From parents' point of view, significant proportions of very low birth weight adolescents experience more emotional and behavioral problems and less competence than normative adolescents. In contrast, very low birth weight adolescents state less problems and similar or higher competence than normative adolescents. Very low birth weight adolescent girls report more emotional and behavioral problems compared with their parents than very low birth weight adolescent boys do. Externalizing problems in very low birth weight adolescent girls are often not recognized by parents. To better understand these seemingly paradoxical findings and to develop adequate intervention programs, there is a need for prospective longitudinal studies.

This modified version of the Mother-Infant Transaction Program improved cognitive outcomes at corrected age of 5 years for children with BWs of <2000 g.

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BackgroundIt is well documented that heightened levels of parenting stress have a negative influence on children’s socio-emotional and behavioral development. Parenting stress may therefore be regarded as an outcome variable in its own right. This study investigated whether a sensitizing intervention influences stress reported by parents of prematurely born children until the children were age nine.MethodsPreterm infants (N =146, birth weight <2,000 g) were randomized to intervention (N =72) with the Mother-Infant Transaction Program (MITP) or a preterm control group (N =74) that received standard hospital care. A term reference group comprised 75 healthy, full-term neonates. Parents reported on the Parenting Stress Index (PSI) when the children were 6 months, 1, 2, 3, 5, 7 years old and on the PSI-Short Form (PSI-SF) at age 9. Main outcomes were the mother’s and father’s reports of total, child and parent-related stress. Cross-sectional and longitudinal analyses were performed using linear mixed models (LMM), taking dependency in the data caused by twin pairs and repeated measures into account. Response rates were high across all follow-ups, and still reached 85% from mothers and 72% from fathers at 9 years.ResultsMothers in the intervention group reported better longitudinal development of child-related stress than mothers of preterm controls, as they perceived their children as being more adaptable and less moody throughout childhood until the age of seven. Less stress in the intervention group was revealed by cross-sectional analysis of maternal reports at all ages, while fathers reported similar differences at ages three and five. Parents in the intervention group reported stronger agreement on several stress scores on several occasions. Fathers with high interventional participation (mean 54%) reported significantly less stress at age nine than those who participated less. Both parents in the intervention group reported levels of stress similar to those experienced by the term reference group at all follow-ups, while differences between the preterm control and term reference groups increased.ConclusionsThis early intervention reduces stress among parents of prematurely born children to a level reported by parents of term-born children and enhances agreement between parents.Trial registrationClinical Trials Gov identifier NCT00222456, 05.09.2005.

This study examined whether the Mother-Infant Transaction Program prevents behavioral problems among preterm children (birth weight < 2000 g) until age 9. The program was administered to 72 preterms, while 74 preterms and 75 full-terms formed control groups (N = 221). Behavior was reported by parents (Child Behavior Checklist) and teachers (Teachers Report Form) and by all on selected Strengths and Difficulties Questionnaire (SDQ) questions. Long-term behavioral development appeared to be qualitatively unaffected by the intervention. At ages 7 and 9, fewer attention problems and better adaptation to school were reported from parents and teachers of the intervention group compared to preterm controls. At age 9, teachers reported fewer difficulties in the intervention group and better academic performance. In these areas they were reported as being at the statistically same level as term controls.

There is a need of clear guidelines about the discharge process from the NICU. This issue must be given further attention.

The Tromsø Intervention Study on Preterms (TISP) randomized 146 preterm-born children either to the Mother-Infant Transaction Program (MITP) or to a preterm control group. Previously, significant reductions of child behavior problems and maternal stress have been reported in the intervention group. This follow-up study examines whether the MITP may have affected the longitudinal adaptation between mothers and their children from two until nine years, expressed as associations between different behavioral problems and parenting stress reported by mothers. Associations between internalizing, attentional, and social problems and different dimensions of parenting stress were analyzed in separate models that included effects of time and group status. The MITP did not influence the development of longitudinal associations as no significant three-way interaction (stress*group*time) was found. Significant stress by group interactions was only found in reports on children’s attentional problems when analyzed with parent- or interaction-related stress. Mothers who had participated in the MITP reported weaker stress–behavior associations than control mothers. This effect was moderated by two independent variables, namely children’s birthweight and years of maternal education for the parent–child difficult interaction stress.

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