The Connection between Parents and their Children

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The Connection between Parents and their Children

• OAPP Care Conference
• February 2, 2007
• New Orleans, LA
• Lynne M. Haverkos, MD, MPH
• National Institute of Child Health and Human
  Development/National Institutes of Health

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National Institute of Child Health and Human
Development

• The mission of the NICHD is to ensure that
  every person is born healthy and wanted, that
  women suffer no harmful effects from reproductive
  processes, and that all children have the chance
  to achieve their full potential for healthy and
  productive lives, free from disease or
  disability,

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Overview

• Background on adolescent development and
  pregnancy
• Attachment importance influences
• Depression parenting attachment
• Relevant research

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Background on Developmental Aspects of Adolescence

• Adolescence time of many changes
• Physical growth and pubertal development
• Cognitive maturation process
• Adolescent developmental tasks
• Identity development
• Independence
• Social relationships
• Search for intimacy
• Experimentation exploration

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Risk Behaviors in Adolescence

• Sexual behavior
• Tobacco use
• Alcohol and other drug use
• Injuries and violence
• Nutrition
• Physical activity

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Teen Births (15-17 yrs) by Ethnicity 1980-2003
Childstats.Gov
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Dual Roles for Adolescent Mothers

• Adolescent development
• Maternal roles responsibilities
• Potential Stressors
• - SES social support
• - academic achievement
• - history of abuse
• - depression or PTSD
• - substance abuse

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Consequences of Adolescent Pregnancy

• Infants
• - low birth weight
• - infant mortality
• - less emotional support cognitive
  stimulation
• - fewer earn high school diploma
• Teen mothers
• - limited educational attainment
• - restricted earning potential
• National Center for
  Health Statistics 2006

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Teen Pregnancy Concerns

• Teen mothers
• Provide less optimal care giving
• Less sensitive to infants cues
• Less interactive sensitivity
• Less emotional verbal
• responsiveness
• DeLissovoy 1973, Ragozin 1982,
• Barratt 1995, Garcia Coll 1986

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Teen Pregnancy Concerns

• Teens
• Lack knowledge of infant and child development
• Rate infants behavior as more difficult
• Infants
• behavioral problems
• poor communicative skills
• cognitive impairment
• school failure
• McCullough 1991, Zuravin 1988, Baldwin
  1980, Becker 1987, Furstenberg et al 1987,
  Whitman et al 1987, and Flanagan 1994.

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Maternal Infant Attachment

• - the strong affectionate tie that infants
  experience with special people in their lives
  that brings pleasure when interacting with them
  especially in stressful times.
• - childs feelings of security and capacity to
  form trusting relationships

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Maternal Infant Attachment John Bowlby
(psychoanalyst)

• Theory of Attachment
• - enduring emotional bond
• - tendency to seek and maintain
• closeness during stressful situations
• secure or anxious categories
• impact on behavior
• relationships

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Early Research on Attachment
ASPE report 1991

• Ainsworth studies - mother/infant interactions
• Ainsworth Strange Situation
• 3 categories
• secure
• anxious/avoidant
• anxious/ambivalent
• 4th category added later
• anxious/disorganized/disoriented.

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Patterns of Attachment

• Secure (65)
• Avoidant (20)
• Resistant (10-15)
• Disorganized/disoriented (5)
• Based on North American infants
• 7th edition of Child Development by Laura Berk,
  2006

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Measures of Attachment

• Ainsworth Strange Situation
• 1-2 year olds
• Attachment Q-Sort
• 1-4 year olds
• 90 descriptive attachment-related behaviors
• Adult Attachment Interview (AAI)

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Stability of Attachment

• Ranges from 30-90
• Secure and stable middle SES with favorable
  conditions
• Insecure low SES with many stressors
• Disorganized also very stable, common in child
  maltreatment

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Determinants of Attachment Patterns

• An important determinant
• mother's sensitive response to baby's needs
• Secure attachment
• positive maternal characteristics
• autonomy, flexibility nurturance
• Anxious attachment
• maternal personality disorders (depression)
• low SES social support

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Factors Affecting Attachment Security

• Opportunity to establish close relationship
• Quality of caregiving
• Infants characteristics
• Family context

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Opportunities to establish close relationship
animal studies

• Animals reared in social
• isolation
• behaviors influenced by early
• parenting
• ( Suomi,1991)
• 
  

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Opportunities to establish close relationship -
orphanages

• Institutionalized infants
• poor conditions, unfavorable outcome (Renee
  Spitz, 1946)
• more favorable conditions but many caretakers,
  late attachments (Tizard and Rees, 1975)
• Early biological programming with
• institutional deprivation effects
  heterogeneous and not deterministic ( Rutter,
  2004, Chisholm, 1998)
• Romanian orphans, relationship problems - Hodges
  and Tizard, 1989 OConnor et al, 2003

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Opportunities to establish close relationship
day care

• Study of Early Child Care and
• Youth Development (SECCYD)
• no significant main effects of child-care on
  attachment security or avoidance
• significant main effects for maternal sensitivity
  responsiveness
• family risk factors strongest predictors of
  behavior problems, prosocial behavior, and
  language skills

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Quality of caregiving

• Sensitive caregiving moderately related to
  attachment security (DeWolf and Van IJzendoorn,
  1997 Posada et al, 2002, 2004)
• Interactional Synchrony
• Highly inadequate caregiving powerful predictor
  of attachment disruptions
• Maltreated infants high rates of disorganized
  attachment

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Quality of caregiving

• Maternal caregiver characteristics
• Quality experiences of caregiver
• Self-esteem
• Depression
• Parenting stress
• Psychological distress
• Mothers perception of infant behavior

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Infant characteristics

• Ill newborns and stressed caregivers - (Willie,
  1991 van IJzendoorn et al, 1992)
• Infant temperament role is debated
• Difficult infant and anxious caregiver can lead
  to disharmonious relationships
• Caregiving can override impact of infant
  characteristics in attachment security (Seifer
  and Schilles, 1995 and Stroufe, 1985)

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Family context

• Stressors undermine attachment by interfering
  with sensitive caregiving (Thompson Reikes,
  2003)
• Social support, good parental relationships,
  mutual assistance with caregiving reduce family
  stress and predict greater attachment security
  (Owen Cox, 1997)

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Attachment in Children of Adolescent and
Non-adolescent Mothers

• Mixed results
• Lamb et al 1987, Spieker 1994, Frodi et al
  1990, Broussard 1995, Ward 1995
• Similar patterns of attachment
• Differences in adolescent parenting exist,
• but do not impair attachment
• Andreozzi et
  al 2002

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Differences in Parenting Adol. vs Non-adol.
Parents Andreozzi
et al, 2002

• Differences in parenting characteristics
• SES
• Marital status
• Parity
• Education
• Lower self-esteem
• Higher levels of depression
• Higher child abuse potential scores
• Poorer quality home environments
• 
  

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Depression, State of Mind, and Attachment

• Maternal attachment state of mind (Bosquet, 2001)
• Maternal state of mind moderates depression and
  attachment (McMahon 2005)
• Postpartum depression (Lyons-Ruth 1983, 2002
  Martin, 2000 Murray 2003)

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NIH and Other Funded Research
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Attachment related research

• Neuropeptides and fMRI
• Minding the Baby
• Health Literacy
• Child Neglect Abuse
• PTSD Depression
• Interventions with preterm infants

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Neuropeptides Social Interaction
Pollak 2005

• Oxytocin Vasopressin
• - role in social bonds and emotion
• Study of adopted orphans and parent-reared 4 year
  olds
• Conclusion critical role for early experience in
  the development of the brain systems underlying
  basic aspects of human social behavior

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Functional MRI Study of Mother/Infant Attachment
Lane Strathearn, PI

• Functional neuroanatomical correlates of
  mother-infant attachment
• Differences in mothers infant-related stress
  responses
• Disruption in attachment secondary to child
  neglect and failure-to-thrive

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Randomly Presented Facial Images in Functional
MRI L. Strathearn
2 sec
2 sec
2 sec
26 sec random inter-stimulus interval
2 sec
2 sec
Own Happy (OH)
Unknown Happy (UH)
2 sec
Unknown Sad (US)
Stimulus Types
Own Neutral (ON)
Unknown Neutral (UN)
Own Sad (OS)
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Dopamine regions activated by Own baby faces
Ventral striatum
Cingulate Cortex
Substantia nigra
VTA
Amygdala
n28, plt0.001(uncorr.)
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L. Strathearn
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Minding the Baby Lois Sadler, PI

• Building maternal competence, sensitivity, and
  responsiveness in teen mothers
• Increasing knowledge of child development and
  parenting strategies
• Helping mothers interpret infants cues
• Helping mothers understand and respond to
  infants mental and emotional states
• Supporting mothers self-efficacy
• Enhancing social support for mothers

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Does Home Visitation Promote Maternal Health
Literacy? Sandra
Smith, PI

• Significance of health literacy
• Development evaluation of Functional Health
  Literacy scales to promote higher maternal
  functioning in home and healthcare system
• Health literacy influences child development and
  health-related behaviors

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Child Neglect Among Adolescent Mothers
Robin Lanzi, PI

• Study of maternal developmental factors regarding
  onset, severity, and duration of child neglect
• Potential etiologic factors - maternal
  responsibility, depression, and social support
• Maternal practices to protect, monitor, and
  promote child's well-being.
• Should inform child neglect prevention programs

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Preventing Child Neglect in High-Risk Mothers
John Borkowsk

• Creating new mental models of parenting new
  parenting styles and practices
• Treatment combines innovative programs
• Phone interviews and maternal history
• Measuring infant attachment, language, mental
  development

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Psychobiology of PTSD Adverse Outcomes of
Childbearing Seng, J PI

• Prospective, psychobiological study to determine
  PTSDs association with adverse outcomes of
  childbearing
• Does low cortisol of PTSD in non-pregnant women
  also occurs in pregnancy?
• Evidence base for potentially modifiable
  maternity care practice guidelines including
  PTSD

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Antepartum Interpersonal Psychotherapy at 3 NYC
Sites M.
Spinnelli, PI

• Antepartum depression (APD) predicts postpartum
  depression (PPD)
• Is Interpersonal Psychotherapy adapted for APD
  (IPT-D) better than Parenting Education Program?
• Examine relationship of ethnicity and SES to
  treatment feasibility, motherhood, and attachment

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Depression Prevention for Poor Pregnant Women
C. Zlotnick, PI

• Postpartum depression occurs in 10-16 of
  recently delivered mothers
• 400,000 cases of PPD annually
• Offspring of depressed mothers are at risk of
  disturbance to infant development and child
  adjustment
• Infants of poor women with PPD are at increased
  risk of early interactional disturbances

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Depression Prevention for Poor Pregnant Women
C. Zlotnick, PI

• Postpartum Prevention Program (PPP) to enhance
  maternal sensitivity and infant attachment
• improve significant interpersonal relationships
• change mothers expectations about their
  relationships
• improve social support system
• master role transition to motherhood

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Adult Attachment and Intervention Efficacy With
Preterms D. Teti, PI

• Intervention to facilitate parent-infant
  interaction, infant physical, mental, motor, and
  socioemotional development
• Moderating role of adult attachment parental
  commitment to intervention
• Parental adjustment and sensitivity to infant

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Supporting the Development of Preterm Newborns
McElaney, PI

• gt400,000 premature infants born in US yearly
• gt50 diagnosed with emotional, behavioral or
  learning disorders by school age
• Gap in media training for parents and NICU
  personnel
• Results expected to shape NICU care delivery to
  help parents understand their infants'
  competencies and vulnerabilities

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Supporting the Development of Preterm Newborns
McElaney, PI

• modular DVD programs for parents of premies
  professionals working in NICUs
• Using mini cameras and emerging brain imaging
  technologies
• to teach about the fetal and neonatal brain the
  neurobehavioral competencies of preterm infants
  and specific care strategies

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Summary

• Adolescence is a time of change
• and challenge
• Maternal infant attachment has
• lifelong implications
• Depression can negatively
• impact attachment
• Maternal sensitivity and
• responsiveness are key issues
• Early intervention holds promise
• 
  
• Thank you