Observational Assessment of the Dyad



Assessment procedures for infants, toddlers, and preschoolers should include caregiver interviews, caregiver-report questionnaires, observational coding procedures, and collateral reports (i.e., medical, child care, etc.). This multimodal assessment approach provides clinicians a systematic means to incorporate the many factors that impact an infant’s clinical presentation. The prior chapter focuses on one aspect of a multimodal psychiatric evaluation, specifically observing the dyadic interaction. In this chapter, we outline key considerations regarding instrument selection, application and interpretation, and provide an in-depth list of dyadic observational measures which have been found to have useful clinical applications.


  1. Ainsworth, M. (1969). Object relations, dependency, and attachment: A theoretical review of the infant-mother relationship. Child Development, 40(4), 969–1025. CrossRefPubMedGoogle Scholar
  2. Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns of attachment: A psychological study of the Strange Situation. Hillsdale, NJ: Erlbaum.Google Scholar
  3. Barnard, K. E. (1979). Instructor’s learning resource manual. Seattle, WA: NCAST Publications, University of Washington.Google Scholar
  4. Barnard, K. E., Bee, H. L., & Hammond, M. A. (1984). Developmental changes in maternal interactions with term and preterm infants. Infant Behavior & Development, 7, 101–113.Google Scholar
  5. Bornstein, M. H. (2012). Cultural approaches to parenting. Parenting: Science and Practice, 12, 212–221. CrossRefGoogle Scholar
  6. Braungart-Rieker, J. M., Zentall, S., Lickenbrock, D. M., Ekas, N. V., Oshio, T., & Planalp, E. (2014). Attachment in the making: Mother and father sensitivity and infants’ responses during the Still-Face Paradigm. Journal of Experimental Child Psychology, 125, 63–84.CrossRefGoogle Scholar
  7. Biringen, Z. (2000). Emotional Availability: Conceptualization and Research Findings. American Journal of Orthopsychiatry, 70, 104–114.Google Scholar
  8. Biringen, Z. (2005). Training and reliability issues with the emotional avaliability scales. Infant Mental Health Journal, 26, 404–405.Google Scholar
  9. Biringen, Z., Robinson, J., & Emde, R. N. (1998). Emotional Availability Scale (3rd ed.) Unpublished manual for the EAS Training. Boulder, CO.Google Scholar
  10. Calkins, S. D., & Hill, A. (2007). Caregiver influences on emerging emotion regulation: Biological and environmental transactions in early development. In J. J. Gross (Ed.), Handbook of emotion regulation (pp. 3–26). New York, NY: The Guilford Press.Google Scholar
  11. Campinha-Bacote, J. (2002). The process of cultural competence in the delivery of healthcare services: A model of care. Journal of Transcultural Nursing, 13(3), 181–184.CrossRefGoogle Scholar
  12. Clark, R. (1983). Interactions of psychiatrically ill and well mothers and their young children: Quality of maternal care and child competence. Evanston, IL: Northwestern University.Google Scholar
  13. Clark, R. (1985, 2010, 2015). The parent-child early relational assessment: Instrument and manual. MadisonWI: University of Wisconsin Medical School.Google Scholar
  14. Clark, R. (1999). The parent-child early relational assessment: A factorial validity study. Educational and Psychological Measurement, 59(5), 821–846. CrossRefGoogle Scholar
  15. Clark, R., Hyde, J. S., Essex, M. J., & Klein, M. H. (1997). Length of maternity leave and quality of mother-infant interactions. Child Development, 68(2), 364–383. PubMedGoogle Scholar
  16. Clark, R., Tluczek, A., & Brown, R. (2008). A mother-infant therapy group model for postpartum depression. Infant Mental Health Journal, 29(5), 514–536.CrossRefGoogle Scholar
  17. Clark, R., Tluczek, A., Evenson, A. L. & Moore, E.C. (In Press) Assessment of early parent-child relationships. In R. Del Carmen & A. Carter (Eds.), Handbook of Infant, Toddler and Preschool Mental Health Assessment 2nd Edition. Oxford: Oxford University Press.Google Scholar
  18. Clark, R., Tluczek, A., Moore, E., & Evenson, A. (2004a). Assessment of early parent-child relationships. In R. DelCarmen-Wiggins & A. Carter (Eds.), Handbook of infant, toddler, and preschool mental health assessment Second Edition. New York, NY: Oxford University Press.Google Scholar
  19. Clark, R., Tluczek, A., Moore, E., & Evenson, A. (2004b). Theoretical and empirical foundations for early relationship assessment in evaluating infant and toddler mental health. In R. DelCarmen-Wiggins & A. Carter (Eds.), Handbook of infant, toddler, and preschool mental health assessment (2nd ed.). New York, NY: Oxford University Press.Google Scholar
  20. Clarke-Stewart, K. A. (1973). Interactions between mothers and their young children: Characteristics and consequences. Monographs of the Society for Research in Child Development, 38(6-7), 1–109. CrossRefPubMedGoogle Scholar
  21. Crowell, J., & Feldman, S. (1988). Mothers’ internal models of relationships and children’s behavioral and developmental status: A study of mother-child interaction. Child Development, 59, 1273–1285.CrossRefGoogle Scholar
  22. Crowell, J., Feldman, S., & Ginsberg, N. (1988). Assessment of mother-child interaction in preschoolers with behavior problems. Journal of the American Academy of Child & Adolescent Psychiatry, 27, 303–311.CrossRefGoogle Scholar
  23. Crowell, J. A., Warner, D. E., Davis, C. R., Marraccini, M., & Dearing, E. (2010). The influence of childhood adversity on mothers’ behavior with preschoolers: Role of maternal attachment coherence, dissociative symptoms, and marital behaviors. Research in Human Development, 7(4), 274–291.CrossRefGoogle Scholar
  24. Dallay, E. G., & Guedeney, A. (2016). Parent-infant interaction assessment. In A. L. Sutter-Dallay, N. M. C. Glangeaud-Freudenthal, A. Guedeney, A. Riecher-Rössler, et al. (Eds.), Joint care of parents and infants in perinatal psychiatry (pp. 93–108). Cham: Springer International Publishing Switzerland.Google Scholar
  25. Day, M., & Parlakian, R. (2003). How culture shapes social-emotional development: Implications for practice in infant-family programs. Washington, DC: Zero to Three.Google Scholar
  26. Dudas, K. I. (2012). Cultural competence: An evolutionary concept analysis. Nursing Education Perspectives, 33(5), 317–321. CrossRefPubMedGoogle Scholar
  27. Earls, L,, Muzik, M., Beeghly, M. (2009). Maternal and infant behavior coding manual. Unpublished manuscript.Google Scholar
  28. Emde, R. N. (1989). The infant’s relationship experience: Developmental and affective aspects. In J. A. Sameroff & R. N. Emde (Eds.), Relationship disturbances in early childhood: A developmental approach (pp. 33–51). New York, NY: Basic Books.Google Scholar
  29. Farran, D., Clark, K., & Ray, A. (1990). Measures of parent-child interaction. In E. Gibbs & D. Teti (Eds.), Interdisciplinary assessment of infants: A guide for early intervention professionals (pp. 227–247). Baltimore, MA: Paul H. Brooks.Google Scholar
  30. Feldman, R., Dollberg, D., & Nadam, R. (2011). The expression and regulation of anger in toddlers: Relations to maternal behavior and mental representations. Infant Behavior & Development, 34, 310–320. CrossRefGoogle Scholar
  31. Fisher, C. B., Hoagwood, K., Boyce, C., Duster, T., Frank, D. A., Grisso, T., et al. (2002). Research ethics for mental health science involving ethnic minority children and youths. American Psychologist, 57, 1024–1040.Google Scholar
  32. Fonagy, P., & Target, M. (1998). Mentalization and the changing aims of child psychoanalysis. Psychoanalytic Dialogues, 8(1), 87–114. CrossRefGoogle Scholar
  33. Gaskins, S. (2006). Cultural perspectives on infant-caregiver interaction. In N. J. Enfield & S. C. Levinson (Eds.), The roots of human sociality: Culture, cognition, and human interaction. New York, NY: Berg.Google Scholar
  34. Gerstein, E. D., Poehlmann-Tynan, J., & Clark, R. (2015). Mother-child interactions in the NICU: Relevance and implications for later parenting. Journal of Pediatric Psychology, 40(1), 33–44. CrossRefPubMedGoogle Scholar
  35. Goodman, S., & Gotlib, I. (Eds.). (2002). Children of depressed parents: Mechanisms of risk and implications for treatment. Washington, DC: American Psychological Association.Google Scholar
  36. Goodman, S. H., & Brumley, E. H. (1990). Schizophrenic and depressed mothers: Relational deficits in parenting. Developmental Psychology, 26(1), 31–39. CrossRefGoogle Scholar
  37. Grace, S. L., Evindar, A., & Stewart, D. (2003). The effect of postpartum depression on child cognitive development and behavior: A review and critical analysis of the literature. Archive of Women's Mental Health, 6(4), 263–274.CrossRefGoogle Scholar
  38. Heller, S., Aoki, Y., & Schoffner, K. (1998). Revision of the Crowell caregiver-child relationship scale. Unpublished manuscript.Google Scholar
  39. Irving Harris Foundation. (2012). Diversity-informed infant mental health tenets. Retrieved from Google Scholar
  40. Jernberg, A. M., & Booth, P. B. (1999). Theraplay: Helping parents and children build better relationships through attachment-based play (2nd ed.). San Francisco, CA: Jossey-Bass Publishers.Google Scholar
  41. Kelly, J. F. & Barnard, K. E., (2000). Assessment of Parent-Child Interaction: Implications for Early Intervention. In S. Meisels & J. P. Shonkoff (Eds.) The Handbook of Early Intervention (2nd Edition, pp. 278–302). Cambridge, Massachusetts: Syndicate of the Press of the University of Cambridge.Google Scholar
  42. Kelly, J. F., Buehlman, K., & Caldwell, K. (2000). Training personnel to promote quality parent–child interaction in families who are homeless. Topics in Early Childhood Special Education, 20, 174–185.Google Scholar
  43. Klotz, M. B., & Canter, A. (2006). Culturally competent assessment and consultation. Retrieved September 14, 2015, from
  44. Korja, R., Ahlqvist-Björkroth, S., Savonlahti, E., Stolt, S., Haataja, L., Lapinleimu, H., et al. (2010). Relations between maternal attachment representations and the quality of mother-infant interaction in preterm and full-term infants. Infant Behavior and Development, 33(3), 330–336. CrossRefPubMedGoogle Scholar
  45. Korja, R., Savonlahti, E., Ahlqvist-Björkroth, S., Stolt, S., Haataja, L., Lapinleimu, H., et al. (2008). Maternal depression is associated with mother-infant interaction in preterm infants. Acta Paediatrica, 97, 724–730. CrossRefPubMedGoogle Scholar
  46. Larrieu, J., & Bellow, S. (2004). Relationship assessment for young traumatized children. In J. O. Osofsky (Ed.), Young children and trauma: Intervention and treatment (pp. 155–172). New York, NY: The Guildford Press.Google Scholar
  47. Lor, M., Crooks, N., & Tluczek, A. (2016). A proposed model of person-, family-, and culture-centered nursing care. Nursing Outlook, 64, 352–366.Google Scholar
  48. Loop, L., Mouton, B., Brassart, E., & Roskam, I. (2016). The observation of child behavior during the caregiver-child interaction: The psychometric properties of the Crowell procedure. Journal of Child and Family Studies.
  49. Lyons-Ruth, K., Bronfman, E., & Parsons, E. (1999). Maternal frightened, frightening, or atypical behavior and disorganized infant attachment patterns. In J. I. Vondra & D. Barnett (Eds.), Atypical patterns of infant attachment theory research and current directions. Monographs of the Society for Research in Child Development, 64, 67–96.CrossRefGoogle Scholar
  50. Marcus, S. M., Flynn, H. A., Blow, F. C., & Barry, K. L. (2003). Depressive symptoms among pregnant women screened in obstetrics settings. Journal of Women's Health, 12(4), 373–380.CrossRefGoogle Scholar
  51. Matas, L., Arend, R. A., & Sroufe, L. A. (1978). Continuity of adaptation in the second year: The relationship between quality of attachment and later competence. Child Development, 49(3), 547–556. CrossRefGoogle Scholar
  52. Minde, K., Faucon, A., & Falkner, S. (1994). Sleep problems in toddlers: Effects of treatment on their daytime behavior. Journal of the American Academy of Child & Adolescent Psychiatry, 33(8), 1114–1121. CrossRefGoogle Scholar
  53. Miron, D., Lewis, M., & Zeanah, C. (2009). Clinical use of observational procedures in early childhood relationship assessment. In C. H. Zeanah (Ed.), Handbook of infant mental health (3rd ed., pp. 252–265). New York, NY: Guilford Press.Google Scholar
  54. Mothander, P. R. (1990). The first year of life: Predictive patterns of infant development, maternal adjustment, and mother-infant interaction. Uppsala: Uppsala University.Google Scholar
  55. Mouton, N., Loop, L., Stievenart, M., & Roskam, I. (2017). Child differential sensitivity to parental self-efficacy improvement: A micro-trial perspective. International Journal of Behavioral Development, 42, 203–213.CrossRefGoogle Scholar
  56. Osofsky, J., Bosquet, M., Kronenberg, M., & Hammer, J. (2003). Revision of parent-child relationship coding manual. New Orleans, WA: Louisiana State University Health Sciences Center.Google Scholar
  57. Pipp-Siegel, S., & Biringen, Z. (1998). Assessing the quality of relationships between parents and children: The emotional availability scales. The Volta Review, 100, 237–249.Google Scholar
  58. Poehlmann, J., Burnson, C., & Weymouth, L. A. (2014). Early parenting, represented family relationships, and externalizing behavior problems in children born preterm. Attachment & Human Development, 16(3), 271–291. CrossRefGoogle Scholar
  59. Robinson, L. R., Morris, A. S., Heller, S., Scheeringa, M. S., Boris, N. W., & Smyke, A. T. (2009). Relations between emotion regulation, caregiving, and psychopathology in young maltreated children in out of home care. Journal of Child and Family Studies, 18, 421–434.CrossRefGoogle Scholar
  60. Roggman, L. A., Cook, G. A., Innocenti, M. S., Norman, V. J., Christiansen, K. (2013). Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO) in Diverse Ethnic Groups. Infant Mental Health Journal, 34, 290–306Google Scholar
  61. Rosenblum, K. L., McDonough, S., Muzik, M., Miller, A., & Sameroff, A. (2002). Maternal representations of the infant: Associations with infant response to the Still Face. Child Development, 73(4), 999–1015.CrossRefGoogle Scholar
  62. Sander, L. S. (1964). Adaptive relationships in early mother-child interaction. Journal of the American Academy of Child & Adolescent Psychiatry, 3, 231–264.Google Scholar
  63. Sarche, M., Tsethlikai, M, Godoy, G., Emde, R., & Fleming, C. (2004) Cultural perspectives for assessing infants and young childrenGoogle Scholar
  64. Schore, A. (2001). Effects of a secure attachment relationship on right brain development, affect regulation, and infant mental health. Infant Mental Health Journal, 22(1-2), 7–66.CrossRefGoogle Scholar
  65. Shonkoff, J. P., Phillips, D. A., & National Research Council (U.S.). (2000). From neurons to neighborhoods: The science of early child development. Washington, DC: National Academy Press.Google Scholar
  66. Slade, A. (1999). Attachment theory and research: Implications for the theory and practice of individual psychotherapy with adults. In J. Cassidy & P. R. Shaver (Eds.), Handbook of attachment Theory research and clinical applications. New York, NY: Guilford Press.Google Scholar
  67. Sprang, G., & Craig, C. (2015). Crowell problem solving procedure: A psychometric analysis of a laboratory measure of the caregiver-child relationship. Child and Adolescent Mental Health, 20, 202–209.CrossRefGoogle Scholar
  68. Sroufe, L. A. (1996). Emotional development: The organization of emotional life in the early years. New York, NY: Cambridge University Press.CrossRefGoogle Scholar
  69. Sroufe, L. A. (2000). Early relationships and the development of children. Infant Mental Health Journal, 21, 67–74.CrossRefGoogle Scholar
  70. Stern, D. (1985). The interpersonal world of the infant. New York, NY: Basic Books.Google Scholar
  71. Stern, D. (2002). The first relationship: Infant and mother. Cambridge, MA: Harvard University Press.Google Scholar
  72. Sumner, G., & Speitz, A. (1995a). NCAST caregiver/parent-child interaction feeding manual. Seattle, WA: NCAST Publications, University of Washington, School of Nursing.Google Scholar
  73. Sumner, G., & Speitz, A. (1995b). NCAST caregiver/parent-child interaction teaching manual. Seattle, WA: NCAST Publications, University of Washington, School of Nursing.Google Scholar
  74. Tamis-LeMonda, C. S., & Song, L. (2012). Parent-infant communicative interactions in cultural context. In I. B. Weiner, R. M. Lerner, M. A. Easterbrooks, & J. Mistry (Eds.), Handbook of psychology: Volume 6: Developmental psychology (2nd ed., pp. 143–170). Hoboken, NJ: John Wiley & Sons.Google Scholar
  75. Tamminen, T. (2006). How does culture promote the early development of identity? Infant Mental Health Journal, 27(6), 603–605. CrossRefPubMedGoogle Scholar
  76. Teti, D. M., Nakagawa, M., Das, R., & Wirth, O. (1991). Security of attachment between preschoolers and their mothers: Relations among social interaction, parenting stress, and mother’s sorts of attachment Q-set. Developmental Psychology, 27(3), 440–447. CrossRefGoogle Scholar
  77. Tronick, E., Als, H., Adamson, L., Wise, S., & Brazelton, T. B. (1978). Infants’ response to entrapment between contradictory messages in face-to-face interaction. Journal of the American Academy of Child and Adolescent Psychiatry, 17, 1–13.CrossRefGoogle Scholar
  78. The St. Petersburg—USA Orphanage Research Team, (2008). The effects of early social-emotional and relationship experience on the development of young orphanage children. Monographs of the Society for Research in Child Development, 73, vii-295.Google Scholar
  79. Verhage, M. L., Schuengel, C., Madigan, S., Fearon, R. M. P., Oosterman, M., Cassibba, R., et al. (2016). Narrowing the transmission gap: A synthesis of three decades of research on intergenerational transmission of attachment. Psychological Bulletin, 142(4), 337–366.CrossRefGoogle Scholar
  80. Vygotsky, L. S. (1978). Mind in society: The development of higher psychological processes. Cambridge, MA: Harvard University Press.Google Scholar
  81. Weber, A. M., & Harrison, T. M. (2014). Maternal behavior and infant physiology during feeding in premature and term infants over the first year of life. Research in Nursing and Health, 37(6), 478–489. CrossRefPubMedGoogle Scholar
  82. Westerlund, M., & Lagerberg, D. (2007). Expressive vocabulary in 18-month-old children in relation to demographic factors, mother and child characteristics, communication style and shared reading. Child: Care, Health and Development, 34, 257–266.Google Scholar
  83. Winnicott, D. W. (1965). The maturational processes and the facilitating environment: Studies in the theory of emotional development. New York, NY: International Universities Press.Google Scholar
  84. Winnicott, D. W. (1970). The mother-infant experience of mutuality. In E. J. Anthony & T. Benedek (Eds.), Parenthood: Its psychology and psychopathology (pp. 245–288). London: Little, Brown.Google Scholar
  85. Zeanah, C. H., Boris, N. W., Heller, S. S., Hinshaw-Fuselier, S., Larrieu, J. A., Lewis, M., et al. (1997). Relationship assessment in infant mental health. Infant Mental Health Journal, 18, 182–197.CrossRefGoogle Scholar
  86. Zeanah, C. H., Larrieu, J. A., Heller, S., & Valliere, J. (2000). Infant caregiver relationship assessment. In C. H. Zeanah (Ed.), Handbook of infant mental health (2nd ed., pp. 222–235). New York, NY: Guilford Press.Google Scholar
  87. Zero to Three: National Center for Clinical Infant Programs. (2016). DC:0-5: Diagnostic classification of mental health and developmental disorders of infancy and early childhood. Washington, DC: Author.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of Psychiatry and Behavioral MedicineTulane University Medical SchoolNew OrleansUSA
  2. 2.University of Maryland School of Social WorkBaltimoreUSA
  3. 3.School of Medicine and Public HealthUniversity of Wisconsin-MadisonMadisonUSA

Personalised recommendations