To examine the relations between infants' sustained withdrawal behavior and children's mental health status and maternal and child relational behavior, 36 clinic-referred and 43 control infants were evaluated. Families were visited at home, mother-child free play and feeding interactions were videotaped, and mothers completed self-report measures. Interactions were coded for sustained withdrawal using the Alarm Distress Baby Scale (ADBB; Guedeney and Fermanian, 2001) and for global relational patterns with the Coding of Interactive Behavior (CIB; Feldman, 1998). Higher ADBB scores were found for the referred group, with many infants (38.9% ) scoring above the clinical cutoff (vs. 11.6% in the control group). More negative relational patterns were found for the withdrawn group in terms of higher maternal intrusiveness, lower reciprocity, and lower child involvement. Associations were found between maternal and child behavior during play and feeding and child sustained withdrawal behavior at play. Sustained withdrawal also was associated with unpredictable child temperament and lower sense of parental self-efficacy. Maternal depressive symptoms were higher in the referred group and correlated with maternal and child relational patterns. The findings contribute to the construct and discriminant validity of the CIB and the ADBB coding systems, and suggest that sustained withdrawal may serve as a risk indicator for early socioemotional disorders.

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To examine the relations between maternal representations, infant socio-emotional difficulties, and mother-child relational behavior, 49 clinic-referred infants and their mothers were compared to 30 non-referred controls. Clinic-referred infants' psychiatric status was determined with the DC 0-3-R classification of Zeanah and Benoit (Child Adolesc Psychiatry Clin N Am 4:539-554, 1995) and controls were screened for socio-emotional difficulties. Mothers were interviewed with the parent development interview (Aber et al. in The parent development interview. Unpublished manuscript, 1985) and dyads were observed in free play and problem-solving interactions. Group differences emerged for maternal representations and relational behaviors. Representations of clinic-referred mothers were characterized by lower joy, coherence, and richness, and higher anger experienced in the mother-infant relationship compared to controls. During free play, clinic-referred mothers showed lower sensitivity and higher intrusiveness and provided less adequate instrumental and emotional assistance and support during problem solving. Referred children showed lower social engagement during free play. Associations were found among maternal representations, maternal interactive behavior, child social engagement, and the child's ability to self-regulate during a challenging task. These findings provide empirical support for theoretical and clinical perspectives suggesting a reciprocal link between maternal negative representations and mother and child's maladaptive behaviors in the context of early socio-emotional difficulties and mental health referrals.

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