The effect of neonatal complications in same-sexed premature twins on their mothers' preference

Parent-Infant Interaction during the First Year of Life in Infants at High Risk for Cerebral Palsy: A Systematic Review of the Literature

Introduction

Perinatal adverse events put neonates at high risk for short and long-term disabilities, including cerebral palsy (CP). The most recent guidelines about early intervention in infants with brain damage have emphasized the importance of family involvement from the very first phases of development. Early parent-infant interactions are pivotal in promoting infant cognitive and social developmental trajectories. However, little is known about the extent to which severe adverse perinatal events can affect the quality of early parent-infant interactions.

Patients and Methods

We systematically searched five databases (PubMed, PsycINFO, EMBASE, CINAHL, and Cochrane Library) for the publications assessing parent-infant interactions in infants at high neurological risk within 1 year of age. Articles were selected if they involved direct comparison between high-risk populations and healthy controls or low-risk populations, and if quantitative or semiquantitative tools were used to assess the parent-infant interaction. Measures of parent-infant interaction included infant interactive behaviors, parental interactive behaviors, and dyadic interactive patterns.

Results

The search yielded 18 publications that met the inclusion criteria. The articles represent a high level of heterogeneity in terms of infant neurological risk, infant age, and tools assessing interactive behaviors. Both infant and maternal behaviors within the investigated interactive exchanges were reported to be compromised, leading to subsequent overall impairment of the dyadic patterns.

Conclusion

While the studies reviewed here provide general and important information, the review did not yield a clear picture of early dyadic interactions in high-risk infant populations. Further observational studies are warranted in order to provide a more accurate knowledge of the early dyadic exchanges between infants at high neurological risk and their parents, as they might provide a critical opportunity for early family centered habilitative interventions.

[The question of cognitive activity in twins]

Cette étude nous a permis de mettre à jour les différents modes d'intéractions qu'une mère établit avec ses jumeaux, ainsi que les évolutions possibles qui en résultent. Mais, bien plus, nous avons modélisé la façon dont les jumeaux élaborent leurs structures de l'activité de connaissance en fonction des sollicitations du milieu, ainsi que l'interdépendance qui les caractérisent.

Grâce à des examens opératoires, réalisés sur une population de 14 couples âgés de 6 a 10 ans, nous avons mis à jour un décalage intra-couple au niveau de la genèse de ces mêmes structures de l'activité de connaissance. Nous nous sommes apercus que sur le plan de la genèse de l'organisation cognitive l'un des enfants a développé des structures figuratives, et l'autre des structures opératives lui permettant d'avoir une connaissance de la réalité plus étendue.

Les liens de dépendance, de fusion, unissant les jumeaux entre eux, pourraient être dus à un développement cognitif parasitaire. Ils génèrent un lien gémellaire à partir de défaillances structurales qui vont apparaître chez chacun d'eux, ce qui ne permet aucunement leur autonomisation réciproque.

Puisque des déficiences apparaissent dans les structures de l'activité de connaissance de ces enfants, les problèmes qu'ils recontrent pourraient trouver leur solution dans une remédiation cognitive opératoire.

Effects of early mother-twin relationships from birth to age 3, on twin bonding

Findings from an earlier phase of this research project clearly pointed to the mother's psychological adaptation inherent to the specificities of triadic interaction. Mothers' attitudes were classified in a typology ranging from "early twinness" where the two babies are treated as though they were a single unit, to attempt to create two dyadic relationships. The current program deals with the effects of the type of parent-child relationship at one year on the emergence of twin bonding. Sixty-eight families of twins (26MZ, 24DZ same sex, 18DZ different sex) are followed up from birth to the age of 3 using a method based on clinical interviews, videotaped observations, and questionnaires. The data cover mothers' rearing attitudes towards organization of babycare and outward signs of twinness, maternal representations of the relationship between the twins and observation of the children's interaction in a standardized game situation. The findings are discussed in terms of zygosity, and parental SCS.

Maternal preference between premature twins up to age four

This paper describes methods of measuring a preference a mother develops for one twin over the other and describes the effect such preference has on the intellectual functioning and behavior of 24 twin pairs over 4 years. Results indicate that the majority of mothers develops a preference for one premature twin within 2 weeks after birth and maintains this preference for at least 4 years. The preferred twin has fewer behavior problems and a higher IQ at age 4. However, temperament is not correlated with preferential status.

Affect attunement, attachment, temperament, and zygosity: a twin study

A twin study examines the relationship of affect attunement to four factors of development: zygosity, temperament, attachment, and twin preference. Affect attunement occurs when an infant expresses affect and a mother responds cross-modally, matching duration, intensity, and rhythm. A sample of 16, same sex, healthy twins (8 MZ, 8 DZ) and their mothers were recruited at 10 to 12 months of age. Monozygous twins attuned at more similar rates than dizygous twins. There was no relationship between attunement, attachment, and temperament, nor between affect signal rate and attunement. Five of eight mothers expressed a twin preference. Eleven of the 16 infants were classified securely attached. Affect attunement is discussed as a measure of the complementarity between an infant's affect signaling rate and a mother's contingent responsiveness.

Mother-twin interaction during early childhood

The components of a research program focusing on early mother-twin interaction is described. Preliminary data obtained from a questionnaire at two months post term, cross-sectional observations at the age of one year, a follow-up study involving home observation and parental interviews from birth to the age of 3, point to the specificity of this triadic situation. During the first months of life, the burden of material tasks and the increase in baby care leave little time for starting a relationship based on pleasure or play. The impossibility of responding simultaneously to the needs of two babies and the difficulty of forming relationships on an individual basis foster early concerns for egalitarianism. The degree of physical resemblance between the babies creates the problem of differentiating them. To tell twins apart, mothers rapidly tend to rely on behavioral characteristics to which they attribute a genetic basis. In contrast, differences in development between the babies that introduce the eventuality of the dominance of one of the twins are often denied. In this highly specific situation, mothers arrive at personal solutions of adjustment over the first 3 years, manifest in a certain number of psychological and educational attitudes. Analysis of these maternal attitudes may help to shed light on some of the features of later psychoemotional development in twins.

Maternal caretaking and play with full-term and premature infants

The contribution of past psychological experiences of the mother and medical complications of the infant to differences in caretaking of pre- and full-term infants are examined. Twenty full- and 20 pre-term matched mother-infant dyads were studied during a feed and play 1, 2 and 3 months after the expected date of birth. Full-term infants were more active than pre-terms at 4 weeks only. Mother of pre-terms showed differences in their interactions at all times. Interactions were related to maternal experiences in full-term infants only. Degree of neonatal illness was correlated with behavioral disorganization of premature infants, leading to differences in caretaking style.

Research on twins: implications for parenting

A review of the literature on twins is provided regarding bonding, parent preference, temperament and personality, the separation-individuation process, cognitive development, and child abuse. practical suggestions are given for successfully parenting twins toward optimal growth and development.

Effect of neonatal complications in premature infants on early parent-infant interactions

A total of 184 infants in a neonatal intensive care unit with birthweights less than 1501 g were rated daily on a Morbidity Scale covering the 20 most common diseases and pathophysiological states in neonatology, the severity of each condition being rated on a scale of 0 to 3. To measure the impact of various degrees of complications on parental caretaking style, 20 infants with serious medical complications were paired with 20 infants who had a comparatively easy medical course. Both groups were observed during maternal visits to the hospital and again during a feeding three months after discharge home. Sick infants showed significantly less motor movements when ill but after recovery were similar to well infants of the same age. Parents visiting sick infants interacted far less with their infants than did parents of well babies, and this continued after recovery. It also persisted at home two months after the expected date of delivery. In addition, mothers whose infants had been seriously ill for less than 17 days interacted with them significantly more than mothers whose babies had been ill for over 35 days. While maternal background variables predicted the level of maternal activity with the comparatively well infants and those with short illnesses, they did not do so in the group of infants with long illnesses.