INFANT CRYING Theoretical and Research Perspectives \0 sARAi,} z. WtLlv YsU llwAvs.

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Written by 8-year-old Alyssa to her S-year-old sister, Sarah CRYING Theoretical and Research Perspectives

Edited by Barry M. Lester and C. F. Zachariah Boukydis The Children 's Hospital and Harvard Medical School Boston, Massachusetts

PLENUM PRESS • NEW YORK AND LONDON Library of Congress Cataloging in Publication Data

Main entry under title:

Infant crying.

Includes bibliographies and index. 1. Crying. 2. Infant psychology . 3. Crying-Research. 4. Interpersonal communica• tion in children. I. Lester, Barry M. II. Boukydis, C. F. Zachariah. [DNLM: 1. Com• munication-in infancy & childhood . 2. Crying-in infancy & childhood . 3. Language Development. WS 105.5.E5 143] BFnO.C78154 1985 155.4'22 84·26414

ISBN-13: 978-1-4612-9455-9 e-ISBN-13: 978-1-4613-2381-5 DOl: 10.1007/978-1-4613-2381-5

© 1985 Plenum Press, New York Softcover reprint of the hardcover 1st edition 1985

A Division of Plenum Publishing Corporation 233 Spring Street, New York, N.Y. 10013

All rights reserved No part of this book may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, microfilming, recording, or otherwise , without written permission from the Publisher To our fathers, Norman C. Lester and A. Charles Boukydis, and to John Lind, one of the fathers of cry research. Contributors

MARTIN BAX, Community Paediatric Research Unit, St. Mary's Hos• pital Medical School, London, England

LOIS BLACK, Department of Psychology, Syracuse University, Syra• cuse, New York

C. F. ZACHARIAH BOUKYDIS, Department of Medicine, Harvard Medical School, and Department of , The Children's Hos• pital, Boston, Massachusetts

T. BERRY BRAZELTON,Division of Child Development, The Children's Hospital, and Department of Pediatrics, Harvard Medical School, Bos• ton, Massachusetts

JENNIFER S. BUCHWALD, Department of Physiology, Brain Research Institute and Mental Retardation Research Center, School of Medi• cine, University of California at Los Angeles, Los Angeles, California

RAYMOND H. COLTON, Department of Otolaryngology and Com• munication Science, College of Medicine, Upstate Medical Center, State University of New York, Syracuse, New York

vii viii CONTRIBUTORS

MICHAEL J. CORWIN, Department of Pediatrics, Boston University School of Medicine, and Department of Pediatrics, Boston City Hos• pital, Boston, Massachusetts

WILBERTA 1. DONOVAN, Infant Development Laboratory, Waisman Center on Mental Retardation and Human Development and Depart• ment of Pediatrics, University of Wisconsin, Madison, Wisconsin

ANN FRODI, Department of Psychology, University of Rochester, Roch• ester, New York

JOHN GLEASON, Department of Psychology, Syracuse University, Syr• acuse, New York

HOWARD 1. GOLUB, Pediatric Diagnostic Service Institute, Cam• bridge, Massachusetts

ANNA-LIISA JA.RVENPA.A., Department of Neonatology, Children's Hospital, University of Helsinki, Helsinki, Finland

LEWIS A. LEAVITT, Infant Development Laboratory, Waisman Center on Mental Retardation and Human Development and Department of Pediatrics, University of Wisconsin, Madison, Wisconsin

BARRY M. LESTER, Harvard Medical School and Division of Child Development, The Children's Hospital, Boston, Massachusetts

PHILIP LIEBERMAN, Department of Linguistics, Brown University, Providence, Rhode Island

JOHN LIND, late of the II Department of Pediatrics, Children's Hospital, University of Helsinki, Helsinki, Finland

KATARINA MICHELSSON, II Department of Pediatrics, Children's Hospital, University of Helsinki, Helsinki, Finland

ANN D. MURRAY, High Risk Infant Development Laboratory, Boys Town National Institute for Communication Disorders in Children, Omaha, Nebraska

THOMAS MURRY, Audiology and Speech Pathology Service, Veterans Administration Medical Center, San Diego, California CONTRIBUTORS ix

JOHN D. NEWMAN, Laboratory of Comparative Ethology, National Institute of Child Health and Human Development, National Insti• tutes of Health, Bethesda, Maryland

PETER F. OSTWALD, Department of Psychiatry, Langley Porter Psy• chiatric Institute, School of Medicine, University of California at San Francisco, San Francisco, California

CARL SHIPLEY, Department of Physiology, Brain Research Institute and Mental Retardation Research Center, School of Medicine, Uni• versity of California at Los Angeles, Los Angeles, California

ALFRED STEINSCHNEIDER, American SIDSInstitute, Atlanta, Georgia

CARL-JOHAN THODEN, II Department of Pediatrics, Children's Hos• pital, University of Helsinki, Helsinki, Finland

OLE WASZ-HOCKERT, II Department of Pediatrics, Children's Hos• pital, University of Helsinki, Helsinki, Finland

PETER H. WOLFF, Department of Psychiatry, The Children's Hospital, Boston, Massachusetts

PHILIPSANFORDZESKIND, Department of Psychology, Virginia Poly• technic Institute and State University, Blacksburg, Virginia Foreword

The cries of and children are familiar to essentially all adults, and we all have our own common sense notions of the meanings of various cries at each age level. As is often the case, in the study of various aspects of human behavior we often investigate what seems self• evident to the general public. For example, if an infant cries, he or she needs atttention; if the cry is different than usual, he or she is sick; and when we are upset by other matters, children's crying can be very annoy• ing. As a pediatric clinician often faced with discussing with their concerns or lack of them with respect to their children's crying, these usual commonsense interpretations were frequently inadequate. As this book illustrates, when we investigate such everyday behaviors as children's crying and adults' responses to crying, the nature of the problem becomes surprisingly complex. As a pediatrician working in the newborn nursery early in my career, I knew from pediatric textbooks and from nursery nurses, that newborn infants with high, piercing cries were often abnormal. In order to teach this interesting phenomenon to others and to understand under what circumstances it occurred, I found I needed to know what consti• tuted a high-pitched cry or even a normal cry, for that matter, and how often this occurred with sick infants. Certainly I saw sick infants who did not have high-pitched cries, but I still wondered if their cries were deviant in some other way. Fortunately, several investigators in the past 25years and many more in the past 10 years have pursued this problem.

xi xii FOREWORD

As might be expected, the number of parameters used to define cries has escalated with improving analyzing techniques. At first, investiga• tors studied the cries of infants with known neurological problems, then the cries of infants who were only at known risk for a neurological problem, and now infants considered to have had normal pregnancies and deliveries who might nevertheless have suffered some neurological problem. Thus the possibilities for clinical application have expanded. The chapters in this book on the cries of newborns and young infants amply illustrate the evolution of these important studies, which I think have great promise. In clinical pediatrics, I also discovered that how and when infants' and children's cries were responded to depended as much on the char• acteristics of the listener as on the characteristics of the cry. While one might superficially think that all adults would give attention to an infant who cried and also become annoyed when the crying was excessive or strident, I was surprised at the many exceptions to this general wisdom. I followed the development of an infant who cried frequently and pro• longedly in the early months of life, whose surprised me by her lack of complaints and her true devotion to this child. She expressed her happiness with this infant because she needed her so much. At the other extreme was the mother of a quiet, competent infant who cried very little, whose mother seemed disappointed, saying that this baby did not seem to need her. These extreme cases reflect the ' perceptions of their roles and what they attribute to their infants. Several chapters of this book address these important issues. I think this area of research is just getting started and is greatly enhanced by the studies of cry characteristics. We are always limited in our interpretations of the precise role of the nervous system in the particular human behaviors we are studying. We, therefore, need animal models that will permit experimentation with the nervous system's controls over vocal output and reception, and such studies have been included in this book. This is the first book that includes studies of the characteristics of infants' and children's normal and abnormal cries, the reasons for vary• ing adult responses, and animal models that might provide further insight into these important subjects. It is an important contribution to this relatively new and exciting field.

ARTHUR H. P ARMELE E Los Angeles, California Acknowledgments

We would like to thank Joel Hoffman, Kate Neff, and Gaye Hoffman for their help in preparing and editing the manuscripts for this book. Contents

CHAPTER 1 Introduction: There's More to Crying Than Meets the Ear...... 1 Barry M. Lester

1. Introduction ...... 1 2. Some Theoretical Speculations 8 2.1. Crying and States of Arousal 8 2.2. Crying and the Development of Inhibition 11 2.3. Crying and Endogenous Oscillators 13 2.4. Developmental Changes in Crying 17 2.5. Clinical Considerations ...... 21 2.6. Parental Perceptions and Feelings 22 2.7. Crying and Soothability 24 3. References 26

CHAPTER 2 The Physiology of Cry and Speech in Relation to Linguistic Behavior ...... 29 Philip Lieberman

1. Human Speech and Human Language 30 2. The Breath Group 32

xv xvi CONTENTS

3. Newborn Infants 37 4. The Development of Sentence Intonation 39 5. Learning to Control Intonation 40 6. Overriding the Vegetative Regulatory System 41 7. Speech Production and Respiratory Regulation 42 8. Imitating Intonation ...... 43 9. Study of Linguistic "Base Forms" ...... 44 10. The Range of Fundamental Frequency Variation 50 11. Duration as a Cue to Sentence Segmentation 50 12. Vowel Production ...... 50 13. Concluding Comments 54 14. References 54

CHAPTER 3 A Physioacoustic Model of the Infant Cry ...... 59 Howard L. Golub and Michael J. Corwin

1. Introduction ...... 59 2. Definitions 60 3. Physioacoustic Model 62 3.1. Overview ...... 62 3.2. Acoustical Component of the Model 67 3.3. Physiological Component of the Model 68 4. Cry Analysis Techniques 69 4.1. Auditory Analysis 69 4.2. Time Domain Analysis 70 4.3. Frequency Domain Analysis 71 4.4. Spectrographic Analysis ...... 72 4.5. Computer-Based Signal Processing 75 5. Preliminary Studies 76 6. Conclusions 79 7. References 80

CHAPTER4 Twenty-Five Years of Scandinavian Cry Research...... 83 Ole Wasz-Hockert, Katarina Michelsson, andJohn Lind

1. Scandinavian Cry Research 83 1.1. Cry Studies in Scandinavia 83 CONTENTS xvii

1.2. Auditory Identification of Cry Types 85 1.3. The Cry Analyzer 86 1.4. Physiological Cry Studies 86 1.5. Cry and Mother-Child Interaction 87 1.6. Baby Carriers Increase the Contact between Parents and Children 87 1.7. Singing-An Aid to Parental Attachment 88 2. Sound Spectrography 88 2.1. The Cry Characteristics ...... 88 3. Cry in Newborn Infants 92 3.1. Cry in Healthy Full-Term Infants 92 3.2. Cry in Low-Birth-Weight Infants ...... 94 4. Cry in Various Diseases 95 4.1. Cry in Clinical Diagnostics 95 4.2. Cry in Chromosomal Abnormalities 95 4.3. Cry in Infants with Endocrine Disturbances ...... 96 4.4. Cry in Infants with Diseases and Malformations of the Orolaryngeal Tract ...... 96 4.5. Cry in Infants with Metabolic Disturbances 97 4.6. Crying in Newborn Infants with Asphyxia 98 4.7. Crying in Diseases of the Central Nervous System . . . 99 4.8. Cries in Malnutrition 100 4.9. Cry in Malformation Syndromes 100 4.10. Cry in Twin Pairs 100 5. Summary 101 6. References 101

CHAPTERS

Sound Spectrographic Cry Analysis of Cry in Prematures 105 Carl-lohan Thoden, Anna-Liisa Jiirvenpiiii, and Kaiarina Michelsson

1. Introduction ...... 105 2. Material and Methods ...... 107 3. Results 108 4. Discussion 113 5. Summary 116 6. References 116 xviii CONTENTS

CHAPTER 6 The Newborn Infant Cry: Its Potential Implications for Development and SIDS 119 Raymond H. Colton, Alfred Steinschneider, Lois Black, andJohn Gleason

1. The Cry and Health ...... 119 2. The Cry and SIDS 121 3. Respiratory Instability, SIDS, and Behavioral Development ...... 122 4. Purpose of this Study 123 5. Procedure ...... 124 5.1. Infant Groups Studied 124 5.2. Method of Recording Cries 124 5.3. Analysis of Cries 125 5.4. Measures of Infant Development ...... 125 6. Results 126 6.1. Intergroup Cry Comparisons 126 6.2. First-versus Fourth-Week Cry Comparisons 128 6.3. Derived Cry Variables 128 7. The Cry and Neonatal Instability 130 8. The Cry, Neonatal Behavior, and Mental and Psychomotor Development ...... 131 9. The Cry, Respiratory Instability, and Development: Implications for Infants at Risk 134 10. References 135

CHAPTER 7 The Communicative and Diagnostic Significance of Infant Sounds 139 Peter F. Ostwald and Thomas Murry

1. Introduction ...... 139 2. The Context ofInfant Cry Behavior ...... 140 3. The Patterning of Infant Cries ...... 142 3.1. Genetic Anomalies 142 3.2. Growth Factors...... 143 3.3. ToxicInfluences 144 CONTENTS ~

4. Factors That Influence Cry Performance ...... 146 5. Technical and Methodological Considerations 150 6. The Communicative Function of Crying ...... 152 7. Summary and Conclusion 155 8. References 155

CHAPTER8 A Developmental Perspective of Infant Crying 159 Philip Sanford Zeskind

1. Introduction ...... 159 2. Developmental Perspective 161 3. The Development of Crying 163 4. Crying and Present Behavioral Organization 166 5. Effects of Previous Development 170 6. Effects on Succeeding Points in Development 173 7. Conclusion ...... 179 8. References 180

CHAPTER 9 Perception of Infant Crying as an Interpersonal Event 187 C. F. Zachariah Boukydis

1. Introduction ...... 187 2. Review of Recent Cry Perception Research 188 2.1. Perception of Cries from Different Populations of Infants 189 2.2. Sound Features That Affect Perception 189 2.3. Adult Population Differences 196 2.4. Some Methodological Issues ...... 198 3. Current Research on Adult Perception of Infant Crying .. 201 3.1. Perception of Crying: Results 202 3.2. Infant Temperament and the Transition to Parenthood: Results 205 4. Toward a Model of Interpersonal Perception of Infant Cry 209 5. Conclusion ...... 212 6. References 213 xx CONTENTS

CHAPTER 10 Aversiveness Is in the Mind of the Beholder: Perception ofInfant Crying by Adults 217 Ann D. Murray

1. Introduction ...... 217 2. Conceptual Models of the Cry's Impact 218 2.1. The Cry as an Innate Releaser of Parental Behavior .. 218 2.2. The Cry as an Aversive Stimulus 219 2.3. The Cry as an Elicitor of Empathy and Altruism 220 2.4. Ontogenetic Considerations 221 3. Studies of the Cry's Impact 221 3.1. Paradigms, Measures, and Subject Populations 222 3.2. Physiological Arousal to Cries 226 3.3. Annoyance Value of Cries 226 3.4. Sympathetic Responses to Cries 227 3.5. Experiential and Biological Influences on Responsiveness 229 4. Evaluation of the Conceptual Models 230 4.1. The Releaser Model Reconsidered 230 4.2. A Reexamination of the Aversive Stimulus or Egoistic Model ...... 231 4.3. The Adequacy of the Empathy Model 233 4.4. The Ontogeny of Human Parental Behavior 234 5. New Directions for Cry Research...... 236 6. References 237

CHAPTER 11 Physiology and Behavior: Parents' Response to the Infant Cry 241 Wilberta L. Donovan and Lewis A. Leavitt

1. Introduction ...... 241 2. The Cry as an Elicitor of Caregiver Response 241 3. Infant Development as a Function of Maternal Response ...... 242 4. Stimulus Processing and Physiologic Response to Infant Signals 243 4.1. Receiver Variables 246 4.2. Infant/Stimulus Variables ...... 249 CONTENTS xxi

5. Learned Helplessness-A Model of Maternal Response . . . 253 6. Summary 258 7. References 259

CHAPTER 12 When Empathy Fails: Aversive Infant Crying and Child 263 Ann Frodi

1. Introduction ...... 263 2. The Contribution of Infant Characteristics to ...... 265 3. The Role of Infant Crying in Child Abuse ,. 267 4. Parental Physiological Responses to Infant Crying 267 5. Parental Responses to Premature Infants' Crying 269 6. Responses of Mothers with Preterm Infants 271 7. Child Abusers' Responses to Child-Related Stimuli 272 8. Summary and Conclusion 275 9. References 276

CHAPTER 13 A Comparative Model of Infant Cry 279 Jennifer S. Buchwald and Carl Shipley

1. Introduction ...... 279 1.1. Relevance of Animal Models to Human Language 280 1.2. Rationale for the Cat Vocalization Model 284 2. Problems of Quantification 285 3. Characteristics of Cat Vocalization 289 3.1. Cat Vocal Repertoire ...... 290 3.2. The Kitten Isolation Cry ...... 290 4. Vocal Learning in the Kitten 293 5. Voluntary Control of Vocalizations in the Cat 295 6. Substrates of Cat Vocal Behavior 296 6.1. Vocal Tract Properties ...... 296 6.2. Neurophysiological Mechanisms 297 7. Similarities between Infant and Kitten Vocal Behavior 299 8. Conclusions 300 xxii CONTENTS

9. References 302

CHAPTER 14 The Infant Cry of Primates: An Evolutionary Perspective 307 John D. Newman

1. Introduction ...... 307 2. Crying in Human Infants ...... 308 2.1. BasicCry Patterns 309 2.2. Pain Cry ...... 310 3. Vocal Repertoire of Human Infants 310 4. Vocal Behavior of Infant Primates: An Overview...... 311 5. The Isolation Call of Primates 312 5.1. Prosimians ...... 313 5.2. New World Primates 313 5.3. Old World Monkeys 314 5.4. Great Apes 315 5.5. Primate Isolation Call Structure: Summary 316 6. Inheritance of Isolation Call Characteristics 317 7. Ontogeny of Isolation Calls 318 8. Neural Substrates of Isolation Calls 319 9. Conclusions ...... 320 10. References 321

CHAPTER 15 Application of Cry Research to Clinical Perspectives 325 T. Berry Brazelton

1. Introduction ...... 325 2. Diagnostic Use 327 3. Parental Role 329 4. Normative Cry Study 330 5. Crying as Part of Normal Development 333 6. Constellation of Neonatal Behavior 334 7. Intervention and Anticipatory Guidance 335 8. A Clinical Example ...... 337 9. Conclusions...... 338 10. References 339 CONTENTS xxiii

CHAPTER 16 Crying: A Clinical Overview...... 341 Martin Bax

1. Introduction ...... 341 2. Crying in the Preschool Child 342 3. Crying at School 343 4. The Diagnostic Value of the Cry-Crying under the Age of Two 344 5. The Toddler-Aged Child ...... 345 6. Crying in the School-Aged Child 346 7. Handicapped Children 347 8. Crying-Its Social Role 348 9. Bibliography 348

CHAPTER 17 Epilogue ...... 349 Peter H. Wolff

1. References 354

INDEX ...... 355