A randomized study of the impact of a sensitizing intervention on the child‐rearing attitudes of parents of low birth weight preterm infants

Nordhov, S. M., Kaaresen, P. I., Rønning, J. A., Ulvund, S. E. & Dahl, L. B. (2010). A randomized study of the impact of a sensitizing intervention on the child‐rearing attitudes of parents of low birth weight preterm infants. Scandinavian Journal of Psychology, 51, 385–391. The background for this study was that nurturant child‐rearing attitudes are associated with positive development in low birth weight (LBW) infants. The objective was to study child‐rearing attitudes and early intervention (EI) in parents of LBW infants from 12–36 months corrected age. LBW infants (BW < 2000 g) were randomized to an intervention (IG) or a control group (CG). The EI consisted of seven in‐hospital sessions prior to discharge, then four home visits. A Child Rearing Practices Report was administered at 12 (mothers only), 24 and 36 months. A total of 146 infants were randomized. The mean BW in IG was 1396 (SD 429) g and 1381 (436) g in CG. The mean GA was 30.2 (3.1) weeks in IG and 29.9 (3.5) weeks in CG. Mothers in IG reported significantly more nurturant child‐rearing attitudes at 12 and 24 months. There was a significant change in restrictive and nurturant attitudes over time. It was concluded that EI may lead to more nurturant child‐rearing attitudes in mothers of preterms.     

Preterm birth and maternal sensitivity: Findings from a non-western country

IntroductionAlthough there are several studies on maternal sensitivity of preterm-born children conducted in Western countries, the factors affecting the sensitivity of mothers of preterm infants have not been investigated outside the Western context.ObjectivesThis study aimed to compare maternal sensitivity of preterm children at 18 months of corrected age with their healthy term-born peers and explore the factors associated with maternal sensitivity in a middle-income non-Western country. Moreover, the associations of maternal sensitivity with socio-demographic factors, maternal depression, and social-emotional competency and behavior problems of infants were investigated.MethodsIn total, 70 (40 preterm-born and 30 term-born) mother-child dyads participated in this study. An observation-based measurement tool, Maternal Sensitivity Scale, was used to assess maternal sensitivity. Social-emotional competency and behavior problems of infants were evaluated via The Turkish version of the Brief Infant-Toddler Social Emotional Assessment. Maternal depressive symptoms were assessed via the Beck Depression Inventory. In addition, a demographic information form was filled out by the mothers.ResultsMaternal sensitivity scores of preterm infants were significantly lower compared to term infants. Depressive symptoms scores and employment status of mothers, socio-economic status (SES), gestational age, breastfeeding duration, and behavior problems of children were the factors related to maternal sensitivity scores. In hierarchical regression analysis, SES and gestational age were the strongest predictors of maternal sensitivity. After controlling SES and gestational age, maternal depressive symptoms scores negatively predicted maternal sensitivity scores.ConclusionThis study pointed out the factors associated with the maternal sensitivity of preterm infants outside the Western context. Interventions to improve sensitive parenting behaviors of preterm infants are needed, especially in socio-economically disadvantaged groups.     

Cortisol reactivity and negative affect among preterm infants at 12 months during a mother-infant interaction task

The purpose of this study was to investigate correlates of preterm (PT) infant’s cortisol reactivity and the association to infant negative affect, during a mother-infant interaction procedure. Participants included 48 infants born prematurely (gestational age < 37 weeks) and their mothers, assessed when infants were 12 months old corrected for prematurity. The examined variables comprised both neonatal and environmental dimensions including maternal interactive behavior. Infant negative affect and maternal interactive behavior were assessed with a standardized mother-infant interaction task. A baseline infant saliva sample was collected before the interaction began, and a second sample after the interaction episodes ended. Results revealed that decrease of infant’s cortisol concentration was significantly associated with the exposure to more sensitive, and less intrusive maternal behaviors. However, once controlled for neonatal risk, family SES and maternal psychological distress, the associations were rendered non-significant. Although the association between cortisol reactivity and negative affect trended toward significance, maternal intrusiveness was the only significant predictor of observed infant negative affect. Findings suggest the importance of primary relational experiences on PT infants' early regulatory competencies.     

Adoption and maltreatment of foster infants by rhesus macaque abusive mothers

In this study we investigated whether infant characteristics play a causal role in the occurrence of maternal abuse of offspring in rhesus macaques )Macaca mulatta) and whether abusive mothers differ from controls in their tendency to adopt alien infants in a cross‐fostering procedure. To this end, 13 infants born to mothers with a previous history of infant abuse were cross‐fostered shortly after birth with infants born to nonabusive mothers and subsequently observed for 12 weeks. Abusive mothers were significantly more likely to reject foster infants than control mothers were. When adoption was successful, all of the abusive mothers maltreated their foster infants whereas none of the control mothers exhibited infant abuse. These findings suggest that infant characteristics do not play an important causal role in the occurrence of infant abuse and that abusive mothers may differ from nonabusive ones in maternal motivation or reactivity to stressful procedures.     

Bed-sharing, breastfeeding and maternal moods in Barbados

Bed-sharing among Barbadian mothers and infants was studied in relationship to maternal and infant characteristics. This prospective study followed 226 healthy, well-nourished mother–infant dyads at birth, 7 weeks, 3 months, and 6 months postpartum. At each age, approximately half of the infants shared the same beds as their mothers. Bed-sharing was associated with demographic characteristics, especially fewer home conveniences, and also maternal characteristics, including less information seeking by the mother and younger maternal age at first pregnancy. Bed-sharing was also associated with lower infant birth weights. Maternal moods were significantly correlated with bed-sharing, such that mothers who reported having more despair and anxiety were also more likely to sleep with their infants. Bed-sharing was also significantly associated with increased breastfeeding at all infant ages, but this relationship was no longer significant once the effects of maternal moods were controlled. This study emphasizes the importance of assessing maternal moods in studies evaluating the risk and benefits of bed-sharing.     

Possible contribution of better maternal psychological well-being to the acquisition of sleeping through the night in infants during the early postpartum period

The objective of this study was to elucidate whether better maternal psychological well-being contributes to the acquisition of “sleeping through the night” (STN) in infants during the early postpartum period. Fifty-two primiparous mothers completed the General Health Questionnaire-28 (GHQ-28) in the third trimester (prenatal) and when the conceptional ages of their babies reached 8–9 weeks (hereafter, 2 months), 12–13 weeks (3 months), and 16–17 weeks (4 months). They also recorded babies’ nocturnal sleep patterns in a timetable for 5 consecutive days each month postpartum. “Regular STN” was defined when the mean of longest nocturnal sleep duration for 5 consecutive days was > 8 h or between 6 and 8 h with < 1.0 nocturnal awakenings. According to these criteria, a total of 14 infants (27 %) acquired regular STN at 4 months (referred to as “STN infants”), with STN infants showing a marked increase in longest nocturnal sleep duration and a decrease in nocturnal awakenings from 2 to 3 months of age. The mothers of STN infants demonstrated steady reductions in postnatal GHQ-28 scores and had significantly lower prenatal GHQ-28 scores compared with the mothers of non-STN infants (3.7 ± 3.0 vs. 6.4 ± 4.1, p = 0.027). In random forest models for binomial classification, both prenatal and postnatal (at 4 months) GHQ-28 scores were identified as significant covariates for distinguishing STN infants, and other important covariates, including weeks of delivery, stepfamily, birth weight of the infant, and maternal co-sleeping at bedtime, were selected. Among these covariates, maternal co-sleeping at bedtime had relatively stronger correlations with both STN infants (r = − 0.440) and prenatal maternal GHQ-28 scores (r = 0.377). In conclusion, because prenatal maternal psychological well-being was thought to predict the acquisition of STN in infants, infants born from mothers with better psychological well-being appear to have some advantages in acquiring STN. These cross-lagged correlations suggest that the pathway from mothers to infants may be mediated by certain parenting behaviors, such as maternal co-sleeping at bedtime.     

Oxytocin trajectories and social engagement in extremely premature infants during NICU hospitalization

Extremely premature infants, born 28 weeks gestation or less, are at high risk for impaired socioemotional development, due in part to exposure to early stressful social experiences that alter brain development. Understanding mediators that link experience with outcomes is necessary to assess premature infant responses to social experiences that are critical to brain development. The hormone oxytocin (OT), released during supportive interactions, has potential as a biomarker of the premature infant's responses to social experiences. The purpose of this study was to examine associations among infant plasma OT trajectories and maternal-infant social engagement behaviors during initial hospitalization. This study also examined demographic correlates of engagement behaviors in mothers and infants. Plasma from 28 extremely premature infants, born gestational ages 25–28 6/7 weeks, was collected at 14 days of life, then weekly until 34 weeks. Social engagement behaviors were measured by the Parent-Child Early Relational Assessment during a videotaped feeding when the infant was receiving one-quarter full oral feeds. Maternal-infant demographics were extracted from the medical record. Higher infant plasma OT was associated with lower infant social engagement, but no associations were found with maternal social engagement. Infant social engagement was positively related to maternal social engagement. Maternal parity was related to maternal social engagement, and infant demographics did not predict infant social engagement. The significant, yet negative, association between infant OT and engagement provides support for the measurement of OT as a neurobiological antecedent to infant social behaviors. Finally, this research suggests that during the earliest period of infant socio-behavioral development, premature infants are behaviorally reactive to the social engagement behaviors of their mothers.     

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.     

Individual differences in non-clinical maternal depression impact infant affect and behavior during the still-face paradigm across the first year

Maternal depression can significantly impact mothers’ sensitivity to their infants’ needs as well as infants’ social and emotional development. The still-face paradigm (SFP) is widely used to assess infants’ understanding of the contingency between their own behavior and that of their caregivers, as well as infants’ ability to self-regulate arousal levels during sudden changes in maternal responsiveness. Infants of clinically depressed mothers display blunted levels of negative affect compared to infants of non-depressed mothers during the still-face (SF) phase. However, little is known about whether individual differences in elevated, non-clinical levels of maternal depression similarly affect mother-infant interactions. The current study examines the longitudinal effects of non-clinical maternal depression on infant and maternal behaviors during the SFP. Infants (N = 63) were assessed at 5 and 9 months and maternal depression was assessed at 5 months using the Beck Depression Inventory (BDI). Infants of mothers with elevated levels of depression displayed less negative engagement during the SF phase compared to infants of mothers with lower levels of depression. This effect was present at 5 months, but not at 9 months. Findings demonstrate that non-clinical levels of maternal depressive symptomatology can have a significant impact on infants’ affective regulation during the first half of the first year of life, but this does not necessarily have a long-lasting influence later in infancy. Interventions may want to target mothers with non-clinical depression to promote healthy infant social and emotional development.     

Infant physiological regulation and maternal risks as predictors of dyadic interaction trajectories in families with a preterm infant

This longitudinal study examined predictors of rates of growth in dyadic interaction quality in children born preterm who did not experience significant neurological findings during neonatal intensive care unit (NICU) hospitalization. Multiple methods were used to collect data from 120 preterm infants (48% girls, 52% boys) and their mothers. Infant heart rate variability (HRV), gestational age, neonatal health, feeding route, and maternal socioeconomic (SES) risks were assessed at NICU discharge (mean of 36 weeks postconception). Mother-child interactions were observed at 4, 9, 16, and 24 months postterm and analyzed with hierarchical linear modeling. On average, children's quality of play, interest, and attention increased over time while their dysregulation and irritability decreased, whereas average maternal positive affect and involvement declined in quality (ps < .05), although there was individual variation in rates of change. Mothers of infants with higher postfeeding HRV (i.e., vagal regulation) exhibited less decrease in positive affect and involvement between 4 months and 24 months, compared with mothers of infants with lower HRV (p < .05). Although infants with higher postfeeding HRV showed less positive affect and communication at 4 months, they exhibited significantly greater increases in positive affect and social competence and decreases in dysregulation and irritability between 4 months and 24 months, compared with infants with lower HRV (ps < .05). Dyads experiencing more SES risks showed less optimal interactions at 4 months; this difference remained as children grew older (ps < .05). Results have implications for our understanding of social development in preterm infants.     

Factors associated with the socioemotional development of preterm infants

Preterm birth is a risk factor for problems in interactions with others. We compared the difference in socioemotional development between hospital discharge and at six months of corrected age of infants born ≤32 weeks and assessed the impact of maternal and infantile factors on socioemotional development rate within a 6 month’s period. Mother-child dyads (n = 144) were assessed by the Mother-Baby Observation Protocol 0–6 months through a video microanalysis. Multivariate model was built. Neonatal, maternal and child factors were associated with interactive gaze, initiate contact, responsiveness, infantile vocalization, and thus contributed to the socioemocional development of preterm infants with their mothers.     

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.     

Selective deficit in spatial location memory in extremely low birth weight children at age six: The PETIT Study

Spatial location memory has rarely been assessed in young children due to a scarcity of developmentally appropriate tests. This study sought to compare nonverbal learning and recall in children born extremely low birth weight (ELBW; <1000 g) and less than 33 gestational weeks (GW) with term-born children at early school age using a recently developed and adapted test. We administered a modification of the Hopkins Board to 210 children at age six; 84 born ELBW (35 born < 26 GW; 49 born 26–33 GW) and 126 term-born. Six measures were obtained: naming, trials-to-criterion, errors-to-criterion, delayed item recall, delayed location recall, and percent retention. After age correction, ELBW children had worse general cognition, item naming, delayed item recall, delayed location recall, and percent retention than term-born children. Delayed item recall and percent retention performances of ELBW children remained worse after correction for general cognition. ELBW groups (< 26 GW and 26–33 GW) groups performed worse than term-born children in naming and delayed item recall with chronological age as covariate. Those born before 26 GW, but not 26–33 GW, performed worse than term-born children in delayed location recall and percent retention. Differences remained significant after controlling for gender, maternal education, and delivery type. All three groups' performance declined from final learning trial to delayed location recall, with a decline greater for less than 26 GW than term-born children. Extreme prematurity (< 26 GW) and ELBW are significant risk factors for spatial location memory deficit. The modified Hopkins Board discriminated high-risk preterm and term-born children at early school age and appears to be a useful test to measure this rarely studied cognitive capacity.     

Maternal perceptions of the infant: Relationship to maternal self‐efficacy during the first six weeks' postpartum

Mothers' perceptions of their infants and their own levels of self‐efficacy contribute to developing maternal‐infant attunement. The purpose of this investigation was to examine the associations between maternal perceptions of their own infants relative to other infants and maternal self‐efficacy in a group of ethnically diverse, low‐income, first‐time mothers during the first six weeks postpartum. By employing a structural equation model approach, we explored relationships between the predictor (maternal neonatal perceptions) and dependent variable (maternal self‐efficacy). Changes in maternal perceptions of their own infants significantly contributed to self‐reported levels of self‐efficacy while controlling for concurrent self‐esteem. Maternal perceptions of her infant as less difficult than the average infant at six weeks postpartum predicted increased levels of maternal self‐reported self‐efficacy. The present study supports further exploration of the first six weeks postpartum as a sensitive period for targeting intervention and support, particularly for mothers and infants at highest risk.     

Mothers’ self-reported emotion dysregulation: A potentially valid method in the field of infant mental health

In the current study, we evaluated the extent to which mothers reported emotion dysregulation on the Difficulties with Emotion Regulation Questionnaire (DERS) (a) converged with physiological indices of emotion dysregulation while parenting, (b) correlated with maternal sensitivity, and (c) predicted infant attachment disorganization and behavior problems in a sample of 259 mothers and their infants. When infants were 6 months old, mothers’ physiological arousal and regulation were measured during parenting tasks and mothers completed the DERS. Maternal sensitivity was observed during distress-eliciting tasks when infants were 6 and 14 months old. Infant attachment disorganization was assessed during the Strange Situation when infants were 14 months old and mothers reported on infants’ behavior problems when infants were 27 months old. Mothers who reported greater emotion regulation difficulties were more physiologically dysregulated during stressful parenting tasks and also showed lower levels of maternal sensitivity at 6 months. Mother-reported dysregulation predicted higher likelihood of infant attachment disorganization and more behavior problems. Results suggest that the DERS is a valid measure of maternal emotional dysregulation and may be a useful tool for future research and intervention efforts aimed toward promoting positive parenting and early child adjustment.     

Effects of maternal depression in the Still-Face Paradigm: A meta-analysis

The Still-Face Paradigm (SFP) enables researchers to examine the quality of mother-infant interactions. In typical infants, a classic still-face effect (SFE) has been confirmed whereby infants demonstrate reduced positive affect (PA), reduced gaze (GA), and increased negative affect (NA). Recently, the SFP has been used to examine the effect of maternal depression upon infant behaviour. However, the nature and consistency of the behavioural responses of infants of depressed mothers during the SFP remains unclear. In the current meta-analysis, we examined whether or not infants of depressed mothers demonstrate the classic SFE, as well as whether or not these infants display the same levels of PA, NA, and GA as their counterparts with non-depressed mothers. Results revealed that infants of depressed mothers display the classic SFE like infants of their non-depressed counterparts. However, infants of depressed mothers also demonstrated significantly higher levels of PA during the still-face episode. One potential interpretation of this finding is that infants prior experience of similar, depressed interactions with their mothers, encourages them to amplify their positive attachment signals in order to engage maternal attention and response. Alternatively, or additionally, infants of depressed mothers could be using PA in order to regulate their own NA.     

Mother–infant communication can be enhanced after conception by in‐vitro fertilization

To determine if stress associated with artificial pregnancy treatment might affect early communication, video microanalysis was applied to examine face‐to‐face play between infants and their mothers in the first 5 months. Three groups of infants participated: 8 born after in‐vitro fertilization (IVF) treatment employing parental gametes; 8 born after standard infertility treatment (INF), which did not include IVF; and 8 infants whose parents had experienced no infertility problems (Control group: C). All were videotaped at home in free play with their mothers at 4, 7, 13, and 21 weeks of age. A 3‐min extract of each video was reviewed in detail by means of an objective coding system, to define the style of communication. Data from this analysis was subjected to two separate repeated measures of analyses of variance. We found no evidence of detrimental effects of infertility treatment on mother–infant communication, but there were “positive” differences in behavior in the pairs where the mother had been so treated. Thus, while maternal “caretaking” episodes had become infrequent in the control group by the age of 21 weeks, in the two treatment groups the mothers continued to show many caretaking behaviors with infants of this age. Furthermore, infants of both the IVF and INF groups showed significantly higher frequencies of “play” episodes than those in the control group (p = 0.018 and p = 0.004, respectively). Apart from these differences, mother–infant interactions were generally the same in the three groups. The results indicate that communication between mothers and infants is likely to develop along the normal path after IVF or INF treatment, but that mothers who have had these infertility treatments may be more attentive to their infants, and their infants are significantly more playful. Since the IVF and the INF groups were similar, it would appear that these differences from the control group are related to the experience of a successful treatment for infertility, and not related to any particular stresses that may be associated with IVF treatment. ©2001 Michigan Association for Infant Mental Health.     

Maternally administered interventions for preterm infants in the NICU: Effects on maternal psychological distress and mother–infant relationship

Although studies have examined the effects of interventions focused on preterm infants, few studies have examined the effects on maternal distress (anxiety, depressive symptoms, post-traumatic stress symptoms, parenting stress) or parenting. This study examined the effects of the auditory–tactile–visual–vestibular (ATVV) intervention and kangaroo care (KC) on maternal distress and the mother–infant relationship compared to an attention control group.240 mothers from four hospitals were randomly assigned to the three groups. Maternal characteristics in the three groups were similar: 64.1% of ATVV mothers, 64.2% of KC mothers, and 76.5% of control mothers were African American; maternal age averaged 26.3 years for ATVV mothers, 28.1 for KC mothers, and 26.6 for control mothers; and years of education averaged 13.6 for ATVV and KC mothers, and 13.1 for control mothers. Mothers only differed on parity: 68.4% of ATVV and 54.7% of KC mothers were first-time mothers as compared to 43.6% of control mothers. Their infants had a similar mean gestational ages (27.0 weeks for ATVV, 27.2 for KC, and 27.4 for control) and mean birthweights (993 g for ATVV, 1022 for KC, and 1023 for control).Mothers completed questionnaires during hospitalization, and at 2, 6 and 12 months corrected age on demographic characteristics, depressive symptoms, state anxiety, post-traumatic stress symptoms, parenting stress, worry about child health, and child vulnerability (only at 12 months). At 2 and 6 months, 45-min videotapes of mother–infant interactions were made, and the HOME Inventory was scored. Behaviors coded from the videotapes and a HOME subscale were combined into five interactive dimensions: maternal positive involvement and developmental stimulation and child social behaviors, developmental maturity, and irritability.Intervention effects were examined using general linear mixed models controlling for parity and recruitment site. The groups did not differ on any maternal distress variable. Kangaroo care mothers showed a more rapid decline in worry than the other mothers. The only interactive dimensions that differed between the groups were child social behaviors and developmental maturity, which were both higher for kangaroo care infants. Change over time in several individual infant behaviors was affected by the interventions. When mothers reported on the interventions they performed, regardless of group assignment, massage (any form including ATVV) was associated with a more rapid decline in depressive symptoms and higher HOME scores. Performing either intervention was associated with lower parenting stress. These findings suggest that as short-term interventions, KC and ATVV have important effects on mothers and their preterm infants, especially in the first half of the first year.     

Social stress in pregnant squirrel monkeys (Saimiri boliviensis peruviensis) differentially affects placental transfer of maternal antibody to male and female infants.

The capacity of prenatal stress to disrupt the placental transfer of maternal antibody was evaluated in neonatal squirrel monkeys (Saimiri boliviensis peruviensis) gestated under different pregnancy conditions. Normal squirrel monkey offspring (n = 63) were compared with infants generated from pregnancies that involved either a single or 3 periods of disturbance (ns = 21 and 29, respectively). At parturition, levels of antibody (IgG) were determined in mothers and neonates. Only the chronic disturbance condition significantly altered antibody levels in the mothers, resulting in lower IgG. Antibody transfer to the fetus was also affected only by chronic disturbance. In this case the effect was bidirectional, influenced by the sex of the infant. Males were born with lower levels, whereas female infants actually had higher-than-normal IgG, despite lower titers in their mothers. Because virtually all IgG is derived from the prenatal transfer of maternal antibody, it indicates that the sex of the fetus differentially affected this placental process. The IgG receptor may have been up-regulated selectively on the placentas of female fetuses, compensating for reduced antibody in the disturbed mothers.     

Compliance,opposition, and behavior problems in toddlers born preterm or low birthweight

Although children born preterm or low birth weight (PT LBW) are more likely to exhibit behavior problems compared to children born at term, developmental and family processes associated with these problems are unclear. We examined trajectories of maternal depressive symptoms in relation to toddler compliance and behavior problems in families with PT LBW infants. A total of 177 infants (93 boys, 84 girls) and their mothers enrolled in the study during the infant's NICU stay. Data were collected at five time points across 2 years. Assessments of maternal depressive symptoms were conducted at all time points, and toddler compliance and opposition to maternal requests and behavior problems were assessed at 2 years. Toddlers born earlier with more health problems to mothers whose depressive symptoms increased over time exhibited the most opposition to maternal requests during a cleanup task at 24 months, consistent with multiple risk models. Mothers with elevated depression symptoms reported more behavior problems in their toddlers. The study has implications for family‐based early intervention programs seeking to identify PT LBW infants at highest risk for problem behaviors.