Course Type

Infant and Toddlers CARE-Index (ICI & TCI)

Duration: 9 days


The Infant CARE-Index (ICI, Crittenden, 1981) is the simplest and most versatile of the DMM assessments. It assesses mother-infant interaction from birth to about 15 months of age based on a 3-minute video-recorded play interaction. It does not assess attachment and captures the best of dyad’s functioning (rather than capturing the dyad’s response to stress, i.e., attachment). The ICI has extensive published validating evidence.

The scales

  1. Are highly correlated with the infant Strange Situation assessment patterns of attachment
  2. Differentiate abusing from neglecting, abusing-and-neglecting, marginally maltreating, and adequate dyads
  3. Can be used during intervention, and
  4. Can be used to assess the effectiveness of intervention.

The information derived from the CARE-Index can be used as quasi-continuous or categorical data by researchers. In addition, however, the procedure is easily applied to “live” observations made by nurses, infant teachers, clinicians, and social workers. Needless to say, such observations cannot be treated as reliable when video is not used, but the method is effective in the same way that other guided observations or interviews are; furthermore, specific training of what to look for sharpens both one’s observation and one’s ability to tell others exactly what the dyad did and why it should be interpreted in a particular manner.

Toddlers CARE-Index and Advanced Training

Training courses

The course is taught from videotapes and depends upon both adult and infant behavior. Non-verbal behavior, interpersonal strategies, and developmental processes are emphasized. Adult patterns consist of sensitivity, controlling, and unresponsivity; the infant patterns are cooperative, difficult, compulsive compliant, caregiving or attention, and passive. The course includes a preliminary reliability test based on a standardized set of American mother-infant dyads. During the course, participants generate a set of videotapes that reflect their intended applications and culture(s). These tapes are used to assess the participant’s competence in administering the procedure.

Who is it for? The Infant CARE-Index is a useful, portable tool for a wide range of Health and Social Care professionals whose work involves assessing and mounting interventions to improve parent-child interaction in the first 15 months of the child’s life. It can be used with families from all backgrounds and cultures and with infants and toddlers, including those with developmental problems such as physical and learning disabilities.

The second course on toddlers (15-30 months) is called Toddler CARE-Index (TCI). The patterns include a wider array of compulsive patterns and coercive patterns (both aggressive and passive) as well as combinations.

Prerequisites for the TCI are: 1) Before the course: ICI, SSP, or PAA 2) Before taking the reliability test, Attachment, Neurodevelopment, and Psychopathology (ANP)

Competency to code is assessed by a reliability test after the training.

Course participants will be expected to undertake practice coding during the training and in between the taught days. Not completing the practice is likely to seriously impede the level of reliability that can be achieved.

As with all courses offered by Dr. Crittenden, participants are given a written and signed statement of their percent agreement with the standard. This reliability can be reported in research articles. Evidence of reliability should be requested if the participant will code data for another researcher.

In addition, courses are offered from time to time for people who wish to become trainers. There are also advanced clinical seminars offered to international groups of experienced coders. These are held in central Italy and on the coast of Nova Scotia, Canada.

To inquire about the course in general, interested parties can contact Dr. Crittenden directly. To register for courses, individuals should check the local events section listed on this web page and contact the relevant organizer. Dr. Crittenden does not handle registration or fee payment. Requests to run a new course can be directed to Dr. Crittenden.

Studies Using The CARE-Index

Risk studies

1. Adolescent mothers
  • Pacquette, D., Bigras, M., Zoccolillo, M., Tremblay, R., Labelle, M-» & Azar, R. (2001). Comparison de la sensibilitè parentale entre des mëres adolescentes et des mëres adultes peu scolarisèes. Revue de Psychoèducation et d’Orientation, 30, 283-298. See also Leadbeater, et al. and Linares et al., below
2. Drug abusing mothers; drug exposed infants
  • Ciotti, F., Lambruschi, F., Pittino, B., & Crittenden, P. (1998). La valutazione della relazione precoce madre-bambino in una popolazione di madri con una storia di tossicodipendenza attraverso l’uso del CARE-Index. Psicoterapia Cognitiva e Comportamentale, 4, 53-59. See also Linares et al.
3. Maternal psychiatric disorder
  • Hughes, S. (1993). The relationship between maternal psychiatric disorder and mother-child responsivity. Dissertation presented to the Faculty of McGill University, Montreal, Canada.
  • Leadbeater, B. J., Bishop, S. J., & Raver, C. C. (1996). Quality of mother-toddler interaction, maternal depressive symptoms, and behavior problems of adolescent mothers. Developmental Psychology, 32, 280-288.
  • Linares, L. O. (in press). Substance abusing mothers involved in the child welfare system. Women’s Health System
  • Leventhal, A., Jacobsen, T., & Miller, L. J. (in press). Parenting attitudes and parenting behavior among mothers with mental illness. Psychiatric Services.
  • Mullick, M., Miller, L. J., Jacobsen, T. (2001). Insight into Mental Illness and Child Maltreatment Risk in Mothers with Major Psychiatric Disorders. Psychiatric Services, 52, 488-492.
4. Handicapping conditions
  • Crittenden, P. M. & Bonvillian, J.D. (1984). The effect of maternal risk status on maternal sensitivity to infant cues. American Journal of Orthopsychiatry, 54, 250-262.
  • Rauh, H., & Calvet-Kruppa, C. (2001). Bindungssicherheit und Verhaltensentwicklung bei Kindern mit Down-Syndrom. Psychologie in Erziehung und Unterricht.
5. Maltreated infants
  • Crittenden, P.M. (1992a). Children’s strategies for coping with adverse home environments. International Journal of Child Abuse and Neglect, 16, 329-343.
  • Crittenden, P. M. (1988). Distorted patterns of relationship in maltreating families: The role of internal representational models. Journal of Reproductive and Infant Psychology, 6, 183-199.
  • Crittenden, P. M. & DiLalla, D. L. (1988). Compulsive compliance: The development of an inhibitory coping strategy in infancy. Journal of Abnormal Child Psychology, 16, 585-599.
  • Crittenden, P. M. (1987). Non-organic failure-to-thrive: Deprivation or distortion? Infant Mental Health Journal, 8, 56-64.
  • Crittenden, P. M. (1985). Social networks, quality of child-rearing, and child development. Child Development, 56, 1299-1313.
  • Crittenden, P. M. (1984). Sibling interaction: Evidence of a generational effect in maltreating families. International Journal of Child Abuse and Neglect, 8, 433-438.
  • Crittenden, P. M. (1981). Abusing, neglecting, problematic, and adequate dyads: Differentiating by patterns of interaction. Merrill-Palmer Quarterly, 27, 1-18.
  • Jacobsen, T., & Miller, L. J. (1998). Compulsive compliance in a young maltreated child. Journal of the American Academy of Child and Adolescent Psychiatry, 37(5), 462-463.
  • Leadbeater, B., & Bishop, S. J. (1994). Predictors of behavior problems in preschool children of inner city Afro-American and Puerto Rican mothers. Child Development, 65, 638-648.
  • Ward, M. J., Kessler, D. B., && Altman, S. C. (1993). Infant-mother attachment in children with failure to thrive. Infant Mental Health Journal, 14, 208-220.
Normative Studies
  • Patino, F. L. (1993). Mothers’ prenatal attachment history, attachment status, and social support satisfaction as predictors of postnatal maternal sensitivity. Dissertation Abstracts International, 53 (7-B): 3787.
Predictive Longitudinal Studies
  • Simó, S., Rauh, H., & Ziegenhain, U. (2000). (English title: Mother-infant interaction during the first eighteen months and attachment security at the end of the second year.) Mutter-Kind-Interaktion in den ersten 18 Lebensmonaten und Bindungssicherheit am Ende des 2. Lebensjahres. Psychologie in Erziehung und Unterricht, 47, 118-141.
  • Ward, M.J., & Carlson E.A. (1995). The predictive validity of the Adult Attachment Interview for adolescent mothers. Child Development,66, 69-79.
Intervention Studies
  • Bigras, M. & Pacquette, D. (2000). L’interdèpendance entre les sous-systëstemes conjugal et parental: Une analyse personne-processus-contexte. Psicologia: Teoria e Pesquisa, 16, 91-102.
  • Cramer, B., Robert-Tissot, C., Stern, D. N., & Serpa-Rusconi, S. (1990). Outcome evaluation in brief mother-infant psychotherapy: A preliminary report. Infant Mental Health Journal, 11, 278-300.
  • Crittenden, P. M. (1985). Maltreated infants: Vulnerability and resilience. Journal of Child Psychology and Psychiatry, 26, 85-96.
  • Linares, L. O. (in press). The effects of an early intervention program on polydrug infants and their families in foster care. In J. Silver (Ed.),Serving the needs of young children involved in the child welfare system. New Jersey.
  • Linares, L.O., Jones, B., Sheiber, F.J. & Rosenberg, F.B. (1999). Early intervention for drug-exposed infants in foster care. In. J. Silver, B. J. Amster & Haecker (Eds.), Young Children and Foster Care (pp. 373-397). Baltimore: Brookes.
  • Pacquette, D., Zoccolillo, M., & Bigras, M. (1999). L’efficacitè des interventions en foyers de groupe pour mëres en difficultè d’adaptation.Dèfi Jeunesse, VI, 30-35.
  • Robert-Tissot, C., Cramer, B., Stern, D., Serpa, S. et-al. (1996). Outcome evaluation in brief mother-infant psychotherapies: Report on 75 cases. Infant Mental Health Journal, 17, 97-114.

Course Trainers