Developmental process and outcome in preterm children: a transactional study

Abstract

Data were gathered on 38 low and very low birthweight preterm and 45 matched fullterm mother-child pairs at five timepoints during infancy, and at four years. Age was corrected for prematurity in infancy, but not at age four. Information was gathered on: biological risk factors; child developmental outcome; family psychosocial function; and mother-child interaction. A multidimensional assessment of social outcome at age four included the "Waiting Task," especially designed to measure social behavior from the perspective of attachment theory.This study sought to: (1) examine developmental outcome differences between preterms and fullterms at age four; (2) use a transactional approach to the study of development to understand preterm-fullterm differences in the developmental process, over the first four years of life; and (3) describe and predict four-year child social outcome.Compared to fullterms, preterms showed a specific "academic" deficit in nonverbal cognition and visuomotor skill. They also showed a cluster of temperamental problems and less optimal parental behavior ratings, while male preterms saw themselves as less accepted by their peers. Notably, the individual preterm child had more chance of significant delay than did his/her fullterm counterpart.Biological factors were not very useful among these relatively healthy preterms as sole predictors of four-year outcome. However, smallness for gestational age was associated with poorer "academic" scores and maleness with less social skill.As suggested by a transactional framework, better prediction of four-year social outcome (in preterms and fullterms) was achieved with knowledge of environmental as well as biological data. Different sets of variables predicted outcome in the two groups, and suggested a stronger impact of familial influences on preterm outcome. There was no support for the often-hypothesized "double whammy" effect, since low SES preterms did not perform more poorly than other groups.Data analysis yielded five social behavior factors at age four, including parent, child and observer viewpoints. Combinations of early biological and environmental data predicted parental views. 12-month security of attachment predicted the child's own view of social acceptance, as well as observed "Waiting Task" behavior.