The CARE-Index

The CARE-Index is the simplest and most versatile of the attachment measures. It assesses mother-infant interaction from birth to about two years of age based on a short, videotaped play interaction of 3-5 minutes. (To see infant patterns of attachment, click here). Once the coder is trained, coding of an interaction takes about 15-20 minutes. The measure assesses mothers on three scales: sensitivity, covert and overt hostility, and unresponsiveness. There are also four scales for infants: cooperativeness, compulsive compliance, difficultness, and passivity. These scales tend to be related to the maternal scales in the order listed. The scales

1. Are highly correlated with the infant Strange Situation assessment patterns of attachment
2. Differentiate abusing from neglecting, abusing-and-neglecting, marginally maltreating, and adequate dyads
3. Can be used during intervention,
   and
4. Can be used to assess the effectiveness of intervention.

The information derived from the CARE-Index can be used as quasi-continuous or categorical data by researchers. In addition, however, the procedure is easily applied to "live" observations made by nurses, infant teachers, clinicians, and social workers. Needless to say, such observations cannot be treated as reliable when video is not used, but the method is effective in the same way that other guided observations or interviews are; furthermore, specific training of what to look for sharpens both one's observation and one's ability to tell others exactly what the dyad did and why it should be interpreted in a particular manner.

Training Courses

The 5-day course is taught from videotapes and depends upon both adult and infant behavior. Non-verbal behavior, interpersonal strategies, and developmental processes are emphasized. Adult patterns consist of sensitivity, controlling, and unresponsivity; the infant patterns are cooperative, difficult, compulsive compliant, caregiving or attentionn, and passive. The course includes a preliminary reliability test based on a standardized set of American mother-infant dyads. At the conclusion of the course, participants generate a set of videotapes that reflect their intended applications and culture(s). These tapes are used to create a course-specific reliability test.

A second 4-day course on toddlers (15-30 months) is now offered. The patterns include a wider array of compulsive patterns and coercive patterns (both aggressive and passive) as well as combinations.

As with all courses offered by Dr. Crittenden, participants are given a written and signed statement of their percent agreement with the standard. This reliability can be reported in research articles. Evidence of reliability should be requested if the participant will code data for another researcher.

In addition, courses are offered from time to time for people who wish to become trainers. There are also advanced clinical seminars offered to international groups of experienced coders. These are held in central Italy and on the coast of Nova Scotia, Canada.

To inquire about the course in general, interested parties can contact Dr. Crittenden directly. To register for courses, individuals should check the local events section listed on this web page and contact the relevant organizer. Dr. Crittenden does not handle registration or fee payment. Requests to run a new course can be directed to Dr. Crittenden.

Studies Using The CARE-Index:

Risk Studies

1. Adolescent mothers

Pacquette, D., Bigras, M., Zoccolillo, M., Tremblay, R., Labelle, M-» & Azar, R. (2001). Comparison de la sensibilitè parentale entre des mëres adolescentes et des mëres adultes peu scolarisèes. Revue de Psychoèducation et d'Orientation, 30, 283-298.
See also Leadbeater, et al. and Linares et al., below

2. Drug abusing mothers; drug exposed infants

Ciotti, F., Lambruschi, F., Pittino, B., & Crittenden, P. (1998). La valutazione della relazione precoce madre-bambino in una popolazione di madri con una storia di tossicodipendenza attraverso l'uso del CARE-Index. Psicoterapia Cognitiva e Comportamentale, 4, 53-59.
See also Linares et al.

3. Maternal psychiatric disorder

Hughes, S. (1993). The relationship between maternal psychiatric disorder and mother-child responsivity. Dissertation presented to the Faculty of McGill University, Montreal, Canada.

Leadbeater, B. J., Bishop, S. J., & Raver, C. C. (1996). Quality of mother-toddler interaction, maternal depressive symptoms, and behavior problems of adolescent mothers. Developmental Psychology, 32, 280-288.

Linares, L. O. (in press). Substance abusing mothers involved in the child welfare system. Women's Health System

Leventhal, A., Jacobsen, T., & Miller, L. J. (in press). Parenting attitudes and parenting behavior among mothers with mental illness. Psychiatric Services.

Mullick, M., Miller, L. J., Jacobsen, T. (2001). Insight into Mental Illness and Child Maltreatment Risk in Mothers with Major Psychiatric Disorders. Psychiatric Services, 52, 488-492.

4. Handicapping conditions

Crittenden, P. M. & Bonvillian, J.D. (1984). The effect of maternal risk status on maternal sensitivity to infant cues. American Journal of Orthopsychiatry, 54, 250-262.

Rauh, H., & Calvet-Kruppa, C. (2001). Bindungssicherheit und Verhaltensentwicklung bei Kindern mit Down-Syndrom. Psychologie in Erziehung und Unterricht.

5. Maltreated infants

Crittenden, P.M. (1992a). Children's strategies for coping with adverse home environments. International Journal of Child Abuse and Neglect, 16, 329-343.

Crittenden, P. M. (1988). Distorted patterns of relationship in maltreating families: The role of internal representational models. Journal of Reproductive and Infant Psychology, 6, 183-199.

Crittenden, P. M. & DiLalla, D. L. (1988). Compulsive compliance: The development of an inhibitory coping strategy in infancy. Journal of Abnormal Child Psychology, 16, 585-599.

Crittenden, P. M. (1987). Non-organic failure-to-thrive: Deprivation or distortion? Infant Mental Health Journal, 8, 56-64.

Crittenden, P. M. (1985). Social networks, quality of child-rearing, and child development. Child Development, 56, 1299-1313.

Crittenden, P. M. (1984). Sibling interaction: Evidence of a generational effect in maltreating families. International Journal of Child Abuse and Neglect, 8, 433-438.

Crittenden, P. M. (1981). Abusing, neglecting, problematic, and adequate dyads: Differentiating by patterns of interaction. Merrill-Palmer Quarterly, 27, 1-18.

Jacobsen, T., & Miller, L. J. (1998). Compulsive compliance in a young maltreated child. Journal of the American Academy of Child and Adolescent Psychiatry, 37(5), 462-463.

Leadbeater, B., & Bishop, S. J. (1994). Predictors of behavior problems in preschool children of inner city Afro-American and Puerto Rican mothers. Child Development, 65, 638-648.

Ward, M. J., Kessler, D. B., & Altman, S. C. (1993). Infant-mother attachment in children with failure to thrive. Infant Mental Health Journal, 14, 208-220. 
 

Normative Studies

Patino, F. L. (1993). Mothers' prenatal attachment history, attachment status, and social support satisfaction as predictors of postnatal maternal sensitivity. Dissertation Abstracts International, 53 (7-B): 3787.
 

Predictive Longitudinal Studies

Simó, S., Rauh, H., & Ziegenhain, U. (2000). (English title: Mother-infant interaction during the first eighteen months and attachment security at the end of the second year.) Mutter-Kind-Interaktion in den ersten 18 Lebensmonaten und Bindungssicherheit am Ende des 2. Lebensjahres. Psychologie in Erziehung und Unterricht, 47, 118-141.

Ward, M.J., & Carlson E.A. (1995). The predictive validity of the Adult Attachment Interview for adolescent mothers. Child Development, 66, 69-79.

Bigras, M. & Pacquette, D. (2000). L'interdèpendance entre les sous-systëstemes conjugal et parental: Une analyse personne-processus-contexte. Psicologia: Teoria e Pesquisa, 16, 91-102. 

Cramer, B., Robert-Tissot, C., Stern, D. N., & Serpa-Rusconi, S. (1990). Outcome evaluation in brief mother-infant psychotherapy: A preliminary report. Infant Mental Health Journal, 11, 278-300.

Crittenden, P. M. (1985). Maltreated infants: Vulnerability and resilience. Journal of Child Psychology and Psychiatry, 26, 85-96.

Linares, L. O. (in press). The effects of an early intervention program on polydrug infants and their families in foster care. In J. Silver (Ed.), Serving the needs of young children involved in the child welfare system. New Jersey. 

Linares, L.O., Jones, B., Sheiber, F.J. & Rosenberg, F.B. (1999). Early intervention for drug-exposed infants in foster care. In. J. Silver, B. J. Amster & Haecker (Eds.), Young Children and Foster Care (pp. 373-397). Baltimore: Brookes. 

Pacquette, D., Zoccolillo, M., & Bigras, M. (1999). L'efficacitè des interventions en foyers de groupe pour mëres en difficultè d'adaptation. Dèfi Jeunesse, VI, 30-35. 

Robert-Tissot, C., Cramer, B., Stern, D., Serpa, S. et-al. (1996). Outcome evaluation in brief mother-infant psychotherapies: Report on 75 cases. Infant Mental Health Journal, 17, 97-114.