Suna Eryigit-Madzwamuse

Very preterm/very low birthweight infants’ attachment: infant and maternal characteristics

Objective To investigate whether there are differences in attachment security and disorganisation between very preterm or very low birthweight (VP/VLBW) (<32 weeks gestation or <1500 g birthweight) and full-term infants (37–42 weeks gestation) and whether the pathways to disorganised attachment differ between VP/VLBW and full-term infants. Design The sample with complete longitudinal data consisted of 71 VP/VLBW and 105 full-term children and their mothers matched for twin status, maternal age, income and maternal education. Infant attachment was assessed with the Strange Situation Assessment at 18 months of age. Maternal sensitivity in the VP/VLBW and full-term samples was rated by neonatal nurses and community midwives in the neonatal period, respectively, and mother-infant interaction was observed at 3 months. Infant difficultness was assessed by maternal report at 3 months and infants developmental status was assessed with the Bayley Scales (BSID-II). Results Most VP/VLBW (61%) and full-term (72%) children were found to be securely attached. However, more VP/VLBW (32%) than full-term children (17%) had disorganised attachment. Longitudinal path analysis found that maternal sensitivity was predictive of attachment disorganisation in full-term children. In contrast, infants distressing cry and infants developmental delay, but not maternal sensitivity, were predictive of disorganised attachment in VP/VLBW children. Conclusions A third of VP/VLBW children showed disorganised attachment. Underlying neurodevelopmental problems associated with VP/VLBW birth appear to be a common pathway to a range of social relationship problems in this group. Clinicians should be aware that disorganised attachment and relationship problems in VP/VLBW infants are frequent despite sensitive parenting.

Personality of adults who were born very preterm

Objectives To examine very preterm (gestational age at birth <32 weeks) and/or very low birth weight (birth weight <1500 g: VP/VLBW) adults’ personality and risk taking when compared with term controls. To investigate whether differences between VP/VLBW adults and controls remain after taking their general cognitive abilities into account. Design The Bavarian Longitudinal Study is a geographically defined prospective cohort study of neonatal at-risk children born in 1985/1986 in Germany. A total of 200 VP/VLBW and 197 controls completed main outcome measures including broad autism phenotype, personality traits (eg, introversion, neuroticism), and risk taking at 26 years of age. Results When compared with term controls, VP/VLBW adults scored significantly higher in autistic features, introversion and neuroticism but not in conscientiousness and closeness scales. They also reported lower risk taking. Profile analysis showed higher introversion, autistic features and neuroticism and lower risk taking as unique features of VP/VLBW adults (Fwithin-group=0.81, ns; Fbetween-group=49.56, p<0.001). These characteristics were found to load onto a single profile factor which was equivalent between the VP/VLBW and control samples (χ2=12.49, df=7, ns; comparative fit index=0.98). VP/VLBW birth significantly predicted the profile factor (β=0.33, p<0.001) and explained 11% of its variance. Adjusting for general cognitive deficits did not alter the findings. Conclusions VP/VLBW birth poses an important risk for a global withdrawn personality, as indicated by being less socially engaged (introversion), low in taking risks, poor in communication (autistic features) and easily worried (neuroticism). This profile might help to explain the social difficulties VP/VLBW individuals experience in adult roles, such as in peer/partner relationships and career.

Uniting Resilience Research and Practice With an Inequalities Approach

The concept of resilience has evolved, from an individual-level characteristic to a wider ecological notion that takes into account broader person–environment interactions, generating an increased interest in health and well-being research, practice and policy. At the same time, the research and policy-based attempts to build resilience are increasingly under attack for responsibilizing individuals and maintaining, rather than challenging, the inequitable structure of society. When adversities faced by children and young people result from embedded inequality and social disadvantage, resilience-based knowledge has the potential to influence the wider adversity context. Therefore, it is vital that conceptualizations of resilience encompass this potential for marginalized people to challenge and transform aspects of their adversity, without holding them responsible for the barriers they face. This article outlines and provides examples from an approach that we are taking in our research and practice, which we have called Boingboing resilience. We argue that it is possible to bring resilience research and practice together with a social justice approach, giving equal and simultaneous attention to individuals and to the wider system. To achieve this goal, we suggest future research should have a co-produced and inclusive research design that overcomes the dilemma of agency and responsibility, contains a socially transformative element, and has the potential to empower children, young people, and families.

Self and parent perspectives on health-related quality of life of adolescents born very preterm.

OBJECTIVES To test whether health-related quality of life (HRQL) based on societal standards differs between very low birth weight/very preterm (VLBW/VP) and full-term (FT) adolescents using self and parent proxy reports. Also, to examine whether self and parent reported HRQL is explained by indicators of objective functioning in childhood. STUDY DESIGN This prospective cohort study followed 260 VLBW/VP adolescents, 12 VLBW/VP adolescents with disability, and 282 FT adolescents. Objective functioning was assessed at 8.5 years; HRQL was assessed at 13 years with the Health Utilities Index Mark 3 (HUI3). RESULTS Adolescents reported more functional impairment than their parents especially in the psychological aspects of health. The mean difference in HUI3 multi-attribute utility scores between FT and VLBW/VP adolescents was small (parents: 0.91 [95% CI, 0.90, 0.92] vs 0.88 [95% CI, 0.86, 0.90]; adolescents: 0.87 [95% CI, 0.85, 0.89] vs 0.84 [95% CI, 0.82, 0.86]), but high for VLBW/VP adolescents with disabilities (0.18, 95% CI, -0.04, 0.40). Objective function did not predict HRQL in FT adolescents but contributed to prediction of HRQL in VLBW/VP adolescents without disabilities. Different indicators of objective functioning were important for adolescent vs parent reports. More variation in HUI3 scores was explained by objective function in VLBW/VP parent reports compared with adolescent reports (25% vs 18%). CONCLUSIONS VLBW/VP adolescents reported poorer HRQL than their FT peers in early adolescence. Improvement in HRQL as VLBW/VP children grow up is, at least partly, explained by exclusion of the most disabled in self reports by VLBW/VP adolescents and the use of different reference points by adolescents compared with parents.

Body-esteem of pupils who attended single-sex versus mixed-sex schools: A cross-sectional study of intrasexual competition and peer victimization

In intrasexual competition (competition for reproductive resources), bullying can be viewed as a tool to devalue competitors, gain a high status and a powerful, dominant position in the peer group which may lead to beneficial gains such as access to potential romantic partners. This study investigated the relationship between intrasexual competition, bullying victimization and body-esteem, in single-sex versus mixed-sex schools. 420 participants completed a body-esteem scale, a retrospective bullying questionnaire, and intrasexual competition scales. Our results showed that relational victimization was associated with low body-esteem for both females and males. Females in single-sex schools experienced higher intrasexual competition which in turn was associated with their body-esteem directly and indirectly via relational victimization. In males, intrasexual competition was indirectly associated with body-esteem via relational victimization. Interventions to improve body esteem may focus on reducing intrasexual competition and peer victimization.

Attention problems in relation to gestational age at birth and smallness for gestational age

BACKGROUND While it is well established that very preterm birth (gestational age at birth <32 weeks) is related to increased attention problems, there is still considerable uncertainty of the effects of moderate or late preterm birth or smallness for gestational age (SGA) on attention regulation. AIMS To investigate the impact of gestational age at birth and SGA, birth on child attention problems. STUDY DESIGN Prospective longitudinal cohort study. SUBJECTS A total of 1435 children sampled from the Bavarian Longitudinal Study (BLS). OUTCOME MEASURES Main outcome variables were parent-reported attention problems and examiner-reported attention skills at 6 and 8 years. Predictors were linked to attention outcomes using hierarchical regression analyses. RESULTS Gestational age at birth ranged from 25 weeks to 41 weeks. We found a quadratic effect of gestational age on attention problems (β6 years=0.161, 95% CI=0.085; 0.236; β8 years=0.211, 95% CI=0.135; 0.287), and attention skills at 6 and 8 years (β6 years=-0.178, 95% CI=-0.252; -0.104; β8 years=-0.169, 95% CI=-0.243; -0.094). Elective caesarean birth did not predict child attention. In adjusted models, SGA was an additional risk factor for attention problems (β=0.080, 95% CI=0.026; 0.134), and attention skills (β=-0.091, 95% CI=-0.143; -0.039) at 6 years but not at 8 years after adjusting for child sex and family SES. CONCLUSION Adverse effects on attention are disproportionately higher at early gestations. In contrast, the impact of SGA status was found to be similar at all gestational ages but disappeared by 8 years.

Patterns of Childcare Arrangements and Cognitive Development

Objectives: The current study investigated (a) whether identifiable patterns of childcare arrangements from birth to 51 months exist and (b) whether these patterns moderate cognitive development from 18 months to 51 months in relation to maternal stimulation of language and infant difficult temperament controlling for SES and child gender. Methods: Of the 1201 who participated in the Families, Children Childcare Study, 978 were included in the current study. Data were collected when children were 3, 18, 36 and 51 months old regarding their mother-reported childcare arrangements, mother-reported child temperament and objective tests of cognitive and language abilities. Results: Six prevailing patterns of childcare arrangements were identified. Variations were found across these in predicting cognitive development. For all types, cognitive ability at 18 months influenced language ability at 36 months, which in turn influenced cognitive ability at 51 months. Cognitive scores at 18 months were directly and significantly influential on cognitive ability at 51 months only in the ‘maternal to centre-based care’ and ‘multi types’ patterns of childcare. Early and ongoing centre-based care predicted higher language ability at 36 months but its impact was not evident at 51 months. When girls entered centre-based care after they were 3 years old, their cognitive scores were negatively influenced. Low family SES was a risk factor for language ability at 36 months when children were not introduced to any non-parental care before the age of three years. Conclusion: This study helped to understand that the particular childcare pathway from birth to the start of school interacts with family and child factors to contribute to child cognitive outcomes at 51 months. This information should be relevant to families as they make decisions about when to start or stop different types of child care during infancy and preschool years.

PS-253 Autistic Features, Personality And Risk Taking Of A Very Preterm And/or Very Low Birth Weight Community Sample Of Adults

Background and aims Previously low risk-taking was reported in very preterm (VP: gestational age at-birth <32 weeks) and/or very low birth-weight (VLBW: birth-weight <1500 grams; subsequently VP/VLBW) samples. Unknown is whether there are other specific personality characteristics associated with VP/VLBW adults. The aim of this study was to examine autistic features, personality characteristics and risk-taking attitudes of VP/VLBW in comparison to full-term controls at 26 years of age. Methods The Bavarian Longitudinal Study is a geographically defined prospective whole population sample of neonatal at-risk children born in Germany. The sample comprised of 200 VP/VLBW adults and 197 controls. The test battery included the Broad Autism Phenotype Questionnaire (autistic features), the Big-5 Inventory (personality), and the Arnett Inventory of Sensation Seeking (risk-taking). Results Compared to the control sample, VP/VLBW adults scored significantly higher in autism, introversion and neuroticism but not in conscientiousness and openness scales. They also reported decreased risk-taking. Profile analysis showed introversion, decreased risk-taking, autism and neuroticism as unique features of VP/VLBW compared to controls (Fwithin-group = 0.70, ns; Fbetween-group = 49.56, p < 0.001). These characteristics also loaded into a single profile factor (χ2 = 7.99, df = 4, ns; CFI = 0.984). VP/VLBW birth significantly predicted the profile factor (β = 0.33, p < 0.001) and explained 11% of its variance. Conclusions VP/VLBW birth poses an important risk for a global withdrawn personality, as indicated by being less socially engaged (introversion), low in taking risks, poor in communication (autistic features) and easily worried (neuroticism). This profile might help to explain the social difficulties VP/VLBW individuals experience in adult roles, such as in peer/partner relationships and career.

Communities of practice in community-university engagement: Supporting co-productive resilience research & practice

For the last 10 years, we have been exploring Communities of Practice (CoPs) as both a conceptual and practical approach to community-university engagement, most notably in our work on resilience with children, young people and families. We have found elements of CoP theory and practice to be a powerful and pragmatic way to approach many of the tensions, considerations and nuances of this work. This chapter focuses on our experiences (academics and community partners) of running a CoP with a diverse membership that meets monthly to discuss, disagree and debate about resilience research and practice. We outline those theoretical areas we have found invaluable in getting us started with CoPs, but we also discuss where we have found ourselves needing to develop our own approaches to help us with the complex circumstances and systems, rather than within one single domain. We identify a series of paradoxes that we have to navigate in making our CoP work—particularly the tensions between being social but intentional in our practice, and how we can disentangle the blend of participation and learning that occurs in our CoP space. We conclude by turning to the future, to consider the conceptual development that might be helpful in this area and to reflect on the potential of supporting co-productive research and practice in pursuing social goals through communities of practice.

Boundaries and Boundary Objects: An Evaluation Framework for Mixed Methods Research

While mixed methods research is increasingly established as a methodological approach, researchers still struggle with boundaries arising from commitments to different methods and paradigms, and from attention to social justice. Combining two lines of work—social learning theory and the Imagine Program at the University of Brighton—we present an evaluation framework that was used to integrate the perspectives of multiple stakeholders in the program’s social interventions. We explore how this “value-creation framework” acts as a boundary object across “boundaries of practice,” specifically across quantitative and qualitative methods, philosophical paradigms, and participant perspectives. We argue that the framework’s focus on cycles of value creation provided the Imagine Program with a shared language for negotiating interpretation and action across those boundaries.