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Postpartum Depression: Diagnosis and Treatment
Postpartum Depression: Diagnosis and Treatment

Section 21
Does Mother’s Depression Affect her Toddler’s Assertiveness?

CEU Question 21 | CEU Test | Table of Contents | Depression
Counselor CEUs, Social Worker CEUs, Psychologist CEs, MFT CEUs

Changes in children's self-concepts, including an increase in agency and changes in self-assertion skills, mark the toddler period (Brandtstadter, 1999; Jennings, 1993; Jennings & Dietz, 2002). Increased agency can be seen in toddlers' desire to complete tasks by themselves and to assert their own agenda in activities (Bandura, 1997; Bullock & Lutkenhaus, 1990; Geppert & Kuster, 1983; Kagan, 1981). During the second year of life, toddlers begin to want to independently complete tasks (Geppert & Kuster), and they actively protest unneeded help (Dietz & Jennings, 2001; Jennings, 1992) and demonstrate preference for doing tasks independently (Roggman, 1989). In joint problem solving tasks, most toddlers insist on completing the final step of a task (Jennings, 1992) and they more frequently express positive emotional reactions, such as pride, to self-produced rather than other-produced outcomes (Bullock & Lutkenhaus, 1988).

Self-assertion is an aspect of social competence in toddlers because it involves the regulation of negative affect and an implicit desire to maintain mastery behavior rather than to engage in oppositional behavior. Self-assertion has been identified as one of the first behavioral manifestations of toddlers' autonomy development and may be an antecedent for more complex social skills, such as cooperation and negotiation (Kuczynski & Kochanska, 1990; Power, McGrath, Hughes, & Manire, 1994). Researchers have shown that self-assertion is related to attachment security (Matas, Arend, & Sroufe, 1978), advanced developmental abilities (Vaughn, Kopp, & Krakow, 1984), and later negotiation skills with parents (Kuczynski, Kochanska, Radke-Yarrow, & Girnius-Brown, 1987). Therefore, self-assertion in toddlers is an important aspect of early social and emotional development and may predict later social competence in children.

Perhaps, as a result of increased agency, noncompliance increases during toddlerhood. A long-standing developmental perspective, that a certain level of resistance to parental directives and noncompliance in the toddler period is normative, is pervasive. Moreover, researchers studying the terrible-twos age have demonstrated that the majority of toddlers who exhibit noncompliant behavior in the second year of life do not necessarily continue to display defiant and dysfunctional behaviors after this developmental period. The increase in noncompliance during toddlerhood also may reflect the beginning of a complex process by which toddlers learn about the limits of their agency and about external standards that guide appropriate behavior in social interactions (Kochanska & Aksan, 1995; Kopp, 1982). Hence, noncompliance in toddlers cannot be conceptualized exclusively in terms of childhood dysfunction (Kuczynski & Kochanska, 1990; Power et al., 1994).

Developmental researchers have recently begun to differentiate between types of noncompliance, paying increased attention to those strategies that involve prosocial behaviors for maintaining autonomous behavior (Crockenberg & Litman, 1990; Kuczynski & Kochanska, 1990; Kuczynski et al., 1987; Power et al., 1994). Researchers studying young children's noncompliance also have identified self-assertion as a strategy toddlers use when they refuse to comply with external demands on their behavior at times they want to continue with independent, goal-directed behavior. Self-assertion also has been viewed as a socially skilled noncompliance strategy that serves positive functions in toddlers' social development. Researchers have defined self-assertion in toddlers during noncompliance situations as a verbal refusal of an external directive, such as saying no, so they can continue with independent, goal-directed behavior (Crockenberg & Litman, 1990).

Kuczynski and colleagues (1990,1987) presented a developmental model of noncompliance that can apply to toddlers' social skill in self-assertive behaviors. Their model consisted of four increasingly skilled behaviors, on the basis of the degree of direct assertion of the toddlers' intentions and the regulation of negative affect and behavior. The most unskilled type of noncompliance was direct defiance, defined as aversive behavior marked by overt resistance and poorly controlled anger. Passive noncompliance, that is toddlers' ignoring external demands and continuing with their volitional behavior evidenced passive noncompliance, was the second level of skill in their hierarchy of noncompliance strategies. Passive noncompliance involved more social skill and self-regulation than did defiance, but still was considered an unskilled response in refusing parental directives. Simple assertion, a verbal expression of disagreement without negative affect (such as saying no), was considered the third and more skilled strategy for noncompliance. Negotiation (attempts by the child to persuade others to modify their demands by offering compromises or explanations for not acquiescing to a request) represented the fourth and most skilled type of noncompliance strategy.

This model of noncompliance development can be used to describe the developmental changes in social skills that toddlers demonstrate when refusing unneeded help on a task and expressing the desire to do something independently. Developmental changes also have been shown to affect the levels of social skill that toddlers demonstrate in their self-assertion. Older toddlers are more likely than are younger toddlers to communicate their intentions in more active and more skillful ways when expressing resistance to parental directives (Kuczynski et al., 1987). This change in the expression of assertion is caused, in large part, by the increased capacity for toddlers to regulate their behavior and affect and to comply with external demands in their second and third years of life. Furthermore, researchers have found moderate stability in the ranking of toddlers' social skill in self-assertion (Bullock & Lutkenhaus, 1990; Kuczynski & Kochanska, 1990). Children who used less skilled self-assertive strategies as toddlers were found to use less skillful self-assertive strategies by the time they reached school age, and those who used more socially skilled self-assertive strategies as toddlers also continued to do so by school age (Kuczynski & Kochanska). Thus, individual differences in self-assertion may exist in children. These differences may become evident during the toddler period.

Self-Assertion in Toddlers and Maternal Depression
Parenting practices may be an important contributor to individual differences in toddlers' noncompliance. Parental behavior and attitudes that encourage more skilled self-assertion have been thought to influence toddlers' development into autonomous agents (Kochanska, 1997; Maccoby & Martin, 1983). Parental autonomy-granting behaviors, which may contribute to toddlers' autonomy development, include offering children choices in matters that affect them, letting children participate in relevant decision-making, complying with the children's requests, and encouraging children to master increasingly challenging tasks (Kochanska & Kuczynski, 1991).

Maternal depression has been studied as a risk factor for reduced parental autonomy-granting and other nonoptimal parenting behaviors. Negative parental mood has been found to undermine effortful parental behavior, to increase negative attribution to toddlers' behavior, and to lower parental thresholds for tolerating difficult behavior (Dix, Reinhold, & Zambarano, 1990; Field, 1995; Kochanska, Kuczynski, Radke-Yarrow, & Darby Welsh, 1987). Mothers with depression have been found to show more negative affective expression and less positive engagement with their infants (Campbell, Cohn, & Meyers, 1995; Cohn, Campbell, Matias, & Hopkins, 1990; Lyons-Ruth, Zoll, Connell, & Grunebaum, 1986); to be negative, critical, and unresponsive toward others, including their children (Shaw & Bell, 1993; Zahn-Waxler, Iannotti, Cummings, & Denham, 1990); and to demonstrate decreased sensitivity and reciprocity in their interactions with their young children (Cicchetti & Toth, 1995; Field, 1995). Mothers with depression also have been observed to be more intrusive, to have more conflicts in interactions with their children, and to be more inconsistent in their control strategies with young children, alternating between harsh and punitive approaches and lax control (Goodman, Adamson, Riniti, & Cole, 1994; Kochanska et al., 1987).

Researchers have found that children of mothers with depression have an increased risk for maladjustment and other negative outcomes in their psychosocial development (Downy & Coyne, 1990; Goodman & Gotlib, 1999; Teti & Gelfand, 1991). Toddlers exposed to maternal depression show evidence of having more difficulties with emotional regulation, impulsiveness, and cooperation than do toddlers not exposed to maternal depression (Cohn & Campbell, 1992; Field, 1992; Zahn-Waxler, Cummings, Iannotti, & Radke-Yarrow, 1984; Zahn-Waxler, Cummings, McKnew, & Radke-Yarrow, 1984). Furthermore, maternal depression and frequent toddler noncompliance may be risk factors for coercive interactions between mothers and their toddlers (Kochanska et al., 1987; Kuczynski, 1984). Defiance in toddlers has been identified as particularly problematic and aversive to parents because it poses a risk for coercive parent-child interactions (Patterson, 1982) and later behavior problems (Campbell, Shaw, & Gilliom, 2000). Hence, the empirical studies of early noncompliance and self-assertive strategies may inform the understanding of developmental psychopathology in children of mothers with depression.

Researchers have investigated the influence of maternal depression on the quality of toddlers' noncompliance (Kuczynski et al., 1990; 1987). Those results demonstrated associations between the severity of maternal depression and the skillfulness of toddlers' noncompliance strategies with toddlers of more severely depressed mothers exhibiting less skilled strategies than toddlers of less severely depressed mothers. However, they found no differences between toddlers' quality of noncompliance on the basis of exposure to maternal depression. In other words, toddlers of mothers with depression demonstrated noncompliance and self-assertive skills that were equivalent to toddlers of mothers without depression. This finding was surprising because of the existing literature results on maternal depression as a risk factor for young children's social development; however, these findings highlighted the importance of considering qualitative aspects of young children's exposure to maternal depression, such as the chronicity and severity of maternal depression.

Nevertheless, the lack of main effects for maternal depression in these studies was possibly related to the heterogeneous sample of mothers who comprised the depressed groups. These studies consisted of a community sample of women who were assessed for depressive symptoms over their lifetime through retrospective interview and self-report measures. Although these mothers endorsed elevated symptoms of depression during some period of time in their lives, these symptoms were not necessarily current or present in the target child's lifetime. The absence of significant differences in toddlers' noncompliance strategies may have been caused by the limitation that all toddlers in the maternal depression group were not exposed to an episode of maternal depression during their lives. As young children's direct experiences with depressed mothers have been hypothesized to pose higher risk for negative outcomes, lifetime history of depression in mothers may not present the same degree of risk to young children as history of depression in young children's lives. Hence, significant differences in noncompliance strategies by group may have obscured by the heterogeneous sample of toddlers with depressed mothers.

Furthermore, previous studies may have assessed young children's self-assertion at developmental points that may not have allowed for children to exhibit the full range of noncompliance strategies. For example, 18-month-old children may not be capable of demonstrating more skilled forms of noncompliance, such as simple assertion or negotiation, and 5-year-old children may be less likely to demonstrate unskilled forms of noncompliance, such as defiance. These studies also relied on mother-child clean-up tasks to assess the quality of toddlers' noncompliance. These tasks were originally designed to assess young children's compliance and noncompliance and may not have provided an adequate context for observing toddlers' self-assertion. Furthermore, these tasks confound the bidirectional effects of the maternal behavior with young children's noncompliance and self-assertion. Because clean-up tasks cannot control for variability in mothers' behavior and parenting styles, it is difficult to determine how much of young children's noncompliance is a reflection of their responses to their mothers' parenting style or a reflection of their competencies. Therefore, it is difficult to compare toddlers' skill in self-assertion across groups and dyads without information about maternal behavior during clean-up tasks.
- Dietz, Laura J., Jennings, Kay Donahue, Abrew, Amy J.; Social Skill in Self-Assertive Strategies of Toddlers with Depressed and Nondepressed Mothers; Journal of Genetic Psychology; Mar 2005; Vol. 166, Issue 1

Personal Reflection Exercise #7
The preceding section contained information regarding the effect of motherly depression on the assertiveness of their toddler.  Write three case study examples regarding how you might use the content of this section in your practice.

Peer-Reviewed Journal Article References:
Blum, L. D., Horenstein, A., Carper, M. M., Stange, J. P., Cohen, J. N., Doyle, A., & Smith, V. (2021). A new instrument to assess counterdependency, evaluated in the context of postpartum depression. Psychoanalytic Psychology, 38(1), 49–57.

Brandão, T., Brites, R., Pires, M., Hipólito, J., & Nunes, O. (2019). Anxiety, depression, dyadic adjustment, and attachment to the fetus in pregnancy: Actor–partner interdependence mediation analysis. Journal of Family Psychology, 33(3), 294–303.

Cao, H., Zhou, N., Leerkes, E. M., & Su, J. (2021). The etiology of maternal postpartum depressive symptoms: Childhood emotional maltreatment, couple relationship satisfaction, and genes. Journal of Family Psychology, 35(1), 44–56.

Online Continuing Education QUESTION 21
What factor has been thought to influence toddlers' development into autonomy? Record the letter of the correct answer the CEU Test.

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Postpartum Depression: Diagnosis and Treatment

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