Doctoral Degrees (Psychiatry)

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Browsing Doctoral Degrees (Psychiatry) by Author "Lachman, Anusha"

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    Shared pleasure in early infant interactions
    (Stellenbosch : Stellenbosch University, 2022-12) Lachman, Anusha; Niehaus, Dana J. H.; Puura, Kaija; Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Psychiatry.
    ENGLISH SUMMARY: Infant mental health is strongly connected to the quality of caregiving relationships, specifically to the mutual adaptation of the infant and caregiver. Positive shared emotions in infant–caregiver relationships build social, intellectual and psychological resources for the infant, which facilitates optimal growth and development. Sharing positive affect fuels the organisation of early infant experiences of socialisation, and the mother–infant interaction may constitute the first environmental context to shape these abilities. Synchronised behaviours (such as mutual gaze and gaze following) between mothers and their infants are thought to create the foundation of early social connectedness and regulation. Infants are extremely sensitive to the emotional states of their mothers and shared joy is the goal for which mother and child instinctively strive. Shared pleasure (SP) moments in parent–infant interaction are defined as “the parent and the child sharing positive affect in synchrony”. This is expressed in facial expressions, such as a laugh or curving of mouth to smile, together with a direct gaze contact, and a simultaneous or synchronised beginning and ending. SP sequences are analysed from free play video recordings of mother–infant interaction situations by coding the occurrence and duration of moments, including shared eye contact and mutual, synchronous smile or laughter. Shared pleasure is considered a marker of more regulated emotions and, when absent, serves as a possible screening marker for early identification of at-risk dyads. This original study of SP in South Africa focused on mothers and their young infants in a clinical and community setting. The aims of the study were to determine the frequency and duration of SP moments in infants born to mothers with and without mental illness, to correlate SP moments with the Bayley scales of infant toddler development and to determine the presence of sustained infant withdrawal as assessed by the Alarm Distress Baby (ADBB) meausurement of infant withdrawal. The first two studies (Maternal and Infant Mental health study, n = 91) showed an overall low occurrence of SP moments (20%) in the clinical sample, although significantly more SP moments (p = 0.02) were recorded in mothers with no mental illnesses. When infants were screened for withdrawal behaviours measured by a validated tool (the Alarm Distress Baby Scale), there was a significant correlation between low occurrence of SP and higher rates of Infant withdrawal (p = 0.0002). Interestingly, in this sample of high-risk infants, those who experienced SP moments with their mothers at 6 months showed an improvement in cognitive (p = 0.052) and motor (0.007) scores at 18 months. While overall cognitive improvements were noted across the sample, further regression modelling showed stronger associations for the presence of SP moments. Additionally, having an SP moment resulted in a smaller decrease in later motor scores compared with those without an SP moment. Results of the third Drakenstein Child Health Study of SP in the community-based sample of 291 infants and mothers showed a much higher occurrence (82%) of SP. There were no associations with SP and any risk factors, including on- screens of substance use, intimate partner violence, or postpartum depression. The high frequency of SP in a sample of high exposure to risk factors may suggest that SP in reciprocal interactions may only be disrupted in extreme cases(such as severe mental illness) and so may serve as an early red flag for screening if absent early in the interaction. A significant positive quality of the mother–infant relationship and parenting capacity has potential to contribute to favourable child development, especially in mothers at risk of mental illnesses. SP as demonstrated in this study may likely be one of those protective contributors. In a lower- and middle income country such as South Africa, it is important to recognise and screen early for relational difficulties between infant and caregivers, and SP may be considered as a potential screening tool for early, culturally appropriate social connectedness.