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The Effects of Prematurity on Development: Process Studies: Attachment Literature

Given the differences in interactional patterns noted between premature infants and their mothers, many investigations have anticipated a greater incidence of insecure attachment patterns in premature infant-mother dyads. However, a large body of research has failed to support this expected association (e.g., Goldberg, Perrotta, Minde, & Corter, 1986; Easterbrooks, 1989; van Ijzendoorn, Goldberg, Kroonenberg and Frenkel, 1992). In fact, in a meta-analysis of attachment studies conducted on clinical samples including premature mother-infant dyads, van Ijzendoorn, Goldberg, Kroonenberg and Frenkel (1992) concluded that the premature birth was not likely to affect attachment relationships. However, close scrutiny indicates that the premature infants in their meta-analysis were of relatively low-risk by contemporary standards. That is, the mean birth weight of these infants was above 1500 grams and their gestational age was greater than 30 weeks. Therefore, the sample of studies investigated may not be representative of the range expected in premature populations which may be needed to influence the effects of prematurity on attachment?

Indeed, when premature mother-infant dyads have been examined according to various risk factors, differences in attachment security do emerge. For example when high-risk premature infants are compared to low-risk premature infants, the former is often found to be insecurely attached (Plunkett, Meisels, Stiefel, Pasick & Roloff, 1986; Willie, 1991; Mangelsdorf, Plunkett, Dedrick, Berlin, Meisels, McHale, & Dichtellmiller, 1996). Plunkett et al. (1986) interpreted these findings to suggest that prolonged separation may cause anxiety and depression in mothers and that this emotional state coupled with an infant who is hard to soothe may lead to insecure attachment. This interpretation is consistent with attachment (Bowlby, 1958) and transactional theories (Sameroff & Chandler, 1975), as it suggests that both maternal and infant characteristics contribute to the quality of the dyadic relationship. It should be noted that results from two of these studies suggest a tendency for high-risk premature infants to shift from security to insecurity over time rather than toward security, as is often seen in full-term samples (Plunkett, Meisels, Stiefel, Pasick & Roloff, 1986; Mangelsdorf, Plunkett, Dedrick, Berlin, Meisels, McHale, & Dichtellmiller, 1996). This therefore suggests that the effects of early aberrations in maternal and infant bonding may become more pronounced over time. These findings concur with Greenberg, Carmicheal-Olson and Crnic, (1992) who have documented secure attachment patterns in premature children at age one year, yet found insecure attachment patterns in the same group some four years later. Mangelsdorf et al (1996) interpret similar findings to suggest that delays in mental and physical development of premature children may also extend to delays in the attachment system. Therefore, assessment of attachment patterns in the first year of the premature child's life may not be an accurate assessment of the relationship between premature infants and their mothers.

The process and attachment studies described thus far, support the assumptions of the transactional model first described by Sameroff and Chandler (1975) in that they emphasise how maternal and infant vulnerabilities contribute to the quality of early relationships and out of these mutual influences, development proceeds. In addition, Horowitz (1992) emphasises that in order to progress beyond the results already obtained, research needs to be better informed of the constituent components of the transactional system which may play a pivotal role in some developmental outcomes and not others. According to Magyary Brandt, Hammond, and Barnard, (1992) both mother and infant's attachment processes during the early post-natal period may play a pivotal role in the social and emotional functioning of premature children's later development.

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