“Expectant Parents”:Study protocol of a longitudinal study concerning prenatal (risk) factors and postnatal infant development, parenting, and parent-infant relationships

BACKGROUND: While the importance of the infant-parent relationship from the child’s perspective is acknowledged worldwide, there is still a lack of knowledge about predictors and long-term benefits or consequences of the quality of parent-infant relationships from the parent’s perspective. The purpose of this prospective study is to investigate the quality of parent-infant relationships from parents’ perspectives, both in the prenatal and postpartum period. This study therefore focuses on prenatal (risk) factors that may influence the quality of pre- and postnatal bonding, the transition to parenthood, and bonding as a process within families with young children. In contrast to most research concerning pregnancy and infant development, not only the roles and experiences of mothers during pregnancy and the first two years of infants’ lives are studied, but also those of fathers. METHODS/DESIGN: The present study is a prospective longitudinal cohort study, in which pregnant women (N = 466) and their partners (N = 319) are followed from 15 weeks gestation until their child is 24 months old. During pregnancy, midwives register the presence of prenatal risk factors and provide obstetric information after the child’s birth. Parental characteristics are investigated using self-report questionnaires at 15, 26, and 36 weeks gestational age and at 4, 6, 12, and 24 months postpartum. At 26 weeks of pregnancy and at 6 months postpartum, parents are interviewed concerning their representations of the (unborn) child. At 6 months postpartum, the mother-child interaction is observed in several situations within the home setting. When children are 4, 6, 12, and 24 months old, parents also completed questionnaires concerning the child’s (social-emotional) development and the parent-child relationship. Additionally, at 12 months information about the child’s physical development and well-being during the first year of life is retrieved from National Health Care Centres. DISCUSSION: The results of this study may contribute to early identification of families at risk for adverse parent-infant relationships, infant development, or parenting. Thereby this study will be relevant for the development of policy, practice, and theory concerning infant mental health

Coping with the effects of deprivation : Development and upbringing of Romanian adoptees in the Netherlands

This thesis describes the effects of early life deprivation on Romanian adopted children in the Netherlands. These children have been exposed to (severe) deprivation in the period they have spend in Romanian children’s homes or hospitals. For a group of 72 families, who had adopted 80 Romanian children, the developmental and behavioral problems of the children, and the parenting burden of the adoptive parents were assessed. The children displayed symptoms of trauma (20%), autism (16%) and ADHD (15%). Forty-one (51%) of the 80 children that participated in our study showed symptoms of behavioral problems to an extent that they scored within the clinical or borderline range of the Child Behavior Checklist, in which case professional support is advised. The behavioral problems changed little over a period of five years. The percentage of children in special education did increase from 31% to 47%, in both cases a much higher percentage than in the normal Dutch population. The parenting burden was higher in these families than in a non-adoptive norm group, but the levels of parenting satisfaction were the same. Up to a certain extent, the strengths of the adoptive parents appeared to compensate for the elevated parenting burden. To gain more insight in the way the problems of these children were dealt with, qualitative analyses were done. For 18 children with severe behavioral problems, and 15 children with little to no behavioral problems, the parents were interviewed. In addition, the teachers (n=17) and mental health workers (n=12) of the children in the group with severe behavioral problems were interviewed. The interviews with the parents revealed that they applied a highly structured, very consistent, and warm and accepting approach towards their children, as this seemed to work best. Parents of these deprived children invested much time and effort in the upbringing. The parents of children with severe behavioral problems indicated that they experienced difficulties in finding appropriate professional help; the process of finding help was long and tiresome for most of them. The teachers (mostly from schools for special education) and mental health workers also emphasized the importance of a consistent and structured approach towards the children. They also indicated that they did not always feel they were sufficiently equipped to deal with the specific problems of deprived children, and did not know where to gain expertise on this subject. It is recommended that parents who adopt a deprived child should receive structured aftercare, and that the teachers and mental health workers involved in the care for these children should have easy access to expertise and relevant information on the possible consequences of early life deprivation

Herstelmogelijkheden voor verwaarloosde kinderen?

A large number of studies evaluating adoption of children have been done. We know that many foreign adopted children have been (severely) neglected before they got adopted. A next relevant step is to study ways of helping these children and their adoptive parents. The adoption of severely deprived children into well-functioning families can be seen as a natural experiment. In this paper the consequences of deprivation and the possibilities for recovery in a healthy environment are reviewed by describing three waves of a longitudinal study among Romanian adoptive children. The development and behavioral problems are discussed, as are the strategies of parents and teachers in dealing with the problems. Based on the results found, recommendations for practice are made

Fathers' experiences during pregnancy: Paternal prenatal attachment and representations of the fetus

Positive attachment experiences during infancy are linked to positive developmental outcomes of children later in life. The parent–infant relationship does not start upon the birth of the child, but already evolves during pregnancy. In this exploratory study, fathers’ experiences during pregnancy are investigated, focusing on their relationship with the unborn baby. At 26 weeks gestational age, expectant fathers from a Dutch community-based sample (N = 301) completed questionnaires concerning feelings of attachment to the fetus and psychological well-being. The semistructured Working Model of the Child Interview was conducted to assess the “meaning” the unborn child has to the father (i.e., the internal representation of the fetus). Results show that the quality of fathers’ prenatal attachment and their representations of the fetus were interrelated. Fathers who reported a higher quality of prenatal attachment were more likely to have balanced representations of their unborn children, whereas fathers with a lower quality of attachment were more likely to show disengaged representations. Furthermore, the quality of fathers’ self-reported prenatal attachment was higher when fathers experienced fewer symptoms of depression and anxiety during pregnancy, when they were younger, and when they expected their first child. These factors were not significantly related to fathers’ internal representations of the fetus. Further research is needed to examine the effects of the prenatal father–infant relationship on postnatal father–child attachment, infant behavior, and infant development

Father's and mother's representations of the infant:Associations with prenatal risk factors

Parents' representations of their infants consist of parents' subjective experiences of how they perceive their infants. They provide important information about the quality of the parent-infant relationship and are closely related to parenting behavior and infant attachment. Previous studies have shown that parents' representations emerge during pregnancy. However, little is known about prenatal (risk) factors that are related to parents' representations. In a prospective study, 308 mothers and 243 fathers were followed during pregnancy and postpartum. Prenatal risk factors were assessed with an adapted version of the Dunedin Family Services Indicator (T.G. Egan et al., ; R.C. Muir et al., ). At 26 weeks' gestation and 6 months' postpartum, parents' representations of their children were assessed with the Working Model of the Child Interview (C.H. Zeanah, D. Benoit, L. Hirshberg, M.L. Barton, & C. Regan). Results showed stability between pre- and postnatal representations, with fathers having more disengaged representations than did mothers. In addition, prenatal risk factors of parenting problems were associated with the quality of parents' prenatal (only in mothers) and postnatal representations. This study provides valuable information concerning parents at risk of developing nonbalanced representations of their children. In clinical practice, these families could be monitored more intensively and may be supported in developing a more optimal parent-infant relationship