Preterm infants who are prone to distress: differential effects of parenting on 36‐month behavioral and cognitive outcomes

Abstract

Background The differential susceptibility (DS) model suggests that temperamentally prone-to-distress infants may exhibit adverse outcomes in negative environments but optimal outcomes in positive environments. This study explored temperament, parenting, and 36-month cognition and behavior in preterm infants using the DS model. We hypothesized that temperamentally prone to distress preterm infants would exhibit more optimal cognition and fewer behavior problems when early parenting was positive; and less optimal cognition and more behavior problems when early parenting was less positive. Methods Participants included 109 preterm infants (gestation < 37 weeks) and their mothers. We assessed neonatal risk and basal vagal tone in the neonatal intensive care unit (NICU); infant temperament and parenting interactions at 9 months postterm; and child behavior and cognitive skills at 36 months postterm. Hierarchical regression analyses tested study hypotheses. Results Temperamentally prone-to-distress infants exhibited more externalizing problems if they experienced more critical parenting at 9 months (β= -.20, p<0.05) but fewer externalizing problems with more positive parenting. Similarly, variations in maternal positive affect (β= .25, p< .01) and intrusive behaviors (β= .23, p< .05) at 9 months predicted 36-month cognition at high but not at low levels of infant temperamental distress. Higher basal vagal tone predicted fewer externalizing problems (β= -.19, p< .05). Conclusions Early parenting behaviors relate to later behavior and development in preterm infants who are temperamentally prone to distress, and neonatal basal vagal tone predicts subsequent externalizing behaviors. These findings suggest that both biological reactivity and quality of caregiving are important predictors for later outcomes in preterm infants and may be considered as foci for developmental surveillance and interventions.

Risk Factors for Internalizing and Externalizing Problems in the Preschool Years: Systematic Literature Review Based on the Child Behavior Checklist 1½–5

“…In some studies, temperament is associated with IEP, but it can also be a moderator between other risks (e.g., contextual, maternal) and IEP (c.f. Poehlmann et al 2012). This is consistent with Belsky's (1997) differential susceptibility hypothesis, which argues that the environment affects children differently depending on their temperament.…”

“…One study (Poehlmann et al 2012) indicated that intrusive and frustrated interactions between parents and children do not increase IEP, but the same study reported that low developmental stimulation (Poehlmann et al 2012) is associated with IEP. Other studies stated that low emotional stimulation (Twomey et al 2013) and less sensitive parenting (Ciciolla et al 2014) increase the odds of children developing IEP.…”

Depression and anxiety symptoms of mothers of preterm infants are decreased at 4 months corrected age with Family Nurture Intervention in the NICU

“…Early mother-infant interactions following term birth are critical factors in child development (Forcada-Guex et al 2011;Hofer 1994;Meijssen et al 2011) and are of great relevance for premature infants due to their increased vulnerability to cognitive, socio-emotional, and behavioral difficulties (Feeley et al 2005;Landry et al 2003). Enhanced sensitivity and responsiveness between mothers and preterm infants can lead to better long-term outcomes in cognitive and social development (Feeley et al 2005;McManus and Poehlmann 2012;Poehlmann et al 2012). Work by others suggests that promoting more optimal parent-infant interactions through an educational and behavioral intervention may lead to reductions in post-discharge maternal depression and anxiety (Melnyk et al 2008).…”

Desarrollo de la Inteligencia en Niños en Edad Preescolar con Desventajas Socioeconómicas

“…The findings revealed that the risk for poor intellectual performance was increased more for the children of the smoking mothers than the non-smoking mothers. Similarly, Poehlmann et al (2012) reported that early exposure of pregnant women to stress caused more critical parenting, and this consequently caused externalizing problems at 9 months. In the same fashion, Evans et al (2011) also reported pre-birth period as an important time frame for maternal depression and its effect on children's cognitive developments.…”