Very Low Birthweight Infants and School Readiness: What Factors Contribute to Their Success?

1. Very Low Birthweight Infants and School Readiness: What Factors Contribute to Their Success? Lisa K. Boyce, Gina A. Cook, & Kim D’zatko Utah State University Logan, UT 84322 Presented at the Society for Research in Child Development Boston, MA March 30, 2007 www.eiri.usu.edu/projects/srcd Work reported in this presentation was funded in part by the U. S. Department of Education, Office of Special Education Program (Award #H324C980138) and the Community/University Research Initiative Grant at the Early Intervention Research Institute at Utah State University, Logan, UT. Early Intervention Research Institute

2. Introduction Children begin school with differing levels of cognitive and social skills which are linked to: • School adjustment • Later academic success (Ladd, 1990; Rimm-Kaufman, Pianta & Cox, 2000). Very low birthweight (VLBW) children are more likely to begin school with problems with: • Attending • Emotional regulation • Language delays.

3. Emotional Regulation The quality of emotion exchanges between parents and their infants is an important predictor of children’s ability to regulate their own emotions and to develop self-control. Mothers regulate infant emotion states by: • Reading emotion signals • Providing appropriate stimulation • Modulating levels of arousal • Reciprocating reactions Infants regulate their mothers’ emotions through: • Receptivity to initiations and stimulation • Approaching and withdrawing from stimulation • Responding contingently to mothers’ emotions (Cole, Martin, & Dennis, 2004; p. 324; Feldman, Greenbaum, & Tirmiya, 1999)

4. Children’s Emotional Regulation Skills: • Are vulnerable to biological and environmental influences (such as prematurity) • Are susceptible to interventions and parental supports • Are related to attachment security • May change over time (Raver, 2004)

5. VLBW infants are more likely than term infants to: Have lower receptive language skills at 3 years of age (Singer et al., 2001). Have lower expressive language and memory skills at 8 years of age (Hack et al., 1992). VLBW infants’ growth in cognitive-language development up to 40 months was greater when parents: Were responsive to children’s interests Were not highly controlling or restrictive (Landry, Smith, Miller-Loncar, & Swank, 1997). Language Development

6. Study Purpose The purposes of this study were to examine the: • Correlates among early risk factors, maternal factors, infant emotionality and attachment security • Behavioral, social, and language skills of VLBW infants as they enter school • Maternal variables that may influence these school readiness skills We hypothesized that attachment security and maternal factors would mediate the effects of family and medical risks on later school readiness indicators of emotional regulation, attending behavior, and language skills. See Figure 1.

7. Maternal Mediating Factors: Sensitivity Depression Competence School Readiness Birth Risk (days on vent) Emotion Regulation Attention Language Demographic Risk (income) Attachment Security Conceptual Model

8. Sample

9. Procedures – Study 1 • Infants 1000 g or <30 weeks gestation age were recruited from 2 local Neonatal Intensive Care Units (NICU’s). • Additional NICU graduates who were <1200 g and <32 weeks were recruited to ensure adequate sample size. • Families were assigned to either a treatment group who received a seamless transition to services in their homes (InReach) or a comparison group based on the Early Intervention (EI) service area in which they lived. • Families were contacted in the NICU and a consent form was completed • In home assessment was completed 1 month after infant was discharged from the NICU and then again 1 year later

10. Procedures Follow Up Study • Data is being collected this year while children are in kindergarten thru 2nd grade. • Children are being assessed by trained data collectors • Parent Interviews are being conducted • N = 17 • Of the 55 families in the study, 23 have been located, of those, 17 have been contacted and tested, 2 have refused, and we are trying to schedule 4. We are still trying to locate the remaining 32 families.

11. Child Measures Follow up study • Woodcock Johnson III subtests: oral language, oral expression, listening comprehension, and applied problems. (Woodcock, McGrew, & Mather, 2001) • Peabody Picture Vocabulary Test. (Dunn & Dunn, 1997) • Leiter-Revised: attention subscale. (Roid & Miller, 2002)

12. Mother-Report Measures Time 1 • Child Attachment Security Q-sort. (Waters, 1987) • Child Temperament: EASI-III Emotionality subscale at 13 months after discharge (Buss & Plomin, 1984) • Parenting Stress Index : Parental sense of competence subscale. (Abidin, 1990) • Maternal Depression CES-D. (Radloff, 1977) • Mother-child Interaction Ratings: Sensitivity subscale. (adapted from Isabella, 1993) (mean of ratings of sensitivity during feeding at 1 month after discharge and feeding and play at about 1 year later) • Income Follow Up Study • Social Skills Rating System. (Gresham & Elliott, 1990)

13. Results Preliminary results support the relations between early risk factors and maternal factors as suggested by our conceptual model. • The greater the number of days on the ventilator the: • lower the mothers’ sensitivity • lower theattachment security • greater the sense of competence. • The lower the income the higher the depression score. • The higher the income the higher the sensitivity rating. • The association between maternal sensitivity and attachment did not reach statistical significance (r = .25, p = .105).

14. Results

15. Results: Follow-up Study Because, we have not yet been able to obtain our expected sample as anticipated we are not able to test our conceptual model with a series of path models as planned. Instead the following three slides illustrate our model descriptively. • First, descriptive statistics suggesting a mix of age-appropriate and below average scores on behavioral, social, and language skills are presented. • Second, a scatterplot illustrating the association between early maternal sensitivity and receptive language scores is presented as an illustration of the links hypothesized in our conceptual model. • Third, a case-study presenting scores for a mother and her child is included as a qualitative representation.

16. Results Behavioral, Social, and Language Skills at School Entry

17. Results Scatterplot of Maternal Sensitivity at Times 1 & 2 (mean) on PPVT III Scores at Time 3

18. Case Study • Female infant born at 30 weeks gestation • 50 days in the hospital • Mother did not report any signs of depression • High maternal sensitivity (mean = 4.47) • High parental sense of competence (51/60) • Secure attachment • Attention – 29/30 raw score • Vocabulary – 131 standard score • Woodcock Johnson – scored between the 90th & 99th percentiles for all subscales • SSRS – scored above average on self-control

19. Summary/Conclusions • Our preliminary results suggest that medical and demographic risks are related to maternal sensitivity and depression. • Our descriptive and qualitative early findings from our follow-up study suggest that these early maternal factors may be related to VLBW children’s later skills at school entry. • As additional study participants are located, regression analyses will be used to further test the conceptual model examining the role of attachment security and maternal factors in mediating the effects of risk factors on later school readiness indicators. • These results highlight the importance of understanding and promoting early parenting behaviors that support the special needs of these VLBW infants in order to help them establish a strong foundation for later skill development.