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TEMPERAMENT AMONG INFANTS

OF DIABETIC AND NONDIABETIC MOTHERS

by

Linda C. Beal

Thesis submitted to the Faculty of the

Virginia Polytechnic Institute and State University

in partial fulfillment of the requirements for the degree of

Masters of Science

in

Family and Child Development

Approved:

Cosby ~. Rogers, Chair R. Michae.l Akers

Victoria A. Fu Philip Sanford Zeskind

June, 1987

Blacksburg, Virginia



by

Linda C. Beal

Cosby s. Rogers, Chair

Family and Child Development

(ABSTRACT)

Temperament of 4-month-old infants of diabetic (n=l6)

and nondiabetic (n=l8) mothers did not differ reliably in

terms of maternal ratings on the Infant Behavior

Questionnaire (IBQ) (Rothbart, 1981). Item analysis

indicated that scales on a reduced version of the IBQ

maintained high internal reliability. Discrete behaviors,

adapted from the Infant Behavior Record (Bayley, 1969), and

conceptually related to each scale of the IBQ, were observed

by mothers and by a trained observer during the infants'

well-child examinations. Group differences for activity

level and duration of orienting were obtained by the trained

observer. These differences were similar in pattern to

those found by Yogman, Cole, Als, & Lester (1982) on newborn

infants of diabetic mothers. Mothers' observations were

reliably correlated with those of the trained observer on

the following scales: (a) smiling and laughter, (b) fear,

(c) distress to limitations, (d) soothability, and (e)

duration of orienting. Mothers' observations were not

reliably correlated with those of the observer on (f)

activity level. The behavioral items were not significantly

correlated with their respective scale on the IBQ. With

subjects from both groups combined, neither gestational age

nor ponderal index was related to temperament ratings or to

discrete behaviors. Results failed to support the

hypothesis that diabetic-related biobehavioral

vulnerabilities and psychoendocrine mechanisms mediated

temperament in 4-month-old infants. However, differences in

discrete behaviors were present. Further studies are

needed to determine whether differences of discrete

behaviors affect later development.

Acknowledgements

There are many people who must be given special

recognition for their contributions to this thesis. I wish

to thank them now.

My greatest appreciation goes to Cosby Rogers for her

expertise, guidance, continuous support, and under-

standing. The completion of this project would not have

been possible without her help.

Dr. Victoria Fu has provided long-term support for my

abilities in the field of Child Development.

Dr. P.S. Zeskind's experience and knowlege contributed to

the research design.

Dr. R.M. Akers looked at the project from a different point

of view.

Mary Canfield was skillful and helpful while performing all

observations for this study.

The doctors, nurses, and secretaries were most cooperative

in searching for the special population in this project.

Mr. and Mrs. W.J. McCartney, my parents, encouraged me and

supplied unconditional support.

Colin and Margaret Beal, my children, kept my life in proper

perspective.

iv

TABLE OF CONTENTS

Temperament Among Infants of Diabetic and

Nondiabetic Mothers • • • • • •

Temperament • • • • •

Clinical Psychiatry

Behavioral Genetics

Psychophysiological

Validity of Maternal Ratings:

A Methodological Issue • • • •

1

4

5

6

7

9

Biological Mediators of Behavior • . • . • . • • • • • • 16

Infants of Diabetic Mothers

Methods

Subjects

Instruments

Results

. . . . . . . . . . . . . . .

Data Reduction • •

Hypotheses Testing

Discussion

19

24

25

30

33

35

v

Tables

References . . . . . . . . . . . . . . . . . . . . . .

Appendix A Recruitment letter . . . . . . . . . . . . . . . .

Appendix B Consent Form

Appendix C

. . . . . . . . . . . . . . . . . . .

40

54

67

69

Behavioral Observation Record . • • • • • • • • • • 71

Appendix D

Infant Behavior Questionnaire • • . • . • . • . • • 74

Vita . . . . . . . . . . . . . . . . . . . . . . . . . 82

vi

Tables

Table 1: Means and Standard Deviations of Background

Variables Broken Down by Group ••••••• 40

Table 2: Ranges and Means of Item-Scale Correlations

for the Infant Behavior Questionnaire •••••••• 41

Table 3: Scale Intercorrelations for Infant Behavior

Questionnaire • • • • • • • • • • • • • • • • • 42

Table 4: Scale Intercorrelations for Infant Behavior

Questionnaire •• . • • 43

Table 5: Coefficient Alphas for IBQ Scales ••••• 44

Table 6: Pearson Correlation Coefficients Between

Scale Scores for 79-itern Versus 53-itern scale •••• 45

Table 7: Means, Standard Deviations, E Values

for Infant Behavior Questionnaire Scales

Broken Down by Group • • • • • • • • • . • • • • • . 46

Table 8: Paired t-test for Matched Subjects •••••• 47

Table 9: Pearson Correlation Coefficients:

Gestational Age with IBQ Scales •••••.•••• 48

Table 10: Multiple R's for Squared and Original

Ponderal Index and IBQ Scales • • • • 49

Table 11: t-test for Group Differences on

Mothers' Observations • • • • • • • •••.•• 50

Table 12: t-test for Group Differences on

Observations by Trained Observer • . ••.••• 51

vii

Table 13: Kendall Tau: Means and Standard Deviations

of Maternal Observations Versus Observers' ••••• 52

Table 14: Kendall Tau: Maternal Ratings (IBQ) Versus

Observations by Mother and Observer • • 53

viii



The purpose of this study was to determine whether

infants of diabetic mothers (IDMs) display temperament

traits and related behaviors which differ from those of

infants of nondiabetic mothers. IDMs are subjected to

metabolic imbalances throughout gestation and at birth have

problems with respiratory distress and metabolic disorders

(Tsang, Ballard, & Braun, 1981). IDMs do score lower on

some items of the Neonatal Behavioral Assessment Scale

(NBAS) (Yogman, Cole, Als, & Lester, 1982). It is plausible

to suggest that these early biobehavioral vulnerabilities

may result in later developmental difficulties, either

through persistent psychoendcrine mechanisms or through

impacts on caregiver/infant interaction. No previous

studies have assessed temperament among infants of diabetic

mothers beyond the newborn period.

Zeskind and Ramey (1978, 1981) demonstrated that

biologically based problems can have long term effects. In

a study of fetally malnourished infants and their controls,

Zeskind and Ramey provided half the subjects with a

supportive educational environment while half remained in an

intellectually nonsupportive caregiving environment for

three years. The malnourished infants in the enriching

environment overcame the initial low scores reported on the

1

Bayley Mental Development Index. The mothers in this group

also continued to show an interest in and to be involved

with their children. This was in contrast to the

infant/mother dyads in the nonsupportive environment in

which the infant IQ scores continued to drop over three

years. These findings indicate that the development of the

fetally malnourished infant occurred as a function of the

enriching environment and the maternal involvement changed

as a function of the progressively developing infant.

Visual alertness in newborns has been found to be a

particularly important influence on parental feelings and

behavior (Robson & Moss, 1970) and thus infants with poor

orienting skills may present problems for their caregivers.

Since IDMs may display poor visual orienting skills (Yogman

et al., 1982) it is plausible that parent/infant interaction

could be impaired.

Although it is unwarranted at this time to suggest that

infants of diabetic mothers are more prone to problematic

relationships, it is not unreasonable to propose that those

infants may present behaviors which could make parenting

more difficult. Further, origins of temperament is a topic

of current interest. If particular temperament traits or

temperament-related behaviors can be identified as

differentially present in children of mothers who are

diabetic compared to those who are not, then parent

2

education prior to delivery could be used to prepare those

whose infants may present challenges to the caregivers.

such preparation could be beneficial in strengthening

parent/child interaction and enhancing cognitive

development.

The specific purpose of this study was to determine

whether infants of diabetic mothers (IDMs) differ from those

of nondiabetics on one or more of the six subscales of the

Infant Behavior Questionnaire (Rothbart, 1981) or on

observations of specific behaviors.

Hypothesis One: There will be significant differences

between 4-month-old inf ants of diabetic mothers versus infants

of nondiabetic mothers as reflected in the scores on one or

more scales of the Infant Behavior Questionnaire. IDMs will

have higher scores on activity level, distress to

limitations, and soothability and lower scores on smiling

and laughter, fear, and duration of orienting.

Hypothesis Two: There will be significant differences

between 4-month-old inf ants of diabetic and those of

nondiabetic mothers in terms of observer ratings on selected

items from the Infant Behavior Record of the Bayley Scales

of Infant Development (1969) which correspond conceptually

to each of the six scales of the Infant Behavior

Questionnaire. IDMs are expected to score higher on

activity level, distress to limitations, and soothability,

and lower on smiling and laughter, fear, and duration of

3

orienting.

Hypothesis Three: On each of the six temperament

scales, maternal perceptions will be significantly

correlated with observations made by the mother and with

those of an independent observer.

Temperament

Temperament is a label used to describe a rubric of

traits that are influenced by biological factors, are

identifiable in infancy, and are relatively consistent

through life (Campos, Barrett, Lamb, Goldsmith, & Stenberg,

1983; Goldsmith, et al., 1987). Interest in the construct

of temperament arose partly from an interest in predicting

later behaviors (Chess & Thomas, 1986; Thomas, Chess &

Birch,1968). Other researchers have been interested in the

correlates of temperament including caregiving difficulties

such as colic and nightwaking (Carey, 1972, 1974), reactions

to birth of a sibling (Dunn, Kendrick, & MacNamee, 1981),

Bayley developmental scores (Bates, Olson, Pettit, & Bayles,

1982; Vaughn, Taraldson, Crichton, & Egeland, 1981), operant

learning (Dunst & Lingerfelt, 1985) and biological

activities (Kagan, 1982; Weissbluth et al., 1985). A third

area of interest is the etiology of temperament (Daniels,

Plomin, & Greenhalgh, 1984)

4

The major perspectives from which temperament has been

studied include clinical psychiatry (e.g., Thomas & Chess,

1977), behavioral genetics (Buss & Plomin, 1975), and

psychophysiology (Rothbart & Derryberry, 1982). A brief

review of each follow.

Clinical Psychiatry

Alexander Thomas, Stella Chess, and their colleagues

(Thomas & Chess, 1977; Thomas et al., 1968; Thomas, Chess,

Birch, Hertizig, & Korn, 1963) have been credited with

pioneering the study of temperament. They introduced the

idea that infants possess intrinsic personality traits that

create individual styles of interaction. According to the

Thomas and Chess perspective, temperament characteristics

are important in personality development and temperament is

defined as the way in which the infant behaves. Individual

differences in infants are presumed to be influenced both by

genetics and the environment (Goldsmith et al., 1987; Thomas

& Chess, 1977). Further, individual differences in

behaviors influence others in the environment and this in

turn affects the interaction between infant and caregiver

(Bell, 1968; Rothbart & Derryberry, 1982a; Rutter, 1982;

Thomas et al., 1968). Thomas and Chess (1977) used the term

goodness-of-fit to describe this interactive process. When

a parent's caregiving style meshes easily with an infant's

temperament there is a positive goodness-of-fit, and this is

a positive factor in the socialization process. Otherwise

5

the child may be at risk for developing behavioral

disorders, socialization difficulties, and problems in

school (Thomas & Chess, 1977).

Thomas and Chess (1977) proposed nine dimensions of

temperament: activity level, rhythmicity, approach-with-

drawal, adaptability, intensity of reaction, threshold of

responsiveness, quality of mood, distractabiliity, and

attention span/persistence. From these dimensions they

derived three typologies of infant temperament: (a) the

easy child, characterized by high rhythmicity, positive

mood, high approach, high adaptability and low intensity;

(b) the difficult child, characterized by the opposite

pattern; and (c) the slow-to-warm-up child, characterized by

high activity, withdrawal, low adaptability, negative mood,

and low intensity.

Behavioral Genetics

Another approach to the study of temperament has been

that of Buss and Plomin (1975; 1984). They were concerned

with the genetic component of individual differences and

used parental ratings of twins to develop their theory.

They defined temperament as heritable traits that are

present in early childhood and are predictive of adult

personality (Buss & Plomin, 1984; Goldsmith et al., 1987).

They suggested five criteria that identify temperament

traits. These discribe the degree to which traits are (a)

6

heritable, (b) stable, (c) predictive of adult personality,

(d) adaptive, and (e) perhaps present in other animals (Buss

& Plomin, 197 5).

Buss and Plomin (1975) proposed four broad dimensions of

temperament for their scale: emotionality, activity,

sociability, and impulsivity (EASI). Later, they eliminated

impulsivity from their scale because of the improbability of

occurrence in infancy (Buss & Plomin, 1984). Buss and

Plomin were more concerned with how temperament affects the

development of personality, than how an infant's temperament

affects the caregiver's behavior (Goldsmith et al., 1987).

Psychophysiological

A third approach to the study of individual differences

in infancy emphasizes the physiological basis of behavior.

Rothbart and Derryberry (1982a, 1982b) included both

physiological reactions and behavioral reactions in their

theory of temperament. They defined temperament as

relatively stable, biologically-based individual differences

in reactivity of the nervous system and the process of the

modulation of this reactivity, i.e., self regulation

(Goldsmith, et al., 1987; Rothbart & Derryberry, 1982b).

Reactivity, according to Rothbart and Derryberry

(1982b), is defined as an individual's overall excitability

as a function of cortical, autonomic, motor, and endocrine

processes. This excitability appears in infants in the

7

patterning of motor, vocal, and attentional reactions.

Infants display individual differences in the way they

express reactivity and also in the temporal dimensions of

reactivity. Some infants seem to build rapidly to a high

peak of motor excitement and recover quickly, whereas others

rise more gradually, peak at lower levels and recover slowly

(Rothbart & Derryberry, 1982b).

Individuals vary in the degree and manner in which they

are able to self-regulate reactivity to changes in the

nervous system (Rothbart & Derryberry, 1982b). Young

infants control the amount of stimulation they receive by

using approach and avoidance behaviors such as leaning

forward to increase the stimulus and averting the gaze to

avoid stimulation. Some infants will approach and/or

tolerate high levels of stimulation, whereas others avoid

stimulation or become distressed at lower stimulation levels

(Rothbart & Derryberry, 1982b). Therefore, individual

differences exist in the way infants respond to stimulation

and also in the variety of levels of stimulation to which

they respond.

Rothbart and Derryberry (1982b) described infant

temperament as a complex organization of structurally and

temporally overlapping response systems. They cautioned,

however, that the infant is also an experiencing organism

and that experience is central to behavior. The infant

experiences physiological reactivity and modulates behavior

8

in relation to past experiences. Rothbart and Derryberry

viewed the development of temperament traits as an interac-

tion between the child's heredity, biological development,

and life experiences. From this theoretical basis, they

have established six temperament dimensions: (a) activity

level, (b) smiling and laughter, (c) fear, (d) distress to

limitations, ( e) soothabil ity, and ( f) duration of orienting

(Rothbart, 1981).

Validity of Maternal Ratings: A Methodological Issue

Empirical studies of the validity of temperament

measures have provided information on criterion-related and

construct-related validity. Hubert, Wachs, Peters-Martin,

and Gandour (1982) reviewed studies on the reliability and

validity of infant temperament measures and organized the

results on validity according to whether the data provided

information on concurrent, convergent, or predictive

validity. They found that no data on validity were reported

for nearly half of the available scales. For the 26 studies

reporting psychometric data, they found reports of low

convergent validity, inconsistent findings on concurrent

validity, and moderate levels of predictive validity. Since

Hubert et al. provided a comprehensive review, only

conceptually important and more recent studies will be

reviewed in the present paper.

9

Although Hubert et al. (1982) organized findings under

the headings of concurrent, convergent, and predictive

validity, the present review will be organized according to

the terms used by Carmines and Zeller (1979), i.e.

criterion-related validity and construct-related validity.

According to Carmines and Zeller criterion-related validity

includes concurrent and predictive validity. However, They

warn that the measurement of concurrent validity requires a

valid criterion against which to measure the concept, a

requirement that is seldom met in the social sciences. This

is due to the fact that it is difficult to confirm that

external criteria are indeed "true" measures of the

construct under consideration. Instead, Carmines and Zeller

(1979) suggested the use of the term construct-related

validity which allows for multiple assessments of the

concept under consideration but does not require that each

criterion be an absolute measure of the concept.

Accordingly, methods that are typically used to validate

instruments aimed at measuring the construct of temperament

shall be referred to as measures of construct-related

validity. A review of recent literature indicated that

studies of construct-related validity typically compare

temperament measures to the following external measures: (a)

observations by independent, trained observers who record an

aggregate of behaviors or who measure discrete behaviors;

{b) observations by mothers; (c) ratings on other

10

temperament questionnaires or interviews; (d) ratings by

others on the same questionnaire; and (e) maternal

characteristics that may be predictive of temperament.

Construct-related validity for temperament measures has

been assessed by correlating maternal reports with judgments

of independent observers who observed in natural settings in

the home and at play or in structured laboratory settings.

Many authors (Goldsmith & Campos, 1986; Hagekull & Bohlin,

1986; Hagekull, Bohlin, & Lindhagen, 1984; Kagan, Reznick,

Clark, Snidman, & Garcia-Coll, 1984; Matheny, Wilson, &

Nuss, 1984; Rothbart & Derryberry, 1982a) have reported low

to moderate (.20 to .61) correlations between laboratory and

home observations with parental questionnaire scores. Others

(Vaughn, Taraldson, Crichton, & Egeland, 1981; Sameroff,

Seifer, & Elias, 1982) found no significant correlations

between maternal reports and observations.

Some researchers have studied temperament by observing

discrete behaviors and comparing them to maternal ratings on

questionnaires. The Newborn Behavior Assesment Scale (NBAS)

(Brazelton, 1973) was used by Worobey (1986) to compare

neonatal behaviors with one-month ratings on the IBQ. He

reported as significant 4 out of 12 relationships between

NBAS scores and IBQ scores. Crockenberg and Acredolo (1983)

reported only one correlation between newborn scores and IBQ

ratings at 3 months. Isabella, Ward, and Belsky (1985)

11

found no significant relationships between newborn scores on

the NBAS and maternal reports of temperament at 3 and 9

months. Others have investigated the relationship between

biological responses such as heartrate variability

(DiBiase, 1987; Healy, 1987), sleeping difficulties

(Weissbluth et al., 1985), neonatal and later activity

level (Korner et al., 1985), feeding difficulities (Nazario

& Coll, 1987), and crying (Fagen & Ohr, 1985) with

temperament and have found some correlations with

temperament ratings by mothers.

When trait ratings are used to measure temperament,

product moment coefficients between maternal ratings and

those of others are low. Field and Greenberg (1982)

reported a correlation of .23 between ratings by mothers and

teachers, using the Revised Infant Temperament

Questionnaire. Lyon and Plomin (1981) reported correlations

ranging from .27 to .44 between mothers' and fathers'

ratings of their inf ants on the Colorado Childhood

Temperament Inventory. Rothbart and Derryberry (1982a)

reported significant correlations between mother and a

second adult in the house for all six scales on the IBQ

(.45-.69). Bates and Bayles (1984) and Simons, McCluskey,

and Mullet, (1986) reported mother/father convergence to

range from .39 to .61.

The degree to which maternal traits such as personality

and mental health are predictive of infant temperament has

12

been assessed by several researchers (e.g., Bates, Freeland,

& Lounsbury, 1979; Sameroff et al., 1982; Vaughn et al.,

1981). Bates et al.(1979) found that less extroverted

mothers tended to see their infants as more difficult than

did mothers who were more extroverted.

Maternal variables, measured before the birth of the

child have also been found to be related to infant

temperament scores. Sameroff et al. (1982) on a population

of mentally ill mothers, reported correlations of .21 to .40

between maternal anxiety, measured prenatally, and

temperament. High anxiety levels were associated with low

rhythmicity (K = .21), poor adaptability (K = .40), low

approach (K = .26), and negative mood (K = .34). However,

because of the nature of the research design, no causal

relationship could be assumed. Vaughn et al. (1981) found

that maternal anxiety, measured prenatally, was correlated

with 3-and 6-month infant temperament as measured by the

ITQ. Fredi, Bridges, Shonk, and Greene (1986) found that

mothers' ratings of temperament were related to child-

rearing beliefs and physiological tendencies measured prior

to birth.

Crockenberg (Crockenberg & Acredolo, 1983; Crockenberg

& Smith, 1982) reported that maternal behaviors were related

to maternal ratings of infant temperament. She found that

mothers of difficult infants took a longer time to respond

13

to a fussy infant, and the infant also took a long time to

calm.

Findings from these studies have been interpreted as

indicating that it may be maternal variables, not

consitutional traits of the infant, that are being measured

(Crockenberg and Acredolo, 1984; Sameroff et al., 1982).

However mother's perceptions, regardless of origin, are

important if there is a concern about mother/infant

interaction. Recognizing that maternal traits might be

influencing maternal ratings of temperament, it remains

important to know whether diabetic and nondiabetic mothers

rate their infants' temperament differently.

Based on the available data, it appears that both

observations and trait ratings obtained from individuals

other than the mother reflect low agreement with maternal

ratings. However, if the mother is trained and asked to

rate specific behaviors, reliability is increased. In a

study by Hagekull et al. (1984), the parent was given

detailed information for arrangement of observational

situations as well as for what and how to record the

behaviors of their infants. An independent observer

recorded the infant behavior concurrently and correlations

between parent and observer ranged from .67 to .83. The

parents were found to be objective observers of their

infants' behaviors thus lending support to vaidity of

maternal observations.

14

One way to study the validity of maternal perceptions

is to objectively measure characteristics of infants.

Studies of infant cries have generally provided support for

the validity of maternal observations. Bates et al. (1979)

reported that there is a modest relationship between

parental perception of diff icultness and the objectively

recorded amount of infant crying. zeskind and Lester (1978)

found that infants with a high number of prenatal and

perinatal complications cried at a higher pitch than did

control infants. Further, it has been established that

these high pitch cries produce greater adult aversion than

cries of control infants (Fredi, Lamb, Leavitt, Donovan,

Neff, & Sherry, 1978; Zeskind & Lester, 1978). Lounsbury

and Bates (1982) found that mothers rate difficult and

average cries of infants unrelated to themselves as sounding

mildly irritating and "spoiled". They reported that pauses

in the cries communicate a sense of urgent demand and the

pitch of the cry at the peaks of intensity may be perceived

as more difficult. Boukydis and Burgess (1982) reported that

cries of infants rated as difficult provoked negative

listener ratings and the cries were often attributed to

emotional reasons or to major pain. Measuring the skin

potential index of arousal on adults, the difficult infant

cries were found to be more arousing (Boukydis & Burgess,

1982). Unrelated adults respond more aversely to cries of

15

infants that are ill or rated as difficult than they do to

normal infants (Frodi et al., 1978; Lounsbury & Bates, 1982;

Zeskind & Lester, 1978). Therefore, mothers who rate their

infants as more difficult may be reacting in part to the

aversive quality of their infants' cries and documentation

of the ability of mothers to discriminate cries lends

credence to the proposition that mothers can be reliable

observers.

After reviewing the literature, there is a concern that

maternal ratings on temperament questionnaires are not

reliable measures of an infant's temperament. There is low-

to-moderate construct-related validity reported in most

articles (e.g., Matheny et al., 1984; Rothbart & Derryberry,

1982a; Vaughn et al., 1981; Worobey, 1986). The temperament

questionnaires may be reporting maternal variables more than

constitutional traits of the infant. These perceptions by

mothers could be important for the mother/infant interaction

and future social-emotional development of the infant. But

to accurately record behaviors an observation situation is

important. There does seem to be some support for mothers as

observers of their infants' specific behaviors reported

immediately following those behaviors (Hagekull et al.,

1984). Therefore, this study will incorporate temperament

ratings by the mother, observations by the mother and

observations by a trained observer, blind to the study.

16

Biological Mediators of Behavior

There is a growing body of knowledge demonstrating a

relationship between the biological state of the infant and

individual behavioral traits. Targets of investigation have

included: heartrate, respiration, birthweight, maturation of

the nervous system, and hormone levels (Campos et al.,

1983) •

Lacey (1959) proposed that individuals manifest stable

patterns of physiological reactions, termed individual

response stereotype. He speculated that individual

differences in heartrate and blood pressure changes might

serve important perceptual-cognitive and social regulatory

functions. Since then, many researchers (e.g., Clifton &

Graham, 1968; Kagan, 1982; Lipton, Steinschneider, &

Richmond, 1966) have investigated the stability of

individual differences in cardiac response to stimulation.

Kagan (1982) reported that high and stable heart rates

during conditions of information processing reflect

vigilance. More recently, Garcia-Coll, Kagan, and Reznick

(1984) found similar results in that young children tended

to be consistently inhibited or uninhibited, and that

extremely inhibited children had significantly higher heart

rates. Dibase (1987) reported a relationship between

heartrate variability and temperament ratings at 5 months

17

while Woodson and Hamilton (1986) reported a relationship

between heartrate and motor activity.

The endocrine system has also been shown to affect

behavior in infants. Tennes, Downey, and Vernadakis (1977)

investigated cortisol levels associated with infants'

stress. Those infants who had higher levels of cortisol

during a control, nonstressful day also had higher cortisol

during stress and exhibited more distress behaviors. Sex

steroid hormones have long been recognized to be associated

with behavioral differences in males and females in animal

studies. Moreover, one recent study on humans linked the

temperament trait of timidity to testosterone, progesterone,

and estradiol levels in boys (Jacklin, Maccoby, & Diering,

1982).

The nutritional status and birthweight of an infant is

directly related to growth and intellectual functioning.

Fetally malnourished infants show deficits in a number of

basic reflexes and are described as generally apathetic,

unresponsive to environmental stimuli, and irritable (Als,

Tronick, Adamson, & Brazelton, 1976; Birch, 1971). Infants

with atypical patterns of fetal growth obtain lower scores

on the NBAS when compared with normal infants (Lester,

Garcia-Coll, Valcarcel, Hoffman, & Brazelton, 1986).

Longterm consequences of being small for date include low IQ

scores (Weiner, 1970) and special educational needs (Rubin,

Rosenblatt, & Balow, 1973).

18

In addition to growth and intellectual functioning,

behaviors which are closely related to temperament may also

be affected. For example, Zeskind (1981) found that over-

weight-for-length as well as underweight-for-length infants

showed less optimal performances on the 5 dimensions of the

Neonatal Behavioral Assessment Scale (NBAS). They displayed

poor ability to orient to social and nonsocial, visual, and

auditory stimulation and poor motor integration. In

addition, underweight-for-length and overweight-for-length

infants displayed a high-pitched cry sound which has been

used to indicate imparied functioning of the central nervous

system (Zeskind & Lester, 1981).

The studies cited above suggest that the biological

state and atypical growth of the infant will affect

behavior. Infants of diabetics are subjected to metabolic

imbalances throughout gestation and are often underweight or

overweight at birth (Hollingsworth, 1984) • Therefore it is

plausible that the biological status of the IDM may

contribute to differences in temperament traits as well as

discrete behavioral traits. Below is a brief review of the

biological factors that may contribute to temperament in the

IDM.

19

Infants of Diabetic Mothers

One of the problems for a female diabetic is the

management of a healthy pregnancy. In utero, the fetus

faces many metabolic imbalances (Freinkel Dooley, & Metzger,

1985). Congenital anomalies occur in infants of diabetic

mothers two to three times more frequently than in the

general population (Coustan, 1985). The cause of this

increased incidence of birth defects remains to be

established, but it appears to be operating during the first

six weeks of gestation. This is often a period of poor

glucose control in diabetic women (Coustan, 1985;

Hollingsworth, 1984; Pederson, 1984) • Poor glucose control

during the first trimester has also been linked to early

growth delay (Pederson, 1984) and to low birth weight

(Hollingsworth, 1984) • Another problem of infants of

diabetics is rnacrosomia. These babies have an increase in

both cell size and number in fat, liver, heart, and adrenal

gland and their large size may contribute to difficult birth

(Hollingsworth, 1984).

With advances in medical care, there have been

reductions in mortality and morbidity for infants of

diabetic mothers (IDMs). During the past 10 years perinatal

mortality among diabetic pregnancies has been reported to be

below 5% compared to 1-2% in the general population

20

(Coustan, 1985) • As death rates have diminished, concern

has switched to congenital anomlies and metabolic disorders

of the IDM.

The IDM faces many medical problems which involve

metabolic homeostasis. Common disorders are hypoglycemia,

hypocalcemia, hyperbilirubinemia, and polycythemia (Tsang et

al., 1981). Many IDN's are delivered prior to 38 weeks due

to maternal preclampsia and placental insufficiency

(Hollingsworth, 1984; Tsang et al., 1981) and this is often

associated with hyaline membrane disease. Studies of the

neurological status of IDMs have shown decreased passive

tone and increased tremulousness (Priestly, 1972) along with

immature sleep EEGs (Schulte, Lassan, Parl, Notte, &

Jurgens, 1969).

Pregnant diabetics who maintain good glucose control

during gestation often have healthy babies without

complications (Hollingworth, 1984; Lin, River, River, Blix,

& Moawad, 1986). But even these healthy infants have

displayed behavioral differences when compared to infants of

nondiabetics (Yogman, Cole, Als, & Lester, 1982). Yogrnan et

al. (1982) reported that IDMs received lower scores on

orientation, autonomic stability, and motor performance and

orientation scales on the Neonatal Behavioral Assessment

Scale (Brazelton, 1973).

Concern about longterm effects of neonatal metabolic

disorders have prompted follow-up studies. There is some

21

controversy as to the long-term effects of hypoglycemia in

the newborn. Two studies have demonstrated a relationship

between hypoglycemia and low IQ (Churchill, Berendes, &

Nemore, 1969; Schier, Povar, Susa, & Schwartz, 1983).

Churchill et al., demonstrated that the offspring of

diabetic mothers had lower Bayley Mental and Motor scores at

8 months of age and lower Stanford Binet scores at 4 years

of age. Other studies have shown similar adverse

neurological and developmental outcomes (Haworth, McRae, &

Dilling, 1976; Stehbens, Baker, & Kitchel, 1977; Yssing,

1975), possibly attributable to poor maternal blood glucose

control. However, others found no relationship between

neonatal hypoglycemia and low IQ (Cummins & Norrish, 1980;

Giffiths & Bryant, 1971; Persson & Gentz, 1984). Thus the

nature and degree of the relationship between diabetes and

infant outcome is a topic of continuing concern.

Technological advances in perinatal and neonatal care

since the mid-1970's have resulted in a marked decrease in

morbidity for infants. Hollingsworth (1984) discussed the

improvement of monitoring and controlling maternal blood

glucose and insulin levels. Two recent studies of the long

term effects of maternal diabetes reflect this improvement

in diabetic care. Persson and Gentz (1984) and Hadden et

al. (1984) found no significant difference in the emotional

state or academic achievement of children born to diabetic

22

mothers.

In a Swedish study (Persson & Gentz, 1984) the

children of diabetic mothers were examined at 5 years of age

for motor and neurological development. A psychologist

interviewed the mothers and established a psychosocial

stress index that included items such as economic resources,

marital status, family support, and disease. When compared

to a matched, control group, no differences were found in

physical health and IQ scores of the children (Persson &

Gentz, 1984).

Hadden et al. (1984) also investigated the long term

effects of maternal diabetes on children. Along with

physical examination of children 5 years and older, parents

and teachers filled out a questionnaire on health, behavior,

and academic progress. When. compared to a control group,

Hadden et al., found no significant differences in minor

health problems, behavioral problems, or academic ability.

Hadden reported a nonsignif icant trend for children of

diabetic mothers to miss more school and to have somewhat

lower academic achievement.

23

Methods

Subjects

Diabetic mothers were recruited through obstetricians in

the New River Valley of Virginia; Roanoke Memorial

Hospitals, Roanoke, Virginia; Medical College of Virginia,

Richmond, Virginia; and Mt. Siani Hospital, New York.

Subjects were recruited by a letter (Appendix A) which was

mailed by the medical personnel, and mothers were asked to

return the consent form if volunteering to participate.

Control subjects were recruited within a 50 mile radius of

Roanoke, Virginia, through private physicians, in waiting

rooms of well-child clinics, and by phone calls, names being

obtained from birth announcements and personal referrals.

Mothers were informed of the general nature of the study and

the requirements to participate, but were not informed of

the hypotheses. After receiving an explanation of the

project, mothers completed a consent form (Appendex B).

Subjects (N = 34) consisted of 16 infants of diabetic

mothers (8 males, 8 females) and 18 infants of nondiabetic

mothers (7 males, 11 females) • Among the IDMs there were

10 white and 6 black subjects; among the infants of

nondiabetic mothers there were 14 white and 4 black

subjects. Chi square analyses indicated no significant

difference between the groups for distribution of sex (x2 (1)

= 0.42, 2 < .52) or race ( x2 (1) = 0.95, 2 < .33.

24

Controls were matched to IDMs on the following criteria:

(a) mother's race, (b) infant's sex, (c) infant's

gestational age (±1 week), (d) age of infant at completion

of questionnaire (±2 weeks), and (e) whether the infant was

seen by a private versus a clinic physician. Of the 34

participants there were 10 controls matched with 10 diabetic

subjects on all of the criteria.

Gestational age of infants in this study ranged from 36

to 42 weeks (M = 39.0) and infant age at observation was

between 15 and 23 weeks (M = 17.94). Maternal age range was

18 to 39 years (M = 27.7). There were no significant

differences between groups for maternal age infant weight

and length at birth, or infant's age at the time of

observation (Table 1). However, gestational age was

significantly higher among the nondiabetic subjects (E

(1,32) = 5.09, p < .05). All subjects met the following

criteria: (a) they were all born 36 to 42 weeks gestational

age; (b) they had no recognizable signs of adnormalities;

and (c)they were considered healthy and ready for discharge

by the pediatrician within one week of birth.

Insert Table 1 about here

25

Instrument

Temperament Rating Scale

The Infant Behavior Questionaire (IBQ) (Rothbart,1981)

was selected for use in this study because the theoretical

orientation allows for contact between psychological

research and neurophysiological research and includes

psychoendocrine responses (Goldsmith et al., 1987) which

Rothbart described as feelings of energy, interest, and

affect. Since the present study was focused on diabetes as

an endocrine mechanism possibly mediating temperament,

Rothbart's view was particularly relevant.

The Inf ant Behavior Questionnaire consists of 94

questions concerning the occurrence of specific infant

behaviors during the previous week. Mothers scored each

item on a 7-point scale ranging from never to always, with a

"does not apply" option. These items comprise six

temperament scales: activity level, smiling and laughter,

fear, distress to limitations, soothability, and duration of

orienting. The definition for each dimension as outlined by

Rothbart (1981) is as follows:

1. Activity level--Child's gross motor activity,

including movement of arms and legs, squirming and locomotor

activity.

2. Smiling and laughter--Smiling or laughter from the

child in any situation.

26

3. Fear-- Child's distress and or extended latency

to approach an intense or novel stimulus.

4. Distress to limitations--Child's fussing, crying, or

showing distress while (a) waiting for food (b) refusing a

food, (c) being in a confining place or position, (d) being

dressed or undressed, (e) being prevented access to an

object toward which the child is directing his/her

attention.

5. Soothability--Child's reduction of fussing, crying,

or distress when soothing techniques are used by the

caretaker or child.

6. Duration of orienting--Child's vocalization,

looking at, and/or interaction with a single object for

extended periods of time when there has been no sudden

change in stimulation.

In constructing the IBQ, Rothbart (1981) used item

analyses and retained only those items correlating .20 or

better with their respective scales. A summary of the

ranges and means of item correlations with their scale as

reported by Rothbart (1981) is given in Table 2. Internal

reliabilities of the scales based on coefficient alphas

ranged from .67 to .81 when used with a sample of 6-month-

olds (Rothbart, 1981).


27

The six scales of the IBQ were designed to avoid

conceptual overlap. However, Rothbart reported significant

positive intercorrelations between scale scores for 6-month-

old infants for the following scales: (a) distress to

limitations and fear (£ = .36), (b) distress to limitations

and activity level (£ = .28), and smiling and laughter and

soothability (£ = .29). A significant negative correlation

between smiling/laughter and fear (£=-.22) was also reported

(Rothbart, 1981).

To assess interrater reliability, Rothbart (1981)

compared ratings by a subsample of 22 mothers with those

made by a second adult caregiver. Pearson product-moment

correlations for the 22 matched pairs of questionnaires were

as follows: smiling and laughter, £ = .45; duration of

orienting, £ = .46; soothability £ = .54; fear, £ = .66;

distress to limitations, £ = .60; activity level, £ = .69.

All correlations were significant a 2 < .OS levels (one-tail

tests) •

Behavioral Observation Record

A behavioral observation schedule was developed for the

present study using selected items on the Infant Behavior

Record of the Bayley Scales of Infant Development (Bayley,

1969) Each of the six behavioral items were selected

because of their conceptual correspondence to one of the six

scales on the IBQ. This observation schedule was used to

28

assess validity of maternal ratings on the Infant Behavior

Questionnaire (Appendix C). Items included descriptions of

behaviors normally elicited during well-baby exams.

Training of the observer, blind to the study, was comprised

of observations by the observer, mother, author, and faculty

advisor who simultaneously observed four normal 4-month-olds

with their mothers in a simulated well-baby exam. Infants

observed during training were not subjects in the study.

Training was carried out at the Laboratory School operated

by the Department of Family and Child Development at

Virginia Tech. Training continued until differences between

trainer, observer, advisor, and mother were no more than two

points apart for any observational item.

Of the 34 subjects, 21 were observed by their mothers

and the trained observer during the infants' well-baby exams

which were scheduled at approximately 4 months (+4 weeks).

The observer explained that she would be recording the

infant's behavior and at the end of the exam would ask the

mother to complete the six-item observation form. The

mother was instructed on which infant behaviors to observe

(e.g. activity, happiness, reaction to the doctor, response

to the examination, response to the immunizations, response

to the ring and rattle) but was not given a copy of the form

until after the exam was completed. The observer entered

the exam room with the mother and infant and remained

29

throughout the exam. The observer performed the ring and

rattle items (see Appendix D) on the observation form at a

time when the physician or nurse was not present. Once the

medical exam was completed and the infant was dressed, the

mother completed the form. When necessary the observer

assisted the mother by holding the baby. The observer

completed her form as soon as possible following the

+examination and all forms were completed within 15 minutes

of the examination.

Results

Data were analyzed to assess group (diabetic vs

nondiabetic) differences in temperament as measured by the

Infant Behavior Questionnaire (Rothbart, 1981) and as

measured by behavioral observations. Behavioral

observations were also compared to maternal ratings on the

IBQ and interjudge agreement for the behavioral observation

schedule was assessed.

Data Reduction

Rothbart's scoring protocal (1981) involves 79 items

for a 3-month-old population. Item analyses on the 79-itern

format for the sample of 4-month-olds in this study

indicated that several items were more highly correlated

with scores of other scales than with those of their

respective scale. For purposes of the present study these

items were deleted for the computation of scale scores and a

30

74-item questionnaire was created. Scale scores were

computed using 13 items on smiling and laughter, 16 items on

distress to limitations, 10 items on duration of orienting,

7 items on soothability, 16 items on activity level, and 12

items on fear. Items deleted for the 74-item format are

marked by the letter "D" on the questionnaire in Appendex

E. Even after reducing the scale to 74-items, data

indicated that 8 of the 15 interscale correlations were

significant as compared to four in the Rothbart (1981) study

(Table 3) •

Item analyses also indicated that additional items

were highly correlated with other scales although

coefficients were not higher than for their respective

scales. The deletion of these items would result in a 53-

item questionnaire. By doing so, the number of significant

scale intercorrelations was reduced from eight to five

(Table 4) and yet the coefficient alphas remained high. A

comparison of coefficient aphas for the 53-item scale, the

74-item scale, the 79-item scale and Rothbart's 6-and 9-

month scales appear in Table 5.

Insert Tables 3, 4, and 5 about here

Examination of coefficient aphas in conjunction with

scale intercorrelations indicate that a 53-item scale might

31

be appropriate for future studies. Further support for the

reduction of the scales is provided by the fact that scale

scores on the 53-item format, correlated significantly with

scores on the original 79-item scale (Table 6). Pearson

product correlations range from .85 to .99. Worobey (1986)

demonstrated that a reduced version (37 items) of the IBQ

was valid for 3-month-olds. However, additional validity

studies are needed in order to determine whether the same

construct is being measured in reduced formats. Therefore,

hypotheses testing for the present study was performed on

data from the 74-item scale. Moreover, the 74-item scale

was selected so that results could be compared more readily

to existing research literature.

Pearson's correlation coefficients between scales

indicated shared variance between some scales (Table 4).

Based upon a conversation with Rothbart (1987) the decision

was made to compute aggregate scores by combining scales

that were related both statistically and conceptually.

Four aggregate scales were computed as follows: (a) control

was computed as the sum of distress to limitations and

activity level; (b) control-fear was computed as the sum of

distress to limitations, activity level, and fear; (c)

calmness was computed as the sum of duration of orienting,

soothing, and fear; and (d) happiness was computed as a sum

of soothability and smile. One-way ANOVAs indicated no

significant group differences on any of the aggregate

32

scores (Control, f = .63, £ < .43; Control F, f = 1.38,

£ < .25, Attachment, f = 0.97, £ < .33; Happiness, f = 0.60,

£ < 0.44).


Hypotheses Testing

Infant Behavior Questionnaire

A series of one way ANOVAs indicated no significant

differences between infants of diabetics and infants of

nondiabetics as measured by maternal ratings of temperament

of the six scales of the IBQ. Means and standard

deviations for maternal ratings on the scales, broken down

by group, are shown in Table 7. Using the subset of data

Cn = 10 pairs) in which infants of diabetics were matched

with controls on race, sex, gestational age, and age at

observation, a series of paired t tests indicated no

significant differences between infants of diabetics and

their matched controls (Table 8) •

Insert Tables 7 and 8 about here

Pearson correlation coefficients revealed no

significant linear relationships between gestational age

33

and any of the six temperament scales of the IBQ (Table 9) •

A Multiple regression with a quadratic function was run to

see if there was a curvilinear relationship between

ponderal index (birth weight in grams x 100/ length3 in

centimeters) and the ratings on the IBQ. No relationship wa

found (Table 10) • Scatter plots were also run to examine

for possible curvilinear relationships and none were

evident.


Behavior Observations

The t-tests comparing mothers' observations by group

indicated no significant differences between infants of

diabetics and infants of nondiabetics on any of the six

behavioral items (Table 11). However, the trained

observer's behavioral ratings indicated a significant group

difference on activity level, 1(1,20) = 2.08, p < .03, and

on duration of orienting 1(1,18) = -2.07, p < .06 (Table

12). Infants of diabetics received higher mean scores on

activity and lower mean scores on duration of orienting as

rated by the observer.


34

To assess interjudge agreement, mothers'

observations were compared with those of the trained

observer. Kendall tau coefficients between maternal and

observer ratings (Table 13) were significant at the £ < .01

level for fear, smiling and laughter, soothability, and

duration of orienting; they were marginally significant at

the £ < .10 for distress to limitations. However, mother

and observer ratings on activity level were not

significantly correlated.


Questionnaire Ratings Versus Behavioral Observations

It was expected that the six behavioral observation

items would correlate with their respective counterpart on

the IBQ both conceptually and statistically. However,

Kendall tau correlations between maternal ratings on the IBQ

and on the observation items showed no significant

relationships (Table 14). Kendall tau correlations between

observers' ratings on the behavioral observation items and

maternal ratings on the IBQ indicated a marginally

significant but low correlation on one scale, distress to

limitations (£ = 0.29, £ < .10).

35


Discussion

An interest in the origins of individual differences in

temperament and temperament-related behaviors led to this

study which dealt with one possible source of neurologically

based temperament differences, i.e. diabetes during

pregnancy. Differences between infants of diabetics and

nondiabetics had been predicted because research has

demonstrated that prenatal metabolic imbalances during

pregnancy may compromise neurological status. Based on

Rothbart's (Goldsmith et al., 1987) hypothesis that

neurological maturation and other psychoendocrine responses

might impact temperament, the present study sought to

determine whether any differences existed between infants of

diabetics and those of nondiabetics in terms of temperament

and discrete behaviors which were assumed to be indicative

of temperament.

Although maternal ratings failed to support the

hypothesis of temperament differences between infants of

diabetics versus nondiabetics, group differences in discrete

behaviors were recorded by a trained observer in the present

study. This study's methodology differs from Yogman's, but

36

it corroborates his finding that group differences exist in

discrete behaviors in infants of diabetic mothers. Yogman

et al. (1982) reported that infants of diabetic mothers had

lower scores on motor, orientation, and autonomic

functioning. In the present study, IDMs were observed to be

more active and to have lower scores on duration of

orientating.

Discrete behaviors did not correlate significantly with

their respective scale on the IBQ, yet they may have

significance for later developmental dispositions. In two

previous studies discrete behaviors did not correlate with

current temperament ratings but they were predictive of

later temperament scores. Daniels et al. (1984) reported

behaviors rated on the Bayley Infant Behavior Record at 12

months predicted temperament scores at 24 months but not at

12 months. Crockenberg and Acredolo (1983) reported

similiar findings with newborn behaviors that were

predictive of temperament at 3 months.

Group differences for two of the six discrete

temperament-related behaviors were obtained (activity,

duration of orienting) from the observer's but not by the

mothers' data. This may be due to differences in the

definition of activity and duration of orienting. Limb and

trunk movements were salient features in the researcher's

definition of activity. Some mothers indicated that infants

were not active unless they were crawling or walking. Also,

37

the researcher and trained observer attended to eye

movements when infants were presented toys, whereas it

appeared many mothers missed these subtle behaviors. The

trained observers' observations were accepted as a valid

source of data for three reasons: (a) she achieved

high interjudge agreement with the trainers; (b) she was

the consistent observer across all subjects and (c) her

observations were highly correlated with those of mothers.

The lack of significant group differences on data

obtained by maternal ratings may be due to the problems

discussed earlier on the validity of maternal perceptions.

The information from temperament questionnaires may not

accurately reflect constitutional traits of the infant, but

instead reflect maternal variables. This may be due to the

amount of retrospection involved in the IBQ which requires

recall of events over a l week period. It is possible that

mothers' ratings would improve if training were provided

one week prior to completion of the questionnaire. Further,

if maternal traits are what is being measured, apparently

the mothers in the two groups were not different.

One area of interest in the present study was whether

any relationship existed between ponderal index and

temperament. Research by Zeskind (Zeskind, 1981; Zeskind &

Lester, 1981) indicated that infants with either a high or a

low ponderal index showed less optimal performances on all

38

dimensions of the NBAS and displayed cries which were

indicative of immature neurological status. Thus, it was

speculated that such infants could have temperament traits

that differed from those with a typical (between the 10th

and 90th percentile) ponderal index. This was of particular

interest in this study because infants of diabetics are

predisposed to be underweight or overweight at birth. In

the present sample, there were 12 infants with ponderal

index below the 10th percentile (PI = 2.30 adjusted for 38

weeks gestational age) and 2 above the 90th percentile (PI = 2.85 adjusted for 38 weeks gestational age) according to

norms reported by Miller and Hassanein (1971). However, no

relationships were found between ponderal index and IBQ

scales. Therefore, the present data does not provide

support for the hypothesis that temperament may be mediated

by growth related factors.

In summary, the differences in discrete behaviors

between 4-month-old infants of diabetic mothers and

nondiabetic mothers were similiar in pattern with those

found by Yogman et al. (1982). The differences in discrete

behaviors between infants of diabetic and nondiabetic

mothers point to the need for further study to determine if

these behaviors will effect temperament traits or behavioral

functioning at a later age.

39

TABLE

Means and Standard Deviations of Background Variables Broken Down by Group

Variables

Maternal age

Weight ( gms. )

Length (cm.)

Gestational age (weeks)

Infant age at observation (~eeks)

*p <.05.

Infants of diabetics (n:16)

M SD

28.06 5.72

3107.89 708.38

504.03 42.18

38.38 1. 54

18.06 2.21

Infants of Nondiabetics (n:18)

M SD

27.39 5.92

3395.68 590.53

525.64 32.64

39.56 1. 50

17.83 1.65

F

0.11

0.88

2.83

5.09*

0.12

40

TABLE 2

Ranges And Means of Item-Scale Correlations for the Infant Behavior Questionaire

Scale 6 Months

Activity level .31-.63 ( .47)

Smiling and laughter .29-.62 (. 49)

Fear .22-.67 (. 43)

Distress to limitations .31-.65 (. 46)

Soothability .38-.55 (. 46)

Duration of orienting .38-.73 (. 58)

Note. - Means are in parentheses.

Alpha (6 months)

• 77

• 77

.81

.80

.75

.67

41

TABLE 3

Scale Intercorrelations for Infant Behavior Questionaire

Scales

Activity level

Fear

Distress to limitations

Smile and laughter

Soothability

Duration of orienting

Activity level

.33*

.43**

.44**

.34*

.20

Note. - 6-month correlations 4-month correlations *p<.05, **p <.01,

Fear

.07

.61***

-.13

.37*

.30

Distress to

Limit.

.28**

.36**

-.21

. 12

.16

above diagonal from below diagonal from ***p <.001.

Smile

• 11

-.22*

- • 19

.49**

. 10

Rothbart

Sooth. Duration of

Orient.

.03 -.01

-.01 .05

- .12 - • 14

.29** • 19

.05

.46**

(n:93) Beal (!:!_:33T, 74-item scale.

42

TABLE 4

Scale Intercorrelations Infant Behavior Questionaire

Activity level

Fear


Smile and laughter

Soothability


Activity level

• 31

.39*

.32

.34*

. 15

Fear

.33

. 19

-.28

.30

.22

Distress to

Limit.

.43**

.60**

-.37*

.04

.06

Smile

.42*

-.10

- .18

.38

-.09

Sooth. Duration of

Orient.

.28 .20

.25 .30

-.02 • 13

.60*** .19

.43***

.40*

Note.-79-item scale above diagonal; 53-item reduced scale below diagonal *p <.05, **p <.01, ***p<.001.

43

TABLE 5

Coefficient Alphas for IBO Scales

Rothbart Rothbart Beal Beal Beal Scales 3 Months 6 Months 79 Items 74 Items 53 Items

Activity level .73 • 77 .88 .89 .88

Smiling and .85 .77 .78 .80 .76 laughter

Fear .80 .81 .85 .86 .80

Distress to .84 .80 .74 .79 .75 limitations

Soothability .84 .75 .78 .75 .75

Duration of • 72 .67 .74 .74 • 72 orienting

44

TABLE 6

Pearson Correlations Between Scale Scores for 79-Items Versus 53-Items Scale

Scale r

Activity .99

Fear .93

Distress to limitations .85

Smiling and laughter .90

Soothability .94

Duration of orienting .98

p <. 001.

45

TABLE 7

Means, Standard Deviations, and F Values for Infant Behavior Questionnaire Scales Broken Down by Group

Infants of Infants of Scales diabetics nondiabetics Significance

(n=16) (n=18) level M SD M SD F

Original IBQ Scales

Activity 4.19 1.16 3.38 1.00 0.63 0.43 level

Fear 2.86 1.25 2.37 0.83 1. 97 o. 17

Distress to 3.45 1.00 3.30 0.70 0.26 0.61 limitations

Smile and 4.48 0.57 5.00 1.16 2.64 0.11 laughter

Soothability 4.81 0.87 4.43 1.06 0.05 0.82

Duration of 4.41 0.97 4.23 0.96 0.32 0.58 orienting

Aggregate Scales

Control 7.64 1. 93 7. 19 1. 32 0.63 0.43

Control F 10. 51 2.79 9.56 1.89 1.38 0.25

Attachment 12.09 2.60 11. 33 1. 95 0.97 0.33

Happiness 9.29 1 . 11 9. 72 2.03 0.60 0.44

Note.- Control = Distress to Limit. + Activity. Control F = Distress to Limit. + Activity + Fear. Attach = Durat. of Orient. + Sooth + Fear. Happy = Sooth. + Smile.

46

TABLE 8

Paired t-test for Matched Subjects

Scale t

Activity level -0.11

Fear -0. 72

Distress to 0.22 limitations

Smiling and a. n laughter

Soothability 0.91

Duration of -0.41 Orienting

Note.- Degrees of freedom = 9 for each t-value. No signi-ficant t-values were obtained.

47

TABLE 9

Pearson Correlation Coefficients: Gestational Age with IBQ Scale

Gestational Scale Age

Activity level

Fear


Smiling and laughter

Soothability


Control

Control-f

Attachment

Happiness

Rothbart Scales

-0.15

-0.23

-0.18

0.14

-0.15

-0.18

Aggregate Scales

-0.20

-0.26

-0.26

0.02

48

TABLE 10

Multiple R's for Squared and Original Pondera! Index and IBQ Scales

Scale R-Square F Value

Rothbart Scales

Activity level 0.11 0.16

Fear 0.01 0. 12

Distress to 0. 11 1. 96 limitations

Smile and 0.02 0.32 laughter

Soothability 0.00 0.06

Duration of 0.03 0.52 orienting

A9gre9ate Scales

Control 0. 14 2.47

Control F 0.09 1.44

Attachment 0.01 0.15

Happiness 0.01 0.20

49

TABLE 11

t-test for Group Differences on Mothers' Observations

Scale Diabetic Nondiabetics t f,"j so M SD

Activity level 5.13 2 .17 4. 77 2.41 0.36

Fear 1.88 1. 36 2.38 1. 71 -0.71

Distress to 3.13 2.75 2.85 2.54 0.24 limitations

Smile and 5.75 2. 12 6.00 1.47 -0.32 laughter

Soothability 5.00 2.83 4.80 2.62 0. 16

Duration of 4.50 1.69 4.73 2.33 -0.23 orienting

Note. - No significant t values found.

so

TABLE 12

t-test for Group Differences on Observations by Trained Observer

Scale Diabetic Nondiabetics t M SD M SD

* Activity level 5.88 0.83 4. 92 1 . 11 2.08

Fear 3.00 1.20 2.69 1.60 0.47

Distress to 4.25 2.38 4. 15 1. 91 0.10 limitations

Smile and 5.50 1.69 5.69 1. 55 -0.27 laughter

Soothability 4.75 3. 11 3.50 2.55 0.94

* Duration of 3.63 1.85 5.27 1.62 -2.07 orienting

* p <.03, one-tail.

51

TABLE 13

Kendall Tau, Means and Standard Deviations of Maternal Observations Versus Observers'

Mother Observer Scales Kendall

M SD M SD tau

Activity level 4.90 2.17 5.29 1.10 0.02 (n:21)

Smiling and laughter 5.90 1. 70 5.62 1. 56 0.54** (n:21)

Fear 2. 19 1.57 2.81 1.44 0. 56** (n=21)

Distress to limitations 2.95 2.56 4.19 2.04 0.30* (n=21)

Soothability 4.89 2.63 4.06 2.80 0.68*** (n:18)

Duration of orienting 4.63 2.03 4.58 1.87 0.55** (n:19)

*.e. <. 10. **.e. <.01. ***.e. <.001.

52

TABLE 14

Kendall's Tau: Maternal Ratings (IBQ) versus Observations by Mother and Observer

Kendall's tau Scale

Mother

Activity level 0.14

Smiling and -0.04 laughter

Fear -0.08

Distress to 0.25 limitations

Soothability -0 .16

Duration of -0.06 orienting

*p <. 10.

Trained Observer

0 .13

0.09

0.05

0.29*

-0.18

0. 11

53

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66

Appendix A

67

VIRGINl1\ rfECI-1

Department of Family and Child Development Wallace Annex

Blacksburg, Virginia, 24061 (703) 961-4794

Dear Mother:

We are conducting a study on infant development at Virginia Tech and we need the help of mothers like you in order to learn more about wqat infants arc like at home.

Would you be willing to fill out a questionnaire when your baby is 4 months old? The questionnaire will ask you to rate your baby's sleeping, eating and other daily habits. It takes about one-half hour to complete. Also, if you are willing, we would like to see your baby at his/her 4 month pediatric check-up.

Any information you put on the form is handlt:d confidentially. There is no risk that anyone would be able to find out how you answered the questions. There is no risk to you or your infant by participation in this study. Of course, participation is strictly voluntary.

If you would like to be part of the project, please send us the completed consent form right away.

Sincerely,

Cosby S. Rogers Project Director

th

Encl: Consent Form

Linda C. Beal Project Coordinator

68

Appendix B

69

VIRGINIA TECH

Department of Family and Child Development \\'allace Annex

CONSENT FORM

I am willing to complete a questionnaire describing my infant's behavior when he/she is 4 months old. I understand that there are no known risks and all information is treated as confidential.

Signature of Mother

You may mail the form to me at:

Name

Address

City State Zip

Telephone

Background Information

What is your age? ____ _ Race: Caucasian Afro-American Oriental

_llispanic _Other Arc you diabetic?_yes __ no Type? _insulin dependent

nutrition controlled _gestational

Arc you hypoglycemic? _yes __ no What is the birth<late of your new infant? ___________ _ What was your new infant's birthwcight? birth length?. ___ _ What is your infant's sex? __ male __ female Was your baby born full term? _yes __ no If not, how many weeks early? __

how many weeks late? __

\'irgini;1 Pol)1n:hnk lnstitutl" anU Sratc.: l 'nin·rsity

Blacksburg, Virginia, 24061 (703) 961-4794

70

Appendix C

71

We understand that your baby's behavior during a medical examination may not be typical. But, we are interested in what your baby did today.

Read through all nine responses for each item. Then circle the number which most closely describes how your baby acted during the doctor's visit.

A. Fearfulness ( Look at the baby face-to-face. Look at baby's eyes; smile and talk to baby. Observe when doctors/nurses approach the baby and when the baby is moved to new situations.)

Uow fearful was the baby? 1. Accepts the entire situation with no evidence of fear, caution, or inhibition

of actions 2. B~tveen 1 and 3 3. Shows some slight vigilance, and restrained behavior in the first few minutes 4. Between 3 and S S. Behavior is affected by the new and strange, but just moderately and for approximately

the first third of examination 6. Between 5 and 7 7. Shows evidence of being botheTed by the strange situation or persons much of the

examination 8. Between 7 and 9 9. Strong indication of fear of the strange, to the extent that he cannot be brought

to play or respond to the test

B. Duration of Orienting ( While child is seated on his mother's lap, facing the mother, dangle the red ring by its string and secure his gaze upon it. Move it slowly around to the child's side, then back across his field of vision to his other side, through several excur-sions. Let the child hold the red ring in his hand for a period of free play and notice what he does with it. Offer the child the rattle or put it in his hand. Allow amole time to observe.)

How responsive was baby to objects or toys? l. Does not look at or in any way indicate interest objects 2. Between l and 3 3. When given materials, glances at them and holds them briefly but does not exploit chem 4. Between 3 and 5 S. Plays with materials when presented; discards or loses interest in each after a brief

reaction 6. Between 5 and 7 7. Sustained interest in the toys, in each new one in turn as presented 8. Be~Jeen 7 and 9 9. Reluctantly relinquishes test materials

C. Distress ~ Limitations ( Observe bahavior of infant while being dressed and undressed and during weighing and measuring.)

How distressed was infant to procedures? l. Unreactive; seems to pay little heed; responds only to stro~g or repeated limitations 2. Between 1 and 3 3. Some tendency to be distressed; displays some disapproval 4. Be~Jeen 3 and 5 S. Moderately distressed, annoyed by procedures 6. Between 5 and 7 7. Distressed; quickly shows awareness of changes 8. Between 7 and 9 9. Very distressed; every little thing seems to upset him/her. She/He startles, reacts

quickly, seems keenly sensitive to limits

72

D. Soothabilitv (Observe infant while vacinations are given)

How easily is inf ant soothed? 1. Cries for extended period; 3 to 4 methods of soothing tried 2. Between 1 and 3 3. Cries for moderate length of time but soothed after l or 2 methods tried 4. Between 3 and 5 S. Cries for short time. Quickly soothed after l or 2 methods tried 6. Between S and 7 7, Cries briefly; soothes self 8. Between 7 and 9 9. Little or no reaction

E. Activitv (Observe infant throughout visit)

How active was infant? l. Stays quietly in one place with practically no self-initiated movement 2. Between 1 and 3 3. Usually quiet and inactive but responds appropriately in situations calling for some

activity 4, Between 3 and S 5. Moderate activity; enters into games with freedom of action 6. Between 5 and 7 7, In action during much of the period of observation 8. Between 7 and 9 9. Hyperactive; cannot be quieted for physical examinations by doctors/nurses

F. Smiling~ Laughter (Observe infant throughout visit)

What is general mood of infant? l. Child seems unhappy throughout the e.'Catllination 2. Between l and 3 3. At times rather unhappy, but may respond happily to interesting procedures 4. Between 3 and 5 S. Moderately happy or contented; may become upset, but recovers fairly easily 6. Between 5 and 7 7. Generally appears to be in a happy state of well-being 8, Between 7 and 9 9. Radiates happiness; nothing unsetting; animated

73

Appendix D

74

'D 1978 Mary K. Rothbart All Rights Reserved

Subject No.

Today's Date

Sex of Child

Infant Behavior Questionnaire

1978 Version

Date of Baby's Birth

Age of Child

INSTRUCTIONS: Please read carefully before starting:

As you read each description of the baby's behavior below, please indicate how often the baby did this during the LAST WEEK (the past seven days) by circling one of the numbers in the left column. These numbers indicate how often you observed the behavior described during the last week.

(1)

Never (2) Very

Rarely

(3) Less Than Half The

Time

(4) About Half

The Time

( 5)

More Than Half The

Time

(6) Almost Always

( 7)

Always (X) Does Not Apply

The "Does Not Apply" (X) column is used when you did not see the baby in the situation described during the last week. For example, if the situation mentions the baby having to wait for food or liquids and there was no time during the last week when the baby had to wait, circle the (X) column. "Does Not Apply" is different from "Never" (I). "Never" is used when you saw the baby in the situation but the baby never engaged in the behavior listed during the last week. For example, if the baby did have to wait for food or liquids at least once but never cried loudly while waiting, circle the (1) column.

Please be sure to circle a number for every item.

Feeding

When having to wait for food or liquids during the last week, how often did the baby:

2 3 4 5 6 7 x 2 3 4 5 6 7 x 2 3 4 5 6 7 x

(1) seem not bothered? (2) show mild fussing? (3) cry loudly?

During feeding, how often did the babv:

2 3 4 5 6 7 x 2 3 4 5 6 7 x

(4) lie or sit quietly? (5) squirm or kick?

75

D

D

D

2

(1) ( 2) (3) (4) ( 5) (6) ( 7) (X) Never Very Less Than About Half More Than Almost Always Does

Rarely Half The The Time Half The Always Not Time Time Apply

Durins f~eding, how often did the bab~:

2 3 4 5 6 7 x (6) wave arms?

2 3 4 6 7 x (7) fuss or cry when s/he had enough to eat?

2 3 4 5 6 x (8) fuss or cry when given a disliked food?

When given a new food or liguid, how often did the baby:

2 3" 4 5 6 x (9) accept it immediately?

2 3 4 5 6 x (10) reject it by spitting out, closing mouth, etc.?

2 3 4 5 6 x (11) not accept it no matter how many times offered?

Sleeping

Before falling asleep at nisht durins the last week, how often did the baby:

2 3 4 6 X ..•. (12) show no fussing or crying?

During sleep, how often did the baby:

2 3 4 6

2 3 4 5 6

2 4 6

x x x

(13) toss about in the crib? (14) move from the middle to the end of the crib? (15) sleep in one position only?

After sleeping, how often did the babv:

2 3 4 6

2 4 6

2 3 4 5 6

2 3 4 6

How often did the

2 3 :. 5 6

2 4 6

2 3 4 5 6

x x

7 x

x

baby:

x

x x

( 16)

( 1 7)

(18)

• (19)

(20)

(21) (22)

fuss or cry immediately?

play quietly in crib?

coo and vocalize for periods of 5 minutes or longer? cry if someone doesn't come within a few minutes?

seem angry (crying and fussing) when you left her/him in the crib? seem contented when left in the crib? cry or fuss before going to sleep for naps?

76

D

D

(1)

Never

( 2)

Very Rarely

( 3)

Less Than Half The

Time

(4)

About Half The Time

( 5)

More Than Half The

Time

Bathing and Dressing

(6)

Almost Always

( 7)

Always (X)

Does Not Apply

3

When being dressed or undressed during the last week, how often did the baby:

2 3 4

2 3 4 2 3 4

5 6

5 6

5 6

7 x 7 x 7 x

(23) (24)

(25)

wave his/her arms and kick? squirm and/or try to roll away? smile or laugh?

When put into the bath water, how often did the baby:

2 3 4 5 6 7 x

2 3 4 5 6 7 x 2 3 4 5 6 7 x 2 3 4 5 6 x 2 3 4 5 6 7 x 2 3 4 5 6 x

(26) startle (gasp, throw out arms; stiffen body, etc. ) ?

( 27) smile? (28) laugh? (29) have a surprised expression? (30) splash or kick? (31) turn body and/or squirm?

When face was washed, how often did the baby:

2 3 4 5 6 7 x 2 3 4 5 6 x

(32) smile or laugh? (33) fuss or cry?

When hair was washed, how often did the baby:

2 3 4 5 6

2 3 4 5 6 x x

(34) smile or laugh?

(35) fuss or cry?

How often during the last week did the baby:

2 3 4 5 6 x

2 3 4 5 6 x

2 3 4 5 6 x

2 3 4 5 6 x

(36) look at pictures in books and/or magazines for 2-5 minutes at a time?

(37) look at pictures in books and/or magazines for 5 minutes or longer at a time?

(38) stare at a mobile, crib bumper or picture for 5 minutes or longer?

(39) play with one toy or object for 5-10 minutes?

77

D

D

4

(1) (2) ( 3) (4) (5) (6) ( 7) (X)

Never Very Less Than About Half More Than Almost Always Does Rarely Half The The Time Half The Always Not

Time Time Apply

How often during the last week did the babv:

2 3 4 5 6 x (40) play with one toy or object for 10 minutes or longer?

2 3 4 5 6 7 x (41) spend time just looking at playthings? 2 3 4 5 6 7 x (42) repeat the same sounds over and over again? 2 3 4 5 6 7 x (43) laugh aloud in play? 2 3 4 5 6 x (44) smile or laugh when tickled? 2 3 4 5 6 x (45) cry or show distress when tickled? 2 3 4 5 6 7 x (46) repeat the same movement with an object for

2 minutes or longer (e.g., putting a block in a cup, kicking or hitting a mobile)?

When something the babl:'. was 2lal:'.ing with had to be removed, how often did s/he:

2 3 4 5 6 7 x (47) cry or show distress for a time? 2 3 4 5 6 x (48) cry or show distress for several minutes or

longer? 2 3 4 5 6 x (49) seem not bothered?

When tossed around 2la):'.full):'., how often did the baby:

2 3 4 5 6 7 x ( 50) smile? 2 3 4 5 6 x (51) laugh?

During a 2eekaboo game, how of ten did the babl:'.:

2 3 4 5 6 x (52) smile? 2 3 4 6 x (S3) laugh?

Daill:'. Activitie~

How often during the last week did the babl:'.:

2 3 4 5 6 7 x

2 3 4 5 6 7 x

(S4) cry or show distress at a loud sound (blender, vacuum cleaner, etc.)?

(SS) cry or show distress at a change in parents' appearance (glasses off, shower cap on, etc.)?

78

D

D

D

5

(1) (2) (3) (4) (5) (6) (7) (X)

Never Very Rarely

Less Than About Half More Than Half The

Time

Almost Always

Always Does Not Apply

Half The The Time Time

How often during the last week did the baby:

2 3 4 5 6 7 x

2 3 4 5 6 x

2 3 4 5 6 x

2 3 4 5 6 7 x

2 3 4 5 6 x 2 3 4 5 6 7 x

(56) when in a position to see the television set, look at it for 2-5 minutes at a time?

(57) when in a position to see the television set, look at it for 5 minutes or longer?

(58) protest being put in a confining place (infant seat, play pen, car seat, etc.)?

(59) startle at a sudden change in body position (for example, when moved suddenly)?

(60) startle to a loud or sudden noise? (61) cry after startling?

When being held, how often did the baby:

2 3 4 5 6 7 X (62) squirm, pull away or kick?

When placed on his/her back, how often did the baby:

2 3 4 5 6 2 3 4 5 6

x x

2 3 4 5 6 x 2 3 4 5 6 7 x 2 3 4 5 6 x

(63) fuss or protest? (64) smile or laugh? (65) lie quietly? (66) wave arms and kick? (67) squirm and/or turn body?

When the baby wanted something, how often did s/he:

2 3 4 5 6 x

2 3 4 5 6 7 x

(68) become upset when s/he could not get what s/he wanted?

(69) have tantrums (crying, screaming, face red, etc.) when s/he did not get what s/he wanted?

When placed in an infant seat or car seat, how often did the baby:

2 3 4

2 3 4

5 6

5 6

x x

2 3 4 5 6 7 x

(70) wave arms and kick? (71) squirm and turn body? (72) lie or sit quietly?

79

D

D

D

D

D

D

D

(1)

Never

(2) Very

Rarely

( 3)

Less Than Half The

Time

(4)

About Half The Time

( 5)

More Than Half The

Time

(6) Almost Always

( 7)

Always

(X) Does Not Apply

When placed in an infant seat or car seat, how often did the baby:

2 3 4 5 6 7 x (73) show distress at first; then quiet down?

6

When you returned from having been away and the baby was awake, how often did s/he:

2 3 4 5 6 7 x (74) smile or laugh?

When introduced to a strange person, how often did the baby:

2 3 4 5 6 7 x 2 3 4 5 6 x 2 3 4 5 6 7 x 2 3 4 5 6 x 2 3 4 5 6 7 x 2 3 4 5 6 x

(75) cling to a parent?

(76) refuse to go to the stranger?

(77) hang back from the stranger? (78) never "warm up" to the stranger?

(79) approach the stranger at once?

(80) smile or laugh?

When introduced to a dog or cat, how often did the babv:

2 3 4 s 6

2 4 5 6 2 3 4 6

x x x

(81) cry or show distress? (82) smile or laugh?

(83) approach at once?

Soothing Techniques

Have you tried any of the following soothing techniques in the last two weeks? If so, how often did the method soothe the baby? Circle (X) if you did not try the technique during the LAST TWO WEEKS.

2 3 4 5 6

2 3 4 6

2 4 5 6

x x x

3 4 6 7 x 2 3 4 5 6 7 x 2 3 4 5 6 7 x 2 3 4 5 6 x

( 84) rocking

(85) holding (86) singing or talking (87) walking with the baby (88) giving the baby a toy (89) showing the baby something to look at (90) patting or gently rubbing some part of the

baby's body D 3 .:. 5 6 x (91) offering food or liquid

80

(1) (2) ( 3) (4) (5) (6) ( 7) (X) Never Very Less Than About Half More Than Almost Always Does

Rarely Half The The Time Half The Always Not Time Time Apply

Soothins; technigues:

2 3 4 5 6 x (92) offering baby his/her security object 2 3 4 5 6 x (93) changing baby's position

D 2 3 4 5 6 x (94) other (please specify)

81

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