Julia Jäkel & Dieter Wolke

1. Changes in mother-child interactions in very preterm and fullterm dyads from preschool to middle childhood Julia Jäkel & Dieter Wolke

2. Theoretical Background I • Very preterm birth = increased risk of neurodevelopmental, cognitive, behavioural and social problems • Proximal factors of development: familial and social conditions • Differences between fullterm and preterm mother-infant dyads: Preterm infants = more compliant and less active Preterm infants’ mothers = less sensitive and more controlling

3. Theoretical Background II • Maternal sensitivity and control reflect different dimensions of parenting behaviour • Little is known about the quality of parent-child interactions beyond the infant and toddler years in preterm populations • What degree of control is appropriate in very preterm children who are more likely to experience a range of behaviour difficulties?

4. Research questions • Are mothers of very preterm children less sensitive and more controlling compared to mothers of term controls, and are the very preterm children less persistent and socially active? • How stable are the interaction patterns from preschool to middle childhood? • Do maternal sensitivity and control differently affect changes in interaction behaviour in very preterm versus control children? • What are the patterns of associations between maternal and child behavioural change in both groups?

5. Samples • Bavarian Longitudinal Study (BLS) • Geographically defined whole-population sample of very premature children and term controlsin the south of Germany very low birth weight (VLBW) = < 1500 gand/or very preterm (VP) = < 32 weeks gestationVLBW/VP • 265 families participated at all three measurement points (neonatal, 6;3 and 8;5 years of age) • 276 term control children (> 37 weeks gestation), group-matched according to sex of child, family SES, maternal age

6. Measures I • Assessment of Mother-Child-Interactionswith the Etch-a-Sketch (AMCIES)at 6;3 (T1) and 8;5 years (T2) • Each mother and child dyad wasinstructed to draw a houseaccording to a template: Etch-a-Sketch house templates, as presented at 6;3 (top) and 8;5 years (beneath)

7. Measures II • Individual sessions were videotaped and evaluated afterwards by two independent trained raters • Mother-child interactions were analyzed with a standardized coding system, the Assessment of Mother-Child-Interaction with the Etch-a-Sketch (AMCIES)(Wolke & Meyer, 2000; Wolke, Rios, & Unzer, 1995) • Rating scales • 6 subscales for the mother • 5 subscales for the child • 2 subscales for mother-child joint behaviour

8. Measures III

9. Measures IV

10. Measures V • Maternal sensitivity, non-verbal control, and criticism Index Scale Maternal Sensitivity (T1: Cronbach’s α = .56; T2: α = .60) • Maternal verbal control and joint control of the session Index Scale Maternal Verbal Control (T1: α = .52; T2: α = .80) • Maternal and child dissatisfaction and emotional tone, andjoint harmony of the session Index Scale Harmony (T1: α = .80; T2: α = .76) • Individual child behaviour scales correlated poorly with each other and between T1 and T2 Child Persistence, Social Interaction, and Activity

11. Results I Etch-a-Sketch Mean Values for VLBW/VP Children Versus Controls at 6;3 and 8;5 Years

12. Results II Individual stability of mother-child interactions over time Pearson’s correlation coefficients revealed a moderate stability of child persistence, maternal sensitivity and control, and harmony within VLBW/VP and control mother-child dyads (r = .21 - .39) Children’s social interaction and activity was unstable between T1 and T2, as indicated by low correlation coefficients (r = .04 - .13) in both groups

13. Results II Mean stability of mother-child interactions over time Repeated-measures ANOVAs: VLBW/VP children significantly improvedtheir persistence(F(1, 264) = 104.74, p < .001) and social interaction (F(1, 264) = 4.77, p < .05) Controls did not increase their persistence (F(1, 275) = .02, n.s.) and social interaction (F(1, 275) = .84, n.s.) Maternal sensitivity, verbal control, and harmony decreased in both groups Children’s overall physical activity during the test situation increased from preschool to middle childhood

14. Results III + IV Associations between individual changes in maternal and child behaviour Difference scores (T2 – T1) for each participant’s behaviour • Maternal verbal control at age 6 predicted VLBW\VP but not control children’s changes in persistence (ß = -.17, p< .01, R² =.03) and social interaction (ß = -.18, p< .01, R² =.03) over time • Changes in VLBW/VP children’s persistence were positively correlated with changes in maternal sensitivity (r = .27) and overall harmony (r = .35) • Changes in social interaction and maternal verbal control were negatively correlated (r = -.31) • Similar pattern of interactions among control mother-child dyads

15. Results IV Associations between mean changes in maternal and child behaviour • Repeated-measures MANOVAs, each with one maternal and one child variable • Significant interaction effects in both groups:

16. Results IV Sensitivity Sensitivity Verbal Control Verbal Control Persistence Persistence Figure 1: Interaction Effects Between VLBW/VP Children’s Persistence, Maternal Sensitivity and Verbal Control Over Time (n = 265) Figure 2: Interaction Effects Between Fullterm Children’s Persistence, Maternal Sensitivity and Verbal Control Over Time (n = 276)

17. Discussion I • The present study investigated patterns of change in dyadic mother-child interactions of VLBW/VP children and term controls from preschool to middle childhood • VLBW/VP children = less persistent and socially active during the task • Mothers of VLBW/VP children = less sensitive and more controlling • Adaptive behaviour pattern

18. Discussion II Similar patterns of change in dyadic interactions: • Maternal sensitivity, verbal control, and overall harmony decreased in both groups but • VLBW/VP children improved their persistence and social interaction over time whereas control children did not • Evidence for a developmental catch-up of VLBW/VP children

19. Discussion IV Our results suggest similar patterns of interactions between the changes in maternal and child behaviour • Developmental plasticity of former VLPW/VP infants • Transactional model of dynamic reciprocity between maternal and child behaviour over time We propose a careful evaluation of highly controlling maternal behaviour among at-risk mother-child dyads with respect to the child’s age and specific developmental needs.

20. Conclusion • Robust mean differences between VLBW/VP and control mother-child dyads’ interactions • Similar patterns of behavioural change in the two groups, but significant improvements in persistence and social interaction from 6 to 8 years only among VLBW/VP children • Maternal control affects changes in very preterm but not control children’s interaction behaviour • Similar patterns of interaction effects between maternal and child behavioural change in both groups More information is needed on the dynamic interplay of the child’s developmental needs, individual maternal and child characteristics, and adaptive maternal behaviour