Wijnroks, Alexander

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   University of GroningenDimensions of mother-infant interaction and the development of social and cognitivecompetence in preterm infantsWijnroks, AlexanderIMPORTANT NOTE: You are advised to consult the publisher's version (publisher's PDF) if you wish to cite fromit. Please check the document version below.Document VersionPublisher's PDF, also known as Version of recordPublication date:1994Link to publication in University of Groningen/UMCG research databaseCitation for published version (APA):Wijnroks, A. (1994). Dimensions of mother-infant interaction and the development of social and cognitivecompetence in preterm infants. Stichting Kinderstudies.CopyrightOther than for strictly personal use, it is not permitted to download or to forward/distribute the text or part of it without the consent of theauthor(s) and/or copyright holder(s), unless the work is under an open content license (like Creative Commons).The publication may also be distributed here under the terms of Article 25fa of the Dutch Copyright Act, indicated by the “Taverne” license.More information can be found on the University of Groningen website: https://www.rug.nl/library/open-access/self-archiving-pure/taverne-amendment.Take-down policyIf you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediatelyand investigate your claim.Downloaded from the University of Groningen/UMCG research database (Pure): http://www.rug.nl/research/portal. For technical reasons thenumber of authors shown on this cover page is limited to 10 maximum.Download date: 08-06-2022In otherd to laterrr for thesignificantinfants innt in ourrelated torere is nonegativelys.rry, whichrdition forr insecurebr optimal' of expec-attachment:ach other.or modelsppropriate-ir personallell, 1974:'feelings ofonsiveness,:nces, both|9), that arnd yet stillotivation tort issues innracteristicmost likelYdevelopingin general,rat is suitedthat a rigidsk may notrutcome. Inat a higherthe infant'sn particularSI]MMARYThis thesis reports on a longitudinal study investigating the contribution ofcharacteristics of the preterm infant and its social environment o individualdifferences in social and c.ognitive competence. This study was aimed atclarifying some of the mechanisms or potential pathways by means of whichinfant characteristics and early mother-infant interaction interact and predictinfant competencies. A second objective of the study was to investigate theeffects of a short-term intervention program. The purpose of the programwas to facilitate cognitive competence in preterm infants by improving theinfant's responsiveness and its ability to regulate attention and emotionthrough the enhancement of the mother's sensitive responsiveness and thequality of her stimulation. The results of this study are thought to increaseour understanding of what constitutes a beneficial environment for thedevelopment of preterm infants. Such knowledge is intended to provide cluesfor the development of effective intervention strategies in future.Chapter 1 is a general introduction to the subject of this thesis. It is claimedthat the preterm or low-birth-weight infant is known to be at risk to developlearning disabilities, visual motor deficits, language delays, attention-deficitdisorders and behaviour abnormalities, but that it has been difficult to predictat an early stage of development which infants will later have such problems.Further, longitudinal studies have shown that to predict the probabilities ofdevelopmental outcomes in children born prematurely with any degree ofcertainty, both the infant's characteristics and the quality of the caregivingenvironment have to be considered. However, exactly what constitutes abeneficial social environment for infants born prematurely is not known. Inparticular, research is needed to identify the aspects of maternal interactionswhich are effective with preterm infants.In this study attention will be paid to the influence of problems in posturalcontrol on mother-infant interaction and cognitive competence. Although,relationships between a preterm birth and postural problems have frequentlybeen demonstrated, there is hardly any knowledge about the short- andlongterm consequences of these problems. Finally, little is known of thedevelopment of preterm infants in terms of changes and stability. To increaseour knowledge on these themes, this study investigates age-changes andinter-age stability of the infant's interactive behaviour, its ability to learncontingencies, its ability to solve problems, its general cognitive status andquality of attachment.201Chapter 2 is a theoretical chapter and it is divided into two parts. In the firstpart, from different theoretical viewpoints, ways in which maternal activitiesmay influence several aspects of the child's competence in the areas ofsocial-emotional, oognitive, motivational and attentional development aresuggested. The second part describes the characteristics and development ofpreterm inÍants. We trace in how far the dimensions of maternal behaviouriclentified in part I are of special relevance for the development of preterminfants. After a discussion of some problems in the interpretation of diffe-rences in early mother-infant interactions befween preterm infants and theirfull-term counterparts, a rationale for intervention is formulated. Theintervention program, which is based on current theories about attention,emotion regulation and stimulation, intends to encourage the mother toprovide stimulation that is not too intensive and that is given at the rightmoment without interupting the infant's attention and activities.In Chapter 3 the design (short-term longitudinal) and method of the study aredescribed. Testing occurred in 5 waves and covered the period 6 months totwo years of age. ln order to evaluate the effects of the interventionprogram, a non-equivalent, untreated control group design with a pretest anda posttest was used. The sample under study consists 66 mothers and theirpreterm infants. lnfants were born after pregnancies of less than 37 weeks inthe Groningen University Hospital. The mothers of 25 infants receivedintervention (the intervention group). The remaining 41 infants formed thetotal control group. The 25 dyads of the intervention group were matchedwith 25 infants (i.e. the matched control group) of the total control group.Intervention was given at 6, 9 and 12 months. Investigation occurred on thefbllowing area's: mother-infant interaction; quality of attachment andcognitive competence. De following aspects of cognitive competence weredistinguished: general cognitive status, contingency learning, and problemsolving. Observations of mother-infant interacties were undertaken in thehome at 6, 9, and 12 months using videorecordings. Quality of attachmentwas assessed at 12 and 18 months in the laboratory using the StrangeSituation. The Bayley Scales of Infant Development were used at 6, 72 and24 months to assess the infant's general cognitive status. A contingencylearning task was developed to investigate the infant's ability to learncontingencies. It was used at 6 and 12 months. Finally, two problemssolving tasks were developed to exarnine the intant's problem solving abilityat 18 and 24 montlrs.In Chapter 4 the development and determinants of interactions and attach-ment between mothers and their preterm infants are investigated. Next, theresults of the effect of the intervention program on mother-infant interaction202ti rrlÀrlrlSbdf tIIpclalITi rtfina(inp ltct i r' SmaÍatc(ind tstmqrIn the firstrl activitiese areas ofrpment arelopment ofbehaviourof pretermn of diffe-s and theirated. Theattention,mother tot the right: study aremonths tortervention)retest and; and their7 weeks ins receivedbrmed thee matchedrol group.red on thement andence werei problem:en in thelttachmente Strange6, 12 andrntingencyto learnproblemsng abilityrd attach-\ext, therteractionare presented. Finally, the relationship between mother-infant interaction andquality of attachment are discussed.The results of the observations of mother-infant interactions revealedthat, of all the infant interactive behaviours studied, only 'duration' and'intensity of positive emotional behaviour' changed over the 6 month period,in particular between 9 and 12 months. As infants became more clear intheir emotional displays, mothers increased in 'sensitive responsiveness'.Mothers of preterm infants showed a moderate to high degree of stability intheir interactive behaviour during the second half of the first year of life oftheir children, while the correlations for the infants indicated mainly in-stability. The relationships between maternal and infant interactivebehaviours were not initially very strong, but became stronger with in-creasing age. Zero-order correlations revealed that 'sensitive responsiveness'and 'involvement' of the mother were positively related to 'positive infantemotional behaviour' and 'responsiveness' of the infant. Further, ourfindings confirmed in part those found by researchers that a high intensity ofmaternal stimulation is related to more negative responses in infants. Such apattern, however, was found only after 6 months.In contrast to our expectations, the relationship between neonatalcharacteristics and mother-infant interaction increased over time. Further, itappeared that mothers of infants scoring high on a neonatal risk index weremore likely to be more active than mothers of infants scoring low on the riskindex. In addition, significant relationships were found between the level ofthe mother's anxiety during the period of infant's hospitalization and herinteractive behaviour. Mothers who reported to be very anxious were moreactive, scored at a higher rate on level of involvement and stimulated theirinfants more intensively than mothers who reported to be less anxious. Earlyproblems in postural control appeard to be related to the infant's rather thanto the mother's interactive behaviour.Slight effects of the intervention program on mother-infant interac-tion could be detected. Mothers who received intervention scored higher on'sensitive responsiveness' and stimulated their infants less intensively thanmothers who received no intervention. Infants of intervention mothersappeared to be more 'responsive' than infants of control mothers.As predicted, the preterm infants in our study were not insecurelyattached more often than infants in normal, low-risk populations. On thecontrary, we found somewhat more securely attached infants and fewerinsecurely-resistant infants than expected on the basis of normative data. Ourdata and those of many others clearly indicate that the mother-infant relation-ship is strongly biologically buffered from perturbations in early develop-ment. Our data showed that maternal and infant behaviour could predict thequality of attachment relatively well, in particular at 18 months.203In Chapter 5 the results concerning the development and determinants ofthree aspects of cognitive competence, general cognitive status, contingencylearning and problem solving, are reported. In addition, the relationshipsbetween neonatal characteristics, problems in postural control and theseaspects of cognitive competence are discussed. Finally, the results of theeffect of the intervention program on each of these aspects are presented.At each age, the mean scores on the Mental Index of the BayleyScales of Infant Development, which were used as an index for generalcognitive status, were within the normal range, but somewhat lower than thescores reported in studies using comparable samples. A relatively highpercentage of mental delay (28 %) was found at 24 months. One of themost important factors which was predictive of a negative cognitive outcomeat age 2, was the presence of more or less severe problems in posturalcontrol in the second half of the first year of life. No significant effècts ofthe intervention program on general cognitive status could be found.The results of the contingency learning task showed that 6-month-oldpreterm infants had problems learning the contingency. These prttblems wereno longer present at 12 months. Regarding the relationship hetween themeasures across the ages, it was found that infants who did not detect thecontingency at 6 months were more likely to have problems controlling thefeedback at 12 months, while those who were able to control the feedback at6 months were equally likely to be able to control the fèedback at 12months. Significant relationships were found between contingency learningat the one hand, and general cognitive status at the other, although not allrelationships were in the expected direction. For example, at 12 months ofage a curvelinair relationship was found between the speed of contingencydetection and the scores on the mental index of the Bayley. Infants whoperceived the contingency at a moderately fast speed had higher mentalscores than either fast or slow perceivers. Speed of contingency detectionwas in a similar way related to neonatal factors, neurological status andproblems in postural control. Each time, moderately fast perceivers weremore optimal than fast or slow perceivers. The intervention program ap-peared not to be eftèctive with regard to the ability to perceive contingen-cies. However, as predicted, it was found that the intervention group spentmore time examining the contingency relationship befirre they started tocontrol the fèedback than the control group.ln comparison to 18 months, infants at 24 months were morecompetent and more active in solving cognitive problems, and showed lessfrequently inattentive behaviour. This final result probably means that at 24months infants are better able to sustain attention fbr a longer time than at i8months. Competenoe in problem solving and inattention showed moderate tohigh inter-age stability. Infants who often looked somewhere other than at204IIItrCCCm(bothttican(tiv,coÍmaoutTprrCrembehpromollessbacwhrtheinsrdevinsetionsohconron. trminants ofcontingency:elationshipsI and thesesults of the:sented.the Bayleyfor general,ver than theatively highOne of the.ive outcomein posturalnt eftècts ofnd.6-month-oldoblems werebetween the)t detect thentrolling thefeedback atlback at 12ncy learningough not all2 months ofcontingencyInfants whogher mentalcy detectionI status and:eivers were)rogram ap-e contingen-group spenty started towere moreshowed lesss that at 24e than at 18moderate tother than atthe task were less competent in problem solving and scored lower on themental scale of the Bayley. No indication was found that a premature birthmay lead to attentional problems before the second year of life. On the otherhand, early problems in postural control were negatively related to com-petence in problem solving and positively to inattention. Finally, no effectsof the intervention program could be detected with respect to the infant'scompetence in problem solving and attentional organization.The major issues in Chapter 6 are the identification of the mother and infantvariables which are most strongly related to variations in infant cognitiveperformance and the clarification of the way in which these variables arerelated to underlying processes of attention and motivation. In addition, therelationship between measures of cognitive competence and quality of attach-ment are discussed.Maternal and infant interactive behaviour appeared to be related tocognitive status, concurrently as well as longitudinally. Consistent with theresults of studies of normal infants, the relations were generally weak tomodest, but became stronger with increasing age. Further, it appeared thatboth maternal and infant variables could predict cognitive status, althoughthe percentage of unexplained variance remained relatively large. In par-ticular, the degree with which mothers stimulated their infant's developmentand the infant's 'responsiveness' appeared to be the 'best' predictors. 'Sensi-tive responsiveness' and 'non-intrusiveness' were only marginally related toconcurrent and subsequent cognitive status. No indication was found thatmaternal stimulation of a high intensity was related to a low cognitiveoutcome in preterm infants.Some significant relationships were found between maternalbehaviour and contingency learning, but not between maternal behaviour andproblem solving. Most interestingly, mothers of infants who were notmotivated to master the contingency at 12 months were more intrusive andless sensitively responsive than mothers of infants who did control the feed-back.Independent of the age at which attachment was measured, infantswho were securely attached had higher mean scores on the Mental Index ofthe Bayley Scales of Infant development at 24 months than infants who wereinsecurely attached. However, when individual differences in continuity ofdevelopment was controlled for, the differences between securely andinsecurely attached infants were no longer significant. No significant rela-tionships were found between quality of attachment and aspects of problemsolving ability. Similarly, no significant relationships were found betweencontingency learning at 6 months and quality of attachment. At 12 months,on the other hand, it was found that infants who detected the contingency205swiftly (fast perceivers) were more likely to be insecurely attached to theirmothers at t, and 18 months of age than infants who needed more time todetect the contingencY.In Chapter 7 some important findings are linked and discussed in moregenerat^terms. Further, our main conclusions are given. In particular, thefiuestion whether high levels of maternal stimulation may have a negativeeffect on the develópment of preterm infants is discussed. Furthermore,attention is paid to tïe finding that the intervention had a very restrictedeffect. Finaliy, some suggestions for the development of home-based inter-vention Programs are given.206

Dimensions of mother-infant interaction and the development of social and cognitive competence in preterm infants

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Dimensions of mother-infant interaction and the development of social and cognitive competence in preterm infants

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