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The Connection between Parents and their Children: 

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

National Institute of Child Health and Human Development: 

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, …

Overview: 

Overview Background on adolescent development and pregnancy Attachment – importance & influences Depression – parenting & attachment Relevant research

Background on Developmental Aspects of Adolescence: 

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

Risk Behaviors in Adolescence: 

Risk Behaviors in Adolescence Sexual behavior Tobacco use Alcohol and other drug use Injuries and violence Nutrition Physical activity

Teen Births (15-17 yrs) by Ethnicity 1980-2003 Childstats.Gov: 

Teen Births (15-17 yrs) by Ethnicity 1980-2003 Childstats.Gov

Dual Roles for Adolescent Mothers: 

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

Consequences of Adolescent Pregnancy: 

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

Teen Pregnancy Concerns: 

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

Teen Pregnancy Concerns: 

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.

Maternal Infant Attachment: 

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. - child’s feelings of security and capacity to form trusting relationships

Maternal Infant Attachment John Bowlby (psychoanalyst): 

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

Early Research on Attachment ASPE report 1991: 

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.

Patterns of Attachment: 

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

Measures of Attachment: 

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)

Stability of Attachment: 

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

Determinants of Attachment Patterns: 

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

Factors Affecting Attachment Security: 

Factors Affecting Attachment Security Opportunity to establish close relationship Quality of caregiving Infant’s characteristics Family context

Opportunities to establish close relationship – animal studies : 

Opportunities to establish close relationship – animal studies Animals reared in social isolation behaviors influenced by early parenting ( Suomi,1991)

Opportunities to establish close relationship - orphanages: 

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; O’Connor et al, 2003

Slide21: 

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 Opportunities to establish close relationship – day care

Quality of caregiving: 

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

Quality of caregiving: 

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

Infant characteristics: 

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)

Family context: 

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)

Attachment in Children of Adolescent and Non-adolescent Mothers: 

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

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

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

Depression, State of Mind, and Attachment: 

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)

Slide30: 

NIH and Other Funded Research

Attachment related research: 

Attachment related research Neuropeptides and fMRI “Minding the Baby” Health Literacy Child Neglect & Abuse PTSD & Depression Interventions with preterm infants

Neuropeptides & Social Interaction Pollak 2005: 

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

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

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

Slide34: 

Randomly Presented Facial Images in Functional MRI L. Strathearn Own: Happy (OH) Unknown: Happy (UH) Unknown: Sad (US) Own: Neutral (ON) Own: Sad (OS) Unknown: Neutral (UN) 2 sec 2 sec 2 sec 2 sec 2 sec 2 sec 2–6 sec random inter-stimulus interval Stimulus Types

Dopamine regions activated by “Own baby” faces: 

Amygdala Cingulate Cortex VTA Ventral striatum Dopamine regions activated by “Own baby” faces Substantia nigra n=28, p<0.001(uncorr.)

Slide36: 

L. Strathearn

“Minding the Baby” Lois Sadler, PI: 

“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 infant’s mental and emotional states Supporting mothers’ self-efficacy Enhancing social support for mothers

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

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

Child Neglect Among Adolescent Mothers Robin Lanzi, PI: 

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

Preventing Child Neglect in High-Risk Mothers John Borkowsk: 

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

Psychobiology of PTSD & Adverse Outcomes of Childbearing Seng, J PI: 

Psychobiology of PTSD & Adverse Outcomes of Childbearing Seng, J PI Prospective, psychobiological study to determine PTSD’s 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

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

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

Depression Prevention for Poor Pregnant Women C. Zlotnick, PI: 

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

Depression Prevention for Poor Pregnant Women C. Zlotnick, PI: 

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

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

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

Supporting the Development of Preterm Newborns McElaney, PI: 

Supporting the Development of Preterm Newborns McElaney, PI >400,000 premature infants born in US yearly >50% 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

Supporting the Development of Preterm Newborns McElaney, PI: 

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

Summary : 

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