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Principles of a dynamic, dyadic systems view of mother-infant face-to-face communication, which considers self- and interactive processes in relation to one another, were tested. We examined the process of interaction across time in a large, low-risk community sample, at infant age 4 months. Split-screen videotape was coded on a 1-s time base for communication modalities of attention, affect, orientation, touch and composite facial-visual engagement. Time-series approaches generated self- and interactive contingency estimates in each modality. Evidence supporting the following principles was obtained: (1) Significant moment-to-moment predictability within each partner (self-contingency) and between the partners (interactive contingency) characterizes mother-infant communication. (2) Interactive contingency is organized by a bi-directional, but asymmetrical, process: maternal contingent coordination with infant is higher than infant contingent coordination with mother. (3) Self-contingency organizes communication to a far greater extent than interactive contingency. (4) Self-and interactive contingency processes are not separate; each affects the other, in communication modalities of facial affect, facial-visual engagement, and orientation. Each person’s self-organization exists in a dynamic, homoeostatic (negative feedback) balance with the degree to which the person coordinates with the partner. For example, those individuals who are less facially stable are likely to coordinate more strongly with the partner’s facial affect; and vice-versa. Our findings support the concept that the dyad is a fundamental unit of analysis in the investigation of early interaction. Moreover, an individual’s self-contingency is influenced by the way the individual coordinates with the partner. Our results imply that it is not appropriate to conceptualize interactive processes without simultaneously accounting for dynamically inter-related self-organizing processes.

Associations of 6-week maternal depressive symptoms (Center for Epidemiological Studies Depression Scale (CES-D)) with 4-month mother-infant self- and interactive contingency patterns during face-to-face play were investigated in 132 dyads. Self- and interactive contingency (auto- and lagged cross-correlation, respectively) were assessed by multilevel time-series analysis. Infant and mother gaze, facial and vocal affect, touch, and spatial orientation behaviors were coded second-by-second from split- screen videotape, and a multimodal measure of facial-visual "engagement" was constructed, generating nine modality pairings. With higher CES-D, the self-contingency of both partners was lowered in most modalities. With higher CES-D, interactive contingency values were both heightened (in some modalities) and lowered (in others), varying by partner. These results are consistent with an optimal midrange model. With higher CES-D, interactive contingency showed the following patterns: (a) Mothers and their infants had a reciprocal orientational sensitivity; (b) mothers and infants manifested a reciprocal intermodal discordance in attention versus affect coordination, lowering gaze coordination, but heightening affective coordination; (c) infants heightened, but mothers lowered, touch coordination with partner touch—an "infant approach-mother withdraw" touch pattern. Nonlinear analyses indicated that altered self- and interactive contingency were similar at both the low ("denial") as well as the high ("endorsement") poles of depressive symptoms, in half the findings. These complex, multimodal findings define different aspects of communication disturbance, with relevance for therapeutic intervention.

Beatrice Beebe, PhD, New York State Psychiatric Institute; Frank Lachmann, PhD, Institute for the Psychoanalytic Study of Subjectivity; Joseph Jaffe, MD, Sara Markese, PhD, Karen A. Buck, MA, Patricia Cohen, PhD, Stanley Feldstein, PhD, and Howard Andrews, PhD, New York State Psychiatric Institute; Henian Chen, MD, PhD, College of Public Health, University of South Florida. This research was supported by The National Institute of Mental Health (Grant MH56130), The Psychoanalytic Fund, the Kohler Foundation, the Edward Aldwell Mother-Infant Research Fund, and the Los Angeles Infant Research and Psychoanalysis Fund. We thank our filming/coding team: Caroline Flaster, Donna Demetri-Friedman, Helen Demetriades, Nancy Freeman, Patricia Goodman, Michaela Hager-Budny, Elizabeth Helbraun, Allyson Hentel, Tammy Kaminer, Sandra Triggs Kano, Limor Kaufman-Balamuth, Greg Kushnick, Lisa Marquette, Jill Putterman, Jane Roth, Shanee Stepakoff, and Lauren Ellman. We also thank our lab assistants: Claire Jaffe, Daniella Polyak, Julia Reuben, Priscilla Caldwell, Jessica Lateck, Carol Scheik-Gamble, Danny Sims, Jake Freeman, Brianna Hailey, Alla Chavarga, Nidhi Parashar, Josianne Moise, Sarah Temech, Hope Igleheart, Yana Kuchirko, Elizabeth White, Greer Raggio, Kate Lieberman, Alina Pavlakos, Adrianne Lange, Kari Gray, Jennifer Lyne, Annee Ackerman, Fernanda Lucchese, Sarah Miller, Max Malitzky, Sam Marcus, Michael Klein, Kara Levin, Matthew Kirkpatrick, Lauren Cooper, Helen Weng, Iskra Smiljanic, and Christy Meyer. Finally, we thank our students and colleagues who contributed: Sara Hahn-Burke, Nancy Freeman, Michael Ritter, Glenn Bromley, Robert Gallaghan, Naomi Cohen, Paulette Landesman, Tina Lupi, Jillian Miller, Alan Phelan, Danielle Phelan, Katherine Weinberg, Edward Tronick, Doris Silverman, Anni Bergman, Lin Reicher, George Downing, Estelle Shane, and the Monday afternoon seminar, who consulted on our findings. Correspondence concerning this article should be addressed to Beatrice Beebe, PhD, New York State Psychiatric Institute #108, 1051 Riverside Drive, New York, NY 10032. E-mail: beebebe@pi.cpmc.columbia.edu Psychoanalytic Psychology © 2012 American Psychological Association 2012, Vol. 29, No. 4, 383–407 0736-9735/12/$12.00 DOI: 10.1037/a0029387

A microanalysis of 4-month mother-infant face-to-face communication predicted 12-month infant disorganized (vs. secure) attachment outcomes in an urban community sample. We documented a dyadic systems view of the roles of both partners, the roles of both self- and interactive contingency, and the importance of attention, orientation and touch, and as well as facial and vocal affect, in the co-construction of attachment disorganization. The analysis of different communication modalities identified striking intrapersonal and interpersonal intermodal discordance or conflict, in the context of intensely distressed infants, as the central feature of future disorganized dyads at 4 months. Lowered maternal contingent coordination, and failures of maternal affective correspondence, constituted maternal emotional withdrawal from distressed infants. This maternal withdrawal compromises infant interactive agency and emotional coherence. We characterize of the nature of emerging internal working models of future disorganized infants as follows: Future disorganized infants represent states of not being sensed and known by their mothers, particularly in moments of distress; they represent confusion about both their own and their mothers’ basic emotional organization, and about their mothers’ response to their distress. This internal working model sets a trajectory in development which may disturb the fundamental integration of the person. The remarkable specificity of our findings has the potential to lead to more finely-focused clinical interventions.

Associations of 6-week postpartum maternal self-criticism and dependency with 4-month mother-infant self- and interactive contingencies during face-to-face play were investigated in 126 dyads. Infant and mother face, gaze, touch, and vocal quality were coded second by second from split-screen videotape. Self- and interactive contingencies were defined as auto- and lagged cross-correlation, respectively, using multilevel time-series models. Statistical significance was defined as p

Associations of maternal self-report anxiety-related symptoms with mother-infant 4-month face-to-face play were investigated in 119 pairs. Attention, affect, spatial orientation, and touch were coded from split-screen videotape on a 1-s time base. Self- and interactive contingency were assessed by time-series methods. Because anxiety symptoms signal emotional dysregulation, we expected to find atypical patterns of mother-infant interactive contingencies, and of degree of stability/lability within an individual's own rhythms of behavior (self-contingencies). Consistent with our optimum midrange model, maternal anxiety-related symptoms biased the interaction toward interactive contingencies that were both heightened (vigilant) in some modalities and lowered (withdrawn) in others; both may be efforts to adapt to stress. Infant self-contingency was lowered ("destabilized") with maternal anxiety symptoms; however, maternal self-contingency was both lowered in some modalities and heightened (overly stable) in others. Interactive contingency patterns were characterized by intermodal discrepancies, confusing forms of communication. For example, mothers vigilantly monitored infants visually, but withdrew from contingently coordinating with infants emotionally, as if mothers were "looking through" them. This picture fits descriptions of mothers with anxiety symptoms as overaroused/fearful, leading to vigilance, but dealing with their fear through emotional distancing. Infants heightened facial affect coordination (vigilance), but dampened vocal affect coordination (withdrawal), with mother's face-a pattern of conflict. The maternal and infant patterns together generated a mutual ambivalence.

A microanalysis of 4-month mother-infant face-to-face communication revealed a fine-grained specification of communication processes that predicted 12-month insecure attachment outcomes, particularly resistant and disorganized classifications. An urban community sample of 84 dyads were videotaped at 4 months during a face-to-face interaction, and at 12 months during the Ainsworth Strange Situation. Four-month mother and infant communication modalities of attention, affect, touch, and spatial orientation were coded from split-screen videotape on a 1 s time base; mother and infant facial-visual "engagement" variables were constructed. We used contingency measures (multi-level time-series modeling) to examine the dyadic temporal process over time, and specific rates of qualitative features of behavior to examine the content of behavior. Self-contingency (auto-correlation) measured the degree of stability/lability within an individual's own rhythms of behavior; interactive contingency (lagged cross-correlation) measured adjustments of the individual's behavior that were correlated with the partner's previous behavior. We documented that both self- and interactive contingency, as well as specific qualitative features, of mother and infant behavior were mechanisms of attachment formation by 4 months, distinguishing 12-month insecure, resistant, and disorganized attachment classifications from secure; avoidant were too few to test. All communication modalities made unique contributions. The separate analysis of different communication modalities identified intermodal discrepancies or conflict, both intrapersonal and interpersonal, that characterized insecure dyads. Contrary to dominant theories in the literature on face-to-face interaction, measures of maternal contingent coordination with infant yielded the fewest associations with 12-month attachment, whereas mother and infant self-contingency, and infant contingent coordination with mother, yielded comparable numbers of findings. Rather than the more usual hypothesis that more contingency is "better," we partially supported our hypothesis that 12-month insecurity is associated with both higher and lower 4-month self- and interactive contingency values than secure, as a function of mother vs. infant and communication modality. Thus, in the origins of attachment security, more contingency is not necessarily better. A remarkable degree of differentiation was identified in the 4-month patterns of "future" C and D infants, classified as resistant and disorganized, respectively, at 12 months. The central feature of future C dyads was dysregulated tactile and spatial exchanges, generating approach-withdrawal patterns. The intact maternal contingent coordination overall safeguards the future C infant's interactive agency. However, future C infants likely come to expect maternal spatial/tactile impingement, and to expect to "dodge" as mothers "chase." They managed maternal touch by tuning it out, sacrificing their ability to communicate about maternal touch. They "approached" by vigilantly coordinating their facial-visual engagement with maternal facial-visual engagement, but they "withdrew" by inhibiting their facial-visual engagement coordination with maternal touch. We proposed that future C infants will have difficulty feeling sensed and known during maternal spatial/tactile impingements. The central feature of future D dyads is intrapersonal and interpersonal discordance or conflict in the context of intensely distressed infants. Lowered maternal contingent coordination, and failures of maternal affective correspondence, constituted maternal emotional withdrawal from distressed infants, compromising infant interactive agency and emotional coherence. The level of dysregulation in future D dyads was thus of an entirely different order than that of future C dyads. We proposed that the future D infant represents not being sensed and known by the mother, particularly in states of distress. We proposed that the emerging internal working model of future D infants includes confusion about their own basic emotional organization, about their mothers' emotional organization, and about their mothers' response to their distress, setting a trajectory in development which may disturb the fundamental integration of the person. The findings have rich implications for clinical intervention, with remarkable specificity for different kinds of mother and infant distress. Heightened and lowered self- and interactive contingency, in different modalities, as well as the specific behavioral qualities identified, provide a more differentiated set of concepts to guide clinical intervention.

Background Exposure to environmental tobacco smoke is associated with detrimental effects on pulmonary function in children. The authors investigated the relation between airway complications in children receiving general anesthesia and the passive inhalation of tobacco smoke. Methods Six hundred two children scheduled to receive general anesthesia were enrolled in this prospective study. The anesthesiologist and the recovery room nurse, unaware of the smoke exposure history, recorded the occurrence of airway complications. A history of passive smoking was assessed by measuring the urinary concentration of the major nicotine metabolite cotinine and by questionnaire. Results Airway complications occurred in 42% of the patients with urinary concentrations of cotinine > or =40 ng/ml, in 33% of the patients with concentrations of cotinine between 10.0 and 39.9 ng/ml, and in 24% of the patients with concentrations of cotinine < 10 ng/ml (P = 0.01 for the trend among the three groups). The gender of the child (P = 0.001) and the educational level of the child's mother (P = 0.0008) significantly modified the effect of the concentration of cotinine on the incidence of adverse respiratory events. Conclusions There is a strong association between passive inhalation of tobacco smoke and airway complications in children receiving general anesthesia. The relationship is greatest for girls and for those whose mothers have a lower level of education. Passive smoking should be regarded as a risk factor in children undergoing general anesthesia.

The level of instrumental functioning of breast cancer cases aged 55 to 84 is compared to that of women of the same age without the disease. A total of 571 cases were selected through the Metropolitan Detroit Cancer Surveillance System and interviewed three (n = 463) and 12 (n = 422) months after diagnosis about their needs in transportation, housekeeping, meal preparation, and grocery shopping. A total of 647 controls aged 55 to 84 were selected through random-digit dialing and interviewed twice over the same period (n = 539 and 478). At three months, cases aged 55 to 74 report greater difficulty and less independence than controls in completing instrumental tasks. Little difference is shown between cases and controls aged 75 to 84. Nine months later, functional status is similar for cases and controls aged 55 to 64. In contrast, cases aged 65 to 74 continue to be less independent than controls of the same age.