Assessment of the quality of parent-child interaction is a priority because of its major impact in the normative emotional and cognitive development of the baby and its importance in psychopathology. It is known that the risks for the development of the child can be pre- or postnatal and are above all linked to the parent-child relationship. They can be linked to particular situations (abuse, deprivations, postnatal depression, parental psychopathology, adoption, etc.) or be the first signs of a disorder: autism, mental deficiency, anxiety, or depressive disorders or behavioral disorders. Particular attention therefore needs to be paid to the mechanisms of development in all of its various aspects (emotional, attachment, cognition, motor development, development of language, and communication) and to possible disorders so as to intervene at the earliest sign, or to prevent them. Interaction difficulties often represent the first and only indication of difficulties and disorders appearing in the infant. Although there is no real consensus on the definition of assessment, this term has become a keyword in the field of perinatal psychiatry. The study of interactions and relationships of the child with its parents is at the heart of the process of clinical assessment of the infant. In order to decide on an effective intervention, essential elements need to be taken into account: an assessment of symptoms and parent-child interactions, as well as parenting skills. Assessment thus holds a central place in the clinical examination.

Studying parent-child interactions began with the mother-baby relationship then looked into the father-baby relationship and later the triadic parent-baby relationship, which are also essential to observe (insofar as one can see how the baby interacts effectively with each of the parents and with the two together and thus assess the ability of alliance and co-parenting of parents to the baby).

Even if an assessment time can be more focused on the functioning of the infant and/or its parents, it is how they usually interact that needs to be analyzed: One can observe the partners’ involvement, terms of behavior and synchronization, the adjustment quality, the sensitivity to the child’s cues, the emotional tone, and the quality of the answers. The parental representations underlying these answers can also be postulated.

We understand that this assessment is quite complex. We need first of all to really assess interactions and not only parental behaviors or just maternal behavior, which is quite limiting but often done. To take into account interactions, we need to observe the mutual effects of the infant on its partner(s) and of the partner(s) on the infant. It is this synchronization that is difficult to grasp and that requires a choice of scales (clinical time, macro- or microanalysis, picture by picture).

This complexity reflects the fact that interactions have been studied in detail much more easily since the advent of video recording in developmental psychology. The video has become easier to use in mental health units and also in the home, thanks to the prices of equipment becoming affordable. Their use has spread in everyone’s life making it a common tool, friendly to use. In the research field, video-based assessment scales are essential to quantify or compare interactions. Many tools have been designed for research and then adapted to clinical settings. Video is now a major tool for training, supervision, and education, but also for clinical assessment.

Assessing interactions should be standard practice for clinicians, but we have noted that this is not always the case. The use of video recordings is not as widespread as we might expect. Sometimes grids or scales of standardized interactions are used, but too many professionals still settle for a quite subjective global assessment, in a more or less standardized situation of observation. There are various reasons for this, for instance, assuming that such tools are for research only (too complicated, time-consuming, etc.), require long and costly training, etc. A large majority of the tools are in English with no translation available, or need local adaptation due to regional, cultural, temporal, or other contributing factors (Higgins et al. 2010). But we must bear in mind that for a reliable and valid assessment, a structured observational tool that specifies the behaviors to observe, with defined scoring criteria, should be used. Professionals who work with babies and dyads would benefit from being trained in and implementing interaction assessments.

Another interest of these tools is that, in clinical practice, using them has a clinical impact in dyadic care and in staff work. Concerning health professionals, an obvious consequence is reported by Gordon and Comfort (2013): “A rarely recognised value of observational parenting assessment is that of improving the practitioner’s own capacity to shift their focus from the child to parent-child interactions.” It helps in defining the components of effective interactions and promotes a common language among co-workers and during supervision. With parents, interaction assessments objectify the observations and their progression and can be useful in establishing and supporting dialogue with them, such as addressing each individual parent’s strengths and needs, and monitor their progress together. When parents and staff discuss specific information from assessments, they can collaborate as a team to focus their efforts, adjust their strategies, and effectively promote the development of the children.

Few handbooks deal specifically with clinical assessment of the baby: Del Carmen-Wiggins and Carter (2004) and the chapters on assessments in the three editions of the Handbook of Infant Mental Health by Charles Zeanah (2005 republished in 2009 and 2012). There is also the recent review of parent-child mutuality coding systems (Funamoto and Rinaldi 2015). In French, the book by Guédeney and Tourrette in 2012 is the first of its kind.

We cannot provide an exhaustive inventory of the tools (scales, questionnaires, tests) useful for the assessment of parent-child interactions. In this chapter, we selectively review a number of specific interactive methods that have been used in developmental and clinical research and that we believe have value for use in clinical settings. Eleven tools are presented in chronological order.