Psychological Development of High Risk Multiple Birth Children

Vita Krall, Sherman C. Feinstein, Sherman Feinstein

• Publisher: Routledge
• Year: 2017
• Print ISBN:
  9781138093539
• eBook ISBN:
  9781351605199
• Topic: Psychology
• Subtopic: Developmental Psychology
• Index: Psychology

Originally published in 1991, this monograph presents pioneering work on the growth and development of triplets, quadruplets and quintuplets. Twelve years were spent researching the effects of multiple caregiving, low birthweight and intra-uterine conditions on the personality development of multiple birth children. Child development specialists, psychologists and clinical psychologists will find this work applies not only to multiple birth children, but also to those born with low birthweights or other high-risk complications.

CHAPTER 1

Introduction and Review of the Literature

Multiple births remain one of nature’s most fascinating and revealing phenomena. Usually considered a delightful, curious event, the birth of twins and other multiples (Scheinfeld, 1967) actually activates numerous biological, sociocultural, and psychological dimensions. This report describes the results of a longitudinal investigation of multiple birth children; quintuplets, quadruplets, and triplets studied over twelve years by a team of behavioral scientists from the Arlene and Marshall Bennett Laboratory for Child Psychiatry Research, Michael Reese Hospital and Medical Center and The Pritzker School of Medicine, University of Chicago. The project began with the opportunity to study a set of quintuplets born to a couple who had been treated with human menopausal gonadotropins as part of a fertility study. Subsequent families were added to the longitudinal study project after fulfillment of the research criteria concerning age and availability.

Prior to the use of the hormone drugs to induce pregnancy, the occurrence of multiple births beyond twins was rare. There is a large literature on twins as multiples, but little data on multiples beyond twins (Scheinfeld, 1967; review of Psychological Abstracts, 1972–1988). A major scientific emphasis in the study of twins has been comparison of monozygotic and dizygotic twins for the purpose of determining concordance or discordance for various traits or psychopathology (schizophrenia) (Feinstein, 1985). These studies have made important contributions to the understanding of genetic influence, particularly in the area of psychopathology. It was apparent to us, however, that our particular cohort would not lend itself to this type of scientific research. Our children were born as a result of fertility drugs and, hence, are all fraternal (born from multiple eggs). It would also not be possible to assume that their environments would be equal, since multiple parenting would certainly be necessary from very early infancy.

Multiple birth infants are often premature and of low birth weight (Feinstein, 1985), as were our earliest subjects. It seemed important to design a protocol that would trace these infants’ early development. There was considerable interest in the pediatric literature then and now as to the outcome of such infants and the ability to predict outcome for premature and low birth weight infants. We asked the question: How do low birth weight and premature infants fare, given the best care by parents who wanted them and had the ability to provide. Studies on low birth weight and premature infants (Sigman, & Parmalee, 1979) often included a large number of cases from lower socioeconomic families whose care had not been optimal.

We also were interested in the nature of the attachment of such low birthweight and premature infants to their mothers given their multiple birth status and the probability that there would be multiple parenting. Did multiple caretaking, particularly in the first year of life, interfere with the development of specific bonding to the mother and later development of object relationships? Did the multiple birth and multiple caretaking situation interfere with later personality development, particularly the development of a cohesive sense of self?

Our basic cohort of subjects are all fraternal and, hence, do not provide the opportunity to compare genetic and environmental influence. The probability is that in each group the amount of similarity between the multiples is no more than that between siblings of different age. However, the literature on twin comparisons can be of considerable help in evaluating the information obtained on our fraternal multiples.

MENTAL DEVELOPMENT

The publications of the Louisville Twin Study offer important information on the risk factors of prematurity and low birth weight as these affect mental development (Wilson, 1985). Their data “showed no evidence of a long-term deficit in mental development assignable to low birth weight by itself.” When low birth weight twins were matched with their higher birth weight twin, “there was no significant deficit in mental functioning.” “If there was a residual effect, it was subtle indeed and was not detected by a standard intelligence test”. They did find, however, that a combination of both very low birth weight and early delivery did seem to be related to some long-term deficit in IQ; but a large proportion of these infants were found to have come from low SES homes. They examined two possible explanations for any effect that low birth weight might have on mental functioning: poor prenatal nutrition or a symptom of a broader constellation of deficiencies. Nutrition is related to other variables such as socioeconomic status and postnatal care. The other hypothesis attempts to explain decrements on the basis of a genetic link to the prematurity status itself: that is, infants are being born who in previous times might have aborted because of other related deficiencies.

These findings support a genetic hypothesis for mental development, even when prematurity and/or low birth weight are involved. Other work (Wilson & Matheny, 1983) finds a very strong link between mental development and parental intellectual level, as measured by educational level of the mother. They do not deny the importance of an effective learning environment.

On the basis of these findings, we might have predicted (had these data been available in 1973 when our study was begun), that our low birthweight and premature infants would eventually catch up and become normative. Our initial findings, reported in 1980 (Krall, Feinstein, & Kennedy, 1980) that both scores adjusted for gestation and unadjusted scores were highly correlated with birth weight in the initial months. There was “catch up” by two years, after an initial lag in development. The question has persisted in the singleton literature for premature and low birthweight infants as to whether there are subtle residuals that will demonstrate themselves in later school years in other than IQ level.

Our infants came from upper socioeconomic families, where mother’s educational level was on the average college or above college level. We can assume both good nutritional care, as well as emotional care as based on the parental desire to have these children. A related question about intellectual development might be whether there was an equal environment in terms of stimulation for children within cohorts. Ainslie, Olmstead, and O’Loughlin (1987) question the equal environmental hypothesis for twins and suggest that parents tend to respond to slight differences in their twins, maximizing them as it were to aid in telling them apart.

ATTACHMENT

A number of studies related to the behavior of newborn twins, both full term and premature, and their attachment to the mother (Riese, 1983, 1984, 1988; Goldberg, Perrotta, Minde & Corter, 1986), and sex differences in the attachment of twins (Brooks & Lewis, 1974). Riese found a similarity in behavior within twin pairs suggesting a constitutional or genetic influence on certain behavior patterns during the neonatal period (irritability, resistance to soothing, reactivity, and reinforcement value). There was a decrease in individual consistency of scores as prematurity increased. Riese suggests that this might mean that the parent would be given “mixed signals” for parenting. In addition, full term infants were more resistant to soothing, and there were also differences in degrees of reactivity, irritability, and activity level during active sleep. Singleton full-term infants were reported by Kurzberg and associates (Kurzberg, Vaugham, Jr., Daum, Grellong, Albin, & Rotkin, 1979) to have higher performance on the visual following and auditory orienting items than low-birthweight infants.

These findings suggest that the preterm infant presents a lower level of arousal in these areas of behavior: activity level, visual following, auditory orienting, and irritability, and a quicker response to soothing. In one sense, this makes the task for the caregiver easier. In another sense, the infant does not stimulate caregiving behavior from the caretaker as well. Also, it has been found that alert and responsive infants have been shown to have more responsive and stimulating mothers (Osofsky, 1976). When there is more than one infant to be cared for as in the multiple situation, the less alert and active infant is less likely to be attended to by the caretaker.

The nature of attachment in full term and preterm twins has been addressed by Goldberg and associates (1986). In their study, a majority of low-birth-weight twins and singletons were securely attached as measured by the strange situation (Ainsworth, Blehar, Waters, & Wall, 1978). Ainsworth et al. (1978) found that mothers in securely attached full term dyads were rated in the first year as being more sensitive, accepting, accessible, and cooperative than those of the less securely attached infants. Goldberg et al. found some inconsistency in their findings for preterm infants. Ratings of maternal behavior were related to subsequent attachment, but ratings of infant behavior were not. It was suggested that the maternal ratings captured the appropriateness of maternal response and the dyadic relationship, and that the infant behaviors would not be expected to do so. Mothers who were found to be securely attached to their preterm infants were rated as more attentive and responsive to their infants at all ages, on all scales (sensitivity, acceptance, accessibility, and cooperation). Szajnberg, Skrinjaric, and Moore (1989), studying attunement and attachment in monozygotic and dizygotic twins at eleven months of age, found no significant relationship between attunement and attachment. However, he pointed out that this is an evolving phenomenon. An infant who is a high affect signaler with a low responding mother, may become a low affect signaler if mother persists: “if there is sufficient interaction between mother and infant, attunement rate may vary with time”.

There was some differential patterning found for Goldberg’s preterm infants as compared with the Ainsworth et al. full-term sample. Goldberg et al. found a reversal for the marginal and insecure attachment groups. One possibility might have been that the marginal group was misplaced with the secure group in the normative sample. Another possibility was that finding the predicted pattern from secure to marginal to insecure only at six weeks might indicate the importance of the early weeks of life in shaping attachment. Another possible explanation for the difference they found in patterning for the preterms might be that for the preterm the mother might be rated low in sensitivity for giving a great deal of auditory stimulation, for example. In other words, qualitatively different forms of maternal relatedness might be necessary to arouse the preterm infant. Another possible explanation given that is quite pertinent to our own subjects, is that for the twins in their preterm group, peer attachment and the presence of a secondary caretaker might have made up some for the diminished capacity of the maternal caretaker. They suggest that without these additional attachments they might have been in the insecurely attached group.

Since our subjects were all fraternal, sex differences in attachment would be of interest. Brooks and Lewis (1974) studied thirteen-month-old, opposite-sex twins. They found that girl twins touch, look at, and seek proximity with their mothers significantly more than do their brothers. These results seem to be related to the sex-appropriate teaching of the mothers. They suggest that maternal socialization minimizes the proximal behaviors exhibited by mother and son, while not restricting mother-daughter interaction. Brief separations from the mother were then found to affect the boys’ but not the girls’ subsequent attachment behaviors. The boys seen second exhibited significantly more proximal behaviors. They state that these same sex differences have been reported for singletons.

Specific influences that the multiple birth has on the parental relationship with the infants have been discussed by Showers & McCleery (1984). Because twins and other multiples may be separated after birth, with one or more infants remaining in the hospital for a time, there may be some interference with bonding with those infants. Hay and O’Brien (1987) found that depression and maladaptive behavior to classroom peers were much more common among those twins discharged from hospital after the cotwin. The parent may attach to the infant taken home, or later become more caring of the weaker infant on return. Szajnberg et al. (1989) found that mothers reported compensating by not attuning to their favored twin. Subsequent influences can be preferences for one or another child and attribution of positive and negative features to different children. Eventually the child may respond by attaching to other caretakers, such as grandparents, which can have a positive effect by facilitating differentiation.

PSYCHIATRIC OUTCOME

A frequent patterning that is reported for twins is a dominance-submissiveness relationship. One retrospective study of twins (Paluszny & Abelson, 1975) has shown that a large number of twins seen in a psychiatric clinic came in for dependency problems. However, there were only half as many twins referred to clinic than would be expected from their occurrence in the general population. One explanation for this finding might be the submissive-dependent relationship is not always a permanent one in any individual twinship and does not always present a problem requiring psychiatric referral. Twins are also described as having role-switching relationships, in which in one type of activity one twin is dominant and in another type of activity the other twin is dominant (Anderson, 1985). Anderson points out that the unique advantage of having a twin is often not emphasized enough. In role switching, each twin (or in the case of larger multiples, siblings) may take turns acting as a model in behaviors in which they excel. The potentiality for empathy and the understanding of a peer of the same developmental age may also be important environmentally for stimulating personal growth. The very need to compete and interact with each other may stimulate the capacity for social interrelationships.

However, in large sample studies of dominance and submissiveness in twins, Moilanen (1987, 1988) reports that submissive twins tended to have more psychosomatic symptoms, and dominant twins tended to have more nervous complaints. They explain the somatic complaints on the basis of having to adapt and be obedient, and the depression on the basis of few opportunities to feel successful, i.e. feelings of inferiority. The nervous complaints are explained by the need always to be active.

LANGUAGE DEVELOPMENT

Some research studies maintain that multiples tend to lag behind singletons in articulation and syntax elements of speech, and language development. Hay, Prior, Collett, and Wi...

Table of contents

• Cover
• Half Title
• Title Page
• Copyright Page
• Table of Contents
• Preface
• Acknowledgements
• CHAPTER 1 Introduction and Review of the Literature
• CHAPTER 2 Our Children
• CHAPTER 3 The Families and How They Coped
• CHAPTER 4 Observing How They Grew
• CHAPTER 5 Catch Up by Two Years of Age
• CHAPTER 6 Six Children and How They Grew
• CHAPTER 7 How Mother and Baby Love Influenced Development
• CHAPTER 8 Parenting and Interventions
• CHAPTER 9 The Path to Speech and Ability
• CHAPTER 10 School Days
• CHAPTER 11 Personality Development
• CHAPTER 12 Summary and Conclusions
• Index