Depressed Motliers' Touching IncreasesInfants' Positive Affect and Attention inStill-Face Interactions
Martha Pelaez-Nogueras
Florida International University
Tiffany M. FieldUniversity of Miami
Ziarat Hossain
Fort Lewis College
Jeffrey PlekensJames Madison University
PELAEZ-NOGUERAS, MAHTHA. FIELD, TIFFANY M., HOSSAIN, ZL^RAT, and PICKENS, JEFFREY De-pressed Mothers' Touching Increases Infants' Positive Affect and Attention in Still-Face Interac-tions. CHILD DEVELOP i:NT, 1996, 67, 1T80-1792. The effects of depressed mothers' touchingon their mfants' behavior were investigated during the still-fece 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 nondepressedmotliers were instructed and shown how to provide touch for their infants during the still-face-with-touch period. Different affective and attentive responses ofthe infants of depressed versust ie infants of nondepressed mothers were observed. Infants of depressed mothers showed morepositive affect (sniiles and vocalizations) and gazed more at their mothers' hands during thestill-face-with-touch period than the infants of Bondepiessed mothers, who grimaced, cried, andgazed away from their mothers' faces more often. The results suggest that by pro\'iding 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 t>'pical lack ofaffectivity (Hat facial and vocal expressions) during interactions
Early interaction disturbances place in- nal depression on early infant interactionsfants of depressed mothers at risk for later and development and have identified theaffective and socioemotional disorders behavior patterns of depressed mothers as(Field, 1992; Gaensbauer, Harmon, Cytryn, unresponsive, insensitive, ineffective, non-& McKnew, 1984; Zahn-Waxler, Cummings, contingent, emotionally flat, negative, disen-McKnew, & Radke-Yarrow, 1984). Having a gaged, intrusive, avoidant of confrontation,depressed mother increases by three times a and generally less competent and unin-child's risk of developing the abnormalities volved with their infants (e.g., Campbell,characteristic of depressed mothers (Weiss- Cohn, & Meyers, 1995; Cohn, Matias, Tron-man et al., 1984). Numerous studies have ick, Connell, & Lyons-Ruth, 1986; Cohn &documented the negative impact of mater- Tronick, 1983; Field, 1984, 1986; Lyons-
The authors wish to thank Julie Malphurs, Jeanette Gonzalez, Claudia Larram, 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 m March 1993 at the meeting ofthe Societ>' forResearch in Ghild Development New Orleans, Louisiana. Gorrespondence and reprint requestsshould be addressed to Dr. Martha Pelaez-Xogueras, Department of Educational Psychologyand Special Education, Florida International Universit\', Miami, Fl 33199.
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.WTien the infants of depressed mothers in-teracted with their nondepressed nurseryteachers, the infants' behavior rescovered,and their activity levels and positive affectrates were higher than when interactingwith their depressed mothers (Pelaez-Nogueras et al., 1994).
In general, depressed mothers and theirinfants appear to share their behavior states,spending more time in negative attentive/affective behavior states than pondepressedmQther-infant dyads (Field, Healy, Gold-stein, & Guthertz, 1990). Different profilesof behavipr 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 aL, 1990; Malphurs, Raag,Field, Pickens, & Pelaez-Nogueras, 1996).But despite the variability observed in themothers' interaction stj-Ies, the infants ofboth disengaged and intrusive mothers areusually uniformly distressed. Also, whetherexperiencing postpartum or chronic depres-sion (Campbell et al., 1995), the commonfindinia 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 s>Tmbolic play(Field, 1984; Gaensbauer etal., 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., Reardslee, Bemp-orad, Keller, & Herman, 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 cumulati\'e risk (Field,1992), and temperament and genetic predis-position (\\Tiiffen & 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 (fc) 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 affective,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 face 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, motor/refiex.
1782 Child Development
For example, an Inter^Sn
5iSnsi(Scafidietal.,19l))
p during Face-to-Face InteractiomFace-tp-face interactions are a primary
way^behavior disorders seem to be transmit--ted from motlier to infant (Cohn et al. 1986-fq«m' 'T^*'^^"^*?'"' ^'''*^*' ^ Goldstein:1986). The qualitj- of infant behavior hasbeen,related to the wiresponsiveness andemotional unavailability of their mothers?^""S*'^^ein1:emctions(Samerbff& S i f ^"S^*' ^ein1:emctions(Samerbff& Seifer1 3 ; Tronicfc & Gianino, 1986). Only a fewstudies have investigated the, effects of ma-ternal toucji during faee-to-face mteractionswitli th.eir infants or ike use of touch inter-ventions to faGilif te better interactions be-tween mothers and tlieir infknts (e.g. Field
for example, Pelaez-Nogueras et al (inp s ^ ) found that touch can reinforce andmaintain high rates of infant eye contact responses, vocalizations, and smiles duringface-to-face inteTactions. In that study usinea ^tjiKhronous-reinforcementopem7tn^ce-dure, touch stirmilition (gentle rubbtogofthe infant's arms, legs, and feetfwasnrovided^ by a care^ver *hile the nfent w s"m^ing eye conSet with hL Af er s t Sponditioning sessions, the infants showedpreferences for the reinforcing stimukHonth^t included touch, as showf b y ^ h ^ Sthat they smiled and vocalised U S andmade more eye contact with the caregiverThos^ findings suggest that i n f k x t s ' a t S ^and positive affect can be leinforce^d andmaiatained by an adult providing ?tactile stimulLion during feSactions
by
to study mother-mLl
i?Sip p
^ ^ g with negative affect and otherbehaviors. Stock and Muir (19901"** '^**'" mothers were asked to be'^responsive, sifent, and not to
*f»"*^ during the stfll-face epi-displayed more grimacing and^^^^^ ^ perms o£ normal
, when touch was intro-^"^ still-face period, infants"and attention was higher. Itbe deteimined, however,*« of depressted mothers are
sensitive to maternal touch than in-o 'Nondepressed mothers. As yet, no
investigated the effects of touchd mothers using the still-face
f
^™»«^ the negative effects elicited by theirt f ^ providing additional touch for
We thought it important t» ex-i^'°'H^^^~ depressed moth-^^'^ '^^^ts, to regulate affectincrease their attention. Theh t ifants of depressed moth-
distressed as the infantsmothers during the stilJ-
,^ita^tio« because they were&eir mothers with flatWt/ ^" ^^^^^ intote, touch(or compensate for) the lack>^^ the other sources (i.e..
^ oth^r hand, the u.mothers were ex-
m
ced in a stjU-face-period, because dieir mothers'
£ * ' ' ™ ' « ««expeeted andexperience.
he, adopt a .tation^ ™od,er
positively than infants of nondepressedmothers when optimal touch (mild strokes/movements) 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 whejther ma-ternal depression could account for the dif-ferences in infant behavior.
Method
SubjectsFort>'-eight 3-month-old infants (mean
age = 13.5 weeks, 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 of medical complications. Subjects wererecruited from a longitudinal study sampleof low socioeconomic status based on thetwo-factor Hollingshead Index. Motherswere primiparous black (33%), 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(A = 16). The Beck Depression Inventorv-(BDI) scores defined the depressed and thenondepressed groups (depression classifica-tion is described in detail in the fiDllowingsection). The groups did not differ on demo-graphic variables, including age, ethnicit\',maritaf 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 BDIit^ms are scored on a fbur-point scale indi-cating absence/presence and severily of de-pressed feelings, behaviors, and symptoms.The scale is among the commonly employed
Pelaez-Nogueras et al. 1783
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 withi this population, approxi-mately 30% ofthe mothers sampled receivedscores greater than 16 on the BDI (e.g., Eieldet al., 1990). The mean BDI score for all de-pressed mothers in our sample was 21 (SD= 9.1), ranged fram 13 to 52, and for thenondepressed moAers 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 laborator>' 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 tlie 32 ex-perimental (half depressed and half nonde-pressed). The order of the periods was not
1784 Child Development
counterbalanced because the purpose was tohave a still-face-no-touch period precedinga still-face-wiA-touch period specifically toinduce distress in order to increase thechances of getting an effect and thus to com-pare Ae depressed and nondepressed dy-ads' performances.
lnstmctions.~-The total procedure re-quired approximately 8 mm. During Ae four30-sec intervals between Ae four period, allmothers were given instructions. Iristruc-tions were standard for all mothers. To ad-dress Ae question of wheAer infants oi de-pressed and nondepressed mothers responddiffferentially to touch when their motlierspose a still face, it was important to reducevariability in moAers' behavior during Aestill-face 'situation. For Ais reason, we irp-posed still-face instructions to all mothers inAe experimental condition.
Before Ae first normal play period^of in-teraction^ mothers in the efPenmental con-dition were instmcted to play vviA then m-fan*s as Aey would normally do at home.For the second period (stiU-face-no-touch),Aese mothers were instructed to look/gazeat Aeir' infants wiA a neutral expressionand to refrain frorn speaking, smilmg, andtoucliing the infant during this period torAe third period of interaction (still-iace-with-touch) instructions were given to looK/gaze at Ae iniknt wiA a neutral expression,to refi-ain from speaking aad smAng, but totouch Ae in&fltas modeled. In Ae last nor-mal period, mothers received the same m-structiions as in the first normal period.
To ensure Aat moAers maintained astill face Aroixghout Ae still-face pemdscontinuous monitoring was conducted byAe second research assistant observing theinteraction from Ae observation room, iheobser^r constantly checked that moAerswere complying wlA instructions and werenot making anj-change in facial expressions,
as instjucted. All mothers in both groupsconiplied with instructions (> 90^°^^^*^time) In those cases where mothers were
EoUowing instructions and smiled, _wcal-I or touched Aeir iniants incorreetiy the' was interrupted and Bostponed tor a
Aan 15 sec, Ae session was interrupted andrescheduled. A total of five mother-mfant dy-ads needed to be retrained and rescheduledfor a second visit.
Touch procedure.—]ust before the still-t-ace-wiA-touch period, ali moAers m Aeexperimental condition received a ^orietdemonstration of optimal touch The opti-mal" touch procedure involved a motherstroking and rubbing rhythmically the m-fants' arms, legs, and feet using the five fin-gers of boA hands for Ae duration of Aestill-face period (90 sec). The experimentermodeled "gentle pressure in slow circaiarir'otions at a rate of approximately one circu-lar rub per sec. Negative touch was avoided.Negative touch involves rough tickling, pok-i n A ^ d tugging while interacting wiA Aeinfant, including poking Ae baby s face,ar'ms, or stomach, or pinching or sqiieemngAe infant, or pulling or shaking Ae infant.MoAers were instrticted not to tickle orpoke, their infants during Ais procedure, norto pull intensively their infants' legs or an^s.The motliers' touch was checked routinelydarin« the interactioBS to make sure Aeywere providing toiieh as instnieted.
Behavior coding,—The onset and offsetof the videotaped behavior were registeredbv pressing numeric codes on a laptop com-DUter All behavior modalities were codedseparately. The behaviors were coded con-tiliouslv and featured a second-oy-secondlisting of behaviors and a matrix «f percent-age ttme Ae behaviors occurred iGuAeitefe'Reia. 1989). One view of &e videorecordwa. used per each modality: (1) mfantfcmleKpressions (three codes: smile, «eutral gr^mace) (2> infant vocal expressions (tlijreeSries^ positive voeafertions, BO vocah^a-tiom, a 4 p«>tBst/cryir«), (3) iniaBt gaze be-havior (used three codes: gaze at moAersfece, SBze away fiom moAer's fece, gaze atSotheVs Wnds). Thus, coding of these mea-sures required three separate viewu^s ofeach record. In this way, coding o. the m-S S ' t e h a v i o r . i-ciudBd three posrtiva be.
smiling, (2) vocalizing.. (3) gazmgexs' ha3»ds, and Areejaegative a t
£ c ^ behaviors: (4) crying, (5) grimacmg,and (6) gazing away from mom.
ForJnfant smiling to be coded^the infmtniouA had to be "i^Ptumed wheAer Aemoutti was open or closed. For lijtant griS ° S s ' t h e iSanfs mouA had to be toned
t s or curled or Ae Infant had to be cry-For gazing away from Ae moAer, Aei h J to fe looking at any oAer place
Pelaez-Nogueras et al. 1785
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 nondiscrete/loud 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 ns 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 (cinick 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. Reliabilit\' 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 secondary'obser/ers on all response measures of infantand mother beha'viors. 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 ort 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.
ResultsThe first analyses were a 2 (group: de-
pressed vs. nondepressed) X 2 (condition:experimental vs. control) x 4 (periods of in-teraction) MAKOVAs on infants' positive be-haviors (smiling, vocalizations, and gazing atmothers' hands), and on infant's negative be-haviors (grimacing, cr>'ing, and gaze awayfrom mothers). For the first MAKOVA on 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 obse]"\'ed 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 obserx'ed betweenthe control and experimental mother-infantdyads in the Hrst normal period. These anal-yses suggested that tlie control and experi-mental conditions were similar at the begin-ning (first normal period) of the study andthat the infants were Bot fatigued over time.
A significant main effect of group (de-pressed vs. nondepressed), F(3, 28) = 7.42,p <.OO1; a significant group x periods inter-action, F(9, 22) = 4.77, p < .001, across pe-riods for positive infant behaviors; a maineffect of group, F(3, 28) = 2.72, p =.06; anda group X periods interaction effect, F(9, 22)= 3.02, p < .01, for negative infant behav-iors, were each obtained in the experimentalcondition.
The repeated-measure ANOVAs for in-dividual dependent measures in the experi-mental condition were conducted to assessfor main and interaction effects associatedwith the primary grouping variable (de-pressed vs. nondepressed) across the fourperiods (normal, still-face-with-touch, still-face-no-touch, normal). Simple effects analy-ses between depressed and nondepressedscores were conducted only when the re-
1786 Child De^^elopment
peated measures showed significant interac-tion effects (Winer, 1971). Paired f tests werealso conducted Within subjects to comparethe between still-face-with-tpuch and still-face-no-touch periods (shown by subscriptsin Table 1). The results on each variablefollow.
Infant Positive BeliaviorsSmiling.—ANOVA results for smiling
yielded a group trend (dejpressed 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 propoition 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 inimediately following still-face-wilh-touch period, til5) = -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)= 16M0, p < .005, with the depressed giroupsmiling more.
Voe^alizations.—An ANOVA yielded asignificant group effect (depressed x" . 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-without7touch 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 < .0.5, and duringthe last normal period, F(l, 30) = 12.50,p < .001, witii infants of depressed mothersvocalizing m:ore than infants of nonde-pressed mathers;. The differences noted ininfants' vocalizations in the normal periodswerd not signiftcant.
teasing at mother's hands.—Results 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 mouther'shands. As expected, the proportion of timeinfapts gazed at mother's hands increasedsigiiificantly from the stili-face-no-touch pe-riod to the still-faee-with-touch period forboth the depressed group, t{15) = —4.88,p < .001, and for the nondepressed group,t{lS) = 5.53, p < .001. Simple main effectsanalysis revealed that infants of depressedmotiiers gazed at their mothers' hands more
often than infants of nondepressed mothersduring the first nornial episode, F(l, 30) =5.10, p < .05, still-face-with-touch period,F(l, 30) = 4.97, p < .05, and dming the lastnormal period, F(l, 30) = 1.3.30, p < .001.
Infant Negative BehaviorsGrimacing.—An ANOVA on grimacing
yielded 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 tq the stiil-face-with-touch period in the depressed group only,i(15) = 2.58, p < .03. simple main effectsanalysis revealed that infants in the de-pressed group grimaced less often than theinfants of nqsndepressed mothers during thestill-faee-with-toiich period, F(l, 30) =11.15, p < .005. Grimacing was also less fre-quent, F(l, 30) = 7.62, p < .01, in the de-presseti group compared to the nonde-pressed group during the last normal period.
Crying.—For crying, only a group x pe-riod j'nteraction effect was obtained, F(3, 90)= 2\B2, p < .05. For the depressed grouponly, infant cmng decreased from the sMll-face-iiO"toueh 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 cOmpaired to the nonde-pressed group during the still-face-with-touch period. Crying continued to be lower,F(l, 30) = 4.39, p < .05, fbr the depressedgroup compared to the nondepressed groupduriflg" the last norrnal 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 Inlaats gazed away from their motherssignificantly decreased, tfl5) = 5.65, p <.001, ffepi the still-faee-no-fouch to the im-mediatipiy following stili-face-with-touch pe-riod ip the depressed groiip but not in thenondepressed group. Simple main effectsanai|fsi| gieifbrmed oii giaing away from themotfifit revealed that &e nondepressedgroup gaaed away more than the depressedgroul diiring the stiU-fece-with-touch pe-riad,:-'Fp-, '30> =18,00, p < .001, and alsodujriiiig the last normal period, F(l, 30) =19,l|,-p < ,005, The difference obsei-ved inthe f rst normal period was not significant.
Mothers' BehaviorRepeated-measures MANOVA on ma-
ternal tottch revealed BO significant main ef-fects of" groups (depressed vs. nondepressed)
3
1788 Child Development
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% ofthe 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 siny potentialdifference in maternal behavior. Also, touchinstructions seemed to produce a carryovereffect of the mothers' touch behavior fromthe still-face-with-touch period to the lastnornial period of interaction, during whichbotla depressed and nondepressed motherstouched their infants more than during tliefirst 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 behawors 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 andurlder experimental control during the still-face-no-touch and still-face-with-touch pe-riods.
DiscussionAs 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 motliers. 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-mediatelv- 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 shovring 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 inti-oduced 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 (Pelaez-Nogueras et al,, 1996;Stacks 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 tlie final return to normalplay period infents of nondepressed mothersdid not appear to "recover" from the dis-tressing still-faee periods, and they began tocry, grimace more, gaze away more, and tosmile and vocalize less compared to infantsof nondepressed motliers. Because we mini-mized the potential sociodemographic con-founds by having a homogeneous sample ofdepressed and nondepressed adolescentmofeeis of low SES, our results can be con-sidered representative for ttiis particularlower-income adolescent population. Giventhis iiomogeneitj' of ova- sample, the resultsmay be limited in generalizability.
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-bistor>? explana-tions, however, should be considered. It hasbeen argued that infents of depressed moth-ers are at unusually bigh risk for developingdepression due to genetic or prenatal. traBS-mission (Zuckerman, Ais, Baacbner, Parker,& Cabrai, 1990). To predict infant "de-pressive" behavioral outcomes from any sin-gle factor, however, is almost impossible,>vhether this factor is genetic or postnatal be-bavior 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 preclicted, touch was more effective inenhancing the positive behavior in infantsof depressed mothers. Depressed mothersseemed to lia^'c facilitated more positive af-fect and attention in their infants by toueh-ing tbem during -die iDteraetioiis, and tlie op-timal/nonintrusive type of touch used i3i thisstudy appeared to provide comfort duringthe stressful still-faee interactions.
The findin,gs can be explained in a num-ber of waj'-s. One possible explanation is thatthe infants of nondepressed mothers did notshow significantly less giiroaciiig and cryingwhen touch was intioduced during the stillface because these infants wetele^s familiarwith maternal unavailabiliig-' (flat face and af-fect) and were thus much more difficult tosootiie when touch was inti-oduced. More-over, infant grimacing and crj'ing continuedto be emitted by the infants of nondepressedmothers even during the resinned nornialperiod. The increase in infant grimacing andcr\'ing during the mothers' subsequent re-turn to noniial play following a period of ma-ternal unavailability was also observed byToda and Fogel (1993).
Typically, mothers "fake good" and "tryharder" to show positive behaviors duringtlie 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 obsewedlater on t i e final p;lay period after still-faceperiods. It is possible that toucli 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 initiallysoo€iing to the infants of depressed mothers,and in the aftermath ofthe still-face periods,the infants of nondepressed mothers werenidre apset. This phenomenon suggests thatas a result of their history of experiences,the infaDts of depressed mothers were lessdistressed by the still-fece perturbations andtiie absence of maternal toucli. Conceivably,infents of depressed mothers could havebeen less distressed in our study becausethey received more optimal touch than they\¥ere used to.
The results ofthe present study can berelated to findings from a recent learningexperiment using a synchronized reinforce-ment procedure (Pelaez-Nogueras et al.,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-inftirced and maintained higher rates of in-fant eye contact, smiles, and vocalizations.InterestVagly, the infants in the presentstudy also increased eye contact with theirmoliers during the still-^faee-with-touch pe-riod- tJnis may have occurred as a result ofjntermittent contingent touch stimulationon tafant making eye eonteict with theirmothers.
Bodi learning and emotional regulationprocesses prepare the infant to develop adap-tive and organized behavior strategies (Pel-aez-5^ogueras, 1992; Thompson, 1994). Thedifferences observed in the infants' behaviormay lie in the different histories of mterac-tions between mother and child and historiesof iufantbehavior regulation. The data for thefirst normal play period show that infants ofdepressed and nondepi'essed mothers dif-fered ill facial grimacing and looking athands, suggesting differences in their learn-ing Jiistories and conceivably in their abilityto regulate their behaviors. However, eventhough there were differences between in-faTits 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 fece 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 infani5 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 infents and their de-pressed mothers.
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