Mother-twin interaction during early childhood

Raising multiples: mental health of mothers and fathers in early parenthood

The rate of twin and higher-order gestation births has risen dramatically in recent decades in the United States as well as other Western countries. Although the obstetrical and neonatal risks of multiple gestation pregnancies are well-documented, much less is known regarding the mental health impact on parents of multiples during the perinatal and early parenthood period. Given that parents of multiples face greater functional demands, as well as other pressures (financial, medical) this population may be at risk for heightened distress. We conducted a systematic review of quantitative, English language studies that assessed mental health outcomes of parents of multiples during pregnancy, in the first postpartum year, and in the period of early parenthood, including depression, anxiety, stress, and related constructs. Twenty-seven articles published between 1989 and 2014 met selection criteria and were included in the review. Studies utilized a wide range of methods and outcome constructs, often making comparisons difficult. Although some studies found no differences, most investigations that compared mental health outcomes in parents of multiples versus parents of singletons found that parents of multiples experience heightened symptoms of depression, anxiety, and parenting stress. We discuss gaps in the existing body of literature on parental mental health related to multiple gestation birth and conclude by discussing the need for novel intervention strategies to meet the needs of this growing population. Parents of multiples may experience worse mental health outcomes than parents of singletons. More research is needed, and future work should explore potential treatment and support options.

Depressive and Psychosomatic Symptoms in Twins With Special Reference to Co-Twin Dependence

We analyzed depressive and psychosomatic symptoms in relation to co-twin dependence in 419 twins at the age of 22 to 30 years. Depressive symptoms were assessed, as previously, with Children's Depression Inventory modified to be suitable for this age and reported as a total score and three subscales (low self-confidence, anhedonia and sadness) based on factor analysis as reported in a previous epidemiological study conducted in Finland. Items assessing nervous complaints and somatic symptoms were adapted from Finnish studies of juvenile health habits. Inter-twin dependence decreased with increasing age in both genders. Monozygotic twins, especially monozygotic females, reported most often to be dependent on their co-twin. When the symptom reporting was evaluated in relation to co-twin dependence, no relation was found between co-twin dependence and depressive symptom reporting. However, dependence-independence imbalance within twin pair was associated with elevated levels of depressive and psychosomatic symptoms, especially in twins who perceived themselves as dependent and the co-twin as independent. We conclude that there was no relation found between co-twin dependence and depressive symptom reporting in male and female twins except for the few imbalance cases, where most symptoms were reported by those dependent twins who felt their co-twin as independent.

Sleep patterns and fatigue in parents of twins

OBJECTIVE

To examine patterns of postpartum parental sleep and levels of fatigue at 2, 12, and 20 weeks following hospital discharge of newborn twins.

DESIGN

Descriptive longitudinal pilot study.

SETTING

Recruitment from 2 hospital postpartum units. Data collected in parents' homes.

PARTICIPANTS

Eight primiparous parents caring for twins delivered at 33 to 38 weeks gestation.

METHODS

Home visits to deliver and retrieve study equipment: wrist actigraphy and sleep diaries to measure sleep, standardized instrument to measure fatigue, and an investigator-developed form to measure demographics and related variables.

RESULTS

Fathers had significantly less night sleep (5.4 hours) and less 24 hour sleep (5.8 hours) than mothers (6.2 and 6.9 hours, respectively) at 2 weeks after twins were discharged. Sleep efficiency increased significantly over time in a linear fashion for both parents. Morning and evening fatigue levels were not significantly different between parents and remained constant over time.

CONCLUSION

Pilot data suggest that mothers and especially fathers of twins experience sleep disturbances after discharge of their twins. Further study is needed to more fully describe the evolution of sleep patterns and clarify factors that influence sleep in parents of twins.

Seeing the Forest for the Trees: A Qualitative Synthesis Project

Although qualitative studies are increasing in the discipline of nursing, their clinical application and knowledge development will be impeded unless the rich understandings revealed in these individual studies can be synthesized. Meta-synthesis is an invaluable method for accumulating knowledge from individual qualitative studies. This article describes a project focusing on qualitative synthesis that the author required her nursing students in a graduate-level research course to complete. In addition, qualitative meta-synthesis is defined, and its benefits are discussed. Then, Noblit and Hare's approach for synthesizing qualitative studies is described. The remainder of the article is devoted to explaining the actual course project and students' evaluation of the project. The benefits of having graduate students conduct a meta-synthesis are many, and as one student shared, "It was a wonderful, very interesting, and challenging way to teach us."

Twins as a natural experiment to study the causes of mild language delay: I: Design; twin-singleton differences in language, and obstetric risks

BACKGROUND

Twins tend to lag behind singletons in their language development, but the causes were unknown. The possibilities suggested include obstetric complications, twin-specific features, and postnatal differences in family interaction. The present study was designed to pit these alternatives against one another as possible causal influences.

METHOD

The Avon Longitudinal Study of Parents and Children (ALSPAC) was used to identify the 116 twin pairs (of whom 96 participated) and 114 pairs of singletons (of whom 98 participated) whose ages were no more than 30 months apart. The McArthur Communicative Development Inventory was completed at 20 months, and the Pre-School Language Scales (PLS-3), and the McCarthy Scales of Children's Abilities at 36 months. Obstetric and perinatal complications were assessed on the basis of detailed systematic parental reports, together with a systematic coded abstraction of all medical records dealing with pregnancy and the neonatal period. Family background details were assessed from parental reports, and the primary carer's verbal functioning was assessed by the Mill Hill Vocabulary Scale. Congenital anomalies were assessed using the method of Waldrop and Halverson.

RESULTS

The language of twins was 1.7 months below that of singletons at 20 months and 3.1 months at 3 years. The verbal cognitive score of twins was about half a standard deviation lower than that of singletons. The twin-singleton differences in language level were found tobe unassociated with obstetric/perinatal features as assessed from both parental reports and medical records, to birthweight or gestation, to birthweight discrepancy within the twin pair, or to congenital anomalies.

CONCLUSION

It is concluded that obstetric/perinatal features do not account for the slower language development in twins as compared with singletons, within a sample born after at least 33 weeks gestation.

Mothering multiples: a meta-synthesis of qualitative research

Increasing numbers of qualitative studies in maternal-child nursing are being published. However, clinical application and knowledge development based on those studies will be hampered unless the rich understandings gleaned from these individual studies can be synthesized. Meta-synthesis is one technique to help accumulate knowledge from qualitative research. The first section of this article explains the technique of meta-synthesis and reviews meta-syntheses published in nursing. The focus then becomes an illustration of a meta-synthesis in maternal-child nursing: Mothering multiples during the first year of life. Six qualitative studies comprised the sample for the meta-synthesis. The meta-synthesis revealed a shared set of five themes that help increase our understanding of mothering multiples: "bearing the burden," "riding an emotional roller coaster," "lifesaving support," "striving for maternal justice," and "acknowledging individuality." Implications for practice derived from this meta-synthesis are addressed.

Releasing the pause button: mothering twins during the first year of life

The purpose of this grounded theory study was to investigate the basic social psychological problem mothers of twins experience during the first year after delivery and the process they use to resolve this fundamental problem. Life on hold was the basic social psychological problem that mothers of twins experienced during the first year of their twins' lives. Releasing the pause button was the four-stage process mothers progressed through as they attempted to resume their own lives. These four phases were (a) draining power, (b) pausing own life, (c) striving to reset, and (d) resuming own life. The most vulnerable period for mothers of twins is the first 3 months postpartum. Intensive interventions need to be in place to support women during this time.

Early parental interactions with and perceptions of multiple birth infants

The perceptions and interactions of mothers and fathers of seven sets of twins and one set of triplets were compared to those of parents of 49 singleton infants. Couples were typically interviewed together three times during the pregnancy and at 1 week and 3 months post-partum. Two-weekly observations of mother-father-infant interactions were conducted after the first postnatal interview. Three major themes were apparent in the interviews--the positive and negative specialness for multiple births, difficulties involved in managing more than one infant, and attachment issues--that were also evident during the observations. Although there were few differences in care-giving and interactive behaviours between the multiple birth and singleton parents, the logistics of caring for more than one infant dictated that multiple birth infants were left alone more and looked at, talked to and held less often. Couples used different strategies to care for their infants, varying in both the extent to which they interacted preferentially with the infants and in the relative involvement of the mother, father and others.

"Mother's child" and "father's child" among twins. A longitudinal twin study from pregnancy to 21 years age, with special reference to development and psychiatric disorders

234 pairs of twins were studied from pregnancy up to 21 years of age on the basis of records from maternity hospitals, neonatal wards and children's health centres and questionnaires filled in by the parents when the twins were aged 2-10 and 12-21 years, and by the twins themselves at age 12-21. 74 twins were personally interviewed about human relationships in their families and with the Present State Examination (PSE) at age 15-21. When the evaluation of parental preference was made by the parents, the mother's favourites had learned to speak earlier and were more often the psychic leader of the pair, but they more often had sleeping difficulties and other psychosomatic symptoms in adolescence. They were most often scored in class 2-3, non-specific neurotic symptoms in the PSE, but none of them was placed in the higher classes of possible or probable psychiatric disorder. Mothers seem to develop a tighter affectionate bond towards their favourites than do fathers, thus inducing a good basic trust and faster language acquisition in childhood, but probably also transient non-specific neurotic symptoms in adolescence in face of the developmental task of entering autonomous adulthood. The father's favorites were more often the physical leaders of the pair, showed less accident proneness and most often reported tendencies towards autonomy from their co-twins, thus indicating that the fathers' attitudes may be more encouraging towards independence. As the least psychosomatic symptoms were seen in twins in the intermediate position regarding parental preference, it seems reasonable that the division of twins between parents on the grounds of favouritism should not be strict.

Twin sibling differences in parental reports of ADHD, speech, reading and behaviour problems

Differences between twins and siblings in behaviour problems were investigated in a non-selected sample of 1938 families with children aged 4-12 years. Families were sent a questionnaire based on DSM-III-R criteria for Attention Deficit Hyperactivity Disorder (ADHD), Oppositional Defiant Disorder (ODD), Conduct Disorder (CD) and Separation Anxiety (SA), which was validated by formal clinical interview. The questionnaire also included measures of speech and reading problems. There were significant differences between twins and siblings for ADHD symptoms, but not for symptoms of ODD, CD or SA. Twins and siblings differed significantly for gestational age, birth weight, speech and reading problems. While there was little evidence for birth weight or gestational age contributing to the difference in ADHD symptoms, there was a strong association between ADHD symptoms and speech and reading problems.

Childcare patterns of mothers of twins during the first year

This study aims to describe the ways in which mothers of twins organize their childcare activities during the first year after a twin birth and to determine what factors might affect these mothering practices. The mother's physical and psychological state, support and help from the father and others in the surroundings, and the type of twinship were among the factors studied. Data on the organization of feeding, sleeping and waking routines were gathered from 51 families. A correspondence analysis and a cluster analysis showed that twin mothering practices can be described along two dimensions: individualized care vs collective care, and level of organization of daily routines. The mother's state of fatigue only partially accounts for the different types of maternal behavior. Likewise, the presence of several caregivers does not lead to greater individualization in care routines. Nor does there seem to be a clear link between the type of maternal behaviour and the type of twinship. The discussion deals with the mother's emotional investment, her personal capacity for adjusting to the "triadic motherhood' process, and the nature of the father's involvement in that process. Another consideration is the impact of the type of childcare pattern on twin development.

Parental ratings of behaviour problems: a twin and general population comparison

Generalization from twin studies relies on the assumption that liability to develop the disorder which is studied is influenced by similar factors in twins and singletons. The present study examines the impact of pre- and perinatal factors on parental reports of behaviour problems in 1832 twins, and compares level of attention problems, internalizing and externalizing behaviour in the twins with 723 children and adolescents from a general population sample. The modest influence of relative birth weight and birth order on level of attention problems in twins did not contribute to significant differences between twins and the general population sample. The levels of attention problems and externalizing behaviour was similar and there was a modest age dependent difference in internalizing behaviour. An increased variance was found for externalizing behaviour in twins.

[The individualization of care practices for twins during the first year]

BACKGROUND

Mothers of twins have some difficulties to individualize their child-raising activities during the first year. This study was aimed to determine factors influencing such activities.

POPULATION AND METHODS

Thirty-seven pairs of twins born after 36 weeks of gestation and weighing more than 2,000 g were included in the study. Relationships between the parents and their children were studied from questionnaires concerning activities during the first trimester and the end of the first year of age. Each item concerning organization of meals and sleeping was graded 1 to 3 according to the degree of individualization of the care. Items concerning support of the mother by the father or other people were graded 1 to 3 according to the degree of this assistance. The physical and psychological status of the mother was also graded according to the presence or not of asthenia and/or depression. Home activities of the mother were also observed.

RESULTS

The state of the mother during the first few months had an impact on her mothering behavior: tired or depressed mothers tend to treat the twins collectively and simultaneously. No link was found between social, paternal or general familial support and the degree of individualization in the maternal behaviors.

CONCLUSIONS

Several factors can interfere with the psychological repercussions of a twin birth on the mother and subsequent psychoemotional development of children. Further studies are necessary to understand how each parent contributes to the organization of the family system.

[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.

Comparison of prevalence of depression in mothers of twins and mothers of singletons

OBJECTIVE

To determine whether the apparent additional and exceptional stresses associated with bearing and parenting twins affect the emotional wellbeing of mothers.

SETTING

Great Britain, 1970-5.

DESIGN

Cohort study of 13,135 children born between 4 April and 11 April 1970. Mothers of all children, both singletons and twins, were interviewed by health visitors (providing demographic data) and completed a self report measure of emotional well-being (the Rutter malaise inventory) when the child was 5 years of age. The malaise scores of mothers of twins were compared with those of all mothers of singletons and then with those of mothers categorised by the age spacing of their children (only one child, widely spaced, or closely spaced), taking account of maternal age, social class, and whether the study child had a disability, by using logistic regression.

SUBJECTS

139 mothers of twins--122 pairs of twins and 17 twins whose cotwin had died--and 12,573 controls, who were mothers of singletons.

RESULTS

A significantly higher proportion of mothers of twins at 5 years had malaise scores indicative of depression than mothers of singletons at the same age. Mothers who had borne twins, one of whom had subsequently died, had the highest malaise scores and were three times more likely than mothers of singletons to experience depression. Both mothers of twin pairs and mothers of singletons closely spaced in age were at significantly higher risk of experiencing depression than mothers of children widely spaced in age or mothers of only one child (p less than 0.0001). Odds ratios indicated that the risk of depression in mothers of twins was higher than that in mothers of closely spaced singletons.

CONCLUSION

Mothers of twins are more likely to experience depression. This suggests a relation between the additional and exceptional stresses that twins present and the mother's emotional wellbeing.

Forms of family reorganization following the birth of twins

A survey questionnaire of 200 families with 2-month-old twins assesses the economic, social and psychological impact of the arrival of twins on family life. The study shows the extent of material difficulties mothers of twins are confronted with, and the ways they cope with them--recourse to mother's helpers, assistance from the father and other members of the family (analyzed in terms of parity and socioeconomic/cultural status), twincare organization strategies, and impact on the decision to stop working. The findings provide an overall picture of the real situation, a necessary prerequisite to an understanding of psychological problems.