Attachment representations and feelings of parental competence: a study of mothers and 3-year-olds born prematurely

Context of the study
This research is part of Ramona Sandnes’ doctoral work on attachment representations of children born very prematurely. The research is supervised by Mr. Bacro and Ms. Nocus, two proffesors – researchers in the field of developmental psychology at the University of Nantes. As for my Master’s thesis, I’ve decided to explore the impact of prematurity on the feeling of parental competence and the attachment representations of children three years after the child’s birth.
 
What are the issues ?
Furthering our knowledge of the psycho-affective development of children born prematurely and of their relationship with their parents is a current challenge. The number of premature births, i.e. less than 37 weeks of gestational age, is increasing every year and worldwide (Belotti et al., 2019). According to these authors, in addition to the consequences of prematurity on the level of health, those on psycho-affective development are numerous (criteria for the diagnosis of psychiatric disorders, anxiety, ADHD, ASD at the age of seven…).
 
What is attachment ?
For Bowlby (1969), all individuals are born with a primary need for contact, which he has named attachment or rather types of attachment represented in the relationship of the caregiver and the infant. These types of attachment are categorized that vary and differ in terms of quality. The main functions of attachment are to provide protection and security for the child. With that, children are able to explore the world and further develop. Mary Ainsworth (1979) subsequently identified four categories of attachment styles: secure, insecure-avoidant, insecure-ambivalent-resistant and disorganised. Children born prematurely may be more prone to develop an insecure attachment style (Laganière et al., 2003; Lopez-Maestro et al., 2017). These attachment styles can be determined by several elements. First of all, just after the birth, the bonding (touch, skin-to-skin, glances from the first days of life) is essential for the creation of the attachment bond. But the conditions in the hospital in the case of a premature birth can limit or even prevent the much necessary bonding to be established (Guédeney et al., 2012). Among other explanatory factors, parental sensitivity is one of the most predictive elements of the attachment style of the children (Atkinson et al., 2000; Tissier et al., 2011). Sensitivity is the caregiver’s ability to read and respond appropriately to the child’s signals (Matos, 2014). However, this parental sensitivity will hampered the  parental stress (Borghini & Müller-Nix, 2015), the hospital and medical context (Laganière et al., 2003), elements that are found in a preterm birth context.
 
What is the feeling of parental competence ?

Looking at the child-parent relationship through the prism of the feeling of parental competence and not just parental sensitivity allows for a more global vision that takes into account the context, the situation and the child’s temperament (Mouton et al., 2017). This also allows permits for a transactional approach of the relationship. In the case of prematurity what we have just outlined is particularly relevant.
 For Bandura (2003), the feeling of parental competence evolves over time, it is not innate and four sources can characterise its origin: it is linked to experiences, to the parent’s observations of other parents, to verbal persuasion and to the parents’ emotional states. Other elements impact on this feeling. For children’s pathologies (Jones and Printz, 2005), the child’s rank in the sibling group, the socio-professional category, the presence of maternal depression, the support of the spouse and maternal age…
 
Thus, we hypothesise that…
The context of prematurity frequently results in traumatic birth, health difficulties for the child with special monitoring and insecure attachment. All these elements lead us to believe that the feeling of parental competence is negatively impacted. Few studies have been carried out on the subject. But those that we do have suggest that it is not (Pennell et al., 2012; Spielman and Taubman – Ben-Ari, 2009; Vance et al., 2020). However, one of the limitations of these studies is that they interview parents up to 24 months after birth. However, the CPS is a transactional concept, which must take into account the child, the moment, the experience, what(pas besoin de what ici) about three years after the child’s birth?
 
Thus, we make the following assumptions:

Children show low security and high disorganisation scores in children born prematurely as in the literature (Laganière et al., 2003; Lopez-Maestro et al., 2017) 

There is a link between children’s safety scores and feelings of parental competence (Atkinson et al., 2000; Borghini & Müller-Nix, 2015; Tissier et al., 2011).

Mothers of children born prematurely do not have a low sense of parental competence. (Pennell et al., 2012; Spielman and Taubman – Ben-Ari, 2009; Vance et al., 2020).

Method
All the data used is collected as part of the AMPLIFY study, conducted with the Nantes University Hospital, the Angers University Hospital and the Grandir Ensemble network. This network offers children born prematurely (i.e. before 34 weeks of amenorrhea) that benefit from a complete medical follow-up until they are 7 years old (Aujard, 2016). Of the 150 mother-child dyads initially planned, very few data could be collected because of the sanitary conditions linked to COVID19. To overcome this problem, we decided to present case studies instead of quantitative statistics. To explore this issue, we submitted a questionnaire to the PSI mothers. The score obtained for the feeling of parental competence is a selected variable. The children participated in the Stories to Complete, directed play sessions that were filmed and coded. As a variable, the child’s safety score was selected.

Key words attachment ; prematurity ; parenting self-efficacy; parenting