2nd Biennial Conference of the International Association for the Study of Attachment (IASA)

(St. John’s College, Cambridge, UK, August 29-31 2010)

Attachment relationships and psychosomatic development

of the child in families with a preterm baby. A study in DMM perspective.

Franco Baldoni MD, PhD, Associate Professor in Clinical Psychology, Faculty of Psychology, Head of Attachment Assessment Lab, Department of Psychology, University of Bologna, Italy

In collaboration with Elisa Facondini, Nicola Ro meo, Mattia Minghetti,

Andrea Landini and Patricia M. Crittenden

Abstract 2nd Biennial Conference of International Association for the Study of Attachment (IASA)

(St. John’s College, Cambridge, UK, August 29-31 2010), pp. 9-10.

Abstract

The aim o f this study is to assess at tachment and the ro le o f Mother -Father-

Child relat ionship in the family with preterm born child (< 1500 gr) from 3 months

to 1 year corrected age compared with a control group of families with term-born children (>

2500 gr).

20 preterm and 20 term couples with their babies were studied (120 subjects). Mother-Child

and Father-Child couples were subjected to CARE-Index and both parents to AAI, Dyadic

Adjustment Scale (DAS), CES-D and STAI Y-2. The child’s psychomotor development

was assessed by the Bayley Scales of Infant Development (BSID II). Attachment

assessment fo llowed the DMM cr iter ia.

Preterm mothers presented high r isk int eract ive behaviors at CARE -Index

( low scores at Dyadic Sensibilit y Scale , p<.002) and high anxiety (p <.01). Preterm

fathers presented low scores at Dyadic Sensibilit y Scale (p<.004) and depressive

symptoms (p<.009). In interact ion, at tachment forerunners suggest an insecure

attachment in preterm mothers (p<.008) and fathers (p<.006) and in preter m

children in t he interact ion with the mother (p<.05). These r isk factors were

correlated, in both parents, with low performance o f the child at Bayley Scales

(p<.04). Preterm mothers presented r isk factors as difficult ies with the ir orig inal

family and a high anxiety fo r the death of the child. Fathers o f p reterm children

frequent ly have a negat ive percept ion of the child and uncomfortable feeling s wit h

it , st ressful events in the last year and a n unsat isfied percept ion of the hospita l

care.

The result s show in the pret erm family insecure forerunners o f at tachment

and high r isk interact ive behavior s with t he baby. In part icular, mothers and

fathers with insecure at tachment and psycho logical difficult ies (unreso lved losses

or t raumas, anxiety, depression), could influence the psychomotor development of

the preterm child. These data will be useful for the organizat ion of specific

programs for prevent ion and t reatment of psycho logical difficult ies in the preter m

child and in its family.

2

Data from the World Health Organization show how premature birth is a very frequent

phenomenon and on the increase in recent years: from 10 to 15% on international estimates and

from 8 to 9% in Italy. Technological progress in medicine has enhanced longer survival in children

born with very low birth weight (VLBW) and consequently subject to greater neonatal

complications and somatic and developmental pathologies. In the treatment of newborns and

assistance to parents, this has meant a gradual shift from a healing objective to that of taking care

and promoting quality of life of the whole family (Jackson et al., 2003). To this end, collaboration is

needed among the various specialists (gynaecologists, neonatologists, psychologists,

physiotherapists, etc.) (Missionier, 2005; Soubieux, Soulè, 2007).

In the family with a preterm birth child, the couple interaction and the relationship between

parents and children are complex. Studies in this field have investigated in detail the influence of

preterm birth on the psychological and somatic development of the baby, on the emotional state of

the mother and on her complex relation with the child. In the literature, frequent psychological

problems have been imputed to the baby’s immaturity (Goldberg, Di Vitto, 1995), early separation

experiences and emotional difficulties of the mother (Negri, 1998; Monti, 2000; Tracey, 2000,

Poehlmann, Fiese, 2001; Muller-Nix et al., 2004). In some of these women a rigid attitude in

interaction and in stimulation of the baby and a specific inhibition of affect expression have been

described. These behaviours have been interpreted as adaptive defences towards the preterm child’s

difficulties, but they have been also considered intrusive, controlling and potentially dangerous

patterns for the child (Greenberg et al., 1992; Minde, 2000; Coppola, Cassiba, 2004). Quality of

interactive exchanges between mother and child in the first months of life has been revealed to be

the most efficient predictor of cognitive, linguistic development and general adaptation at 6 months

(Smith et al., 1996), as well as cognitive, linguistic and psychomotor development at 9 months, and

cognitive development at 12 months (Poehlmann, Fiese, 2001). Moreover, an important role seems

to be played by parent reaction in front of the premature birth experience: a higher level of stress

and maternal depression in child’s first semester of life usually results in a higher incidence of

child’s behaviour problems at the age of three (Miceli et al., 2000). Among other risk factors we can

list low socio-economic level (Bacharach and Baumeister, 1998), lack of adequate social support

(Miceli et al., 2000), a history of infant abuse in the mother (Trickett, 2010) and absence of the

paternal figure (Ricciuti, Scarr, 1990).

Recent studies described preterm babies and their mothers as relatively competent in the

relation, at least after the first year (Caplan, Mason, Kaplan, 2000). These results contradict past

research data and could be the consequence of medical and psychological progress in neonatal care

(intensive neonatal operative units development, better nursery operators child care, involvement

3

and presence of parents during hospitalization, better psychological aid to the family) (Beltrami et

al., 2000; Coppola, Cassibba 2004). A check of past studies validity is important.

It has been evidenced how preterm birth represents a risk factor for the development in the

child of insecure attachment and of cognitive, affective-relational and social difficulties (Muller-Nix

et al., 2004; Trombini et al., 2008). Premature babies have greater difficulties in regulating their

own physiological and emotional functions and in managing their environment and, hence, they

depend, all the more than full-terms, on the mother figure: a sensitive caregiver is a determining

factor in their development.

Currently, the most recent research is focusing on how preterm birth involves the entire

family, and therefore psychological assessment has shifted to study of the mother-father-child triad

(Tracey, 2000; Jackson et al., 2003).

Research on families with preterm children evidenced how, in the first years, the style of

parental attachment seems especially important in the subgroup of newborns at high risk: a sensitive

mother with secure attachment, able to receive and respond to the child’s needs, seems to have a

positive influence on the development of these newborns. Likewise, parents who are little

responsive and not flexible seem to have negative influence on these preterms at high risk whose

linguistic and cognitive capacities, in the first year of life, are lesser than those of term born babies

(Minde, 2000; Coppola, Cassiba, 2004).

Empirical research has evidenced how in the perinatal period the mother’s and father’s

emotional states are significantly correlated (Harrison, Magill-Evans, 1996; Buist et al., 2002;

Kaitz, Katzir, 2004; Paulson, Bazemore, 2010, Baldoni, Ceccarelli, 2010). In particular, fathers

whose companions have undergone affective post partum disorders show greater levels of anxiety,

depressive symptoms, irritability, and tendency to somatic complaints and worry about their own

health and paternal role up to the fifth month of pregnancy (Baldoni, Baldaro, Benassi 2009).

Moreover, in the perinatal period, fathers themselves may also suffer from affective disorders

similar to post partum depression with a frequency ranging in the world from 2% to 31.3%, with a

mean of 10.4 % in 2010 (Paulson, Bazemore, 2010, Baldoni, Ceccarelli, 2010). The symptoms of

Paternal Perinatal Depression (PPD) differ from those of Maternal Perinatal Depression (MPD),

the symptoms are less severe, the disorders are less definite and range from neurotic reactions of

restlessness and sadness to melancholy, through states of impotence, desperation, discomfort and

somatic complains. Empirical research has found a significant correlation between PPD and MPD

(Soliday et al., 1999; Matthey et al., 2000; Buist et al. 2002).

The traumatic experience of preterm birth, the anxiety for illness and death, and the early

and prolonged separation from the baby are psychologically stressful and dangerous events for the

4

family. In these situations the family attachment system will be activated, specially in the parents

who will react on the basis of their Internal Working Models (IWM) (Bowlby 1973). Therefore,

they will express adaptive and defensive reactions that could influence the development of infant

attachment.

The majority of first-time parenthood research was realized in Anglo-Saxon countries and

studied emotional feelings and fantasies of the couple during pregnancy and post-partum period.

Only recently were studies conducted on the father’s role into the “transition to parenthood”

perspective. Researches on father’s stress and on adaptation factors of the male to fatherhood (Buist

et al., 2003), on father’s mental wellbeing during perinatal period (Condon et al. 2004), on male

psychological experience in the change from couple to family (Kaitz, Katzir, 2004) and on “secure

base” function of the father toward the mother-child dyad (Baldoni, 2005) were conducted.

At present, the development of attachment and the influence of the father on the preterm

born child is far from being sufficiently investigated, in particular through longitudinal studies

(Tracey, 2000; Miceli et al., 2000; Singer et al., 2003). Among these, Harrison and Magill-Evans

(1996) showed lower scores in interaction scale of Nursing Child Assessment Teaching Scale in

preterm father in comparison with mothers. Previous works on preterm families by our research

group (Baldoni et al., 2007, 2008, 2009) evidenced significant risk factors in parents-child

interaction that confirm the importance of the father’s role. In particular, fathers with an insecure

attachment style (dismissing or preoccupied) or with psychological difficulties (unresolved losses,

significant stressful events in the last year, high anxiety and depression) were significantly

correlated with the development of insecure attachment forerunners manifested by the children (at 3

months corrected age) in the interaction with the mother. This could be linked to lesser support and

protection by the father towards the companion, which may influence the child to develop insecure

attachment representations that could consolidate during growth to adult age, exposing it to

manifestation of physiological, psychological or relational disorders (eating, sleep, behavior,

learning, sphincter control, emotional regulation).

Thus to assess the development of the relation mother-father-preterm child from admission

to the months following discharge is fundamental, and it is necessary to perform specific follow-ups

in the critical phases of development and early interventions focused on the prevention or

modification of dysfunctional parent-child relations and any subsequent development disorders.

(Kaaresen et al., 2006; Van der Pal et al., 2007). In past works (Trombini et al., 2006, 2008) we

evidenced how the characteristics of Neonatology Units (in particular the collaboration between

neonatologists, nurses, psychologists and physiotherapists, even after discharge of the baby through

follow-ups in the first year of life) influence positively the perception levels of stress in mothers,

5

fostering an adequate consciousness of the cognitive-affective and relational competence of their

own baby. Early interventions focused on increasing parental knowledge and competence, and the

child’s psychological and physical skills, can be effective for reduction of the psychomotor deficit

frequently displayed by very low birth weight children in school age (at 4 years). Confronting these

data with those of attachment research, greater psychological and somatic capacities in children

with secure attachment patterns are confirmed (Sajaniemi et al., 2001).

Research

The aim of the research unit is to study the development of attachment, the psychological

difficulties, the parental couple adjustment quality, the role of father-mother-child relationship and

the psychomotor development of the child in the family with preterm birth child from 3 to 30

months corrected age.

The main hypotheses of the research are :

1) preterm birth represents for the family a traumatic and stressful event that involves the

whole family and activates the family attachment system. During perinatal period the emotive states

of mothers and fathers are connected. In preterm birth, in particular, the parents will display

defensive and adaptive behaviours, therefore their attachment styles and psychological

characteristics (in terms of dyadic sensitivity and levels of anxiety, depression and stress

perception) will influence the quality of the parental couple and mother-child-father relations and

the attachment and psychomotor development of the child.

2) In this critical situation, the psychological characteristics of the father are important for

the protection of the family and the development of a valid attachment pattern in the child. The

father would carry on a secure base function (Bowlby 1988), protecting his partner from too high

levels of affective suffering (Baldoni, 2005). Fathers with avoiding attachment patterns (type A) or

preoccupied attachment patterns (type C), and those with psychological difficulties (unresolved loss

traumas, anxiety, depression) or behavioural problems, are thought to influence the development of

their preterm child.

In particular our research unit intend to study:

1.Attachment patterns and dyadic sensitivity of parents in the interaction with preterm child;

2. The couple adjustment and the expression in the parents of eventual psychological

suffering (anxiety, depression, behavioural problems) and high perceived stress levels.

3.The psychological characteristics of preterm child’s father (attachment style, dyadic

sensitivity, anxiety, depression, stress perception).

6

4. The connection of these aspects with the development of child’s attachment (assessing

attachment forerunners at 3 months, and attachment pattern at 1 year of corrected age) and the

psychomotor development of the preterm baby.

Finally, a secondary aim of the study is to confront different models of attachment

assessment (DMM, Main and Goldwyn AAI, self-reports questionnaires like ASQ, RQ and PBI)

particularly regarding their validity and utility in clinical application (the Bologna Attachment

Assessment Project).

Experimental design

We are studying an experimental group consisting of 40 families. 20 families with preterm

born children (birth weight < 1500 gr, gestational age 24-32) and a control group of 20 families

with term-born children (birth weight > 2500 gr, gestational age > 40) for 120 total subjects.

Families, once informed on the aim and method of the study, were short-listed exclusively on the

basis of their willingness to participate in the research, excluding families whose children present

ascertained neurological damage. Listings were made in collaboration with the Neonatal Intensive

Care Units of AUSL Bologna, Ospedale S. Orsola-Malpighi (Direttore: Prof. Giacomo Faldella),

AUSL Rimini, Ospedale Infermi, Rimini (Director: Dr. Nicola Romeo) and AUSL Brescia,

Ospedale (Director: Dr. Gaetano Chirico). The research benefits from the scientific consultation by

Prof. Patricia M. Crittenden, Head of Family Relations Institute, Miami, Florida, USA, and

President of International Association for the Study of Attachment (IASA).

The aim of the research unit is to assess the mother-father-preterm child triad from the first

to the second year of corrected age. The study is based on a longitudinal survey with data collection

in four steps (3, 6, 12 and 30 months corrected age of the baby), corresponding to particularly

important phases for the child’s psychomotor development and internal representations of

attachment (see Tab. 1).

The research plans on providing the following assessment tools:

To Mother-Child and Father-Child couples:

• Child-Adult Relationship Experimental Index (CARE-Index) (Crittenden, 1979-2004) for

assessment of the attachment forerunners and the parental dyadic sensitivity.

To both parents:

• Center for Epidemiologic Studies Depression Scale (CES-D) (Radloff, 1977) for

depressive symptoms assessment;

7

• State Trait Anxiety Inventory Form Y2 (STAI-Y2) (Spielberger et al., 1983) for the trait

anxiety assessment;

• Dyadic Adjustment Scale (DAS) (Spanier, 1976) for quality of couple adjustment

assessment;

• Parenting Stress Index (PSI) (Abidin, 1987-2006) for parental stress assessment;

• Adult Attachment Interview (AAI) (George , Kaplan, Main, 1986; Crittenden, 1999);

• Self report questionnaires for adult attachment assessment: Attachment Style Questionnaire

(ASQ) (Feeney, Noller, Hanrahan, 1994); Relationship Questionnaire (RQ) (Bartholomew,

Horowitz, 1991); Parental Bonding Instrument (PBI) (Parker, Tupling, Brown 1979).

To mother-child:

• Strange Situation (SS) (Ainsworth, Witting, 1969) for assessment of attachment styles in

first childhood.

To the child:

• Bayley Scales of Infant and Toddler Development (BSID III) (Bayley, 2006) for child’s

psychomotor and linguistic development assessment.

Tab. 1 – Research Design

For statistical assessment, subjects were divided in subgroups on the basis of the quality of

the father’s attachment and dyadic sensitivity (attachment forerunners and dyadic sensitivity at

CARE-Index, attachment pattern at AAI).

Every research step needs from 30 to 120 minutes of total administration time, to be divided

in different sessions. The attachment assessment was conducted following the Dynamic-

Maturational Model (DMM) criteria (Crittenden 1999, 2000, 2008). The assessment instruments

StepsSteps TimeTime TestsTests

11 3 months

corrected age

CARE-Index, CES-D,

STAI-Y2, PSI

22 6 months

corrected age

DAS, AAI, BSID-III

33 12 months

corrected age

SS, ASQ, RQ, PBI, BSID-III

44 30 months

corrected age

CES-D, STAI-Y2, PSI, DAS,

BSID-III

StepsSteps TimeTime TestsTests

11 3 months

corrected age

CARE-Index, CES-D,

STAI-Y2, PSI

22 6 months

corrected age

DAS, AAI, BSID-III

33 12 months

corrected age

SS, ASQ, RQ, PBI, BSID-III

44 30 months

corrected age

CES-D, STAI-Y2, PSI, DAS,

BSID-III

Longitudinal survey in four steps

(3, 6., 12 and 30 months corrected age of the baby)

8

(CARE index, Strange Situation, AAI) were administered and codified in blind conditions by expert

and reliable operators trained in specific courses. Statistical elaboration of data was carried out

using parametric (Univaried ANOVA, Bonferroni Post Hoc test) and non-parametric methods

(Kruskall-Wallis test).

Results

At present, preterm couples and term families were studied from 3 to 12 months corrected

age. Data analysis evidenced in mothers of preterm children high risk interactive behaviors at

CARE-index (low scores at Dyadic Sensitivity Scale, p< 0.01) (see Figg. 1-2), high levels of

anxiety traits at STAI-Y2 (p< 0.01), of parental stress at PSI (p< 0.01) and a lower couple

adjustment at DAS, with particular regard to a lower level of consensus in the relation with the

partner (Dyadic Consensus scale, p< 0.04).

Figg. 1-2 - Mother-child CARE-Index

Fathers of preterm children also manifested low scores at Dyadic Sensitivity scale of CARE-

index (p< 0.004) (see Figg. 3-4) and high levels of depressive symptoms at CES-D (p< 0.009).

In interaction with the child, assessed with CARE-Index, attachment forerunners show more

frequently an insecure attachment in mothers (p< 0.008) (see Figg. 1-2) and in fathers of preterm

children (p< 0.006) (see Figg. 3-4) and in preterm born children in the interaction with the mother

(p< 0.05) (see Figg. 5-6).

(p < .01)

40% of preterm mothers are

at risk vs 5% of controls

(p < .008)

30%

65%

30% 30%

40%

5%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Adequate Intervention area High risk

DYADIC SENSITIVITY SCALE

PRETERM MOTHERS

TERM MOTHERS

30%

75%

30%

10%

40%

15%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Sensitive Controlling Not responsive

ATTACHMENT FORERUNNERS

PRETERM MOTHERS

TERM MOTHERS

9

Figg. 2-4 – Father-child CARE-Index

Figg. 5-6 – Child attachment forerunners at CARE-Index

Moreover, in mothers of preterm children, risk factors were pointed out as difficulties in

relation with the origin family and a high anxiety for the death of the children.

Risk factors in fathers of preterm children are even more important than those of mothers. In

particular they have frequently: a negative perception of the child, more difficulties in interaction

and an intense uncomfortable feeling during the first contact with it, significant stressful events in

the last year (work and economic difficulties, health problems, losses) (p< 0.02) and a less satisfied

perception of the hospital care (p< 0.00).

(p < .04) (p < .006)

75% of preterm fathers

are at risk vs 30% of controls

0%

10%

25%

60%

75%

30%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Adequate Intervention area High risk

DYADIC SENSITIVITY SCALE

PRETERM FATHER

TERM FATHER

25%

70%

20%

10%

55%

20%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Sensitive Controlling Not responsive

ATTACHMENT FORERUNNERS

PRETERM FATHERS

TERM FATHERS

P < .05 N.S

MOTHER-CHILD INTERACTION FATHER-CHILD INTERACTION

25%

70%

50%

5% 5% 5%

20%20%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Cooperative Compulsive Difficult Passive

ATTACHMENT FORERUNNERS

PRETERM CHILD

TERM CHILD

35%

65%

25%

10%15%15%

25%

10%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Cooperative Compulsive Difficult Passive

ATTACHMENT FORERUNNERS

PRETERM CHILD

TERM CHILD

10

Dividing the sample on father’s attachment forerunners basis and on their dyadic sensitivity

at CARE-Index, univaried ANOVA data evidenced in the insecure fathers group and in the low

dyadic sensitive fathers group (independently from the term or preterm birth of their child)

significantly high levels of anxiety at STAI (p< 0.02), of parental stress (p< 0.03) and a negative

perception of the child (p< 0.000) at PSI. Insecure attachment forerunners, low dyadic sensitivity

and high levels of depressive and anxious symptoms were correlated, in both parents, with lower

scores of the performance of the child in almost all Bayley scale indexes (p< 0.04). In particular,

children with fathers with insecure attachment forerunners reported significantly lower scores at all

Bayley scales. Post Hoc tests (Bonferroni) confirmed significant differences between fathers with

low and high dyadic sensitivity, fathers with secure and insecure forerunners of attachment, but not

between individual insecure patterns (controlling, not responsive).

No significant effects of father’s characteristics on child’s development were evidenced in

preterm group, perhaps because of the limited sample, but the trend is the same as that of the whole

group.

Strange Situation and Adult Attachment Interview codifying is in progress. Preliminary

analysis of the AAI data show a correlation with insecure high index patterns (A+ and C+) with a

lower psychomotor performance of the child (term and preterm) at Bayley scales.

Discussion

These research data show the dyadic sensitivity, and the interactive mother-child and father-

child behaviors at three months corrected age are significantly different in the families of preterm

born children towards the control group. 40% of mother-preterm child interactions (against 5% of

controls) and 75% of father-preterm child interaction (against 30% of controls) are in the “high risk

area” suggested by CARE index, an area that often requires psychological and pharmacological

treatment. Attachment forerunners in preterm children’s parents, moreover, are significantly

different from those of term children’s families.

Psychosocial risk factors evidenced in the preterm child’s parents (lower couple adjustment,

high levels of anxiety, depressive symptoms and perceived stress) resulted significantly correlated

to a lower psychomotor development of the preterm child assessed at six months of age by Bayley

scales.

In our sample, mothers of preterm children are characterized by maternal behaviors

apparently affective, but really controlling, intrusive or “not responsive”, i.e. not sensitive towards

11

the child’s signals, particularly the negative ones. Only few of these mothers showed a sensitive

pattern.

The significance of this maternal attitude, for the development of the child, is still unclear.

Regarding the possible effects of an excessive maternal stimulation, studies on premature

children show different and frequently contradictory results and hypotheses. Some authors judge

negatively an excessive maternal intrusion, considering it implies an overload of stimulations for

the baby. Other authors consider it a type of compensation developed by the mother to fill the

possible developmental difficulties of the premature baby (Monti, 2000; Riva Crugnola et al.,

2004). An analysis in DMM perspective could be useful for understanding the adaptive function of

these parental behaviors and fostering the skills of the family. An intrusive and controlling attitude,

in fact, could reflect the maternal attitude to adapt flexibly to the requests and developmental

rhythms of the child.

An interesting datum evidenced by this study is the high number of fathers of preterm

children that show difficulties in interaction with the child (low dyadic sensitivity and insecure

attachment forerunners at CARE-index) and other psychological risks factors (negative perception

of the child, intense uncomfortable feeling during the first contact with it, depressive symptoms),

even more frequent and intense than the mothers’.

Moreover, mothers of preterm children showed a lesser couple adjustment, in particular

lower levels of dyadic consensus with the partner (at DAS). These factors may affect negatively the

mother-child-father relationship. Research evidenced a positive correlation between satisfaction in

couple relation and quality of mother-child relation. Therefore, a valid help supplied by the father to

the companion fosters a better mother-child relation (Dickie, 1987; Broom, 1994).

Following attachment theory, an important male function, in perinatal period, seems to

supply a secure base for his companion, helping her to overcome the difficulties, keeping the

suffering at endurance levels and fostering the conditions by which the special relation between the

mother and the baby can develop in an adequate way. In fact, preoccupied, too anxious or depressed

fathers, or those with behavioural problems (pathological aggressiveness, alcoholism, addiction

disorders) can be a handicap for the emotional equilibrium of their companion and for the good

development of the relationship between mother and child (Das-Eiden, Leonard 1996; van

IJzendoorn, De Wolff 1997; Luca, Bydlowsky 2001; Baldoni 2005; Baldoni, Baldaro, Benassi

2009; Baldoni, Ceccarelli, 2010). A lack of this protective function can foster an affective disorder

in the mother and negatively influence the attachment and psychomotor development of the child.

12

Lower dyadic sensitivity and insecure attachment forerunners, in fathers, (independentely

from the term or preterm birth of their child) resulted significantly correlated to a lower

psychomotor development at all Bayley scales assessed at six months.

Fathers of preterm children show also more significant stressful events in the last year that

can remove them from couple and parental tasks, focusing them on external problems, rather than

dedicating themselves to the family (Parke, 1982).

The first data of this research underline the necessity of longitudinal studies on wide

samples to assess internal working models (i.e. attachment styles) of preterm born children’s

parents, their sensitivity in the relation with the child and the link between parenting stress and

quality of family attachment. These researches could check if parental behavior in these families is

adaptive and transitory, or a negative trend that will influence the development of the child in the

future.

Conclusions

This study confirms the research data concerning the influence of attachment style and

relational capacities of both parents on psychomotor development of preterm born children and the

attachment relationship between this and the mother. In particular, in fathers it shows a correlation

between insecure attachment and low dyadic sensitivity with a low adjustment by the couple, the

development of an infant’s insecure attachment and a manifestation of psychomotor difficulties in

the preterm born child. The research will provide useful data for the development of preventive and

treatment interventions, increasingly targeted and sustained over time, considering also the father

figure and taking into account the specific developmental needs, the psychological difficulties of the

preterm infant and its family, also considering eventual difficulties of the siblings (psychological

help from the physician and nurses in the ward, assistance from a psychologist, psychoeducational

groups, possible individual, couple or family counselling or therapy) (Baldoni et al. 2009;

Facondini et al. 2009; Cena, Imbasciati, Baldoni, 2010). It will be also possible to organize special

training seminars and consulting meetings for operators of the Departments of Obstetrics and

Gynaecology and Neonatal Intensive Care Unit to ensure a long-term monitoring of psychological

and physical health of the premature born child and an appropriate psychological help for its family.

This study is funded by Italian PRIN 2007 as a nationally relevant research

13

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For information: Franco Baldoni, Department of Psychology, University of Bologna, Italy.

franco.baldoni@unibo.it