Mental health articles

It has been observed since 1964 (Drillien) that VLBW infants are at risk for a
range of behavioural difficulties including major and minor psychiatric
disorders. Even earlier, Benton (1940) described children born prematurely as restless, easily tired and nervous, which resulted in distractibility and poor
concentration.
However, most studies of the 1970s and 1980s only looked at physical and
cognitive development and did not look at behavioural characteristics.
Minde’s study (Minde, Perrotta & Hellmann, 1988) looking at outcomes of a
premature birth and the experience of NICU, found at four years that all the
children showed normal intelligence and good physical health. However, 43 per
cent of the children scored within the abnormal range on a behaviour
questionnaire completed by the parents, which indicated a likelihood of a
behaviour disorder. This was four times higher than found in a nonclinical
group. Teachers rating a preschool behaviour questionnaire found 24 per cent of
premature children scored in the abnormal range. After analysing the problems
indicated by parents and teachers, Minde conceptualised the symptoms to
represent a general immaturity, possible hyperactivity, or an overall poor
behavioural organisation. However, only 10.9 per cent received a psychiatric
diagnosis.
The same population was assessed on the Ainsworth Strange Situation
Procedure (SSP) at 12 months (see Chapter 2 for a description of the SSP) and
differences between secure and insecure attachment did not predict high or low
scores on the behaviour questionnaire at age four. However, 75 per cent of
children who were given a ‘D’ (disorganised) classification at 12 months were
given a psychiatric diagnosis three years later. Minde et al. (1988) suggest that
the disorganised attachment classification may predict premature children’s
emotional disturbance. For the teacher’s ratings, it was the mother–child
relationship and family functioning that were the best predictors of behavioural
difficulties. This confirms what other authors report; that for premature infants,
as for all infants, the best predictor for emotional outcome is the infant–mother
relationship and family variables.
Heidelise Als has focused on the NICU environment and its effects on infants
who have suddenly been displaced from the ‘econiche’ of the maternal womb,
which functions to nurture neurodevelopmental progress to an ‘unecological’
environment. Als refers to the severing of continuous organism–environment
interaction and other developmental principles, which explains many of the
neurodevelopmental problems these infants experience, and the difficulties for
parents (Als & Gilkerson, 1997). For example, the interference with the
development of cortical neurones, which occurs at a phenomenal rate in the
middle and later part of the pregnancy, would affect infant attention and selfregulation,
making the infant more difficult to ‘read’ by the parent.