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Interaction Guidance (IG)

Scientific Rating:
3
Promising Research Evidence
See scale of 1-5
Child Welfare System Relevance Level:
Medium
See descriptions of 3 levels

Note: The IG program was not responsive to the CEBC's inquiry. The following information was obtained from publicly available sources.

About This Program

Interaction Guidance (IG) has been rated by the CEBC in the area of: Infant and Toddler Mental Health (Birth to 3).

Brief Description

IG treats infants with a variety of early regulation disorders including feeding, sleeping, and excessive crying. The program was developed for families who have been difficult to engage in treatment due to risk factors such as poverty, substance abuse, mental illness, or other family stressors. IG uses observation of interactions between the baby and caregiver as representations of family structure. Therapeutic techniques include reviewing videotaped interactions to reinforce positive aspects and enhance caregivers' understanding of infant behavior and development.

Goals of Interaction Guidance (IG):

Please check in the Brief Description section above for the program's goals. If they are not there, the program's representative has not provided these since we began requesting them in Fall 2010.

Target Population: Not Specified

Education and Training Resources

Publicly available information indicates there is a manual that describes how to implement this program, and there is some training available for this program.
See contact info below.

Training Contact:
  • Dr. Susan McDonough
    University of Michigan's Comprehensive Center for Depression
    phone: (734) 936-4400

Relevant Published, Peer-Reviewed Research

This program is rated a "3 - Promising Research Evidence" on the Scientific Rating Scale based on the published, peer-reviewed research available. The practice must have at least one study utilizing some form of control (e.g., untreated group, placebo group, matched wait list study) establishing the practice's benefit over the placebo, or found it to be comparable to or better than an appropriate comparison practice. Please see the Scientific Rating Scale for more information.

Child Welfare Outcome: Permanency

Show relevant research...

Robert-Tissot, C., Cramer, B., Stern, D. N., Serpa, S. R., Bachmann, J. P., Palacio-Espasa, F., & Mendiguren, G. (1996). Outcome evaluation in brief mother-infant psychotherapies: Report on 75 cases. Infant Mental Health Journal, 17(2), 97-114.

Type of Study: Randomized controlled trial
Number of Participants: 75 mother-infant pairs

Population:

  • Age range — Under 30 months
  • Race/Ethnicity — Not Specified
  • Gender — Not Specified
  • Status — Children referred to the Child Guidance Clinic for sleep, feeding, and behavioral disorders.

Location / Institution: Child Guidance Clinic, Geneva, Switzerland.

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Mother-child pairs referred for treatment were randomly assigned to receive either Interaction Guidance (IG) or Psychodynamic Mother-Infant Psychotherapy (PD). Problem symptoms were assessed at baseline, 1 month, and 6 months post-treatment using the Symptom Check-List. Each mother was also interviewed to assess her representations of herself, her child, her role, and the child's father. Structured mother-infant interactions were videotaped and coded for quality, sensitivity, and child emotions. Both treatments showed improvements in symptoms, particularly for sleep problems which were the most common reason for referral. Behavior problems were more resistant to treatment and tended to increase with age, although those who were referred specifically for behavior problems did show improvements. Mother-child interactions and maternal self-esteem also improved. This study was limited by lack of an untreated comparison group. The authors also note that large developmental differences in the youngest versus the oldest children could have influenced results.

Length of post-intervention follow-up: 6 months.

Benoit, D., Madigan, S., Lecce, S., Shea, B., & Goldberg, S. (2001). Atypical maternal behavior toward feeding-disordered infants before and after intervention. Infant Mental Health Journal, 22(6), 611-626.

Type of Study: Non-randomized matched comparison group.
Number of Participants: 28 mother-infant pairs

Population:

  • Age range — IG group: 18.2 months on average; Feeding-focused group: 17.5 months on average.
  • Race/Ethnicity — Not Specified
  • Gender — Not Specified
  • Status — Infants referred for feeding difficulties and infants being tube-fed due to feeding difficulties.

Location / Institution: Infant psychiatry clinic in a tertiary care pediatric hospital, Toronto, Ontario, Canada

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Mother-infant pairs received either 5 weeks of the Interaction Guidance (IG) intervention or 7 weeks of the feeding-focused intervention. Measures included the Atypical Maternal Behavior Instrument for Assessment and Classification (AMBIANCE), a coding protocol that assesses mother-infant interaction on the dimensions of affective communication errors, role/boundary confusion, frightened/disoriented behavior, intrusiveness/negativity, and withdrawal. Results showed improvement in AMBIANCE scores for the IG (play-focused) group, but not for the feeding-focused group. This study is limited by a small sample size and lack of a randomized design.

Length of post-intervention follow-up: None for IG group, 14 weeks for feeding-focused group.

Madigan, S., Hawkins, E., Goldberg, S., & Benoit, D. (2006). Reduction of disrupted caregiver behavior using modified interaction guidance. Infant Mental Health Journal, 27(5), 509-527.

Type of Study: Pretest/posttest
Number of Participants: 11 caregiver-infant pairs

Population:

  • Age range — 18.2 months
  • Race/Ethnicity — Not Specified
  • Gender — Not Specified
  • Status — Infants referred to an infant psychiatry clinic for feeding problems.

Location / Institution: Infant psychiatry clinic in a tertiary care pediatric hospital, Toronto, Ontario, Canada

Summary: (To include comparison groups, outcomes, measures, notable limitations)
Note: This analysis uses a subgroup of the sample used in Benoit et al., 2001. Mother-infant pairs were assessed at baseline and at a final feedback session. They received either 3, 4, or 5 Interaction Guidance (IG) treatment sessions depending on need and availability. Interactions were assessed using the AMBIANCE protocol. The current analysis focused on disrupted caregiver behavior, which consists of frightened or frightening behaviors on the caregiver's part during interactions with her infant. Result showed that mothers who underwent treatment with IG showed a reduction in disrupted behavior.

Length of post-intervention follow-up: None.

References

McDonough, S. C. (2000). Interaction Guidance: An approach for difficult-to-engage families. In C. H. Zeanah, Jr. (Ed.) Handbook of infant mental health (2nd ed.) (pp. 485-493). New York, NY: Guilford Press.

McDonough, S. C. (2004). Interaction Guidance: Promoting and nurturing the caregiving relationship. In A. Sameroff, S. C. McDonough, & K. L. Rosenblum, (Eds.) Treating parent-infant relationship problems: Strategies for intervention (pp. 79-96). New York, NY: Guilford Press.

McDonough, S. C. (1993). Interaction Guidance: Understanding and treating early infant-caregiver relationship disturbances. In C.H. Zeanah, Jr. (Ed.) Handbook of infant mental health (pp. 414-426). New York, NY: Guilford Press.

Contact Information

Name: Dr. Susan McDonough
Agency/Affiliation: University of Michigan
Department: Comprehensive Depression Center
Email:
Phone: (734) 936-4400

Date Research Evidence Last Reviewed by CEBC: December 2009

Date Program Content Last Reviewed by Program Staff: December 2009