A idade gestacional é uma medida importante, pois quando o bebê nasce antes da 37ª semana há riscos para alterações do desenvolvimento. A relação dos bebês com pais fornece base para o desenvolvimento dos padrões de autorregulação, para o aumento da sensibilidade materna, e para o desenvolvimento do apego. Permeando a hipótese de que, a idade gestacional pode influenciar no desenvolvimento infantil, o objetivo do estudo foi verificar a influência da idade gestacional nas habilidades do desenvolvimento infantil (motora grossa, motora fina-adaptativa, pessoal-social e de linguagem) e a qualidade da interação na díade mãe-bebê, ao longo do primeiro ano de vida (três, nove e 12 meses). Cumpriram-se os princípios éticos. Participaram do estudo 28 díades mãe-bebê, com crianças nascidas entre a 32ª a 40ª semana de gestação, recrutadas ao nascimento. Aos três meses os familiares foram contatados para a primeira avaliação, que constou da aplicação do protocolo de anamnese, aplicação do procedimento Face to Face Still-Face (FFSF) e do Teste de Screnning de Desenvolvimento Denver II (TSDD-II). Aos nove meses repetiu-se a aplicação do FFSF, TSDD-II e foi verificada a qualidade da interação por meio do Child-Adult Relationship Experimental Index (CARE-Index). Aos 12 meses repetiu-se a medida do desenvolvimento TSDD-II e foi aplicada o paradigma laboratorial da Situação Estranha (SE). O tratamento estatístico constou de análise descritiva e aplicação do Teste de Correlação de Spearman, Teste exato de Fischer, Teste de Mann-Whitney e Teste Anova de Medições Repetidas. Os resultados indicaram influência da idade gestacional nas habilidades do desenvolvimento infantil (motora grossa, motora finaadaptativa, pessoal-social e de linguagem), aos três, nove e doze meses, com valor maior nível de significância aos três meses. A qualidade da interação avaliada por meio do CARE-index, indicou predomínio de mães com alto nível de sensibilidade (81,82%). Os padrões de autorregulação avaliados por meio do procedimento FFSF indicaram que 57,14% da casuística apresentaram orientação social não positiva e 42,86% orientação social positiva aos três e aos nove meses 78,57% orientação social não positiva e 21,43% orientação social positiva. O padrão de Apego, avaliado pela SE, verificou apego inseguro para 60,71% e apego seguro em 39,29% da casuística. / Gestational age is an important baseline because when the infant is born before the 37th week there are risks for developmental changes. The relationship between infants and parents provides a basis for the development of self-regulation standards, for the increase of maternal sensitivity, and for the development of attachment. Permeating the hypothesis that gestational age may influence infant development, this study aimed to verify the influence of gestational age on infants developmental skills (gross motor, fine-adaptive motor, personal-social and language), and the quality of gestational age of the mother-infant dyad interaction during the first year of life (three, nine and 12 months). Ethical principles were fulfilled. The study included 28 mother-infant dyads, with children born between the 32nd and 40th weeks of gestation, recruited at birth. At three months old the family members were contacted for the first evaluation, which included the application of the protocol of anamnesis, application of the Face to Face Still-Face (FFSF) procedure and the Denver Development Screening Test II (DDST-II). At nine months the FFSF, DDST-II was repeated and the quality of the interaction was verified through the Child-Adult Relationship Experimental Index (CARE-Index). At 12 months the DDST-II development measurement was repeated and the laboratory paradigm of the Strange Situation (SE) was applied. The statistical treatment consisted of descriptive analysis and application of Spearman\'s Correlation Test, Fischer\'s Exact Test, Mann-Whitney Test and Repeated Measures Anova Tests. The results indicated the influence of gestational age on infant\'s developmental abilities (gross motor, fine-adaptive motor, personal-social and language) at three, nine and twelve months, with a higher level of significance at three months old. The quality of the interaction evaluated through CARE-index, indicated predominance of mothers with a high level of sensitivity (81.82%). Self-regulation standards assessed through the FFSF procedure indicated that 57.14% of the case analysis had non-positive social guidance and 42.86% had positive social guidance at three, and at nine months 78.57% non-positive social guidance and 21.43% positive social orientation. The Attachment pattern, evaluated by the SE, found unsafe attachment to 60.71% and Secure attachment in 39,29% of the cases analysis.

Submitted by BÁRBARA CAMILA DE CAMPOS (badecampos@gmail.com) on 2016-05-16T15:27:39Z No. of bitstreams: 1 Dissertacao Barbara Campos FINAL.pdf: 1452376 bytes, checksum: dbbbdf21eee3b025be1737c1e1447968 (MD5) / Approved for entry into archive by Ana Paula Grisoto (grisotoana@reitoria.unesp.br) on 2016-05-17T14:30:10Z (GMT) No. of bitstreams: 1 campos_bc_me_bauru.pdf: 1452376 bytes, checksum: dbbbdf21eee3b025be1737c1e1447968 (MD5) / Made available in DSpace on 2016-05-17T14:30:10Z (GMT). No. of bitstreams: 1 campos_bc_me_bauru.pdf: 1452376 bytes, checksum: dbbbdf21eee3b025be1737c1e1447968 (MD5) Previous issue date: 2016-02-24 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Desde o nascimento a interação do recém-nascido com o mundo é facilitada pela mãe. Estudos indicam que a saúde mental materna pode afetar a qualidade desta interação e, por exemplo, mães deprimidas podem interagir pouco com seu bebê, podendo gerar déficits comportamentais e cognitivos, identificáveis ao longo do desenvolvimento. Este trabalho, composto por dois estudos, pretendeu descrever e relacionar o índice de depressão pós-parto apresentado por mães de bebês com as variáveis sociodemograficas e avaliar a relação entre a presença da depressão e a qualidade da interação mãe-bebê. Participaram mães e seus bebês, usuárias do Projeto de Extensão “Acompanhamento do desenvolvimento de bebês: avaliação e orientação aos pais”. No primeiro estudo pretendeu-se identificar fatores de risco para a depressão pós-parto considerando variáveis sociodemograficas maternas, dos bebês e familiares. Uma amostra de 103 mães participou da primeira etapa em que responderam a uma entrevista inicial para a coleta de dados sociodemográficos e a “Escala de Depressão Pós-Parto de Edimburgo” (EDPE). Os resultados apontaram que 33% das mães apresentaram depressão pós-parto. Segundo o teste estatístico ρ de Pearson observou-se correlação linear negativa com a escolaridade materna (p=0,008), ou seja, quanto maior o índice de depressão, menor o número de anos de estudo. Além disso, houve uma correlação linear positiva entre a depressão e a condição socioeconômica (p=0,044), sendo que a variação da ABEP é decrescente. Desta forma, quanto mais pontos na EDPE mais pontos na ABEP, caracterizando menor nível socioeconômico. A análise da regressão linear múltipla indicou que a baixa escolaridade materna (p=0,010) pode ser um preditor para depressão pós-parto. No segundo estudo, pretendeu-se descrever comportamentos interativos maternos e do bebê considerando o índice de depressão pós-parto. Neste estudo a amostra foi de 30 díades divididas em Grupo 1 (grupo clínico) e Grupo 2 (grupo não clínico) de acordo com o ponto de corte 12 na EDPE, a análise da interação foi feita pelo Sistema de Codificação da Interação Mãe-Criança Revisado (CITMI-R). As participantes do G1 apresentaram pontuação média na EDPE de 14 pontos e as do G2 cinco pontos. Ao comparar G1 e G2, com o Teste T de amostras independentes, houve uma diferença significativa no comportamento de choro ou Protesto de Choro/Protesto (p=0,002) e para o Comportamento Protetor Neutro o Negativo (p=0.020) com médias mais altas para bebês filhos de mães deprimidas (L: 8,46; 2,94 e P0/-: 5,46; 3,60). O resultado da correlação de Pearson indicou correlação positiva entre a depressão com comportamento de Choro/Protesto (p=0,009) e correlação negativa entre a depressão e o Comportamento Protetor Positivo (p=0,039). Há diferenças importante para os resultados obtidos na análise de correlação dos comportamentos interativos dos grupos separadamente, no G1, houve correlação positiva significativa entre o Comportamento de Aproximação Social Neutro com o Sensível Neutro (p=0,049) e de Passividade ou Apatia com Comportamento Não-Responsivo (p=0,005), os resultados do G2 indicam que na interação das díades os comportamentos que se correlacionaram, positivamente foram os de Aproximação Social Positiva com os Comportamentos Sensível Positivo (p=0,031) e Sensível Neutro (p=0,050), além da correlação negativa do primeiro com o Comportamento Protetor Neutro (0,005). Os dados contribuem para compreensão do papel presença da depressão para a interação e o desenvolvimento infantil. Ao identificar as diferenças entre os comportamentos expressos nos dois grupos considerando a variável depressão, houve diferença em algumas categorias. Os resultados confirmam outros estudos e tendências em relação à baixa responsividade e sincronia da díade em que a mãe está deprimida, desta forma têm-se aí um grupo de risco em que a díade deve ser cuidada, garantindo saúde e um desenvolvimento adequado. / The newborn interaction with the world is facilitated by his mother. Studies indicates that maternal mental health can affect the quality of this interaction, for example, depressed mothers may interact less with their baby and it can cause behavioral and cognitive deficits throughout the development. This work, consisting on two studies which describe and relate the index of postpartum depression presented on the baby’s mothers with socio-demographic variables and evaluate the relationship between the presence of depression and quality of mother-infant interaction. Participated mothers and their babies, Extension Project users "Monitoring the development of babies: evaluation and guidance for parents." In the first study aimed to identify risk factors for postpartum depression considering maternal, babies and family socio-demographic variables. A sample of 103 mothers participated in the first step in responding to an initial interview to collect demographic data and "Edinburgh Postpartum Depression Scale" (EPDS). The results showed that 33% of the mothers had postpartum depression. The average age of the infants was 4.4 months, the gestational age of 36.9 weeks, with respect to risk condition (prematurity, low birth weight and teen mom), 46% had some of these characteristics. The average age of the mothers was 27.2, about the type of family, 78% of the sample is nuclear family and the socioeconomic level of the sample is Class B (68%). In the second study was intended to describe maternal interactive behaviors and baby considering the postpartum depression index. The results showed that 33% of mothers had postpartum depression. According to statistical Pearson test was observed negative linear correlation with maternal education (p = 0.008), the higher the rate of depression, lower the number of years of study. In addition, there was a positive linear correlation between depression and socioeconomic status (p = 0.044), and the variation of ABEP is decreasing. In this way, the more points in EDPE more points in ABEP, featuring lower socioeconomic status. The analysis of multiple linear regression showed that low maternal education (p = 0.010) can be a predictor of postpartum depression. In the second study was intended to describe maternal interactive behaviors and baby considering the postpartum depression index. In this study the sample was 30 dyads divided into Group 1 (clinical group) and Group 2 (non-clinical group) according to the cutoff point 12 in EDPE, the analysis of the interaction was taken by System of the Mother-Child Interaction Coding revised (CITMI-R). The participants of the G1 had a mean score in EDPE 14 points and G2 five points. When comparing G1 and G2, with the T test for independent samples, there was a significant difference in Crying or Protest Behavior (p = 0.002) and the Neutral or Negative Behavior of Protect (p = 0.020) with higher average for children of depressed mothers babies (L: 8.46; 2.94 and P0 / -: 5.46; 3.60). The result of Pearson correlation showed a positive correlation between depression with Crying or Protest Behavior (p = 0.009) and negative correlation between depression and Positive Protect Behavior (p = 0.039). There are important differences in the results obtained in the analysis of correlation of interactive behaviors of the groups separately, the G1, there was a significant positive correlation between Neutral Behavior of Social Approaching with Neutral Sensibility (p = 0.049) and Passivity or Apathy Behavior with Non-Responsive (p = 0.005), results in G2 indicate that the interaction of dyads behaviors that correlate positively were the Positive Social Approach to Positive Behavior of Sensibility (p = 0.031) and Neutral Sensibility (p = 0.050), and the negative correlation of the first with the Neutral Behavior of Protect (0,005). The data contribute to understanding the role of the presence on depression for interaction and child development. By identifying the differences between the behaviors expressed in both groups considering the variable depression, there were differences in some categories. The results confirm other studies and trends in relation to low responsiveness and timing of the pair in which the mother is depressed in this way to have there as a risk of group in which the dyad must be looked after, ensuring health and proper development. / FAPESP: 2014/08845-2

Made available in DSpace on 2015-05-14T12:43:23Z (GMT). No. of bitstreams: 1 arquivototal.pdf: 1170320 bytes, checksum: e2b9102611133fedb8bfab5546876ff8 (MD5) Previous issue date: 2009-12-16 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The enunciation of personal deixis is a point of tension between language and the subject, highlighting the movements of the emergence of subjectivity in discourse. In language acquisition, deictic designation furthers our understanding of the initial process of subjectivity experienced by the infans, while allowing us to glimpse the different mechanism as to initiate the subject in language. On this assumption, we must consider how perceptive the subject is of the process of subjective constitution that he/she is passing through, by the linguistic marks of their registration statement (personal deixis), when invoking the formal apparatus of enunciation (BENVENISTE, 1989, p. 81-84), makes the use of language and its reversibility proper in a situation of enunciative interaction with others. Our goal is therefore to investigate the relationship between language acquisition and the formation of the subject, as proposed by Benveniste (1988 and 1989), by observing the appearance and operation of personal deixis in enunciative productions of the baby in situation of interaction with the mother. To do so, we will take longitudinal data from three mother-infant dyads (12 to 32 months of age), in naturalistic situation of interaction. The results show that, when considering the different movements of the mechanism of personal deixis in children's language, we can see the various subjective shifts in which the child passes: at first, the child seeks a place for himself in the enunciative structure; then comes to the game of reversible deictic personal, and finally enters the logic of the mechanism of personal deixis. In this sense, the use of personal deictic has as a property to express, in the particular circumstances of living / being of each subject in the language, the regularities of enunciative distinct movements contained in the initial stages of language acquisition. / A enunciação da dêixis pessoal constitui um ponto de tensão entre a linguagem e o sujeito, pois evidencia os movimentos de instalação da subjetividade no discurso. Na aquisição da linguagem, a designação dêitica possibilita a compreensão do processo inicial de subjetivação por que passa o infans, ao mesmo tempo em que nos permite vislumbrar os diferentes mecanismos enunciativos de instauração do sujeito na linguagem. Partindo desta premissa, cabe-nos analisar de que modo o sujeito dá a conhecer o processo de constituição subjetiva por que está passando, por meio das marcas lingüísticas de sua inscrição no enunciado (dêixis pessoal), quando, valendo-se do aparelho formal da enunciação (BENVENISTE, 1989, p. 81-84), torna próprio o uso da língua e sua reversibilidade em situação de interação enunciativa com o outro. Nosso objetivo é, portanto, investigar a relação entre a aquisição da linguagem e o processo de constituição do sujeito, tal como proposto por Benveniste (1988 e 1989), através da observação do aparecimento e do funcionamento da dêixis pessoal nas produções enunciativas do bebê em situação de interação com a mãe. Para isso, iremos nos valer de dados longitudinais de três díades mãe-bebê (de 12 a 32 meses de idade), em situação naturalística de interação. Os resultados mostram que, ao analisar os diferentes movimentos do mecanismo da dêixis pessoal na linguagem infantil, podemos perceber os diversos deslocamentos subjetivos pelos quais a criança passa: a princípio, busca um lugar para si na estrutura enunciativa; em seguida esbarra no jogo reversível dos dêiticos pessoais; por fim, adentra na lógica do mecanismo da dêixis pessoal. Nesse sentido, o uso dos dêiticos pessoais tem a propriedade de explicitar, dentro das singularidades do estar/ser de cada sujeito na língua, as regularidades de movimentos enunciativos distintos e constantes na fase inicial de aquisição da linguagem.

La première partie de ce travail vise à étudier les effets de la présence vocale maternelle, chant et la parole, sur l'état clinique de l'enfant prématuré, évalué en termes de paramètres physiologiques (fréquence cardiaque, oxygénation du sang et événements critiques) et sur son état comportemental. Dans cette partie on observe donc la mère comme sujet actif et stimulant, par rapport à un bébé prématuré qui, à travers des indices comportementaux et physiologiques, montre bénéficier de la stimulation directe de la voix de la mère. La comparaison des périodes avec et sans stimulation vocale maternelle révèle un plus haut niveau de saturation en oxygène et la fréquence cardiaque et significativement moins d'événements critiques négatives (p <0,0001) lorsque la mère parle et chante. Une connexion renouvelé à la voix de la mère peut être une expérience importante et significative pour les enfants prématurés. L'exposition à la parole et au chant de la mère montre des effets bénéfiques précoces importantes sur l'état physiologique du bébé, tels que les niveaux de saturation en oxygène, le nombre d'événements critiques et la prévalence de l'état d'alerte calme. Ces résultats ont des implications pour les interventions en USIN, encourageant l'interaction maternelle avec leurs nouveau-nés prématurés médicalement stables.La deuxième partie inverse le point de vue, visant à évaluer les effets du comportement de l'enfant sur la mère qui chante et parle: on évalue la capacité de l'enfant à être un partenaire actif dans ces première proto-interactions en vis à vis. On analyse en termes acoustiques les effets du comportement du nouveau-né sur la voix maternelle directe. La voix de la mère présente des caractéristiques spécifiques en termes de minimum de fréquence fondamentale (F0min) pendant les 5 secondes qui précèdent les réactions positives des nouveau-nés. Les mères ont élevé la hauteur de leur voix en présence d'un comportement positif de l'enfant, en particulier dans la communication parlée. En outre, la variance de la F0 (F0sd), augmente en particulier dans la langue maternelle, lorsque l'enfant ouvre les yeux. Ces résultats suggèrent que les comportements positifs des prématurés nés hospitalisés, dans le contexte des interactions, peuvent évoquer, dans les mères des formes précoces de attachement, mesurée par l'augmentation des caractéristiques du parler-bébé. En particulier, le F0min a un rôle crucial pour détecter la réactivité émotionnelle de la mère au cours des interactions vocales. Dans la dernière partie, enfin, on analyse dans le détail quelques épisodes de régulation réciproque dans la dyade mère-enfant: une hypothèse hasardeuse. Il s’agit de trouver, dans une relation dyadique profondément compromise, les traces de syntonisations affectives, des imitations amodales, des épisodes d’ajustement mutuel, de désengagements suite aux stimulations excessives. Nous avons analysé trois situations différentes dans lesquelles les mères et les nouveau-nés prématurés interagissent. Les trois séquences présentent (a) un cas de imitation intermodale, où la mère accompagne par la voix et du visage imitation changement postural du nouveau-né; (b) une séquence interactive dans laquelle on peut identifier un moment d’échange du regard entre les deux partenaires, qui est interrompue et réglementé par le bébé prématuré. La troisième microanalyse (c) vise à montrer les caractéristiques acoustiques d'une interaction vocale entre l’adulte (père et mère) et le nouveau-né prématuré. / This thesis investigated the effects, the responsiveness, the characteristics of maternal voice speaking and singing to preterm infants in NICU.In Study 1 we investigated the effects of live maternal speaking and singing on physiological parameters of preterm infants in the NICU and to test the hypothesis that vocal stimulation can have differential effects on preterm infants at a behavioural level.Methods: Eighteen mothers spoke and sang to their medically stable preterm infants in their incubators over 6 days, between 1 and 2 pm. Heart rate (HR), oxygen saturation (OxSat), number of critical events (hypoxemia, bradycardia and apnoea) and change in behavioural state were measured.Results: Comparisons of periods with and without maternal vocal stimulation revealed significantly greater oxygen saturation level and heart rate and significantly fewer negative critical events (p < 0.0001) when the mother was speaking and singing. Unexpected findings were the comparable effects of maternal talk and singing on infant physiological parameters and the differential ones on infant behavioural state.Conclusion: A renewed connection to the mother’s voice can be an important and significant experience for preterm infants. Exposure to maternal speech and singing shows significant early beneficial effects on physiological state, such as oxygen saturation levels, number of critical events and prevalence of calm alert state. These findings have implications for NICU interventions, encouraging maternal interaction with their medically stable preterm infants. In Study 2 we aimed (1) to examine qualitative change in maternal infant-directed singing and speaking, prior to a positive behaviour display by the preterm infants (i.e. eye opening and lip-corner raising), (2) to analyse the effects of the two behaviours on concomitant acoustic characteristics of maternal infant-directed vocal communication (IDVC), (3) to determine whether changes in maternal voice quality persist after the infant’s positive behavioural display.Methods: Participants included 10 mothers who were asked, on different occasions, to speak and sing to their medically stable infants in incubators, 128 vocalization extracts were examined. Results: The maternal voice shows specific characteristics in terms of fundamental frequency minimum (F0min) during the 5 seconds before the positive reactions of newborns. Mothers raised their pitch in presence of infant’s positive behaviour, especially during the speaking stimulation, reinforcing the higher pitched ID speech. Moreover, the variance of the F0 (F0sd), increases in particular in the maternal speaking, when the infant opens the eyes. Conclusions: These findings suggest that the preterm hospitalized infants’ positive displays, in the context of interactions, can evoke in mothers early forms of attachment, measured by the increase of the characteristics of Infant Directed Speech. In particular the F0min has a crucial role for detecting maternal emotional responsiveness in contingent vocal interactions. In the third part we aimed to analyse, with qualitative methods, the interaction between mothers and preterm infants. We will analyse three different situations in which mothers and preterm infants interact. The three sequences will present (a) a case of intermodal imitation, where the mother accompanies through voice and facial imitation postural change of the newborn; (b) an interactive sequence in which we can identify a moment of eye contact between the two partners, which is interrupted and regulated by the premature baby. The third microanalysis (c) aims to show the acoustical features of a vocal interaction bertween adults (mother and father) and their preterm infants.

A idade gestacional é uma medida importante, pois quando o bebê nasce antes da 37ª semana há riscos para alterações do desenvolvimento. A relação dos bebês com pais fornece base para o desenvolvimento dos padrões de autorregulação, para o aumento da sensibilidade materna, e para o desenvolvimento do apego. Permeando a hipótese de que, a idade gestacional pode influenciar no desenvolvimento infantil, o objetivo do estudo foi verificar a influência da idade gestacional nas habilidades do desenvolvimento infantil (motora grossa, motora fina-adaptativa, pessoal-social e de linguagem) e a qualidade da interação na díade mãe-bebê, ao longo do primeiro ano de vida (três, nove e 12 meses). Cumpriram-se os princípios éticos. Participaram do estudo 28 díades mãe-bebê, com crianças nascidas entre a 32ª a 40ª semana de gestação, recrutadas ao nascimento. Aos três meses os familiares foram contatados para a primeira avaliação, que constou da aplicação do protocolo de anamnese, aplicação do procedimento Face to Face Still-Face (FFSF) e do Teste de Screnning de Desenvolvimento Denver II (TSDD-II). Aos nove meses repetiu-se a aplicação do FFSF, TSDD-II e foi verificada a qualidade da interação por meio do Child-Adult Relationship Experimental Index (CARE-Index). Aos 12 meses repetiu-se a medida do desenvolvimento TSDD-II e foi aplicada o paradigma laboratorial da Situação Estranha (SE). O tratamento estatístico constou de análise descritiva e aplicação do Teste de Correlação de Spearman, Teste exato de Fischer, Teste de Mann-Whitney e Teste Anova de Medições Repetidas. Os resultados indicaram influência da idade gestacional nas habilidades do desenvolvimento infantil (motora grossa, motora finaadaptativa, pessoal-social e de linguagem), aos três, nove e doze meses, com valor maior nível de significância aos três meses. A qualidade da interação avaliada por meio do CARE-index, indicou predomínio de mães com alto nível de sensibilidade (81,82%). Os padrões de autorregulação avaliados por meio do procedimento FFSF indicaram que 57,14% da casuística apresentaram orientação social não positiva e 42,86% orientação social positiva aos três e aos nove meses 78,57% orientação social não positiva e 21,43% orientação social positiva. O padrão de Apego, avaliado pela SE, verificou apego inseguro para 60,71% e apego seguro em 39,29% da casuística. / Gestational age is an important baseline because when the infant is born before the 37th week there are risks for developmental changes. The relationship between infants and parents provides a basis for the development of self-regulation standards, for the increase of maternal sensitivity, and for the development of attachment. Permeating the hypothesis that gestational age may influence infant development, this study aimed to verify the influence of gestational age on infants developmental skills (gross motor, fine-adaptive motor, personal-social and language), and the quality of gestational age of the mother-infant dyad interaction during the first year of life (three, nine and 12 months). Ethical principles were fulfilled. The study included 28 mother-infant dyads, with children born between the 32nd and 40th weeks of gestation, recruited at birth. At three months old the family members were contacted for the first evaluation, which included the application of the protocol of anamnesis, application of the Face to Face Still-Face (FFSF) procedure and the Denver Development Screening Test II (DDST-II). At nine months the FFSF, DDST-II was repeated and the quality of the interaction was verified through the Child-Adult Relationship Experimental Index (CARE-Index). At 12 months the DDST-II development measurement was repeated and the laboratory paradigm of the Strange Situation (SE) was applied. The statistical treatment consisted of descriptive analysis and application of Spearman\'s Correlation Test, Fischer\'s Exact Test, Mann-Whitney Test and Repeated Measures Anova Tests. The results indicated the influence of gestational age on infant\'s developmental abilities (gross motor, fine-adaptive motor, personal-social and language) at three, nine and twelve months, with a higher level of significance at three months old. The quality of the interaction evaluated through CARE-index, indicated predominance of mothers with a high level of sensitivity (81.82%). Self-regulation standards assessed through the FFSF procedure indicated that 57.14% of the case analysis had non-positive social guidance and 42.86% had positive social guidance at three, and at nine months 78.57% non-positive social guidance and 21.43% positive social orientation. The Attachment pattern, evaluated by the SE, found unsafe attachment to 60.71% and Secure attachment in 39,29% of the cases analysis.

Abstract The present longitudinal follow-up study had two main goals. Firstly, this study aimed to describe aspects of maternal interactive/communicative behaviour that could be considered constitutive in sensitive responsiveness. Secondly and most importantly, it aimed to find predictive relations between characteristics of mother-infant interaction around the onset of infant intentional communication and subsequent child communicative and linguistic development. The participants were 27 Finnish-speaking mothers and their healthy first-born infants. Analyses of the amount and types of maternal and infant communicative acts as well as maternal responses to infant signals were carried out from videotaped free-play samples at the infants' age of 10 months. In addition, the CARE-Index was used to rate maternal sensitivity and infant co-operativity. At 12 months, children's communicative and linguistic skills were assessed by using the MacArthur Communicative Development Inventories and the Communication and Symbolic Behaviour Scales. At 30 months, the Reynell Developmental Language Scales III was used to assess comprehensive and expressive language. The results suggest that maternal activity in eliciting interaction and conversational interchanges is characteristic of sensitive responsiveness around the onset of infant intentionality. However, very distinctive aspects of verbal behaviour that might be constitutive in sensitive responsiveness were not found — probably as a result of considerable individual variation in all aspects of maternal as well as infant interactive/communicative behaviour that were analysed. As predictors of communicative and linguistic skills at 12 months, both maternal and infant characteristics made a significant contribution. In general, the predictive relations found were quite specific. In turn, except for the predictive validity of maternal sensitivity for comprehensive language at 30 months, later language outcomes were predicted only by children's communicative and linguistic skills at 12 months, suggesting that over time, language development becomes increasingly child-driven. Individual differences in early communicative capacities may also to some extent mask the language-facilitating effects of parenting. On the other hand, some potentially facilitating effects of parental behaviour may be elicited by the infant's well-advanced communicative skills. The importance to acknowledge transactional processes in parent-child interaction is highlighted — both in future research and clinical applications.

Advances in neonatology have led to increased numbers of high-risk neonates surviving and intensified interest in the developmental outcomes of this population. In the South African context prematurity and low birth weight are the most common causes of death in the perinatal period and the same risk factors that contribute to infant mortality also contribute to the surviving infants’ increased risk for developmental delays. As a result of the interacting biological and environmental risk factors of prematurity, low birth weight, poverty and HIV and AIDS in the South African context Kangaroo Mother Care (KMC) has been developed as best practice to promote infant survival and to facilitate mother-infant attachment. Mother-infant attachment may lead to synchronous interaction patterns between the mother and infant which forms the basis of early communication development. Early communication intervention (ECI) services are recommended as early as possible as high-risk infants are especially at risk for feeding difficulties and communication developmental delays. It is, however, not clear what the content of an ECI programme should be and how it should be implemented according to the changing communication and feeding developmental needs of the infant while receiving KMC. There appears to be a dearth of research on the earliest stages of communication development in high-risk neonates, which should form the foundation of such a programme. A descriptive survey was conducted to describe the development of 25 high-risk infants and their mothers’ changing needs from admission to discharge from a KMC unit. Each participant and mother dyad was followed up over an average of 11 days of data collection with three to four data collection sessions. Data was collected by means of direct observation during routine care-giving activities. The different developmental subsystems of the participants’ feeding, communication, neuro-behavioural organization and mother-neonate interaction were described. The results demonstrated that subtle, but definite changes could be observed in the participants’ development. Development in all the different areas occurred over time as the participants progressed through the three developmental states of the in-turned state, coming-out state and reciprocity state. As the participants progressed during the 11 days of data collection and were increasingly able to attend to their environment, they also developed the ability to regulate and organize their own behaviour in order to develop more complex communication, feeding and interaction skills with their mothers. The functioning of the participants’ sensory systems developed in a specific order namely tactile, auditory and then visual. Although the participants developed consistently throughout their stay in the KMC unit, mother-neonate interaction never reached optimal levels. The importance of an individualized training programme for each mother is reflected in the finding that the neonate’s developmental level and progress needs to be considered when implementing the ECI programme. The need for speech-language therapy involvement in KMC is emphasized in the light of a shortage of practicing speech-language therapists in South Africa. It is therefore imperative that the prevention of communication delays and feeding difficulties in high-risk neonates as well as parent training assume priority. / Dissertation (MCommunication Pathology)--University of Pretoria, 2008. / Speech-Language Pathology and Audiology / unrestricted

Contexte : Les personnes atteintes de trouble de personnalité limite (TPL) présenteraient un déficit de mentalisation, soit la capacité de percevoir et interpréter les états mentaux chez soi et chez l’autre. Dans le cadre de la relation mère-bébé, un tel déficit est susceptible d’entraîner des perturbations relationnelles ayant des conséquences néfastes sur le développement de l’enfant. L’orientation mentale se mesure par le biais des verbalisations du parent au sujet des états mentaux de son enfant et constitue donc un reflet de la mentalisation du parent durant cette interaction. Toutefois, aucune étude n’a encore investigué l’orientation mentale chez des mères avec TPL durant l’interaction avec leur bébé. Objectif : Le but de cette étude était d’évaluer l’orientation mentale de 38 mères en interaction avec leur enfant âgé de 12 mois, incluant 10 mères atteintes de TPL et 28 sans diagnostic psychiatrique. Méthode: L’orientation mentale maternelle fut évaluée à partir de vidéos d’interaction mère-enfant dans un contexte de jeu libre. Le TPL a été identifié à l’aide du Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II). Résultats: Les mères atteintes de TPL ne se sont pas distingué concernant la fréquence de commentaires faisant référence aux états mentaux de leur bébé. Toutefois, les commentaires mentaux des mères souffrant de TPL se sont avérés être 4.7 fois plus fréquemment jugés non-appropriés à l’état mental de l’enfant comparés à ceux des mères sans diagnostic psychiatrique. Conclusions : Les commentaires mentaux des mères atteintes de TPL semblent plus fréquemment empreints d’erreurs d’interprétation des états mentaux de leur enfant, ce qui pourrait poser un risque pour le développement de l’enfant. / Background. Mothers with Borderline Personality Disorder (BPD) have been theorized to have decreased mentalization ability, which is the capacity to perceive and interpret mental states. This could potentially increase the risk for troubled relationships with their infants and therefore have adverse consequences on the social and emotional development of the child. Mind-mindedness (MM), assessed through the mother’s references to her infant’s mental states during an interaction, is one aspect of maternal behavior that relies heavily on the mother’s mentalizing ability. However, research has yet to examine MM in mothers with BPD. Aims. Our objective was to assess the MM ability of 38 mothers during interactions with their 12 month-old infants, including 10 with BPD and 28 without a psychiatric diagnosis. Method. Trained observers assessed maternal MM from 2 minutes of videotaped mother-infant free play. BPD was assessed by the Structured Clinical Interview for DSM-III-R-Personality Disorders (SCID-II). Results. Mothers with and without BPD did not differ in the frequency of comments referring to infant mental states. However, the mind- related comments made by mothers with BPD were 4.7 times more frequently judged as non- attuned to her infant’s mental state by a trained observer compared with those of controls without a psychiatric diagnosis. Conclusions. Mothers with and without BPD appear equally likely to envision and refer to mental states in their infants. However, mothers with BPD appear more likely to misread the mental states of their infants. This could put the child at risk for adverse developmental outcomes.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal.

Mémoire numérisé par la Division de la gestion de documents et des archives de l'Université de Montréal