Treating Parent-Infant Relationship Problems: Strategies
for Intervention
Edited by Arnold J. Sameroff, Susan C. McDonough and Katherine L. Rosenblum,
New York, NY, Guilford Publications, 2004, 304 pp., $40.00, Hardcover.
This book is an amazing collection of
essays on “infant mental health” practice
by world-renown experts in this field.
The editors: have extensive experience
in collaborative research and practice
with parents and infants. As Sameroff
indicates in the first chapter, “Treating
early relationship problems is important
for two aspects, the relief of current suf-
fering and the prevention of long-term
consequences.” With this purpose in
mind, the book offers a wealth of under-
standing for pediatricians and others
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who collaborate with pediatricians in
providing services, and developing pro-
grams for families and infants.
The first three chapters deal cogently
with central themes and frameworks for
understanding parent-infant work, espe-
cially for those whose primary training
involves diagnosing and treating the ill-
nesses of individuals. As Sameroff indi-
cates, in this work, the “real patient” is
the parent-infant relationship. In Ports of
entry and the dynamics of mother-in-
fant interventions he provides a frame-
work for addressing problems in fami-
lies. Practitioners learn to choose a
therapeutic practice or “port of entry”
which may vary between: addressing
health concerns effecting infant behav-
ior; changing parental perceptions of in-
fant behavior, modifying parent-infant in-
teractions, or developing parenting
abilities.
In The motherhood constellation:
Therapeutic approaches in early rela-
tional problems noted psychiatrist,
Daniel Stern, discusses a new clinical cat-
egory, the ‘prototypic’ patient, a mother
(and her infant) and discusses what is
unique, and non-clinical about women
becoming mothers. His therapeutic ap-
proach takes into account both the be-
havior and representations (inherent
perceptions deriving from current and
remembered interactions) of both partic-
ipants in the interaction; the mother’s
actions and representations and the in-
fants’ actions and representations. Ap-
proaches may emphasize either ob-
served interactions or representations,
but Stern details what underlies these
72 Book Reviews
approaches and what is necessary in the
unique relationship between clinician
and mother.
In Defining infant mental health: A
developmental relational perspective
on assessment and diagnosis Katherine
Rosenblum discusses exceptional chal-
lenges in diagnosing disruptions and dis-
orders in parent-infant relationships. In-
cluded in this chapter is the new Zero to
Three approach: DC:0-3 to diagnosis,
combining primary infant diagnosis with
relationship disorder classifications.
Ways of conducting multi-focal assess-
ments with parents and infants are de-
scribed as well.
The rest of text addresses significant
variations in parent-infant clinical work –
based primarily on therapeutic approach
and/or populations of parents and in-
fants addressed. Interaction guidance:
Promoting and nurturing the caregiv-
ing relationship describes Dr. McDon-
ough’s way of engaging troubled families
and collaborating with them; in identify-
ing positive aspects of their taped inter-
actions with their infants; and in modify-
ing interactions over time that promote
satisfying exchanges for infant and par-
ent. In Child-parent psychotherapy: A
relationship-based approach to the
treatment of mental health disorders in
infancy and early childhood Alicia
Lieberman describes her well researched
approach which involves alternating be-
tween discoveries made between past
history and current representations, is-
sues in the therapist-parent relationship
that may reflect past attachment pat-
terns, and ongoing patterns of interac-
tion with the infant.
The primary triangle: treating in-
fants in their deals with working with
mothers, fathers and infants and includes
addressing the dyads within the primary
triangle (mother-infant; father-infant;
mother-father). A sensory processing ap-
proach to supporting infant-caregiver
relationships” derives from Dr. Winnie
Dunn’s extensive experience with treat-
ment of infants and children. The chap-
ter indicates how to use the infant’s sen-
sory processing issues in consultation
Journal of Developmental & Behavioral Pediatrics
with parents. In A multifocal neonatal
intervention Dr. Nadia Bruschweiler-
Stern, a pediatrician, describes how to
use newborn assessment as a context for
consulting with parent and infant. The
chapter provides a framework for under-
standing what mothers bring to the con-
sultation and how joint observation of
infant functioning can change ongoing
interaction and improve care.
Lessons from STEEPTM: Linking the-
ory, research, and practice for the well-
being of infants and parents describes
an innovative, well researched approach
involving a multidisciplinary early inter-
vention team that can address the many
facets of childhood problems and high-
lights engaging parents as collaborators
in the process. Treating parent-infant
relationships in the context of maltreat-
ment: An integrated systems approach
by Julie Larrieu and Charles Zeanah, de-
tails the functioning of the multidisci-
plinary ‘infant team’ with families. The
team functions to keep the parent-infant
relationship at the core of treatment in
spite of complex family and systems is-
sues.
In Therapeutic relationships in in-
fant mental health and the concept of
leverage Drs. Robert Emde, Kevin Ever-
hart and Brian Wise integrate the previ-
ous thinking in the book and reflect
upon their extensive clinical experience.
Central to this chapter is the concept of
‘leverage’, defined as thinking about a
“maximum point of efficiency for inter-
vention in the process of relationships
influencing other relationships”.
This masterful work has a great deal
of offer psychologists, social workers,
counselors, and infant mental health spe-
cialists. I would say that early interven-
tionists, maternal-child nurses, and early
childhood mental health consultants
would benefit from what the book has to
offer.
Zack Boukydis, PhD
Erikson Institute, Chicago, IL
 What Causes ADHD? Understanding What Goes Wrong
and Why
by Joel T. Nigg PhD, New York, NY: The Guilford Press, 2006, 422 pp., $42
(hard cover).
Despite being the subject of intense
scientific research and much public dis-
cussion, Attention-deficit/hyperactivity
disorder (ADHD) remains poorly under-
stood. In this ambitious work, Joel Nigg
sets out to improve the reader’s under-
standing of ADHD by summarizing the
present scientific knowledge about the
neuropsychological mechanisms and
neural processes affected in ADHD and
reviewing the current research on ge-
netic and environmental etiologies for
the disorder.
Part I of Nigg’s book, “Conceptual
Context,” sets the stage by summarizing
current public controversies regarding
ADHD and then how and why ADHD has
been defined as a disorder. Importantly,
Nigg addresses public concern that
ADHD incidence and treatment rates are
rapidly rising by providing a summary
and critique of the current epidemio-
logic literature. He discusses the validity
and utility of defining ADHD as a disor-
der, and appropriately highlights the
clinical heterogeneity of the ADHD
grouping.
Part II, “How Does ADHD Work?” de-
scribes the mechanisms of cognitive and
behavioral dysfunction seen in individu-
als with ADHD. “Neural Systems” pro-
vides an overview of the available litera-
ture on the key brain regions,
neurochemical pathways, and neural ac-
tivation and circuitry patterns implicated
in ADHD. “Attention and Arousal;” “Ex-
ecutive Functioning and Cognitive Con-
trol;” “Motivation;” and “Motor Control
and Timing,” describe dysfunction in the
core affected areas as they relate to the
clinical picture seen in children with
ADHD. Nigg includes detailed explana-
tions of the neuropsychological tests
Vol. 29, No. 1, February 2008
used to define dysfunction in these areas,
as well as the brain regions and neural
systems thought to correspond to each
area.
Part III, “Where Does ADHD Come
From?” reviews the scientific literature
on ADHD etiologic mechanisms. “Multi-
ple Pathways,” discusses ADHD’s likely
causal heterogeneity. “Genetic Effects,”
summarizes behavioral genetic findings
to date, including the magnitude of her-
itability estimates in ADHD, and the evi-
dence regarding specific candidate
genes, chromosomal regions implicated
in whole genome scans, and genotype-
environment interactions. “Uncommon
Experiential Risk Factors,” provides an
overview of the evidence linking ADHD
to less common but modifiable risk fac-
tors, including low birth weight, prena-
tal alcohol and nicotine exposure, child-
hood toxicant exposures (lead, mercury,
manganese), and psychological trauma
(i.e., abuse, deprivation, and attachment
problems). “Common Experiential Risk
Factors,” details the evidence for and
against more prevalent potential ADHD
environmental risk factors, including di-
etary factors (food additives, sugar, caf-
feine, omega-3 fatty acid deficiencies),
electronic media (television and video
games), and environmental toxins (pesti-
cides and PCBs). Overall, this overview
of potential etiologic risk factors is ex-
haustive and authoritative. However,
two potential risk factors for attention
dysfunction not reviewed in What
Causes ADHD? include iron and zinc de-
ficiencies.
Part IV, “Integration,” summarizes
and integrates the causal mechanisms
and etiologic factors detailed in Parts II
and III. Notably, this work concludes
with a roadmap for future research areas
which, based upon his literature review,
hold promise “to generate break-
throughs in understanding that can lead
to meaningful prevention” of ADHD.
The intended audience for What
Causes ADHD? includes researchers in
child psychology, child psychiatry, pedi-
atrics and school psychology, as well as
graduate students and practitioners in
these areas. Researchers, in particular,
will appreciate this masterful synthesis
of the current scientific literature on
causes of dysfunction in ADHD. Nigg
also makes What Causes ADHD? acces-
sible for clinicians by beginning each
chapter with an overview of how the
subject matter relates to common paren-
tal concerns, and ending each chapter
with a section on “Clinical Implications,”
a table detailing families’ “Frequently
Asked Questions” and proposed an-
swers, and a final “Summary” section.
However, patient families, and even cli-
nicians lacking strong neuropsychology
training, will likely find the body of each
chapter daunting in its complexity and
level of detail. In fact, in his first chapter,
Nigg asserts that What Causes ADHD?
“assumes that readers are acquainted
with or can easily access a range of clin-
ically relevant background issues.” In
other words, while this synthesis of the
scientific literature is rightly described as
a tour de force, What Causes ADHD? is
not aimed at the uninitiated.
Tanya Froehlich, MD, MS
Division of Developmental - Behavioral
Pediatrics, Cincinnati Children’s
Hospital Medical Center
Cincinnati, OH
© 2008 Lippincott Williams & Wilkins 73