Protecting the child while preserving the relationship: Using baby’s relational withdrawal to gauge the effect of parental visitation

<div><p>The impact of children’s interactions with parents in the context of out-of-home placements is receiving much-needed cross-disciplinary attention. However, the paucity of instruments that can reliably represent young children’s experiences of such interactions precludes a nuanced evaluation of their impact on wellbeing and development. In response to this empirical gap, the present study investigates children’s relational withdrawal as a clinically salient, easily observable and conceptually valid measure of infants’ and toddlers’ responses to parents. Relational withdrawal, challenging behaviors and salivary cortisol were assessed before, during and after parental visits. Conceptually, the findings suggest that observations of relational withdrawal correlate meaningfully with measure of neurobiological reactivity. Clinically, three profiles of cross-variable responses in children appeared, distinguishing between groups that experience increased, decreased or unchanged levels of stress in response to parental visits. Taken together, the findings lend empirical support to systematic observations of relational withdrawal to bolster evaluations of young children’s experience of parental visitation during out-of-home placements.</p></div

Data collection scheme.

<p>Data collection scheme.</p

Estimated marginal means (logarithmic) for reaction profiles and repeated measures ADBB scores including age and duration of placement as covariates.

<p>Estimated marginal means (logarithmic) for reaction profiles and repeated measures ADBB scores including age and duration of placement as covariates.</p

Estimated marginal means of salivary cortisol by group of relational withdrawal.

<p>Estimated marginal means of salivary cortisol by group of relational withdrawal.</p

Estimated marginal means of salivary cortisol as a function of reaction profile (interaction).

<p>Estimated marginal means of salivary cortisol as a function of reaction profile (interaction).</p

Maternal characteristics in the eligible OLIMPE study population, the included population and the included population still participating at 6 months corrected age.

<p>Maternal characteristics in the eligible OLIMPE study population, the included population and the included population still participating at 6 months corrected age.</p

Relationships between disordered interaction at discharge and 6 months based on ADS infant (i-ADS) and mother (m-ADS) subscales.

<p>Relationships between disordered interaction at discharge and 6 months based on ADS infant (i-ADS) and mother (m-ADS) subscales.</p

Neonatal characteristics in the eligible OLIMPE study population, the included population and the included population still participating at 6 months corrected age.

<p>Neonatal characteristics in the eligible OLIMPE study population, the included population and the included population still participating at 6 months corrected age.</p

6–15 months period: categories from the intervention manual and as developed at each stage of the qualitative analysis.

<p>6–15 months period: categories from the intervention manual and as developed at each stage of the qualitative analysis.</p

Interrater reliability of ADS infant and mother subscales at discharge and 6 months.

<p>Interrater reliability of ADS infant and mother subscales at discharge and 6 months.</p