The Caregiving Environment and Developmental Outcomes of Preterm Infants: Diathesis Stress or Differential Susceptibility Effects?

Abstract

The interactions between premature birth and the caregiving environment on infants' cognitive and social functioning were examined. Participants were 150 infants (83 preterm, 67 full-term) and their parents. When infants were 6 months old, parents reported on their levels of emotional distress, and triadic family interactions were filmed and coded. At 12 months of age, the infants' cognitive and social functioning was assessed. Prematurity moderated the effects of maternal (but not paternal) emotional distress and triadic interactions on infants' cognitive and social outcomes. Whereas for cognitive functioning the interactions were consistent with a diathesis-stress approach, for social functioning the interactions were consistent with a differential susceptibility approach. The differential effects of the caregiving environment between groups and outcomes are discussed.

Is level of prematurity a risk/plasticity factor at three years of age?

“…Additionally, in Poehlmann et al’s (2012) study on a group of solely preterm infants, the cognitive outcomes of an easily-distressed subgroup of infants were in line with differential susceptibility. However, in Gueron-Sela et al’s (2015) study – which had a control group of full-term infants – diathesis stress best explained the interaction between prematurity and maternal emotional distress for children born between 28 and 33 weeks. Recent studies of low birth weight infants – who are often, but not exclusively preterm – also found that children’s cognitive and academic outcomes are consistent with diathesis stress (Camerota, Willoughby, Cox, Greenberg, & the Family Life Project Investigators, 2015; Jaekel, Pluess, Belsky, & Wolke, 2015).…”

“…Gueron-Sela et al’s (2015) study comparing infants born between 28 and 33 weeks gestation and full-term infants showed that preterm infants exposed to higher levels of maternal distress or low quality triadic family interactions demonstrated lower social competence than full-term infants at 12 months of age, while those exposed to low maternal distress or high quality family interactions outperformed the full-term infants on measures of social competence. Because biological risk factors affect social abilities to a smaller degree than cognitive abilities (Bendersky & Lewis, 1994), the social abilities of children born preterm may have more space to be positively impacted by high quality caregiving than their cognitive abilities.…”

“…This inclusivity has been explicitly called for in recent studies (e.g. Gueron-Sela et al, 2015). Third, despite the association between being born preterm and difficulties in motor skill development (Moster, Lie, & Markestad, 2008), this outcome has often been overlooked when investigating processes underlying the developmental outcomes of being born preterm.…”

“…However, recent research has suggested that preterm birth may, instead, be a plasticity factor (e.g. Gueron-Sela, Atzaba-Poria, Meiri, & Marks, 2015; Shah, Robbins, Coelho, & Poehlmann, 2013) – that is, a factor that makes one more sensitive to both negative and positive environmental influences (Belsky & Pluess, 2009). …”

Executive function in children born preterm: Risk factors and implications for outcome

“…111,112 Given that children born preterm already have neural and physiological vulnerabilities, they may be even more vulnerable to the deleterious effects of these stressors. 113 Unfortunately, few studies have focused on the joint roles of medical and social risk in shaping executive function outcomes in children born preterm, an important oversight given the potential role of family-based interventions in fostering EF in this population. In one study, young low birth weight children whose parents who were more warm and responsive to the child during structured play activities caught up to NBW controls on measures of EF between ages 3 and 5 years, whereas parents of low birth weight children who were more harsh and intrusive during these interactions remained behind.…”