Observational Tools For Measuring Parent-Infant Interaction

Clin Child Fam Psychol Rev (2015) 18:99132
DOI 10.1007/s10567-015-0180-z
Observational Tools for Measuring ParentInfant Interaction:

A Systematic Review
Annett Lotzin Xiaoxing Lu Levente Kriston
Julia Schiborr Teresa Musal Georg Romer
Brigitte Ramsauer
Published online: 3 April 2015

Springer Science+Business Media New York 2015
Abstract The quality of the parentinfant interaction is Most tools demonstrated a valid rating procedure, repro-
essential for the infants development and is most objec- ducibility, and discriminant validity, based on studies with
tively measured by observation. The existing observational credible quality. The tools lacked factorial and predictive
tools for assessing parentinfant interaction were identified validity, and standardized norms. Further refinement of the
and described, and their psychometric soundness was existing tools is needed, particularly in the domains of
evaluated. Twenty electronic databases from inception content validity and consequential validity. The synthe-
through June 2013 were searched. Validity was evaluated sized validity evidence and descriptions of the tools
in five domains (test content, response process, internal reported in this review might guide clinicians and re-
structure, relations to other variables, and consequences). searchers in the selection of an appropriate tool.
Of the 23,961 citations identified, 24 tools were included.
Keywords Motherinfant interaction
Fatherinfant interaction Behavioral observation
Measurement Psychometrics Validation studies
Electronic supplementary material The online version of this
article (doi:10.1007/s10567-015-0180-z) contains supplementary
material, which is available to authorized users.
Introduction
A. Lotzin (&) J. Schiborr G. Romer B. Ramsauer
Department of Child and Adolescent Psychiatry, Psychotherapy
and Psychosomatics, University Medical Center Hamburg- Pediatric (Committee on Psychosocial Aspects of Child
Eppendorf, Martinistr. 52, 20246 Hamburg, Germany Family Health 1997; Hagan et al. 2008) and Early Head
e-mail: A.Lotzin@uke.de Start (Early Head Start National Resource Center 2013)
initiatives call for the routine observation of the parent
Present Address:
A. Lotzin infant interaction in clinical work, early intervention,
Department of Psychiatry and Psychotherapy, University and research, stating that the childs relationship and
Medical Center Hamburg-Eppendorf, Hamburg, Germany interactions with his or her caregiver should form the
cornerstone of the assessment (Early Head Start Na-
X. Lu T. Musal
Department of Psychology, University of Hamburg, Hamburg, tional Resource Center 2013, p. 6). These
Germany recommendations have been informed by research,
indicating that the quality of the parentinfant interac-
L. Kriston
tion is crucial for the childs development in early
Department of Medical Psychology, University Medical Center
Hamburg-Eppendorf, Hamburg, Germany childhood, including attachment (Barnard et al. 1989;
Biringen et al. 2005; De Wolff and van Ijzendoorn 1997;
Present Address: Evans and Porter 2009), socialemotional development
G. Romer
(Hofheimer and Appelbaum 1992; Kochanska et al.
Department of Child and Adolescent Psychiatry, Psychosomatics
and Psychotherapy, University Hospital Muenster, Muenster, 2005a), cognitive development (Barnard et al. 1989;
Germany Evans and Porter 2009; Feldman et al. 2004; Hofheimer
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100 Clin Child Fam Psychol Rev (2015) 18:99132
and Appelbaum 1992) and clinical outcome (Ramchan- during their first year of life more frequently developed a
dani et al. 2013; Wan et al. 2012). Furthermore, the secure attachment (De Wolff and van Ijzendoorn 1997;
observed quality of the parentinfant interaction predicts NICHD Early Child Care Research Network 1997) and
the childs social and cognitive development (Stams were more likely to develop advanced attentional (Gart-
et al. 2002; Stright et al. 2008) and academic compe- stein et al. 2008), cognitive (Feldman et al. 2004) or
tence (Stright et al. 2008) in middle childhood. language skills (Tamis-LeMonda et al. 2001), compared
Consequently, observation of the interaction between with infants exposed to less sensitive or responsive par-
parent and infant is crucial for identifying strengths and ents. Some observational tools address facets of learning
problems that may impact the childs developmental support, such as scaffolding, structuring, or encouraging
outcomes. the infant to explore objects. Infants of parents that had
Observational tools of parentinfant interaction permit fostered their cognitive growth during early infancy later
an objective assessment of the parents and the infants developed better cognitive skills (Barnard et al. 1989;
behavior, whereas self-reports might be biased by the Oxford and Findlay 2012). Observational tools of parent
parents linguistic skills, thoughts, and feelings, or the infant interaction may also cover parent behaviors that
tendency to respond in a socially desirable manner (Cor- interfere with infant development, for example, intru-
coran and Fischer 2013). Microanalytic observational tools siveness, control, or hostility. Infants of parents that had
enable to assess the fine-grained details of the parentinfant been more intrusive (Beebe et al. 2010; Biringen et al.
interaction that often occur without awareness: how the 2005) or hostile (Biringen et al. 2005) were less likely to
behavior between parent and infant unfolds over time, and develop a secure attachment and enhanced cognitive
how the parents or the infants behavior is influenced by abilities (Bernstein et al. 1987) than infants of parents
the behavior of the interaction partner (Gardner 2000). But that had been less intrusive or hostile.
observational tools involve a higher investment in training, Infant behaviors measured by observational tools of
technical equipment, and time for administration than parentinfant interaction often cover infant responsiveness,
questionnaire assessments (Bagner et al. 2012). Parent-re- engagement, or involvement. Infants that had been more
port questionnaires might be preferred when less complex responsive during their first year of life were more likely to
information about the parentinfant interaction is required; develop a secure attachment (Barnard et al. 1989; Biringen
they are often brief, easy to administer, and particularly et al. 2005), or advanced cognitive skills (Barnard et al.
helpful for identifying infants who need more extensive 1989). Observational tools may also measure infant posi-
assessment (Halle et al. 2010). Parent-reports even out- tive or negative affect. Infants that had expressed more
weigh observational assessments if the addressed construct positive vocal or facial affect during early infancy were
is difficult to observe, such as the parents feelings, more likely to develop a secure attachment (Braungart-
thoughts, or perceived relationship quality between parent Rieker et al. 2001; Cohn et al. 1991), whereas infants that
and infant (Gardner 2000). had displayed higher vocal distress, or more combined
Importantly, observational and self-report assessments expressions of vocal and facial distress, were more likely to
are non-interchangeable: They correlate only weakly to develop a disorganized than a secure attachment (Beebe
moderately (Alderfer et al. 2008). Therefore, an evaluation et al. 2010). Infant clarity of cues is covered by some of the
of the parentinfant interaction should be guided by the observational tools, which has been shown to predict infant
particular purpose of the assessment (Snow et al. 2008), for secure attachment (Barnard et al. 1989) and cognitive
example, to screen for potential problems for further abilities (Oxford and Findlay 2012).
evaluation, or to diagnose problems in the parentinfant On the dyadic level, observational tools of parentin-
interaction to determine the need for intervention. If a fant interaction measure the coordination of the behaviors
comprehensive evaluation of the parentinfant interaction between parent and infant by constructs such as syn-
is needed, this should ideally include both parent-reports chrony, reciprocity, or mutuality. Both lowered and
and behavioral observations (Bagner et al. 2012; Halle heightened levels of synchrony or reciprocity may impair
et al. 2010; Shepard et al. 1998). infant development. For example, infants of parentinfant
Observational tools of parentinfant interaction cover dyads that had been shown lowered or heightened parent
a broad range of constructs. The most prevalent con- infant synchrony of their facial or vocal affect more fre-
structs addressed by observational tools include aspects quently developed unfavorable attachment outcomes
of responsive caregiving, such as sensitivity, contingent (Beebe et al. 2010; Jaffe et al. 2001), compared with in-
responsiveness, or emotional availability. These con- fants of dyads with medium levels of synchrony. Deviant
structs have been shown to be related to infants parentinfant synchrony was also related to infants later
attachment and cognitive development: Infants that had cognitive development (Gartstein et al. 2008; Kochanska
been exposed to more sensitive or responsive parents et al. 2005b).
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Clin Child Fam Psychol Rev (2015) 18:99132 101
Although these relations between specific parentinfant as the amount of time needed to conduct and evaluate the
interaction constructs and infants later development have assessment, training availability and cost, and the popu-
been documentedparticularly for infants attachment and larity of a tool.
cognitive abilitiesit should be noted that most parentinfant To obtain this critical information, a systematic review
interaction studies predict the infants later development by a of the existing observational tools for measuring parent
tools total score derived from summing up different parent infant interaction and an evaluation of the tools psycho-
infant interaction constructs (Mahoney et al. 1996). metric properties might be particularly helpful. However,
The selection of a particular observational tool of par- to our knowledge, a comprehensive systematic review of
entinfant interaction is challenging because it requires the psychometric properties of observational tools of par-
extensive knowledge about the constructs needed for this entinfant interaction has not yet been performed.
specific purpose (Early Head Start National Resource Bagner et al. (2012) reviewed assessment procedures for
Center 2013). Researchers or clinicians should also con- measuring behavioral and emotional problems in infants
sider the availability of tools for measuring the behaviors younger than 2 years. In addition to parent-report measures,
of interest, and the limitations, as well as the strengths of the authors identified four observational tools of parentin-
these often complex tools (Early Head Start National Re- fant interaction and concluded that the four observational
source Center 2013; Margolin et al. 1998). This tools provided adequate support for reliability and validity.
information may be difficult to obtain because most ob- However, the authors did not report on the eligibility criteria,
servational tools are not published, and no tool is accepted search strategy, study selection process, or methods used to
as the gold standard for measuring parentinfant interac- evaluate the observational tools. Consequently, it remains
tion. But if an observational tool is not chosen carefully, unclear why the authors identified only four out of the nu-
the assessment will be costly in time and resources and merous existing observational tools of parentinfant
may result in incorrect judgments that are useless or even interaction. Halle et al. (2011) conducted a comprehensive
harmful to the evaluated parents and infants (Mahoney search for observational tools of parentinfant interaction,
et al. 1996). but narrowed their review to relations between the tools
Knowledge of research findings related to a tools psy- constructs and infant outcomes; other sources of validity
chometric properties (i.e., validity evidence) is essential for evidence were not considered. Finally, the systematic review
the purposeful assessment of a tool. The standards for of Munson and Odom (1996) considered indices of the re-
educational and psychological testing (American Educa- liability and validity of observational tools of parentinfant
tional Research Association, American Psychological interaction, but is outdated. A more rigorous systematic re-
Association, & National Council on Measurement in view that focuses on the psychometric quality of current
Education 1999) outline five domains of possible validity observational tools of parentinfant interaction is needed.
evidence: evidence based on test content (content); the We systematically searched through the literature of the
responses of the test administrators and assessed indi- last hundred years to identify the available observer-rated
viduals (response process); the structure of item responses tools for measuring parentinfant interaction. Our aim was
or subscales (internal structure); the relations between the to describe the existing tools and the evidence of their
tests scores and other variables relevant to the constructs psychometric quality in order to support researchers and
(relations to other variables); and the consequences of clinicians in making evidence-based choices.
testing (consequences). Each of these validity sources
indicates possible evidence for or against the application of
a test and should guide the selection of a tool with regard to Methods
the purpose for which the tool will be used.
For example, if researchers or clinicians plan to evaluate Our systematic review report followed the guidelines pub-
the effectiveness of an intervention to promote reciprocity lished in the Preferred Reporting Items for Systematic
between depressed parents and their infants, they might Reviews and Meta-Analyses (PRISMA, Moher et al. 2009).
search for a tool that comprises evidence to measure the We pre-specified a review protocol and registered the sys-
construct of reciprocity, has a rating procedure of re- tematic review in the PROSPERO database (http://www.crd.
ciprocity that is valid, and is sensitive to the change in york.ac.uk/prospero; registration number CRD42012002435).
reciprocity in response to the intervention. Even if all cri-
teria are met, the assessment will be of limited use if an Eligibility Criteria for Tool Selection
increase in reciprocity does not correspond with a benefit to
the assessed family, such as the infants developmental We included tools that (1) were quantitative measures; (2)
outcome. Researchers or clinicians might also consider were designed for the observation of the interaction be-
practical arguments for or against the choice of a tool, such tween one parent and one infant by an external observer;
123
and (3) measured both parent and infant behavior. We Nursing and Allied Health Literature (CINAHL), Current
focused our review on tools that (4) could already be used Contents Connect (CCC), Cochrane Database of Systematic
before the infants age of 12 months (i.e., tools applicable Reviews (CDSR), Cochrane Central Register of Controlled
for infants aged 1030 months were included). We focused Trials (CENTRAL), Cochrane Methodology Register
on these tools because problems in the parentinfant in- (CMR), Database of Abstracts of Reviews of Effects
teraction should be identified as early as possible before (DARE), Excerpta Medica dataBASE (EMBASE), Educa-
more severe difficulties have been developed (Early Head tion Resources Information Center (ERIC), Educational
Start National Resource Center 2013). Testing Service Test Collection (ETS), Medical Literature
We excluded tools that (1) primarily measured constructs Analysis and Retrieval System Online (MEDLINE), Mental
other than the observed parentinfant interaction. This ex- Measurements Yearbook with Tests in Print, PsycINFO,
clusion criterion was set because our pilot searches identified PSYNDEXplus Literature and Audiovisual Media,
many tools that included one single rating of the parentinfant PSYNDEXplus Tests, Science Citation Index Expanded
interaction, but focused on other constructs; for these tools, (SCIE), Social Sciences Citation Index (SSCI), SocINDEX,
no or very limited evidence for the psychometric properties of Health Technology Assessment Database (HTA), and Pro-
the observational constructs existed. Tools were also ex- Quest Dissertations & Theses. Google Scholar and Google
cluded if (2) they were rated by the parent or (3) no full-text were also searched. We used combinations of text words and
article was available that described or psychometrically subject headings (if available) related to parentinfant in-
evaluated the tool. To prevent the inclusion of minimally used teraction and behavioral observation. As an example, the
tools, or tools that have been only used with older children, we search strategy for MEDLINE can be found in Appendix 1.
excluded tools that had been used in (4) fewer than two peer- Our manual search covered the electronic directories of
reviewed primary journal articles with infants aged between 0 twelve test publishers (Behavior Science Systems, Brookes
and 12 months by different research teams since 1992. Publishing, Hogrefe, Pearson Assessment & Information,
For each tool, two types of articles were considered: Mind Garden, NCAST Programs, PAR, PRO-ED, Riverside
(a) articles describing the development or application of the Publishing, Scholastic Testing Service, Slosson Educational
tool (e.g., a description of the tools theoretical back- Publications, and Western Psychological Services), as well
ground, scale construction, or implementation) and as ten books that described assessments for parents and in-
(b) articles evaluating the tools psychometric quality (e.g., fants (Clark et al. 2004; DelCarmen-Wiggins and Carter
validation studies of any study type that evaluated the 2004; Goldman et al. 2008; Groth-Marnat 2009; Keyser and
tools reliability or factorial validity). Sweetland 1984; Maddox 1997; Shonkoff and Meisels 2000;
Snow, Van Hemel, Committee on Developmental Outcomes
Search Strategy and Assessments for Young Children, and National Research
Council 2008; Zaslow 2011; Zeanah 2009). Additional test
To identify potentially relevant tools and related articles, publishers and books identified during the search were also
we conducted a systematic literature search using elec- hand searched. Published and unpublished reviews of par-
tronic databases and manual searches of other sources. The entinfant tools, including their reference lists that were
search strategy was developed with the assistance of a li- known by the authors or identified during the literature
brarian. Pilot searches revealed that we could not identify search, were also manually searched. An additional strategy
most of the available psychometric studies by using involved contacting experts in the field to locate further tools.
methodological search terms. Therefore, we developed a
more comprehensive search strategy. We first searched for Tool Selection
articles that used or described observational tools for
measuring parentinfant interaction. On the basis of these Two reviewers (AL and TM) independently performed the
articles, we compiled a list of potentially relevant tools. We eligibility assessment of the tools. If there was disagree-
screened these tools against our inclusion and exclusion ment between the two reviewers, a third reviewer was
criteria (except exclusion criteria 3 and 4 for the tools; see consulted, and the three reviewers reached a consensus for
section on eligibility criteria for tool selection). To locate inclusion or exclusion.
further information on the relevant tools, we searched the Titles and abstracts of the articles that were identified
electronic databases using the full titles and tool acronyms. through the database searches were screened first. If the name
Databases were searched from each databases first al- of the tool was not mentioned in the abstract, the full text of
lowable search date through June 2013. No limitations on the article was examined. A database was created containing
language or publication year were used. The following all potentially relevant tools and related sources that de-
databases were searched systematically: Child Care and scribed or used the tool. If the identified information about a
Early Education Research Connections, Cumulative Index to tool was insufficient to make a decision regarding eligibility
123
for inclusion, we contacted the authors or publishers (2) Response process: responses of the raters and ob-
(n = 258) to obtain further information. The response rate was served individuals; (a) behavioral response: validity
71 %. All authors or publishers were asked to provide in- of the observed behavior; (b) rater training; and
formation about the included tools. Articles in Japanese, (c) scoring procedure.
Dutch, Italian, Portuguese, and Spanish were translated by (3) Internal structure: (a) internal consistency: Cronbachs
professional translators into English or German. alpha, inter-item correlation, item-discrimination
(item-total statistic); (b) reproducibility (objectivity):
Data Extraction inter-rater reliability, intra-rater reliability, testretest
reliability, parallel-test reliability; (c) sensitivity to
Data were extracted from articles that psychometrically change; (d) dimensional structure: inter-scale correla-
evaluated or described the included tools. We followed a tion, factorial validity, measurement invariance.
systematic approach by implementing a standard Excel (4) Relation to other variables: (a) convergent or diver-
data extraction sheet, pilot-tested it on twenty randomly gent validity: correlation between a tools construct
selected eligible articles, and refined it accordingly. Two and other measures of the same construct (convergent
review authors (AL and XL) independently extracted the validity) or the absence of a correlation between a
data from the articles. The reviewers resolved disagree- tools construct and other measures of a different
ments in data abstraction through consensus. If no construct (divergent validity); (b) criterion validity:
agreement could be reached, a decision was made with the correlation between a tools construct and the childs
help of a third reviewer. Duplicate reports of any of the developmental outcomes (concurrent, predictive va-
studies were eliminated from data extraction. lidity); c) discriminant validity: differences in the
Our general description of the tools was primarily based tools constructs between relevant subgroups.
on data from the tools manuals. If a manual was not (5) Consequences of assessment: four outcome levels
available or the desired information was not reported, we corresponding to Kirkpatricks (1967) hierarchy:
extracted the information from the authors description of (a) reaction: parents or raters views on the assess-
the tool in the identified articles. We extracted the name ment; (b) learning: parents or raters modification of
and purpose of the tool, the tools target population, the knowledge, skills, or attitudes; (c) behavior: modifi-
measured constructs, the observational setting, and practi- cation in parents, infants, or raters behavior;
cal information for administration, such as tool and training (d) results: benefits of assessment to parents and
availability. As an indicator of the popularity of the tools, infants, or change in health care practice or society.
we assessed the total number of published and unpublished
For each sub-domain (e.g., discriminant validity) of the
empirical studies for each tool.
five validity domains, two reviewers (AL and XL) indepen-
The following information from the articles that described
dently evaluated whether or not the extracted data supported
or psychometrically evaluated the included tools was ex-
evidence for validity (0 = no evidence, 1 = evidence). If the
tracted: tool name, citation, study design, country, child age,
two reviewers disagreed, a third reviewer was consulted.
sample characteristics, sample size, rater characteristics,
location of observation, type of task, and type of observation.
Study Quality Rating
The unified validity theory of Messick (1995), endorsed by
The Standards for Educational and Psychological Testing
The methodological quality of all included empirical
(American Educational Research Association et al. 1999),
studies was critically appraised by two independent review
guided our extraction approach. In this framework, validity
authors (AL and XL) using a standardized form for psy-
is conceptualized as an integrated evaluation of the degree to
chometric reviews (Fallon et al. 2008). Reviewers
which the empirical evidence and theoretical rationales
determined the adequacy of the study design, sample size,
support the intended interpretations of test scores (Messick
sample selection, representativeness of the sample for the
1995). The degree of validity evidence is evaluated across
tools target population, tool description, data analysis
multiple sources: test content, response process, internal
methods, and blinding as adequate, not adequate,
structure of the test, relations of test scores to other variables,
unclear, or not applicable. On the basis of these cri-
and the consequences of the assessment.
teria, the credibility of each study was globally rated as
Data on a tools validity argument were extracted in five
unequivocal (evidence from a study that is of excellent
validity domains:
methodological quality, directly relevant to the population
(1) Content: (a) theory-driven item development; (b) lit- of interest, and appropriately uses psychometric tests),
erature review-based item development; and (c) item credible (evidence from a study that has good method-
review by experts (expert consensus). ological quality but contains potential flaws, such as a
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small sample size, partial divergence from the population 23,961 Records
of interest, or questionable use of psychometric tests), or 13,683 Initial database search
9,072 Database search using tool name as
unsupported (evidence from a study with poor method- search term
ological quality, little direct relevance to the population of 670 Google search
428 Reference lists
interest, or inappropriate use of psychometric tests). The 85 Books
inter-rater reliability of the credibility levels of the studies 17 Directories of test publishers
6 Personal communication
was = .87. Differences in credibility levels between the
two raters were reconciled by discussion. Studies with low 10,008 Duplicates removed
quality were not excluded from the data synthesis.
13,953 Records screened
Data Synthesis 6,463 Records excluded based on title and

abstract review
4,936 Records excluded based on full-text
We used the criteria and guidelines of Cicchetti (1994) and review
Cicchetti and Sparrow (1990) to evaluate psychological
tests for appraising the validity evidence of the included 906 Potentially relevant tools used in 2,554
articles assessed for eligibility
tools. Discrepancies in validity evaluation were resolved by
involving a third reviewer. Inter-rater reliability for the 882 Tools excluded
validity evidence of each data source (n = 153) in the five 587 Fewer than two peer-reviewed primary
journal articles since 1992
validity domains between the two reviewers was excellent 81 No infant behavior
(content validity = .93, response process = .92, in- 75 Not usable before infants age of 12
months
ternal structure = .90, relations to other variables 61 No parent behavior
= .93, consequences = .86). 30 Primarily measured other constructs
23 No article describing or evaluating tool
13 No English version
8 No quantitative measure
4 Not designed for the observation of one
Results parent and one infant
24 Included tools described or

Review Process psychometrically evaluated in 104 articles
Figure 1 summarizes the results of the study identification Fig. 1 Flowchart of the review process
process. After 10,008 duplicates were removed, 13,953
records were screened. We identified 906 potentially rele-
vant tools based on the title and abstract or a full-text articles were grey literature (Schoepfel et al. 2005), in
review. We excluded more than half of these potentially other words non-commercially published or unpublished
relevant tools because the tools were utilized in fewer than written articles (conference abstracts, tool manuals, and
two peer-reviewed primary journal articles. Typically, other unpublished reports).
these tools were developed for one study and were not The publication dates of the articles ranged from 1975 to
subsequently used. After a detailed assessment, we in- 2012. The articles were from 19 countries, with most from
cluded 24 tools with 104 articles describing or the USA. Seventy-five percent of the articles were from
psychometrically evaluating the tools in our review. The North America, 19 % from Europe, 7 % from Asia, 2 %
full texts of five additional sources describing or evaluating from Australia, and 2 % from South America.
the tools (two conference abstracts, two manuals, and one Two-thirds (66 %, n = 69) of the included articles re-
unpublished report; see Appendix 2) were irretrievable and ported empirical research studies. In these 69 articles, 86
were excluded from data extraction. empirical studies were reported that involved heteroge-
neous populations, methods, and outcomes (see
Characteristics of the Articles that Described Supplement A in ESM 1). Two study types (Grimes and
or Psychometrically Evaluated Observational Tools Schulz 2002, see Table 2) were most common: a cross-
for Measuring ParentInfant Interaction sectional study without a comparison group (descriptive
cross-sectional study) and a prospective longitudinal design
More than half of the included articles were peer-reviewed without a comparison group (descriptive longitudinal
journal articles (see Table 1). Twenty percent of the articles study). A few studies (8 %) used a prospective longitudinal
were commercially published in formats other than peer- design with a comparison group (cohort study). No study
reviewed journal articles (book sections, conference ab- had a randomized or non-randomized controlled interven-
stracts, and tool manuals). Twenty-two percent of the tion trial design. Two percent of the studies conducted
123
Table 1 Characteristics of 104 articles describing or psychometri- Table 2 Characteristics of 86 empirical studies evaluating direct
cally evaluating direct observational tools for measuring parent observational tools for measuring parentinfant interaction
infant interaction
Characteristics n %
Characteristics n %
Study design
Type of article Cohort 7 8.1
Peer-reviewed journal article 60 57.7 Cross-sectional 9 10.5
Conference abstract, poster, or paper 11 10.6 Descriptive cross-sectional 36 41.9
Book section 12 11.5 Descriptive longitudinal 32 37.2
Tool manual 13 12.5 Not reporteda 2 2.3
Masters thesis or dissertation 4 3.8 Sample size (dyads)
Other unpublished report 4 3.8 150 25 29.1
Publication (year) 51100 27 31.4
19751979 2 1.9 101200 19 22.1
19801989 18 17.3 201400 6 7.0
19901999 36 34.6 601800 1 1.2
20002009 39 37.5 Database of studiesb 4 4.7
20102012 9 8.7 Not reported 4 4.7
Countrya Study quality
Asia Unequivocal 5 5.8
Israel 3 2.9 Credible 29 33.7
Japan 3 2.9 Unsupported 52 60.5
Taiwan 1 1.0 Raters
Australia 2 1.9 Student 8 9.3
Europe Researcher 13 15.1
Austria 1 1.0 Health professionals 14 16.3
Finland 2 1.9 Not reported 55 64.0
France 1 1.0 Locationc
Germany 3 2.9 Center 6 7.0
Iceland 1 1.0 Home 29 33.7
Italy 4 3.8 Hospital 14 16.3
Netherlands 2 1.9 Laboratory 21 24.4
Portugal 1 1.0 Not reported 23 26.7
Spain 1 1.0 a
Studies re-analyzed data from previous studies and the study design
Switzerland 1 1.0 of the original studies were not reported
United Kingdom 3 2.9 b
Database of previously conducted studies. The sample size of the
North America original studies were not reported
Canada 1 1.0 c
Percent add up to more than 100 because eight studies used two
United States 77 74.0 locations of observation
South America
Brazil 1 1.0
and 3). The study quality was most often rated as unsup-
Argentina 1 1.0
ported because the studies did not provide information on
a
Percent add up to more than 100 as two studies included popula- all of our study quality criteria (27.9 %, n = 24), reported
tions of more than one country small sample sizes (7.0 %, n = 6), or both (12.8 %,
n = 11). The remaining studies with low quality (12.8 %,
n = 11) were judged as unsupported because they showed
secondary analyses of previously collected study data. considerable risk of bias in at least two of the following
Twenty-nine percent of the studies included sample sizes domains: The study was not well designed (n = 9), the
of 50 parentinfant dyads or fewer. Only 8 % of the studies sample was not representative of the target population of
used more than 200 dyads. the tool (n = 1), the data analysis methods were not ap-
The majority of the studies (60.5 %, n = 52) had low propriate (n = 8), or the raters were not blinded to the
methodological quality (see Supplement B and C in ESM 2 tools objective (n = 10).
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Most studies did not report the characteristics of the used feeding observations. Thirteen tools (54 %) required
raters of the parentinfant interactions. If reported, the video recording of the parentinfant interaction, seven tools
raters were most often health care professionals (e.g., (29 %) could be used for either video or live rating, and four
nurses, pediatricians, psychiatrists) or researchers. The tools (17 %) were designed for live rating only. The recom-
observation of the parentinfant interaction was frequently mended time of the behavioral observation ranged from 1 to
conducted at the homes of the observed families. Obser- 45 min. Although the authors frequently reported the tools
vation in a laboratory was also common. observation time, they rarely reported the time needed for
scoring the observed behavior. If reported (n = 8, 33 %),
Description of Observational Tools for Measuring scoring time ranged from 5 to 50 min.
ParentInfant Interaction A commercially published manual was available for six
tools (25 %), and an unpublished manual was available for
The 24 tools measured heterogeneous constructs (see twelve tools (50 %). Eleven (46 %) of these published or
Table 3), which ranged from direct behavior (e.g., gaze) to unpublished manuals could be obtained from the tools
broad constructs (e.g., maternal sensitivity). Fifteen tools authors or a commercial test publisher, whereas seven
(63 %) assessed constructs of the parentinfant interaction manuals (29 %) were restricted to individuals who attended
at a dyadic level; four of these tools (17 %) exclusively specific training. For six tools (25 %), no manual was
measured dyadic constructs. The number of items of the available, but a tool description was published in a peer-
tools ranged from 4 to 84. Eleven tools (46 %) contained reviewed journal article or book section. For most of the
less than 20 items and could be rated in a short time. tools (n = 21, 88 %), authors stated that training was re-
Nineteen tools (79 %) used a global rating approach, four quired for the use of the tool. The definition of training
tools (17 %) used microanalytic coding, and one tool (4 %) ranged from self-study of the manual to personal training
used both microcoding and global ratings to score parent by the tools authors. A certificate of competence
infant interactions. (achievement of inter-rater reliability) was needed for the
The authors often reported multiple purposes (Washing- use of five tools (21 %). Personal or distance training was
ton State Office of Superintendent of Public Instruction unavailable for five tools (21 %). The number of citations
2008) of the tools (see Table 4): Fourteen tools (58 %) were of empirical studies for the tools ranged from 2 to 359
appropriate for screening potential problems to be further (Md = 26.0, M = 69.5, SD = 98.7). The median number of
evaluated; six tools (25 %) aimed to diagnose problems in the citations per year since the tool had been developed was
parentinfant interaction to determine the need for inter- 1.1 (M = 2.7, SD = 3.6, range 0.215.0). The EAS (full
vention; twelve tools (50 %) were applicable for monitoring tool names are reported in Table 3) was the most popular
progress of parentinfant interaction over time; and seven tool, with a yearly citation rate of 15. A tools popularity
tools (29 %) were appropriate to evaluate treatment outcome. was not necessarily a good indicator of how often its
For four tools (17 %), no purpose of the tools was stated. psychometric properties were examined. The percentage of
Most authors designed the tools for both low- and high- articles evaluating the tools out of all empirical studies of a
risk populations (n = 15, 63 %). Three tools (13 %) were tool ranged from 1.5 to 50 (Md = 8.8, M = 12.8,
only appropriate for high-risk populations, and two tools SD = 13.2).
(8 %) were only suitable for low-risk populations. For four
tools (17 %), the authors did not specify whether the tool Validity Evidence Based on Studies with Credible
was designed for high-risk or low-risk populations. The or Unequivocal Study Quality
entire age range of 012 months was covered by fourteen
tools (58 %). Fourteen tools (58 %) were applicable for The validity evidence for the observational tools in the five
clinical work and research. Seven tools (29 %) were only validity domains, synthesized on the basis of the studies
appropriate for clinical use, and two additional tools (8 %) with credible or unequivocal study quality, is reported in
were only suitable for research use. The authors of one tool Table 5 (for more details, see Supplement B in ESM 2).
did not state the clinical or research use of the tool. None of the 24 tools provided evidence for all five domains
Most tools (n = 17, 71 %) could be used for home obser- of validity. Ten tools (42 %) demonstrated evidence for
vations as well as for observations outside the home of the four validity domains (BMIS, EAS, GLOS-R, M-I/TFS,
observed family. Six tools (25 %) were designed for settings MICS, MRO, NCAFS, NCATS, PIOG, and PIPE).
outside the home, such as a laboratory, center, or hospital. One
tool (4 %) was designed for home observation only. Twelve Content
tools (50 %) were appropriate for different observational tasks
or settings. The observational task most often used was play or Evidence for content validity was provided for nine tools
face-to-face interaction (n = 21, 88 %). Eight tools (33 %) (EAS, IPSIC, M-I/TFS, MRO, NCAFS, NCATS, PCERA,
123
PIOG, and PIPE). For six tools (EAS, MRO, NCAFS, Unnamed, BMIS, CARE-Index, EAS, GLOS-R, MRO, and
NCATS, PCERA, and PIOG), data indicated that the tools RCS), evidence of testretest validity was demonstrated.
were theoretically based. For five tools (IPSIC, MRO, Evidence for the sub-domain of sensitivity to change in
NCATS, PCERA, and PIPE), there was evidence that the response to the infants development or a parentinfant
tools were developed on the basis of a literature review. intervention was provided for five tools (Belsky/Unnamed,
The IPSIC and the M-I/TFS demonstrated evidence that BMIS, EAS, MRO, and RCS).
tool development included item reviews by experts. In the sub-domain of dimensional structure, data of eight
tools (ADS, CARE-Index, EAS, GLOS-R, GRS, MRO,
Response Process PCERA, and RCS) established evidence. Data for six tools
(ADS, CARE-Index, EAS, GRS, PCERA, and RCS)
Eighteen tools (ADS, AMIS, BMIS, CARE-Index, DMC, demonstrated within-tool inter-scale correlations in the
EAS, GLOS-R, GRS, IPSIC, M-I/TFS, MICS, MRO, expected directions (scales with similar constructs corre-
NCAFS, NCATS, PCERA, PIOG, PIPE, and RCS) lated higher than scales with dissimilar constructs). The
demonstrated evidence for valid responses of the raters or GLOS-R, MRO, and PCERA provided evidence for fac-
observed individuals. torial validity. Data supporting measurement invariance
The EAS provided evidence for all three sub-domains of was available for the MRO.
response process validity. Thirteen tools (ADS, AMIS,
BMIS, CARE-Index, EAS, GLOS-R, GRS, IPSIC, Relations to Other Variables
NCAFS, NCATS, PCERA, PIPE, and RCS) demonstrated
evidence for appropriate rater training. Sixteen tools The data of fifteen tools (Belsky/Unnamed, BMIS, CARE-
(AMIS, CARE-Index, DMC, EAS, GLOS-R, GRS, IPSIC, Index, DMC, EAS, GLOS-R, GRS, M-I/TFS, MICS,
M-I/TFS, MICS, MRO, NCAFS, NCATS, PCERA, PIOG, MRO, NCAFS, NCATS, PIOG, PIPE, and RCS) demon-
PIPE, and RCS) showed evidence for a valid rating pro- strated validity evidence. The BMIS and the PIOG
cedure. The EAS and the M-I/TFS provided evidence that provided evidence on all three sub-domains of the domain
the behavioral responses of the observed individuals were relations to other variables (convergent or divergent va-
valid. Evidence was established by the assessment of par- lidity, discriminant validity, and criterion validity).
ent-reports, indicating that their behavior in the laboratory Evidence for convergent or divergent validity (asso-
was representative of their typical interactions at home. ciation of the tools constructs with similar or dissimilar
constructs) was found for seven tools (BMIS, DMC, MICS,
Internal Structure MRO, NCAFS, NCATS, and PIOG). Fourteen tools (Bel-
sky/Unnamed, BMIS, CARE-Index, DMC, EAS, GLOS-R,
Evidence of internal structure validity was demonstrated by GRS, M-I/TFS, MRO, NCAFS, NCATS, PIOG, PIPE, and
sixteen tools (ADS, AMIS, Belsky/Unnamed, BMIS, RCS) discriminated between relevant groups (often high-
CARE-Index, DMC, EAS, GLOS-R, GRS, MICS, MRO, risk vs. low-risk groups). Four tools (BMIS, EAS, GLOS-
NCAFS, NCATS, PCERA, PIPE, and RCS). The EAS and R, and PIOG) demonstrated evidence for concurrent cri-
the MRO provided evidence for all four sub-domains of terion validity; four tools (BMIS, EAS, GLOS-R, and RCS)
this validity domain. showed evidence for predicting a criterion (e.g., the in-
For the sub-domain of internal consistency, ten tools fants attachment security or development).
(ADS, Belsky/Unnamed, BMIS, DMC, EAS, MICS, MRO,
NCAFS, NCATS, and PCERA) demonstrated evidence, Consequences of Assessment
which most commonly was based on the Cronbachs test
statistic. Data on inter-item correlations additionally sup- Five tools (BMIS, GLOS-R, M-I/TFS, MICS, and PIOG)
ported the internal consistency for the MRO. provided validity evidence for the consequences of the
Evidence in the sub-domain of reproducibility (objec- assessment of a tool.
tivity) was provided for fifteen tools (ADS, AMIS, Belsky/ The BMIS and the MICS demonstrated evidence based
Unnamed, BMIS, CARE-Index, DMC, EAS, GLOS-R, on the reaction of raters in response to the tools use, which
MICS, MRO, NCAFS, NCATS, PCERA, PIPE, and RCS). was generally positive. For the BMIS and the PIOG,
The most commonly reported test statistic was inter-rater learning in terms of an increase in the raters knowledge and
reliability, for which the data of fourteen tools (ADS, skills in response to the assessment was reported. For none
AMIS, Belsky/Unnamed, BMIS, CARE-Index, DMC, of the tools, data suggested evidence for modifications in
EAS, MICS, MRO, NCAFS, NCATS, PCERA, PIPE, and rater behavior in response to the tools use. Data from the
RCS) established evidence. Only the NCATS demonstrated BMIS, GLOS-R, and M-I/TFS presented evidence that the
evidence of intra-rater reliability. For seven tools (Belsky/ assessment had benefits for the evaluated parents or infants.
123
Evidence was mostly established by reporting norms or cut- M-I/TFS, MIPIS, Monadic Phases, NCAFS, NCATS,
off scores to guide treatment decisions. However, the sam- PCERA, PIIS, and RCS). Four tools (AMIS, DMC, MICS, and
ples on which norms were based could often not be NCATS) provided evidence for the sub-domain of sensitivity
considered fully representative of the target population. to change in response to the infants development or a parent
infant intervention. For the sub-domain of dimensional
Further Validity Evidence Based on Studies structure, the NCAFS and NCATS established evidence.
with Unsupported Study Quality, or Based on Articles
Describing an Observational Tool Relations to Other Variables
Additional validity evidence for the included observational In the domain of relations to other variables, the data for
tools of parentinfant interaction, based on studies with nine tools (AMIS, BMIS, DMC, FEAS, MIPIS, Monadic
unsupported study quality, or based on articles describing a Phases, NCAFS, NCATS, and PIIS) demonstrated validity
tool, is summarized in Table 6 (for details, see Supplement evidence.
C and D in ESM 3 and 4). Evidence for convergent or divergent validity was found
for four tools (Monadic Phases, NCAFS, NCATS, and
Content PIIS). Five tools (BMIS, DMC, FEAS, NCAFS, and
NCATS) discriminated between relevant groups. Evidence
Evidence of content validity was provided by fifteen tools for criterion validity was demonstrated by four tools
(ADS, AMIS, CARE-Index, CIB, DMC, FEAS, GLOS-R, (AMIS, MIPIS, NCAFS, and NCATS).
MICS, MIPIS, Monadic Phases, NCAFS, NCATS, PIIS,
PIOG, and RCS). Consequences of Assessment
For eleven tools (ADS, CARE-Index, CIB, DMC,
FEAS, GLOS-R, MICS, MIPIS, Monadic Phases, PIIS, and Validity evidence for the consequences of the assessment
RCS), authors reported that the tools were theoretically of a tool was constituted by eight tools (ADS, BMIS,
based; for seven tools (ADS, AMIS, FEAS, MICS, DMC, FEAS, M-I/TFS, NCAFS, NCATS, and PIOG).
NCAFS, PIIS, and PIOG), authors stated that the tools Four tools (BMIS, NCAFS, NCATS, and PIOG) estab-
were developed on the basis of a literature review. For four lished evidence based on the reaction of raters in response
tools (NCAFS, NCATS, PIOG, and RCS), experts re- to the tools use. An increase in the raters knowledge,
viewed the tools items during the tools development. skills, or attitudes in response to the assessment (learning)
was reported for five tools (ADS, BMIS, NCAFS, NCATS,
Response Process and PIOG). The data of four tools (BMIS, NCAFS,
NCATS, and PIOG) suggested evidence for modifications
Eleven tools (ADS, AMIS, CARE-Index, EAS, FEAS, M-I/ in rater behavior in response to the tools use. Evidence
TFS, Monadic Phases, NCAFS, NCATS, PIOG, and RCS) that the assessment had benefits for the evaluated parents or
provided evidence for the validity of the response process. infants was reported for six tools (ADS, DMC, FEAS, M-I/
Evidence for appropriate rater training was demon- TFS, NCAFS, and NCATS).
strated by seven tools (CARE-Index, EAS, FEAS, M-I/
TFS, NCAFS, NCATS, and PIOG). Evidence for a valid
rating procedure was available for nine tools (ADS, AMIS, Discussion
EAS, M-I/TFS, Monadic Phases, NCAFS, NCATS, PIOG,
and RCS). The NCATS provided evidence that the be- We systematically reviewed the literature to identify ob-
havioral responses of the observed individuals were valid. servational tools for measuring parentinfant interaction,
described the existing tools, and evaluated their psycho-
Internal Structure metric soundness. We identified 24 observational tools for
assessing parentinfant interaction that were described or
Based on studies with unsupported study quality, evidence of psychometrically evaluated in 104 articles from 19 coun-
internal structure validity was found for fifteen tools (AMIS, tries. Evidence in all five domains of validity (i.e., content,
BMIS, CIB, DMC, EAS, GLOS-R, M-I/TFS, MICS, MIPIS, response process, internal structure, relations to other
Monadic Phases, NCAFS, NCATS, PCERA, PIIS, and RCS). variables, and consequences) based on studies with cred-
For the sub-domain of internal consistency, data of four ible study quality was identified for none of the tools. Ten
tools (CIB, MIPIS, NCAFS, and NCATS) showed evidence. observational tools provided evidence in four domains of
In the sub-domain of reproducibility (objectivity), evidence validity; most of these tools have the potential for wider
was demonstrated for eleven tools (BMIS, EAS, GLOS-R, use with additional research on their consequential validity.
123
Aspects of Validity that Need Improvement A more thorough understanding is needed of which of
the wide range of heterogeneous constructs are causally
Content validity was most often demonstrated by a theory- related to child developmental outcomes. At present, the
driven or literature review-based development of item con- prediction of an infants later developmental outcomes is
tent. In contrast, content validity evidence based on item often based on a tools overall composite. At the level of
content reviews by experts was rarely reported and should be the measured constructs, less support exists that constructs
conducted more often in future research. Evidence on re- causally influence developmental outcomes (Mahoney
sponse process validity was often consolidated by the et al. 1996). Constructs or items that are not related to the
training of raters, whereas evidence indicating the validity of childs developmental outcome could be eliminated; this
the observed behavior was minimally or not described. Be- may be especially important for tools with an excessive
cause parentinfant interaction is often observed in non- amount of items (four tools included more than 60 items).
naturalistic settings, the observed behavior might not rep- To enable precise predictions of the childs later develop-
resent the familys typical daily behavior at home (Gardner ment, studies could specify which constructs relate to
2000). Further studies should attend more to the validity of which domain of infant developmental outcomes (e.g., at-
the observed behavior of parents and infants. tachment, socialemotional development, or cognitive
In the validity domain of internal structure, authors development).
typically reported and established adequate levels of in- Observational tools for measuring parentinfant inter-
ternal consistency and inter-rater reliability. On the basis of action often lacked a user manual, and if available, the
the empirical studies with at least credible study quality, manuals often did not contain information on the tools
only three tools provided evidence for factorial validity. validity evidence. Tools would benefit from the develop-
The theoretically assumed dimensionality of the remaining ment of user manuals with clear guidelines on scoring and
tools should be confirmed using factor analysis. Validity interpretation. It would also be helpful if the purpose and
based on relations to other variables was often demon- target group of the tool were stated more clearly. Infor-
strated by evidence that the tools constructs correlated mation about the tools psychometric evidence, norms, and
with similar constructs or discriminated between high- and cut-off values would enable appropriate use. As is common
low-risk groups. Whether the tools scores prospectively practice in the field of questionnaire assessments, it would
predicted child developmental outcomes was less often be helpful for tool administrators if tool manuals were
confirmed. Rather than examining whether parentinfant available from commercial test publishers or authors before
interaction constructs discriminate between subgroups, training is attended so that individuals interested in a
further studies could evaluate whether these constructs are measure could obtain critical information about a tool.
related to important child outcomes. To date, none of the tools has been thoroughly validated
The consequences of the behavioral assessment were with paternal samples. Thus, the tools cannot be recom-
rarely reported. Few tools demonstrated that the assessment mended for use with fathers. Only one tool included a pure
had benefits for the parent or the infant. In particular, more father sample in the initial validation study. The adaption
information is needed on the interpretability of scores by and validation of observational tools for fatherinfant in-
providing norms and cut-off scores, including the assessment teraction remains an imperative avenue of research because
of the specificity and sensitivity of a tool to identify infants fathers have become more involved in child care in Wes-
who are at risk for unfavorable mental health outcomes. tern cultures compared to past generations (Pleck and Pleck
Without such information, a tool might be of limited value 1997). Further studies should clarify the domains in which
for diagnostic, prognostic, and treatment indications. fatherinfant interaction differs from motherinfant inter-
action. Current reports indicate conflicting results (Aksan
Steps to Improve the Quality of ParentInfant et al. 2006; Harrison et al. 1999; Nakamura et al. 2000).
Interaction Research The cultural applicability of observational tools for
assessing parentinfant interaction is another central field
Our findings suggest further steps to improve the quality of of future research. Most parentinfant interaction research
research in the area of parentinfant interaction. Re- included in this review was based on samples from North
searchers and clinicians should use tools with evidence of America and Western Europe. As culture may influence
validity. The existing research does not always follow this parentinfant interaction (Bornstein et al. 2012), further
recommendation; we found more than 500 tools that were studies might clarify whether the items of the observational
only used in one or no peer-reviewed journal article. The tools for measuring parentinfant interaction represent
use and refinement of an established tool with evidence of similar interactional constructs across cultures.
validity might be a better investment of time and resources Research on parentinfant interaction needs improved
than the ongoing development of new assessment tools. standards in the design and report of studies. Most studies
123
110
Table 3 Scoring format and constructs of direct observational tools for measuring parentinfant interaction
Tool name Scoring format Number of Total number Parent constructs Infant constructs Dyadic constructs
123
(citation) scales and of items (number of items) (number of items) (number of items)
summary scores
Emotional 3-point or 7-point 4 Caregiver scales 42 Sensitivity (7) Responsiveness to adult (7) N/A
Availability global rating 2 Infant scales Structuring (7) Involvement to adult (7)
Scales (13 or 17; higher 1 Total score Nonintrusiveness (7)
(EAS, Biringen values indicate
2008) more optimal 1 Global rating Nonhostility (7)
behavior)
Coding Interactive 5-point global 3 Mother scales 43 Sensitivity Social involvement Dyadic reciprocity
Behavior rating 2 Infant scales Intrusiveness Negative emotionality Dyadic negative
(CIB, Feldman (1 = low, 2 Dyadic scales Limit-setting (16 items in total) states
1998) 5 = maximum (5 items in total)
level of behavior) No total score (22 items in total)
Additional codes
and constructs for
play and feeding
ChildAdult 3-point global 3 Caregiver scales 15 Sensitivity Cooperativeness Dyadic synchrony

Relationship rating 4 Infant scales Control Difficultness (1)
Experimental (02 or 014;
Index 1 Dyadic synchrony rating Unresponsiveness Compulsiveness
higher values
(CARE-Index, indicate more (7 items that can be assigned to each of Passivity
Crittenden 2006) optimal behavior) the scales) (7 items that can be assigned to
each of the scales)
Nursing Child Dichotomous 4 Parent scales 76 Sensitivity to cues (16) Clarity of cues (15) N/A
Assessment global rating 2 Infant scales Response to the childs distress (11) Responsiveness to caregiver (11)
Feeding Scales (yes or no) 1 Parent total score Socialemotional growth fostering (14)
(NCAFS, Sumner
and Spietz 1994) 1 Infant total score Cognitive growth fostering (9)
1 Total score
1 Infant contingency score
1 Parent contingency score
1 Contingency score
Nursing Child Dichotomous 4 Parent scales 73 Sensitivity to cues (11) Clarity of cues (10) N/A
Assessment global rating 2 Infant scales Response to the childs distress (11) Responsiveness to caregiver (13)
Teaching Scales (yes or no) 1 Parent total score Social-emotional growth fostering (11)
(NCATS, Oxford
and Findlay 1 Infant total score Cognitive growth fostering (17)
2012) 1 Total score
1 Infant contingency score
1 Parent contingency score
1 Contingency score
Table 3 continued
summary scores
ParentInfant Dichotomous 34 Parent scales 2736 Actions to meet childs needs and Expression of needs and wants N/A
Observation global rating 34 Infant scales wants (5) (Clarity of signals) (4)
Guide (present or absent) Responding to childs activity and Using parents help (4)
No total score
(PIOG, Bernstein interests (5) Involvement with parent (4)
et al. 1992) Positive feelings shown to child (5) Positive feelings shown to parent
Helping child learn new skills and (4, only for 412 months)
language (5, only for 412 months)
ParentInfant 5-point global 7 Mother scales 10 Acknowledging (1) Child social referencing (1) Dyadic reciprocity
Interaction Scale rating 2 Infant scales Imitating (1) Child gaze aversion (1) (1)
(PIIS, Clark and (1 = poor, 1 Dyadic scale Expanding/Elaborating (1)

Seifer 1985) 5 = excellent)
3 Summary scores Parent direction of gaze (1)
(Interaction style, Social Parent affect (1)
reference, Interaction
context) Forcing (1)
Overriding (1)
Dyadic Mutuality Dichotomous 2 Mother scales 6 Maternal sensitive responsiveness (1) Infant clarity of cues (1) Mutual attention
Code global rating 1 Infant scale Maternal pauses (1) (1)
(DMC, Censullo (1 = absent, 3 Dyadic scales Positive affect (1)
2004) 2 = present) Turn-taking (1)
1 Total score
ParentChild Early 5-point global 3 Parent scales 57 Positive affective involvement and Positive affect, communicative and Mutuality and
Relational rating 3 Infant scales verbalization (11) social skills (8) reciprocity (4)
Assessment (1 = area of Negative affect and behavior (5) Quality of play, interest, and Disorganization
2 Dyadic scales
(PCERA, Clark concern, 5 = area Intrusiveness, Insensitivity, attentional skills (10) and tension (5)
1985)a of strength) No total score
Inconsistency (8) Dysregulation and irritability (6)
InfantParent 15-s time sampling 4 Mother scales 9 Response contingency (1) Initiation (1) Theme continuity
Social Interaction Dichotomous rating 4 Infant scales Directiveness (1) Participation (1) (1)
Code (presence or 1 Dyadic scale Intrusiveness (1) Signal clarity (1)
(IPSIC, Baird et al. absence)
1992) No total score Facilitation (1) Intentional communicative acts (1)
3-point global
rating
(high, middle, low;
higher values
indicate higher
frequency of
behavior)
Belsky/Unnamed 15-s time sampling 2 Mother scales 15 Non-involvement (2) N/A Reciprocal
(Belsky et al. 1984) Dichotomous rating 2 Dyadic scales Basic care (2) interaction (9)
(presence or No total score Distress (2)
absence)
111
123
Table 3 continued
112
123
summary scores
Assessment of 5-point global 15 Mother scales 25 Spatial distance (1) Predominant infant state (1) Synchrony in
MotherInfant rating 7 Infant scales Holding Style (1) Predominant infant mood/affect (1) response to
Sensitivity (15; higher values pleasurable affect
3 Dyadic scales Predominant maternal mood/affect (1) Vocalizations (1) (1)
(AMIS, Price 1983) indicate greater
sensitivity) 3 Summary scales Verbalization (tone) (1) Distress (1) Regulation of
(Holding/handling, Verbalization (content) (1) Visual behavior (1) feeding at
Social/affective, Visual interaction behavior (1) Posture (1) initiation (1)
Feeding/caregiving) Modulation of distress episodes (1) Response to stimulation to feed at Regulation of
1 Total score satiation (1) feeding at
Caregiving style (1)
termination (1)
Stimulation of infant (1)
Response to changing levels of infant
activity (1)
Burping style (1)
Stimulation to feed (1)
Manner of stimulation to feed (1)
Frequency of stimulation to feed (1)
Response to infant satiation (1)
MotherInfant Play 5-point global 1 Mother scale 16 Maternal scale (10) Infant scale (3) Dyadic scale (3)
Interaction Scale rating 1 Infant scale (Holding style, expression of affect, (predominant infant wakeful (Overall dyadic
(MIPIS, Walker (15; higher values 1 Dyadic scale expression of affectquality of response level, predominant quality of
and Thompson indicate higher contingency to infant, caregiving infant mood/affect, visual interaction,
1982) responsivity) 1 Total score style, visual interaction, style of play, interaction) synchrony of
vocalization stylegeneral, affect,
vocalization stylequantity of termination of
contingency, attempts at smile interaction)
elicitation, kinesthetic quality of
interaction)
MotherInfant 5-point global 4 Mother scales 24 Distress (3) N/A Language and
Communication rating 1 Dyadic scale Feeding (5) synchrony (8)
Screening (15; higher values 1 Total score Play/neutral state (4)
(MICS, Raack indicate more
1989) optimal Rest (4)
interaction)
Global Rating 5-point global 34 Mother scales 2528 Good to poor (5) Good to poor (3) Good to poor (5)
Scales of rating 2 Infant scales Intrusive to remote (4) Inert to fretful (4)
MotherInfant (1 = poor,
Interaction 1 Dyadic scale Signs of depression (4)
5 = good)
(GRS, Fiori- 1 Total score Additional items for infants aged 4
Cowley et al. 5 months (3)
2000)
Table 3 continued
summary scores
Greenspan 15-s time sampling No scales 78 Somatic patterning/homeostasis (7) Somatic patterning/homeostasis N/A
Lieberman (event sampling No total score (Direct physical punishment, and attachment (12)
Observational for newborn (Resisting physical contact,
Scale-Revised version) (but factor analytically physical overstimulation,
derived subscales by abrupt handling, physical overstimulation/distress,
(GLOS-R, Dichotomous rating Hofheimer and
Greenspan and rough-and-tumble, seeking proximity,
(presence or Appelbaum 1992)
Lieberman 1989) absence) rhythmic behavior, seeking physical contact,
affectionate physical behavior) affectionate physical behavior,
Consoling, soothing avoidance of physical contact,
Attachment (7) initiation of social interaction,
interrupts social interaction or
(Facilitation of interpersonal
exchanges, physical contact,
pleasure, aggressive behavior,
guarded as if pleasure, pleasure,
flat affect, distress,
non-participating but available, flat affect)
non-participating withdrawn, Somato-psychological
differentiation (15)
aversively intrusive)
(Contingent response (5 sub-items),
Somato-psychological differentiation
(18) non-contingent response (5 sub-
items),
(Contingent response (6 sub-items),
anticontingent response (5 sub-
non-contingent behavior (6 sub-items), items))
anticontingent behavior (6 sub-items)) Initiative and organization (4)
Initiative and organization (15) (Onlooking behavior,
(Chains of contingent exchanges (6 orientation to inanimate
sub-items), environment,
chains of anticontingent exchanges (6 exploratory manipulation,
sub-items),
exploratory roaming)
developmentally facilitating behavior,
facilitation of involvement,
interfering or undermining)
Functional 3-point global 34 Parent scales 2747 Self-regulation (6; 5 clinical version) Self-regulation (9; 9 clinical N/A
Emotional rating 23 Infant scales Attachment (5; 34 clinical version) version)
Assessment Scale (0 = behavior not Attachment (9; 5 clinical version)
1 Total parent score Two-way communication (6; 5 clinical
(FEAS, Greenspan at all or very version) Two-way communication (5; 4
et al. 2001) briefly observed, 1 Total child score
Behavioral organization (7; 3 clinical clinical version; only for 10
2 = behavior 1 Total score 12 months)
consistently version; only for 1012 months)
present, observed
many times)
113
123
Table 3 continued
114
123
summary scores
Bethlem Mother 5-point global 6 Mother scales 7 Eye contact (1) Babys contribution to interaction (1) N/A
Infant Interaction rating 1 Infant scale Physical contact (1)
Scale (0 = appropriate, 1 Dialog score Vocal contact (1)
(BMIS, Kumar and sensitive, and well
Hipwell 1996) organized, 1 Total score Mothers Mood (1)
4 = very severe General routine (1)
disturbances Risk to the baby (1)
resulting in
physical
separation of the
child
Massie-Campbell 5-point global 7 Mother scales 14 Gazing (1) Gazing (1) N/A
Scale of Mother rating 7 Infant scales Vocalizing (1) Vocalizing (1)
Infant Attachment (1 = avoid contact
Indicators During No total score Touching (1) Touching (1)
or are not
Stress responsive, Response to touch (1) Response to touch (1)
(ADS, Massie and 5 = overanxious Holding (1) Holding (1)
Campbell 1992) behavior, intense Affect (1) Affect (1)
attachment or
Proximity (1) Proximity (1)
unusually strong
reaction to stress)
Monadic Phases 1-s time sampling 7 Mother scales 84 Avert (6) Protest (9) N/A
(Tronick et al. Dichotomous rating 10 Infant scales Social attend (neutral engagement) (3) Avert (4)
1982) (presence or Social elicit (4) Social attend (8)
absence)
Object attend (7) Social play (6)
Play (positive engagement) (5) Object attend (8)
Object play (7) Object play (6)
Talk (2) Talk (5)
Pick-me-up (2)
Greet (1)
Positive away (1)
MotherInfant/ 4-point global rating 5 Dyadic scales 46 N/A N/A Dyadic reciprocity
Toddler Feeding (03; higher values No total score (16)
Scale, indicate higher Dyadic conflict (12)
also named amounts of Talk and
Observational positive or distraction (4)
Scale for Mother negative
infant interaction behavior) Struggle for control
during Feeding or (7)
Chatoor Feeding Maternal non-
Scale contingency (7)
(M-I/TFS, Chatoor
et al. 1997)
Table 3 continued
summary scores
Mutually 5-point global 4 Dyadic scales 1617 N/A N/A Coordinated

Responsive rating 1 Total score routines (2)
Orientation (15; higher values Harmonious
(MRO, Aksan et al. indicate higher communication
2006) MRO) (4)
Mutual cooperation
(45)
Emotional
ambiance (6)
Revised Relational 2-s (minimum) 5 Dyadic scales 9 N/A N/A Symmetrical (2)
Coding System event sampling No total score Asymmetrical (2)

(RCS, Fogel et al. Dichotomous rating Unilateral (3)
2003) (presence or Disruption (1)
absence)
Unengaged (1)
Pediatric Infant 6-point or 7-point 3 Dyadic scales 4 N/A N/A Easy engagement
Parent Exam global rating 1 Total score vs. inappropriate
(PIPE, Fiese et al. (05 or 17; higher and bizarre
1 Global rating engagement (1)
2001) scores indicate
increase of Easy playfulness
interaction vs.
problems) inappropriately
play (1)
Gradual cool down
vs. unable to stop
game (1)
Overall impression
of interaction
(adaptive vs.
maladaptive, 1)
Tools are ordered according to the tools similarity of the addressed constructs
A range of item or scale numbers (i.e., 05) indicate that different numbers of items or scales are used for different age ranges of the infant
N/A not applicable
a
Scale description is based on Clark (1999) because the tools manual was not available
115
123
116
Table 4 Characteristics of direct observational tools for measuring parentinfant interaction

Tool name Purpose Clinical Target Age of Live Location Task Time to Availability Required Training Total Number
or population child or administer (min) qualifications availability number of studies
123
research (months) video of per year
use studies
EAS Screen Clinical LR and HR 0 Video Home Any task, stress Observation 20 Published Training and Personal and distance 359 15.0
Monitor Research caregivers 14 yearsa Laboratory suggested for 30 manualb certificate training
LR and HR short observations Published
Outcome
children article
CIB Screen Clinical LR and HR 0 Video Home Free play Not reported Unpublished Training and Personal training 65 4.3
Monitor Research caregivers 13 yearsa Laboratory Feeding manualb certificate
Outcome LR and HR Caregiving Published
children article
Problem-solving
task
Book reading
CARE- Screen Clinical LR and HR 030a Video Center Free play Observation 35 Unpublished Knowledgec Personal training 137 4.4
Index Diagnose Research caregivers Home (at least 2) manualb Training and
Monitor LR and HR Hospital Scoring 1015 Published certificate
children article
Outcome Laboratory
NCAFS Screen Clinical LR and HR 012 Live Home Feeding Observation Published Practitioners Personal and distance 182 5.4
Monitor Research caregivers Video Laboratory time = feeding manualb Non- training
LR and HR time Book section practitioners
Outcome
infants Training and
certificate
NCATS Screen Clinical LR and HR 036 Live Home Teaching age Observation 15 Published Practitioners Personal and distance 321 9.4
Monitor Research caregivers Video Laboratory appropriate task manualb Non- training
Outcome LR and HR Book section practitioners
children Training and
certificate
PIOG Screen Clinical HR parents 08 yearsa Live Home Feeding Observation and Unpublished Practitioners Not available 20 0.8
Monitor Children Laboratory Play (free play, scoring 10 manual Non-
game play, toy Published practitioners
play) article with
Caregiving (diaper knowledgec
change, meal Training
time, bathing)
PIIS Diagnose Clinical Parents 018 Video Center Free play Observation 68 Published Practitioners Not available 8 0.3
HR infants article Non-
practitioners
Training
DMC Not Clinical LR and HR 06 Live Laboratory Face-to-face Observation 5 Unpublished Practitioners Personal training 12 0.5
reported Research mothers Video interaction Scoring 5 manual Researchers
LR and HR Published Training
infants article
Table 4 continued
use studies
PCERA Diagnose Clinical LR and HR 060 Video Center Feeding Observation 20 Unpublished Practitioners Personal training 193 6.9
Monitor Research caregivers Home Age appropriate manualb Training
LR and HR task (toy play, Published
Outcome article
children book reading)
Free play
Separation/reunion
IPSIC Diagnose Not LR and HR 036 Video Home Free play Observation 10 Published Training Distance training 5 0.3
reported mothers Laboratory Scoring 1550 article
LR and HR (1035 with
children routine)
Belsky/ Not Clinical Mothers 09 Live Home Naturalistic Observation 45 Published Training Not available 21 0.8
Unnamed reported Research Infants Laboratory contexts Scoring time = article
observation
time
AMIS Screen Clinical Mothers 03 Video Home Feeding Observation 15 Published Not reported Not reported 22 0.6
Infants Laboratory Play 30 article
Diapering
MIPIS Monitor Clinical LR mothers 11.5 Live Home Free play Observation 5 Book section Training Not available 11 0.4
Research LR infants Video Scoring 510
MICS Screen Clinical LR and HR 012 Live Center Health encounter Observation 10 Published Practitioners Distance training 7 0.3
mothers Video Home Interview manual Training (self-study of
LR and HR Published manual and guided
Hospital Caregiving instruction)
infants (feeding) article
Rest
Distress
Free play
Neutral state
GRS Screen Clinical LR and HR 25 Video Home Face-to-face Observation 5 (at Unpublished Training Personal training 56 3.5
Research mothers Laboratory interaction least 3) manual
Infants
GLOS-R Screen Clinical HR mothers 048a Video Laboratory Free play Observation 812 Unpublished Training Personal training 20 0.6
Research LR and HR manual
children Book section
FEAS Screen Clinical LR and HR 748a Video Home Toy play (symbolic Administration Published Practitioners Personal training 46 2.3
Research caregivers Live Hospital play, tactile play 1530 manual Training
LR and HR and movement Observation 15 (book)
children play) Published
article
117
123
Table 4 continued
118
123
use studies
BMIS Diagnose Clinical HR mothers 012 Live Hospital Clinical routine Not reported Published Practitioners Not available 12 0.5
Monitor Infants Video Feeding article
Free play
ADS Screen Clinical LR and HR 018 Live Center Any task (mild to Observation 6 Published Practitioners Self-study of manual 30 1.0
Monitor parents Home moderate stress manual Training
LR and HR suggested) Published
Outcome Hospital article
children
Website
Monadic Not Research Mothers 06 Video Laboratory Face-to-face Observation 310 Unpublished Training Personal training 58 1.8
Phases reported Infants interaction Scoring long manual
Published
article
M-I/TFS Diagnose Clinical Caregivers 136a Video Laboratory Feeding Observation 20 Unpublished Training Personal and distance 35 1.3
Monitor Research LR and HR manualb training
children Published
article
MRO Not Clinical LR parents 715 Video Home Caregiving (meal Observation 45 Unpublished No training Self-study of manual 8 1.3
reported Research LR infants Laboratory time) (6 tasks) manual necessary
Free play Published
article
Toy play
Opening a gift
RCS Screen Research Caregivers Any age Video Home Free play Not reported Unpublished Practitioners Distance training 37 1.9
Monitor Children Laboratory Any task manual Training
Book section
PIPE Screen Clinical Caregivers 412 Live Center Brief game without Observation 15 Unpublished Practitioners Personal training 2 0.2
LR and HR Home toys (peekaboo) Preparation manual Non-
infants short Published practitioners
Hospital article
Scoring short with
Laboratory knowledgec
Training
Tools are ordered according to the tools similarity of the addressed constructs
Number of studies = number of published and unpublished empirical studies which used the tool; screen = to identify potential problems which have to be further evaluated; diagnose = to identify problems to
determine intervention; monitor = to monitor progress of the parentinfant interaction over time; outcome = to evaluate treatment outcomes on a group level; LR = low risk; HR = high risk; live or video = live or
video observation; location = location of observation; published article = published journal article describing the tool; practitioners = practitioners in related professions, e.g., pediatricians, child psychologists, pediatric
nurses
a
Different versions for different age groups
b
Manual restricted to persons who attended training
c
Knowledge of parentinfant interaction or infant development
Table 5 Validity evidence of direct observational tools for measuring parentinfant interaction based on studies with credible or unequivocal study quality
Tool name No. of validity No. of validity Content Response Internal structure
domains sub-domains
Theoretical Literature Expert Rater Rating Behavioral Internal Reproducibility Sensitivity Dimensional
basis review consensus training procedure response consistency to change structure
ADS 2 4 0 0 0 1 0 0 1 1 0 1
AMIS 2 3 0 0 0 1 1 0 0 1 0 0
Belsky/ 2 4 0 0 0 0 0 0 3 2 1 0
Unnamed
BMIS 4 10 0 0 0 1 0 0 3 2 2 0
CARE- 3 5 0 0 0 2 1 0 0 3 0 2
Index
CIB 0 0 0 0 0 0 0 0 0 0 0 0
DMC 3 5 0 0 0 0 1 0 1 1 0 0
EAS 4 10 1 0 0 5 10 4 1 9 3 3
FEAS 0 0 0 0 0 0 0 0 0 0 0 0
GLOS-R 4 7 0 0 0 1 1 0 0 2 0 4
GRS 3 4 0 0 0 1 2 0 0 0 0 1
IPSIC 2 4 0 1 1 2 2 0 0 0 0 0
M-I/TFS 4 5 0 0 1 0 2 1 0 0 0 0
MICS 4 5 0 0 0 0 1 0 1 1 0 0
MIPIS 0 0 0 0 0 0 0 0 0 0 0 0
Monadic 0 0 0 0 0 0 0 0 0 0 0 0
Phases
MRO 4 9 1 1 0 0 1 0 4 3 1 5
NCAFS 4 7 1 0 0 2 1 0 1 1 0 0
NCATS 4 8 1 1 0 4 2 0 2 3 0 0
PCERA 3 7 1 1 0 1 2 0 1 2 0 3
PIIS 0 0 0 0 0 0 0 0 0 0 0 0
PIOG 4 6 1 0 0 0 1 0 0 0 0 0
PIPE 4 5 0 1 0 1 1 0 0 1 0 0
RCS 3 7 0 0 0 4 2 0 0 3 1 4
119
123
120
123
Table 5 continued
Tool name No. of validity domains No. of validity sub-domains Relations to other variables Consequences
Convergent Discriminant Criterion Reaction Learning Behavior Results
Divergent
ADS 2 4 0 0 0 0 0 0 0
AMIS 2 3 0 0 0 0 0 0 0
Belsky/ 2 4 0 1 0 0 0 0 0
Unnamed
BMIS 4 10 1 2 2 2 1 0 1
CARE-Index 3 5 0 6 0 0 0 0 0
CIB 0 0 0 0 0 0 0 0 0
DMC 3 5 1 1 0 0 0 0 0
EAS 4 10 0 5 3 0 0 0 0
FEAS 0 0 0 0 0 0 0 0 0
GLOS-R 4 7 0 4 5 0 0 0 1
GRS 3 4 0 2 0 0 0 0 0
IPSIC 2 4 0 0 0 0 0 0 0
M-I/TFS 4 5 0 3 0 0 0 0 1
MICS 4 5 1 0 0 1 0 0 0
MIPIS 0 0 0 0 0 0 0 0 0
Monadic Phases 0 0 0 0 0 0 0 0 0
MRO 4 9 3 1 0 0 0 0 0
NCAFS 4 7 1 1 0 0 0 0 0
NCATS 4 8 1 3 0 0 0 0 0
PCERA 3 7 0 0 0 0 0 0 0
PIIS 0 0 0 0 0 0 0 0 0
PIOG 4 6 1 1 1 0 1 0 0
PIPE 4 5 0 3 0 0 0 0 0
RCS 3 7 0 15 3 0 0 0 0
Numbers reported in the five validity domains indicate the number of sources that supported evidence for validity. No. of validity domains = number of validity domains with validity evidence.
No. of validity sub-domains = number of validity sub-domains with validity evidence
Table 6 Further validity evidence of direct observational tools for measuring parentinfant interaction based on studies with unsupported study quality and articles describing an observational
tool
Tool name No. of validity No. of validity Content Response Internal structure
domains sub-domains
Theoretical Literature Expert Rater Rating Behavioral Internal Reproducibility Sensitivity Dimensional
basis review consensus training procedure response consistency to change structure
ADS 3 5 1 1 0 0 1 0 0 0 0 0
AMIS 4 4 0 1 0 0 1 0 0 0 1 0
Belsky/ 0 0 0 0 0 0 0 0 0 0 0 0
Unnamed
BMIS 3 5 0 0 0 0 0 0 0 2 0 0
CARE- 2 2 1 0 0 1 0 0 0 0 0 0
Index
CIB 2 2 1 0 0 0 0 0 1 0 0 0
DMC 4 4 1 0 0 0 0 0 0 0 1 0
EAS 2 3 0 0 0 2 1 0 0 2 0 0
FEAS 4 5 1 1 0 1 0 0 0 0 0 0
GLOS-R 2 2 1 0 0 0 0 0 0 1 0 0
GRS 0 0 0 0 0 0 0 0 0 0 0 0
IPSIC 0 0 0 0 0 0 0 0 0 0 0 0
M-I/TFS 3 4 0 0 0 1 1 0 0 2 0 0
MICS 2 3 1 1 0 0 0 0 0 0 1 0
MIPIS 3 4 1 0 0 0 0 0 1 1 0 0
Monadic 4 4 1 0 0 0 1 0 0 2 0 0
Phases
MRO 0 0 0 0 0 0 0 0 0 0 0 0
NCAFS 5 14 0 1 1 6 4 0 2 5 0 1
NCATS 5 15 0 0 1 8 5 1 7 4 3 3
PCERA 1 1 0 0 0 0 0 0 0 1 0 0
PIIS 3 4 1 1 0 0 0 0 0 1 0 0
PIOG 3 7 0 1 1 1 1 0 0 0 0 0
PIPE 0 0 0 0 0 0 0 0 0 0 0 0
RCS 3 4 1 0 1 0 2 0 0 1 0 0
121
123
122
123
Table 6 continued
Tool name No. of validity domains No. of validity sub-domains Relations to other variables Consequences
Convergent Discriminant Criterion Reaction Learning Behavior Results
Divergent
ADS 3 5 0 0 0 0 1 0 1
AMIS 4 4 0 0 1 0 0 0 0
Belsky/ 0 0 0 0 0 0 0 0 0
Unnamed
BMIS 3 5 0 4 0 1 1 1 0
CARE-Index 2 2 0 0 0 0 0 0 0
CIB 2 2 0 0 0 0 0 0 0
DMC 4 4 0 2 0 0 0 0 1
EAS 2 3 0 0 0 0 0 0 0
FEAS 4 5 0 4 0 0 0 0 1
GLOS-R 2 2 0 0 0 0 0 0 0
GRS 0 0 0 0 0 0 0 0 0
IPSIC 0 0 0 0 0 0 0 0 0
M-I/TFS 3 4 0 0 0 0 0 0 2
MICS 2 3 0 0 0 0 0 0 0
MIPIS 3 4 0 0 1 0 0 0 0
Monadic Phases 4 4 1 0 0 0 0 0 0
MRO 0 0 0 0 0 0 0 0 0
NCAFS 5 14 1 17 3 1 1 1 4
NCATS 5 15 1 20 11 1 1 1 4
PCERA 1 1 0 0 0 0 0 0 0
PIIS 3 4 1 0 0 0 0 0 0
PIOG 3 7 0 0 0 2 1 1 0
PIPE 0 0 0 0 0 0 0 0 0
RCS 3 4 0 0 0 0 0 0 0
Numbers reported in the five validity domains indicate the number of sources that supported evidence for validity. No. of validity domains = number of validity domains with validity evidence.
No. of validity sub-domains = number of validity sub-domains with validity evidence
included in this review suffered from unsupported study for Measurement of the Environment Inventory (Caldwell
quality. For example, researchers recruited convenience and Bradley 2001). Such tools were not in the scope of our
samples, and 29 % of the studies used a sample of 50 or review and should be evaluated in a separate review. The
fewer participants. These study samples are too small to exclusion of tools that were only used in one or no peer-
produce sufficiently precise reliability and validity coeffi- reviewed journal articles may have biased our analysis
cients (Charter 2003). If possible, future research should because these tools may differ systematically from the
randomly select large representative clinical or general others. However, the exclusion of these tools prevented us
population samples. Multicenter studies could help to in- from reporting a huge number of tools with little or no
crease the sample size and to improve the generalizability impact on the field. Finally, the extent to which the re-
of the findings. Guidelines that define and standardize the viewed tools are valid across different cultures is
criteria by which the quality of a tool should be evaluated questionable because most of the included studies were
would also be helpful for an evidence-based selection of conducted in the USA.
parentinfant interaction tools.
Practical Recommendations for Selecting a Tool
Strengths and Limitations
Decisions about the selection of a tool should be guided by
One major strength of this review is the comprehensiveness a clear idea of what behavior requires assessment, how it
of our search. We searched twenty databases and identified will be assessed, and the purpose for which it will be used
and screened more than 13,000 unique sources, including (McCloskey 1990). After a particular purpose has been
grey literature, in all languages and publication years. This defined, researchers or clinicians should precisely define
approach may have minimized the likelihood of missing the constructs that are relevant to the assessment. Ac-
relevant evidence. We used a highly sensitive approach by cording to these definitions of the constructs, an assessment
searching for observational tools in all identified articles that approach with a corresponding level of specificity should
used or reported on an observational tool of parentinfant be chosen, such as counts of single behaviors or global
interaction. This strategy enabled the identification of a high ratings of complex constructs (a description of the con-
number of tools. The tools and study characteristics chosen structs of the tools can be found in Table 3). If multiple
for data extraction and evaluation were determined a priori, tools are identified as appropriate for a particular purpose,
and our search strategy was pilot-tested. The evaluation of evidence for the validity of these tools should be reviewed.
the validity evidence of the tools was based on accepted The tools that have established evidence in a high number
standards in assessment (Cicchetti 1994; Cicchetti and of validity domains might be a good starting point. Re-
Sparrow 1990) and showed sufficient inter-rater reliability. searchers or clinicians should prioritize particular
In addition to these strengths, this review has limitations psychometric features of the tool with respect to their
that should be considered in interpreting our results. No purpose of assessment (e.g., predictive validity if the
standardized guideline exists for psychometric reviews of measured aspects of parentinfant interaction should pre-
observational tools. Therefore, the criteria we used to dict later child outcomes). This information can be
evaluate the validity evidence of the tools are debatable. obtained from Tables 5 and 6, and Supplement B and C in
Validity evidence was based on articles that psychometri- ESM 2 and 3. Practical constraints might also be important
cally evaluated or described the tools. Other types of arguments for or against a tool, such as the accessibility of
studies are likely to exist that could have added validity training, required resources for training, observation and
evidence. To examine a representative sample of the lit- rating, and the extent of the tools use by others to allow
erature, we did not exclude studies with low comparisons with previous assessments (see Table 4).
methodological quality. Instead, we separately reported the Clinicians should also consider the feasibility of tool im-
validity evidence for studies with credible study quality plementation in clinical practice.
and for studies with unsupported study quality. For the
studies with unsupported study quality, study samples were
often small, which may have resulted in inaccurate re- Conclusion
liability and validity estimates (Charter 1999, 2003).
We focused our review on tools that measured both Our review provides a synthesis of the available validity
parent and infant behavior. Other observational tools with evidence of observational tools for measuring parentin-
good psychometric properties might be available that fant interaction. We identified 24 tools, of which most
assess only the parents behavior or the infants behavior. provided sufficient evidence on the rating procedure, the
We also excluded tools that did not primarily focus on the reproducibility (objectivity), and discriminant validity,
parentinfant interaction, such as the Home Observation based on studies with credible study quality. Most tools
123
suffered from a lack of credible empirical research in the dyadic behavio$.mp OR interpersonal relations/ OR
domains of content validity and consequential validity. interpersonal relation$.mp OR motherchild relations/
Several psychometric properties of the tools, particularly OR motherchild relation$.mp OR fatherchild rela-
the behavioral response, sensitivity to change, factorial tions/ OR fatherchild relation$.mp
validity, predictive validity, norms, and cut-off scores, 7. 5 and 6
have been understudied and should be considered more 8. observation/ OR observation$.mp OR behavio$ cod$.
carefully in future research. mp OR behavio$ assessment$.mp OR behavio$ mea-
This review adds to the current knowledge on the va- sure$.mp OR rat$ scale$.mp OR cod$ system$.mp OR
lidity of observational tools for measuring parentinfant microanalys$.mp OR checklist/ OR checklist$.mp OR
interaction. The synthesized validity evidence and de- videotape recording/ OR videotap$.mp OR video$
scriptions of the tools can guide researchers and clinicians record$.mp
in the selection of an appropriate tool. Such an evidence- 9. 7 and 8
based selection may advance the quality of research on
parentinfant interaction and family care in mental health
and social services.
Appendix 2
Acknowledgments We would like to thank the following indi-
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Kroger for their help in reviewing articles; Klaus-Dieter Papke for his Evaluating Direct Observational Tools
support in the development of the search strategy; Justine Konig for
her literature order; Ina Weitkamp for her review of the manuscript;
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manuscript. Mutually Responsive Orientation between parents and
their young children: Toward methodological advances
Conflict of interest The authors declare that they have no conflict in the science of relationships. Developmental Psy-
of interest.
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Observational Tools For Measuring Parent-Infant Interaction

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Observational Tools For Measuring Parent-Infant Interaction

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Clin Child Fam Psychol Rev (2015) 18:99132

Observational Tools for Measuring ParentInfant Interaction:

Published online: 3 April 2015

Data Synthesis 6,463 Records excluded based on title and

24 Included tools described or

ChildAdult 3-point global 3 Caregiver scales 15 Sensitivity Cooperativeness Dyadic synchrony

(PIIS, Clark and (1 = poor, 1 Dyadic scale Expanding/Elaborating (1)

Mutually 5-point global 4 Dyadic scales 1617 N/A N/A Coordinated

Coding System event sampling No total score Asymmetrical (2)

Table 4 Characteristics of direct observational tools for measuring parentinfant interaction

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