Leila Beckwith

Characteristics of attachment organization and play organization in prenatally drug-exposed toddlers

Prenatally drug-exposed toddlers were compared to preterm toddlers of similar low socioeconomic status, ethnicity, and single-parent households on intellectual functioning, quality of play, and security of attachment to the primary caregiver. The drug-exposed toddlers had significantly lower developmental scores, less representational play, and the majority had insecure, disorganized, avoidant attachments. In all areas investigated, the prenatally drug-exposed toddlers showed more subtle behavioral deficits within each domain. Although developmental quotients were within the average range, they were significantly lower than the preterm comparison group and did not adequately represent the more evident deficits seen through play in an unstructured situation. Unstructured assessments that required the childs initiation, goal setting, and follow-through were more revealing of developmental disorganization within and among domains than were adult structured assessments such as developmental tests. While modest differences were seen in structured tasks, the marked differences between the drug-exposed and preterm groups were most evident in the unstructured tasks. The lack of coherence across developmental domains was illustrated by the large difference between developmental quotient scores and the poor performance in the cognitive representional competencies demonstrated in play. Insecurity and disorganization in attachment were found to compromise further the development of the drug-exposed toddlers.

Quality of attachment and home environments in children prenatally exposed to PCP and cocaine

Quality of attachment, disorganization in attachment, and the contribution of caregiver interactions in the home were investigated for infants prenatally exposed to PCP and cocaine and their caregivers. The drug-exposed infants were compared with infants of similar ethnicity, socioeconomic status (SES), and living in the same geographical area of the city with non-substance-abusing mothers. The majority of drug-exposed infants were insecurely attached to their caregivers and did not differ in the percentage of security in the three caregiving environments in which the infants were growing up: biologic mother care, kinship care, or foster mother care. The majority of drug-exposed children were disorganized. Change in caregivers during the first year was not found to be related to the rate of insecurity in any of the caregiving environments. The majority of the non-drug-exposed comparison infants were securely attached, and only a small percentage were disorganized. The high incidence of insecurity in the drug-exposed group is discussed in relation to maternal and environmental circumstances that can alter the assumption of security in attachment for the majority of children and caregivers toward insecurity in attachment.

Maternal Sensitivity during Infancy and Subsequent Life Events Relate to Attachment Representation at Early Adulthood.

A prospective longitudinal research study of 86 prematurely born children from birth to age 18 years provided empirical evidence for continuity from infancy experience to representations of attachment at age 18 years. Young adults whose representation of attachment was dismissing had been objectively observed during infancy, 16-17 years earlier, to receive less sensitive maternal care than those infants who were later judged at early adulthood to have secure or preoccupied representations. Infancy experience alone did not differentiate young adults with secure representations from those with preoccupied representations. Rather, adverse life events through age 12, particularly parental divorce, reduced the likelihood of secure representations and increased the likelihood of preoccupied representations. The absence of adverse life events did not increase the likelihood of security for those who had not experienced early sensitive caregiving.

Cognitive development in preterm infants: birth to 8 years.

This report summarizes the outcome at age 8 of a group of preterm infants followed intensively from birth. The study was designed primarily to follow the processes of interaction between biological and environmental factors in determining the childhood outcome of infants born preterm rather than to report the incidence of particular types of outcomes for special subgroups of infants. A high percentage of the children were performing within the normal range. Social factors played a major role in determining the outcome regardless of neonatal complications. Functional assessment of newborn visual attention and sleep organization showed a modest relation to outcome. A subgroup of preterm infants from Spanishspeaking families, for cultural and language integration reasons, followed a somewhat different course from infancy to childhood outcome than did the group from English-speaking families. The results suggest that in longitudinal studies of preterm infants, different cultural and language groups should be analyzed separately so that one may understand the developmental processes and outcomes.

Preterm birth: Hazardous obstetrical and postnatal events as related to caregiver-infant behavior

It has been suggested that diminished caregiver-infant interaction is likely with biologically-at-risk infants. This paper examines the question: Does the presence of adverse conditions surrounding the pregnancy and birth interfere with caregiver-infant interaction with preterm infants? Birth weight, gestational age, length of hospitalization, hazardous obstetrical, and postnatal events in a sample of 123 preterm infants were correlated with caregiver and infant behaviors in naturalistic observations in the home when the infants were one-month-old. Caregiver behaviors were related to prior events such that the infants who had experienced a more hazardous biological course received more social interaction as well as routine caretaking. Infant behaviors were also related to prior obstetrical and postnatal events. Infants with a more hazardous course had a shorter period of wakefulness and were less irritable during their awake time. The results suggested that hazardous obstetrical and postnatal events tended to alter infant behaviors and enhanced, rather than diminished, caregiver-infant interaction with preterm infants, at least 1 month of age.

Early intervention in the family system: A framework and review

A framework for understanding the effect of early intervention on family structure and functioning is presented. The framework uses five sets of variables to characterize families: Their ecology; and the values, roles, personalities, and interactions of family members. Twenty research studies that met criteria of having comparison/control groups, beginning intervention either prenatally or during the first 3 months of infancy, and directing intervention to family functioning are abstracted and examined in detail. Successful and unsuccessful studies are compared as to population and nature of intervention. Two criteria of success are used: (1) The commonly used criterion of any positive change; (2) a more rigorous criterion of change in at least three areas of family functioning, based on the assumption that more pervasive change will have more lasting influence on child development. Application of the first criterion found that 75% of early family focused intervention studies showed a successful outcome. Application of the latter criterion found that 50% showed a successful outcome. Further, there were no significant differences between successful and unsuccessful studies as to target group or type of intervention. The review suggests that early intervention targeted at family functioning is effective and that a more pervasive and sustained effect is likely if the intervention includes at least 11 or more contacts over at least a 3-month period.

Why does infant attention predict adolescent intelligence

Abstract Ninety-three 18-year-olds were tested with measures thought to tap information processing, sustained attention, executive function, and intelligence. The visual fixation patterns and home rearing conditions of these adolescents, born preterm, had been observed in early infancy. Infant fixation durations were negatively associated with information processing, executive function, and intelligence scores but did not predict ability to sustain attention. Continuity between infant attention and adolescent intelligence was moderated by qualities of the home environment so that “short-looking infants” whose caregivers vocalized a great deal had mean intelligence quotients that were 20 points higher than “long-looking infants” with less vocal caregivers. The results suggest that at least some of the continuity between infant attention and adolescent intelligence stems from infant capacities to process information efficiently and to inhibit prepotent responses and that this continuity is affected by caregiver responsiveness.

Continuity in cognitive abilities from infancy to 12 years of age

Abstract The aim of this study was to determine the nature of the continuity between a measure of duration of fixation at infancy and later cognitive competence. Sixty-seven 12-year-olds, born preterm and followed from birth, were tested with measures of information processing, sustained attention, and capacity to use relevant and irrelevant novel information. As hypothesized, short fixation durations were predictive of accuracy on a speeded information processing task requiring focused attention and were unrelated to sustained attention at 12 years. Neonates who fixated visual stimuli briefly were also more successful at adolescence on verbal analogies in which novel information was irrelevant than those who as neonates looked for long durations at unchanging visual stimuli. Intelligence at age 12 was a function of the characteristics of the infant and of the caregiving environment considered jointly.

Psychopathology, mother–child interaction, and infant development: Substance-abusing mothers and their offspring

The course of severe depressive symptoms from pregnancy to 6 months postpartum, as well as the occurrence of severe paranoid symptoms prenatally, were examined by the Millon Clinical Multiaxial Inventory I and the Beck Depression Inventory, in 78 women who were heavy, chronic cocaine users and who retained custody of their children after birth. Six months postpartum, the quality of caregiving was observed and assessed in the home, and the children were assessed on the Bayley MDI Index in the laboratory. Mothers who were depressed and paranoid prenatally, regardless of whether the depression continued to 6 months postpartum, were less sensitive in caregiving than women without severe symptoms of paranoia or depression during pregnancy or those who reported only depression that lifted by 6 months postpartum. Mothers who were depressed prenatally and continued to be depressed by 6 months postpartum, regardless of the presence or absence of paranoia, had infants who earned lower Bayley MDI scores than the offspring of women without severe psychological symptoms or women whose depression had lifted. Severe depressive symptoms during pregnancy, if they did not continue to 6 months postpartum, did not appear to adversely influence either caregiving or infant functioning.

Caregiving behaviors and early cognitive development as related to ordinal position in preterm infants.

Naturalistic home observations of 54 preterm infants and their caregivers were made when the infants were 1, 3 and 8 months of age. Differences were found in the kinds of everyday transactions which occur with preterm infants raised with and without siblings. At 1 month of age the care of firstborn and later-born infants was similar in most ways. At 3 months and 8 months firstborn infants clearly received more responsive care and more stimulation from their mothers than later-born infants. Furthermore, the firstborn infant received more social transactions from anybody. Firstborn preterm infants obtained higher Gesell developmental scores than later-born infants, replicating results reported with infant test performance of full-term infants.