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Depressed Mothers' Touching IncreasesInfants' Positive Affect
and Attention inStill-Face Interactions
Martha Pelaez-NoguerasFlorida International University
Tiffany M. FieldUniversity of Miami
Ziarat HossainFort Lewis College
Jeffrey PickensJames Madison University
PELAEZ-NoGUERAS,MARTHA;FIELD,TIFFANYM.; HOSSAIN,ZIARAT;and
PICKENS,JEFFREY.De-pressed Mothers' Touching Increases Infants'
Positive Affect and Attention in Still-Face Interac-tions.
CHILDDEVELOPMENT,1996, 67, 1780-1792. The effects of depressed
mothers' touchingon their infants' behavior were investigated
during the still-face situation. 48 depressed andnondepressed
mothers and their 3-month-old infants were randomly assigned to
control andexperimental conditions. 4 successive 90-sec periods
were implemented: (A) normal play, (B)still-face-no-touch, (C)
still-face-with-touch, and (A) normal play. Depressed and
nondepressedmothers were instructed and shown how to provide touch
for their infants during the still-face-with-touch period.
Different affective and attentive responses of the infants of
depressed versusthe infants of nondepressed mothers were observed.
Infants of depressed mothers showed morepositive affect (smiles and
vocalizations) and gazed more at their mothers' hands during
thestill-face-with-touch period than the infants of nondepressed
mothers, who grimaced, cried, andgazed away from their mothers'
faces more often. The results suggest that by providing
touchstimulation for their infants, the depressed mothers can
increase infant positive affect and atten-tion and, in this way,
compensate for negative effects often resulting from their typical
lack ofaffectivity (Hat facial and vocal expressions) during
interactions.
Early interaction disturbances place in-fants of depressed
mothers at risk for lateraffective and socioemotional
disorders(Field, 1992; Gaensbauer, Harmon, Cytryn,& McKnew,
1984; Zahn-Waxler, Cummings,McKnew, & Radke-Yarrow, 1984).
Having adepressed mother increases by three times achild's risk of
developing the abnormalitiescharacteristic of depressed mothers
(Weiss-man et aI., 1984). Numerous studies havedocumented the
negative impact of mater-
nal depression on early infant interactionsand development and
have identified thebehavior patterns of depressed mothers
asunresponsive, insensitive, ineffective, non-contingent,
emotionally flat, negative, disen-gaged, intrusive, avoidant of
confrontation,and generally less competent and unin-volved with
their infants (e.g., Campbell,Cohn, & Meyers, 1995; Cohn,
Matias, Tron-ick, Connell, & Lyons-Ruth, 1986; Cohn
&Tronick, 1983; Field, 1984, 1986; Lyons-
The authors wish to thank Julie Malphurs, Jeanette Gonzalez,
Claudia Larrain, and AngieGonzalez, for aiding with data collection
and Roberto Pelaez for help with data analyses. Theresearch
reported in this article was supported by National Institute of
Mental Health ResearchScientist Award MH00331 and National
Institute of Mental Health Basic Research GrantMH46586. Portions of
these data were presented in March 1993 at the meeting of the
Society forResearch in Child Development, New Orleans, Louisiana.
Correspondence and reprint requestsshould be addressed to Dr.
Martha Pelaez-Nogueras, Department of Educational Psychologyand
Special Education, Florida International University, Miami, Fl
33199.
[Child Development, 1996,67,1780-1792. © 1996 by the Society for
Research in Child Development, Inc.All rights reserved.
0009·3920/96/6704·0031$01.00]
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Ruth, Zoll, Connell, & Grunebaum, 1986;Pelaez-Nogueras,
Field, Cigales, Gonzalez,& Clasky, 1994).
Infants of depressed mothers, in turn,appear to develop a
depressed mood style asearly as 3 months. The "depressed"
infantstypically exhibit less attentiveness, fewersmiles, more
fussiness, more gazing away,and lower activity levels when
interactingwith their depressed mothers than infants ofnondepressed
mothers (Cohn, Campbell,Matias, & Hopkins, 1990; Gelfand &
Teti,1990; Goodman, 1992). Moreover, maternaldepression has been
significantly associatedwith attachment insecurity among infantsand
preschoolers (Teti, Gelfand, Messinger,& Isabella, 1995).
Infants of depressed moth-ers, however, do not necessarily
generalizetheir "depressed mood" to other adults.When the infants
of depressed mothers in-teracted with their nondepressed
nurseryteachers, the infants' behavior recovered,and their activity
levels and positive affectrates were higher than when
interactingwith their depressed mothers (Pelaez-Nogueras et aI.,
1994).
In general, depressed mothers and theirinfants appear to share
their behavior states,spending more time in negative
attentive/affective behavior states than nondepressedmother-infant
dyads (Field, Healy, Gold-stein, & Guthertz, 1990). Different
profilesof behavior have been identified, includingdisengaged
mothers (withdrawn and pas-sive) and intrusive mothers (e.g., angry
facialexpressions and intrusive poking of the in-fant) (Field et
aI., 1990; Malphurs, Raag,Field, Pickens, & Pelaez-Nogueras,
1996).But despite the variability observed in themothers'
interaction styles, the infants ofboth disengaged and intrusive
mothers areusually uniformly distressed. Also, whetherexperiencing
postpartum or chronic depres-sion (Campbell et aI., 1995), the
commonfinding in the literature is that the depressedmothers'
negative mood states and lack ofaffective responses negatively
affect thechild's behavior. In this way, the infants ofdepressed
mothers begin to show growthand developmental delays at 1 year if
theirmothers remain depressed over the firstyear. Normally, the
developmental delaysare manifested by inferior performance onBayley
Mental and Motor Scales at 1 year ofage, but other behavioral
deficits have alsobeen noted, including heightened emotion-ality
and a lower level of symbolic play(Field, 1984;Gaensbauer et aI.,
1984; Samer-off& Seifer, 1983;Whiffen & Gottlib, 1989).
Researchers have prospectively studiedinfants and toddlers of
depressed mothers toanalyze the processes and mechanismswhereby
depression may affect infant be-havior. Diverse mechanisms have
been hy-pothesized to produce the negative out-comes observed in
infants and children ofdepressed mothers (e.g., Beardslee,
Bemp-orad, Keller, & Klerman, 1983; Cummings &Cicchetti,
1990; Hammen, 1992). However,elucidation of the mechanisms and
pro-cesses involved in the transmission of soci-oemotional
behavioral problems from de-pressed mothers to their infants is
still amajor challenge for developmental research-ers. This is
because early development ofinfant depression may result from the
inter-action of multiple influences, including bio-logical factors
and psychosocial factors. Sev-eral models of early development
ofdepression have been proposed, includingmutual regulation
(Tronick & Gianino,1986), multivariate cumulative risk
(Field,1992), and temperament and genetic predis-position (Whiffen
& Gottlib, 1989). Thesemodels have focused on the effects of
multi-ple factors that include prenatal influencesand postnatal
experiences. An infant show-ing a depressed-mood pattern could
be(a) biologically predisposed to depressiondue to prenatal
exposure to the depressedmother's physiological imbalance and
hor-monal status or due to a potentially congeni-tal predisposition
or (b) environmentally af-fected due to continuing maternal
depressedbehavior patterns, like unresponsivenessand flat affect.
Thus, multiple factors seemto be affecting both mothers' depression
andinfants' behavioral patterns denoting "de-pression," and there
are multiple interac-tions between these underlying
aflective,perceptual, physiological, and biochemicalprocesses.
The objective of the present study wasto determine whether
depressed motherscan improve their infants' attentive and
af-fective responses by providing touch stimu-lation during
still-bce interactions. Touch,as a source of stimulation, has
received littleattention in the mother-infant interaction
lit-erature. The studies reported below suggestthat tactile
stimulation is a significant con-tributor to infant growth and
social devel-opment.
Touch Stimulationin High Risk Populations
Studies involving touch of premature in-fants and neonates have
reported improve-ments in physiological growth, motorIre flex,
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cognitivellanguage, and visual/auditory de-velopment (see
Ottenbacher et aI., 1987).For example, an intervention program
ofstroking and passive limb movements threetimes daily for a total
of 45 min per day ledto increased weight gain, increased
wake-fulness and activity level, and improved per-formance of pre
term infants on the Brazeltonscales of orientation, motor, and
range ofstate behavior (Field, Schanberg, et aI.,1986). A follow-up
study suggested continu-ing advantages for the stimulated infants,
in-cluding better growth and development(Scafidi et aI., 1990).
Touch during Face-to-Face InteractionsFace-to-face interactions
are a primary
way behavior disorders seem to be transmit-ted from mother to
infant (Cohn et aI., 1986;Field, Vega-Lahr, Scafidi, &
Goldstein,1986). The quality of infant behavior hasbeen related to
the unresponsiveness andemotional unavailability of their
mothersduring these interactions (Sameroff & Seifer,1983;
Tronick & Gianino, 1986). Only a fewstudies have investigated
the effects of ma-ternal touch during face-to-face interactionswith
their infants or the use of touch inter-ventions to facilitate
better interactions be-tween mothers and their infants (e.g.,
Field,1977; Malphurs et aI., 1996; Pelaez-No-gueras et aI., 1996;
Stack & Muir, 1990,1992).
For example, Pelaez-Nogueras et aI. (inpress) found that touch
can reinforce andmaintain high rates of infant eye contact
re-sponses, vocalizations, and smiles duringface-to-face
interactions. In that study, usinga synchronous-reinforcement
operant proce-dure, touch stimulation (gentle rubbing ofthe
infant's arms, legs, and feet) was pro-vided by a caregiver while
the infant wasmaking eye contact with her. After
severalconditioning sessions, the infants showedpreferences for the
reinforcing stimulationthat included touch, as shown by the
factthat they smiled and vocalized more andmade more eye contact
with the caregiver.Those findings suggest that infants'
attentionand positive affect can be reinforced andmaintained by an
adult providing contingenttactile stimulation during face-to-face
inter-actions.
Infants' affective responses to stressfulevents like the still
face of their mothersduring interactions have also been
investi-gated (Cohn & Tronick, 1983; Tronick, Als,Adamson,
Wise, & Brazelton, 1977). In thestill-face procedure, the
mother's behavior ismanipulated by having her adopt a station-
ary, expressionless poise. The still-face pro-cedure has been
used to study mother-infantinteractions and to examine the effects
ofmaternal behavior on infant affect and atten-tion (e.g., Gusella,
Muir, & Tronick, 1988;Lamb, Morrison, & Malkin, 1987; Mayes
&Carter, 1990; Toda & Fogel, 1993) and oninfant social
referencing (Gewirtz & Pelaez-Nogueras, 1992). During the
still-face situa-tion the continuation of maternal gaze to-ward the
infant, coupled with her lack ofresponding and lack of touch, may
lead to aninfant reacting with negative affect and othercoping
behaviors. Stack and Muir (1990)found that when mothers were asked
to befacially unresponsive, silent, and not totouch their infants
during the still-face epi-sode, infants displayed more grimacing
andless smiling compared to periods of normalinteraction. However,
when touch was intro-duced during the still-face period,
infants'positive affect and attention was higher. Itremains to be
determined, however,whether infants of depressed mothers aremore
sensitive to maternal touch than in-fants of nondepressed mothers.
As yet, nostudies have investigated the effects of touchby
depressed mothers using the still-faceprocedure.
The present study was designed to testthe hypothesis that
depressed mothers canreduce the negative effects elicited by
theirstill faces by providing additional touch fortheir infants. We
thought it important to ex-amine if touch provided by depressed
moth-ers can help their infants to regulate affectbehavior and
increase their attention. Therationale was that infants of
depressed moth-ers would not be as distressed as the infantsof
nondepressed mothers during the still-face-with-touch situation
because they wereused to seeing their mothers with flat affect.We
expected that for these infants, touchcould minimize (or compensate
for) the lackof stimulation from the other sources (i.e.,voice
'llnd face). On the other hand, the in-fants of nondepressed
mothers were ex-pected to be more difficult to soothe, evenafter
touch was introduced in a still-face-with-touch period, because
their mothers'continuous still face was so unexpected andatypical
in their experience.
The main assumption was that, for thedepressed group only, even
when motherscontinue displaying flat affect, their use oftouch
could decrease the negative effects ofthe still-face condition. Due
to their historyof repeated exposure to unresponsive mater-nal
behavior, it was thought that infants ofdepressed mothers would
respond more
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positively than infants of nondepressedmothers when optimal
touch (mild strokes/movelJlents) was introduced in the
still-facesituation. Thus, maternal behavior was ma-nipulated,
touch was standardized, and themain grouping (independent) variable
wasmaternal depression score. By standardizingtouch we minimized
differences in de-pressed and nondepressed mothers' kinds oftouch
and were able to assess whether ma-ternal depression could account
for the dif-ferences in infant behavior.
MethodSubjects
Forty-eight 3-month-old infants (meanage = 13.5weeks, SD = 1.2)
and their moth-ers (mean age = 19.1, SD = 2.7) partici-pated in
this study. All infants were healthy,born at gestational age (M =
38 weeks),were of normal birthweight, and had no his-tory ofmedical
complications. Subjects wererecruited from a longitudinal study
sampleof low socioeconomic status based on thetwo-factor
Hollingshead Index. Motherswere primiparous black (53%),
Hispanic(40%), or Caucasian (7%), and were single(86%) adolescents,
and their infants werenormal full term infants. Three mother-infant
dyads needed to be rescheduled be-cause the babies were fussy and
sleepy.
Mother-infant dyads were assigned toone of four groups:
Depressed Mothers-Experimental (N 16),
NondepressedMothers-Experimental (N = 16), and De-pressed Control
and Nondepressed Control(N = 16). The Beck Depression
Inventory(BDI) scores defined the depressed and thenondepressed
groups (depression classifica-tion is described in detail in the
followingsection). The groups did not differ on demo-graphic
variables, including age, ethnicity,marital status, and SES,
resulting in a homo-geneous sample. To ensure group equiva-lence,
infants and their mothers were as-signed to control or experimental
groupsthrough a random stratification procedure,stratifying in
accordance to maternal depres-sion score.
ProcedureMaternal depression assessment.-
Assignment to the depressed groups wasbased on cutoff scores on
the Beck Depres-sion Inventory (BDI; Beck, Ward, Mendel-son, Mach,
& Erbaugh, 1961). The 21 BDIitems are scored on a four-point
scale indi-cating absence/presence and severity of de-pressed
feelings, behaviors, and symptoms.The scale is among the commonly
employed
instruments in research on nonclinically de-pressed samples.
This self-report scale wasused rather than a diagnostic interview
be-cause Cohn and Campbell (1992) have re-ported that depressed
mothers' interactionbehaviors are more highly correlated
withself-report depression scores than they arewith diagnostic
interview measures. Moth-ers with BDI scores of 13 or greater
(cutpointof depression in most research protocols)were assigned to
the depressed group andmothers with scores of 9 or less were
as-signed to the nondepressed group. We ad-ministered the BDI to 61
mothers to yieldour sample of 24 depressed mothers. In pre-vious
studies with this population, approxi-mately 30% of the mothers
sampled receivedscores greater than 16 on the BDI (e.g., Fieldet
aI., 1990). The mean BDI score for all de-pressed mothers in our
sample was 21 (SD= 9.1), ranged from 13 to 52, and for
thenondepressed mothers was 4.1 (SD = 2.7),ranged from 1 to 9.
Mothers with BDI scoresof zero, 10, 11, and 12 did not participate
inthis study. The BDIs were administered 15min before the
interaction in a waiting roomnext to the laboratory by a research
assistant.
Apparatus and setting.-Infants wereseated in an infant seat
facing their mothersat a distance of approximately 15
inches.Mothers were seated directly facing their in-fants at eye
level. Two cameras, located oneither side of the mother-infant
dyad, wereconnected to a video recorder and a specialeffects
generator to yield a split-screen im-age. One camera recorded the
frontal viewof the infant, and the second camera re-corded the
mother's face and hands. A time-date generator connected to the
monitor wasused to time the duration (in minutes, sec-onds, and
milliseconds) of each period forsubsequent coding.
Design.-A repeated-measures be-tween-groups design was
implemented: twogroups (depressed vs. nondepressed) x twoconditions
(control vs. experimental) x foursuccessive periods: (A) 90-sec
normal inter-action, followed by (B) 90-sec still-face-no-touch,
(C) 90-sec still-face-with-touch, andfinally, (A) 90-sec normal
interaction. Six-teen additional mother-infant dyads wereused as a
no-still-face control group. Mothersin the control condition only
received thenormal interaction instructions across thefour
consecutive periods of the study. Thedesign compares the 16
controls (half de-pressed and half nondepressed) to the 32
ex-perimental (half depressed and half nonde-pressed). The order of
the periods was not
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counterbalanced because the purpose was tohave a
still-face-no-touch period precedinga still-face-with-touch period
specifically toinduce distress in order to increase thechances of
getting an effect and thus to com-pare the depressed and
nondepressed dy-ads' performances.
Instructions.- The total procedure re-quired approximately 8
min. During the four30-sec intervals between the four periods
allmothers were given instructions. Instruc-tions were standard for
all mothers. To ad-dress the question of whether infants of
de-pressed and nondepressed mothers responddifferentially to touch
when their motherspose a still face, it was important to
reducevariability in mothers' behavior during thestill-face
situation. For this reason, we im-posed still-face instructions to
all mothers inthe experimental condition.
Before the first normal play period of in-teraction, mothers in
the experimental con-dition were instructed to play with their
in-fants as they would normally do at home.For the second period
(still-face-no-touch),these mothers were instructed to look/gazeat
their infants with a neutral expression,and to refrain from
speaking, smiling, andtouching the infant during this period.
Forthe third period of interaction (still-face-with-touch)
instructions were given to look/gaze at the infant with a neutral
expression,to refrain from speaking and smiling, but totouch the
infant as modeled. In the last nor-mal period, mothers received the
same in-structions as in the first normal period.
To ensure that mothers maintained astill face throughout the
still-face periods,continuous monitoring was conducted bythe second
research assistant observing theinteraction from the observation
room. Theobserver constantly checked that motherswere complying
with instructions and werenot making any change in facial
expressions,thus, maintaining their "neutral" still facewhile
gazing at the infant. In addition, wemonitored that mothers were
not cooing orvocalizing and that their touch was the sameas
instructed. All mothers in both groupscomplied with instructions
(> 90% of thetime). In those cases where mothers werenot
following instructions and smiled, vocal-ized, or touched their
infants incorrectly, thesession was interrupted and postponed for
asecond visit when further training was pro-vided. If an infant was
showing signs of be-ing distressed during any of the four
experi-mental periods or cried consistently for more
than 15 see, the session was interrupted andrescheduled. A total
of five mother-infant dy-ads needed to be retrained and
rescheduledfor a second visit.
Touch procedure.-Just before the still-face-with-touch period,
all mothers in theexperimental condition received a
briefdemonstration of optimal touch. The "opti-mal" touch procedure
involved a motherstroking and rubbing rhythmically the in-fants'
arms, legs, and feet using the five fin-gers of both hands for the
duration of thestill-face period (90 see). The experimentermodeled
gentle pressure in slow circularmotions at a rate of approximately
one circu-lar rub per sec. Negative touch was avoided.Negative
touch involves rough tickling, pok-ing and tugging while
interacting with theinfant, including poking the baby's face,arms,
or stomach, or pinching or squeezingthe infant, or pulling or
shaking the infant.Mothers were instructed not to tickle orpoke
their infants during this procedure, norto pull intensively their
infants' legs or arms.The mothers' touch was checked
routinelyduring the interactions to make sure theywere providing
touch as instructed.
Behavior coding.- The onset and offsetof the videotaped behavior
were registeredby pressing numeric codes on a laptop com-puter. All
behavior modalities were codedseparately. The behaviors were coded
con-tinuously and featured a second-by-secondlisting of behaviors
and a matrix of percent-age time the behaviors occurred
(Guthertz& Field, 1989).One view of the videorecordwas used per
each modality: (1) infant facialexpressions (three codes: smile,
neutral, gri-mace), (2) infant vocal expressions (threecodes:
positive vocalizations, no vocaliza-tions, and protest/crying), (3)
infant gaze be-havior (used three codes: gaze at mothers'face, gaze
away from mother's face, gaze atmother's hands). Thus, coding of
these mea-sures required three separate viewings ofeach record. In
this way, coding of the in-fants' behaviors included three positive
be-haviors: (1) smiling, (2)vocalizing, (3)gazingat mothers' hands,
and three negative af-fective behaviors: (4) crying, (5)
grimacing,and (6) gazing away from mom.
For infant smiling to be coded the infantmouth had to be
"upturned," whether themouth was open or closed. For infant
gri-macing, the infant's mouth had to be turneddown or curled or
the infant had to be cry-ing. For gazing away from the mother,
theinfant had to be looking at any other place
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but the mother's face, hands, or body. Posi-tive vocalizations
were discrete sounds likethose involved in cooing and babbling
(butthe infant could not be fussing or protesting).For crying, the
infant had to be grimacingand emitting nondiscretelloud sounds.
Given the highly standardized proce-dure of this study, for
control purposes themother's behaviors were also coded; that
is,mother's touch, facial expressions (smiles,negative/angry,
neutral), and mother's vocalsounds were coded. This allowed us to
en-sure that mothers were following the still-face, no voice, and
no-touch and touch in-structions. For touch behavior, five(numeric)
codes on the laptop computerwere used to code touch behavior:
(1)mother's hand resting on baby, (2) mildtouching (stroking,
caressing, rubbing), (3)intense touching (tickling, poking), (4)
mildmovement (lifting baby's feet or arms inslow, rhythmic
cycling), and (5) intensemovement (quick intense movements ofarms
and legs or pulling arms or legs) (Stack& Muir, 1990). The
purpose to measuretouch was to ensure that mothers were pro-viding
mild touch and movements (2 and 4)for at least 75% of the time
during the still-face touch period and were not making in-tense
movements or pulling the infant's legsor arms.
Observer ReliabilityObservers were unaware of the hypoth-
eses and of the mothers' depression status.The two independent
raters were trained to90% reliability on each response categorywith
an experienced rater. Reliability of thebehavior measures was
determined on one-third of the sample. Product-moment corre-lation
coefficients were obtained on the per-centage scores of primary and
secondaryobservers on all response measures of infantand mother
behaviors. Observer reliability,calculated separately for each
response mea-sure, was at p < .001 for each measure.
Thereliability coefficients obtained for infants'behaviors were as
follows: infant smile, r =.96; infant vocalization, r = .92; infant
gazeat hands, r = .90; infant grimacing, r = .97;infant crying, r =
.94; infant gaze away,r = .98. For mothers' behaviors the
reliabil-ity coefficients were: (1) mother's hand rest-ing on baby,
r = .99; (2) mild touching, r =.95; (3) intense touching, r = .92;
(4) mildmovement, r = .96; and (5) intense move-ment, r = .93;
vocal sounds, r = .98; smiles,r = .92; negative/angry face, r = 88;
andneutral face, r = .96.
Results
The first analyses were a 2 (group: de-pressed vs. nondepressed)
x 2 (condition:experimental vs. control) x 4 (periods of
in-teraction) MANOVAs on infants' positive be-haviors (smiling,
vocalizations, and gazing atmothers' hands), and on infant's
negative be-haviors (grimacing, crying, and gaze awayfrom mothers).
For the first MANOVAon in-fant positive behaviors, the analyses
yieldeda significant three-way interaction effect ofgroup x
condition x periods, F(9, 36) =2.56, p < .05. Then, significant
main effectswere also observed for group, F(3, 42) =4.28, p <
.01, and condition, F(3, 42) = 2.7,p = .05. For the MANOVA on
negative be-haviors, the analyses yielded a significantthree-way
interaction effect of group x con-dition x periods, F(9, 36) =
2.56, p < .05.For the negative infant behaviors significantmain
effects were also observed for group,F(3, 42) = 3.90, p < .05,
and for condition,F(3, 42) = 2.68, p = .05.
Separate analyses for the control and theexperimental conditions
revealed: (1) nochanges in the control condition on any be-havior
were observed over time, across thefour periods; (2) no significant
differences inthe behavior of the infants of depressed
andnondepressed mothers were observed in thecontrol condition
across the four periods;(3) no differences were observed betweenthe
control and experimental mother-infantdyads in the first normal
period. These anal-yses suggested that the control and
experi-mental conditions were similar at the begin-ning (first
normal period) of the study andthat the infants were not fatigued
over time.
A significant main effect of group (de-pressed vs.
nondepressed), F(3, 28) = 7.42,p
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peated measures showed significant interac-tion effects (Winer,
1971). Paired t tests werealso conducted within subjects to
comparethe between still-face-with-touch and still-face-no-touch
periods (shown by subscriptsin Table 1). The results on each
variablefollow.
Infant Positive BehaviorsSmiling.-ANOVA results for smiling
yielded a group trend (depressed vs. nonde-pressed), F(l, 30) =
3.68, p < .06, and a sig-nificant group x period interaction
effect,F(3, 90) = 2.94, p < .05. The proportion ofsmiling
decreased from the normal period ofinteraction to the
still-face-no-touch periodin both groups (Table 1). However, only
thedepressed group showed a significant in-crease in smiling from
the still-face-no-touchto the immediately following
still-face-with-touch period, t(15) = - 2.33, p < .05.
Simplemain effect tests performed on infant smilingrevealed that
the depressed and nonde-pressed groups differed in the
still-face-with-touch period, F(l, 30) = 11.15, p <.005, and in
the last normal period, F(l, 30)= 16.00, p < .005, with the
depressed groupsmiling more.
Vocalizations.-An ANOVA yielded asignificant group effect
(depressed vs. non-depressed), F(l, 30) = 4.79, p < .05, and
asignificant group x period interaction effect,F(3,90) = 8.74, p
< .001. The proportion oftime spent vocalizing decreased from
thefirst normal period of interaction to the
still-face-without-touch period for the nonde-pressed group only
(Table 1). Post hoc sim-ple main effects revealed group
differencesin vocalizing during the still-face-with-touchperiod,
F(l, 30) = 5.52, p < .05, and duringthe last normal period, F(l,
30) = 12.50,p < .001, with infants of depressed
mothersvocalizing more than infants of nonde-pressed mothers. The
differences noted ininfants' vocalizations in the normal
periodswere not significant.
Gazing at mother's hands.-ResuIts re-vealed a main effect for
group (depressed vs.nondepressed), F(l, 30) = 10.90, p <
.005,and a group x period interaction effect, F(3,90) = 3.72, p
< .01, in gaze at mother'shands. As expected, the proportion of
timeinfants gazed at mother's hands increasedsignificantly from the
still-face-no-touch pe-riod to the still-face-with-touch period
forboth the depressed group, t(15) = -4.88,p < .001, and for the
nondepressed group,t(15) = 5.53, p < .001. Simple main
effectsanalysis revealed that infants of depressedmothers gazed at
their mothers' hands more
often than infants of nondepressed mothersduring the first
normal episode, F(l, 30) =5.10, p < .05, still-face-with-touch
period,F(l, 30) = 4.97, p < .05, and during the lastnormal
period, F(l, 30) = 13.30, p < .001.Infant Negative Behaviors
Grimacing.-An ANOVA on grimacingyielded a group effect
(depressed vs. nonde-pressed), F(l, 30) = 5.50, p < .05, and
agroup X period interaction effect, F(3, 90)= 7.01, p < .001.
For the depressed group,infant grimacing decreased from the
still-face-no-touch period to the still-face-with-touch period in
the depressed group only,t(15) = 2.58, p < .05. Simple main
effectsanalysis revealed that infants in the de-pressed group
grimaced less often than theinfants of nondepressed mothers during
thestill-face-with-touch period, F(l, 30) =11.15, p < .005.
Grimacing was also less fre-quent, F(l, 30) = 7.62, p < .01, in
the de-pressed group compared to the nonde-pressed group during the
last normal period.
Crying.-For crying, only a group x pe-riod interaction effect
was obtained, F(3, 90)= 2.92, p < .05. For the depressed
grouponly, infant crying decreased from the still-face-no-touch
period to the still-face-with-touch period, t(15) = 3.43, p <
.005. Cryingwas lower, F(l, 30) = 4.98, p < .05, in thedepressed
group compared to the nonde-pressed group during the
still-face-with-touch period. Crying continued to be lower,F(l, 30)
= 4.39, p < .05, for the depressedgroup compared to the
nondepressed groupduring the last normal period.
Gazing away from mother.-AnANOVA yielded a group effect
(depressedvs. nondepressed), F(l, 30) = 5.79, p < .05,and a
group x period interaction effect, F(l,30) = 7.55, p < .001. The
proportion of timethe infants gazed away from their
motherssignificantly decreased, t(15) = 5.65, p <.001, from the
still-face-no-touch to the im-mediately following
still-face-with-touch pe-riod in the depressed group but not in
thenondepressed group. Simple main effectsanalysis performed on
gazing away from themother revealed that the nondepressedgroup
gazed away more than the depressedgroup during the
still-face-with-touch pe-riod, F(l, 30) = 18.00, p < .001, and
alsoduring the last normal period, F(l, 30) =19.14, p < .005.
The difference observed inthe first normal period was not
significant.
Mothers' BehaviorRepeated-measures MANOVA on ma-
ternal touch revealed no significant main ef-fects of groups
(depressed vs. nondepressed)
-
TABLE
1
MEA
NPER
CEN
TAG
EO
FI""FA
NTS'(N
=16
Depressed
andN=
16N
ondepressed)BEH
AV
IORS
ACRO
SSFO
UR
SUCCESSIV
ECO
ND
ITION
S
NO
RM
AL
PLAY
STILLFA
CE-N
o-ToUCH
STILL-FA
CE-W
ITH-TO
UCH
NO
RM
AL
PLAY
INFA
NTS
Non-
Non-
Non-
Non-
EFFECT
BEH
AV
IORS
Depressed
depressedD
epresseddepressed
Depressed
depressedD
epresseddepressed
p
Smile
..............29.0_
33.7.7.3_
2.6b
18.6_2.8
b32.1_
16.7cI*
(24.6)(24.9)
(10.6)(3.3)
(18.6)(3.5)
(25.0)(17.3)
Vocalizations
........10.5_
20.5_1O
.9_b
6.5b
17.3_c4.8
b27.1c
4.1b
G*I****
(9.1)(22.0)
(15.0)(6.3)
(20.7)(4.8)
(22.6)(4.5)
Grim
ace............
5.0_.O
b5.6_
11.6_1.3
b8.1_c
2.5_b
32.5d
G*I****
(9.3)(.0)
(8.6)(19.1)
(1.9)(10.5)
(4.1)(43.3)
Crying
.............1.6_
.2.8.2
b1O
.6b
1.1_1O
.1b
2.9_13.4
b1*
(2.9)(.5)
(10.2)(16.2)
(1.6)(16.2)
(4.9)(19.3)
Gaze
athands
.......15.3_
4.8b
1.8c.4c
38.5b
19.6_25.5_
2.4b
G***I**
(20.3)(6.4)
(3.0)(.6)
(30.8)(14.0)
(25.1)(3.3)
Gaze
away
..........14.3_
10.3_55.4
b53.3
b17.8_
46.4b
14.2_39.3
bG
*I****(15.9)
(8.3)(30.9)
(30.9)(13.2)
(23.5)(13.1)
(18.8)
NO
TE.-M
eansbearing
differentsubscripts
aredifferent
atp<
.05or
lessrevealed
bypost
hoccom
parisonof
adjacentgroups.
G=
groupeffect.
I=
group(depressed/nondepressed)
xperiod
interactioneffect.
Standarddeviations
arein
parentheses.*p<
.05.**
p<
.01.***
p<
.005.****
p<
.001.
-
or group X period interaction effects (p >.10). Touch was
provided almost continu-ously by all mothers (97.7% of the time
bydepressed mothers and 93.7% of the time bynondepressed mothers)
during the 90-secstill-face-with-touch period (Table 2).
Theinstructions provided to both groups for thestill-face-no-touch
and for the still-face-with-touch periods minimized any
potentialdifference in maternal behavior. Also, touchinstructions
seemed to produce a carryovereffect of the mothers' touch behavior
fromthe still-face-with-touch period to the lastnormal period of
interaction, during whichboth depressed and nondepressed
motherstouched their infants more than during thefirst normal play
period. The higher amountof touch during the last normal period
com-pared to the first normal period could haveaccounted for the
significant differences ob-served in infant behaviors between
thesetwo periods.
Overall MANOVA for mothers' vocalsounds, smiles, and stillface
revealed no sig-nificant main effects of groups (depressed
vs.nondepressed) or group X period interac-tion effects (p >
.10). This result was alsoexpected given that the maternal
behaviorin both groups was highly standardized andunder
experimental control during the still-face-no-touch and
still-face-with-touch pe-riods.
Discussion
As predicted, infants of depressed moth-ers responded more
positively to the rein-statement of touch following a
still-face-no-touch episode than did infants of nonde-pressed
mothers. Infants of depressed moth-ers showed more positive affect
(moresmiles and vocalizations) and gazed more attheir mothers'
hands during the still-face-with-touch period than the infants of
nonde-pressed mothers, who grimaced, cried, andgazed away from
their mothers' face moreoften during this period.
We should note that, by specifically in-troducing a
still-face-with-touch period im-mediately after a
still-face-no-touch period,we were able to measure the soothing
effectsof touch in the still-face situation right whenthe infants
began showing the distressing ef-fects produced by their mothers'
still-facewithout touch. All infants became somewhatsimilarly
distressed during the still-face-no-touch procedure; in particular,
their gazeaway from mothers' face (gaze aversion) wassignificantly
higher during this period com-pared to the other three periods.
When touchwas introduced in the still-face situation,
however, the effects were more soothing forthe infants of
depressed mothers and gazeaversion significantly decreased, but
onlydecreased for the infants of depressed moth-ers. In this way,
the distress caused by ma-ternal lack of facial expressions and
voicewas reduced by instructing mothers to ac-tively touch their
infants. These findingssuggest that the effects caused by the
stillface (lack of emotional expressions) can bepartially
eliminated (or reduced) by mothersactively touching their infants
while still fa-cially and verbally unresponsive.
In general, both groups of infantsseemed to like touch, and they
showed it bysmiling and vocalizing more when theywere touched. This
study extends the previ-ous findings (Pehiez-Nogueras et aI.,
1996;Stack & Muir, 1990, 1992) by examining dif-ferences
between depressed and nonde-pressed groups. In addition to finding
thatinfants of depressed mothers smiled and vo-calized more,
oriented more to their de-pressed mothers, and cried and
grimacedless than infants of nondepressed mothersduring the
still-face-with-touch period, wefound that during the final return
to normalplay period infants of nondepressed mothersdid not appear
to "recover" from the dis-tressing still-face periods, and they
began tocry, grimace more, gaze away more, and tosmile and vocalize
less compared to infantsof nondepressed mothers. Because we
mini-mized the potential sociodemographic con-founds by having a
homogeneous sample ofdepressed and nondepressed adolescentmothers
of low SES, our results can be con-sidered representative for this
particularlower-income adolescent population. Giventhis homogeneity
of our sample, the resultsmay be limited in generalizability.
The effects observed in infant behaviorwere not accounted for by
immediate groupdifferences in maternal behavior. That is,the
depressed and nondepressed mothers'behaviors were not significantly
different inthe conditions in which infant behavior dif-ferences
were observed. This uniform pat-tern of maternal behavior was
expectedgiven the highly standardized procedures ofthis study with
both groups of mothers. Bothdepressed and nondepressed mothers
werespecifically instructed and given a demon-stration showing them
how to behave in thestill-face-no-touch period and how to
touchtheir infants during the still-face-with-touchperiod. In the
absence of immediate groupdifferences in maternal behavior, the
differ-ences in the pattern of infant behaviorsacross conditions
can be related to the in-
-
TABLE
2
MEA
NPER
CEN
TAG
EOF
MO
THER
S'(N=
16D
epressedand
N=
16N
ondepressed)BEH
AV
IORSA
CRO
SSFOU
RSU
CCESSIV
EPERIO
DS
NO
RM
ALPLA
YSTILL
FACE-N
o-ToUCH
STILL-FACE-W
ITH-TOU
CH
NO
RM
ALPLA
Y
Non-
Non-
Non-
Non-
Depressed
depressedD
epresseddepressed
Depressed
depressedD
epresseddepressed
Mother's
totaltouch:
63.865.3
.47.37
97.993.7
88.975.6
(31.3)(30.1)
(1.5)(1.0)
(3.4)(15.2)
(12.3)(27.1)
Resting
onbaby
............10.8
10.8.00
.1212.4
11.224.4
18.3(10.3)
(9.3)(.00)
(.50)(ILl)
(13.3)(18.7)
(19.4)M
ildtouch
.................24.4
16.4.47
.2547.8
54.321.3
11.6(24.7)
(17.4)(1.5)
(1.0)(30.4)
(36.0)(19.1)
(16.0)Intense
touch..............
7.1ILl
.00.00
13.29.0
12.17.3
(11.0)(13.8)
(.00)(.00)
(19.9)(12.7)
(11.8)(7.6)
Mild
movem
ent............
21.626.1
.00.00
24.519.3
27.834.6
(31.0)(20.2)
(.00)(.00)
(26.8)(24.1)
(24.2)(23.2)
Intensem
ovement
...........0
1.0.0
.0.0
.03.4
4.0(.0)
(2.2)(.0)
(.0)(.0)
(.0)(6.5)
(5.9)M
other'svocal
sounds.........
86.589.7
2.7.7
3.61.2
80.689.5
(13.4)(12.8)
(3.9)(1.9)
(9.5)(3.4)
(22.7)(16.5)
Mother's
face:Sm
iles.....................
70.466.2
4.32.8
3.1.9
51.846.7
(21.7)(32.0)
(7.3)(6.7)
(5.9)(2.2)
(28.8)(28.7)
Negative/angry
.............1.3
1.23.5
5.33.9
3.51.6
4.8(3.4)
(3.8)(14.0)
(20.7)(13.0)
(9.9)(3.5)
(9.6)N
eutral....................
28.432.8
92.391.7
93.195.6
46.748.7
(2Ll)(32.7)
(14.6)(21.5)
(14.2)(9.8)
(27.6)(27.9)
NO
TE.-MA
NO
VA
srevealedno
groupand
nogroup
Xperiod
interactioneffects.Standard
deviationsare
inparentheses.
-
fant's prior history of interactions with a de-pressed mother.
The differences observed inthe infants' behavior may be attributed
tomaternal depression and its concomitant his-tory of
interactions.
Alternatives to learning-history explana-tions, however, should
be considered. It hasbeen argued that infants of depressed moth-ers
are at unusually high risk for developingdepression due to genetic
or prenatal trans-mission (Zuckerman, Als, Bauchner, Parker,&
Cabral, 1990). To predict infant "de-pressive" behavioral outcomes
from any sin-gle factor, however, is almost impossible,whether this
factor is genetic or postnatal be-havior experience. To elucidate
the etiologyof infant depression was not the objective,rather, our
goal was to determine if a shortintervention with touch by
depressed moth-ers would increase infants' positive affectand
attention during still-face interactions.As predicted, touch was
more effective inenhancing the positive behavior in infantsof
depressed mothers. Depressed mothersseemed to have facilitated more
positive af-fect and attention in their infants by touch-ing them
during the interactions, and the op-timallnonintrusive type of
touch used in thisstudy appeared to provide comfort duringthe
stressful still-face interactions.
The findings can be explained in a num-ber of ways. One possible
explanation is thatthe infants of nondepressed mothers did notshow
significantly less grimacing and cryingwhen touch was introduced
during the stillface because these infants were less familiarwith
maternal unavailability (flat face and af-fect) and were thus much
more difficult tosoothe when touch was introduced. More-over,
infant grimacing and crying continuedto be emitted by the infants
of nondepressedmothers even during the resumed normalperiod. The
increase in infant grimacing andcrying during the mothers'
subsequent re-turn to normal play following a period ofma-ternal
unavailability was also observed byToda and Fogel (1993).
Typically, mothers "fake good" and "tryharder" to show positive
behaviors duringthe initial moments of videotaping in experi-ments.
Thus, the absence of group differ-ences in maternal behavior in the
initialnormal play period should not be overinter-preted. For the
purpose of this study, thefirst normal play period may neither be
rep-resentative of a "true" baseline nor as rele-vant as the
subsequent differences observedlater on the final play period after
still-faceperiods. It is possible that touch was moresoothing for
infants of depressed mothers,
who might normally be deprived of contin-gent maternal touch and
contact at home.Touch may have quickly become nonsooth-ing, and
perhaps aversive, for the infants ofnondepressed mothers, who might
normallynot be deprived and were more upset andstressed by the
preceding still-face-no-touchperiod.
During the resumed normal play inter-action, then, the infants
of depressed moth-ers were not as distressed as those of
nonde-pressed mothers. Touch was initiallysoothing to the infants
of depressed mothers,and in the aftermath of the still-face
periods,the infants of nondepressed mothers weremore upset. This
phenomenon suggests thatas a result of their history of
experiences,the infants of depressed mothers were lessdistressed by
the still-face perturbations andthe absence of maternal touch.
Conceivably,infants of depressed mothers could havebeen less
distressed in our study becausethey received more optimal touch
than theywere used to.
The results of the present study can berelated to findings from
a recent learningexperiment using a synchronized reinforce-ment
procedure (Pelaez-Nogueras et aI.,1996). Pelaez-Nogueras and
colleaguesfound that contingent tactile stimulation bya caregiver
during face-to-face interactionsincreases affect and attention in
3-month-oldinfants. In that study, when touch was usedas part of
the caregiver's social stimulationand provided contingently, it
effectively re-inforced and maintained higher rates of in-fant eye
contact, smiles, and vocalizations.Interestingly, the infants in
the presentstudy also increased eye contact with theirmothers
during the still-face-with-touch pe-riod; this may have occurred as
a result ofintermittent contingent touch stimulationon infant
making eye contact with theirmothers.
Both learning and emotional regulationprpcesses prepare the
infant to develop adap-tive and organized behavior strategies
(Pel-aez-Nogueras, 1992; Thompson, 1994). Thedifferences observed
in the infants' behaviormay lie in the different histories of
interac-tions between mother and child and historiesof infant
behavior regulation. The data for thefirst normal play period show
that infants ofdepressed and nondepressed mothers dif-fered in
facial grimacing and looking athands, suggesting differences in
their learn-ing histories and conceivably in their abilityto
regulate their behaviors. However, eventhough there were
differences between in-fants of depressed and nondepressed
moth-
-
ers, we should be cautious when attributingthese differences to
the infants' prior interac-tive histories with their mothers in
light ofthefact that there were no immediate group dif-ferences in
the mothers' behaviors in the firstnormal play period.
In sum, the effects of maternal touchduring still face were more
powerful for in-fants of depressed mothers than for infantsof
nondepressed mothers, even when theamount and type of touch
provided by thedepressed and nondepressed mothers werethe same.
Touch appears to have strong posi-tive influences on infant
behavior, it can in-crease positive affect, increase infants'
nega-tive affect, and direct infants' attention, inparticular, the
attention of infants of de-pressed mothers during face-to-face
interac-tions. The type of stimulation that involvestouch during
face-to-face interactions needsto be investigated further. Although
short-term positive effects were achieved in thepresent study,
long-term assessments andimplementations of this type of
interventionare needed to determine the more prolongedpositive
effects of touch on infant behavior.Future research should focus on
touch inter-vention strategies with infants and their de-pressed
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