Maternal postpartum depression can cause many impairments for not only mothers but the infants that they care for. There is much research highlighting the impact maternal depression has on infant development. Infants utilize sensory modulation in order to regulate sensory input in positive ways to interact with their environment. Given that maternal depression can influence levels of infant distress as well as impact the parent-infant relationship, it is important to understand how maternal depression impacts an infant’s sensory modulation abilities.
Using an archival dataset from the Parent-Infant Center at Mount Sinai Hospital, maternal depression will be examined within the context of infant sensory modulation difficulties. This study will examine the relationship between maternal depression and infant sensory modulation as well as the impact maternal depression has on various areas of sensory processing. Depending upon the relationship, the findings may present a need for more specific parent-infant dyadic interventions that directly focus on specific areas of sensory processing difficulties and how maternal mood impacts this. However, if the relationship does not exist, treatment modalities focusing on the parent-child dyadic relationship that are currently in use should remain. Keywords: maternal depression, postpartum, sensory processing, sensory modulation, infancy, parent-infant mental health Maternal Depression and Infant Sensory Processing Abilities There has been much research on the challenges of adjustment during the postpartum period. Adjustments in daily routines including sleep, completion of daily roles and other areas of life are impacted and changes need to be made (Henegan, Silver, Bauman, & Stein, 2000).
In addition to this, caregivers are now learning the specific needs of their infant in order to meet these while adjusting to these various changes. Research has shown the impact of maternal depression on a variety of behaviors specific to sensory processing difficulties in infancy with specific regard to sleeping and eating. It has been shown that maternal depressive disorders are associated with infant sleeping difficulties and can be transmitted by changes in sleep patterns amongst mothers diagnosed with depression (Martini, Petzoldt, Knappe, Garthus-Kniegel, Asselmann, & Wittchen, 2017). Additionally, feeding concerns and excessive crying were also associated with maternal depression (Martini, Petzoldt, Knappe, Garthus-Kniegel, Asselmann, & Wittchen, 2017). Further research promotes that maternal depression increases sensory processing difficulties in children who have been diagnosed with colic (DeSantis, Lester, Coster, & Bigsby, 2004). Research has highlighted the importance of an infant’s ability to regulate affect and behavior as this promotes positive psychosocial adjustment throughout childhood (Dale, O’Hara, Schein, Inserra, Keen, Flores, & Porges, 2011). Regulatory processes allow infants to positively cope with various changes in the environment, thus the capacity to self-regulate bodily states and utilize behaviors to self-soothe as well as receive soothing from caregivers is a crucial feature of positive development (McGeorge, Milne, Cotton, & Whelan, 2015). Sensory processing abilities including excessive crying, fussy temperament, difficulties self-soothing, challenges with sleep behaviors and others can be considered indicative of a regulatory processing disorder in infancy (Dale et al.
, 2011). This study will examine parent ratings of these abilities in their children in relationship to self-reported symptoms of maternal depression through use of the BDI-II and the Infant Sensory Profile Index. As previous research indicates the impact of maternal depression on specific behaviors related to infant sensory abilities such as sleeping and fussiness, the impact of maternal depression on scores related to behavior type will be studied. Maternal Depression Postpartum depression (PPD) is a commonly unrecognized diagnosis that impacts approximately 20% of women following childbirth (McGrath, Keita, Strickland, & Russo, 1990). According to the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association, 2013) PPD is defined as a major depressive episode with onset in pregnancy or within four weeks of delivery. Symptoms of depression can include feelings of sadness and/or anhedonia (i.
e. loss of interest in usual or pleasurable activities), sleep and appetite disturbances, loss of energy, cognitive changes such as difficulty concentrating, and recurrent thoughts of death. All of these must occur for at least two weeks consistently. Women are more likely to encounter a depressive episode between the ages of 25 and 44 which is also during the common period of childbearing age (APA, 2013). Additionally, these periods can last an upwards of four months at a time, which significantly impairs a mother’s ability to care for a child, especially a newborn. Much research has focused on the impact of maternal depression on infant development given the importance of the mother-infant relationship.Given that depression can often lead to difficulties in the parent-child relationship which can lead to negative developmental outcomes for the child, including various sensory modulation difficulties including withdrawal behaviors, avoidance, distress, irritability and others (Maxted, Dickstein, Miller-Loncar, High, Spritz, & Lester, 2005). Infant Sensory ModulationSensory modulation is the ability to regulate and manage one’s response to sensory input in a graded and adaptive manner (Dunn, 2001).
In sensory modulation, one’s nervous system adjusts to various sensory stimuli so that the individual can essentially focus on the most important stimuli as they relate to what the individual needs in that moment (Bart, Shayevits, Gabis, & Morag, 2011). Most infants are able to modulate their reaction to sensory stimuli or balance arousal and suppression in relation to how one reacts to a perceived stimulus (Slater, Fabrizi, Worley, Meek, Boyd, & Fitzgerald, 2010). Dunn (1997) proposed a model describing how sensory processing issues can impact early childhood development. As mentioned above, the nervous system guides one’s behaviors and sensory integration; for children this occurs throughout the day with regards to daily activities within one’s environment.
Dunn (1997) proposed that each child has a neurological threshold that guides him or her in determining how much stimulation is needed for the nervous system to respond to these activities in the environment. Thus, some children may need more textures in their foods than others, or more parental soothing when upset during early childhood. Essentially the idea is that each individual’s needs are different and thus regulated differently throughout the day.These individual differences one has in responding to the environment are known as sensory modulation. Issues in sensory modulation arise when they impact one’s daily functioning, such as crying intensely and struggling to be soothed or refusing to eat (Thompson, Bruns, & Rains, 2009). Without having the proper ability to regulate the stimuli one is exposed to daily, having difficulties in sensory modulation, one may experience maladaptive behaviors such as difficulties with feeding, sleeping, and crying/self-soothing. Sensory modulation patterns in children need to be studied as extreme patterns may interfere with daily functioning (Dunn, 1997).
Dunn (1997) proposed a model in which sensory modulation is characterized by four patterns: (a) sensory sensitivity—distress and distraction from sensations, (b) sensation avoiding—controlling or limiting the amount and type of sensations, (c) low registration—lack or low awareness of sensations, and (d) sensation seeking—enjoyment and interest in increasing sensations. Both sensory sensitivity and sensation avoiding represent sensory overresponsiveness, whereas low registration and sensation seeking represent sensory underresponsiveness to various stimuli in one’s environment (Dunn, 1997). As mentioned previously, crying, sleeping and feeding behaviors fall into these categories when attempting to understand sensory modulation within the context of infancy. Maternal Depression & Infant Sensory ModulationWhen the parent-child relationship is struggling, poor outcomes in relation to these areas of behavior are seen as well. Studies have found that maternal depression relates to fussy/difficult infant temperament, specifically colic behaviors (Maxted et al, 2005).
Sleep difficulties in the second 6 months of life are associated with maternal depression and found to commonly occur, with studies revealing mothers reporting increased mental health difficulties having infants with more challenging sleep behaviors (i.e. waking frequently, difficulty falling asleep, etc.) (Bayor, Hisock, Hampton, & Wake, 2007). Infant sleep problems are associated with maternal depression, specifically postpartum depression which impacts a large population of mothers as discussed above.
Again, maternal depression is known to have adverse effects on children’s cognitive, behavioral and emotional development. In one study, mothers attending a pediatric sleep outpatient clinic, 40% reported clinical postpartum depression (Mindell & Owens, 2003). In a community setting, maternal reports of sleep problems in infants aged 6–12 months was significantly associated with symptoms of postpartum depression as well (Mindell & Owens, 2003). Additionally, research has highlighted the relationship between fussy crying in early infancy and postpartum depression (Armstrong, Quin, & Dadds, 1994). Crying in infancy, more specifically colic, is determined by parents’ ability to tolerate various thresholds of crying (Maxted et al.
, 2005). Often, parents seek support when they are distressed by these crying behaviors and it has been determined that excessive infant crying is not overly reported, rather it is an issue many parents struggle with. Additionally, families’ relationships are impacted by the extent to which these crying behaviors impact the family relationship. Amongst mothers with severe depression, communication challenges were observed when interactions with their infants with colic were videotaped, indicating a reciprocal relationship between the two (Lester & Barr, 1997).
There is also evidence that maternal depression influences and challenges a mother’s ability to perceive and respond to infant cries, which can lead to poor developmental outcomes if the child’s cries are not met (Schuetze & Zeskind,2003). Again, maternal depression plays a role in the parent-child relationship and development therefore the co-occurence of maternal depression and infant sensory modulation difficulties may be particularly detrimental to developmental outcomes. MethodProposed DesignThis study is an analysis of collected data to examine the impact of maternal depression on infant sensory processing abilities, or sensory modulation.
Thus, maternal scores of depression will be utilized to determine their effect on four different infant sensory processing styles. The research will use archival data from the Parent-Infant Center client database, at Mount Sinai Hospital in New York, specifically data related to maternal depression scores (BDI-II) and infant sensory profile scores (Sensory Profile Index). The research from the database includes clients from 2014-2017 as this is the timeframe of measures collected and able to be placed into a database for use for this project. The data will be requested through the Mount Sinai Hospital Institutional Review Board (IRB) process. The research proposal will also be submitted to Fielding Graduate University via their IRB process. A review and analysis of the data will aid in answering the research question.
The data must include all requested fields for each participant to ensure necessary data can be analyzed and compared.ParticipantsThe sample will include 96 parent-infant dyads seen at an outpatient Parent-Infant Mental Health Clinic. The participants are single mothers with infants ranging from zero to twelve months at the time of assessment. Fathers as well as outside caregivers (i.
e. foster parents) will be excluded from this dataset. Additional dyads will be included to expand the sample size if assessed prior to the start of this project. Questionnaires completed by the mother prior to treatment onset measured depressive symptoms in the mother (BDI-II) and the infant’s sensory processing abilities (Infant Sensory Profile Index). Procedure Following IRB approval from Mount Sinai Hospital and Fielding Graduate University, the data will be obtained along with a data user agreement.
Informed consent is not necessary since the data will be a limited dataset and personal identifiable information will be anonymized or possibly removed from the dataset prior to obtaining access. Additionally, those who completed the initial measures at the Parent-Infant Center had completed a consent form at the start of their treatment if they agreed to allow their forms to be included in future research studies. The data will not include the individual’s names, medical record numbers, social security numbers, or biographical information that could be used collectively to identify a person. The requested data will include the following: diagnosis of parent and infant, symptom severity (based on measures – BDI and Infant Sensory Profile), and demographic data (age, race/ethnicity, marital status, education, employment status).MeasuresBeck Depression Inventory (BDI-II) The Beck Depression Inventory is a 22-item scale that provides an overall score of depression-symptom severity (Beck, Ward, Mendelson, Mock, & Erbaugh, 1961). This scale has been used and studied in both clinical and non-clinical settings, across a variety of populations with a wide range of mental health diagnoses.
Total scores range from 0 to 63 and cutoff scores have been established (Steer, Beck, & Garrison, 1985). Scores below ten indicate low depression-symptom severity, 10 to 17 indicate moderate symptoms and above 17 is indicative of clinically significant symptom severity. However Field and colleagues have found that individuals with scores between 0 and four can often be considered as “Faking Good” therefore for the purposes of this study, scores between four and ten will indicate low depression-symptom severity. The Beck Depression Inventory (BDI) has served as a screener for depression during pregnancy as well (Holcomb, Stone, Lustman, Gavard, & Mostello, 1996). Sensory Profile IndexThe Infant/Toddler Sensory Profile (ITSP) is a 48-item caregiver questionnaire that measures sensory modulation abilities as reflected in daily experiences in children ages 7 months to 36 months (Dunn, 2002). Parents rate the frequency of child behaviors on a 5-point scale from 1 (almost always) to 5 (almost never).
The total frequency of behaviors is calculated for each sensory modulation section: Auditory, Visual, Vestibular, Tactile, and Oral Sensory. Scores are then grouped into four quadrant scores: Low Registration, Sensation Seeking, Sensory Sensitivity, and Sensation Avoiding. A low threshold score is calculated by summing Sensitivity and Avoiding quadrant scores.
Lower scores indicate a higher frequency of response. Extreme scores are defined as scores that are more than 1 SD above norms in frequency and are considered clinically meaningful. Reliabilities for the various composite scores ranged from .69 to .85. Test validity was established in several studies (Dunn, 2002; Dunn & Daniels, 2002; Kay, 2001). Data Analytic ProceduresDescriptive statistics will be conducted for all demographic variables. A multivariate analysis of variance (MANCOVA) will be conducted to determine the relationship between maternal depression and infant sensory type.
Maternal depression will be defined as non-depressed versus depressed with scores ranging from 4-16 as non-depressed and scores above 17 as depressed, and the Infant Sensory Type defined across scores of the four categories according to the Sensory Profile. All analyses with p-values < 0.05 are considered statistically significant. Additionally, a regression analysis will be conducted to examine the amount of variance scores on the BDI account for when examining the Infant Sensory Profile score across the four categories.