five tests of reliability and concurrent validity that it “passed”. of the parent-child relationship ranging from effects of and on the child's development . is with the ideals, the more positive the evaluations of that relationship. Evaluation tools were Mother-Child Bonding Evaluation Protocol and Self-Report Questionnaire. We used statistical analysis χ2 and Student-t tests. A 5%-level. But this does give a good, fine-grained, assessment of parental sensitivity and baby's responses, . easier training than KIPS. This has been tested for validity ( see IMHJ, to screen for problems in the mother-baby relationship. This has four .
To identify and describe research tools used to evaluate bonding between mother and child up to one year of age, as well as to provide information on reliability and validity measures related to these tools.
Thirteen evaluation research tools were identified concerning mother and child attachment: From all tools analyzed, the Prenatal Attachment Inventory presented the higher validity and reliability measures to assess mother and fetus relation during pregnancy. Concerning the puerperal period, better consistency coefficients were found for Maternal Attachment Inventory and Postpartum Bonding Questionnaire. Besides, the last one revealed a higher sensibility to identify amenable and severe disorders in the affective relations between mother and child.
The majority of research tools are reliable to study the phenomenon presented, although there are some limitations regarding the construct and criterion related to validity.
In addition to this, only two of them are translated into Portuguese and adapted to women and children populations in Brazil, being a decisive gap to scientific production in this area. Mother-child relations, Maternal behavior, Reproducibility of results Introduction The establishment of bonding between mother and child is a physical and psychological need of babies, which provides comfort and protection.
Thus, the mother is considered the safe haven for the establishment of the first emotional attachments of the child, which will reflect on all future social relations.
Mother-child bonding assessment tools
In childhood, these emotional interactions are primarily developed with parents in order to impart comfort, protection, affection, and love. In adolescence and adulthood, they are enhanced and modified, and new bonds with significant others are developed and incorporated. The quality of the bond between mother and baby exerts direct influence on the child's mental health. Therefore, this relationship should be warm, intimate, continuous, and affectionate, providing pleasure and comfort for both.
It is an ongoing process, initiated during pregnancy, in which the fetus becomes part of everyday life of the pregnant woman more intensely, consisting of fantasies, desires, dreams, and representations of models of motherhood.
A review performed inaimed at describing the main instruments used to analyze the relationship between mother and child, retrieved a total of ten tools.
For the mothers significant events were their infancy, adolescence, gestation, delivery, post partum period and current situation professional, personal, marriage and family satisfaction. This questionnaire of self-information is a screening instrument for mental illness that identifies non-psychotic disorders in the community.
The instrument has 20 questions with affirmative or negative answers and its purpose is to track the mother's emotional status in the last 15 days. Summing all "yes" answers a score varying from is obtained.
These instruments were applied by pedagogues and psychologists. Those professionals performing interviews were previously trained in order to use the same kind of approach. Statistical analysis The sample was described using tables with descriptive statistical values for quantitative variables age and SRQ divided according to bonding category good and weak and total.
For qualitative variables such as formal education, duration of marriage and social conditions tables with frequency distribution and percentages of these variables were used in each bonding category and total. The SRQ was analyzed in two ways: To verify the presence of an association between age and SRQ with bonding, their means were compared in the two categories of bonding using the Student's t test. To the adjusting model we adopted the method of selection of variables, the forward stepwise.
Table 1 shows descriptive statistical values concerning maternal age in years by bonding category. Descriptive statistics for SRQ scores are presented in table 2. Means and median were higher in the weak bonding group than in the strong bonding group. For this reason, it was possible to assume the presence of an association between bonding and SRQ, in other words, mothers with weak bonding had higher possibility to develop mental illness than mothers with good bonding.
Considering SRQ categories, table 3 was designed to present distributions of SRQ frequencies and percentages in each category of bonding. We observed that the percentage of mothers with changed SRQ was higher in the group with weak bonding. The percentage of mothers with weak bonding in the category of changed SRQ was Regarding formal education only 2 mothers 2. Illiterate mothers and those with elementary education were included in the same group; the same was done with mothers with high school and college degree.
The majority of mothers in both bonding groups had completed high school or college: A higher percentage of mothers with better education was seen in the group with good bonding. Table 4 shows that most mothers had low social status in both bonding categories. Interestingly, the percentage of mothers in this status was higher in the good bonding group.
Based on these findings it is possible to raise the hypothesis that mothers who had little knowledge or information concerning mental illness and future expectations, as well as the possible difficulties of acceptance of a mentally deficient child by the society, were feeling that the situation is part of a definitive destiny in which they can only be near their child.
It is possible that they perceive with simplicity and resignation the reality imposed. For this reason, these perceptions may work as a protective factor for the bonding with their children.
However, it is known that the impact of having a mentally deficient child can difficult and even prevent maternal reactions that, natural and intuitively, supply their child's needs. This study showed that the majority of mothers from higher social classes tended to show a weak bonding with their children. One hypothesis to explain this finding is the fact that they have more information about the deficiency and are more conscious that despite the positive familiar environment, institutional resources and special schools, the child will have social difficulties and problems in learning, among others.
The course of life may justify the little energy to accept the condition, interfering in the quality of bonding with their child. Results of this study revealed that families go through different phases in which they learn to deal with the child that presents some type of special needs.
According to Casarin 17some families live an acute crisis period but after a while they may recover. Other families may have more difficulties and develop a "chronic sadness". The situation turns to be more difficult because the child will require specific care and high availability of caregivers.
It is important to mention that when only one person delivers care for the child, a changing in the relationship with other family members may cause imbalance in the relationships and affect negatively on the quality of bonding between mother and the mentally deficient child, generating a vicious cycle which perhaps explains the results found in this study. Mothers from high social status showed low energy, initiative and emotional investment, as well as, sometimes, deficient care with themselves, and often, with the child.
Feelings of less value possibly interfere on the quality of bonding with the child as well as on the maternal and family behavior concerning the child's development. The deficient infant or child exploratory behavior depends on an adequate stimulation.
According to Bowlby 9when the infant responds less or seems apathetic there is more chance of negligence because the child compensates less the mother and her behavior can change by the child's lack of reaction and vice versa. Perhaps these hypotheses justify the results found in this study.
It was also found that mothers with weak bonding showed in average a higher possibility to develop mental disorders than those with good boding. We should consider what was stated by Vygotsky It is by means of these activities that children start to become part of intellectual, mental and emotional life of those surrounding them, specially the mother, who is the main person to deliver care for them".
To the mother the child means the continuation of her existence and, even before birth, there is a predetermined place in her mind where a number of expectations are placed.
When the health status and the child's appearance do not correspond to what was imagined and idealized by the mothers it is very likely that they suffer a psychic rupture especially because the bonding with the child may not have been strong enough. According to Voivodic 19 "after a period of time, the disorganized family finds releif in the intense stimulation activities, but many times these activities can take the place of an affective relationship and the mother's availability to perceive and interact with the child".
Because of the mother lack of emotional investment in the child her emotional health can be compromised as well as her child's health which explains the results found. The quality of emotional bonding is built along the relationship. It is possible that when the mothers experience rejection feelings they feel guilty and have difficulty in understanding that affection occurs along a companionship process, among other factors.
These feelings may lead them to develop significant conflicts because of the impossibility to differentiate the non-acceptance of the deficiency from their own child.
Rejection affects feelings concerning the deficiency and may be present along the vital cycle. But mothers who developed healthy psychological resources can elaborate their life's condition - her real child- and acquire a better emotional structure to deal with this diversity. We believe that mothers more emotionally committed can enhance the already existing difficulties in the relationship with their child because, perhaps, they take back the pain when remembering the moment they became aware of their child's syndrome.
The Parent Adult-Child Relationship Questionnaire (PACQ)
It is important to highlight that depressive mothers are more vulnerable to emotional disorders, especially because they feel as incompetent mothers and, as a result, also evaluate their child negatively 18a fact that can also justify the results of this study.
Emotionally fragile mothers have close links with the feelings experienced by the lost of an "ideal" child and that could be expressed as shock, sadness, rejection, guilty and anger 20, Brazelton 22 stated that to accept a deficient child is difficult for parents.
Besides, each person needs a time to elaborate these feelings and this process has to be considered It is not possible to expect resignation from parents just after the birth of a deficient child, moreover, one cannot count that they will be available to participate promptly of an educational process 19, As stated by Regen It is natural to be disappointed, depressed, feel pain, unsureness and fear, besides the wish that everything disappears as if it were a nightmare".