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.     

Exposure to Parents’ Negative Emotions as a Developmental Pathway to the Family Aggregation of Depression and Anxiety in the First Year of Life

Depression and anxiety load in families. In the present study, we focus on exposure to parental negative emotions in first postnatal year as a developmental pathway to early parent-to-child transmission of depression and anxiety. We provide an overview of the little research available on the links between infants’ exposure to negative emotion and infants’ emotional development in this developmentally sensitive period, and highlight priorities for future research. To address continuity between normative and maladaptive development, we discuss exposure to parental negative emotions in infants of parents with as well as without depression and/or anxiety diagnoses. We focus on infants’ emotional expressions in everyday parent–infant interactions, and on infants’ attention to negative facial expressions as early indices of emotional development. Available evidence suggests that infants’ emotional expressions echo parents’ expressions and reactions in everyday interactions. In turn, infants exposed more to negative emotions from the parent seem to attend less to negative emotions in others’ facial expressions. The links between exposure to parental negative emotion and development hold similarly in infants of parents with and without depression and/or anxiety diagnoses. Given its potential links to infants’ emotional development, and to later psychological outcomes in children of parents with depression and anxiety, we conclude that early exposure to parental negative emotions is an important developmental mechanism that awaits further research. Longitudinal designs that incorporate the study of early exposure to parents’ negative emotion, socio-emotional development in infancy, and later psychological functioning while considering other genetic and biological vulnerabilities should be prioritized in future research.     

Parental decision-making: infant engagement with smartphones

Smartphones have become a ubiquitous part of life, and as a result, many children are engaging with smartphones beginning in infancy. Little is known regarding the thought processes used by parents in deciding when and how to allow their infants to engage with smartphones. Using a sample of twelve parents with infants younger than one year, this qualitative study examines parental smartphone use, their perspectives regarding use by their young children, and what sources informed their decision-making about allowing their infants to use a smartphone. Results found that the smartphone has become such a common part of everyday life that choices to use a smartphone around, and with, infants has become one that is nearly automatic. These research data showed that most parents are largely unaware of guidelines for childhood screen time provided by the American Academy of Pediatrics and the World Health Organization. Given our current knowledge that smartphone use can have a significant impact on the cognitive development of young children, this topic is an important area of future research.     

Recognizing the infant as subject in infant-parent psychotherapy

Drawing on Winnicott's view of infants as subjects entitled to an intervention in their own right, infants as the referred patient have been seen in infant-parent psychotherapy for 20 years at the Royal Children's Hospital, Melbourne, Australia. This is a radically different view of infant symptomatology than viewing it as only expressing an aspect of the mother's unconscious. The clinical pathway differentiates the therapy from much parent-infant psychotherapy. The author describes the theoretical model of a twofold approach to understanding the infant's experience through interactive dialogue between therapist and infant, and sharing this understanding with the parents, and illustrates it with cases of failure-to-thrive infants. She discusses two criticisms: first, that infant-parent psychotherapy may undermine the parents and, second, that brief parent-infant psychotherapy does not alter parents' insecure attachment status. Videotaped sessions often show rapid improvement; parents generally feel relieved. This approach potentially shapes not only parents' and infants' representations, but also their implicit knowledge of relationships-partly, it is suggested, through activating the mirror neuron system to bring about implicit memory change. Change may therefore be longer lasting than psychoanalytic theory presently conceives. The approach is relevant in an outpatient setting: gains were maintained long term in 90% of out-patient cases.     

The privileging of ‘Support-From-Below’ in early spatial language acquisition

Spatial terms that encode support (e.g., “on”, in English) are among the first to be understood by children across languages (e.g., Bloom, 1973; Johnston & Slobin, 1979). Such terms apply to a wide variety of support configurations, including Support-From-Below (SFB; cup on table) and Mechanical Support, such as stamps on envelopes, coats on hooks, etc. Research has yet to delineate infants’ semantic space for the term “on” when considering its full range of usage. Do infants initially map “on” to a very broad, highly abstract category – one including cups on tables, stamps on envelopes, etc.? Or do infants begin with a much more restricted interpretation - mapping “on” to certain configurations over others? Much infant cognition research suggests that SFB is an event category that infants learn about early - by five months of age (Baillargeon & DeJong, 2017) - raising the possibility that they may also begin by interpreting the word “on” as referring to configurations like cups on tables, rather than stamps on envelopes. Further, studies examining language production suggests that children and adults map the basic locative expression (BE on, in English) to SFB over Mechanical Support (Landau et al., 2016). We tested the hypothesis that this ‘privileging’ of SFB in early infant cognition and child and adult language also characterizes infants’ language comprehension. Using the Intermodal-Preferential-Looking-Paradigm in combination with infant eye-tracking, 20-month-olds were presented with two support configurations: SFB and Mechanical, Support-Via-Adhesion (henceforth, SVA). Infants preferentially mapped “is on” to SFB (rather than SVA) suggesting that infants differentiate between two quite different kinds of support configurations when mapping spatial language to these two configurations and more so, that SFB is privileged in early language understanding of the English spatial term “on”.     

The relationship of perinatal birth status to handedness: A prospective study

As part of a longitudinal study of the consequences of high risk birth, 66 infants born to right-handed parents were given two unimanual tasks at 24 months of age to assess their hand preference. The 66 infants had been assigned to one of four diagnostic categories at birth: Premature with no postnatal medical complications; premature and having experienced respiratory distress; term and having experienced birth asphyxia during labor and delivery; term with normal delivery and postnatal course. Results of the handedness tasks revealed an increased incidence of use of the left hand among the term infants who underwent birth asphyxia and among the healthy preterm infants. The data indicate that timing of birth stress may play an important role in the ontogeny of pathological left-handedness.     

The association between maternal interaction and infant cortisol stress reactivity among preterm and full term infants at 4 months adjusted age

The purpose of this study was to assess the association between maternal interactive behavior and infant cortisol stress reactivity in response to the Still Face paradigm (SF) in a cohort of four-month old infants (adjusted age) born preterm (<32 weeks gestation, N = 22) compared with infants born full term (>37 weeks gestation, N = 28). Infant cortisol reactivity was calculated as area under the curve (AUC) from baseline to the third cortisol sample (30 min post-SF) using the trapezoidal rule, while the percent of time mothers spent using a contingent interaction style was measured (0–100%) during episodes 1 (Play; baseline), 3 (Reunion#1), and 5 (Reunion#2) while mother-infant dyads participated in the SF paradigm. We hypothesized that because infants born preterm are at increased risk for dysregulation, they would show, compared to full-term infants, a blunted stress response, involving under-responsiveness. We found blunted cortisol stress reactivity among the preterm infants. We also found that mothers of preterm infants demonstrated less contingent maternal interaction during Renion#1 of the SF; and that contingent maternal interaction at Reunion#2 of the SF was protective against cortisol stress reactivity in response to the SF. However, we did not find that the influence of maternal interaction on cortisol reactivity was moderated by gestational age group (full term vs preterm): the association between contingent maternal interaction and stress reactivity was similar for both gestational groups across episodes. In order to improve self-regulation and longer term social and cognitive developmental outcomes in medically at-risk infants, future research is warranted to determine how these findings relate to infants’ stress reactions in naturalistic settings, and the directionality and temporal relationship between cortisol stress responses and maternal interactive behavior.     

Gaze aversion during social interaction in preterm infants: a function of attention skills?

Preterm infants avert their gaze more often and for longer periods in early social interactions compared to full term infants. In previous studies this finding is interpreted as being a function of the higher degree of parental stimulation that is often found in parents of preterm children. The current study explores an additional hypothesis. Since the development of general visual attention abilities is found to be less optimal in preterm children, it is possible that less optimal maturation of attention abilities partially explains the elevated gaze aversion in a social context. Therefore, the current study investigated the association between gaze aversion in a social context and the ability to disengage and shift visual attention in a non-social context in 20 preterm and 42 full term infants aged 4 and 6 months. Results confirm that preterm infants are slower to shift their attention in a non-social context and that they avert their gaze more often in a social context compared to full term children. Furthermore, more frequent gaze aversion during social interaction at 6 months was related to longer disengagement and the shifting of attention at 4 and 6 months, but only within the preterm group. The results suggest that attention maturation is less optimal in preterm children; this can be observed in a non-social as well as a social context. Less attention maturation in preterm children can negatively influence the amount of time they can stay actively involved in social interaction.     

The Influence of Gender and Parental Attitudes on Preschool Children's Interest in Babies: Observations in Natural Settings

This paper reports on two studies of parents'observations of their preschool children's interactions with infants. In Study 1 parents observed 69 3- and 5-year-old white children with three nonsibling infants whom the children encountered during their daily lives. In Study 2 parents observed 46 3- to 6-year-old primarily white children with three nonsibling infants and completed measures of their own gender-related child-rearing attitudes.Consistent with findings from previous laboratory research, this research in naturalistic settings found girls to show more interest in, more nurturance toward,and more interaction with babies than did boys. In Study 2, children whose parents had traditional gender-stereotyped attitudes were more likely to show this gender difference than children whose parents had more egalitarian child-rearing attitudes.     

Phonotactic acquisition in healthy preterm infants

Previous work has shown that preterm infants are at higher risk for cognitive/language delays than full‐term infants. Recent studies, focusing on prosody (i.e. rhythm, intonation), have suggested that prosodic perception development in preterms is indexed by maturational rather than postnatal/listening age. However, because prosody is heard in‐utero, and preterms thus lose significant amounts of prenatal prosodic experience, both their maturation level and their prosodic experience (listening age) are shorter than that of full‐terms for the same postnatal age. This confound does not apply to the acquisition of phonetics/phonotactics (i.e. identity and order of consonants/vowels), given that consonant differences in particular are only perceived after birth, which could lead to a different developmental pattern. Accordingly, we explore the possibility that consonant‐based phonotactic perception develops according to listening age. Healthy French‐learning full‐term and preterm infants were tested on the perception of consonant sequences in a behavioral paradigm. The pattern of development for full‐term infants revealed that 7‐month‐olds look equally at labial‐coronal (i.e. /pat/) compared to coronal‐labial sequences (i.e. /tap/), but that 10‐month‐olds prefer the labial‐coronal sequences that are more frequent in the French lexicon. Preterm 10‐month‐olds (having 10 months of phonetic listening experience but 7 months of maturational age) behaved as full‐term 10‐month‐olds. These results establish that preterm developmental timing for consonant‐based phonotactic acquisition is based on listening age (experience with input). This questions the interpretation of previous results on prosodic acquisition in terms of maturational constraints, and raises the possibility that different constraints apply to the acquisition of different phonological subcomponents.     

Partners becoming parents: A question of difference

The relationship between parents forms a significant part of the social environment within which infants and children develop. Research and clinical practice indicate that the process of becoming a parent can place a strain on a couple's partnership and that the presence of children can be associated with diminished levels of satisfaction within marriage. This paper considers why marital satisfaction may decline with the roles and responsibilities of parenthood and pays particular attention to the problem of managing difference at personal and public levels when unconscious assumptions and conscious expectations merge and apply pressure on the individual parents and their relationship.     

Increasing parenting self-efficacy: The Fussy Baby Network® intervention

High levels of infant crying place families at risk for disrupted relationships, parenting stress, and even for child maltreatment. We conducted an evaluation of the Fussy Baby Network^® (FBN), a program supporting families struggling with infant crying and related concerns. The study contrasted 29 families who sought help from FBN with 27 families with excessively crying infants who did not seek services. Researchers measured parenting self-efficacy, depression, and stress in each group before and after the intervention. Results from hierarchical multiple regression analysis indicated greater improvements over time in parenting self-efficacy for parents receiving FBN services. Furthermore, the greater improvements in parenting self-efficacy in the intervention group were not directly attributable to reductions in infant crying. These findings provide preliminary evidence that the FBN approach may be effective at boosting the confidence of parents struggling with caring for their infants. Future research with larger samples with baseline equivalence and stronger research designs should explore this intervention further. This study also suggests that interventions for families with excessively crying infants should move beyond the focus of reducing infant crying to a broader strategy of supporting parents and strengthening relationships between parents and their infants to build parenting capacity.     

The prematurity stereotype: Empirical evidence and implications for practice

The prematurity stereotype is defined as a set of biased beliefs about infants who are identified as having been born prematurely. This article reviews studies that have explored how this prematurity stereotype may negatively influence adults' perceptions of, expectations for, and behavior toward premature infants. The findings from these studies are considered in the context of more general knowledge about how expectations can influence behavior and result in self-fulfilling prophecies. Recent research designed to investigate how prematurity stereotyping can be reduced also is described and evaluated. Finally, the implications of this program of research for intervention with parents of premature infants and suggestions for future research directions are discussed.     

Early interactions and the socioemotional development of deaf infants

Studies of the early face-to-face interactions and later attachment behaviours between infants and their caregivers are reviewed, with a particular focus on implications for deaf infants. Since the majority of deaf infants are born to hearing parents, it is to be expected that many parental responses will rely on vocalizations which are inaccessible to the deaf infant. Are other sensory modalities enhanced or used in a compensatory manner by hearing parents so as to make their communication with a deaf infant more effective? Is the deaf infant's heightened need for visual and tactile input adequately met during normal interactions with their caregivers? Does the deaf infant develop the same strategies for signalling distress and coping with separation as does the hearing infant? Although the research literature on this population is sparse, there are beginning to be more reports addressing these questions as early identification becomes increasingly possible. Therefore, this paper will cover issues of the role of eye contact and mutual coordination in early interactions, compensatory parenting behaviours from the perspective of the ‘intuitive parenting’ model, and precursors to later attachment behaviours in deaf infants.     

Two-month-olds' attention and affective response to maternal still face: a comparison between term and preterm infants in Taiwan

Maternal still face is a robust experimental procedure designed to examine infants’ sensitivity to social contingency and reactivity to its violation. To extend earlier research on the still-face effect on term infants in Western cultures, the present study compared Taiwanese term and preterm infants’ attention and affective response to and recovery from a modified maternal still-face procedure that used an additional still-face reengagement sequence at 2 months of age (corrected age for preterm infants). Infants’ gaze and facial affect were coded from videos. Results showed that preterm infants were as sensitive as term infants to the interruption to social contingency. Both groups of infants reacted with decreased gaze and positive affect across episodes, together with a decreased latency to gaze aversion and an increased latency to positive affect. Both term and preterm infants also demonstrated a W-shaped pattern of decline-followed-by-recovery in their latency to negative affect. However, compared to term infants, preterm infants became distressed faster and stayed in a negative affective state longer after the first exposure to maternal still face. Effects of prematurity on infant attention and affect regulation were discussed. Implications of preterm infants’ heightened affective negativity to mild stress for intervention studies were also addressed.     

Coping with dialects from birth: Role of variability on infants’ early language development. Insights from Norwegian dialects

Previous research suggests that exposure to accent variability can affect toddlers’ familiar word recognition and word comprehension. The current preregistered study addressed the gap in knowledge on early language development in infants exposed to two dialects from birth and assessed the role of dialect similarity in infants’ word recognition and comprehension. A 12-month-old Norwegian-learning infants, exposed to native Norwegian parents speaking the same or two Norwegian dialects, took part in two eye-tracking tasks, assessing familiar word form recognition and word comprehension. Their parents’ speech was assessed for similarity by native Norwegian speakers. First, in contrast to previous research, our results revealed no listening preference for words over nonwords in both monodialectal and bidialectal infants, suggesting potential language-specific differences in the onset of word recognition. Second, the results showed evidence for word comprehension in monodialectal infants, but not in bidialectal infants, suggesting that exposure to dialectal variability impacts early word acquisition. Third, perceptual similarity between parental dialects tendentially facilitated bidialectal infants’ word recognition and comprehension. Forth, the results revealed a strong correlation between the raters and parents’ assessment of similarity between dialects, indicating that parental estimations can be reliably used to assess infants’ speech variability at home. Finally, our results revealed a strong relationship between word recognition and comprehension in monodialectal infants and the absence of such a relationship in bidialectal infants, suggesting that either these two skills do not necessarily align in infants exposed to more variable input, or that the alignment might occur at a later stage.     

Reconsidering the dead donor rule: is it important that organ donors be dead?

The "dead donor rule" is increasingly under attack for several reasons. First, there has long been disagreement about whether there is a correct or coherent definition of "death." Second, it has long been clear that the concept and ascertainment of "brain death" is medically flawed. Third, the requirement stands in the way of improving organ supply by prohibiting organ removal from patients who have little to lose--e.g., infants with anencephaly--and from patients who ardently want to donate while still alive--e.g., patients in a permanent vegetative state. One argument against abandoning the dead donor rule has been that the rule is important to the general public. There is now data suggesting that this assumption also may be flawed. These findings add additional weight to proposals to abandon the dead donor rule so that organ supply can be expanded in a way that is consistent with traditional notions of ethics, law, public policy, and public opinion.     

Parent mind-mindedness,sensitivity, and infant affect: Implications for attachment with mothers and fathers

Previous research examining links between parenting and attachment has focused on behavioral aspects of parenting such as sensitivity. However, by assessing how parents reflect on infants’ mental states (mind-mindedness) we gain a broader understanding of parenting and how it impacts attachment. Mothers, fathers, and their infants (N = 135) participated in the Still Face Paradigm (SFP) at 3-, 5-, and 7- months of age, and the Strange Situation with mothers at 12 months and fathers at 14 months. Parent sensitivity and infant affect were coded from the SFP and all videos were transcribed and later coded for parents’ use of appropriate and non-attuned mind-mindedness toward their infants. Attachment with each parent was coded from the Strange Situation. Mixed effects models examined trajectories of parents’ mind-mindedness in relation to parent sensitivity and infant affect across attachment groups. Significant differences between parent gender and attachment category were detected. Specifically, parents who were less sensitive were also less mind-minded toward insecure-avoidant infants; parents used more non-attuned mind-mindedness when infants had higher negative affect. Findings suggest that, in addition to parent sensitivity, parents’ use of appropriate and non-attuned mind-mindedness during a parent-infant interaction provides insight into the developing attachment relationship for mothers and fathers.     

Infant day care. Maligned or malignant?

Today, the mothers of half the infants in the United States work outside the home. This concerns psychologists and parents because of the possible detrimental effects on these infants of separations from mother and experience in day care. Available data suggest that infants whose mothers work full time are somewhat more likely as one-year-olds to avoid their mothers after a brief separation and later to be less compliant with their mothers and more aggressive with their peers. The argument that these behaviors indicate that infants in day care are at risk for emotional insecurity and social maladjustment is evaluated in light of current research results. It is concluded that other interpretations of the data are more plausible and that further research on the factors moderating and mediating the effects of infant day care is needed.