Maternal Parenting Stress in the Face of Early Regulatory Disorders in Infancy: A Machine Learning Approach to Identify What Matters Most.

Objective: Early regulatory disorders (ERD) in infancy are typically associated with high parenting stress (PS). Theoretical and empirical literature suggests a wide range of factors that may contribute to PS related to ERD. The aim of this study was to identify key predictors of maternal PS within a large predictor data set in a sample of N = 135 mothers of infants diagnosed with ERD. Methods: We used machine learning to identify relevant predictors. Maternal PS was assessed with the Parenting Stress Index. The multivariate dataset assessed cross-sectionally consisted of 464 self-reported and clinically rated variables covering mother-reported psychological distress, maternal self-efficacy, parental reflective functioning, socio-demographics, each parent's history of illness, recent significant life events, former miscarriage/abortion, pregnancy, obstetric history, infants' medical history, development, and social environment. Variables were drawn from behavioral diaries on regulatory symptoms and parental co-regulative behavior as well as a clinical interview which was utilized to diagnose ERD and to assess clinically rated regulatory symptoms, quality of parent-infant relationship, organic/biological and psychosocial risks, and social-emotional functioning. Results: The final prediction model identified 11 important variables summing up to the areas maternal self-efficacy, psychological distress (particularly depression and anger-hostility), infant regulatory symptoms (particularly duration of fussing/crying), and age-appropriate physical development. The RMSE (i.e., prediction accuracy) of the final model applied to the test set was 21.72 (R 2 = 0.58). Conclusions: This study suggests that among behavioral, environmental, developmental, parent-infant relationship, and mental health variables, a mother's higher self-efficacy, psychological distress symptoms particularly depression and anger symptoms, symptoms in the child particularly fussing/crying symptoms, and age-inappropriate physical development are associated with higher maternal PS. With these factors identified, clinicians may more efficiently assess a mother's PS related to ERD in a low-risk help-seeking sample.

The Efficacy of Brief Parent-Infant Psychotherapy for Treating Early Regulatory Disorders: A Randomized Controlled Trial.

OBJECTIVE: Early regulatory disorders (ERD) place considerable strain on the parent-infant relationship and are associated with high parental distress. Brief (4-session) psychodynamic-based focused parent-infant psychotherapy (fPIP) treats ERD by strengthening the quality of the parent-infant relationship. This randomized controlled trial investigates the efficacy of fPIP for treating ERD compared to standard pediatric care (treatment as usual [TAU]). METHOD: Participants were 154 mothers and infants from 4 to 15 months who met criteria for persistent excessive crying, sleeping disorders, feeding disorders, or regulation disorders of sensory processing and were randomly assigned to fPIP (n = 81) or TAU (n = 73). Assessments took place at baseline and at the end of treatment after 12 weeks. Primary outcomes were the infants' regulatory symptoms and remission rate. Secondary outcomes were parents' psychological distress, depression, parenting stress, maternal self-efficacy, parental reflective functioning, and observer-rated emotional availability. RESULTS: fPIP was superior to TAU in reducing infants' overall symptoms (p = .004, η2 = 0.05, CI = 0.01-0.12), night-waking disorders (p = .030, odds ratio = 3.12, CI = 1.21-9.22), and mothers' psychological distress (p = .000, η2 = 0.08, CI = 0.03-0.16) and depression (p = .002, η2 = 0.06, CI = 0.02-0.13). There was a trend suggesting that fPIP led to increased maternal self-efficacy and parental reflective functioning. CONCLUSION: Results underscore the efficacy of brief fPIP in significantly reducing symptoms in infants with ERD and their mothers. Generalizability is restricted to low psychosocial risk samples with highly distressed mothers and comorbid ERD with a predominance of night-waking disorders. CLINICAL TRIAL REGISTRATION INFORMATION: The Efficacy of a Brief Parent-Infant Psychotherapy for the Treatment of Early Regulatory Disorders: A Randomized Controlled Trial; https://www.drks.de/drks_web/; DRKS00005739.

[Parental Reflective Functioning and its Relation to Parenting Stress in a Sample with Early Regulatory Disorders]. / Elterliche Mentalisierungsfähigkeit und der Zusammenhang mit elterlicher Belastung bei frühkindlichen Regulationsstörungen.

Parental Reflective Functioning and its Relation to Parenting Stress in a Sample with Early Regulatory Disorders Parents' capacity to reflect on their child as a mental agent, is defined as an important competence for the early parent-infant relationship. One way to operationalize this is parental reflective functioning (PRF) that distinguishes between mentalizing and non-mentalizing modes of reflection. Until today PRF has not been investigated in samples of infants/toddlers with early regulatory disorders. Goal of the present study is to investigate PRF by comparing a clinical group with parents of infants/toddlers with early regulatory disorders (N = 98) with a healthy control group (N = 27) and testing if PRF is related to parenting stress, past mental illness of the mother, and stress factors related to pregnancy and birth. A semi-structured clinical interview, the Parenting Stress Index, the Symptom-Check-List-90R-S, the Parental Reflective Functioning Questionnaire, and an anamnestic questionnaire were used. Compared to the control group, mothers of infants/toddlers with early regulatory disorders reported significant more prementalizing. Prementalizing in the total sample was significantly predicted by parenting stress, accounting for 16.3 % of the variance. None of the other independent variables significantly predicted prementalizing. Results are discussed in relation to early regulatory disorders and implications for clinical practice.

[Impact of Socioeconomic Risk Exposure on Maternal Sensitivity, Stress and Family Functionality]. / Einfluss der sozioökonomischen Risikobelastung auf mütterliche Feinfühligkeit, Stressbelastung und Familienfunktionalität.

Impact of Socioeconomic Risk Exposure on Maternal Sensitivity, Stress and Family Functionality Parental stress exposure can influence the parent-child relationship, child development and child wellbeing in negative ways. The aim of this study was to investigate the impact of socio-economic risk exposure on the quality of the mother-child-interaction and family functionality. A sample of 294 mother-infant dyads at psychosocial risk was compared with a lower-risk, middle-class sample of 125 mother-infant-dyads in regard to maternal sensitivity/child's cooperation (CARE-Index), maternal stress (PSI-SF) and family functionality (FB-K). Lower levels of maternal sensitivity/child's cooperation and by trend also of the family functionality were found among the mothers from the at-risk sample in comparison to the low-risk sample. The level of maternal stress was similar in both samples. The results underpin the negative effects of a socio-economic risk exposure on the mother-child relationship. An early, sensitivity-focused family support could be encouraged to counteract the negative effects of early socioeconomic stress.

The link between infant regulatory problems, temperament traits, maternal depressive symptoms and children's psychopathological symptoms at age three: a longitudinal study in a German at-risk sample.

BACKGROUND: Difficult conditions during childhood can limit an individual's development in many ways. Factors such as being raised in an at-risk family, child temperamental traits or maternal traits can potentially influence a child's later behaviour. The present study investigated the extent of regulatory problems in 6-month-old infants and their link to temperamental traits and impact on externalizing and internalizing problems at 36 months. Moderating effects of maternal distress and maternal depressive symptoms were tested as well. METHODS: In a quasi-experimental, longitudinal study, a sample of 185 mother-infant dyads at psychosocial risk was investigated at 6 months with SFS (infants' regulatory problems) and at 3 years with CBCL (children's behavioural problems), EAS (children's temperament), ADS (maternal depressive symptoms) and PSI-SF (maternal stress). RESULTS: A hierarchical regression analysis yielded a significant association between infants' regulatory problems and both externalizing and internalizing behaviour problems at age 3 (accounting for 16% and 14% variance), with both externalizing and internalizing problems being linked to current maternal depressive symptoms (12 and 9% of the variance). Externalizing and internalizing problems were found to be related also to children's temperamental difficulty (18 and 13% of variance) and their negative emotionality. With temperamental traits having been taken into account, only feeding problems at 6 months contributed near-significant to internalizing problems at 3 years. CONCLUSIONS: Our results underscore the crucial role of temperament in the path between early regulatory problems and subsequent behavioural difficulties. Children's unfavourable temperamental predispositions such as negative emotionality and generally "difficult temperament" contributed substantially to both externalizing and internalizing behavioural problems in the high-risk sample. The decreased predictive power of regulatory problems following the inclusion of temperamental variables indicates a mediation effect of temperamental traits in the path between early regulatory problems and subsequent behavioural problems. Our results support the main effects of a child's temperament, and to some degree maternal depressive symptoms, rather than the diathesis stress model of interaction between risky environment and temperamental traits. Trial registration D10025651 (NZFH).

[Health-related long-term effects of adverse childhood experiences - an update]. / Gesundheitliche Langzeitfolgen psychosozialer Belastungen in der Kindheit - ein Update.

In the last decade strong empirical evidence from several long-term studies supports the conclusion that physical and sexual abuse as well as emotional deprivation in childhood make people significantly more vulnerable to mental and functional disorders across their lifetime. Additionally, an increased vulnerability to several somatic disorders (cardiovascular disorders, type-2-diabetes, hepatitis, chronic obstructive pulmonary disease (COPD), immunological and pain disorders, pharynx and lung cancer) was demonstrated - most of them with a reduced life expectancy. A review of the current research will be presented that outlines the underlying developmental neurobiological and psychological mechanisms mediating these long-term effects. There is now sufficient evidence about familial risk constellations that demonstrates the well-documented impact of specific prevention strategies by several model projects. Only by establishing these strategies, future enormous health-related burdens and high economic costs (unfitness to work, early retirement) can presumably be limited.

Terapia psicodinámica familiar de la anorexia nerviosa / Psychodynamic family therapy for anorexia nervosa / Teràpiafamiliar psicodinàmicade l’anorèxianerviosa

La anorexia nerviosa es un grave trastorno psicosomático, aunque muchas veces está íntimamente enlazado con las relaciones familiares. En algunos casos, también se produce en un contexto multifactorial, diferenciando cuatro niveles de desarrollo de la patología: el nivel biológico (neurofisiológico), el social, el familiar y el individual (psíquico). La dinámica familiar de la patología suele tener un elevado impacto en la relación terapéutica y en la dinámica de transferencia y contratransferencia. A continuación, se presentan la experiencia clínica y algunos resultados de estudios efectuados en las dinámicas familiares de la anorexia, así como también los pasos de su tratamiento. También se hablará sobre la indicación de las sesiones de terapia familiar y su ajuste al caso concreto. A través de las barricadas: entre profesores y estudiantes adolescentes

Anorexia nervosa is a severe psychosomatic disorder, but one that is often deeply interwoven with family interactions. In some cases it also appears in a multigenerational context. Four levels of development of the illness must be differentiated: the biological (neurophysiological), social, family and the individual (psychic) levels. The family dynamics involved with this illness often have a high degree of impact on the therapeutic relationship and the dynamic of transference and countertransference. Clinical experiences and some research results on the family dynamics of anorexia are presented, as well as the steps for treatment. Questions of indications for family therapy sessions and their setting will also be discussed

L’anorèxia nerviosa és un greu trastorn psicosomàtic, tot i que moltes vegades està íntimament enllaçat amb les relacions familiars. En alguns casos també es produeix en un context multifactorial, i es diferencien quatre nivells de desenvolupament de la malaltia: el nivell biològic (neurofisiològic), el social, el familiar i l’individual (psíquic). La dinàmica familiar de la malaltia sovint té un elevat impacte en la relació terapèutica i en la dinàmica de transferència i contratransferència. Seguidament es presenten l’experiència clínica i alguns resultats d’estudis efectuats en les dinàmiques familiars de l’anorèxia, així com també els passos del tractament. També es parlarà sobre la indicació de les sessions de teràpia familiar i de l’ajustament al cas concret

[The Family Questionnaire (FB-K) - A Short Version of the General Family Questionnaire and its Reliability and Validity]. / Der Familienbogen (FB-K) - eine Kurzversion des Allgemeinen Familienbogens, seine Reliabilität und Validität.

UNLABELLED: A standardized assessment of a family system plays a crucial role in family therapy research and diagnostic, as well as in a family therapy itself. A 14-item short version of the General Family Questionnaire (FB-K) was designed to get a tool for assessing family functionality that is low time-consuming. METHOD: The short version was developed by factor analysis from the long version FA-A. The quality criteria of the family questionnaire were verified in a control sample of 208 high-risk families four months after the birth of their child. The new family questionnaire demonstrates a very good reliability and a satisfactory 8-months-stability. The concurrent validity with the FACES scale "cohesion" is assured. Regarding the construct validity a positive correlation to the feeling of coherence was found. The family questionnaire shows a negative correlation to the maternal postnatal depressive symptoms, the degree of maternal stress burden, the dysfunctionality of the mother-child-relationship and impaired bonding. The values taken from a norm sample with infants are higher by trend and in the sample with children under 18 do not deviate from the values of the risk sample. FB-K covers two aspects of family functioning, the bond between family members and their willingness to communicate. The internal consistency of FB-K is excellent, the criterion and the construct validity are good.

Affective Instability and Reactivity in Depressed Patients With and Without Borderline Pathology.

The quality of depression in borderline personality disorder (BPD) was reported to differ from that in patients with major depressive disorder (MDD) only. However, little is known about affect dynamics in "borderline-depression." The authors assessed affective instability and reactivity in 20 MDD patients with BPD and in 21 MDD patients without BPD by Ambulatory Assessment. Participants reported on current affect, daily events, and attribution of affective states to events five times per day over a 7-day period. The results do not indicate higher affective instability in MDD patients with BPD comorbidity. Depressed patients with BPD reported less subjectively perceived affective reactivity, while observed associations between events and affect were not different between groups, except for one finding: In depressed patients with BPD, overall mood was lower after being alone. These findings suggest impaired attribution of mood changes and less tolerance of being alone as specific for depression in BPD.

Tracking functional brain changes in patients with depression under psychodynamic psychotherapy using individualized stimuli.

OBJECTIVE: Neurobiological models of depression posit limbic hyperactivity that should normalize after successful treatment. For psychotherapy, though, brain changes in patients with depression show substantial variability. Two critical issues in relevant studies concern the use of unspecific stimulation experiments and relatively short treatment protocols. Therefore changes in brain reactions to individualized stimuli were studied in patients with depression after eight months of psychodynamic psychotherapy. METHODS: 18 unmedicated patients with recurrent major depressive disorder were confronted with individualized and clinically derived content in a functional MRI experiment before (T1) and after eight months (T2) of psychodynamic therapy. A control group of 17 healthy subjects was also tested twice without intervention. The experimental stimuli were sentences describing each participant's dysfunctional interpersonal relationship patterns derived from clinical interviews based on Operationalized Psychodynamic Diagnostics (OPD). RESULTS: At T1 patients showed enhanced activation compared to controls in several limbic and subcortical regions, including amygdala and basal ganglia, when confronted with OPD sentences. At T2 the differences in brain activity between patients and controls were no longer apparent. Concurrently, patients had improved significantly in depression scores. CONCLUSIONS: Using ecologically valid stimuli, this study supports the model of limbic hyperactivity in depression that normalizes after treatment. Without a control group of untreated patients measured twice, though, changes in patients' brain activity could also be attributed to other factors than psychodynamic therapy.

Assessing DSM-5 level of personality functioning from videotaped clinical interviews: a pilot study with untrained and clinically inexperienced students.

Several authors have raised the concern that the DSM-5 Level of Personality Functioning Scale (LPFS) is relatively complex and theory laden, and thus might put high requirements on raters. We addressed this concern by having 22 untrained and clinically inexperienced students assess the personality functioning of 10 female psychotherapy inpatients from videotaped clinical interviews, using a multi-item version of the LPFS. Individual raters' LPFS total scores showed acceptable interrater reliability, and were significantly associated with 2 distinct expert-rated measures of the severity of personality pathology. These findings suggest that, contrary to the previously mentioned concerns, successfully applying the LPFS to clinical cases might require neither extensive clinical experience nor training.

Operationalized psychodynamic diagnosis as an instrument to transfer psychodynamic constructs into neuroscience.

This theoretical article makes a contribution to the field of "psychoanalytically informed neuroscience". First, central characteristics of psychoanalysis and neuroscience are briefly described leading into three epistemic dichotomies. Neuroscience versus psychoanalysis display almost opposing methodological approaches (reduction vs. expansion), test quality emphases (reliability vs. validity) and meaning of results (correlation vs. explanation). The critical point is to reach an intermediate level: in neuroscience an adequate position integrating both aspects-objective and subjective-of dual-aspect monism, and in psychoanalysis the appropriate level for the scientific investigation of its central concepts. As a suggestion to reach that level in both fields the system of Operationalized Psychodynamic Diagnosis (OPD; OPD Task Force, 2008) is presented. Combining aspects of both fields areas, expansion and reduction as well as reliability and validity, OPD could be a fruitful tool to transfer psychodynamic constructs into neuroscience. The article closes with a short description of recent applications of OPD in neuroscience.

Influence of early regulatory problems in infants on their development at 12 months: a longitudinal study in a high-risk sample.

BACKGROUND: This study examined the extent to which regulatory problems in infants at 4 and 6 months influence childhood development at 12 months. The second aim of the study was to examine the influence maternal distress has on 4-month-old children's subsequent development as well as gender differences with regard to regulatory problems and development. METHODS: 153 mother-child dyads enrolled in the family support research project "Nobody slips through the net" constituted the comparison group. These families faced psychosocial risks (e.g. poverty, excessive demands on the mother, and mental health disorders of the mother, measured with the risk screening instrument Heidelberger Belastungsskala - HBS) and maternal stress, determined with the Parental Stress Index (PSI-SF). The children's developmental levels and possible early regulatory problems were evaluated by means of the Ages and Stages Questionnaires (ASQ) and a German questionnaire assessing problems of excessive crying along with sleeping and feeding difficulties (SFS). RESULTS: A statistically significant but only low, inverse association between excessive crying, whining and sleep problems at 4 and 6 months and the social development of one-year-olds (accounting for 5% and 8% of the variance respectively) was found. Feeding problems had no effect on development. Although regulatory problems in infants were accompanied by increased maternal stress level, these did not serve as a predictor of the child's social development at 12 months. One-year-old girls reached a higher level of development in social and fine motor skills. No gender differences were found with regard to regulatory problems, nor any moderating effect of gender on the relation between regulatory problems and level of development. CONCLUSIONS: Our results reinforce existing knowledge pertaining to the transactional association between regulatory problems in infants, maternal distress and dysfunctionality of mother-child interactions. They also provide evidence of a slight but distinct negative influence of crying and sleeping problems on children's subsequent social development. Easily accessible support services provided by family health visitors (particularly to the so-called "at-risk families") are strongly recommended to help prevent the broadening of children's early regulatory problems into other areas of behavior.

[Empirical basis of the Questionnaire for Crying, Feeding and Sleeping]. / Empirische Grundlagen des Fragebogens zum Schreien, Füttern und Schlafen (SFS).

The Questionnaire for Crying, Feeding and Sleeping of an infant, constructed based on theory and factor analysis, is assessed for internal consistency, inter-correlations, and its relation to a behaviour diary. A clinical and a non-clinical sample are compared. The sample of in total 704 infants younger than one year consists of different subsamples. To test the differences between a clinical and a non-clinical sample assessed with the questionnaire, data of 134 infants brought to the outpatient unit for parents with their infants and toddlers and a matched sample are used. The principal components analysis results in three well-interpretable scales correlating with each other, which all show a high internal consistency. The connections to the diary records and the differences between the means of the clinical and the non-clinical sample are found in the expected directions. The results of the Questionnaire for Crying, Feeding and Sleeping, including the criterion of Wessel, are consistent with the behaviour diary as well as the clinical diagnostics. The Questionnaire for Crying, Feeding and Sleeping shows validity according to these criteria and can therefore be used in research and clinical practise for the assessment of problems concerning crying, feeding and sleeping in the first year of life.

[Maternal affect regulation of mothers with a history of abuse in mother-infant-interaction]. / Mütterliche Affektabstimmung von Müttern mit Missbrauchserfahrungen in der Mutter-kind-Interaktion.

Maternal intuitive skills can be threatened as a result of severe deprivation or unresolved trauma in the own childhood and can even be inaccessible to the mother. A mother's own childhood experience of abuse maybe a risk factor for repeated child abuse. As a follow-up study to assess the emotional availability of abused mothers it was investigated how a physical or sexual abuse appears in the mother-child interaction and communication in the context of "cycle of abuse" and whether it could give effect to it. Interactions of mothers with abuse experience were compared with those of mothers without an abuse experience and evaluated five months postpartum with the Munich clinical communication scale (MKK). The results suggest that maltreatment experienced mothers show less emotion tuning to their child in a standardized interaction sequence.

Assessing the level of structural integration using operationalized psychodynamic diagnosis (OPD): implications for DSM-5.

A key ingredient in the current proposal of the DSM-5 Work Group on Personality and Personality Disorders is the assessment of overall severity of impairment in personality functioning: the Levels of Personality Functioning Scale (LPFS). The aim of this article is to contribute a conceptual and empirical discussion of the LPFS from the perspective of the Operationalized Psychodynamic Diagnosis (OPD) system (OPD Task Force, 2008 ). First, we introduce the OPD Levels of Structural Integration Axis (OPD-LSIA), a measure of individual differences in severity of personality dysfunction that is rooted in psychodynamic theory. We show that the OPD-LSIA is reliable, valid, and highly associated with observer ratings of personality disorders. In the second part, we present results from an OPD expert consensus study exploring potential limitations of the current LPFS item set from the perspective of the OPD-LSIA. We conclude with highlighting implications for future revisions of the DSM-5 proposal.

[Persistent, excessive crying in 5-month-old infants and the pre-, peri- and postnatal adversities of their mothers in a high-risk sample]. / Das exzessive Schreien bei 5 Monate alten Säuglingen und prä-, peri- und postnatale Belastungen ihrer Mütter in einer Hoch-Risiko-Stichprobe.

OBJECTIVE: To investigate the relationship between persistent, excessive crying in 5-month-old infants and the pre- and perinatal adversities as well as postpartal mood of their mothers. METHOD: A sample of 300 mother-child dyads was examined at infants' age of 18.5 weeks. All mothers exhibited psychosocial risks such as poverty, lack of social support, being underage, drug abuse or mental disorders. Excessive crying was assessed by the Wessel's «rule of threes¼. Pre-, peri- and postnatal problems were measured by self-report questionnaires. RESULTS: Multivariate data analysis revealed an increased risk for social adversities during pregnancy (OR = 17.66) and unwanted pregnancy (OR = 13.77). For the postnatal period persistent crying was associated with a higher rate of maternal postpartum depressive symptoms, maternal stress, dysfunctional mother-child interactions, perception of the infant as being «difficult¼ as well as bonding problems. CONCLUSIONS: The results point to the influence of prenatal stress in mothers and a primarily unwanted pregnancy on infants' persistent crying. An increased need for support is suggested in cases of considerably reduced well-being of the mother or bonding problems. The combined effect of prenatal variables and relationship variables influences the occurrence and perpetuation of early regulation problems.

Changes in prefrontal-limbic function in major depression after 15 months of long-term psychotherapy.

Neuroimaging studies of depression have demonstrated treatment-specific changes involving the limbic system and regulatory regions in the prefrontal cortex. While these studies have examined the effect of short-term, interpersonal or cognitive-behavioural psychotherapy, the effect of long-term, psychodynamic intervention has never been assessed. Here, we investigated recurrently depressed (DSM-IV) unmedicated outpatients (N = 16) and control participants matched for sex, age, and education (N = 17) before and after 15 months of psychodynamic psychotherapy. Participants were scanned at two time points, during which presentations of attachment-related scenes with neutral descriptions alternated with descriptions containing personal core sentences previously extracted from an attachment interview. Outcome measure was the interaction of the signal difference between personal and neutral presentations with group and time, and its association with symptom improvement during therapy. Signal associated with processing personalized attachment material varied in patients from baseline to endpoint, but not in healthy controls. Patients showed a higher activation in the left anterior hippocampus/amygdala, subgenual cingulate, and medial prefrontal cortex before treatment and a reduction in these areas after 15 months. This reduction was associated with improvement in depressiveness specifically, and in the medial prefrontal cortex with symptom improvement more generally. This is the first study documenting neurobiological changes in circuits implicated in emotional reactivity and control after long-term psychodynamic psychotherapy.

[Assessing risk exposure in families within the scope of early intervention: the Heidelberg Stress scale (HBS) and its quality criteria]. / Einschätzung der Risikobelastung in Familien im Rahmen von Frühen Hilfen: Die Heidelberger Belastungsskala (HBS) und ihre Gütekriterien.

The aim of the study presented is to introduce the newly developed instrument to assess stress, the Heidelberg Stress Scale (Heidelberger Belastungsskala--HBS), and to examine its psychometric characteristics. The HBS was developed for a low-threshold and multi-professional assessment of a family's stresses and resources after the birth of a child. The HBS can be used in the outreach work of family midwives, for instance, as well as in research. The validity of the HBS was tested in a sample of 284 psychosocially stressed families after the birth of their child; the inter-rater reliability was tested in a sample of 41 families that were also in stress. The HBS exhibits an excellent inter-rater reliability within a homogeneous professional group (psychology students). As relates to the construct validity, a strong positive connection between the HBS and Kindler's screening sheet was found; the HBS exhibits a negative correlation with maternal sensitivity and a positive correlation with maternal stress level. With a high level of stress in the HBS, the risk of taking the child into care is increased by 4.5 times; the sensitivity amounts to 63.6%. The quality criteria are satisfactory.