A semi-standardized music therapy intervention for girls with Rett syndrome: A descriptive essay.

Rett syndrome (RTT) is a severe neurodevelopmental disorder resulting in a wide range of functional impairments and therefore greatly impacts the lives of both patients and their families. While genetic and medical aspects have been studied for several decades, rehabilitation intervention research is still in its infancy. In this study, the investigating researchers have presented a rehabilitative framework by using music therapy for girls with RTT. This model is founded upon the use of music therapy in light of Stern's proposal of subjective experience and affect attunement; it also refers to Rosenbaum's family-centered rehabilitation medicine perspective. This study both describes the theory behind this intervention and presents a newly developed outcome measure. This novel tool may have future clinical and research applications. Music therapy for patients with RTT has not been well researched yet, and, as a result, is not universally recommended. However this study's findings suggest that music therapy is an important component of multidisciplinary therapy. Further collaborative research should be encouraged in order to study and implement the use of music therapy in the treatment of severe disabilities. Projects such as the Enablin+ program with the support from the European Commission constitute fundamental tools in promoting integrative medical research and international networks.

The role of oxytocin in early mother-infant interactions: Variations in maternal affect attunement.

The aim of the present research was to investigate the relationship between oxytocin and maternal affect attunement, as well as the role of affect attunement in the relationship between oxytocin and infant social engagement during early mother-infant interactions. Forty-three mother-infant dyads participated in the present study when infants were 4 months. They were observed during (1) a situation where no communication took place and (2) a natural interaction between mother and infant. During this procedure, three saliva samples from mothers and their infants were collected to determine their levels of oxytocin at different time points. Maternal affect attunement (maintaining attention, warm sensitivity) and infant interactive behaviors (gaze, positive, and negative affect) were coded during the natural interaction. Results indicated that overall maternal oxytocin functioning was negatively related to her warm sensitivity, while infant oxytocin reactivity together with maternal affect attunement were associated with infant positive social engagement with their mothers. Specifically, infant oxytocin reactivity was significantly related to their gazes at mother, but only for infants of highly attuned mothers. These results point to the complex role oxytocin plays in parent-infant interactions while emphasizing the need to analyze both overall oxytocin functioning as well as reactivity as different indices of human affiliative behavior.

La imitación y el entonamiento afectivo en el juego social temprano / Imitation and affect attunement in early social play

Con el objetivo de estudiar las pautas adultas de imitación y entonamiento afectivo que ocurren en las situaciones de juego social temprano entre adulto y bebé, se realizó un estudio longitudinal de caso único, con una díada adulto-bebé. La edad del bebé en la primera sesión, según la convención piagetiana [año; mes (día)], fue: 00; 3 (05) y en la última sesión: 00; 6 (28). Se filmaron 8 sesiones de interacción espontánea de la díada, en su hogar, cada 15 días. De cada sesión se seleccionaron los primeros 10 minutos de juego social temprano. Con este material se generó una video-secuencia de juego social temprano a la que se le aplicó un código observacional con categorías para las pautas de actividades de coincidencia maternas (imitación y entonamiento afectivo). Los datos obtenidos en este estudio indican que las actividades de coincidencia maternas de imitación y entonamiento afectivo aparecen en todo el período estudiado, con una frecuencia de dos eventos de coincidencia por minuto de juego social temprano. Se observó que las pautas de entonamiento afectivo materno casi duplican a las de imitación entre los 3 y 6 meses de vida del bebé. Asimismo, se registró que la mayoría de los entonamientos afectivos fueron transmodales y que la madre utilizó su voz como modalidad conductual privilegiada para establecer coincidencias comportamentales con su bebé, ya sea a través de la imitación o del entonamiento. Las imitaciones maternas más frecuentes ocurrieron como respuesta a las vocalizaciones del bebé y los entonamientos afectivos fueron provocados principalmente por los movimientos del bebé.

This paper focuses on two specific matching activities of maternal behavior in early social play: imitation and affect attunement. Imitationis a pattern of frequent interaction between adult and baby, providing a pleasant experience to both participants. In that context, imitation is not only bi-directional, but it is the adult who imitates more frequently. Affect attunement is an intuitive and fleeting interaction pattern, through which the adult attunes to the baby's affective state. It is a matching activity, where the amodal features of the infant's behavior (intensity, temporal organization, spatial pattern and / or quantity) are reflected through a different conduct. Previous research indicates that during the first 6 months of the baby's life, the adult very often uses imitation as well as affect attunement for interacting (which involves performing a different behavior than the baby's in which the adult matches the intensity, temporal pattern, spatial pattern, and / or the amount of the child's original behavior). Maternal affect attunement events have been observed from 2 months of age, and the frequency ratio between affect attunement and maternal imitation has been observed to change in ontogenetic development: between the baby's 2nd and 6th months the adult's imitative activity occurs at higher rates; while in the second half of the first year of life, the relationship is reversed. This paper presents the results of a longitudinal case study on a mother-infant dyad, about maternal imitation and affect attunement behaviors in early social play situations between the 3rd and 6th months of the baby's life. According to Piaget's convention [year; month (day)], the baby's age was 00; 3(05) in the first session, and 00; 6 (28) in the last session. Every 15 days, a total of 8 sessions of the dyad's spontaneous interaction, were filmed in their home. From each session, the first 10 minutes of early social play were selected. With this material a video-sequence of early social play was generated to which an observational code with categories for maternal matching activity patterns (imitation and affect attunement) was applied. The percentage of each category's occurrence in each evolutionary period was calculated. The data obtained in this study indicate that maternal matching activities of imitation and affect attunement appear from the beginning of the studied period. These results confirm those previously obtained in other studies that show the early emergence of adult imitation and affect attunement behavioral patterns. The data also indicate that matching activities of imitation and affect attunement appear throughout the studied period with a frequency of two events perminute of early social play. These results partially confirm those previously obtained in other studies. The new information obtained in our study concerns the frequency of both reciprocity patterns, and the type of behavior of the mother and baby involved in these matching activities. Patterns of maternal affect attunement almost double those of imitation between the baby's 3rd and 6th months. It was also reported that most affect attunements were transmodal and that the mother used her voice as a privileged way to establish a behavioral match with her baby, either through imitation or affect attunement. The most frequent maternal imitations occurred in response to the baby's vocalizations, and affect attunements were caused mainly by the baby's movements. Without detracting from the dyad's intense vocal activity already registered in the field's literature, the high frequency of affect attunements in response to infant movement highlights a trait less noticed in previous research: the adult's mastery in reading the baby's body and movement.

The Role of Patient-Practitioner Relationships in Placebo and Nocebo Phenomena.

INTRODUCTION: Placebo and nocebo effects form part of all therapeutic environments and play a significant role in the effectiveness of treatment outcomes. Patient expectancies drive these phenomena, which can be shaped through contextual factors including verbal suggestions, conditioning, and social observation. OBJECTIVES: This review seeks to identify the biopsychosocial factors of the patient-practitioner interaction that play a role in the development of placebo and nocebo effects, as well as the anthropological elements of the biodynamic process of relating that are meaningful in the development of expectancies. METHODS: We conducted a narrative review of frameworks of the placebo and nocebo effect, including the impact of expectancies and interpersonal relationships in the context of healing and the clinical setting. RESULTS: Expectancies leading to placebo and nocebo effects can be modified by macro and micro factors, such as culture and society, as well as individual psychobiological traits, respectively. The developmental sociobiological adaptations that form and consolidate mindsets and meaningful contexts play an important role in shaping patient expectancies, as well as patients' conscious and subconscious reactions to signs and actions taking place within the clinical environment. Practitioner characteristics, like empathy, friendliness, and competence, favor the formation of positive expectancies. Caring and warm patient-practitioner interactions can enhance the therapeutic value of clinical encounters when patients' positive expectancies are actively encouraged and engaged. CONCLUSION: A patient-centered approach rooted in demonstrating care and empathy can positively enhance a patient's experience within the clinical environment and activate psychosociobiological adaptations associated with the placebo phenomenon. Pain patients could particularly benefit from non-invasive approaches for improving treatment effectiveness and quality-of-life.

El Entonamiento Afectivo en las Interacciones Tempranas Adulto-Bebé: una Revisión / Affect Attunement in Early Adult-Infant Interactions: A Review / A Sintonização Afetiva nas Interações Precoces Adulto-Bebê: uma Revisão

Resumen Este artículo presenta una revisión de las investigaciones sobre entonamiento afectivo en interacciones tempranas adulto-bebé, que siguen la definición original propuesta por Stern. El entonamiento afectivo constituye una pauta de interacción intuitiva que sirve para sintonizar con el estado afectivo del bebé momento a momento. Si bien este concepto ha sido claramente definido y ampliamente aceptado, hasta ahora hay pocos estudios realizados. La mayoría de ellos son estudios observacionales y transversales que se concentran en la descripción de situaciones de juego social madre-bebé durante el primer año de vida del infante. Se reflexiona sobre la escasa cantidad de trabajos realizados en el área y se proponen futuras vías de investigación: la prolongación de su estudio en el segundo año de vida y en poblaciones con dificultades del desarrollo; la evaluación de la incidencia de la disposición corporal y de la presencia de objetos en la frecuencia de entonamiento afectivo en interacciones espontáneas.

Abstract This article reviews research on affect attunement in early adult-infant interactions, following Stern's original definition. Affect attunement is a pattern of intuitive interaction to share the affective state of the infant. Although this concept has been clearly defined and widely accepted, until now few studies on this have been done. Most of those that have been done are observational and cross-sectional focusing on the description of mother-infant social play situations during the infant's first year. The article reflects on the scarceness of work done in this area and proposes future research areas: continuation of the study into the second year of life and in populations with development difficulties, an evaluation of the role of body disposition and the presence of objects in the frequency of affect attu-nement in spontaneous interactions.

Resumo Este artigo apresenta uma revisão das pesquisas sobre sintonização afetiva em interações precoces adulto-bebê, que seguem a definição original proposta por Stern. A sintonização afetiva constitui uma pauta de interação intuitiva que serve para sintonizar com o estado afetivo do bebê momento a momento. Ainda que esse conceito tenha sido claramente definido e amplamente aceito, até agora, há poucos estudos realizados. A maioria deles são estudos observacionais e transversais, que se concentram na descrição de situações de jogo social mãe-bebê durante o primeiro ano de vida da criança. Reflexiona-se sobre a escassa quantidade de trabalhos realizados na área e propõem-se futuras vias de pesquisa: a pro-longação do estudo no segundo ano de vida e em populações com dificuldades de desenvolvimento; a avaliação da incidência da disposição corporal e da presença de objetos na frequência de sintonização afetiva em interações espontâneas.

The nature of affect attunement used by disability support workers interacting with adults with profound intellectual and multiple disabilities.

BACKGROUND: The interactions experienced by adults with profound intellectual and multiple disabilities (PIMD) with their disability support workers (DSWs) may have a large impact on life quality. However, defining good-quality interaction has presented challenges for this group. It has been suggested that in typically developing infant-mother dyads, the presence of affect attunement may be an indicator of quality. Affect attunement refers to the recasting of one person's affect by another with emphasis. METHOD: The presence and nature of affect attunement in interactions between 21 pairs of adults with PIMD and their DSWs were explored in this study. Natural interactions were videorecorded for 21 pairs of adults with PIMD and their DSWs. The recordings were analysed for the presence and nature of affect attunement incidents, and analysed using descriptive statistics. RESULTS: Affect attunement incidents were observed in 16 of the pairs. The DSW's attunement behaviour was in response to subtle, short duration behaviours of participants with PIMD. CONCLUSION: These brief moments of connection may be a basis of good-quality interaction.

The evaluation of music therapy process in the intersubjective perspective: the music therapy rating scale. A pilot study.

This study presents a tool (Music Therapy Rating Scale [MTRS]) to evaluate the progression of the relationship between the patient and the therapist during music therapy sessions. The rating scale was developed from an intersubjective framework and from an improvisational music therapy technique. It mainly consists of two behavioral classes: non-verbal communication (NVC) and sonorous-musical communication (SMC). Five levels for each class are given (from 0 to 4). Every 15 seconds, two sets of two music therapists coded the behaviors in seven sessions with different patients. The patients were seven children (four males; three females) aged 3-10 years (mean age = 6.28), diagnosed with Pervasive Developmental Disorder. The reliability indices were computed and there was a substantial agreement in the assessments of the video raters (non-verbal relationship: ρ = 0.70; sonorous-musical relationship: ρ = 0.77). A digital output of the program to use the MTRS is presented and clinical implications are discussed.