Frontiers of Infant Psychiatry - Vol. 2

By Justin D. Call; Eleanor Galenson et al. | Go to book overview

21
An Intervention Program for Mothers of
Low-Birthweight Babies:
Outcome at Six and Twelve Months

Barry Nurcombe, M.D.

Virginia Rauh, Sc.D., A.C.S.W.,

David C. Howell, Ph.D.

Douglas M. Teti, M.D.

Paul Ruoff, M.D.,

Barbara Murphy, M.S.

John Brennan, M.B.B.S.

The preterm baby is prone to a number of developmental difficulties, particularly mental retardation and cerebral palsy. More subtle defects in attention and concentration, motor control, learning ability, and social competence may also appear in childhood (Caputo et al., 1981; Lubchenco et al., 1972).

In some instances, these developmental disabilities are clearly due to perinatal brain damage, particularly when the infant is very immature or sick at birth; however, the long‐ term follow-up of large samples of low-birthweight infants, such as that by Werner and colleagues (1971), indicates that, overall, the socioeconomic status of the family has the preponderant association with cognitive and psychosocial development, far outweighing that of perinatal biomedical factors. Such a finding could be accounted for on a genetic basis or explained on the ground that psychosocially

disadvantaged families do not provide a favorable environment for the development of vulnerable infants, a situation Sameroff and Chandler (1975) call "the continuum of caretaking casualty."

The environmental theory has been expanded by Sameroff and Chandler in their transactional model. In this paradigm, mother and infant are described as affecting each other reciprocally, over time, as a result of innumerable interactions, which cumulatively enhance or impede both infant development and maternal adaptation. The theory is supported not only by the developmental difficulties of low‐ birthweight infants, but also by the disproportionately high incidence of child abuse in their parents (Thoman, 1980).

If the transactional theory is correct, and if disadvantaged parents are less likely to provide an environment that compensates for infant vulnerability, what is the nature of their failure to do so, and how could it be counteracted by intervention?

In general, there have been four approaches

____________________
The Vermont Infant Studies Project is funded by NIMH Grant #1-R01-MH-32924, and by March of Dimes 12-88.

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