Regulatory competence and social communication in term and preterm infants at 12 months corrected age. Results from a randomized controlled trial

Temperamental regulatory competence and social communication in term and preterm infants at 12 months corrected age was studied in a randomized controlled intervention trial aimed at enhancing maternal sensitive responsiveness. Surviving infants <2000 g from a geographically defined area were randomized to an intervention (71) or a control group (69), and compared with term infants (74). The intervention was a modified version of the "Mother-Infant Transaction Program". Regulatory competence was measured with the Infant Behavior Questionnaire, and social communication with the Early Social Communication Scales. Preterm intervention infants with low regulatory competence had higher responding to joint attention than preterm control infants. A sensitizing intervention may moderate the association between temperament and social communication, and thus allow an alternative functional outlet for preterm infants low in regulatory competence. The finding may have implications for conceptualizations of the role of early sensitizing interventions in promoting important developmental outcomes for premature infants.     

Joint attention in term and preterm infants at 12 months corrected age: the significance of gender and intervention based on a randomized controlled trial

This study tested the effects of optimized neonatal mother–infant transactions on joint attention performance at 12 months. Surviving infants <2000 g from a geographically defined area were randomly assigned to a preterm intervention (n = 71) or preterm control group (n = 69). Comparisons were made between preterm groups, secondary with a term group (n = 75). Joint attention was measured using the Early Social Communication Scales. Preterm intervention infants scored significantly higher than preterm control infants on elements Initiating Joint Attention (p < 0.05), Initiating Object Requests (p < 0.05), and Responding to Social Interaction (p < 0.0005). Intervention was not associated with performance on elements Responding to Joint Attention, or on Responding to Requests. ELBW infants scored significantly lower than VLBW and LBW infants on imperative functions. Girls outperformed boys on all communication elements. An intervention implemented during the neonatal period can be of advantage for certain aspects of joint attention performance in preterm infants.     

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.     

Emotional interaction in a group of preterm infants at 3 and 6 months of corrected age

Twenty preterm infants (birthweight<1500 g) and 20 healthy fullterm infants were compared with respect to emotional interaction with their mothers in a face‐to‐face situation at 3 months of age and in a feeding situation at 6 months of age (ages corrected for preterm birth). The assessed outcome was analysed with respect to infant variables (group, gender, gestational age, birthweight and neonatal risk factors) and maternal variables (age, education and parity). The outcomes at 3 and 6 months of age were also compared with findings of Griffiths’ testing at 10 months of age. At 3 months of age, the findings reveal no significant difference between the two groups with respect to emotional interaction. Maternal variables are more important for this interaction than are infant variables. The mother's level of formal education has a significant impact in both groups. In the group of fullterm infants, significantly lower scores for interaction are obtained by first‐time mothers in comparison with multi‐parae mothers. At 6 months of age, the difference between fullterm and preterm infants is significant. The preterm infants and their mothers now relate to one another more poorly than is the case for the fullterm dyads. These findings suggest that the difficulties encountered by the preterm infant emerge with time. Emotional interaction at this age and the results of Griffiths’ testing 4 months later are significantly correlated. Copyright © 1999 John Wiley & Sons, Ltd.     

Stability of developmental status and risk of impairment at 24 and 36 months in late preterm infants

BackgroundFew studies investigated whether late preterm infants might have developmental delays in several domains in early life and how stable the lag in developmental status might be.AimWe aimed to examine the stability of potential delays across developmental domains at 24 and 36 months of age in late preterm (34°-36⁶ weeks) and term (≥37 weeks) children and whether the risk of delays remained high at 36 months.Study design, subjects, and outcome measureWe conducted a prospective cohort analysis of the children of pregnant women participating in the Vitamin Antenatal Asthma Reduction Trial (VDAART). 652 children who were prospectively followed up and had parent-completed Ages Stages Questionnaires (ASQ-3) questionnaires at both 24 and 36 months were analyzed to assess their domain-specific developmental status.Results6.61 % (42/635) of children had a late preterm birth. Developmental delays were stable between 24 and 36 months on all 5 domains for the children born preterm and on 4/5 domains for those born at term. The developmental domains with the status stability at 24 and 36 months in both late preterm and term children were the gross motor, communication, personal-social skills, and problem-solving. Late preterm children compared with term children remained at higher risk of delays at 36 months for gross motor, communication, and problem-solving skills (aOR = 4.54, 95 %CI: 1.81−10.79; aOR = 8.60, 95 %CI: 3.10−23.28 and aOR = 3.80, 95 %CI: 1.58−8.73, respectively).ConclusionLate preterm birth is associated with suboptimal development and stability in several domains at both 24 and 36 months and compared with term birth, requiring early monitoring and assessment of the developmental lag to avoid potential long-term implications.     

Precursors of social emotional functioning among full-term and preterm infants at 12 months: Early infant withdrawal behavior and symptoms of maternal depression

This study forms part of a longitudinal investigation of early infant social withdrawal, maternal symptoms of depression and later child social emotional functioning. The sample consisted of a group of full-term infants (N = 238) and their mothers, and a group of moderately premature infants (N = 64) and their mothers. At 3 months, the infants were observed with the Alarm Distress Baby Scale (ADBB) and the mothers completed the Edinburgh Postnatal Depression Scale (EPDS). At 12 months, the mothers filled out questionnaires about the infants’ social emotional functioning (Infant Toddler Social Emotional Assessment and the Ages and Stages Questionnaire-Social Emotional). At 3 months, as we have previously shown, the premature infants had exhibited more withdrawal behavior and their mothers reported elevated maternal depressive symptoms as compared with the full-born group. At 12 months the mothers of the premature infants reported more child internalizing behavior. These data suggest that infant withdrawal behavior as well as maternal depressive mood may serve as sensitive indices of early risk status. Further, the results suggest that early maternal depressive symptoms are a salient predictor of later child social emotional functioning. However, neither early infant withdrawal behavior, nor gestational age, did significantly predict social emotional outcome at 12 months. It should be noted that the differences in strength of the relations between ADBB and EPDS, respectively, to the outcome at 12 months was modest. An implication of the study is that clinicians should be aware of the complex interplay between early infant withdrawal and signs of maternal postpartum depression in planning ports of entry for early intervention.     

Effects of early hospital-based intervention on mothers and their preterm infants

Mothers of eight Israeli preterm infants were exposed to a standardized but individualized intervention during their stay in the hospital and before their infants were discharged. Mothers and infants in the intervention group were compared to eight control subjects using various outcome measures. While the intervention did not affect maternal personal attitudes and feelings, it positively affected the mother-infant interactions and mothers' perceptions of their infants. The importance of individualized interventions with parents of preterm infants is discussed.     

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.     

Emergence of amae crying in early infancy as a possible social communication tool between infants and mothers

Amae is defined as “wishing to be loved (Scheidlinger (1999). The Journal of the American Academy of Psychoanalysis, 27(1), p. 91)”. Amae crying is known as crying of infants when seeking intimate emotional communication with caregivers. The objective of this study was to delineate when and how amae crying emerges in early infancy. Crying episodes of four infants were observed bimonthly, in the natural context of their homes, from birth to 6 months of age, for approximately 60 min per session. Crying episodes (total = 275) as determined by two coders were analyzed with respect to several behavioral measures. Results indicated that amae crying emerged at the age of 2 months, and consistently accounted for 30–40% of the total crying episodes after the ages of 3 months. Amae crying could be accurately identified when infants were not in acute discomfort and had already got the attention of their mothers. At such times, infants did not shed tears, cried with a fussy voice, and frequently looked at their mothers. Mothers responded to amae crying more promptly than they did to other types of crying behaviors. It is concluded that 3 months of age, when infants probably begin to use crying as a social communication tool is a major turning point for crying behavior from the perspective of its biological and social roles. It is suggested that amae crying might play an important role in strengthening and encouraging mother–infant interactions.     

Relationships between regulatory temperament dimensions and self-regulatory behaviors at 4 and 6 months of age

The present study focused on relationships between temperament and behavior in early regulation development. Unlike most studies on the topic, we observed infant behavior in a naturalistic playful situation rather than in experimental stressful procedure, and employed temperament measures uniquely reflecting regulatory dispositions rather than a global measure of reactivity. The infant's self-regulatory behaviors were observed at 4 and 6 months during face-to-face interactions and regulatory dimensions were assessed at 4 months. We found that low intensity pleasure and soothability dimensions, related to the infant physical and social experience, respectively, significantly affected regulatory behavior and their influence showed to depend on the infant's age, with the former dimension being influential at the earlier age and the latter being influential when the behavior was observed at the later age. Results are interpreted on the light of a dynamic view of regulation development.     

Parent coaching at 6 and 10 months improves language outcomes at 14 months: A randomized controlled trial

Previous studies reveal an association between particular features of parental language input and advances in children's language learning. However, it is not known whether parent coaching aimed to enhance specific input components would (a) successfully increase these components in parents' language input and (b) result in concurrent increases in children's language development. The present randomized controlled trial assigned families of typically developing 6‐month‐old infants to Intervention (parent coaching) and Control (no coaching) groups. Families were equivalent on socioeconomic status, infants' gender, and infants' age. Parent coaching took place when infants were 6 and 10 months of age, and included quantitative and qualitative linguistic feedback on the amount of child‐directed speech, back‐and‐forth interactions, and parentese speech style. These variables were derived from each family's first‐person LENA recordings at home. Input variables and infant language were measured at 6, 10, and 14 months. Parent coaching significantly enhanced language input as measured by two social interaction variables: percentage of speech directed to the child and percentage of parentese speech. These two variables were correlated, and were both related to growth in infant babbling between 6 and 14 months. Intervention infants showed greater growth in babbling than Control infants. Furthermore, at 14 months, Intervention infants produced significantly more words than Control infants, as indicated by LENA recordings and parent report via the MacArthur‐Bates Communicative Developmental Inventory. Together, these results indicate that parent coaching can enrich specific aspects of parental language input, and can immediately and positively impact child language outcomes. A video abstract of this article can be viewed at: https://youtu.be/7wqR28gPiwo     

Dyadic co-regulation,affective intensity and infant's development at 12 months: A comparison among extremely preterm and full-term dyads

Extremely low gestational age children (ELGA, born below 28 weeks of GA) represent the most at-risk preterm group in terms of survival, developmental sequelae and rates of impairment and cognitive delays. However, the impact of an extremely preterm birth on mother–infant co-regulation and affective intensity which may affect early infant's development has not been investigated. Based on a relational dynamic system approach, our study aimed to investigate the quality of co-regulation and affective intensity during spontaneous play interaction in 20 mother–infant ELGA dyads compared to 20 full-term (FT) dyads at 12 months (corrected age for ELGA infants). Relationships between the quality of dyadic co-regulation and the infant's level of cognitive, motor and language development were also investigated. The quality of dyadic co-regulation was assessed using the Revised Relational Coding System (R-RCS) by Fogel et al. (2003), the mothers’ and infants’ affective intensity was coded using a coding system by Lunkenheimer, Olson, Hollenstein, Sameroff, and Winter (2011). Infants’ development was assessed using the Bayley Scales (BSID-III, 2006). With respect to FT dyads, ELGA dyads were characterised by less frequent symmetric and more frequent unilateral co-regulation patterns and by less positive and more neutral affective intensity of both infants and mothers. Cognitive, motor and language scores were lower in ELGA infants than in FT infants. Symmetrical co-regulation was related to motor scores in ELGA infants, and to cognitive scores in FT infants. Our findings contribute to the literature by demonstrating the difficulties of ELGA mother–infant dyads at 12 months in sharing the symmetric co-regulation and positive affective intensity and how symmetric co-regulation is strictly related to motor development in ELGA infants. Based on these findings, intervention programmes to foster joint attention, active involvement and positive affective intensity in ELGA dyads and infants’ development in the first year of life should be designed.     

Infant carrying as a tool to promote secure attachments in young mothers: Comparing intervention and control infants during the still-face paradigm

Infants of adolescent mothers have a greater risk of developing insecure attachment types and attachment disorders into adulthood. Previous research suggests that skin-to-skin contact predicts secure attachment; however, it is largely unknown whether infant carrying or “babywearing” has similar benefits. We hypothesized that adolescent mothers (Mage=19.1 years, SD = 2.0; 40.6 % Hispanic; 40 %< = 11th grade) who were randomly assigned to an infant carrying condition at 2–4 weeks’ post-partum (n = 16; 1 h daily for 3 months), compared to a control group (n = 17; reading), would be more likely to have securely attached infants at 7 months (M = 29.0 weeks, SD = 3.4). We coded infant gaze orientation, fretfulness, affect, self-soothing behaviors, and vocalizations in the reunion phase of the Still-Face Paradigm, and used an algorithm derived from the infant Global Rating Scales to determine attachment type. Infants in the intervention condition were more likely to have secure attachments and less likely to have disorganized attachments compared to the control condition. Hours spent babywearing was positively correlated with secure attachment, r_pb = .40, and negatively correlated with disorganized attachment, r_pb =−0.36. There were no statistically significant differences between the conditions or babywearing hours for avoidant or resistant attachment types. The results suggest that infant carrying may be an effective tool at promoting secure attachments, particularly for mothers and infants at greater risk for attachment insecurity.     

My Disaster Recovery: a pilot randomized controlled trial of an Internet intervention

Abstract

This pilot study tested the efficacy of the My Disaster Recovery (MDR) website to decrease negative affect and increase coping self-efficacy. Fifty-six survivors of Hurricane Ike were recruited from a larger study being conducted at the University of Texas Medical Branch at the first anniversary of the storm. Restricted randomization was used to assign participants to the MDR website, an information-only website, or a usual care condition. Group×time interactions indicated that MDR reduced participant worry more than the other conditions. A similar trend was also identified for depression. Both websites were accessed a small to moderate amount and participants reported mixed satisfaction for both websites. Although the effect sizes for worry and depression were in the moderate to large range, small sample size and timing of the intervention qualify the findings. These preliminary findings encourage further evaluation of MDR with a larger, demographically diverse sample and indicate that the MDR website might be helpful in reducing worry and depression.     

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.     

A randomised controlled trial of the effectiveness of writing as a self-help intervention for traumatic injury patients at risk of developing post-traumatic stress disorder

The study investigated the effects of writing and self-help information on severity of psychological symptoms in traumatic injury patients at risk for developing post-traumatic stress disorder (PTSD). Patients attending Accident and Emergency (A & E), were screened for Acute Stress Disorder and randomised to an information control group (n = 36) or a writing and information group (n = 31). Participants in both groups received an information booklet one-month post-injury. Participants in the writing group also wrote about emotional aspects of their trauma during three 20-min sessions, five to six weeks post-injury. Psychological assessments were completed within one month and at three and six months post-injury. There were significant improvements on measures of anxiety, depression and PTSD over time. Differences between groups on these measures were not statistically significant. However, subjective ratings of the usefulness of writing were high. In conclusion, the results do not currently support the use of writing as a targeted early intervention technique for traumatic injury patients at risk of developing PTSD.     

Efficacy of an internet-based intervention for burnout: a randomized controlled trial in the German working population

Background and Objectives: Internet-based interventions are a viable treatment option for various mental problems. However, their effects on the burnout syndrome yielded mixed results. In this paper, we examine the efficacy of a structured and therapist-guided internet intervention, based on solution-focused and cognitive-behavioral therapy, for individuals with symptoms of burnout.

Design: Two-arm, Internet-based, randomized, wait-list controlled trial (RCT).

Methods: Participants were recruited through in-house events and online advertising. They were randomly assigned to the intervention or a wait-list. Group comparison was conducted three months after randomization. Outcomes were the burnout level according to the Maslach Burnout Inventory (MBI-GS) and the levels of depression, anxiety and stress according to the DASS-21.

Results: Thirty-nine participants were included in the trial; 36 (92.3%) took part at the 3-months-follow-up. Intention-to-treat analyses revealed significant group differences in favor of the intervention group in depression (d?=?0.66), cynicism (d?=?0.87) and personal accomplishment (d?=?0.75).

Conclusions: The intervention helped ameliorate symptoms of work-related stress and burnout. Although limited by a small sample size, the study suggests that the program provides effective support for affected individuals. However, further studies with bigger sample sizes should be conducted to examine the effects of such programs more precisely.     

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.