Risk and protective factors in post-natal Risk and protective factors in post-natal developmentdevelopment

• Birth defects and prematurity place child at risk for developmental difficulties

• Impact of risk factors depends on post-natal environment

-- parent-child relationship

-- resources available to the parent

A. Assumptions of Transactional ModelA. Assumptions of Transactional Model

• Everything depends on everything else

• RiskRisk and protectiveprotective factors operate at:

-- all levels of Bronfenbrenner model

-- all stages of development

• R and P factors affect all developmental tasks: cognition, language, socio-emotional

Person in Person in context andcontext and time time

GENES

COGNITIONS

ANS

CNS

MOTIVES

AF

FE

CT

PERSONPERSONBEHAVIOR

SUPPORTIVENESS

STR

UC

TUR

E

FAMILY

FUNCTIONING

COMMUNITY

ATTITUDESVIO

LENCE

LEGAL

RESOURCESATTIT

UDES

STRUCTUREHEALTH

SYSTEM

SOCIETY

B. Evolution of transactional model in B. Evolution of transactional model in medicine and psychologymedicine and psychology

a. Medicine: biological risk

Continuum of reproductive casualty (Pasamanick)

• Direct relation between severity of impairment and severity of birth defect

• Conclusion based on retrospective data:

(Do people with the same level of reading disability have the same level of birth defect?).

Retrospective study: Given the outcome, try to Retrospective study: Given the outcome, try to reconstruct the causereconstruct the cause.

Continuum of caretaker casualty (Sameroff)

• Birth defects of similar severity are associated with range of outcomes

• Social class and family factors affect the link between severity of birth defects and severity of developmental problems.

• Based on prospective studies (Do people with same risk factor show the same outcome).

Prospective study: Follow people with the same Prospective study: Follow people with the same risk factor forward in timerisk factor forward in time.

Pasamanick’s continuum of reproductive casualtyPasamanick’s continuum of reproductive casualty

Severity of biological injury

mild severe

Severity ofdevelopmentalprblems

Normal

Severe

Normal

mild

Continuum of reproductive casualty Continuum of reproductive casualty + Continuum of caretaking casualty = Transactional + Continuum of caretaking casualty = Transactional

modelmodel

Severity of biological injury

Severity of developmentalproblem

Normal

Severe

Severe

High risk caretaking environment

Low risk caretakingenvironment

Normal

C. Contribution of parent and child to post-natal C. Contribution of parent and child to post-natal parent-child relationshipparent-child relationship

• Normal term Child’s contribution

• Premature child’s contribution

• Nondepressed parent’s contribution

• Depressed parent’s contribution

Normally Developed Child At BirthNormally Developed Child At Birth

1. Visual discrimination

-- movement

-- borders of high contrast

-- complex stimuli

2. Auditory discrimination

-- frequencies within normal voice range

-- vocal inflections

-- high frequencies

3. Use attentional focus to control adult behavior

Mutual reinforcement of feelings of effectiveness

Physically immature or impaired childPhysically immature or impaired child

1. Less responsive and alert

2. Unreadable cry (respiration problems)

3. More fussy, squirmy

Response of parent of premature/impaired childResponse of parent of premature/impaired child

1. Less involved with child

2. Hold further from body

3. Touch less

4. Talk less

5. Place in face-to-face positions less

A. Parents of premature infants try harder

B. Differences decrease over time

Caretaker difficulties: Depressed mothersCaretaker difficulties: Depressed mothers

Reduction in effortful parentingReduction in effortful parenting

1. Response to infant:

slower, less contingent, less consistent

2. Little positive affect

3. Less likely to use exaggerated speech

4. Can be more hostile, intrusive, or irritable

Infants of depressed mothersInfants of depressed mothers

1. Look less at the mother

2. Less happy

3. More fussy and irritable

Parent at risk + Child at riskParent at risk + Child at risk(Bugenthal study)(Bugenthal study)

Child

Mom Difficult Easy

Feels incontrol

OK BEST

Feelspowerless

WORST OK

D. Broader context of parent-child interactionD. Broader context of parent-child interaction

--- What causes parents to become depressed, - What causes parents to become depressed, compromising caretaker-infant relationships?compromising caretaker-infant relationships?

• stressors in broader environment (Vaughn et al study)

-- What can help reduce the negative outcomes in -- What can help reduce the negative outcomes in troubled caretaker-infant dyads?troubled caretaker-infant dyads?

• supports in the broader environment (Pianta et al study, Crockenberg)

Person in Person in context andcontext and time time

GENES

COGNITIONS

ANS

CNS

MOTIVES

AF

FE

CT

PERSONPERSONBEHAVIOR

SUPPORTIVENESS

STR

UC

TUR

E

FAMILY

FUNCTIONING

COMMUNITY

ATTITUDESVIO

LENCE

LEGAL

RESOURCESATTIT

UDES

STRUCTUREHEALTH

SYSTEM

SOCIETY

Community Disadvantage

Linking stress, distress, parenting, child difficultiesLinking stress, distress, parenting, child difficulties

Stressors Distress Reduction ineffortfulparenting

Difficultchildbehavior

-interpersonal-noninter-personal

Linking stress, distress, parenting, child difficultiesLinking stress, distress, parenting, child difficulties

Stressors Distress Reduction ineffortfulparenting

Difficultchildbehavior

-interpersonal-noninter-personal

SupportSupportSupportSupport

StressStress

Vaughn et al. (1979)

Data: Minnesota

Outcome variable: Changes in security ofof attachment between 12 and 18 mo.

Predictor variable: Stressful life eventsbetween 12 and 18 months

31% changed attachment status in thishigh-risk sample

Change from secure to insecure wasassociated with high stress

Stress and changes in attachment securityStress and changes in attachment securityMinnesota Low Income Sample

Attachment type Stress score

12 months 18 months Mean

Secure Anxious 10

Anxious Anxious 7

Anxious Secure 6

Secure Secure 5

How stress and support affect attachmentHow stress and support affect attachment Pianta, Sroufe, & EgelandPianta, Sroufe, & Egeland

Stress ----> decline in maternal sensitivity (responding appropriately to child)

Support ---> increase in maternal sensitivity

Example: Crockenberg study

Outcome: Infant Attachment at 12 moOutcome: Infant Attachment at 12 mo. (Strange situation)

Predictor variables:

1. Mother's responsiveness (3 mo.)

(Time to respond to child distress)

2. Irritability ( 1 week)

(Neonatal Behavioral Assessment)

3. Social support (3 mo.)

(Mother's report of support - stress)

Findings:

1. More support ----> Less insecure babies

2. Mother's unresponsiveness & infant irritability ----->

insecure attachment only if support is low

Minnesota Study: Adult BPD

• Disorganized attachment

• Maltreatment

• Difficult Child Temperament

• Maternal Stress

• Maternal Hostility

Note: Supportive adults promoted adult health

F. Implications of transactional model for research F. Implications of transactional model for research and interventionand intervention

• InterventionsInterventions --> reduce risk, increase protective factors

• Interventions usually with multi-risk multi-risk families: high risk, low protection

• Even if experiment works for group as whole it may not work for subgroup most in need