Parent-Infant Relationship Global Assessment
ZERO TO THREE. (2005). Diagnostic classification of mental health and developmental disorders of infancy and early childhood (rev.). Washington, DC: Author.
Then go to e-store and purchase the DC: 0-3R.
The PIR-GAS is a research-based rating instrument covering the full range of parent/infant relationships used for research purposes to describe the strengths of a relationship as well as to capture the severity of a disorder. A clinical interview with the parent coupled with observed behavior patterns allows the clinician to place the relationship into one of nine categories, ranging from well adapted (100-91) to grossly impaired (10 and under). Relationship difficulties are assessed based on the intensity, frequency, and duration of maladaptive interactions and a score below 40 marks a disordered relationship. Three aspects of the parent/infant relationship are evaluated in order to classify a disordered relationship: the behavioral quality of interactions, affective tone, and psychological involvement.
The PIR-GAS is influenced by developmental, psychodynamic, family systems, relationship, and attachment theories, as well as clinical case studies, observation in naturalistic settings, and assessments based on attachment theory.
|Quality of parent-infant relationship|
91-100 Well Adapted relationship
|Extremely well functioning conflict free relationship that promotes growth and development.|
|81-90 Adapted relationship||Relationship marked by reciprocal and synchronous interactions that are reasonably enjoyable and do not hinder development in any way.|
71-80 Perturbed relationship
|Overall relationship functions reasonably well but a disturbance in one area exists lasting no more than a few weeks.|
|61-70 Significantly Perturbed relationship||Overall relationship is adequate and satisfying to partners but a disturbance exists in one or two problematic areas. The caregiver may be stressed by the perturbation, but the dyad is able to negotiate the challenges successfully and the pattern is not enduring.|
|One or both partners may be experiencing some distress within the relationship, and the developmental progress of the dyad will likely be impeded if the pattern does not improve. Overt symptoms resulting from the disturbance are unlikely and some level of flexibility and adaptive qualities are maintained. |
|40-49 Disturbed||The relationship places the dyad at significant risk for dysfunction. The adaptive qualities of the relationship are beginning to be overshadowed by problematic features of the relationship and are beginning to adversely affect one or both partners.|
The relationship is characterized by relatively stable, maladaptive interactions and distress in one or both partners. Interactions may be conflicted or grossed inappropriate developmentally without overt conflicts.
20-29 Severely Disordered
The relationship is severely compromised and one or both partners are significantly distressed by the relationship itself. Maladaptive interactions are rigidly entrenched, have endured over time, and most interactions are conflicted.
|10-19 Grossly Impaired|
The relationship is dangerously disorganized and the infant is in danger of physical harm.
Interrater reliability has been established with small sample sizes, but not established in large population samples. Validity has not been established.
One study has attempted to establish predictive validity.
Aoki et. al. (2002) describe their PIR-GAS scores as predictive of mothers reporting child internalizing symptomatology four months later, contributing to the predictive validity of the PIR-GAS measure.
A score of 39-21 is considered a disordered relationship, 20-11 a severely disordered relationship, and 10 and below designates a grossly impaired relationship. A disordered relationship is classified as either overinvolved, underinvolved, anxious/tense, angry/ hostile, a mixed relationship, or abusive.
The NCCIP task force drew primarily from literature reviews and discussion of knowledge from case reports and clinical experiences to reach a consensus on diagnostic categories and specific patterns of emotional and behavioral problems.
|Population Type:||Measure Used with Members of this Group||Members of this Group Studied in Peer-Reviewed Journals||Reliable||Good Psychometrics||Norms Available||Measure Developed for this Group|
|1. Developmental disability||Yes|
|3. Lower socio-economic status||Yes|
|4. Rural populations||Yes|
|5. Children 0-3 and Caregivers||Yes|
Pros & Cons/References
1. Creates a relationship-focused diagnosis as a warning for increased risk of future child DSM-IV diagnoses
2. Captures the significance of the caregiver relationship in assessing infants and young toddlers
3. Has ability to assess both the strengths and weaknesses the infant-caregiver relationship may have, covering the full range of possible relationships and placing it along a continuum
4. Utilizes a non threatening approach towards assessment in which a clinician may primarily observe spontaneous interactions if necessary, making it suitable for vulnerable populations
5. Suitable for clinical work and research; can facilitate stronger communication between both
1. Reliability or validity have not been clearly established
2. Ambiguous instructions on identifying a precise score
3. Clinicians must have extensive background in child development and in making diagnoses with the DSM-VI, ICD-10, and Axis I of the DC: 0-3
4. No specific training instructions exist to aid clinicians in using the measure
5. Clear implications of the diagnosis of a relationship disorder have yet to be determined
6. No variation in assessment across cultures
Bjorn, S., & Sandell, R. (2011). A randomized controlled trial of mother-infant psychoanalytic treatment: II. Predictive and moderating influences of qualitative patient factors. Infant Mental Health Journal, 32(3), 377-404.
Bjorn, S., & Sleed, M. (2010). The Ages & Stages Questionnaire: Socio-Emotional: A validation study of a mother-report questionnaire on a clinical mother-infant sample. Infant Mental Health Journal, 31(4), 412-431.
Faugli, A., Emblem, R., Bjørnland, K., & Diseth, T., H. (2009). Mental health in infants with esophageal atresia. Infant Mental Health Journal, 30(1), 40–56.
Skovgaard, A., M., Houmann, T., Christiansen, E., & Andreasen, A., H. (2005). The reliability of the ICD-10 and the DC 0-3 in an epidemiological sample of children 11/2 years of age. Infant Mental Health Journal, 26(5), 470-480.
Aoki, Y., Zeanah, C., H., Heller, S., S., & Bakshi, S. (2002). Parent-infant relationship global assessment scale: A study of its predictive validity. Psychiatry and Clinical Neurosciences, 56(5), 493-497.
Keren, M., Feldman, R., & Tyano, S. (2001). Diagnoses and interactive patterns of infants referred to a community-based infant mental health clinic. Journal of the American Academy of Child and Adolescent Psychiatry, 40(1), 27-35.
Skovgaard, A., Olsen, E., Christiansen, E., Houmann, T., Landorph, S., Jørgensen, T. & the CCC 2000* Study Group. (2008). Predictors (0–10 months) of psychopathology at age 1½ years – a general population study in The Copenhagen Child Cohort CCC 2000. Journal of Child Psychology and Psychiatry, 49(5), 553–562.
Knapp, P., K., Ammen, S., Arstein-Kerslake, C., Poulsen, M., K., & Mastergeorge, A. (2007). Feasibility of expanding services for very young children in the public mental health setting. Journal of the American Academy of Child & Adolescent Psychiatry, 46(2),152-161.