Improving the quality of parental interaction with very low birth weight children: A longitudinal study using a Mediated Learning Experience model

Cognitive performance of 3-year-old, very low birth weight children (N = 42) was found to be more significantly related to the quality of parent-child interaction than to early measures of cognitive performance or measures of developmental risk such as birth weight and APGAR. The subjects were randomly divided into an intervention and a control group. The intervention group was visited at home, infrequently, by a mediator who identified basic criteria of quality of parent-child interaction and provided the parents with feedback on the quality of interaction with their own children. The intervention procedure continued for 7 months. The extent of a family's participation in the intervention varied depending upon the initial quality of parent-child interaction and the amount of time it took a family to reach criteria. Quality of parent-child interaction and children's cognitive performance were pretested and reassessed 3 years after the intervention. The sample was reduced to 29 due to attrition over time. Parental behavior following the intervention had changed significantly with respect to all criteria. Parents who had received intervention, as compared to the control group parents, provided their children with more behaviors related to focusing attention, exciting and rewarding, expanding children's understanding of the world around them, preplanning and regulating behavior. Three years after the relatively unintensive intervention, parents continued to show significant gains in quality of mediation. Differences were found between parents of Small for Gestational Age (SGA) and Appropriate for Gestational Age (AGA) children in favor of the SGA group. In children's cognitive performance, scores of the intervention group on the Peabody Picture Vocabulary Test (PPVT) were significantly higher than those of the control group. On other cognitive measures, a consistent trend in favor of the intervention group was noted. More children in the control as compared to the experimental group were rated by their parents as having difficulties with language, fine motor, and sociability skills 3 years after the intervention. L'on a decouvert que la performance cognitive des enfants ǎges de trois ans dont le poids a la naissance etait treAs bas (N = 42) etait bien plus liee B la qualite de l'interaction parent-enfant qu'a des mesures precoces de performance cognitive ou des mesures de risque de developpement telles que le poids aa la naissance et l'APGAR. Ces sujets ont ete divises au hasard en un groupe d'intervention et un groupe de contrǒle. Un mediateur a irregulierement rendu visite au groupe d'intervention. Ce mediateur qui identifiait les criteres de base d'une interaction parent-enfant de qualite et donnait aux parents du feed-back sur la qualite de leur interaction avec leurs enfants. Le degre de participation a l'intervention d'une famille a varie selon la qualite initiale de l'interaction parent-enfant et le temps qu'il fallut B la famille pour atteindre les criteres. La qualite de l'interaction parent-enfant et la performance cognitive des enfants ont ete pre-testees, puis reevaluees trois annees apres l'intervention. L'echantillon fut reduit au nombre de 29 du fait de l'attrition au fil du temps. Le comportement parental apres l'intervention avait considerablement change en ce qui concerne tous les criteres. Les parents qui avait recu l'intervention, en comparaison avec le groupe contrǒle de parents, offraient a leurs enfants plus de comportements lies a la concentration de l'attention, au fait de passionner et de recompenser les enfants, d'elargir leur comprehension du monde qui les entoure, et au comportement organisateur et regulateur. Trois annees apres l'intervention relativement peu intensive, les parents ont continue a manifester une qualite de mediation bien superieure. Des differences ont ete decouvertes entre les parents d'enfants Petit pour l'Age Gestationnel (en anglais “Small for Gestational Age,” soit SGA) et Bien pour l'ǎge Gestationnel (“Appropriate for Gestational Age,” soit AGA), cela en faveur du groupe SGA. En ce qui concerne la performance cognitive des enfants, les scores du groupe d'intervention au Test Image de Vocabulaire Peabody (PPVT) ont ete considerablement plus eleves que ceux du groupe contrǒle. En ce qui concerne les autres performances cognitives, l'on a constate une tendance constante mise au credit du groupe d'intervention. Par rapport au groupe experimental, plus d'enfants dans le groupe contrǒle avaient, selon leurs parents, des difficultks avec la langue et leurs competences moteur et sociales, ceci trois annees apres l'intervention.