Infant irritability and early mother–infant reciprocity patterns

Infant and Child DevelopmentInf. Child Dev. 8: 71–84 (1999)

Infant Irritability and EarlyMother–Infant ReciprocityPatterns

Susan Lowinger*,1

Department of Education, Baker Center, Bar-Ilan University,Ramat-Gan 52900, Israel

This study investigated how various forms of neonatal irritabil-ity (at 3 days) and irritability at 10 weeks are related to reciprocalinteractions between mothers and their infants. Fifty-six full-term, first-born male infants were examined using the NeonatalBehavioral Assessment Scale (NBAS-K) at 3 days postpartum.Each infant was rated for irritability to aversive stimuli, generalirritability, consolability and responsiveness to visual–auditorystimuli. At 10 weeks of age, during a home visit, mother–infantreciprocity was scored for gaze, smile, vocalization and holdbehaviors. Based upon maternal reports and behavioral observa-tions, infant irritability was scored at 10 weeks using the NBAS-K scoring system. Findings revealed that: (1) there were twodistinct forms of reciprocity: social and physical; (2) generalirritability at 3 days was negatively related to reciprocal holdinteraction and positively related to reciprocal social interactionat 10 weeks, and (3) neonatal irritability to aversive stimuli (at 3days) was positively related to subsequent reciprocal social inter-action. Regression analyses showed that neonatal variables werethe foremost predictors of reciprocal hold at 10 weeks. Findingsare discussed in terms of (1) the need to differentiate betweensocial and physical behavioral patterns, and (2) time-lag effectswith respect to mother–infant interactions. Copyright © 1999John Wiley & Sons, Ltd.

Key words: irritability; consolability; NBAS-K; social interaction;physical interaction; mother–infant reciprocity

Infant irritability has been cited for its influence on mother–infant interactionpatterns (Klein, 1984; McGrath et al., 1993; Schuler et al., 1995). High levels ofirritability on the part of the infant during the postnatal period lead to less thanoptimal maternal contact (van den Boom and Hoeksma, 1994). Excessive infantcrying has been implicated for its connection with the development of insecureinfant attachments (Crockenberg, 1981; Goldsmith and Alansky, 1987; Bell, 1990;Sussman-Stillman et al., 1996) leading the way to intervention studies aimed at

* Correspondence to: Department of Education, Bar-Ilan University, Ramat-Gan 52900, Israel.1 Tel.: +972 3 9362372; fax: +972 3 5333132.

CCC 1522–7227/99/020071-14$17.50Copyright © 1999 John Wiley & Sons, Ltd.

Received 10 March 1997Accepted 10 November 1998

S. Lowinger72

helping mothers cope with their irritable infants or at helping the infantsthemselves become less irritable (Field, 1992; van den Boom, 1994).

Nevertheless, there have been conflicting reports in the literature as to thespecific ways that infant irritability affects care-giving behavior. Some studiesshow that irritable babies tend to have more contact with their mothers, otherstudies show that irritable infants have less responsive mothers, and still othersdiscuss changing patterns of maternal behavior over time (Fish et al., 1991; vanden Boom, 1994). One explanation for these contradictory findings is thatdifferences arise because some studies use maternal report measures whileothers use observational measures of infant irritability (Crockenberg, 1986; vanden Boom, 1994).

An alternative explanation for conflicting reports as to the relationship be-tween irritability and care-giving behavior may lie in the profusion of defini-tions of irritability. In recent years, defining infant irritability has become animportant issue of research (Barr, 1995).

Some researchers contend that irritability is a specific index of the infant’sresponsiveness to stress (Davis and Emory, 1995; Gunnar et al., 1995). Othersdefine irritability as a temperamental trait that cuts across all types of experi-ences and presents itself in a variety of contexts (Sussman-Stillman et al., 1996).It has been suggested that using the terms ‘irritability’ ‘difficult temperament’and ‘persistent crying’ interchangeably in the literature poses problems in themeasurement of the longitudinal stability of temperament (Papous' avek andHofacker, 1995).

Perhaps the substitution of terms such as ‘negative emotionality’ for ‘irritabil-ity’ and the usage of other numerous and varied definitions of irritability leadto conflicting results regarding infant irritability and its relation to maternalbehavior.

The clinical need to differentiate between types of irritability that mightinfluence not only how an infant is perceived by his mother, but how she relatesto him, led researchers to add a General Irritability item to the BrazeltonNeonatal Behavioral Assessment Scale–Kansas version (Horowitz et al., 1978). Inthe original NBAS examination, infant irritability was scored on the basis ofhow many times the infant cried to very real aversive situations (Brazelton,1973). This posed difficulties in assessment of the infant who did not necessarilycry as a response to being bothered, but was easily annoyed by all kinds ofcontact, including visual and auditory stimulation and even possibly being heldand cuddled by his mother. It was assumed that the mother–infant relationshipwould be different for the infant who was generally irritable even duringinteractive situations.

In their study regarding consistency of infant temperament from birth to 9months, Matheny et al. (1985) assessed irritability using a variety of measures,including measures of spontaneous irritability as well as irritability to aversivestimuli. In recent years, some researchers explain their findings in terms ofspontaneous versus reactive types of irritability (DiPietro and Porges, 1991) andsome recommend the use of two measures of infant irritability: (a) irritability tostressful experiences, and (b) overall irritability to moderately novel situations.Fish et al. (1991), for example, found that many 5-month-old infants fussed orcried only during a stressful procedure (i.e. arm restraint) and that other infantswho were fussy during less aversive procedures did not necessarily exhibitirritability under stressful circumstances. The present study examined howvarious forms of neonatal irritability (i.e. irritability to aversive stimuli, generalirritability) and irritability at 10 weeks (general irritability based upon observa-

Copyright © 1999 John Wiley & Sons, Ltd. Inf. Child Dev. 8: 71–84 (1999)

Irritability and Reciprocity 73

tions and maternal reports) would be related to reciprocal interactions betweenmothers and their infants.

METHOD

Subjects

The subjects were 56 infants and their mothers selected from the birth registersof two Israeli hospitals. All infants were fullterm, with birth weights from 2.300to 4.050 kg and Apgar ratings of 8 or better at 1 and at 5 min. The sample wasrestricted to first-borns to eliminate any variations due to birth order. Since sexdifferences have been shown in infants’ levels of irritability (Belsky et al., 1991;Davis and Emory, 1995) and in relation to maternal contact (Moss, 1967), onlymale infants were included in the sample.

Mothers ranged in age from 18 to 35 years (mean age of mothers=24,S.D.=3.6). In order to reduce variability in educational status, only motherswho were married and had a minimum of 10 years of school (number of yearsrequired education in Israel) were included. Mothers were approached to obtaintheir agreement to participate in a research project concerned with infantdevelopment. Three of the women approached did not give their consent to takepart in the study. Most of the women expressed interest in the research andwere more than willing to participate.

Overall design

Babies were tested using the NBAS-K exam when they were 3 days old andgiven scores for general irritability and irritability to aversive stimuli, as well asfor consolability and orientation to animate and inanimate stimuli. Ten weekslater, a home visit was conducted at which (1) mother–infant interactions wereobserved and both infants and mothers were rated for gaze, vocalization, smile,touch and hold behaviors, (2) babies were scored for general irritability, con-solability, and responsiveness to stimuli and (3) mothers were interviewed withregard to their infants’ crying patterns.

Procedure

The reporting of procedures is divided into three sections, one dealing withneonatal measurement of irritability, another with assessment of reciprocityduring mother–infant interactions at the 10 week home visit and the third withmeasurements of irritability at the 10 week home visit.

Assessment of irritability in the neonateBabies were tested with the NBAS-K exam during the third day postpartum

(mean infant age=55 h, S.D.=13.9). In 12 instances, due to the need toaccommodate to hospital schedules, it was necessary to administer the examduring the baby’s second day. The exam was conducted in a quiet roomadjacent to the nursery.

The NBAS items were performed in the following order: (a) uncover infant,(b) undress infant, (c) light pinprick on the sole of the foot, (d) pull-to-sit, (e)place infant in prone position, (f) hold infant in horizontal and up-to-shoulderposition, (g) orientation items, (h) cloth on face maneuver, (i) elicitation of thetonic neck reflex, (j) elicitation of the Moro reflex. If the infant became upsetduring the procedures and could not quiet himself within 15 s, the examiner


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used the NBAS consoling procedures in their prescribed order. The exam tookbetween 20 and 30 min to administer. Irritability items (irritability to aversivestimuli and general irritability) as well as consolability and orientation to visualand auditory stimuli were scored according to the NBAS-K scoring systemimmediately after administration of the NBAS exam.

The two investigators in the study had earlier established testing reliabilitywith trained NBAS-K examiners and had extensive experience in administeringthe NBAS-K to infants in Israeli nurseries. Immediately prior to the presentstudy, they rated a pilot sample of ten infants and achieved an interscorerreliability index of 0.95 or better on each NBAS-K item, calculated by dividingagreements by the sum of agreements plus disagreements.

Assessment of reciprocal mother– infant interactions at 10 weeksIn order to study the mother–infant system under conditions that were as

natural as possible, follow-up observations were conducted in the subjects’homes. When the infant was approximately 10 weeks of age (mean age ofinfants=72 days, S.D.=6.2), the mothers were contacted. An appointment wasmade to observe the baby at home at a time that was convenient for the motherand after he had recently been fed. At this point in the study, the examiner wasunaware of the NBAS scores of the baby at 3 days.

The third month was selected as the age for the follow-up visit because it wasfelt that by that time most mothers would have established a reasonable routine,and would be past the immediate effects of childbirth, while the infants at thisage could be expected to express behavior along all of the modalities underinvestigation. Furthermore, in most cases, at this age the mother is still theprimary caretaker, since in Israel even mothers who work outside the home donot usually return to their jobs until the infant is 3 months old.

Upon arrival, mothers were told that the research study was concerned withyoung babies’ responses to visual stimuli. The observer explained that shewould show the baby a set of colored circles two times, with a 15-min intervalbetween the first and second times to ensure that the ‘effects’ of the first stimuli‘wore off’. The only instructions given to the mother were that she remain in thesame room as the baby because it might upset him if she went out. No otherpersons were present in the room during the observations. Mothers readilyaccepted this explanation of the study’s purposes and most did not show muchcuriosity as to the entire procedure. In general, the atmosphere during the homevisit was relaxed and casual.

Infants were then shown colored circles on a white rectangular background.The stimuli were held 25 cm from the infant’s eyes and moved slowly in an arcof 180°. The observer noted whether the infant was responsive to these inani-mate stimuli and if he showed visual following. The observer also presented hersmiling face to the infant and noted his responsiveness to visual and auditoryanimate stimuli. During the next 15 min, mother and infant behaviors wereobserved and coded using the mother–infant interaction scale.

Mother– infant interaction scale. The mother–infant interaction scale used in thisstudy was based upon the Campbell Initial Rating Scale (Campbell, 1977) inwhich each mother and infant is scored on several behavioral modes (visualengagement, vocalization, smiling, touching, holding and maintenance of prox-imity) in order to measure their degree of interaction. In the original researchproject by Campbell, mothers and infants were given a score of 1 or 0 to indicatethe presence or absence of each of the behaviors during the observation period(weighing procedure at the well-baby clinic). In the present study, a score of 1



or 0 was given to mother and/or infant for each specific mode displayed in aninterval of 30 s during the 15-min observation period.

Other investigators have used similar observation procedures rating mothersand infants every 30 s (Fish et al., 1991). Thus, scores ranged from 0 to 30 foreach of the following behavioral modes:

Maternal behavioral modes: (1) en face gazing at infant, (2) vocalizing to infant, (3)smiling at infant, (4) touching infant (i.e. kisses, fondles, pats), (5) holding theinfant (i.e. mother holds the baby in her arms, lap or at her shoulder, accommo-dating her body to her infant’s physical movements).

Infant behavioral modes: (1) gazing at mother’s face, (2) vocalizing (i.e. includingcoo, whimper, fuss or cry), (3) smiling at mother, (4) touching mother, (5)participating in hold by molding to mother’s body. In addition, the baby’s statewas recorded as were the mother’s proximity to the infant, as well as hersoothing techniques when the baby cried.

Mother– infant interaction scores: When the mother and infant showed same-modebehavior during an interval, reciprocal interaction was scored for that behavior.Thus, reciprocity scores for a mother–infant dyad could range from a minimumof 0 (no reciprocal interactions during any of the intervals) to a maximum of 30(reciprocal interactions during all of the intervals) for gazing, vocalizing, smil-ing, touching and holding. To establish inter-rater reliability for the interactionscale, dual observations were made on ten mother–infant pairs. The degree ofagreement between the two observers for the reciprocal gaze, smile, vocal andhold measures was established at 0.85 or greater. The reciprocal touch measuredid not reach satisfactory levels of inter-observer reliability and was, therefore,not included in the data analyses.

Assessment of the infant at 10 weeksFollowing the 15-min observation, the infant was again shown the visual

stimuli, after which the examiner conducted a semi-structured interview withthe mother. The mother was asked ‘Tell me about your baby’. After the motheroffered a description of her baby, in which she generally discussed the infant’scrying and eating habits and his level of responsiveness to stimuli, she wasasked ‘What kinds of things make your baby cry?’ and ‘If he cries how do youconsole him?’.

The following are the irritability, consolability and reponsiveness to stimuliscores at the 10 week home visit:

(a) General irritability—observed: general irritability of the infant during the15-min observation was scored on a scale of 1–9 using the NBAS-K scoringsystem.

(b) General irritability—reported: a score for general irritability was derivedfrom the information gathered in the interview with the mother. Using theNBAS scoring system as closely as possible, the score was based upon themother’s report of: (1) whether the baby cried often, sometimes or wasusually placid and (2) whether the baby cried only when he was exposed toaversive stimuli (i.e. hunger, pain) or for more emotionally related reasons(i.e. frustration, displeasure).

(c) Consolability—observed: a consolability score from 1 to 9 (using to theNBAS rating system) was given according to the number and kinds ofmethods used by the mother to console him during the observation session.


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(d) Consolability—reported: a score for consolability was derived from theinformation gathered in the interview with the mother. The followingsources of information were used in order to compute the NBAS scalesystem score: (1) how easy or difficult it was to console the infant; (2) whichmethods the mother used to console the baby; (3) which soothing methodswere sometimes effective and which methods could always be relied uponto console the infant when he cried.

(e) Responsiveness to stimuli: responsiveness of the infant was scored in arange of 1–5 according to his response to animate and inanimate stimuli asobserved during the presentation of visual stimuli.

RESULTS

Reciprocal behavior patterns

It was found that there were two main categories of reciprocal behavior. Thefirst category that will be referred to as reciprocal social behavior, includedreciprocal gaze, reciprocal vocal and reciprocal smile behaviors. These threemodes of interaction were highly correlated with one another. The secondcategory included only reciprocal hold, which proved to be negatively corre-lated with reciprocal gaze, reciprocal vocal and reciprocal smile behaviors(Table 1). Reciprocal social and reciprocal hold behaviors were negativelycorrelated to one another (r= −0.36, pB0.01).

Irritability and reciprocal behavior patterns

The assumption that mother–infant reciprocity patterns are related to infantirritability was tested by means of Pearson correlations. Results indicate thathigh general irritability at 3 days (a) was negatively related to reciprocal holdinteraction (r= −0.23, pB0.05) at 10 weeks; and (b) was positively related toreciprocal social interaction (r=0.27, pB0.01) at 10 weeks. Irritability to aver-sive stimuli at 3 days was positively related to reciprocal social interaction at 10weeks (r=0.25, pB0.01).

An analysis of the relationship between general irritability at the 10 weekobservation (15 min) and reciprocity at that time indicates that high generalirritability (observed) (a) was positively related to hold interaction (r=0.22,pB0.05) and (b) negatively related to social interactions (r= −0.30, pB0.01)(Table 2).

Table 1. Pearson correlations between reciprocity behaviors

Reciprocity behaviors (2) (5)(3) (4)

1. Total reciprocity 0.110.57***0.80***0.79***2. Reciprocal gaze 0.63*** 0.67*** −0.34**

0.43*** −0.25*3. Reciprocal vocal4. Reciprocal smile −0.36**5. Reciprocal hold

Note: N=56.* pB0.05, ** pB0.01, *** pB0.001.



Table 2. Pearson correlations between infant irritability (neonatal and 10 weeks) andreciprocal interactions

Infant irritability (10-weeks)Infant irritability (neonatal)

Irritability to General GeneralGeneralirritabilityirritabilityaversive stimuli irritability

reported observed(N=51) (N=55)(N=55)(N=56)

Reciprocal hold 0.01 −0.23* −0.01 0.22*0.25* 0.27** 0.01 −0.30**Reciprocal social

* pB0.05, ** pB0.01.

Irritability, consolability, and responsiveness to stimuli: intercorrelations andrelationship to reciprocity

Correlations between general irritability and consolability—both at the neonatalobservation and at the 10 week observation—indicate that these variables aresignificantly dependent upon one another (see Table 3). There are significantnegative correlations between general irritability and consolability as measuredon the NBAS-K examination at 3 days (r= −0.48, pB0.001) and again betweengeneral irritability and consolability as measured at 10 weeks by maternal report(r= −0.47, pB0.001) and by observation (r= −0.40, pB0.001).

Infant responsiveness to stimuli was measured (at 3 days and at 10 weeks) inorder to ascertain the infant’s general irritability to all forms of stimulation.According to these results, orientation to stimuli at 3 days is positively corre-lated with his responsiveness to stimuli at 10 weeks (r=0.34, pB0.01). Further-more, the 10-week-old infant’s responsiveness to stimuli is related to concurrentmeasures of irritability and consolability (see Table 3). There is a negativecorrelation with observed level of general irritability (r= −0.37, pB0.01) and apositive correlation with his observed ability to be consoled (r=0.31, pB0.05).

In addition, the relationship between responsiveness to stimuli and mother–infant reciprocal interactions was tested by means of Pearson correlations.Results indicate that infant responsiveness at 10 weeks is positively correlatedwith reciprocal social interaction between mother and child (r=0.45, pB0.001).

To further determine the relationships between irritability, consolability, andresponsiveness and their power to predict reciprocal interactions between theinfant and his mother, a series of regression analyses was conducted. For theregression analyses, the dependent criteria were: (a) reciprocal hold interactionand (b) reciprocal social interaction. For each of these two dependent variables,regression analyses were performed using the items measured by the NBAS-Kexam at 3 days and the variables measured at the 10 week observation as theindependent variables. Regression equations were computed by a stepwisemethod that entered the infant variables into the equations in the order of thesignificance of their contribution to the explained variance. Results for theanalyses of regression are presented in Tables 3 and 4. The tables include adescription of the inter-correlations between all variables in the regressionequations (Table 3) and a summary table of predictors for reciprocal hold andreciprocal social (Table 4) interaction. (The criteria for stopping variable entrywas when the partial correlation was B0.15).


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Table 3. Inter-correlations between infant irritability, consolability and responsivity (neonatal and 10 weeks)

(4) (5) (6) (7) (8) (9)(2) (3)Infant behaviors

−0.19 −0.211. Irritability to averse stimuli (neonatal) 0.11 0.040.42*** −0.04 −0.02 0.00−0.28* −0.13 −0.03 0.14−0.022. General irritability (neonatal) −0.09−0.048***

0.203. Consolability (neonatal) −0.11 0.20 0.36* −0.17−0.13−0.12 0.09 0.04 0.34**4. Orientation to stimuli (neonatal) −0.02

0.21 −0.47*** −0.22 −0.145. General irritability (reported, 10 weeks)−0.19 −0.40*** −0.37**6. General irritability (observed, 10 weeks)

0.46*** 0.237. Consolability (reported, 10 weeks)0.31*8. Consolability (observed, 10 weeks)

9. Responsiveness to stimuli (10 weeks)

Note: N’s range from 36 to 46 for correlations involving variables (7) and (8) for all other correlations, N ranges from 48 to 56.* pB0.05, ** pB0.01, *** pB0.001.


Results show that the first predictor for reciprocal hold—from all the neonataland 10 week variables—is the infant’s general irritability at 3 days. Orientationand consolability (neonatal) each add 3% to the variance. The only 10 weekvariable that adds significantly to the variance (4%) is observed generalirritability.

In contrast, the better predictors for reciprocal social interaction are the 10week variables. Responsiveness of the infant at 10 weeks accounts for 20% of thevariance. Only irritability to aversive stimuli—as measured at 3 days—is asignificant predictor of social reciprocity.

DISCUSSION

Reciprocal behavior patterns and irritability

In this study, two forms of reciprocity emerged: one, the more physicalinteraction, with the mother and infant giving and receiving pleasure byholding/being held, the other, a more socially oriented kind of interaction,including vocalizing, smiling and gazing. The fact that these forms exist iswell-documented (Stern, 1977; Ainsworth, 1982; Waters and Deane, 1982; vanden Boom and Hoeksma, 1994). The interesting and somewhat unexpectedresult of this study was the separation of these two reciprocal interactions intosomewhat mutually exclusive behavior patterns.

The differentiation between social and physical reciprocal patterns provedcritical to understanding the results concerning infant irritability and themother–infant relationship. This paper’s results indicated that the relationshipbetween the infant’s general irritability and the type of reciprocal mother–infantinteraction depends upon the specific point in time that these variables weremeasured. Infants who were more irritable and cried more during the 10 weekobservation showed higher hold reciprocity and less social reciprocity with theirmothers. The simplest explanation for this would be that, at the time, the mosteffective way of quieting a crying infant was to hold him and due to the infant’sirritable state, there was no disposition on either the mother’s nor on the infant’spart to engage in social interaction. The crying infant terminates social interac-tion bouts: both partners are literally ‘not in the mood’ to become involved insocial interaction (Papous' ek and Papous' avek, 1977; Papous' avek and Hofacker,1995).

Table 4. Summary table of regression analyses of neonatal and 10 weeksvariablesa using reciprocal hold and reciprocal social criteria

R2 ChangeMultiple RStep and Variable

Reciprocal Hold0.050.231. General irritability (neonatal)0.030.292. Orientation to stimuli (neonatal)

0.35 0.043. General irritability (observed, 10 weeks)4. Consolability (neonatal) 0.39 0.03

Reciprocal Social0.200.451. Responsiveness to stimuli (10 weeks)

2. Irritability to aversive stimuli (neonatal) 0.51 0.060.070.573. Consolability (reported, 10 weeks)

4. General irritability (observed, 10 weeks) 0.020.59

aThe criteria for stopping variable entry was when the partial correlation was B0.15.


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But the reciprocal pattern was different for those infants who showed higherlevels of overall irritability at 3 days: infants who were more generally irritableas newborns were less likely to be held by their mothers (at 10 weeks) and weremore likely to engage in social interactions with their mothers at the 10 weekhome visit.

Irritability and Reciprocal HoldIn their longitudinal study of infant irritability and mother–infant interactions

(measured at 1, 2, 3, 4, 5 and 6 months), van den Boom and Hoeksma (1994)found that mothers of non-irritable infants displayed more physical contact thanmothers of irritable infants. Dunn (1975) found a time-lag in the associationbetween affectionate contact and crying: higher crying rates at one time (at 10days and at 14 weeks) were related to less contact at a subsequent period (8weeks and 20 weeks, respectively). The time-lag effect with respect to mother–infant interactions is a phenomenon reported in various studies (Field et al.,1987; Lowinger, 1990). The eventual decrease found in reciprocal hold could beexplained as follows: infants who cried a great deal were probably held a greatdeal by their mothers. If these infants were not comforted by being held, andcontinued to be irritable, their mothers learned that holding was not rewardingand eventually held their babies less.

Perhaps the best support for this explanation (non-successful handling lead-ing to less hold) comes from the results concerning different forms of irritability.Two kinds of irritability had been measured during the neonatal exam: (a)general irritability; and (b) irritability to aversive stimuli. Examination of theresults shows that only general neonatal irritability is associated with a decreasein reciprocal hold. There was no relationship between irritability to aversivestimuli and eventual ‘hold’ interaction. General irritability—as outlined in theBrazelton Neonatal Behavioral Assessment Scale Kansas revision (NBAS-K)—includes consolability as an inherent part of its definition and is a function notonly of irritability to aversive stimulation. It is an interactive measure, whichreflects on the mother’s ability to handle and console her infant. But irritabilityto aversive stimuli is simply a count of number of times the infant cried to veryreal aversive situations. There is no connection to whether he was subsequentlyeasy or difficult to console. Thus, irritability to aversive stimuli may be a formof responsiveness to stimuli, an adaptive response that can serve as a predispo-sition to higher levels of attention to stimuli in the environment (this is in linewith the results showing that irritability to aversive stimuli is related toreciprocal social interaction, see following section). The difference between thetwo forms of irritability may be that one is only a measure of irritation to beingbothered, while the other is also a measure of irritation to the mother’s attemptsat handling and consoling. If the infant was highly irritable in terms of hisresponsiveness to his caretaker, this proved to be an important factor related torapport in holding/being held in the future. When the irritability measure wasonly an adaptive response to being disturbed, there was no such negativecorrelation with future holding.

What are the possible implications for this decrease in holding as related toneonatal general irritability? Perhaps, as the infant gets older, mother and infantwill search for more distal forms of activity and maintain less proximity withone another (Jones, 1985; Gersten et al., 1986). The results regarding socialreciprocity and irritability suggest that the decrease in holding does not neces-sarily lead to mother–infant rejection of one another and a breakdown of therelationship probably occurs only in the most extreme cases. If the mother and



infant find alternative satisfying ways of interacting, the child’s future psycho-logical development need not be affected by being held less often.

Irritability and social reciprocityInfants who showed high irritability during the neonatal observation had

greater social reciprocity at 10 weeks. In the case of social interactions—asopposed to the more physical interaction discussed previously—both forms ofneonatal irritability (i.e. irritability to aversive stimuli and general irritability)were positively related to social reciprocity.

Many studies regarding infant irritability—even while showing differenteffects on the mother–infant interactive relationship (positive versus nega-tive)—present results indicating that high irritability is positively related toinfant attention (Riese, 1987), visual discrimination (Moss et al., 1988), ex-ploratory play and Bayley MDI scores in preterm infants (DiPietro and Porges,1991). DiPietro and Porges, who differentiate between spontaneous and elicitedirritability, state that both reactive and spontaneous irritability were positivelyassociated with developmental outcome. If irritability to aversive stimuli is aform of responsiveness, it is easy to see why this high level of awareness to thesurroundings might be conducive to increased social interaction.

There are several possible explanations why general irritability in the neonateis negatively related to hold reciprocity at 10 weeks but positively related tosocial reciprocity: (1) compensation—the highly irritable infant–mother pairswho gradually engaged in less reciprocal hold may be trying to compensate forthe lack of physical interaction and thus channel their energies into highly activesocial interactions, and (2) mothers’ expectations—during each stage of infancy,the mother adjusts her behavior to the physical and psychological needs of herbaby (Scholler et al., 1982). Mothers time the beginning of various caretakingactivities depending upon their expectations of what an infant is capable ofdoing at a particular age (Ninio, 1979). A new mother has certain expectationsof her crying infant. If he cries for a reason (i.e. aversive stimulation) and hiscrying is not related to his response to her, his irritability will not affect hisphysical or social relationship with her in a negative way, and may enhance it.If he cries in response to her attempts at soothing him, she will lose confidencein her ability to console him (Donavan and Leavitt, 1989). At this stage of hisdevelopment (the first few weeks), she expects him to be consoled by being heldand will eventually hold him less. But, because she does not think her newbornwill be very responsive to visual and auditory stimuli in the first few weeks, themother has fewer expectations with regard to his pleasure in these forms ofstimulation and his general irritability during the neonatal period will not berelated to her continued desire to gaze, smile and vocalize to him in the future.Perhaps, if we take another period a few months later, when the mother’sexpectations are greater with regard to his responsiveness to social interaction,she will be less patient with general irritability to all forms of stimulation andeventually reach less social reciprocity with him. This supposition is supportedby the finding that those infants who showed high general irritability (observed)at the 10 week observation had lower reciprocal social interactions with theirmothers.

Consolability and reciprocity

The correlations between consolability and reciprocal measures (both hold andsocial) at 10 weeks are not significant, though they do follow an oppositepattern to the one shown by general irritability: high consolability is associated


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with more hold and less social interaction. Considering the important roleconsolability plays as part of the general irritability variable, how can thenon-significant correlations with the reciprocity variables be explained? Theanswer may lie in the way consolability is measured. The Brazelton Scaleconsoling maneuvers include procedures that may not be clinically viable(showing the infant face, face and voice, hand on belly, restraining both arms).In other words, mothers seem to find myriad ways to console their infants (aswas found in the interviews with the mothers at the 10 week observation) andthe assumption that quieting to the mother’s face alone is ‘better’ than needingto be picked up (but then being readily soothed) seems to be an arbitrary wayof determining higher consolability. The critical element is for the mother to feelshe has been successful in her ministrations and that happens when the baby iseffectively and quickly consoled. Since the general irritability item on theNBAS-K exam does not specify how the baby is consoled when upset, but onlydemands that he be easily consoled (which includes hold and rock), it is perhapsa better indicator of the mother–infant interactive situation than consolability asmeasured by the NBAS exam.

Defining the level of consolability at the 10 week observation inspired its ownmethodological problems. Scoring consolability according to the NBAS systemwas even less relevant coming as it was after mothers had developed 20 or moresingle and combined soothing forms.

It seems it is difficult to separate consolability from irritability. Those infantswho were more irritable during the observation were also the least likely to beconsoled. The general irritability variable probably includes in its predictivepower the strength of the consolability determinant.

The regression analyses enable us to explain the results in the simplestmanner. According to the results of the regression analyses, level of generalirritability at 3 days postpartum is the first predictor of reciprocal hold at 10weeks. In contrast, the best predictors for social interaction are those variablesmeasured at the 10 week observation. The responsive, non-irritable infant wasmore available for social interaction. At the 10 week observation, the baby’s cryprovoked maternal proximity and holding, but did not promote social inter-change. The non-availability of the irritable infant for social interaction haspotentially serious implications with regard to the child’s social development.

Summary and conclusions

Perusal of the results indicates that it was not possible to use a unidimensionalform of reciprocity but that there were two kinds of reciprocity that werenegatively related to one another: social reciprocity and hold reciprocity. A gooddeal of what was found concerning infant irritability depended on differentiat-ing between the two forms of reciprocal interaction.

The main findings regarding irritability/consolability and reciprocity were asfollows: when an infant showed irritability only to aversive stimuli, this was apositive predictor for social reciprocity. Perhaps, irritability to aversive stimuli isan adaptive response and lack of crying shows apathy and lethargy. Neonatalcrying, when unrelated to consolability, had no averse bearing on the baby’sinteractions with this mother. On the contrary, the mother comes into increasedsocial contact with him.

Still, the behaviors most relevant to social interaction at 10 weeks occur at thetime of the observation. Infants who were highly responsive, showed lowgeneral irritability, and high consolability were most likely to engage in social



interactions with their mothers. On the other hand, a time-lag effect with regardto mother–infant hold was found. Holding interaction seems to be related tolevels of general irritability at a previous time: the more generally irritable theneonate, the less his mother held him at the later observation.

There are a number of important caveats that should be kept in mindregarding these findings. The fact that the research sample included onlyfirstborn, male infants may limit the generalizability of the findings. In addition,this paper’s definition of mother–infant reciprocal interaction was restricted tosame-mode behavior. The results may have been different if cross-mode interac-tions had been counted (i.e. mother smiling and infant vocalizing during thesame 30-s interval).

Infant behaviors do affect their care-giving environments. In the case of theirritable/inconsolable infant, his mother may resist holding him and may needhelp in finding alternative ways of interacting with her baby. In the case of thequiet, unreactive baby, who rarely cries even during stressful moments, themother may be unaware of how little social stimulation he is getting and shemay need help in increasing the social attentions she gives him. It would,therefore, be important to conduct additional research in order to help identifythese early incipient problems in interaction.

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Infant irritability and early mother–infant reciprocity patterns