Attachment representations in mothers of preterm infants

The aim of the study was to assess attachment representations in mothers of preterm infants using the Working Model of Child Interview (WMCI) at the 12 months of the infant's corrected age. In addition, the relation between WMCI representation categories and the Edinburgh Postnatal Depression Scale score at 6 months of the infant's corrected age was studied. There were 38 mothers of preterm infants (<1500 g or <32 gestational weeks) and 45 mothers of full-term infants. The results showed no differences between the study groups in the distribution of the three main representation categories (balanced, disengaged and distorted). However, there were qualitative differences in representations between the groups. Furthermore, maternal depression symptoms were associated with distorted representation category. We suggest that despite the qualitative differences in the mothers’ representations, mothers of preterm infants are as likely to form balanced attachments with their infants as mothers of full-term infants.     

Prem Baby Triple P a new parenting intervention for parents of infants born very preterm: acceptability and barriers

Over 10% of preterm infants develop major disabilities, 50% develop behavioural problems and 40% need special education ( [Huddy et al., 2001] and [0185] ). Prem Baby Triple P is a new variant of the Positive Parenting Program (Triple P) adapted specifically for parents of very preterm infants. The aim of this study is to assess the acceptability of Prem Baby Triple P to parents of infants born preterm and to test whether parental attributions and parental perception of infant health/developmental status are barriers to intervention acceptability. One hundred and twenty-three parents of preterm infants participated, 83 parents of very preterm infants and 40 parents of preterm infants. In addition, 32 parents of term infants participated as a comparison group. The acceptability of Prem Baby Triple P was moderately high and did not differ significantly across the three groups. Parental attributions were not found to be barriers to intervention acceptability and parental perceptions that their infant is less healthy/developmentally delayed facilitated Prem Baby Triple P acceptance in parents of infants born very preterm. This suggests that the planned Prem Baby Triple P content is acceptable to parents of infants born very preterm and sensitised to medical and developmental issues. These findings, as social validation data, will contribute towards the further development of Prem Baby Triple P and a future randomised controlled trial.     

Maternal attachment representations and the development of very low birth weight premature infants at two years of age

There is a consensus that prematurity could increase the risk of attachment impairment. We studied 90 premature children with very low birth weights (<1,500 g) and 96 healthy children born at term with similar age and sociodemographic characteristics. Our objective was to assess maternal stress and attachment representations, and compare development indices on both groups at 2 years of age. Premature infants had a medium‐to‐severe degree of immaturity and biological risk (M gestational age = 29.98 weeks; birth weight = 1,159.76 g), with 57% staying in the ICU ≥1 week. These children born prematurely had lower scores on the development indices within the normal range. Mothers of premature infants (n = 74) reported higher levels of stress during their first year of life (59%) than did controls (41%), but no significant differences were detected in maternal attachment discourse between the two groups. The findings confirm that premature birth has a great influence on maternal emotional responses and the health and development of children in the first years of life, and indicate that stress responses in parents and warning signs for attachment problems should be assessed as early as possible.     

Mother- and father-infant interactions at 3 months of corrected age: The effect of severity of preterm birth

Early interactions of 92 preterm infants with their mothers (n = 54) and fathers (n = 38) were explored at 3 months using CARE-Index. Results showed differences in interactions based on parent's gender, with higher control in mothers and unresponsiveness in fathers, while no effect of severity of birth weight emerged.     

Maternal ratings of infant regulatory competence from 6 to 12 months: influence of perceived stress, birth-weight, and intervention: a randomized controlled trial

Mothers’ reports of preterm and term infants’ temperament from 6 to 12 months of age were studied, with intervention and stress as predictors. Preterm infants with a birth weight <2000 g were randomized to an intervention (71) or a control (69) group. A control group of healthy term infants (74) was also established. The intervention was a modified version of the “Mother–Infant Transaction Program”, aimed at sensitizing caregivers to the infants’ individual characteristics. Temperament was measured with the Infant Behavior Questionnaire, and stress with the Parenting Stress Index. There were no group differences in temperament at 6 or 12 months or in change during the same period. There was a strong association between stress and negative reactivity in the preterm control group at 12 months. In the preterm intervention group, there were strong negative correlations between stress and regulatory competence at 6 months. The intervention seemed to change the relationship between stress and temperament. The strength of this association indicates that the intervention sensitized mothers to the temperamental regulatory competence of their preterm infants.     

Maternal self-confidence during the first four months postpartum and its association with anxiety and early infant regulatory problems

Maternal self-confidence has become an essential concept in understanding early disturbances in the mother-child relationship. Recent research suggests that maternal self-confidence may be associated with maternal mental health and infant development. The current study investigated the dynamics of maternal self-confidence during the first four months postpartum and the predictive ability of maternal symptoms of depression, anxiety, and early regulatory problems in infants. Questionnaires assessing symptoms of depression (Edinburgh Postnatal Depression Scale), anxiety (State-Trait Anxiety Inventory), and early regulatory problems (Questionnaire for crying, sleeping and feeding) were completed in a sample of 130 women at three different time points (third trimester (T1), first week postpartum (T2), and 4 months postpartum (T3). Maternal self-confidence increased significantly over time. High maternal trait anxiety and early infant regulatory problems negatively contributed to the prediction of maternal self-confidence, explaining 31.8% of the variance (R = .583, F_3,96 = 15.950, p < .001).Our results emphasize the transactional association between maternal self-confidence, regulatory problems in infants, and maternal mental distress. There is an urgent need for appropriate programs to reduce maternal anxiety and to promote maternal self-confidence in order to prevent early regulatory problems in infants.     

Effect of early intervention on social interaction between mothers and preterm infants at 12 months of age: a randomized controlled trial

In a randomized controlled trial at 12-months of age, the effect of the Mother Infant Transaction Program was tested on social interaction between mothers and moderately and late preterm infants with gestational age ≥ 30.0 and <36 weeks. Ninety-three play sessions were videotaped and coded, 46 mothers-infants in the intervention group and 47 mothers-infants in the control group. The intervention mothers scored higher on maternal sensitivity/responsiveness (p = .05). Being a first-time mother was a moderator that enhanced the effects of the intervention. First-time mothers were more sensitive/responsive to their infant's cues (p = .01), and the dyads evinced higher level of synchrony (p = .02) as compared with experienced mothers. More positive mood was observed among their infants (p = .04). The findings suggest that the intervention contributes to better mother-infant interactions in moderately and late preterm infants of first-time mothers.     

An examination of the impact of maternal fetal attachment,postpartum depressive symptoms and parenting stress on maternal sensitivity

The current study aimed to examine the impact of maternal depression, maternal fetal attachment (MFA) and parenting stress on maternal sensitivity, intrusiveness and positive regard for the child with a sample of 36 low-income, mothers-infant dyads that were followed from pregnancy through the first year postpartum. Maternal depression and parenting stress were expected to have a negative impact on maternal sensitivity, intrusiveness and positive regard, while high MFA was hypothesized to have a positive impact on these three outcomes. Our data provide partial support for our hypotheses. Findings from this study add to the literature by examining the stability of the maternal prenatal and postpartum bond with her infant as well as by looking at the impact of parenting stress on maternal behaviors and processes that may lead to later attachment security differences, such as maternal sensitivity and responsiveness.     

Mother's attachment representations of their premature infant at 6 and 18 months after birth

The effects of premature birth on attachment have generally been examined from the infant's perspective. There is a lack of data concerning parental attachment representations toward a premature child. Because of the psychological stress engendered in parents confronted with a premature birth, we hypothesized that their attachment representations would be altered during the first months after the hospital discharge. Fifty families with a premature infant (25–33 gestation weeks) and a control group of 30 families with a full‐term infant participated to the study. Perinatal risks were evaluated during hospitalization. To assess mothers' representations of their infant, the Working Model of the Child Interview (WMCI, Zeanah & Benoit, 1995 & Benoit, Zeanah, Parker, Nicholson, & Coolbear, 1997) were administered when their children were 6 and 18 months old. The severity of the perinatal risks was found to have an impact on the mothers' attachment representations. At six months, only 20% of the mothers of a prematurely born infant (30% at 18 months) had secure attachment representations, vs. 53% for the control group (57% at 18 months). Furthermore, mothers of low‐risk premature infants more often had disengaged representations, whereas distorted representations were more frequent in the high‐risk group of premature children. These findings suggest that the parental response to a premature birth is linked to the severity of postnatal risks. The fact that secure attachment representations are affected in mothers of low‐risk infants just as much as they are in mothers of high‐risk infants points to the need to conduct further studies aimed at evaluating whether preventive intervention for both low‐risk and high‐risk premature will be helpful.     

The expression and regulation of anger in toddlers: relations to maternal behavior and mental representations

Anger is an intense and adaptive approach emotion that undergoes significant development during the toddler years. We assessed the expression of anger and the strategies toddlers use to regulate it in relation to maternal behavior and mental representations. Seventy-four toddlers were observed in three anger-eliciting paradigms: toy removal (TR), still-face (SF), and delayed gratification (DG). Anger expression and three clusters of regulatory behaviors were micro-coded: putative regulatory behaviors, attention manipulation, and play behaviors. Maternal relational style was coded for sensitivity and intrusiveness, and mental representations of the mother-child relationship were assessed for joy and anger. Children expressed the most anger during the TR, less during the SF, and minimally during the DG. Use of putative regulatory behaviors was highest during the SF, whereas during the TR children employed newly acquired skills, such as focused attention and substitutive play, in the service of anger regulation. Anger expression and regulation were differentially related to the negative and positive components in the mother's behavior and representations, and maternal intrusiveness moderated the relations between angry representations and the degree of child anger during the SF. Results are consistent with dynamic models of emotions and accord with perspectives that emphasize the role of sensitive parenting in facilitating emotion regulation.     

Maternal sociodemographic factors differentially affect the risk of behavioral problems in Brazilian and Italian preterm toddlers

The main aim of the present study was to examine differences in behavioral problems in toddlers born very preterm in Brazil and Italy. The sample comprised 154 toddlers (18–24 months of age) born very preterm, including 76 toddlers from Brazil and 78 toddlers from Italy. The Child Behavior Checklist was used to assess behavioral problems. Specific sociodemographic factors (i.e., maternal age at childbirth and maternal education) and neonatal factors (i.e., gestational age, sex, and length of hospitalization) were tested as potential mediators of country-related differences in behavioral problems. Brazilian toddlers presented more internalizing, externalizing, and total behavioral problems compared with their Italian counterparts. The effect of country on the toddlers’ internalizing and total behavioral problems was mediated by maternal age at childbirth and education. Independent effects of country, maternal age at childbirth, and maternal education emerged for externalizing behavioral problems. No significant effect emerged for neonatal variables. These findings suggest that sociodemographic factors, in addition to country-related differences, should be considered when assessing the risk of behavioral problems in preterm toddlers.     

依恋对情绪调节过程的影响

以依恋理论为基础的研究已证明依恋对情绪调节的影响,但这些研究忽视了情绪调节作为一个过程的复杂性和多样性,因此现有研究无法回答依恋为何会对情绪调节产生影响。扩展过程模型将情绪调节分为三个阶段,并清晰地描述了情绪调节的过程以及过程中各因素之间的关系。从该模型来看,在情绪调节的三个阶段均可发现与依恋有关的个体差异,并且依恋对于情绪调节早期阶段的影响可能是导致后期阶段产生个体差异的原因。未来的研究应在探讨依恋对情绪调节的影响的同时关注环境因素的影响;设计新的实验范式以证实情绪调节三阶段的连续性并探索依恋影响情绪调节的潜在机制;探讨依恋对情绪调节灵活性的影响。此外,未来的干预研究应设计更具针对性的干预措施来改善非安全依恋个体的情绪调节。     

Maternal stress and perceptions of self-efficacy in socioeconomically disadvantaged mothers: an explicative model

Studies have demonstrated that maternal stress and perceptions of self-efficacy influence a mother's performance, affecting her ability to interact with her child and to understand and answer his needs. The purpose of this study was to evaluate maternal stress and the perception of self-efficacy in the mothers of infants who are cared for in child-care centers and belong to the poorest segment of the Chilean population. To this end, these aspects were studied in 121 low-income, high-social-risk mothers with children between the ages of 4 and 9 months. The final goal was to generate an explicative model of self-efficacy and maternal stress that considered characteristics of the family and the child. The results revealed that family characteristics - especially household size, per capita incomes and mother age - are more relevant for explaining maternal self-efficacy and stress. The findings and implications for practice are discussed.     

Stability of young children's attachment representations: Influence of children's and caregiver's characteristics

This research explores the stability of attachment representations, assessed by the Attachment Story Completion Task, within early childhood. Hypotheses were also formed about the influence of parenting, externalizing behavior and intelligence quotient (IQ) on the developmental course of children's attachment representations. Data were collected from 358 French-speaking Belgian children. Security and disorganization showed a linear improvement with age. The effect of time on the two growth curves was influenced by the child's externalizing behavior. When language abilities were controlled for in a subsample of referred children for externalizing behavior, the growth in security was found to be influenced by reasoning IQ, but the effects for disorganization were unchanged. The implications of the results for both research and clinical purposes are discussed.     

Randomized controlled evaluation of an early intervention to prevent post-rape psychopathology

A randomized between-group design was used to evaluate the efficacy of a video intervention to reduce post-traumatic stress disorder (PTSD) and other mental health problems, implemented prior to the forensic medical examination conducted within 72 h post-sexual assault. Participants were 140 female victims of sexual assault (68 video/72 nonvideo) aged 15 years or older. Assessments were targeted for 6 weeks (Time 1) and 6 months (Time 2) post-assault. At Time 1, the intervention was associated with lower scores on measures of PTSD and depression among women with a prior rape history relative to scores among women with a prior rape history in the standard care condition. At Time 2, depression scores were also lower among those with a prior rape history who were in the video relative to the standard care condition. Small effects indicating higher PTSD and Beck Anxiety Inventory (BAI) scores among women without a prior rape history in the video condition were observed at Time 1. Accelerated longitudinal growth curve analysis indicated a videoxprior rape history interaction for PTSD, yielding four patterns of symptom trajectory over time. Women with a prior rape history in the video condition generally maintained the lowest level of symptoms.     

Predictors of early person reference development: Maternal language input,attachment and neurodevelopmental markers

In a longitudinal natural language development study in Germany, the acquisition of verbal symbols for present persons, absent persons, inanimate things and the mother–toddler dyad was investigated. Following the notion that verbal referent use is more developed in ostensive contexts, symbolic play situations were coded for verbal person reference by means of noun and pronoun use. Depending on attachment classifications at twelve months of age, effects of attachment classification and maternal language input were studied up to 36 months in four time points. Hierarchical regression analyses revealed that, except for mother absence, maternal verbal referent input rates at 17 and 36 months were stronger predictors for all referent types than any of the attachment organizations, or any other social or biological predictor variable. Attachment effects accounted for up to 9.8% of unique variance proportions in the person reference variables. Perinatal and familial measures predicted person references dependent on reference type. The results of this investigation indicate that mother-reference, self-reference and thing-reference develop in similar quantities measured from the 17-month time point, but are dependent of attachment quality.     

Tier 1 and Tier 2 early intervention for handwriting and composing

Three studies evaluated Tier 1 early intervention for handwriting at a critical period for literacy development in first grade and one study evaluated Tier 2 early intervention in the critical period between third and fourth grades for composing on high stakes tests. The results contribute to knowledge of research-supported handwriting and composing instruction that informs practice as school psychologists are empowered to embrace the role of intervention specialist. The first study found that neurodevelopmental training (orthographic-free motor activities and motor-free orthographic activities) led to improved accuracy and legibility of letter formation, but that direct handwriting instruction with visual cues and verbal mediation led to improved automatic handwriting (rate of writing legible letters) and transfer to improved word reading. The second study found that neither motor training nor orthographic training alone added value to direct instruction in automatic letter writing and composing practice in developing handwriting skills, which transferred to improved word reading; but the added motor training did improve performance on a grapho-motor planning task for sequential finger movements that is relevant to composing. A related analysis showed that direct instruction with visual cues and memory delays may reduce reversals. A third study found that adding handwriting to reading instruction improved handwriting but did not add value to reading outcomes for at risk readers; reading instruction alone was beneficial for word reading, decoding, and comprehension. The fourth study showed that comprehensive, explicit instruction in the processes of composition led to more significant improvement, based on group and individual data, than did the regular fourth grade program, on high stakes writing assessment.     

Mothers' attachment representations and choice of infant care: center care vs. home

In the debate concerning the effects of day care on infant development, insufficient attention has been paid to the potential relationship between pre‐existing emotional differences among mothers and the type of care they choose for their infants. To shed light on this issue, this study examines the attachment representations of mothers who choose day‐care centres as opposed to mothers who choose to remain at home with their infants. Participants were 76 primiparous mothers. Mothers' attachment classifications were assessed by the Adult Attachment Interview [AAI; Main M, Kaplan N, Cassidy J. 1985. Security in infancy, childhood, and adulthood: a move to the level of representation. In Growing Points of Attachment Theory and Research. Monograph of the Society for Research in Child Development, 50, (1–2, serial no. 209), Bretherton I, Waters E (eds); 66–104]. Results indicate that more Day‐care than Home‐Care mothers are classified as insecurely attached. These results highlight the contribution of maternal emotional characteristics to the effects of diverse child care arrangements on infant development. Copyright © 2001 John Wiley & Sons, Ltd.