Academic journal article Merrill-Palmer Quarterly

Mother–Toddler Interaction Quality as a Predictor of Developmental and Behavioral Outcomes in a Very Preterm Sample

Academic journal article Merrill-Palmer Quarterly

Mother–Toddler Interaction Quality as a Predictor of Developmental and Behavioral Outcomes in a Very Preterm Sample

Article excerpt

Each year, 10,000 U.S. infants, 2% of all American infants, and 4% of African American infants, are delivered very preterm (<32 weeks of gestation) (National Institute of Child Health and Human Development [NICHD], 2010). Due to advances in technology and neonatal intensive care, mortality has declined significantly in this population, even for infants with high medical risk profiles, but morbidities have not (Johnson, 2007; NICHD, 2010; Saigal & Doyle, 2009). As noted in a comprehensive review by the Institute of Medicine (IOM) (2007a), infants born very preterm are at significant risk for suboptimal developmental and behavioral outcomes, relative to infants born full term. Although the incidence of major handicaps in the very preterm population has not increased over the past few decades, there is a rising prevalence of less severe developmental sequelae, such as mild-to-moderate cognitive and motor delays, attention/executivefunctioning problems, and emotion regulation difficulties, which may contribute to later learning disabilities and academic problems, including the requirement for special assistance in school (Aylward, 2005; Bhutta, Cleves, Casey, Cradock, & Anand, 2002; Brummelte, Grunau, Synnes, Whitfield, & Petrie-Thomas, 2011; Clark & Woodward, 2014; Doyle & Saigal, 2009; Feldman, 2009; Hack, 2005; Johnson, 2007; Johnson & Marlow, 2014; Roberts, Bellinger, & McCormick, 2007; Spittle & Orton, 2014; van de Weijer-Bergsma, Wijnroks, & Jongmans, 2008). Approximately 50%-70% of children born very preterm have these problems, and the incidence increases with decreasing birth weight and gestational age (Aylward, 2002, 2005; McCormick, 1997).

Yet not all very preterm infants exhibit developmental or behavioral problems. Individual outcomes vary widely based on factors not yet fully identified or explained (IOM, 2007a). A sizable number function in the normative range in later life-for example, more than 32% of children born very preterm with very low birth weight (VLBW) (<1,500 g but ≥1,000 g) or extremely low birth weight (ELBW) (<1,000 g) are in mainstream classrooms and do not require special educational services (Aylward, 2005).

Heterogeneous outcomes are also reported for very preterm children with associated medical problems, such as chronic lung disorders (e.g., bronchopulmonary dysplasia [BDP]; Kinsella, Greenough, & Abman, 2006; J. S. Landry, Chan, & Menzies, 2011) or neonatal white-matter damage (WMD) (Holling & Leviton, 1999; Volpe, 2009). By age 2, 47.7% of preterm children with BPD score within normal limits on developmental tests (J. S. Landry et al., 2011), and 44% of preterm children with documented WMD have normal intelligence at age 6 (Whitaker et al., 1996). Moreover, the standard deviation for developmental test scores of preterm children with WMD or BPD is typically elevated, relative to that observed for typically developing, full-term children (Aylward, 2005; J. S. Landry et al., 2011; Volpe, 2009).

Given the high expense associated with the special school services and multidisciplinary interventions required for preterm children exhibiting developmental problems (IOM, 2007b), there is an urgent need to understand the factors that foster positive developmental outcomes in this population (McCormick, 1997). Clearly, medical risk factors alone do not adequately account for the variance in developmental and behavioral outcomes in this population (IOM, 2007a; Poehlmann et al., 2014).

Recent research grounded in modern developmental theory (e.g., bioecological systems theory [Bronfenbrenner & Morris, 2006] and dynamic transactional models [Sameroff, 2010; Tronick & Beeghly, 2011]) suggests that proximal caregiving processes (i.e., parent-child interactions) may be important candidates for further study in this regard. Parent-child interactive processes are inherently bidirectional in nature and reflect the contributions of both parent and child (Deater-Deckard & O'Connor, 2000; Kochanska & Aksan, 2004; Maccoby, 1999). …

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