent également à notre compréhension du comportement maternel lié à l'attachement ambivalent.

The combined contribution of maternal sensitivity and disrupted affective communication to infant attachment in an Israeli sample.

Maternal sensitivity and disrupted communication are usually considered independently as antecedents of attachment security and attachment disorganization, respectively. This study examined whether considering them jointly allows specific predictions of attachment classifications. The sample (N = 159) was selected from a previous study conducted in Israel between 1991-1993, and over-represented disorganized and ambivalent attachment. Attachment was assessed at 12 months in the Strange Situation Procedure (SSP), sensitivity was assessed from free-play observations at 6 and 12 months, and disrupted communication was coded from the SSP. As hypothesized, high sensitivity and low disruption predicted secure attachment; low sensitivity and high disruption predicted disorganized-insecure attachment or ambivalent attachment; and high sensitivity and high disruption predicted disorganized-secure attachment. Low sensitivity and low disrupted communication did not predict avoidant attachment. The results show that combining maternal sensitivity and disrupted communication improves the precision in identifying maternal antecedents of attachment.

Attachment to fathers and mothers in preschoolers with an Autism Spectrum Disorder diagnosis.

We examined whether the Strange Situation Procedure (SSP) is applicable not only for assessing children with Autism Spectrum Disorder (ASD) and their mothers but also with their fathers. Forty preschoolers with ASD were observed in the SSP with their mothers and 39 with their fathers. Unexpectedly, the SSP was found to be not applicable (NA) to 25% of the SSPs with fathers because levels of attachment behavior were minimal, but all SSPs with mothers were codable. NA children had lower cognitive functioning and more severe symptoms than those not so coded. Insecure children with their fathers had more severe symptoms than secure children, but were not different in their cognitive functioning. No associations between attachment with mother and severity of symptoms/cognitive functioning were found. Attachment was unrelated to parents' distress or Broad Autism Phenotype. The study raises questions regarding the applicability of the SSP with fathers of children with ASD.

Nursing aides' mentalization, expressed emotion, and observed interaction with residents with dementia: A quasi-experimental study.

This study examined the associations between nursing aides' mentalization, expressed emotion, and observed sensitivity towards their residents with dementia. The study also explored whether nursing aides' mentalization and expressed emotion are relational constructs that vary with residents' characteristics and behavior. To assess mentalization and expressed emotion (i.e., criticism and positive comments), twenty nursing aides provided "Three Minutes Speech Samples" regarding two residents, one nominated by the head nurse as "difficult", and one nominated as "easy". Next, nursing aides were videotaped interacting with each of the two residents to assess their sensitivity and residents' engagement. Findings indicated that nursing aides' mentalization and positive comments were associated with their sensitivity. Nursing aides' mentalization and positive comments did not vary with residents' "easy" versus "difficult" nominations, but they were associated with residents' engagement. Results suggest training and supervision programs should involve efforts to improve nursing aides' mentalization skills and their ability to perceive their residents positively.

Emotional availability in dyads of nursing aide - resident with dementia: Old tool, new perspective.

OBJECTIVES: This study examined the emotional availability of nursing aide-resident with dementia dyads in a long-term care-facility. Emotional availability refers to the nursing aide's sensitivity toward the resident, structuring their interactions in a non-intrusive and non-hostile manner and the resident's responsiveness to and involvement of the nursing aide. The study evaluated the reciprocity in the emotional availability of nursing aides and the residents and examined whether emotional availability varies with the level of difficulty of taking care of the residents and with the context of the interaction. METHOD: The study was conducted in three wards in one long-term care-facility. Twenty nursing aides and 40 residents took part in the study. Each nursing aide was videotaped during feeding, structured and unstructured interactions, with two residents, one that was nominated by the head nurse as difficult to take care of and one that was nominated as easy to take care of. The interactions were coded using the emotional availability scales. RESULTS: Linear mixed-effect model analyses indicated that higher emotional availability of nursing aides was related to higher emotional availability of the residents. Nursing aides' emotional availability did not vary between "difficult" and "easy" residents or across the three interaction contexts. "Difficult" residents involved their nursing aides less than "easy" residents. DISCUSSION: The study documented the reciprocal nature of the interaction between nursing aides and residents with dementia. It suggests that nursing aides have an important role in promoting residents' responsiveness and involvement.

Disrupted affective communication characterizes mothers of infants with disorganized but also ambivalent attachments: An Israeli study.

This study examined whether maternal disrupted communication, which is associated with disorganized infant attachment, also characterizes mothers of ambivalent infants. The study, conducted in Israel, included a Jewish sample (N = 163; 68 Girls) from diverse socioeconomic status, collected between 1991 and 1993 in an earlier study. The sample over-represented ambivalent and disorganized attachments. Attachment was assessed in the Strange Situation Procedure (SSP) at 12 months and disrupted communication was coded from the SSP using the Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE; Lyons-Ruth et al., 1999). Mothers of ambivalent infants showed higher disrupted communication than mothers of secure, avoidant, and disorganized infants. The findings shed further light on the correlates of ambivalent attachment and call for research regarding maternal and infant characteristics that differentiate ambivalent versus disorganized attachment.

Disrupted maternal communication and attachment disorganization in children with autism spectrum disorder.

We examined whether disrupted maternal communication, which is associated with disorganized attachment in typically developing children, is also associated with disorganized attachment in children with ASD. The attachments of 45 boys with ASD and maternal disruption were assessed in the Strange Situation Procedure. Analyses revealed a link between low cognitive functioning and resistant/ambivalent and disorganized attachment, and children's functioning was therefore controlled. Contrary to expectations, mothers of children with disorganized attachments did not show more disrupted communication than mothers of children with organized attachments. However, the 4-way attachment breakdown showed that the mothers of disorganized and ambivalent/resistant children had higher disruption scores than mothers of secure and avoidant children. The findings suggest that the expected associations between maternal disruption and attachment disorganization apply to children with ASD as well, but raise questions whether disrupted behavior is a unique antecedent of disorganized attachment or also of resistant/ambivalent attachment.

The reaction to diagnosis questionnaire: a preliminary validation of a new self-report measure to assess parents' resolution of their child's diagnosis.

Parents' resolution of their child's diagnosis is associated with parental sensitivity and secure child attachment. The Reaction to Diagnosis Interview (RDI) is the accepted measure for assessing resolution, but its administration and coding are time and labor intensive. This study examined the psychometric properties of the Reaction to Diagnosis Questionnaire (RDQ), a new self-report measure that assesses resolution. 75 mothers of children diagnosed with Cerebral Palsy or Developmental Delay completed the RDI and the RDQ and reported on family characteristics. The RDQ showed good internal consistency. Mothers who were classified as resolved using the RDI had higher RDQ scores compared with mothers who were classified as unresolved. The networks of associations of the RDI and the RDQ with family characteristics were similar, although formal equivalence testing could not be performed. The RDQ may be a promising time- and cost-effective tool. Nevertheless, more research is needed to further establish its validity.

Maternal mind-mindedness and its association with attachment: the case of Arab infants and mothers in Israel.

We examined the association between maternal Mind-Mindedness (MM) and secure attachment in an Arab sample in Israel. Seventy-six infant-mother dyads were observed during free play to assess maternal MM and in the Strange Situation Procedure to assess attachment. Mothers of secure infants were hypothesized to use more appropriate and fewer non-attuned mind-related comments than mothers of insecure infants. The results showed that mothers of secure infants used more appropriate mind-related comments than mothers of disorganized infants, with no significant differences compared to mothers of ambivalent infants. Also, mothers of secure infants used less non-attuned mind-related comments than both mothers of disorganized infants and mothers of ambivalent infants. In addition, the findings showed that: (1) mothers of secure infants were most likely to show the combination of high appropriate and low non-attuned mind-related comments; (2) mothers of disorganized infants were most likely to show the combination of high non-attuned and low appropriate mind-related comments; and (3) a nonsignificant trend indicated that mothers of ambivalent infants were most likely to show a combination of high appropriate and high non-attuned mind-related comments.The findings support the relevance of MM in an Arab sample.

Maternal insightfulness protects against the detrimental effects of postpartum stress on positive parenting among at-risk mother-infant dyads.

The current study evaluated whether maternal insightfulness can buffer the negative influence of postpartum stressful life events on maternal parenting behaviors. Participants were 125 mother-infant dyads (55% boys) who present a subsample of a larger longitudinal study on maternal maltreatment during childhood and its impact on peripartum maternal adjustment. Women were primarily white and middle class. At 4 months postpartum, mothers reported on the stressful life events experienced after the child's birth and current depressive symptoms. At 6 months postpartum, maternal parenting quality was assessed using videotaped mother-infant interactions and maternal insightfulness was evaluated using the Insightfulness Assessment. Insightfulness significantly moderated the effect of postpartum stressful events on maternal parenting behaviors. Mothers who were insightful displayed high levels of positive parenting during interactions with their infant regardless of the amount of stressful life events experienced. In contrast, mothers classified as non-insightful showed less positive parenting as they experienced more stressful life events. Findings highlight the protective role of maternal insightfulness in the face of postpartum stress, and suggest that efforts to enhance insightfulness during the early postpartum period may be particularly relevant for women in high-risk contexts.

Adolescent insightfulness toward a close friend: its roots in maternal insightfulness and child attachment in infancy.

Two antecedents of the insightfulness of adolescents into a close friend's experience were examined: The insightfulness of the mother and the attachment of the child, both measured when the adolescent was an infant. We hypothesized that both antecedents would be associated with adolescent insightfulness. Maternal insightfulness was assessed using the Insightfulness Assessment (IA) in which mothers are interviewed about their children's thoughts and feelings after viewing short video segments of their interactions with their children, and infant attachment was assessed using the Strange Situation Procedure. Adolescent insightfulness was assessed using an adaptation of the IA in which the adolescents were interviewed about their friend's thoughts and feelings after viewing short video segments of their interactions with them. As predicted, the results showed that adolescents were more likely to show insightfulness toward their friend when their mothers had been insightful toward them when they were infants and when they had secure attachment with their mothers. When both predictors were considered together, maternal insightfulness remained predictive of adolescent insightfulness but infant attachment was no longer significant.

Parental insightfulness: retrospect and prospect.

We open this introductory paper to the special issue with the theoretical and clinical roots of the insightfulness concept. Next, the Insightfulness Assessment (IA) is presented, followed by a review of key empirical findings supporting the IA. The central points in the papers in this special issue are reviewed next. These include the use of the IA with parents of children ranging in age from infancy to adolescence, its applicability outside the parent-child relationship (e.g. insightfulness toward a close friend), its use with high-risk mothers, and the usefulness of insightfulness both as a continuous and a categorical measure. The clinical applications of the IA are discussed, and we close with future directions for IA research.

Infant Attachment and Maternal Sensitivity in the Arab Minority in Israel.

This study is the first to examine infant-mother attachment in the Arab culture. Eighty-five Arab 1-year-old infants from Israel were observed in the strange situation, and maternal sensitivity was assessed from home observations. Supporting attachment theory's normativity hypothesis, no differences were found between the Arab-Israeli attachment distribution and Jewish-Israeli, Western, and non-Western distributions when examined at the two-way secure versus insecure level, although a few differences emerged when examined at the four-way ABCD level. Supporting the sensitivity hypothesis, mothers of secure infants were more sensitive than those of insecure infants but only in the case of Christian (and not Muslim) mothers. The findings provide support to attachment theory's generalizability but raise questions regarding the assessment of maternal sensitivity cross-culturally.

Parental insightfulness is associated with cooperative interactions in families with toddlers.

A growing body of research has highlighted the importance of mother-father-child interactions in families with toddlers, but little is known about the internal processes underlying parenting in such interactions. Dyadic studies of parent-child relationships have focused on parental insightfulness as promoting sensitive parent-child interactions, and the goal of the present study was to examine whether insightfulness would similarly be associated with cooperative triadic interactions. To address this question, we observed 77 mother-father-toddler triads in the Lausanne Trilogue Play (LTP) procedure to assess family cooperation, and the insightfulness of each parent was assessed using the Insightfulness Assessment, a video replay procedure in which parents are interviewed regarding their children's thoughts and feelings after watching short video clips of the children. The results showed that families in which both parents were insightful had higher Family Cooperation and Coparenting scores compared to families in which only 1 parent was insightful and families in which neither parent was insightful. The implications of these findings for research on the internal processes underlying parenting in a triadic context are discussed. (PsycINFO Database Record

Stability and change in resolution of diagnosis among parents of children with autism spectrum disorder: Child and parental contributions.

The contribution of change over time in parent and child characteristics to parents' resolution of child's diagnosis was examined among 78 mothers and fathers of children with autism spectrum disorder. Children's characteristics (e.g., mental age and severity of symptoms), parental characteristics (e.g., attachment-related anxiety and stress level), and parents' resolution of their child's diagnosis (resolved vs. unresolved) were examined at Time 1, and reassessed 3 years later at Time 2. Results indicated a deferential contribution of change in parent and child characteristics among mothers and fathers. An increase in child symptom severity and in maternal attachment-related anxiety, as well as longer durations of time since receiving the diagnosis, significantly predicted maternal resolved status at Time 2. Conversely, none of the changes in children's or paternal characteristics predicted paternal resolved status at Time 2. Results are discussed in relation to child and parental contributions to resolution, the differences in the adjustment and well-being of mothers and fathers of children with autism spectrum disorder, parental growth following receiving the diagnosis, and the need for intervention components specific to parental resolution and attachment-related anxiety.