Symposium
Chairs: Dieter Wolke and Blaise Pierrehumbert
Discussant: Grazilla Fava Viziello
Preterm birth has been found to consistently effect mother-infantinteraction during the first year of life. Mothers of preterm infants havebeen reported to be either more intrusive and overstimulating oralternatively less engaged with their infants. Intervention studiesindicated that these differences in early interaction may be amenable toearly intervention. Most studies in the 1970's and early 1980's includedpreterm infants who are now considered to be at low to moderate risk forlongterm developmental sequelae. Continued advances of neonatal intensive care have led to the survival ofever smaller infants with more than 90% of infants born more than 8 weeksearly now surviving. This symposium brings together a number of short-term longitudinal studiesof very preterm infants and examines the relative influence of very pretermbirth, the neonatal complications experienced by these infants, maternalattachment representation and initial parenting behaviour on infant-motherinteraction patterns during the first two years of life. It re-examines howthese factors contribute to the development of the infant-motherrelationship and whether the quality of interaction can be enhanced byearly intervention.Both papers by Pierrehumbert and colleagues and Wolke and colleaguesexamine the relative effects of neontal risk, neonatal parental behaviourand coping with the trauma of preterm birth on infant-mother interactionquality within short-term longitudinal observation studies. It is exploredwhether different mechanisms identified for full-term infants areinfluential to the quality of the infant-mother relationship in verypreterm infants. First findings (e.g. by Wolke and colleagues) suggest thatthe quality of the infant-mother relationship may be more stronglyinfluenced by early infant medical complications and maternal behaviour inthe intensive care unit than by maternal childhood recollections. The studyby Laganiere & Tessier addresses similar questions and includes a 16 monthQ-sort assessment of quality of mother-infant attachment as an outcomemeasure. Again, the findings indicate that the severity of neonatalcomplications strongly influences early socio-emotional development. Theintervention study by Schnuecker and colleagues which randomised verypremature dyads into an intensive psychotherapeutic intervention andcontrol group further indicates that no direct influence of thepsychotherapeutic intervention could be observed on infant-motherinteraction at three months. Rather early neurobiological risk of theinfants appears to have an over-riding effect on the infant-motherrelationship.The findings so far indicate that different models of the development ofearly infant-mother relationships need to be applied to very preterminfants that would not have survived thirty years ago. Infant factors (e.g.severity of neonatal illness, irritability) appear more influential thanpreviously reported in fullterm samples The need for more specific theoriesof socio-emotional development in neonatal high risk infants and earlyintervention approaches will be discussed.
Details of individual items:
paper
A longitudinal study investigated the effect of very low birth weight (<1500g) on the emotional climate of the family, as well as on children's cognitive and somatic development.The impact of the child's neurobiological deficits as well as a psychotherapeutic intervention on the mother-child interaction were explored. Sample: Families were recruited from the NICU of the University hospital. Data on 69 mother-child pairs are presented, where the mother-child interaction as well as the neourobiological status of the child are available. Children's birthweight ranged from 450g-1490g (M966g) and their mean gestational age was 27 weeks (range 24-35 weeks). Thirty six of the children were boys and 33 girls.Method: All families were followed up in the first two years of the child's life. An intervention programme was offered to half of the families after having been randomly assigned to either the control group or the intervention group. The psychotherapeutic intervention allowed parents who had just experienced a premature birth to obtain support from a therapist, from other parents in a parent group and by neonatal nurses during a home visit. At 3 months (corrected age) the parent-child interaction was filmed in the laboratory during a 10 minute nappy changing and play sequence. A split-camera technique allowed detailed observation of parent's and child's interactive behaviour. The rating scale focused on both quanitative and qualitative analyses of the dyadic interaction.Results: First results of the quantitative analyses on aspects of vocalisation, interactive content, and emotional climate are available to date. Dyadic analyses encompassing the synchronicity and reciprocity of the mother and child will be presented once the analyses are complete. In the parameters of the mother-child interaction assessed so far, no direct influence of the psychotherapeutic intervention could be observed. The mother-child pairs in the intervention group did not have a more favourable interaction at 3 months (corrected age) on quantitative measures of the interaction than the mother-child pairs in the control group. When assessing the effect of the children's neurobiological risk in the first months of life on the mother-child interaction, results suggest a difference in the interactive behaviour. Children who have suffered more neurobiological impairement, as assessed by the paediatrician, have less face to face contact, look less at a toy presented by the mother and laugh less than children with few neurobiological deficits.Discussion: What implications the children's neourobiological deficit has on the mother-child interaction and later development is explored. Explanations considering the design and focus of the intervention programme as well as the sample characteristics will be discussed, which may clarify the lack of impact of the intervention programme.
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Prematurity has been found to interfere with the infant's capacity tocommunicate and regulate emotion and with the mother's ability to providesensitive, appropriate responses to the infant's cues. Unclear is whichfactors predict mother-infant interaction in this risk group: early medicalcomplications, early behaviour regulation, early maternal sensitivity, ormaternal attachment recollections (from childhood, during pregnancy, afterbirth, and current). The relationship of these factors assessed before andat term on very preterm infants' attentional abilities and responses tostructured and perturbed (still-face) interactions at 3 months (correctedage) was investigated in 60 very preterm infants (<32 wks) and theirmothers (sub-sample of the GAIN Study). Neonatal assessments in hospitalincluded: mother-to-infant attachment (pre- and postnatal), nurse-reportedmaternal sensitivity in hospital; infant attentional abilities at term(Brazelton NBAS), measures of infant irritability and maternal attachmentrecollections (AAQ). Outcome assessments at 3 months included a structuredmother-infant interaction observation and the still-face procedure(Tronick), as well as a structured researcher based assessment of infantattention. Preliminary results indicate that mothers who reported feelingmore attached to their infant during pregnancy and who were perceived asmore sensitive in hospital were rated as more sensitive during structuredinteractions at 3 months post-term. Maternal attachment recollections werenot related to dyadic interactions or infant still-face response. Infants' 'attentional abilities' at term and 3 months were related to theirresponses to structured play and the still-face at 3 months. Medical riskfactors, as well as infant irritability at term were related tointeractional behaviour at 3 months. These results highlight the specificrole of early infant factors directly and medical risk on laterinfant-mother interaction: VLBW infants' limited attentional capacities andincreased irritability can impede on their response to structured play andstill-face. Maternal attachment and sensitivity towards their infant inhospital were related to their behaviour in interaction more than threemonths later. The experiences of prematurity have overridden the influenceof maternal childhood recollections. These findings have importantimplications for later socio-emotional development, as early interactionsand still-face response have been linked to attachment security.
paper
Premature birth involves an objective threat for the child's survival orhis/her well-being. It can represent an important perinatal traumaticexperience for the child as well as for the parents. As a traumaticexperience, it may alter the parents' reactions and representations, andinduce a rupture in the normal transition to parenthood (promoting emotionregulation, adequately stimulating and protecting against excessiveexcitement, appropriate expectations concerning the child, the parentalroles and competence, balanced attachment to the infant, etc.). Theparents' traumatic experience may then play a key role in the child'smental functioning. But also, the subjective traumatic experience may notbe proportionate to the objective severity of the perinatal troubles. Thereare relatively few empirical reports considering the possible effects of aperi-natal traumatism, from the perspective of the parents, in the contextof a premature birth.Objectives : 1) To describe possible parenting dysfunctions in relation toprematurity ; 2) To assess the degree of relation (or of independence)between the severity of perinatal troubles and these dysfunctions ; 3) Toassess the degree of relation between the severity of perinatal troublesand later neuro-cognitive developmental outcomes ; 4) To envisage parentingfunctions (expectations, perceptions, representations, attitudes,attachment) as possible mediating factors in the relation between perinataltroubles and later developmental outcomes. It is hypothesized that adequateparental functioning can remediate potential adverse effects of severeperinatal troubles.Method : As part of a longitudinal study, N3D74 mothers with a prematureinfant (born between 25-33 gestation weeks) and a control group of N3D32mothers with a full term infant were interviewed, as children reached 6months (corrected age), in a clinical setting (Meyer et al., 1992CLIP-interview and Stern et al., 1989 R-interview) ; mothers and theirchildren were observed in a semi-structured play setting, and children wereevaluated through the Griffith Developmental Scale. The Perinatal RiskInventory (Scheiner & Sexton, 1991) was derived from perinatal data(gestational age, birth weight, complications, lesions, etc). The maternalworking model of attachment to the child is coded using Benoit, Zeanah etal. (1997) IWMCI procedure ; interactions are coded using Ainsworth's(1974) maternal sensitivity scale and Crittenden's (1981) care index ;representations of parental competence are assessed through a maternalself-report inventory, a parental competence questionnaire and a stressorappraisal rating scale.Results and conclusions : the paper will present extensive data analysis,which will be discussed from the perspective of clarifying whether apremature birth may alter the normal transition to parenthood and implyspecific patterns of representation, attachment and interaction. It will bequestioned whether such patterns can have a mediating effect on thedevelopmental implications of prematurity. Clinical work with parents ofpremature infants often shows that they endure feelings of emptiness, whilethe child stays for long periods in the neonatal intensive care unit. Thisstudy should contribute to the orientation of liaison intervention inneonatology and to promotion of preventive measures in providing a supportto premature children's parents during the early stages of parenting (GrantFNRS #32-49712.96).