Abstract
The infant-parent relationship has been shown to be of particular significance to preterm infants’ socio-emotional development, and preterm children have been reported to be at higher risk of developing attachment insecurity and disorganized attachment (Pennestri et al., 2015; Wolke, Eryigit-Madzwamuse, & Gutbrod, 2014). In this paper on attachment development of preterm and full-term infants, the authors (Witting, Ruiz, & Ahnert, 2016) present three single cases to describe the qualitative differences with respect to the parents’ interactions with their boys. Attachment was observed at home with the Attachment-Q-Sort (AQS) and in the lab with the Strange Situation (SS). One aim was to describe differences and similarities in the children’s attachments with their parents in order to generate hypotheses for a larger sample. Including the specific role of fathers in the child’s development has been an important tradition since the German longitudinal attachment studies with normative samples (Grossmann et al., 2002) started to explore this issue; an increasing number of studies are now focusing on the role of fathers for premature infants. Interestingly, the observations by Witting et al. revealed differences in the attachment repertoire during daily-life situations when the two preterm boys were compared with the child born at term in their toddlerhood years. Since the responses of the involved parents were sensitive, all three boys displayed secure attachment patterns when observed with the AQS. In contrast, when their attachment system was activated during the SS, both preterm boys shifted to avoidant or anxious features, specifically with their fathers, compared to secure strategies with their mothers. The authors correctly recommend that parent-child interventions should aim to facilitate the fathers’ understanding of the vulnerability in their babies, especially in stressful situations.
Training programs for parents with preterm infants indeed aim to improve parent-child interactions (Evans et al., 2014; Steinhardt et al., 2015), and to ensure a high quality of information, which is an important task for NICU staff and especially for fathers (Ignell Modé, Mard, Nyqvist, & Blomqvist, 2014; Twohig et al., 2016). Fathers generally do not spend as much time with their preterm infant in NICUs as mothers (Garten, Maass, Schmalisch, & Bührer, 2011). The comparison of mothers and fathers with preterm infants revealed that maternal disrupted attachment representations were marked by role/boundary confusion or disorientation, whereas paternal disrupted attachment representations were characterized by withdrawal (Tooten et al., 2014). This implies that it might be essential to tailor interventions according to the parent’s attachment representations (Hall et al., 2014). The individualized approach in the present study has a profitable clinical value for analyzing the fathers’ awareness of fatherhood (Benzies & Magill-Evans, 2015), strengthening confidence and gaining specific skills with the preterm infant (Lindberg, Axelsson, & Ohrling, 2008). Moreover, a deeper understanding of preterms’ fathers experience in NICUs is considered to be helpful for informing nursing practice (Provenzi & Satoro, 2015). In sum, the paper by Witting and co-authors raises important questions, which have to be proven in a larger sample; the focus on fathers with preterm infants is a promising research field with new challenges for clinicians and staff atthe NICU.