Identification of Developmental Risk in Infants with Medical Problems: A Program of Research
Holditch-Davis, Diane L.
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Session presented on Saturday, July 25, 2015: This session will summarize my lifetime of research on the needs of youngest patients with whom nurses work: premature and other high-risk infants. These infants are at high-risk for developmental and health problems throughout childhood and into adulthood. As such, interventions to reduce this risk or to improve parenting or the emotional distress in their mothers can have a lifetime of benefit for them. The major focus of this program of research has been examining risk for developmental problems. In particular, I have examined three related threads: identifying the effects of parenting and parental psychological distress on developmental outcomes, using measures of biological risk to predict developmental outcomes, and improving developmental outcomes. Although I have explored these threads in premature infants, medically fragile infants, infants of HIV positive mothers, infants of infertile couples, and infants of low income mothers, most of my studies have focused on premature infants so this presentation with focus primarily on this population. Premature, and other medically at risk infants, have a high incidence of developmental problems. Although major developmental disabilities occur in only about 10% of premature infants, by school-age 50% of prematurely boRNhildren show at least minor problems. Prediction of developmental outcome is difficult because development is not just a result of the neurological competencies of the child, rather developmental outcomes are the result of complex interactions between the child's developmental status and the social environment. Thus, there is not a one:to:one relationship between neurological insults and outcomes. Therefore, one focus of my research program has been on identifying the effects of parenting and parental psychological distress on infant development. For example, we found that at hospital discharge 40-50% of mothers of preterm infants have elevated depressive symptoms and 6 months later 20-25% still have elevated depressive symptoms. The level of depressive symptoms was more closely related to Maternal characteristics, particularly stress and worry, than to infant illness severity. My research has also found high levels of other types of psychological distress in mothers: anxiety, worry, acute stress, and post-traumatic stress disorder. These high levels of psychological distress may affect infant development by altering mother-infant interactions. We have found that elevated stress symptoms and worry are closely correlated with the quality of mother-infant interactions. We also identified a parenting style common in mothers of pre-school aged prematurely boRNhildren that we called 'compensatory parenting' because, the mothers reported that their major goal in parenting was to compensate the child for what he or she went through in the NICU. This compensatory parenting style developed as a result of the mother's emotional reactions to prenatal factors and the neonatal illness. It further developed as a result of disrupted Maternal role attainment, the child's subsequent health problems, and personal and family factors. This compensatory parenting style may be one factor contributing to the developmental problems in premature infants. Another focus of my research has been the prediction of developmental outcomes in medically at risk infants particularly using measures of biological risk and the social environment. I examined the development of sleeping and waking states as markers of developmental risk. Sleep and waking involve wide spread areas of the brain and require integration of neuronal population from the brain stem to the cerebral cortex. Both the patteRNg of sleep-wake states and the brain undergo rapid development in the preterm period. In two longitudinal studies, I showed that sleep-development in the preterm period could be used to predict cognitive and language development 2 to 3 years later. Finally, I am conducting studies to improve the developmental outcomes of premature infants. In my study of a nursing support intervention for mothers of preterm infants, my colleagues and I are testing an intervention for rural African American mothers of premature infants. By improving Maternal psychological well-being and use of early intervention services, we were able to improve parenting but not the developmental outcomes of the infants. In a study of Mother-Administered Interventions for premature infants, I examined the effects of two Maternally administered interventions for preterm infants on infant health and development, Maternal psychological well-being, and the Maternal-child relationship. Administering one of these interventions allows the mother to assume a specific role in the care of her infant in the hospital. We found that only kangaroo care had an effect on Maternal distress and then only on lowering worry. Both interventions affected the mother-infant interactions although the effects were stronger on infant behaviors than mother behaviors.