Family orientated early intervention enhances social-interactive behaviour of premature infants and mother-infant-interaction

The primary outcome measure was the improvement in social-interactive behaviour of the infants, mother's sensitivity and the dyadic quality of interaction. Before discharge the nurses assessed the early mother sensitivity with the Boston City Hospital Assessment of Parental Sensitivity (BCHAPS)(Timepoint 1). This questionnaire consists of 13 closed-ended items, evaluating the mother's sensitive responsivness and care giving competence. The items are ranked on 5-point scales from "poor" to "competent" and the scores totalled.

At 6 months corrected age the infant social-interactive behaviour and mother-infant interaction were assessed with the Mother-Infant Structured Play Assessment (MISPA)(Timepoint 2). This is an 8-minute, semi-structured face-to-face play interaction which includes the Still-Face Paradigm, which provides a method to access infant regulatory capacities and illustrates central qualities of the young infant's capacities for interpersonal engagement. For the interaction records the infants were placed on a blanket or mat on the floor and mothers were asked to sit on the floor opposite their infant. A mirror was mounted at an angle, which enabled the examiner to videotape both the face and body of the infant and the face and upper torso of the mother. Standardised instructions were used to explain the procedure to the mothers.

Episode 1 involved the mother playing with her baby with a rattle (warm-up). After 2 minutes (Episode 2) she was cued to lay aside the rattle and play (without a toy) with her baby for another 2 minutes. Then she was asked to get her baby to watch her face, which lasted for 1 minute (Episode 3). Next she was asked to make a still-face for 1.5 minutes (Episode 4) and then finally asked to resume playing with her baby for another 1.5 minutes (Episode 5).

Three existing schemes were modified and adapted to create a suitable coding scheme:
1. The Play Observation Scheme and Emotion Ratings (POSER)
2. The Emotional Availability Scales (EAS)
3. Tronick and Weinberg's Infant and Caregiver Engagement Phases (ICEP)

Each interaction episode was coded with 5-point scales reflecting maternal sensitivity (apart from episode 4) and infant social regulatory behaviour. Maternal Sensitivity consisted of 5 rating scales (sensitivity, positive response, negative facial emotional expression, verbal involvement, undercontrol) that were totalled to gain a measure of maternal sensitivity. Social Regulatory Behaviour was also assessed using 5 rating scales (emotional state, attentiveness, responsivness, vocalisation, clarity of signals).

Quality of dyadic interaction consisted of 2 five-point rating scales (Harmony, Control over interaction) and the scores were totalled. Each of the five episodes in the MISPA was scored separately, and infant, maternal and dyadic behaviours were coded individually. The last episode demonstrating mother-infant reunion after perturbation of interaction was decided to be confirmative for the effect of the intervention. This episode presents the infant with a complex and demanding regulatory task: the infant needs to simultaneously cope with the resumption of the maternal behaviour, as well as the carry-over of negative affect from the still-face episode.

The demographic characters and the medical and psychosocial burden of the families were recorded with a structured mother-interview at both time points. Several items of the interview ware totalled showing a dyadic adjustment scale and a psyochosocial stress-index.