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The adolescent mother and her infant

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The adolescent mother and her infant
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Hofheimer, Julie Anne, 1952-
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English

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Adolescents ( jstor )
Child development ( jstor )
Infant development ( jstor )
Infants ( jstor )
Mothers ( jstor )
Parenting ( jstor )
Parents ( jstor )
Pregnancy ( jstor )
Prenatal care ( jstor )
Psychomotor development ( jstor )
City of Gainesville ( local )

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University of Florida
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University of Florida
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Copyright Julie Anne Hofheimer. Permission granted to the University of Florida to digitize, archive and distribute this item for non-profit research and educational purposes. Any reuse of this item in excess of fair use or other copyright exemptions requires permission of the copyright holder.
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23296302 ( ALEPH )
6392974 ( OCLC )

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THE ADOLESCENT MOTHER AND HER INFANT:
CORRELATES OF TRANSACTION AND DEVELOPMENT





By

Julie Anne Hosfheimer


































A DISSERTATION PRESENTED TO THE GPLrAUATE COUNCIL
OF THE UNIVERSITY OF FLORI,,DA IN
PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF DOCTOR OF PHILOSOPHY



UNIVERSITY OF FLORIDA

1 07C














Copyright 1979

by

Julie Anne Hofheimer














This work is lovingly dedicated to my family for enduring my never-ending adolescence and most especially, for teaching me the true meaning of attachment and bonding

J.A.H., 1979













If one is to succeed in leading a man to a certain goal, one has to take care to find him where he actually is and to begin there; to be of real help to a person, one must understand more than he does, but in the very first place, one must understand what he understands.

Kierkegaarde














ACKNOWLEDGEMENTS

Throughout the course of my doctoral work there have been a number of individuals who have contributed a great deal. It is with a most special appreciation for their sensitivity that I recognize them.

The author gratefully acknowledges the contributions of Dr. Charles Mahan and Ms. Marci Hall of the Department of Obstetrics and Gynecology for the support of this study. Appreciation for their cooperation is also extended to Drs. Don Eitzman, Michael Resnick and June Holstrum of the Division of Neonatology, Department of Pediatrics. These individuals offered a great deal of sensitivity to this study of mothers and their babies and represent the College of Medicine's humanistic approach to the family.

Of most importance to the author were the continued guidance and thoughtful encouragement; the time and care taken in the midst of hectic schedules. It is with heartfelt thanks that appreciation is

extended.

My chairman, Dr. Athol Packer, has my deepest respect and gratitude for his gentle direction and thoughtful guidance. My thanks, too, for his patience in teaching me to reason with feeling and feel with reason. His consistent support and open-minded faith in me has been

a most important part of my growth.

To Dr. Michael Resnick, a special thanks for opening up a whole new world and allowing me to dream dreams and make them come true. I am appreciative, as well, for being given the freedom to explore.

It is for all of his creative idealism that I am especially grateful.


Vf







To Dr. PPatricia Ashton, my appreciation for her- insigT in helping me take a step back and look at mothers and babies from all perspectives. A special thanks, too, for being such a strong model of all that is soft and feminine, while at the same time exemplifying scholarship and professionalism.

To Dr. Jim Algina, my thanks for his intuitive assi stance in the analysis of my data. I have especially appreciated his ability .to tie up the loose ends and so patiently help me try to understand some difficult concepts.

Dr. Bob Soar has been continuously supportive. His

sensitive methodological recommendations and interpretations of my analyses are greatly appreciated.

I would also like to extend my thanks to Drs. Bill

Ware and Maria Llabre for so patiently helping me look at the world analytically and with high standards of excellence in research. I am grateful for their support of me in my most difficult endeavor and for giving me the confidence to persue a new interest,

To the friends who have staesd by my side, I am

especially grateful for thcir faith in. me and their help in keeping it all in the proper perspective ...... for the tender understanding and, most of all, for always being there.















vi








The following individuals provided assistance throughout .the

course of the study. The encouragement and enthusiasm proved instrumental to its success. Their committment gave me the strength to carry on and I am most appreciative of their help.

Kimberly Bounds Maria Fiankenfield

Francis Graves Becky Montevideo

Linda Schlosser Lisa Schiavoni

Susan Shome Bob Rose

Beth McLaurin Rutledge Withers

Debbie Roberts Susan Mock

Beth Clark Tess Bennett Imogene Clark Renee Miller

My thanks are extended, as well, to the staff of the Pediatric

Clinic and the Infant Development Project for thcir encouragement and support.



























vii
















TABLE OF CONTENTS

PAGE

ACKNOWLEDGEMENTS . . . . . . . . . . . . :v

ABSTRACT . . . . . . . . . . . . . . ix

CHAPTER

I. INTRODUCTION. . . . . . . . . .. .. 1

Adolescent Family Development ............. 2
The Concept of Parent-Child Transaction and
Infant Development. ... ............... . 4
Questions Posed by the Study.. ............ 6
Summary . . . . . . . . . . . .. 7

II. THE REVIEW OF THE RESEARCH. ..... . . . .. 9

Parent-Child Transaction and Infant Development ..... 10 The Young Mother and Her Infant ............ 21
Summary . . . . . . . . . . . .. 34

III. THE METHODOLOGY ...... ..... .. ... . 45

Questions Posed by the Study. ............. 45
Definition of Terms .................. 47
The Subjects. . ................ .... 49
The Procedure ................... .. 50
Instrumentation ................... .. 52
Statistical Analyses. .................. 57
Limitations of the Study. ................ 62
Summary . . . . . . . . . . ... 63

IV. THE RESULTS ................... .... 64

The Dimensions of Mother-Infant Transaction ....... 64 Description of the Sample ... .... ..... ... 74
Mother's Age, Perinatal Risk and Socioenvironmental,
Educational and Medical Resources ........... 83
The Prediction of Infant Development ......... 92
Summary . . . . . . . . . .. ... .. 104







viii









TABLE OF CONTENTS Continued

PAGE

V. DISCUSSION AND IMPLICATIONS . . . .. . . . 106

The Age of the Mother as a Predictor of
Infant Development and Mother-Infant Transaction 106
Prenatal and Perinatal Factors and Socioenvironmental, Medical and Educational Resources ..... 108
The Prediction of Developmental Risk
in Infancy ....... . . . . .. . .110
Mother-Infant Transaction as a predictor
of Infant Development . . ........... . 112
Summary and Conclusions .. ..... . . . . 113

APPENDICES

A. PARENTS CONSENT .. ......... ..... . 115
THE ASSESSMENT PROTOCOL .. ......... ... . 116
CWHilLD iAND FAMILY :DEVELOPMENT -QUESTIONNAIRE . . 118 B. DEFINITIONS 'OF MOTHER AND INFANT BEHAVIORS . . 120 C. BAYLES SCALES OF 'INFANT DEVELOPMENT . ...... 123

D. PERINATAL RISK- SCA-LE . . . . .......... 126

REFERENCES ..... ......... ... ...... . 131

BIOGRAPHICAL SKETCH . . . . . . . . . . 140

























iX I















Abstract of Dissertation Presented to the Graduate Council
of the University of Florida in Partial Fulfillment of the Requirements
for the Degree of Doctor of Philosophy



THE ADOLESCENT MOTHER AND HER INFANT:
CORRELATES OF TRANSACTION AND DEVELOPMENT By

Julie Anne Hofheimer

August, 1979

Chairman: Athol B. Packer
Major Department: Early Childhood Education The increasing number of births to adolescent mothers has prompted

serious concern by professionals attempting to enhance the quality of life for the family. We have reason to believe that the young mother

and her infant are at risk for problematic development; yet our present sources of knowledge are limited in number and yield inconclusive findings. The primary purpose of this study was to assess the contributions

of the mother's age, perinatal 7isk status, and socioenvironmental,

medical and educational resources to the prediction of the dimensions of

the mother-infant transaction process and the developmental status of

the infant. A second purpose of the study was to ascertain the ability

of the transaction dimensions to predict the mental and psychomotor

development of the infant.

The data were collected in a clinical setting on an age-specific

sample of 77 mothers and their six monthold infants. The mental and psychomotor development of the infant was evaluated using the Bayley Scales of Infant Develonment. Yother-infant transaction was analyzed ix







using the Adapted Beckwith Behavior Scale. Demographic and socioenvironmental data were obtained from the Child and Family Development Interview, which was developed for use in this study.

In order to reduce the number of variables and define the more global dimensions of mother-infant transaction, a correlation matrix of the 27 variables of the Adapted Beckwith Scale was subjected to a principle components analysis. As a result of this analysis, five dimensions of mother-infant transaction were defined and each subject's composite score was calculated for each of the five rotated components.

In the first multivariate multiple regression analysis, the

dimensions of mother-infant transaction and the infant's mental and psychomotor development were considered to be the outcome measures of early pregnancy and parenting. These measures were regressed on mother's age and education, baby's sex and birth order, yearly income, ethnic origin, social support system, perinatal risk status, prenatal complications and the type of prenatal care received by the mother.

The follow-up univariate analyses indicated that the age of the mother and the absence of prenatal complications had a positive relationship with the infant's mental development. The plots of the residuals evidenced no deviation from linearity. It was concluded that there was a positive linear relationship between these variables and the infant's mental development. The type of prenatal care received by the mother contributed to the prediction of the infant's mental development. The follow-up pairwise comparisons of each type of prenatal care indicated significantly higher means for infants whose mothers received Teenage Pregnancy Team care (comprehensive services)

when compared to those groups receiving care from a private physician



x







and Shands Teaching Hospital High Risk Clinic (obstetric care only). The data did not support tle hypothesis t~iat moth e-inajj_ tanlaction varied as a function o. thle age oi the mother.

In order to ascertain the ability of the transaction components to predict the development of the infant, a second multivariate multiple regression analysis was implemented. The dimensions of mother-infant transaction were found to contribute a significant proportion of shared variance to the infant's psychomotor development. The component of transaction which contributed a uniquely significant proportion was responsive vocalization.

Based upon the results of the follow-up univariate analyses, the variables which were identified as predictors of mental development were: 1) the age of the mother; 2) the type of prenatal care received by the mother; and 3) the presence of prenatal complications. Psychomotor development was found to vary as a function of: 1) responsive vocalization of the mother-infant transaction process; and 2) the type of prenatal care received by the mother. The regression coefficents indicated that for each year of mother's age, the infants differed, on the average, by 2.6 points on the Mlental Development Index and by 1.2 points on the Psychomotor Development Index.

The results of this study suggest that the infants of young mothers are at risk for problematic development and would benefit from early intervention efforts. The data also supported the idea that the mother-infant relationship is important to the infant's development of competence. Based upon the findings presented in this study, we have reason to believe that more comprehensive interdisciplinary models of prenatal, perinatal and pediatric support are associated



xi







with enhanced development of the infant. These findings suggest several considerations for the design of parent and infant-centered interventions for the young parent family in order to enrich the quality of care and stimulation provided by the adolescent mother and thus enhance the development of the infant.

















































xii













CHAPTER I

INTRODUCTION

The emergence of a phenomenal number of births to adolescent mothers has prompted serious concern by professionals attempting to enhance the quality of life for the individual and the family. While there exist serveral studies which explore the various aspects of early pregnancy and parenting, very little is known about the nature of the relationship between the adolescent mother and her infant and the infant's development.

!What are the characteristics of the very young mother -- how do her behaviors differ from or simulate those of her "of age" peer? How does she relate to her baby and what are the effects of her style of mothering on her baby and the developing family unit? Answers to these questions pose a challenge to the researcher and are in need of investigation. Such is the task at hand. Most importantly, this study attempts to explore the role of the adolescent as a mother in an effort to understand her strengths and limitations and their implications for her baby's development.

It is the purpose of this study, therefore, to examine the

relationship between infant development and mother-infant transaction in the adolescent family. The information obtained as a result of this study will assist professionals by increasing their understanding of the developmental status of the infant and the parenting style of the young mother in order to design more comprehensive programs for the young family.


1








The essence of "comprehensive care" involves a thorough understanding of the adolescent undertaking the tasks of early parenthood. It is through this understanding that our interdisciplinary efforts may become more sensitive to the complex needs of the young mother, her infant and her family. The commitment to quality care implies a change on the part of the professional community--a change based on empirical evidence which documents the educational and developmental competencies and capabilities of the very young mother. By focusing on the attengthz within the family, our efforts will project a more supportive quality. It is this belief in the positive characteristics of young parents--courage, enthusiasm, adaptability and, above all, an optimistic view of the future--that is the philosophy upon which this study is based.

Adolescent Family Development: The Scope of the Problem

The threatening impact of early parenthood has become.a source of great concern in the recent past. In 1976, the Guttmacher Institute reported that about 10 percent of American adolescents become pregnant each year--one. million young women. Ninety-four percent of these women have chosen to keep their babies. What happens to these young families remains a challenging question.

The early years of parenthood, even under the most optimal circumstances, are commonly viewed as a transitional period--one in which the individual is attempting to establish equilibrium and adjust to the responsibilities of becoming a parent; of caring for another human life (Rossi, 196 ; Packer, Resnick, Wilson..and Resnick, 19-79). This can be an extremely stressful period for all members of the family.




3



The impact of the transition to parenthood on the individuals

involved as it related to future parent-child transaction has been the subject of many current studies, Brazelton's (1973) findings suggest critical interrelated components through which the mother forms the beginning of attachment to the infant. The stages include: 1) planning the pregnancy; 2) confirming the pregnancy; 3) accepting the pregnancy; 4) acknowledgement of fetal movement; 5) acceptance of the fetus as an individual; 6) birth; 7) seeing the baby; 8) touching the baby; and 9) giving care to the baby. Russell's (1974) examination of 511 couples and their 6-56 week old infants supports the view that the transition to parenthood is a crisis situation which involves a reorganization of the family's social structure. This change in family relationships was noted to be "bothersome" to new parents. Relevant adaptational factors noted by Russell from self-report checklists were: 1) the pattern of communication which affected the planning of the birth and a positive adjustment to marriage; 2) a high degree of commitment to the parenting role; 3) good maternal health; 4) a nonproblemnatic baby; and 5) preparation for parenthood. These factors are compounded in magnitude in the developmental tasks of the adolescent mother.

Of special concern for the very young mother is her ability to cope with the multidimensional aspects of parenthood and to facilitate positive transactions with her child. The five factors discussed above suggest the need for further exploration as they involve two very specific developmental tasks: I) the adolescent's acquisition of an independent concept of self; and 2) the parent's role transition from an individual to a member of either a dyad or a triad. When one considers the magnitude of each of these tasks separately and then as occurring simultaneously, the situation of the young mother and her baby becomes potentially more devastating.




4

An area of general concern is the lifestyle chosen by the mother

and its implications for the development of the mother, her baby and the developing family unit. Alternatives chosen by the mothers have included marrying the father, raising the child alone or living with the extended family, relatives or friends. The ramifications of the choice of lifestyles have been the focal point of several studies which have noted the "burdens and benefits" of early parenting (Furstenberg, 1978). Negative outcomes have been related to: 1) a loss of educational and vocational skills; 2) family impoverishment due to the high incidence of repeated pregnancies in the adolescent population (Moore, 1978); 3) a 60 percent divorce rate for pregnant adolescents who marry; 4) a higher degree of medical complications and risks during prenatal and neonatal periods for mother's lacking in prenatal care (Placek and Jones, 1976); and 5) a lack of preparation for the parenting role (Crider, 1976; Badger et al., 1974) resulting in a lack of skills in facilitating parent-child relationshins, as well as a high degree of suspected child abuse (DeLissovoy, 1973).

The positive outcomes of early parenting are difficult to assess and often far more difficult to accept. More staggering than the sheer numbers of young mothers and more perplexing than the risks in questions are the prevalent attitudes of today's society. The negativism faced by the mother in the school, professional-environment and community is potentially more devastating than early parEnthood itself, In effect, this says to rhe mother, "you can*t. be a good moher--. you're too young!" If our efforts are to be fruitful, we must onen our minds and maintain a realistic perspective in order to understand the role of the adolescent as a parent.

The Concept of Parent-Child Transaction and Infant Development

The past decade has witnessed considerable research in the area of neonatal characteristics with respect to innate competencies and capabilities. The data indicated that the newborn arrives with two




5

sequentially integrated systems of readiness (Gordon, 1975). The ability of the sensory system to receive and the central nervous system to process information is referred to as "responsive readiness." From this point, "adaptive readiness" allows the infant to cope with and modify the environment accordingly. It is this reciprocal relationship between the infant and the environment which is described as transaction and which forms the base upon which future development and learning grow. The attachments formed as a result of these first transactions between parent and newborn thus become important to an understanding of development.

Of primary significance to the newborn are those individuals with

whom the first contact is made and a relationship established--the mother, father and other family members. Numerous studies have dealt with the implications of these first bonding experiences--those which establish the attachment of one individual to another through the unique exchange of sensory stimulation and affective warmth (Ainsworth, 1972; Bell, 1974; Brazelton, 1975; Klaus and Kennell, 1976; Lamb, 1977). The use of direct and videotaped observations of dyadic interaction has been one useful means of exploring the parent-child relationship. The analyses of structural patterns and behavioral components in the observations have indicated that several specific variables are directly related to the infant's language, cognitive, and socioemotional growth (Clark-Stewart, 1973). These variables include affective warmth, face-to-face orientation, and responsive (rather than directive) behaviors and verbalizations. It is these attributes which are the focal point of this study. Of special interest is the relationship between the mother's ability to interact in a manner which is responsive to the needs and capabilities




6


of her infant and the infant's ability to participate in a reciprocal manner.

In summary, the research indicates that the infant is a competent human being--capable of responding to and with the environment. The infant posesses many competencies, yet is unable to perform certain tasks, and must depend on other individuals for life sustaining and enhancing functions. The quality of the care provided for the infant is the vital element which will promote the most positive growth during the child's first three years of life (Gordon, 1975). What temainas in qu ston is the quality of care provided by the very young mother. While the risks of early parenthood are obvious, the strengths of the young mother have vet to be empiricsially umented. An assess ent of the strengths and limitations of the mother-infant relationship and the infant's development will thus contribute toward a more thorough understanding of their needs and: will make itipossible to design more comprehensive services for the young family.

Questions Addressed in the Study

The independent variables under investigation in the study are age of the mother, education of the mother, sex of the infant, birth order, perinatal risk status, socio-economic status, social support system, ethnicity and participation in prenatal treatment and childbirth and parenting education programs. The relationships between and among the independent and dependent measures of infant development and motherinfant interaction were investigated by an overall test of no association between the two sets of variables. Follow-up tests on the specific variables under investigation indicated the degree to which they contributed. to the prediction of:developmental outcomes.





7



The general questions addressed in the study were investigated as follows:

1) Do infant development and mother-infant transaction vary as

a function of the age of the mother?

2) Is the relationship between the mother's age and each dimension

of transaction and infant development linear after controlling

for all other independent variables?

3) What is the nature of the relationship between prenatal medical

care and development at six months after controlling for all

other independent variables?

4) Which variables contribute predictive information to the

identification of developmental delays on infant development

measures at six months?

5) Is there a positive relationship between the extent of prenatal

and postpartum parenting education and infant development

and mother-infant transaction at six months?

6) Is there a positive relationship between the extent of the

mother's social support system and transaction and the infant's

development?

Summary

The purpose of this study was to investigate the transactional relationship between the adolescent mother and her infant and the infant's development. We have reason to believe that the young mother and her infant are at risk for problematic development; yet our current sources of information are limited in nuriber and yield inconclusive findings. This study was designed to explore the unique contributions




8



of socioenvironmental, medical and educational variables in order to increase our understanding of the needs of the young mother and her infant. As a result, our interdisciplinary efforts to provide comprehensive services will be able to become more sensitive to the special needs of the young family.
















CHAPTER II

THE REVIEW OF THE RESEARCH



This study was designed to explore the transactional relationship

between the very young mother and her infant and her infant's development. In order to understand the implications of early parenthood on the mother and her baby, it is necessary to synthesize the literature from several sources of knowledge.

The variables which are the focal point of the present study -prenatal and perinatal risk factors and socioenvironmental, medical and educational resources -- are presented in this review as they relate to the sequential development of the adolescent as a mother. Specific discussions of the role of the extended family and psychosocial influences on the young woman undergoing the transition to parenthood are presented within the context of each phase of the transition. These topics are also discussed as they relate to the development of the child born to a very young mother.

As noted previously, the adolescent undertaking the task of motherhood faces both a transition from her family of origin to psychological independence and the transition to the responsibilities of parenthood. Her relationship with her baby and her baby's growth can be viewed as a function of the mother's ability to establish




9




10



equilibrium in these two multidimensional stages of develcDment. The literature reviewed in this chapter has therefore been selected from two distinct fields: 1) the study of parent-infant transaction as it is related to infant development; and 2) the special study of adolescent parenting.

A review of the research related to young mothers' transactions with their infants is limited by the fact that there exists but one observational study to date (Badger.et al., 1973). 'For this reason, nonage-specific studies of the mother-infant relationship and transaction process as they relate to infant development are presented as a basis for understanding the process and the aspects which concern the young mother and her infant. The presentation of this material in such a manner is based on the assumption that there are certain universal aspects of mothering and infant development and that these are generalizable to the study of adolescent mother-infant transaction. It is beyond the scope of this study to deal with the many issues associated with adolescent pregnancy, except as they concern the role of the mother and her baby's development.

Parent-Child Transaction and Infant Development

The emergence of current information regarding the newborn's competence and capabilities has been accompanied by investigations of the earliest years of a child's life and those who play significant roles in the development of the child. The child's concept of self forms a major basis for the developmental process and has been thought to be related to early transactions between the newborn and parent, When the concept of self is viewed as a learned rather than







than an innate phenomenon the child's self-concept--appears to develop. :as a function of the growth .process through transactions with people of significance. Gordon (1966) summarized much about the development of the Self in infants and young children when he stated:

Their original images of themselves are formed in the family
circle. They develop the notions of who they are in relation
to people around them, particularly through ways in which their
behavior is received by adults who are important (and that) the origins of self-concept are the results of interactions
with his parents and the meanings he assigns these experiences.
(The Self thus becomes) the motivating and selecting factor of
behavior (and learning) . and is the sum of subjective
judgements he makes with regard to himself and his experiences.
(p. 74)

In this way, predispositioned feelings about self are conceived and ramifications for future development become evident.

It becomes important then to turn to the more global studies of the parent-infant relationship. In this way we may better understand the development of the adolescent as a mother and the ramifications of this process for the growth of her child.

How does the mother-infant relationship begin? What is meant by the terms attachment and bonding and how do they affect future development? How can we better extend our understanding of these abstract concepts with more concrete evidence? These questions have prompted a considerable amount of research concerning the evolution of the newborn's first experiences within the family.(Ainsworth, 1972; Bell, 1974; Brazelton, 1975; Klaus and Kennell, 1976; Lamb, 1977). Let us review Brazelton's (1973) discussion of the interrelated components through which the mother forms the beginning of attachment to the infant. The stages include: 1) planning the pregnancy; 2) confirming the pregnancy; 3) accepting the pregnancy; 4) acknowledgement of fetal movement; 5) acceptance of the fetus as an individual;




12



6) birth; 7) seeing the baby; 8) touching the baby; and 9) giving care to the baby.

In view of the findings by Zelnick and Kantner (1978) regarding the large number of unplanned births to adolescent women, the subsequent development of feelings of attachment to the infant remains in question. This is confounded by the fact that the pregnancy is often confirmed and acknowledged in the second or third trimester. These factors pose additional threats to the relationship between the adolescent mother and her infant. The delayed confirmation and acceptance of the pregnancy have remained unstudied with respect to their impact on the adolescent mother-infant relationship and are in need of further exploration.

When considered within the framework of social learning and

experiences, the feelings brought by the mother to the first encounter with her newborn are a product of her identification with her environment, the effects of imitation and modeling, cultural influences, values and expectations (Klaus and Kennell, 1975). The role of the very young mother's environment and family of origin has thus been an important area studied with respect to early pregnancy and parenting. Fox (1978) notes the familyts multifaceted impact on the adolescent as a social "interactor" which is operationalized through childrearing styles and by the quality of the relationships between dyads within the family and among family members.

In studies of maternal-infant attachment, Ainsworth (1972)

has examined the qualitative characteristics of interaction from the study of separation and has offered some defining attributes of




13



attachment as a phenomenon. This attachment is viewed as an environmental adaptation evolving from the infant's attempt to gain proximity to the primary caretaker. Attachment differs from dependency in that it involves an affective preference for contact or multisensory stimulation, as opposed to the desire for the fulfillment of a physical need. Attachment is initiated through the process of mutual gazing and the establishment of eye contact with the mother, Observations have shown that gazing is followed by locomotor approach. Lamb (1974) stressed the need to view these characteristics as a series of interrelated components of behaviors which are uniquely individual expressions and must be viewed as a part of a sequence in the transactional process. Behaviors are then clustered to find measurable criteria without threatening attachment as a concept,

In an attempt to categorize structural patterns and behavioral components and to quantify optimal maternal behavioral variables, several studies have focused attention on direct and videotaped observations of dyadic interaction. Brazelton et al. (1975) stated that "it is through an early system of affective interaction that the development of an infant's identification with culture, family and other individuals will be fueled" (p,80). The study examined twelve pairs of mothers and infants involved in face-to-face interaction over a twelve month interval. Behaviors such as vocalization, head position, direction of gaze, body position, amount of movement and handling revealed that the quality of each partner's actions were in direct relationship to the other. The behaviors were viewed as an indication of intentional affectivity and indicated that each partner modified




14




and adapted reciprocally in response to feedback from the other individual. The sequence of phases which emerged from the observations of the mother-infant dyads comprised: 1) initiation; 2) mutual orientation; 3) greeting; 4) play dialogue; and 5) disengagement. This notion of the infant's social self-regulation was interpreted from intentional explorations -- both cognitive and affective -- and the mother's ability to enhance the infant's attending to her for important cues.

Lamb (1977) supported the notion that the infant's active participation is directly related to a sensitivity to signals. He cautioned, however, that it is as yet unclear whether infants emit behaviors which elicit a response, or whether they regulate their own behaviors to engage in reciprocal interaction as a function of their intellectual competence. The question of the infant's competence in evoking a response has also been investigated by Sameroff (1979). He suggested that a distinct feature of the transaction (as opposed to interaction) model is the recognition given to the infant and the abilit- of the infant to modify the environment. Ainsworth and Bell (1973) acknowledged the infant's contribution to the transaction process in the statement:

Whatever the role may be played by the baby's
characteristics in establishing the initial pattern
of mother-infant interaction, it seems quite clear
that the mother's contribution to the interaction and
the baby's contribution are caught up in an interacting
spiral. It is because of these spiral effects some
"vicious" and some "virtuous" that the variables are so
confounded that it is not possible to distinguish independent from dependent variables. (p.160).

The relationship between infant competence anac the mother-infant transaction process remains in need of further exploration.





15


The effects of the quality of mother-infant interaction on the development of both mother and infant has been investigated as well. An intensive nine month study of 369 eighteen month olds in repeated observations, interviews and developmental assessments- lends support to a view of social competence in the infant and -a dependence upon its nurturance through reciprocal transactions (Clarke-Stewart, 1973). Findings indicated a significant relationship between maternal stimulation, responsiveness, and expression of affection and the child's developmental changes and social, emotional, cognitive, and language competence. The most influential factor was found to be the quality, rather than nonresponsive quantity, of verbal stimulation. Other important factors included the mother's role as an environmental mediator, her expression of positive emotion, and frequency of responsiveness, stimulation, or affectionate behavior as it related to the child's competence. The data suggested that responsiveness to the infant's behavior had a duel effect as it not only reinforced specific behavior, "but created an expectancy of control within the infant which generalized to new situations and unfamiliar people" (Clarke-Stewart, 1973, p. 107). Other studies indicated maternal involvement with the neonate immediately after birth as having positive effects on the mother's psychological state and thus her ability to reciprocate responsively (Powell, 1974; Klaus, Kennell and Krause, 1975).

The. fact that many adolescents do marry or enlist the support of

theefather necessitates a:hrief discussion of current-studies which have explored the importance of the father's role and his transaction with the infant. By means of a self-report questionnaire and interviews, Wente and Crockenberg (1976), examined the nature of the transition to fatherhood with respect to the husband-wife relationship and the effect of Lamaze




16



preparation for childbirth. While it was noted that there existed a high correlation between the husband-wife relationship and total adjustment to perceived changes, medical preparation in childbirth was insignificant in facilitating adjustment after birth. What appeared meaningful in the transition from dyad to triad was the sense of "family" established as a result of the father's participation in the birth. Total adjustment was found to correlate negatively with the disruption of affection and intimacy, a decreasing amount of time spent with the wife, and a discrepancy between the father's expected and actual caretaking role due to breast feeding. This aspect of early marriage and fatherhood has been virtually ignored with respect to early parenting (Chilman, 1979).

Studies of fathers' involvement have supported--the importance of the father- infant transactional relationship, Parke:and Sawin's (1976) observations of fathers, both with the mother and alone with the neonate, indicated that the fathers were equally involved in establishing eye contact, holding, vocalizing and touching the infant. Fathers were also successful in caretaking routines, and often exceeded the mother's participation. In the context of feeding and on other measures, fathers were found to be sensitive to infant cues and were able to interpret infant behavior and modify their own behavior in response. It was also noted that fathers touched and vocalized to first-born males more often than to other offspring. Longitudinal studies indicated that those fathers who were given the opportunity to learn and practice skills in the hospital were more involved with infants at six months (Parke and Sawin, 1976).

The results of the stud), on the strength of mother-child and fatherchild attachment supported the father's role in the child's developing




17



competence (Lamb,.1976b). During unstructured free-play in a laboratory playroom, observations of twelve month olds were used to measure the effects of each parent on the transaction process involving the other parent. The effect of a stranger's presence (a stressful situation) was also investigated in this study. The findings indicated a significant reciprocal effect in the presence of both parents on both mother-infant and father-infant relationships. The infant's affiliation behaviors -- smiling, reaching and touching -- and interaction during play showed a preference for the father. In a stressful situation, however, primary attachment surfaced and infants under two years of age sought proximity to the mother. Lamb (1976) points out that the results of his two studies should not be used to equate affiliation with attachment as an affective preference for one parent or the other.

The findings that early interpersonal transactions are of

importance to the young child's development of competence stimulated further investigation into the expanding socialization process. This process has been shown to have a pronounced relationship to total development in infancy and throughout early childhood. The parent-child relationship was shown to be related to the language, social, emotional and mental development measures of infants who were followed from nine to eighteen months of age (Clarke-Stewart, 1973).

Based upon the assumption that the infant is preadapted to

selectively attend to stimuli and facilitate adult-infant interaction, numerous studies have explored the notion that reciprocity is an









outgrowth of the mutual enhancement of feelings of efficacy (Ainsworth, 1972; Bell, 1974; Brazelton et al., 1975; Klaus and Kennell, 1975). The parent's distinctive interpretations of the infant's states of arousal have been shown to prompt an appropriate response to stimulation. The extent to which the behaviors of significant others can be anticipated from contextual events functions as a determinant of the quality and extent of the infant's responsive reaction (Goldberg, 1977). The ability of the young mother to interpret the state of her infant and facilitate appropriate transaction has been questioned by a-number of authors (Hardy et al., 1978; DeLissovoy, 1973) and was investigated in the present study.

Beckwith et al. (1976) studied the preterm infants' interactions with their mothers at one, three and eight months of age through observations in the families' homes. Her findings indicated that infants whose Gesell developmental quotient was higher at nine months spent less time being in routine care at one and three months and were given more floor freedom at eight months. Higher scores on sensorimotor measures were associated with more mutual gazing during one month observations, with smiling and contingent responses to distress at three months and general attentiveness at eight months. Beckwith's (1971) study of maternal attributes and their infant's I.Q. scores revealed freedom to explore the home, experience with people other than the mother and the adoptive and natural mothers! socioeconomic status to be important interaction variables which were related to enhanced development.

Much research has been undertaken which deals with dyadic communication skills in an attempt to trace qualitative interpersonal skills and note





19



essential characteristics of social reciprocity. From initial attachment bonds, the infant acquires skills in evoking a response and, as a result, an "emotional connectedness" is formed between the infant and others (Bell, 1974; Brazelton et al., 1975).

In looking at the quality of interaction of mothers and their young children, we can better understand the impact of the mother-infant relationship in infancy. A recent study of early mother-child verval interaction indicates the mother's capability to adapt her language behavior to cues from the young child. Moerk (1975) found a correlation between the mode, length and complexity of mothers' responsive language and the child's developmental level. This suggests that the young children's competence is related to their mothers' modeling, explanation, corrective feedback and expansion of their behaviors and ideas. Holtzman's (1974) findings further illustrate this concept of social learning in verbal content which stimulated the child to work through "contextual solutions from within his cognitive repertoire" (p. 34). The nonverbal aspect of interpersonal communication between five year olds and their mothers was explored by Schmidt and Hore (1970). They noted a difference between sopntaneous signals not intended as communication and expressive behavior transformed by the intention to communicate. Their findings show more use of reciprocal glancing and complex language with children of higher socioeconomic status. No significant differences in body contact or closeness were found to be associated with socioeconomic status.

Emotional implications of the verbal and nonverbal environment

were the subject of investigations done in sequential semi-structured observations of one and two year olds in middle class homes (Nelson, 1973). If was found that nondirective parental strategies which were accepting of the child's behavior, including feedback and nonselective




20


responding, were significant in the facilitation of emotional and language development. Behavioral evidence which supports the effects of encouragement and reflective responsiveness was seen in laboratory observations of mother-child transactionas facilitating attention control, spatial orientation and field-independent cognitive styles (Bronson, 1972; Campbell, 1975). In studies relating infancy to early childhood, the child of between three and five years was seen as able to interpret the level of expressiveness and abstractness and was developmentally verging on the ability to differentiate the "perspective reality orientation" of the partner through increasing empathy and decresing egocentricity (Newman, 1976). This suggested that from early transactions, the young child comes to learn how to affect another individual. Through this process, the infant (and young child) learns as well that the response of another is an expression of feelings and ideas and that these expressions are directly related to the process of interaction.

Summary

In summary, the development of the child appears to be strongly associated with the quality of the relationship between mother and infant. These studies which have dealt with the concept of transaction clearly demonstrate that the mother-infant relationship is of prime importance to the development of the child. Still, surprisingly little is known about the infants of adolescent mothers. Often our sources

of information have been limited in generalizability. They do, however, acknowledge the:-need-for concern regarding the psychosocial, educational and medical risks associated with early childbearing. It is hoped that the consideration of the very young mother in future research will extend our knowledge base. Exploratory studies of the young parent family will thus strengthen efforts to improve the quality of professional services to the family as a unit and enhance the quality of life for each individual.




21


The Young Mother and Her Infant

Churchill once said crisis is a dangerous opportunity.
If pregnancy in adolescence can be defined as the
crisis, what [happens to] the infant may well be the
dangerous opportunity (Howard, 1976, p. 247).

This "dangerous opportunity" to which Howard referred is one about which very little is known. The past decade has given rise to great concern about the increasing numbers of adolescents who become parents each year. We have begun to investigate the medical, social, economic, psychological and educational consequences of early pregnancy and parenting, but surprisingly few studies have dealt with the development of the infants of very young mothers. Even less is known about how the young mother relates to her baby--the strengths and weaknesses in her style of parenting. To date, too few observational studies exist which document her unique repertoire of mothering behaviors. Our present sources of knowledge are thus lacking in relevant information, and are limited by a lack of methodological refinement in early research.

Before proceeding to a discussion of the research related to early parentin,it is necessary to explain some of the methodological problems in this area. In two separate reviews of the research, Crider (1976) and McKendry, et al., (1979) cautioned against the attempt to generalize from existing studies. In many cases, biases in our present sources are due to sample selections which were lacking in age specificity and inappropriate methodological procedures. Specifically, the analytical treatment of variables such as socioeconomic status and mothers' age was such that we do not know how much each contributes separately to the outcome measures of early pregnancy and parenting. A persistent bias is found when statements




22


of generalization about the parenting style of adolescents are made without regard to the design of the given study. For example, many authors described negative behaviors of the adolescent parents (DeLissovoy, 1973; Presser, 1974), but the sampling was such that only adolescents were included. If one is to suggest that young mothers display a higher incidence of dysparenting, it is necessary to include the "of age" mother in the design. Without this inclusion, we are unable to ascertain the relative contribution of mother's age to her style of parenting. A similar constraint is placed on generalization from studies of the infants of adolescent mothers. For this reason limitations will be noted in early research concerning the young mother and her infant.

In order to better understand the consequences of early childbearing on the mother and her infant it is necessary to compare the young mother to her "of age" peer. Variables of interest include the trends in birth rates, medical risks to the neonate and follow-up assessments of the infants of adolescents. This review will therefore address these issues from the perspective of their relationship to the adolescent's role as a mother and the development of her baby.

The Etiology of Early Pregnancy

In looking realistically at newer research on adolescent parenting, it is evident that there are two distinct categories. One is the study of pregnant teenagers and the second is the study of teenage mothers. In other words, e A L a ttiking difftence beteet becoming a pegnant teenager a nd becoming a teenage mothat. This issue is concerned with the element of choice upon the confirmation of pregnancy. The individual often is able to choose whether to: I) abort or continue the pregnancy; and 2) give the baby up for adoption or undertake the tasks ofparenthood.




23



Several disciplines have taken issue with the phenomenal number of pregnancies which have occured during adolescence. The biomedical explanation of how and why pregnancy occurs is quite well known and involves the science of human reproduction. From the political, sociological and educational perspective we find that a large number of early pregnancies are also due to young people's lack of knowledge or misinformation about contraception and a lack of confidential family planning services made available to them (Klein, 1978; McKendry et al., 1979).

The psychological and psychosocial antecedents of early pregnancy are more intricate since we are concerned here with the dimensions of human sexuality. From this standpoint, early sexual activity and resultant pregnancy become more comprehensible.

Paulker's (1970) data from a study of girls who became pregnant out of wedlock suggests that "the girls are not pregnant because they are different, but are somewhat different because they are pregnant" (p. 163). Rossi (1968) interpreted this concept in her discussion of the transition to parenthood and its direct relationship to the intent of the individuals involved. Rossi stated, "the inception of a pregnancy S. is not always a voluntary decision, for it may be the unintended consequence of a sexual act that was recreative in intent rather than procreative" (p. 31).

The question of intent has been explored by Zelnik and Kantner (1978) in their 1971 and 1976 studies of first pregnancies of women between the ages of 15 and 19 years of age. Their findings, based on National Probability Survey statistics, revealed that there has been little change in the proportion of white teens who become sexually active and pregnant each year, but there has been a substantial decline in the number who delivered. The authors stated that "few who become





24


pregnant do so intentionally, but few who become pregnant use contraception" (p. 11). The black population evidenced little change in the number of first pregnancies and an eight percent decline in premarital intercourse. The authors stated that a discrepancy existed in the number of live births and abortions reported by Blacks which was possibly due to the negative attitude of the culture towards abortion. Blacks were noted to report a higher number of live births and fewer abortions than were actually counted in the National Survey. It is important to note that any information obtained by means of self-report questionnaires and interviews is that which the subject is willing to disclose. This limitation is especially relevant to this study due to the extremely personal nature of the questions regarding intent. Regardless of the intent, we are faced with the fact that one million adolescents become pregnant each year (Alan Guttmacher Institute, 1976).

Turning to the study of adolescent psychology (or psychopathology, as it may seem), several conflicting studies focus on the personality of the adolescent as an explanation of her sexual behavior. A composite personality profile of the pregnant adolescent is one of a young woman who typically came from a broken home, was sexually active with one partner on a steady basis, reached an early menarche, was sexually impulsive, narcissistic, sociopathic, rejected, isolated, lonely, unsuspecting, and/or unprepared (Kane and Luchenbrugh, 1973; Rosen, 1661; Cobliner et al., 1973; Barglow et al., 1967; Malmquist, 1967; Claman, 1969; Gottschalk, 1964). Another view is that "adolescent patients became pregnant being normal adolescents doing normal adolescent things" (Malmquist, 1967). Each of these studies is characterized by a methodological problem in either the use of small samples or the lack of a comparison group of women over the age of




25



19 years. A third approach to this area of study is best summarized by Cutright (1971) in answer to the question, "who is the pregnant school-age girl and why is she pregnant?" Cutright answered:

'Why is she pregnant?' To me this question implies a pathology behind pregnancy, and denies human sexuality. In the United States we keep trying to find out what kind of people
(in psychological terms) get pregnant out-of-wedlock--what
could we do if we found an answer? We do not ask of married women experiencing unwanted pregnancy 'why are you pregnant?' Yet 20 percent of white and 36 percent of all nonwhite legitimate births during 1960-1965 were unwanted by the parents.
Rather, we ask what means were available to control conception
and gestation, and then move to devise a program to help
married women control unwanted pregnancy and birth. We infer nothing pathological when we speak of unwanted pregnancy among
married women, and it is time we do the same for unmarried
pregnant women. (p. 13)

The Growth and Development of the Very Young Mother

Now that we have briefly reviewed the background information regarding pregnancy in adolescence, let us turn to the resolution of the pregnancy; specifically, the decision to continue the pregnancy and become a parent. At the onset of this discussion, a clarification is in order. In many instances, there is no viable choice to be made by the pregnant teenager. Unless pregnancy is confirmed during the first twelve weeks of gestation, abortion is no longer an option. Another constraint is the cultural pressure facing the adolescent which is quite ambivalent towards abortion. We have reason to believe this is changing (Hardy, 1978), but to date, there is a general lack of acceptance of abortion among members of minority cultures. This lack of acceptance of abortion as a viable alternative to parenthood should not be construed to mean that minority cultures condone or accept early pregnancy and parenting in their offspring. To the contrary, the works of Furstenberg (1976, 1978), Butts (1978), Martinez (1978), and Wright- Smith : (1975) confirmed that feelings of disappointment,




26



social disgrace, and the stress of financial burden are feelings which are shared among all families of pregnant adolescents, regardless of their cultural origins. The family's reaction to the pregnancy has been shown to be important to the adolescent's development as a mother.

As has been noted frequently throughout this work, we are concerned here with the special ways in which mothers and their infants establish a relationship and grow together. The study of early parenting involves a unique set of characteristics and stages through which the young woman must pass.

The first stage following the confirmation of the pregnancy

concerns the decision regarding its resolution. Because the adolescent often feels guilt, shame, and fear upon the acknowledgement (Furstenberg, 1976) this becomes a critical point in her development as a mother. The study of this phase in the transition to parenthood has been synthesized by the three authors who, coming from the different perspectives of developmental and social psychology, have developed surprisingly congruent theories. The works of Chilman (1979),Furstenberg (1978)- and Fox (1978) have emphasized the importance of the family (often referred to as "the family of origin") and especially that the motherdaughter relationship has perhaps the most pronounced effect on how the pregnancy is resolved.

Furstenberg (1976) has discussed the impact of the discovery

of the daughter's pregnancy on the family. He found that for threefourths of the families he studied, this was the family's first

acknowledgement of the daughters sexuality. The reaction was often shock and disappointment. This contradicts the often held belief that early pregnancy and illigitimacy is an acceptable trend among lower socioeconomic and/or minority cultures. Presser (1974)





27


complemented this with her finding that therewas an association between early maternal childbearing and the behavior of the daughter. Chilman (1979) cited the fact that "daughters whose mothers had early pregnancies were more likely to become pregnant as teenagers". (p. 209) As found in her earlier work, "actual maternal behavior is apt to be moreinfluential than stated attitudes and goals for the [developmental outcomes of] children" (p. 209).

The influence of the family of origin on the prevention of

pregnancy and the use of contraception and abortion has been another area of interest. In general, the authors have concluded that a young girl's decisions both to become sexually active and to use contraception are related to her parent's values and support of her, her relationship with each parent and the degree of connectedness within the family CJessor and Jessor, 1975; Lewis, 1973). Fox (1978) cited the Rosen (1977) finding that, when adolescents consulted their families, the young woman was more likely to continue the pregnancy and keep her baby. In contrast, those who sought abortions rarely consulted their parents.

- The plans implemented by the young mother following the decision to continue the pregnancy were discussed by Young, Birkman and Rehr (1975). In their study of the role of the mothers of teens who carried their pregnancies to term, the mother was noted to be especially influential in the decision making process. The daughters living arrangements, educational plans and child care and childrearing arrangements were those most often influenced by the mother.

We can look to the National Center for Health Statistics for a quantitative summary of those who gave birth during adolescence in order to understand the trends. In comparing the birth rate of




28


adolescents to that of older women, Baldwin C(1976) has noted a peak in the rate for 18 and 19 year olds and older women. This peak occurred during the 1950's and has declined steadily since that time. The decline has been less extreme for 16-17 year olds. For the youngest teens (< 15 years), the birth rate has risen. The comparison of birth rates by race has revealed a striking pattern. Baldwin noted "the birth and illigitimacy rates are both higher for black than white teenagers. However, recent rises in birth and illegitimacy rates in the young reflect changes in the white population. The birth rate for black teenagers has declined steadily and the illigitimacy rate is fairly stable (Baldwin, 1978)."

A more recent survey from the final 1977 National Natality

Statistics revealed a surprising trend in the fertility rate of those mothers below the age of 18. The fertility rate "declined slightly for women under 18 [as did the] rates of out-of-wedlock births among Blacks and whites younger than 15 and among Blacks aged 15-17"[Family Planning Perspectives, 1979]. While this most recent trend is encouraging, the fact remains that one of every five babies born today is born to an adolescent mother (Baldwin, 1978).

The rate of child bearing and its relationship to childrearing

trends has been summarized by the Alan Guttmacher Institute (1976). In 1971, of those adolescents who gave birth out-of-wedlock, 87 percent kept their babies, five percent sent the baby to live with family members or friends, and 8 percent gave the baby up for adoption. This large percentage of infants raised by very young parents has led to the study of the mother's ability to care for her baby and the consequences of early parenting on the baby's development.




29


The Transactional Relationship Between the Very Young Mother and Her Infant

The research to date regarding the adolescent mother-infant

relationship is characterized by serious shortcomings. We are presented with problems in understanding the needs of the young family due to the fact that: 1) the transactional process has been virtually unstudied; 2) there is an extremely high degree of controversy in the research related to adolescent caregiving; and 3) when the relationship has been explored, the sampling has been such that no comparison to the "of age" mother has been made. Our discussion of the adolescent mother-infant relationship is thus limited. It is to this specific gap in our knowledge that the present study was directed.

As has been noted throughout- the purpose-of:this study was to address the questions regarding the behavioral repertoire of the young mother.- An important aspect of early parenting has been the developmental tasks of adolescence which bear heavily on the transition to motherhood. Fox (1978) summarized the importance of several tasks related to parenting which were: 1) resolving feelings about the family of origin in order to separate and become autonomous; 2) an intense need for closeness and concurrent feelings of being "smothered"; 3) coming to terms with the "who am I?" question:in defining one's self; and 4) the establishment of appropriate attachments apart from the family. As has been stressed before, these are often overwhelming-and have been noted to influence the young mother's relationship with her child. --In a study of adolescent's expectations and attitudes towards their infants, DeLissovoy (1973) found disturbing charactristics of the young parents. He noted them to be "an intolerant group--impatient, insensitive, irritable and prone to use physical punishment




30



with their children" (p. 22). DeLissovoy also found young parents to have a lack of knowledge about child development and unrealistic expectations of the infant. It was suggested that this lack of knowledge governed the parents' actions to the child and constituted a form of emotional abuse. These findings were based upon interviews conducted during five visits in the homes of 48 adolescent families residing in semirural Pennsylvania. The results prompt a caution regarding their generalizability due to the lack of a comparison group of urban or adult parents (Crider, 1976).

The conslusions reached regarding young mothers' inappropriate attitudes and expectations towards her child were discussed from the perspective of its relationship to her intent to become pregnant. In an age-specific sample of 408 urban women (15-29 years) Presser (1974) found that almost half of all mothers between fifteen and nineteen years of age wished they had postponed their first birth. The mothers cited the reason that the infant "restricted their life choices far more than they had anticipated" (p. 13). The author concluded that early first births and resultant child care are in need of more indepth investigation in order to assess their importance to the woman's development as a mother. Klein (1973) supported this notion of the adolescents' having been "less than adequate as nurturing mothers" (p. 1154), and concluded that the lack of knowledge and preparation for parenthood suggested a need for more appropriate interventions.

Epstein (1979) addressed the lack of knowledge about infant development and its implications for mothering. On prenatal and six months postnatal assessments of 125 mothers in the High Scope Project, teens evidenced a lack of knowledge about the infants' cognitive and socioemotional development. The author noted that "babies were seen as




31



passive creatures requiring little more than basic caregiving" (p. 64). The expectation of "too little -- too late" led to her conclusion that because young mothers are unrealistic about what they need to give, they "are likely to miss the gratifications able to be received from a baby" (p. 64). The results of this study provide valuable information regarding the educational needs of young mothers. Again, we are unable to ascertain whether or not this lack of knowledge is attributed to youth due to the lack of a comparison group of older mothers.

The findings regarding the problematic mothering style of the young mother have led to the often unwarranted conclusion that adolescents are likely to abuse and neglect their children to a significantly greater extent than the "of age" mother. Epstein (1979) contrasts her findings of expecting "too little, too late" with the child abuse literature regarding abuser's expectations of "too much, too soon." Crider (1976) noted the fact that most of the child abuse studies have found the infant's birthweight, not the age of the parent, to be significantly related to abuse.

Kotelchuck's (1979) most recent investigation into the prediction of pediatric social illness has illuminated the relative importance of the mother's age in predicting child abuse and dysparenting. His findings from a study in Boston revealed the parent's social isolation to be the most significant predictor of inappropriate or abusive parenting. In a discriminant analysis which accounted for 40 percent of the variance among abusers and nonabusers, the author found all measures of depression and isolation to be significant, No significant relationship was found due to mother's age, immediate stress, birth factors or baby temperment.




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Extending this concept of the parent's social support system to

the adolescent mother-infant relationship has proven to be illuminating. In a cross-cultural study of mothers and their newborns, Brazelton and Lester (Note 1) compared adolescent mother-infant dyads in Puerto Rico to those in the rural South. Their findings revealed the supportive nature of the extended family to be strongly related to both motherinfant transaction and the behavioral assessment of the neonate.

Perhaps the most in-depth studies of the importance of the extended family to the adolescent mother-infant relationship are those of Furstenberg (1976; Furstenberg and Crawford, 1978). His longitidunal studies showed that most adolescent mothers were "apparently loving, responsible, effective parents" (Chilman, 1979, p. 261) of young children, especially if the responsibilities of child care were shared by another adult.

Furstenberg's most recent work explored the family's support in the early years of parenthood and its relationship to longitudinal assessments of childrearing attitudes and practices. At the five year follow-up of a sample of 404 Baltimore families, no differences in mothers' reports of self confidence or ratings of parent-child interaction were noted among families of differing residential careers or childcare arrangements. Among those mothers living alone or apart from the extended family, Furstenberg noted a higher level of control over the child's behavior and a higher level of interest in the child. The author concluded that the mother's ability to establish her own support system independent of the family was an important dimension of her parenting role (1978) and evidenced a willingness to take responsibility for herself and her child.









The impact of the extended family has yet to be explored within the content of varying mothers' ages. This is especially important in view of the large number of single-parent adolescent families. The most recent estimates reveal that "39 percent of the children whose mothers gave birth before the age of 20 experienced a family breakup by age 15" (Family Planning Perspectives, 1979, p. 115). Intervention With Young Mothers and Their Infants

In reviewing the outcomes of early parenting with respect to the mother-infant relationship, we are confronted with disturbing findings. Perhaps the most promising results, while few in number, have been the investigations of interventions designed to assist the young mother through her transition to parenthood.

In a smaller (N = 39), quasi-experimental evaluation of the effects of weekly mother-infant classes in a pediatric clinic, Badger (1974) found significant gains in mothers' knowledge of infant development, nutritional needs and infant health care. Most promising were the significant increases in mothers' responsiveness to their infants and the infants' increased responsiveness to the mothers. Badger noted that the program had a significantly stronger impact on the behaviors of the youngest mothers.

In an educational and medical program for adolescents in Syracuse, Osofsky and Osofsky (1973; 1978) examined the mother-child relationship among 450 dyads. The authors noted the young mother's warmth, physical interaction and attentiveness to their infants as being a strong foundation upon which interventions were based. They also found a major weakness to be a lack of verbal interaction. W hile




34




the study lacked a comparison group of older mothers and adolescents

who were given traditional treatment, the findings suggested important

areas in need of intervention.

Summary

Our sources of information remain limited with respect to their

methodology, scope and the documented strengths and limitations of early

parenting. They do, however, provide an intriguing basis for both

future intervention and research designs. In summary, the conflicting

results of studies investigating early parenting are inconclusive.

We are unable to ascertain whether young parents are any different

in their caregiving attitudes, feelings and behaviors than parents

who have postponed childrearing. Chilman (1979) systhesized the views

of those who are more optimistic when she stated:

By age 16 or so, most young people are at a higher level
of development and integration,but need more time to assess
their values, goals and heterosexual relationships. Because
child care requires the ability to be nurturant to another,
to carry a heavy load of responsibility, to control one's
impulses, to make wise judgments, and to be able to provide
the child with a wealth of experiences and firm guidance*,
it seems unlikely that younger adolescents would on the
average, be as effective in their childrearing as older ones.
It also seems likely that, on the average, a premarital pregnancy would particularly strain a youthful marriage.

On the other hand, 'ages and stages' are far from the
whole story in human development and the capacity for parenthood. People who have been 'well-parented' themselves,
whose motivations, values, interests and experiences have
particularly prepared them to care happily and effectively
for children, may be excellent parents, regardless of their
age, especially if various support systems are available
to them in their own families and in the community. (p. 261)




*In sober truth, who can be and do all these things? (Chilman, 1979, p. 261)




35


The Children of Very Young Mothers: Perinatal Risk Factors

Thus far, we have discussed early pregnancy and parenting from the perspective of the young mother. Of equal importance are the consequences of early childbearing and childrearing for the infants born to adolescents. Intuitively, we can guess that these infants are at high risk for medical, developmental and educational problems. Several factors have been brought to our attention by Crider (1976) and McKendry et al. (1979) in their reviews of the risks associated with adolescent pregnancy. The increased obstetric and neonatal risk of pregnancy in a physiologically immature woman has been repeatedly documented to have long range ramifications on the developmental outcomes of the infant (Grant and Heald, 1970). This is often complicated by delayed and inadequate prenatal care, poor nutritional status, economic impoverishment, social isolation and emotional stress (McKendry et al., 1979). As with much research on early parenting, the investigations of the relationship between these factors and infant development have revealed inconsistent findings. They do, however, offer relevant information regarding the consequences of early pregnancy and parenting for the infants of young mothers.

The most recent investigation of the prenatal, perinatal and neonatal complications associated with adolescent pregnancy was discussed by Ryan and Schneider (1978) at the University of Tennessee Center for the Health Sciences. The authors studied the obstetric performance and the status of the neonate at birth among a predominantly black sample of 222 teens who were 19 years of age or less at delivery. The findings revealed these patients to have high rates of inadequate prenatal care, prenatal complications and complications during labor and delivery. The perinatal death rate was found to be twice that of the general population.




36

The neonatal complications indicated by low Apgar scores ( 5), central nervous system depression, pallor and decreased tone were found to occur significantly more often in babies of adolescent mothers. These findings offer important information to be considered in the assessment of the developmental status of newborns of very young mothers. A methodological concern should be noted with regard to the author's comparison of their sample's results to a previously unspecified sample of older teens and "of age" mothers.

The findings, as discussed above, about perinatal risk and mortality of very young (5 16 years) adolescents, have been consistently documented throughout the obstetric and pediatric research (McGanity et al,, 1969; Crider, 1976; Jones and Placek, 1978; Knox, 1971; and McKendry et al., 1979). Additional obstetric complications of mothers under 16 years of age were found by Knox (1971). Very young adolescents were noted to have a significantly higher incidence of cesearean section births, premature rupture of membranes and prolonged labor. Other obstetric complications summarized by McKendry et al. (1979) and Crider (1976) included abnormal presentations and infections at delivery (McGanity et al., 1969), uterine dysfunction and one day fever (Coates, 1970), and cephalopelvic disproportion (irregular size or position of the fetus head in relationship to the mother's pelvic structure) (McKendry et al., 1979). These problems have been related to the physiological and gynecological (the time span between the age at menarche and first pregnancy) immaturity of the other (latnik and Burmeister, 1977; Erkan, Rimer and Stein, 1972).

The relationship between adolescents' obstetric complications and neonatal risk has been closely studied by several authors (Crider, 1976; McKendry et al., 1979; Mecklenburg, 19'73; Dott and Fort, 1976;




37


Coates, 1970; Grant and Heald, 1970; Hardy, 1971; Youngs et al. 1977; Semmens, 1965). Findings which were consistently documented by these authors indicated that the infants of young mothers were at high risk for perinatal, neonatal and infant mortality. Crider (1976) cited a North Carolina study of perinatal mortality in an age specific sample which found that the mortality rate was highest when mothers were under 15, and declined through the age of 20.

The rate of morbidity (impaired medical and/or developmental

functioning) was also found to increase significantly as the mother's age decreased. Mother's age and medical risks to the neonate included respiratory distress syndrome, hyperbilyrubinemia, fetal distress with anemia, fetal distress with asphyxia (Coates, 1970), low birthweight associated with prematurity and low birthweight associated with small size for gestational age (Crider, 1976).

In studies where a comparison group of "of age" mothers were included in the designs,we are presented with different findings. Niswander and Gordon's (1972) discussion of the National Collaborative Perinatal Study results indicated no significant differences between mothers under 20 years of age and those over 20 with respect to perinatal death. Neonatal death was found to occur significantly more often when the mother was less than 15 years old. Their data did not support an association between out of wedlock births and perinatal risk. Dott and Fort (1976) concurred with the finding that the "unique medical problems [of the adolescent] are controllable and do not differ appreciably from older women" (p. 536).

McKendry et al. (1979) have summarized the limitations of

studies which have regarded the age of mother as a single predictor of obstetric performance and neonatal status. The authors concluded:





38



These studies must be read carefully as a result of differences in sample characteristics, the lack of controls, and
the inconsistency of terminology. The reader should be especially wary of many review articles that treat these medical conditions as proven fact; ironically, many times
these reports base their conclusions on inconclusive findings (Stewart, 1976). However, there appears to be more credence
in the proposition that the young girl and her infant are highrisk . patients, than in the proposition that they are
not. (p. 23).

When variables other than mother's age were analyzed as predictors of perinatal and neonatal status, the findings revealed no significant relationship to the age of the mother. The variables that were consistantly noted to predict obstetric and neonatal outcomes were: 1) nutritional status of the mother; 2) socioeconomic status; 3) quantity of prenatal care; 4) parity (number of prior pregnancies); and 5) spacing of births (McKendry et al.. 1079; Menken, 1972; Dott and Fort, 1976; Stine, Rider and Sweeny, 1974; Mecklenburg, 1973). As noted earlier by Dott and Fort (1976), many of the nutritional, obstetric and family planning problems of adolescents are "controllable," but control remains dependent upon the professional community's ability to make these services available to young women and the woman's motivation to use them.

Dwyer's (1974) study of 231 12-16 year olds enrolled in a prenatal program found no significant incidences of anemia, toxemia, labor and delivery complications, low Apgar scores or post-partum problems. Premature birth did result in 39 cases, however. While Dwyer's findings are promising and suggest the managability of the adolescent's perinatal outcome, they are based on a. study which failed to use a comparison group of older women or those with different prenatal care.

Semmen's (1961) study of 12,847 adolescents and nonadolescents who received care in a U.S. Naval Hospital found socioeconomic status, rather than race, marital status or age, to be the most





39



significant predictor of perinatal outcomes. The prematurity rate was identical in the two groups. The only difference was the adolescent's higher incidence of precipitate (less than three hours) labor and resultant fetal damage due to unattended deliveries.

The Louisiana Infant Mortality Study (Dott and Fort, 1976) revealed that younger adolescents were less likely to utilize antenatal services and that, when adequate prenatal care was given, the perinatal and neonatal death rate was significantly lower. The authors discussed the role of social and demographic variables in the outcomes of the infants, of young women. In the discussion of the roles of social and demographic variables in the outcomes of young women's infants, the authors concluded that "the burden of early motherhood falls most heavily on the offspring . infant morbidity and mortality are the greatest risks associated with [early childbearing]" (p. 536).

In a report of the Collaborative Perinatal Study at Johns Hopkins Medical Center, Hardy (Welcher et al., 1971) summarized the ramifications of perinatal and neonatal outcomes in her statement:

The scope of fetal wastage is two dimensional: 1) in terms of
perinatal mortality; and 2) in terms of the perinatal insult,
which while not sufficiently severe to cause fetal or neonatal
death, results in long-term handicapping conditions of the
surviving infant--for example, cerebral palsy, mental retardation, congenital malformation, blindness, deafness and other
neurological defects.(p. 238)

This point was stressed as well by Dallas (1971). He extended Hardy's perinatal risk factors to conclude that "later fetal outcome and intellectual performance are dependent upon the complex interaction of genetic, biological and environmental variables" (p. 249).




40

The ramifications of neonatal risk on'the development of the infants of adolescent mothers has remained relatively unstudied (Guttmacher Institute, 1976). There have been, however, a handful of longitudinal studies of children born to women enrolled in the Collaborative Perinatal Project (Niswander and Gordon, 1972). The followup assessments of these infants included the age of the mother in the design and constitute our main sources of information regarding developmental outcomes of the children of young mothers. Developmental Outcomes of Adolescent Pregnancy

The earliest and longest follow-up assessments of infants of adolescents were done as part of the Johns Hopkins Child Development Study sponsored by the Collaborative Perinatal Project. For this investigation, Hardy, Welcher, Stanley and Dallas (1978) defined adolescence to be 16 years of age or less at delivery. The sample of 4,557 mother-infant dyads was selected at random in 1964 and followed at a rate of 85-93 percent over a 12 year period. The sample consisted of 706 mothers who were 17 years of age or less at delivery. At birth, there were no significant differences between the under 16 and over 16 groups on perinatal or infant death rates. All risk factors were significantly higher for blacks than for whites.

At eight months of age, infants were assessed with the Bayley Scales

of Infant Development. The infants of mothers 20-25 years of age attained significantly higher scores on.. thementai .scale than those of adolescents, Hardy concluded that this was suggestive of "more effective childrearing practices" (p. 1224). At four years of age, children were assessed using the Stanford-Binet Intelligence Test for Children, tests of fine and gross

motor functioning, the Graham Block Sort Concept Formation Test, a behavioral profile and psychological impression. On all measures, a higher proportion of




41



children of adolescents were found to have inadequate outcomes. At seven years of age, the children of adolescent mothers performed less well than those of 20-24 year olds on the Weschler Intelligence Scale for Children (WISC), the Bender-Gestalt Visual-Motor Test and the Wide Range Achievement Test (WRAT). The children of adolescent mothers were also found to have negative outcomes related to academic achievement and repetition of school grades on the twelve year assessment. Self-concept was measured by the Coopersmith and Piers-Harris tests. No significant differences were found between the children of adolescents and those of older mothers.

Hardy et al. (1978) have provided an abundance of valuable

information regarding the long term effects of early motherhood on the child. The negative developmental outcomes attributed to the age of the mother are distressing and suggest a need for early and intense intervention. A major limitation of this study is due to the lack of empirical evidence about the childrearing practices of the mothers involved. While other studies using Bayley measures at eight months have demonstrated that social, language and cognitive development were empirically demonstrated to be correlated with motherinfant transaction- (Beckwith, 1973; Beckwith et al., 1976),the Hardy et al. (1978) study failed to assess the transaction process in a controlled situation.

Furstenburg (1976) used interviews, tests and observational

data in a longitudinal study of low-income Black adolescent mothers and their children. He found no differences on the Preschool Inventory in the three year old children of 15 year olds when they were compared to those of mothers of 18 and 19 years of age. He did find significantly higher scores among children raised by more than one adult. Children





42


whose parents married early and stayed married had the highest scores.

In a five year follow-up, Furstenburg (1978 ) compared children of young mothers to children of older mothers who were in preschools. He found that children who were cared for by grandparents in the home scored significantly higher than those who were in preschools. The author concluded that the child's cognitive ability was enhanced as a result of the aid his mother received from her parents which allowed her to become more educated and socioeconomically advanced. These findings point directly to the long term assets of the mother's social support system. The study is limited, however, due to small size of the sample and the lack of a comparison group of nonBlack families.

Holstrum (1979) studied the intellectual, perceptual-motor,

language and behavioral outcomes of premature infants at three years of age. Her findings revealed that socioenvironmental and neonatal variables contribute significantly to the prediction of developmental outcomes. Socioenvironmental variables investigated included mother's age, material resources and amount of social stress. Followup simultaneous univariate analyses revealed that the age of the mother did not contribute to the developmental outcome of three year olds.

Broman, Nichols and Kennedy (1975) studied a sample of 26,760 children born to mothers in the Collaborative Perinatal Project. They tested the significance of 169 prenatal and developmental variables in order to ascertain their ability to predict intellectual

performance at four years. Their findings revealed that maternal




43



education and socioecnomic status were major contributors to explained variance in preschool IQ scores. The age of the mother was not found to be a significant predictor. Bayley assessments at eight months were found to be predictive of delayed intellectual development in early childhood. These findings are particularly interesting in that they reflect the contributions of the mother's age in a random, rather than age-specific sample.

In an age-specific study comparing children of mothers under 18 years '(n = 86) to those at age 18 and older (n = 86), Oppel and Royston (1971) investigated nurturing behavior, family composition, physical,social, and psychological characteristics. Subjects were matched on economic status, birthweight, parity and race. Data were collected at six to eight and ten to twelve years using the Binet and Wechsler intelligence tests, the Wide Range Achievement Test, psychological observations and the Maternal Behavior Research Instrument. At both eight and ten years, children not reared by the biological mother were at significantly greater risk on all measures. There was also a significant difference in the child's physical size, which revealed more children of young mothers to fall below the third percentile in height. They also "displayed a trend towards lower weight" (p. 752). No significant differences in intelligence or psychological adjustment were found. Children of adolescents were at a significantly lower reading level, however, and were rated to be more dependent and distractible. Younger mothers were noted to give more independence to the child, were less anxious, had less intense emotional involvement with the child and were less likely to have intellectual interests. The conclusions reached by the






44

authors are based on thorough documentation. The use of a matched rather than random sample,however, has limited our understanding of the relative contributions of race, socioeconomic status and birthweights. Had these variables been controlled statistically rather than in the experimental design, the resultswould have been more generalizable. Another limitation of this study is the fact that the data were collected for a purpose other than that for which they were analyzed.

In summary, the long range outlook for the child born to a

young mother appears quite dismal. Regardless of the methodology, almost every study has documented the intellectual, emotional, educational, developmental and medical risks associated with early pregnancy and parenting. Our only evidence of a more hopeful future for these children comes from those investigations into the role of the mother's support from her family and the professional community. Our knowledge base is lacking in both the number and scope of studies into the consequences of early parenting forthe young mother and her child. It is to this specific gap in our knowledge that the present study was directed.















CHAPTER III

METHODOLOGY

The purpose of this study was to ascertain the contribution of mother's age, perinatal risk status, and socioenvironmental, medical and educational resources to the prediction of mother-infant transaction and the mental and psychomotor development of the infant. The population from which the sample was drawn consisted of mother-infant dyads who were served by the College of Medicine at the University of Florida. The subjects were stratified on the basis of the age of the mother and were selected at random from the Birth Log at the Shands Teaching Hospital. Ninety-two mothers and their six months old infants participated in the study.

The assessment procedures consisted of a six minute videotape of mothers and infants in a free play situation and the administration or the Bayley Scales of Infant Development. Demographic and socioenvironmental data were obtained from the Child and Family Development interview which was developed for use in this study. Following the assessment, a

parent and infant-centered protocol was implemented which was based on the infant's needs as assessed on the mental and psychomotor scales of the instrument. The data collection procedures were implemented in the Pediatric Clinic of Shands Teaching Hospital. 'he sample, design and the procedures for data collection and analysis are described in this chapter .

As noted in Chapter I, the questions posed by the study were: 1) Do infant development and mother-infant transaction vary 45




46



as a function of the age of the mother?

2) Is the relationship between mother's age and each dimension

of transaction and infant development linear after controlling for mother's education, yearly income, ethnic origin

social support system, infant's sex and birth order and type

of prenatal care?

3) What is the nature of the relationship between prenatal

medical care and development at six months after controlling

for all independent variables?

4) Which variables contribute predictive information to the

identification of developmental delays on infant development

measures at six months?

5) Is there a positive association between the extent of

prenatal and postpartum parenting education and infant development at six months?

6) Is there a positive relationship between the extent of the

mother's social support system and transaction and the

infant's development?

In keeping with the exploratory nature of this study, additional questions were investigated. The questions were:

7) Is there a relationship between the age of the mother and infant

development after controlling for transaction, infant's sex

and birth order, perinatal risk status, ethnicity, yearly

income, social support system and type of prenatal care and

education?

81 Are the transactional behaviors of the mother-infant




47



relationship -- warmth, reciprocity, responsive vocalization, negative affect and nonresponsive stimulation -- associated

with the mental and psychomotor development of the infant after controlling for mother's age and education, infant's sex and birth order, perinatal risk status, yearly income, ethnicity, social support system and type of prenatal care

and education?

9) Is there a relationship between perinatal risk status and the

mental and psychomotor development of the infant after

controlling for the mother's age and education, the infant's

sex and birth order, yearly income, ethnicity, social support

system and type of prenatal care and education?

Definition of Terms

For the purpose of this study, the following definitions of terms were used:

1) Infant Development consisted of the composites specified by the

Mental Development Index (MDI) and the Psychomotor Development Index (PDI) of the Bayley Scales of Infant Development. These

indices reflect the mental, psychomotor, language and socioemotional competence of the infant.

2) Mother-Infant Interaction is the categorical identification

of behaviors described in the Beckwith Behavior Scale. These

behaviors were coded from videotaped transaction sequences.

3) Reciprocal/Responsive Behavior is that which is observed to

be directly related to the behavior of another individual.

4) Nonresonsive Behavior is that behavior which is observed




48



to be self-initiated and without regard to the behavior

of another individual.

5) Mother-Infant Transaction refers to the entire repertoire of interaction behaviors between mother and infant.

6) Developmental Delay refers to a score of 68 or less on either the Mental or Psychomotor Development Index of the Bayley

Scales Infant Development.

7) High Risk for developmental delay refers to a score between 68 and 84 on either the Mental or Psychomotor Development

Index of the Bayley Scales of Infant Development.

8) At Risk for developmental delay refers to a score between

85 and 100 on either the Mental or Psychomotor Development

Index of the Bayley Scales of Infant Development.

9) Prenatal Care by Private Physician refers to those patients

who received obstetric treatment from physicians in the

Private Diagnostic Clinic at Shands Teaching Hospital.

10) Public Health Department Prenatal Care refers to those who

received obstetric care at a public health department clinic. 11) bMternal-Infant Care Clinic Treatment involved patients in a

13 county area surrounding Gainesville, Florida. These

patients received prenatal and postpartum obstetric, neonatal and pediatric care, family planning services, social service and nutritional counseling and optional prenatal childbirth

education CMahan.and Eitzman, Note 3).

12) Teenage Pregnancy Team Care refers to patients who received

prenatal and postpartum obstetric, neonatal and pediatric




49


care, family planning services, social service and nutritional

counseling, a mandatory prenatal and childbirth education

class and an optional infant, parenting and family development

education class. This treatment was received by women who

were 18 years of age and younger and who lived in a five

county area within the Maternal-Infant Care district (Mahan,

Note 2).

13) Shands Teaching Hospital (S.T.H.) High Risk Clinic refers

to care which was specialized for those women identified as having a high risk pregnancy. Obstetric and neonatal

services were provided and an optional prenatal and childbirth education class was offered to these women.

The Subjects

The population of interest in this study was that of mother-infant dyads residing in North Central Florida who were served by the College of Medicine at the University of Florida, Gainesville, Florida. Utilizing the Birth Log (a list of information pertinent to labor and delivery records) available through the Shands Teaching Hospital, a stratified sample was drawn (N=250). Stratification was on the basis of mothers' ages (<15, 16-17, 18-19, 20-24, >25 years). This method of sampling was used in order to obtain age specificity lacking in previous research.

This method produced an age-specific sample of invited subjects who received the appointment letter, reminder postcard and phone call, as outlined in Appendix A. Socioeconomic and cultural representativity, while not expected, were additonal results of the sampling procedure and are presented in Table 7.




50


Of the 250 invited subjects, 92 participated in the study; complete data sets were obtained for 77 of these subjects. This attrition rate is comparable to that found by Resnick et al. (1978). The sample thus represents those subjects who were motivated to participate. Attrition was also due to other variables associated with poverty and/or early parenthood such as: 1) lack of transD ation; 2) conflicting school and work schedules; 3) moving out of the state; and 4) giving the baby up for adoption. Many families traveled as many as 150 miles to participate in the study.

During the course of the data collection process, the investigator

questioned a random number of subjects as to the reasons for participating or not participating in the study. Responses included: "I thought I was supposed to come!" "I wanted to see how my baby was doing -- if he was doing o.k." "We don't have a camera and I wanted a picture." "I was worried about my baby's arm, leg/ear." Negative responses included: "My baby's fine and I don't need you to tell me! I'm already pottytraining him."

Frequent attempts were made to call each family for whom a phone number was listed. In three telephone conversations, mothers refused to bring their babies to the clinic. These were private patients who were living in the Gainesville area. A total of 80 families were reached by phone prior to their appointments. Of the families who agreed to come, only 10 did not participate (2.5 percent).

Procedure

All subjects in the sanmile were contacted by mail to notify them

that their babies were scheduled for a six month developmental assessment








in the Pediatric Clinic. When the families -- often including fathers, friends and extended family members -- arrived at the clinic, a brief explanation of the procedures preceeded the assessment. Subjects in the study were informed as to the nature of the developmental testing procedure employed and the purpose of the study. They signed a statement of informed consent, but were not told the variables under investigation in order to prevent bias during the data collection process (Appendix A). Treatment of participants was in accordance with the standards of the American Psychological Association and the Committee for the Protection of Human Subjects at the University of Florida.

Following an explanation of the procedures, the families were

requested to come into the playroom where a mat and toys were available for play. Mothers were encouraged to engage in a brief play period prior to the actual videotaped sequence. The videotaped segment was then recorded as the mothers participated in free play with their infants. The initial play period(and the videotaped play sequence) was designed to allow the baby to adjust to the environment. Each family was given the identical assortment of toys for the free play, which included rattles, balls, a mirror and a set of colorful faces. Mothers were told that the purpose of the free play was: 1) to allow the baby to adjust; and 2) to get an idea of how the baby played in an unstructured situation while at ease with the parent.

Following the free play session, the examiner engaged in a two to three minute warm-up play period with the baby before administering the Bayley Scales of infant Development. The parent was informed as to the nature of each task and its purpose in the assessment throughout the




52



administration of the scales. After the evaluation, the results regarding the mental, psychomotor, language and socioemotional growth of the baby were discussed with the parent with respect to age ranges in each area of development. Parent's questions were encouraged and concerns were discussed during all phases of the assessment.

Following the assessment, the infant-centered intervention

phase proceeded and focused on the specific strengths and limitations observed in the baby. Delayed or problematic development was explained and appropriate protocols for remediation were discussed. It was emphasized that many of these delays found at six months could be overcome in a short time with an additional amount of stimulation and prescribed activities. Where applicable, developmental, nutritional and medical referrals were made to the appropriate agencies. In all cases, parents were also given a book of educational activities and a photograph of their baby to take with them.

Following the assessment, Infant and Family Development Specialists interviewed the mothers to obtain demographic data. This was done in order to insure that the examiner remained naive to the age and prenatal care group of the mother.

Instrumentation

The Assessment of Infant Development

The Bayley Scales of Infant Development were chosen as a direct measure of the infants' psychomotor and mental abilities. The mental scale measured adaptive and language behavior as evidenced on eye-hand coordination, problem solving, exploratory and manipulative tasks. Also included are linguistic vocalizations and the




53



comprehension of communication by others. The motor scale measured gross body control and locomotion and fine motor coordination. Additional features of the instrument were its adaptability to the testing situation and the availability of a trained evaluator. Appropriate features of the test include the test materials, which were highly attractive to infants, and the administration of the test which allows the infant to be held by the mother. Split-half reliability coefficients for the motor and mental scales at six months are reported as .89 and .92, respectively (Bayley, 1969).

In their study of test-retest reliability (with eight month olds) Werner and Bayley (1966) noted correlations between first and second assessments of mental and motor development to be .76 and .75, respectively. These assessments were one week apart. Items involving emerging skills in social and interpersonal development and motor coordination were found to have a test-retest reliability of .76. This issue is especially important in a study of six month olds as this is a critical time for the emergence of several new behaviors. It is therefore necessary to acknowledge that a baby's score at six months could vary greatly from day to day.

Inter-observer agreement is another aspect of reliability studied by Werner and Bayley (1966). These coefficients were noted to be "markedly higher" than independent assessments since the same assessment was scored by each observer. Tester-observer reliability was found to be .89 and .93 on mental and motor development, respectively. Examples of items in the scales can be found in Appendix C.




54



Perinatal Risk Status

In order to assess the perinatal (last month of pregnancy through first month of life) risk status of the infant at birth, the Prenatal and Intrapartum Risk Scale (Hoble et al., 1973) was adapted for use in this retrospective design. This instrument was developed as a system for the prospective analysis of perinatal risks and rates various complications in prenatal (maternal), labor and delivery and neonatal screening characteristics (see Appendix D). Information regarding the risk status of the neonate was obtained from the infant's medical records.

Mother-Infant Transaction

The systematic observation of the transaction process has become a meaningful way to investigate behavioral components of the parent-infant relationship.

In order to examine parenting behaviors, a low-inference observation system was used. The measurement of maternal-infant interaction was based on the assumption that reciprocal/responsive behavior can be measured through the use of the Beckwith Behavior Scale. The scale was previously used by Beckwith (1976) and Grossman (1979) to analyze parent-infant transaction in two separate studies of one, three, six and eight month old infants and their mothers.

The Beckwith Behavior Scale consists of 27 behavioral categories, each of which is assigned individually to parent or infant behavior. The behavioral.-. categories of the instrument were selected for their appropriate record of "parenting skills" which have consistently





55


demonstrated a strong relationship to infant development and were the focal point of this study:

1) The constructive expression of affect (both positive and

negative).

2) The ability of the parent to become in tune perceptually

to the actual world of the infant at varied levels of

cognitive and emotional development.

3) The ability of the parent to interact with the child

in a manner which is responsive to the actual state of the child as observed and interpreted over time.

The behaviors and their descriptions are presented in Appendix B. Because of the highly sensitive and potentially ambiguous nature of the transaction process, it was necessary to pilot the use of the instrument within the experimental context under investigation and obtain appropriate estimates of intercoder reliability. A reliability study was previously implemented with Beckwith by computing a Pearson Product-Moment Correlation on independent ratings of two observers. On 18 behavioral categories, the coders were found to have a mean agreement of r = .92 (Beckwith, 1971; Beckwith et al., 1976). Similar observational records have been found to have predictive validity from observational records at nine months to Bayley mental scores at one year (Gordon, Soar and Jester, 1979; Long, 1979). These studies assessed transaction among dyads of varied age, developmental and socioeconomic status.

The decision was made to adapt the Beckwith Behavior Scale for use in this study based on several theoretical and practical




'56



aspects of mother-infant transaction. The instrument was originally constructed for observations of infants and mothers in the home. Certain variables Csuch as floor freedom and mutual gaze during feeding) were not applicable to this investigation. Another issue which influenced the adaptation was that the scale was constructed and implemented with preterm infants and their caregivers at one, three and eight months of age and adapted by Grossman (1979) for use with infants of six months of age. These considerations were of importance in this study and were the basis upon which some original variables were substituted with ones which were more applicable to the simulated playroom setting in a study of six month olds.

The coding of the videotapes was also adapted so that behaviors were coded every five seconds or when the behavior changed, rather than every 15 seconds as originally implemented. The rationale for this adaptation was based on the dynamic characteristics of mother-infant transaction which necessitated the more precise analysis of the process as behaviors occur in a five (rather than 15) second time span.

Interobserver agreement

The issue of reliability--the extent to which measures of behavior are measured consistently--has been a subject of great concern. This concept is best clarified by Cronbach and Rajartnam (:1963) in their statement: "an investigator asks about the precision or reliability of a measure because he wishes to generalize from the observation in hand to -some class of observations to which it belongs (p. 144).




57



The two observers were selected on the basis of their prior experience in coding parent-infant transaction videotapes. In another study (Eyler, 1979) these observers evidenced skills in analyzing observable behaviors of mothers and their premature newborns and were found to be consistent in their ratings.

Training of the coders involved detailed explanations and

numerous examples of each behavioral category. The observers were assessed initially and at randomly determined periods throughout the coding process in order to ascertain the extent to which behaviors were rated consistently. Fifteen of the videotapes were coded by both coders. This permitted the assessment of intercoder reliability. Table 1 presents the Pearson Product-Moment Correlations between the frequencies reported by the two coders.

In order to reduce the number of variables to be used in subsequent analyses and to represent more global dimensions of mother-infant transaction, a correlation.matrix of observation measures was subjected to a Principle-Component analysis using the varimax rotation. The results of these analyses are discussed in detail in Chapter IV.

Statistical Analyses

The variables under investigation in the study were the age

of the mother, the education of the mother, the sex and birth order of the infant, perinatal risk status, yearly income, ethnic origin and type of prenatal care. The analyses were designed to assess the contributions of these variables to the prediction of




58


Table 1

Inter-Observer Reliability of Mother-Infant Transaction Behaviors




Behavior r Behavior r


Mother Behaviors Baby Explores .69

Comments .88 Baby Fusses 1.00

Commands .70 Reciprocal Behavior

Criticizes .96 Mother's Positive Response .82 Nonverbal Bid .67 Mother's Negative Response ** Initiating Behaviors .73 Mother's Contingent Ver- .97 bal/vocalizations
Repetitive Nonverbal Bids .89
Face to Face Orientation .88 Staccoto Bursts 1.00
Mother's Ignoring Response .95 Affectionate Touches .83
Baby's Positive Response .68 Interfering Touches .19
Baby's Negative Response Repetitive Verbalizations 1.00
Baby's Contingent Vocal- ** Baby Behavior ization

Bid to Caregiver .90 Mutual Gaze ** Smiles ** Baby's Ignoring Response .81

Vacant Behavior **


**No correlation computed; one or both ratings evidenced no variability.




59



Table 2

Means and Standard Deviations
for Beckwith Behavior Variables




Variable Mean SD Comments 7.6154 5.7349 Commands .7564 1.5474 Criticizes .6923 1.6221 Nonverbal Bids 3.7051 3.6328 Initiating Behaviors 13.0897 5.2476 Repetitive Nonverbal Bids .0251 .8430 Staccato Bursts .6667 1.904 Affectionate Touch 1.7692 2.8916 Interfering Touch 1.9744 2.2961 Repetitive Verbalizations .2308 .8046 Bid to Caregiver .6667 1.1584 Baby's Vocalizations 1.6538 2.4.697 Baby's Smiles .9487 1.9863 Self-Stimulation .0128 .1132 Vacant Behavior .0128 .1132 Baby Explores 16.7051 9.3602 Baby Fusses 1.0769 3.1200 Mother's Positive Response 4.1026 2.9081 Mother's Negative Response .1026 .3810 Mother's Contingent Vocalizations 1.1026 1.9177 Face-to-Face Orientation 3.5513 3.6597




60



Table 2 Cont.




Variable Mean SD Mother's Ignoring Response .7564 2.8108 Baby's Positive Response 12.6538 6.0663 Baby's Negative Response .3333 .8778 Baby's Contingent Vocalization .2179 1.3737 Mutual Gaze .0641 .2945 Baby's Ignoring Response 3.7051 3.6149




61



mother-infant transaction and infant development as outcome measures of early pregnancy and parenting.

In order to reduce the number of variables and represent

the more global dimensions of mother-infant transaction in subsequent analyses, a correlation matrix of the 27 behavioral categories was subjected to a Princip:le Components analysis. As a result of this analysis, five dimensions of mother-infant transaction were defined and each subject's incomplete composite component score was calculated for each of the five components. These calculations were based on the addition of the total number of behaviors which had a positive loading on the component and the subtraction of the number of behaviors which had negative loadings on the component. The reliability of the observers was computed on each of the five component score dimensions using a Pearson Product-Moment Correlation procedure. These analyses were executed using the Statistical Package for the Social Sciences (SPSS) (Nie et al., 1975).

In the first multivariate multiple regression analysis, the

dimensions of mother-infant transaction and the infant's mental and psychomotor development were considered to be the outcome measures of early pregnancy and parenting. These measures were therefore treated as dependent variables and were regressed on mother's age and education, baby's sex and birth order, yearly income, ethnic origin, social support-system, perinatal risk status and type of prenatal care.

The second multivariate multiple regression analysis addressed the question regarding the ability of the transaction components to









predict the mental and psychomotor development of the infant. In this analysis, mental and psychomotor development were regressed on mother's age and education, baby's sex and birth order, ethnic origin, yearly income, social support system, perinatal risk status, type of prenatal care and the five dimensions of mother-infant transaction. The multivariate multiple regression analyses were executed using the General Linear Model program of the Statistical Analysis System (SAS) (Barr et al., 1976).

Limitations of the Study

The use of videotape analyses in a low-inference observation record to measure interaction between individuals is subject to the limitation imposed by the fact that the behavior observed is that which the adult subject is willing to express in the given situation. This effect is confounded as well by the atmosphere found within any medical setting; this often produces anxiety in the mother and thus affects infant behavior. In an attempt to alleviate possible stress in the assessment environment the "playroom" setting was simulated in the Pediatric Clinic.

The purpose of an evaluation of infant development at six months of age is to establish a baseline for use in diagnostic and prescriptive protocols regarding the infant's strengths and limitations. While the information obtained is useful for the identification of competencies and delays, the scales are unable to predict future development.

Another limitation is the fact that the families studied were

those who responded to the request and were motivated to participate




63




in the study. Those subjects who were contacted, but did not participate may differ systematically from those who participated.

A final limitation placed on the study is the ex-post-facto or correlational nature of the design. While associations and relationships among the variables can provide useful information, no inferences of causality can be interpreted from the results of the study.

Summary

In summary, the data were collected and analyzed in order to assess the behavioral dimensions of mother-infant transaction and the mental and psychomotor development of the infant in an age specific sample. In addition, the study was designed to explore the mother's age, social support system, perinatal risk status, prenatal medical care, and participation in childbirth and parenting education programs in order to assess their contributions to the prediction of transaction and development at six months. The results of the analyses are presented and discussed in Chapter IV.














CHAPTER IV

RESULTS



The purpose of this study was exploratory in nature and was

based on the fact that relatively little is known about the developmental outcomes of very young mothers and their infants. The analyses were implemented in order to ascertain the contributions of the mother's age, social support system, perinatal risk status, type of prenatal care, type of prenatal childbirth education and type of parenting education as they related to mothers' transactions with their infants and the infants' development. The questions addressed in this study and the analyses are discussed in this chapter.

The Dimensions of Mother-Infant Transaction

Before proceeding to the analyses which addressed the major questions posed by the study, the dimensions of mother-infant transaction were studied. The number of behaviors in each category of the Adapted Beckwith Scale were first tallied for each subject. A correlation matrix of the variables was then subjected to a Principle Components analysis.

The analysis yielded eleven components with eigenvalues

greater than 1.0. These components accounted for 74 percent of the variance. The components corresponding to the five largest eigenvalues were rotated using the Varimax procedure. The five rotated components



64




65



accounted for 46 percent of the variance. Table 3 reports the loadings of the variables on each component. Table 4 reports the factor score coefficients of the variables.

The results of the Principle Components analysis were used to guide the formation of the subjects' composite scores on each of the five components. Variables were included in these scores such that those with factor score coefficients greater than .25 defined the component. In the fifth component, mother's negative responses were included in the composite component score based upon theoretical interpretations of the observed behaviors of the mother-infant transaction process. The total number of tallies per behaviors with positive coefficients were added to calculate each component score. The behaviors which had negative coefficients were subtracted from this sum. This process often resulted in the composite score of a subject on a component being less than or equal to zero. The following formulae were used to calculate the composite scores on each of the five components:

Component Score 1 (Warmth) = Affectionate Touches +

Smiles + Face-to-face Orientation

Component Score 2 (Reciprocity) = Baby's Positive Responses +

Mother's Positive Responses + Initiating Bids

Baby's Exploratory Behavior

Component Score 3 (Responsive Vocalization) = Baby's Vocalizations + Miother's Contingent Vocalizations +

Baby's Contingent Vocalizations Mother's

Nonverbal Bids














Table 4

Factor Score Coefficients of Mother-Infant Behaviors




Component 1 Component 2 Component 3 Component 4 Component 5 Variable Warmth Reciprocity Responsive Negative Nonresponsive Vocalization Affect Stimulation


Comments .137 -.019 -.033 .169 -.087 Commands .047 .049 .023 .283 -.047 Criticizes .001 -.005 .036 .321 -.023 Nonverbal Bids .107 -.148 -.270 -.091 -.081 Initiating Behavior -.006 .193 .030 .123 .148 Repetitive Nonverbal -.053 .173 -.025 -.084 -.127
Behavior

Staccato Bursts .073 -.067 -.030 -.126 .302 Affectionate Touch .281 -.096 -.111 -.139 .095 Interfering Touch .008 -.104 -.068 .192 .202 Repetitive Verbalization .108 .023 -.008 .023 .021 Bid to Caregiver -.108 -.067 -.005 .005 .071 Vocalizations .023 -.030 .345 -.032 .004 Smiles at Mother .254 .90. .071 -.070 .052







Table 4--extended


Self Stimulation .023 -.032 -.045 .038 -.018 Vacant Behavior .011 .055 .122 -.065 .138 Explores -.227 -.202 -.031 -.078 .005 Fusses .017 .044 -.155 -.043 -.135 Mother's Positive .043 .285 -.022 -.051 -.079
Response

Mother's Negative -.044 -.054 .015 .035 .168
Response

Contingenr't. Verbal- .027 -.056 .286 --.054 -.038
i zations

Face to Face Orientation .264 -.041 .017 .010 -.004 Maternal Ignoring -.124 -.047 .000 -.075 -.043 Baby's Positive Response .034 .336 .001 -.035 .029 Baby's Negative Response -.048 -.038 .031 .282 -.008 Contingent Vocalization .000 -.004 .305 .026 .012 Mutual Gaze .076 .014 .071 -.118 .309 Baby Ignoring .005 .013 -.033 .034 .289 Total Percent 12.000 10.200 8.900 7.700 7.000
of Variance














Table 3

Rotated Factor Matrix of Principle Components:
Regression Weights of Mother-Infant Behaviors



Component 3 Component 4 Component 5
Component 1 Component 2 Responsive Negative Nonresponsive Variable Warmth Reciprocity Vocalization Affect Stimulation


Comments .4484 -.0630 -.0361 .4009 -.2194 Commands .2038 .0820 .0475 .6401 -.0805 Criticizes .0761 -.0627 .0789 .7263 -.0225 00 Nonverbal Bids .2850 -.3335 -.5379 -.1742 -.2040 Initiating Behavior -.0522 .5373 -.0338 .2788 .4015 Repetitive Nonverbal -.1309 .4443 -.0809 -.2340 -.2235
Behaviors

Staccato Bursts .0766 -.0762 -.1160 -.2263 .6303 Affectionate Touch .7288 -.1917 -.2077 -.2407 .1003 Interfering Touch -.0203 -.2203 -.1886 .4778 .4687 Repetitive Verbalization .3008 .0657 -.0185 .0732 .0222 Bid to Caregiver -.3326 -.1540 -.0277 .0094 .1825 Vocalizations .1100 -.1803 .8097 .0789 -.1052 Smiles at Mother .7040 -.2488 .2168 -.1024 -.0254







Table 3--extended

Self Stimulation ,0732 -.0841 -.0879 .0943 -.0411 Vacant Behavior .0130 .1564 .2391 -.1386 .281.9 Explores -.6607 -.5153 -.0440 -.1980 .0332 Fusses .0693 -.1080 -.3048 -.1023 -.2880 Mother's Positive -.12965 -.7501 -.1080 -.1469 -.1129
Response

Mother's Negative -.1764 -.1029 -.0019 .0992 .3814
Response

Contingent Verbal- .1332 -.2486 .6988 -.1321 -.2425
izations

Face to Face Orientation .7599 -.1271 .0921 .0731 -.1198 Maternal Ignoring -.3504 -.1266 .0112 -.1952 -.0782 Baby's Positive Response .0696 .9087 -.0983 -.1038 .1444 Baby's Negative Response -.0884 -.1213 -.0767 .6370 .0318 Contingent Vocalization .0454 -.1026 .7009 .0504 -.0535 Mutual Gaze .0956 .1140 .0930 -.2195 .6417 Baby Ignoring -.0854 .0522 -.1525 .1202 .6623 Total Percent 12.0000 10.2000 8.9000 7.7000 7.0000
of Variance

Eigenvalue 3.239 2.761 2.397 2.072 1.877









Component Score 4 (Negative Affect) = Mother's Commands +

Mother's Criticisms + Mother's Interfering

Touches + Baby's Negative Responses

Component Score 5 (Nonresponsive Stimulation) = Mother's

Staccato Bursts + Mother's Interfering Touches +

Baby's Ignoring Responses + Mutual Gaze +

Mother's Negative Responses

A Pearson Product-Moment Correlation procedure between the frequencies of the original variables and the component scores was implemented. The correlation coefficients are reported in Table 5 and indicated that the individual variables chosen to compute the component scores are highly correlated with the new composites. It also indicated that the variables which should not be correlated with the components were not. These coefficients supported the interpretation of the composites of variables selected to define the dimensions of mother-infant transaction.

The reader should recall that 15 of the videotapes were coded by two coders. This permitted the computation of two composite scores for each component of mother-infant transaction and the assessment of interobserver reliability for the composites. The Pearson Product-Moment Correlations between each pair of composite scores are reported in Table 6. The results of this analysis indicated that the two observers were consistent in the coding of the five dimensions of the transaction process.














Table' 5

Pearson Product-Moment Correlation Coefficients
of Mother.-Infant Transaction Variables with Cotlponent Scores



Component 3 Component 4 Component 5
Component 1 Component 2 Responsive Negative Nonresponsive Variable Warmth Reciprocity Vocalization Affect Stimulation


Comments .3136 .0615 .0218 .1317 -.1392 Commands .0973 .1176 .0197 .6683 -.0460 Criticizes -0164 .0154 .1313 .7327 -.0601 Nonverbal Bids .2431 -.1447 -.6931 -.1341 -.0979

Initiating Behavior -.2409 .6588 -.0045 .0588 3685 Repetitive Nonverbal -.1443 .1884 -.0468 -.1536 -.1162
Behaviors

Staccato Bursts -.0034 -.0058 -.1076 .0176 .6346 Affectionate Touch .7897 .0656 -.1897 -. 0715 .0758 Interfering Touch .0007 -.0574 -.1074 .7178 ..5990 Repetitive Verbalization .1663 .1372 .0137 .0279 -.0408 Bid to Caregiver -,1903 -.1273 .0456 .0679 .0876 Vocalizations .1668 -.1149 .7816 -.0786 -.2180







Table 5--extended

Self StimulaLion .0433 .0187 -.0768 .1555 -.0095 Vacant Behavior -.0400 .0952 .0993 -.0446 -.0293 Explores -.4644 -.8397 -.0605 -.1056 .1184 Fusses -.0159 .0575 -.2841 -.1262 -.2156 Mother's Positive .0187 .6513 -.1114 -.0857 -.0875
Response

Mother's Negative -.1101 -.0162 .0163 .1490 .2482
Response

Contingent Verbali- .1350 -.2068 .6794 -.1698 -.2941
zations (M)

Face to Face Orientation .8433 .1612 .0355 .0842 -.1918 Maternal Ignoring -.1301 -.2028 .0383 -.1126 -.0684 Baby's Positive Response -.1281 .8631 -.1353 -.1433 .0460 Baby's Negative Response -.1246 -.0436 .0391 .4951 .1236 Contingent Vocalization (B) .0360 -.0348 .6155 .0483 .0867 Mutual] Gaze .0256 .1218 .0014 .0132 .3547

Baby Ignoring -.1281 .1046 -.0938 .1085 .8544




73


Table 6

Interobserver Reliability of
Mother-Infant Transaction Components




Component r Warmth .91 Reciprocity .97 Responsive Vocalization .75 Negative Affect .80 Nonresponsive Stimulation .70




74




Description of the Sample

Descriptive statistics and a correlation matrix of the

independent and dependent variables were calculated for the sample of 77 mother-infant dyads. Frequency distributions were calculated for the independent and dependent variables and are reported in Tables 7, 8 and 9. The means and standard deviations of the dependent variables are presented in Table 10.

An inspection of of the distributions of the measures

of perinatal risk indicated that the majority of the sample was within normal limits at birth. The means and frequency distributions for the measures of infant's mental and psychomotor development indicated that the entire sample was within normal limits of development at six months of age. The means of the sample are considerably higher than those reported in the Bayley Scales of Infant Development Manual (Bayley, 1969). The standard deviations of the sample are equivalent to those reported in the manual, An interpretation of these findings is discussed in Chapter V.

Interobserver reliability was then computed by means of a

Pearson-Product Moment Correlation on the rotated component scores. The results of this analysis are presented in Table 6. The purpose of the assessment of interobserver reliability was to measure the extent to which the two independent observations of behavior were consistent. From the results of this analysis it can be seen that the measurement of transaction was consistent across observers.




75

Table 7

Frequency Distributions for Several Independent Variables



Variable Frequency Variable Frequency


Mother's Age Baby's Sex

S15 5 Male 40 16-17 21 Female 37 18-19 12 Baby's Birth Order 20-24 18 Ist Born 54 2 25 21 2nd Born 17 Race 3rd Born 5 Black 42 7th Born 1 NonBlack 35 Yearly Income Prenatal Care < $3,000 19 Teenage Pregnancy Team 20 $3,000 $5,000 18 Maternal Infant Care Proj. 19 $6,000 $10,000 21 Shands Teaching Hospital 13 $11,000 $20,000 15 Public Health Department 9 > $20,000 4 Private 16 Social Support System Mother's Education 0 Living alone-no asst. 1 < 12 years 37 1 Cohab. Support Only 33 12-14 years 31 2 Cohab. & Income or 38 Childcare Asst.
15-18 years 9
3 Cohab. & Income & 5
Prenatal Complications Childcare Asst. Uncomplicated Pregnancy 59 Perinatal Risk Status Presence of Complication in 18 < 10 Points 37
Pregnancy (Anemia, Toxemia,
Veneral Disease or Infec- 10 19 Points 20 tion)
20 40 Points 18

> 40 Points 2




76


Table -8

Frequency Distributions for
Mother-Infant Transaction




Variable Frequency Warmth

0 15 69 16 30 7 31 50 1 Reciprocity

-25 0 16

1 25 38 26 52 23 Responsive Vocalizations

-20 -10 4

-9 0 47 1 9 23 10 33 3

Negative Affect

0 4 52 5 9 19 10 23 6

Nonresponsive Stimulation

0 4 32 5 9 31 10 -19 12 20 -37 2




77



Table 9

Frequency Distributions for Infant Development Variables




Variable Frequency


Bayley Scales of Infant Development

Mental Development Index

68 0

68 83 1 84 99 7 100 116 18

117 132 22 133+ 29 Physical Development Index

68 0

69 83 0 84 -99 8 100 116 24 117 132 35 133+ 10





78


Table 10

Means and Standard Deviations for Scores
on the Bayley Scales of Infant
Development, and the Beckwith Behavior Scale




Variable N Mean SD


Bayley Scales of Infant Development

Bayley Mental Index 77 125.28 19.26 Bayley Psychomotor Index 77 117.64 12.62 Component: Beckwith Behavior Scale

Warmth 77 6.29 6.95 Reciprocity 77 12.96- 18.16 Responsive Vocalization 77 -.67 6.58 Negative Affect 77 3.71 4.39 Nonresponsive Stimulation 77 6.55 5.84




79






An initial inspection of the cross tabulations revealed

the type of prenatal care to be highly correlated with the type of prenatal childbirth and postpartum parenting education received by the mother. The type of prenatal care received by the mother determined to a great extent the type of educational program she was offered. As a result, prenatal childbirth education and parenting education were omitted from further analyses. The variable "type of prenatal care" contained more information due to the differences in prenatal and parenting education programs offered in conjunction with prenatal medical care. The cross tabulations are presented in Table 11.

The correlation matrix is presented in Table 12 and

indicated that the perinatal risk status of the mother and infant were not correlated with the presence or absence of prenatal complications. Complications found among women in this sample included anemia, toxemia, venereal disease and infection. The fact that these risk factors were uncorrelated was not expected due to the fact that the measure of perinatal risk included prenatal complications. It is possible, however, that the rating system employed by the scale is not useful for studies which are retrospective in nature. Another possible interpretation is that the scale may not be sensitive to the importance










Tab I le 11

Cross Tabulations of Type of Prenatal Care, Prenatal Childbirth Education and Parenting Education




Prenatal Childbirth Education Parenting Education

Teenage Maternal- S.T.H. Teenage Infant &
Pregnancy Infant High Pregnancy Family
Type of Team Care Risk Team Development Prenatal Care Project Clinic School Other None Education School Other None Program



Private 9 4 3 3 1 5 7 Physician 16

Public Health 2 7 3 6 Department 9

Maternal- 10 1 8 1 6 11 Infant Care
Project 19

Teenage 18 2 6 1 1 12 Pregnancy
Team 20

S.T.H. High 6 7 1 1 11 Ri sk
Clinic 13


*Tnfant and Family Development Education Program, Department of Early Childhood Education and Division of Neonatology, University of Florida (Packer, et al. 1979).












Table 1Z

Correlation Matrix of the Independent and Dependent Variables




1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 1) Mother's Age 1.00 -.04 .57 .42 -.18 .68 .58 -.46 .03 -.05 -.01 -.10 -.22 .14 -.09 -.08

2) Baby's Sex 1.00 -.14 -.02 -.09 .02 -.12 -.04 .00 .22 -.23 -.11 .08 .02 .19 .01

3) Baby's Birth 1.00 .11 -.12 .08 .20 -.11 -.05 -.23 -.07 .06 .05 -.00 -.03 .09
Order
00
4) Family's Ethnic 1.00 -.04 .37 .51 .30 -.06 .03 -.21 .26 .12 -.18 -.15 -.09
Origin

5) Quality of 1.00 -.08 -.05 .39 .00 -.03 -.01 .24 .13 -.13 .00 -.12
Social Support

6) Mother's Educa- 1.00 .52 -.28 .04 -.04 .12 -04 -.28 .13 -.07 -.16
tion

7) Yearly Income 1.00 -.21 .16 .02 -.19 .20 -.04 .13 -.26 -.22

8) Prenatal Complications 1.00 -.19 -.17 .16 -.18 -.08 -.01 -.08 -.00

9) Bayley Mental Index 1.00 .34 .16 -.25 -.20 .23 .04 -.00

10) Bayley Motor Index 1.00 -.13 -.16 -.26 .26 .06 .09 11) Perinatal Risk Status 1.00 .25 .25 -.22 -.05 -.04 12) Warmth 1.00 .18 .22 .04 -.14 13) Reciprocity 1.00 -.01 .07 .10







Table 12--extended


14) Responsive Vocalization 1.00 .01 -.14 15) Negative Affect 1.00 .39 16) Nonresponsive Stimulation 1.00








of the many prenatal complications present in adolescent patients. As a result, the presence or absence of prenatal complications was included in subsequent analyses.

The Relationship of Mother's Age, Perinatal Risk Status and
Socioenvironmental, Medical and Educational Resources
To Mother-Infant Transaction and Infant Development

In keeping with the exploratory purpose of the study which

was to obtain information regarding the outcomes of early pregnancy and parenting, a number of hypotheses were tested. Two multivariate analyses were implemented which involved several multiple regression procedures. These analyses, which addressed the ability of the independent variables to predict mother-infant transaction and infant development, were subjected to a conservative critical value in each univariate and multivariate test of significance. The experimentwise alpha rate was set at .05 for the multivariate tests. Using the Bonferroni approach, this was divided by the total number of dependent variables such that the criterion for significance was dependent upon the hypothesis being tested. On each univariate follow-up analysis, the criterion for significance was set at .01. Mother's Age as a Predictor of Transaction and Development

The questions of utmost importance in this study concerned: 1) the ability of the very young mother to facilitate positive transaction with her baby; and 2) the developmental status of the infants of young mothers. This led to the questions regarding the nature of the relationship between mother's age and transaction and development. The specific questions addressed in the first




84



analysis were:

Question One: Do infant development and mother-infant interaction vary as a function of the age of the mother? Question Two: Is the relationship between mother's age and each dimension of transaction and infant development linear after controlling for all independent variables?

To test the hypothesis that there would be no relationship between mother's age and interaction and development, a multivariate multiple regression analysis was used. In this analysis, the dependent measures were mental development, psychomotor development, warmth, reciprocity, responsive vocalization, negative affect and nonresponsive stimulation. The independent variables were mother's age and education, baby's sex and birth order, ethnic origin, yearly income, social support system, prenatal complications, perinatal risk status and type of prenatal care.

The results of the univariate tests of the contribution of each dependent variable to overall prediction indicated that only mental development was significant. The results are presented in Table 13. A visual inspection of the plot of the residuals against the predicted values of mental development revealed that the data met the assumption of homoskedasticity (homogeneous error variance around the regression line) and were appropriate for the analyses.

The tests of significance of the multivariate main effects (Table

14) indicated that the age of the mother did not contribute to the overall prediction of mother-infant transaction and infant development (a=.05), but did contribute to the prediction of the infant's mental development








Table 13

Results of the Univariate Tests of the Contributions
of Several Dependent Variables to MotherInfant Transaction and Infant Development




Dependent Variable R P Mental Development .34 <.01 Psychomotor Development .27 .06 Warmth .23 .15 Reciprocity .19 .32 Responsive Vocalization .14 .05 Negative Affect .17 .49 Nonresponsive Stimulation .18 .44




86



Table 14

Results of the Multivariate Significance
Tests of Contributions to Mother-Infant Transaction and Infant Development




Variable F* df P


Mother's Age 1.45 7,57 .20 Baby's Birth Order 1.07 7,57 .40 Baby's Sex 2.05 7,57 .06 Ethnic Origin 1.35 7.57 25 Social Support System .84 7.57 56 Mother's Education .93 7.57 .49 Yearly Income 1.81 7,57 .10 Type of Prenatal Care 1.60 28,206 .03 Prenatal Complications 1.37 7,57 23 Perinatal Risk 1.11 7,57 .37



*Transformation of Wilks' Criterion to an F statistic




37



(a=.01). The results of this analysis did not support the hypothesis that the psychomotor development of the infant and the mother-infant transaction process varied as a function of the age of the mother. The results of the univariate analyses are presented in Tables 15 and 16.

The preceding multivariate multiple regression analysis was also designed to answer additional questions posed in the study:

Question Five: Is there a positive relationship between the

extent of prenatal care, prenatal and postpartum parenting education and infant development and mother-infant transaction at six months? Question Six: Is there a positive association between the

mother's social support system and transaction and the infant's development?

The analysis of the multivariate main effects (Table 14) revealed that the presence of prenatal complications and the type of prenatal care received by the mother contributed significantly to the prediction of infant development. The type of prenatal care accounted for 6 percent of the variance in mental development. The follow-up analysis of the pairwise comparisons of each type of prenatal care indicated significantly higher means for infants whose mothers received Teenage Pregnancy Team care when compared to those receiving treatment by a private physician and Shands Teaching Hospital High Risk Clinic. The results of the pairwise comparisons and the adjusted means for each prenatal care group are presented in Tables 17 and 18. As noted earlier, this question can only be answered with respect to the association between prenatal care and the dependent variables. The different types of prenatal care and their




Full Text
122
22. Baby's negative responding: baby responds to mother's bid
by fussing, crying, turning away, etc.
23. Baby ignoring: ignores bids or activity of mother.
24. Face-to-face orientation: mother is in a position facing
baby.
25. Mutual gaze: the two faces are in the sarnie vertical and
horizontal plane.
26. Mother's contingent verbalization to infant vocalization:
mother either imitates or responds vocally to nondistress
vocalization by infant.
27. Baby's contingent vocalization: baby either imitates or
responds vocally to mother's behavior.


43
education and socioecnomic status were major contributors to explained
variance in preschool IQ scores. The age of the mother was not found
to be a significant predictor. Bayley assessments at eight months
were found to be predictive of delayed intellectual development in
early childhood. These findings are particularly interesting in that
they reflect the contributions of the mother's age in a random, rather
than age-specific sample.
In an age-specific study comparing children of mothers under
18 years (n = 86) to those at age 18 and older (n = 86), Oppel and
Royston (1971) investigated nurturing behavior, family composition,
physical, social, and psychological characteristics. Subjects
were matched on economic status, birthweight, parity and race.
Data were collected at six tc eight and ten to twelve years using the
Binet and Wechsler intelligence tests, the Wide Range Achievement.
Test, psychological observations and the Maternal Behavior Research
Instrument. At both eight and ten years, children not reared by the
biological mother were at significantly greater risk on all measures.
There was also a significant difference in the child's physical size,
which revealed more children of young mothers to fall below the
third percentile in height. They also "displayed a trend towards
lower weight" (p. 752). No significant differences in intelligence
or psychological adjustment were found. Children of adolescents were
at a significantly lower reading level, however, and were rated to be
more dependent and distractible. Younger mothers were noted to
give more independence to the child, were less anxious, had less
intense emotional involvement with the child and were less likely
to have intellectual interests. The conclusions reached by the


.1.53-
Broman, S., Nichols, ?., Kennedy, W. Preschool IQ: Prenatal and
early developmental correlates. Mew York: Wiley & Sons, 1975.
Bronson, G. Infant's reactions to unfamiliar persons and novel
objects. Monographs of the Society for Research in Child
Development, 1972, 37(3), 1-45.
Butts, J. D. Adolescent sexuality and the impact of teenage
pregnancy from a black perspective. Paper presented at Family
Impact Seminar Conference on Teenage Pregnancy, George Washington
University, 1978.
Campbell, S. Mother-child interaction in reflective, impulsive and
hyperactive children. Developmental Psychology, 1975, _11(6), 100-10.
Chilman, C. Adolescent sexuality in a changing American society.
DHEW Publication No: (NIH) 79-1426, Washington D. C.: U. S.
Government Printing Office, 1979.
Claman, A. D. Reaction of unmarried girls to pregnancy. Canadian
Medical Association Journal, 1969, 101, 328-34.
Clarke-Stewart, . K. Intervention between mothers and their young
children. Monographs of the Society for Research in Child Devel
opment 1973, 38(6-7), 1-109.
Coates, J. Obstetrics in the very young adolescent. American Journal
of Obstetrics and Gynecology, 1970, 108(1), 270-277.
Coblinear, W. G., Schulman, H., Romney, S. L. The termination of
adolescent out of wedlock pregnancy and the prospects for their
primary prevention. American Journal of Obstetrics and Gynecology,
1973, 65(3), 432-444.
Cohen, C., Beckwith, L., Parmalee, A. Receptive language development
in pre-term children as related to caregiver-cnild interaction.
Pediatrics, 1978, 61(1), 17-19.
Crider, E. School-age pregnancy, childbearing and childrearing: A
research review. Dept, of HEW, U.S.O.E. Contract 7-P0076271;
November, 1976.
Cronbach, L. J., Gleser, G. C., Manda, H., Rajaratnam, N. The
dependability of behavioral measurements: Theory of generaliza-
bility for scores and profiles. New York: Wiley and Sons, 1972.
Cronbach, L. J. & Rajartnam, N. A. Theory of generalizadility: A
liberalization of reliability theory. British Journal of Statis-
tical Psychology, 1963, 16, 137-1631
Cullen, K. J. A six year controlled trial of prevention of children's
behavior disorders. Journal of Behavioral Pediatrics, 1976,
88 (4), 662-666.


127
II. Maternal Factors
T
,
Moderate-severe toxemia
10
11.
Second state 2-1/2
(preeclampsia)
hours
2.
Hydramnios/oligchydramnios
10
12.
Labor > 20 hours
3.
Amnionitis
10
15.
Clinical small pelvis
4.
Uterine rupture
10
14.
Medical induction
5.
Mild toxemia
5
15.
Precipitous labor
< 3 hours
6.
PROM 12 hrs.
n
D
16.
Primary cesarean
7.
Primary dysfunctional
5
section
labor
17.
Repeat cesarean
8.
Secondary arrest of
dilation
5
section
18.
Elective induction
9.
Demerol 300 mg.
5
19.
Prolonged latent phase
10.
MgSo4 25 gm.
5
20.
Uterine tetany
21.
Pitocin augmentation
Ill
Placental Factors
1.
Placenta previa
10
4.
Meconium stained
amniotic fluid (light)
2.
Abruptio placentae
10
6.
Marginal separation
3.
Postterm;42 weeks
10
4.
Meconium stained amni-
otic fluid (dark)
10
5
5
5
5
5
5
5
1
i
1
1
5
i


103
vocalization in the mother-infant transaction process. It can be
concluded that several of the variables contributed to the prediction
of risk in infant development.
Mother-Infant Transaction as a Predictor of Infant Development
One of the fundamental questions investigated in this study
concerned the relationship between mother-infant transaction and
the mental and psychomotor development of the infant. The question
addressed was:
Question Nine: Are the transaction components of
the mother-infant relationship--warmth,
reciprocity, responsive vocalization,
negative affect, and nonresponsive
stimulation--associated with the psycho
motor and mental development of the infant
after controlling for mothers age and
education, baby's sex and birth order,
yearly income, ethnic origin, social
support system, perinatal risk and type
of prenatal care?
The preceding analysis was conducted to test the hypothesis
that the transaction components predicted mental and psychomotor
development in infancy when all other variables were held constant.
The analysis involved testing the hypothesis for each dependent
variable separately. The F statistics for mental and psychomotor
development were 2.34 and 3.36, respectively and were computed in the


Abstract of Dissertation Presented to the Graduate Council
of the University of Florida in Partial Fulfillment of the Requirements
for the Degree of Doctor of Philosophy
THE ADOLESCENT MOTHER AND HER INFANT:
CORRELATES OF TRANSACTION AND DEVELOPMENT
By
Julie Anne Hofheimer
August, 1979
Chairman: Athol B. Packer
Major Department: Early Childhood Education
The increasing number of births to adolescent mothers has prompted
serious concern by professionals attempting to enhance the quality of
life for the family. We have reason to believe that the young mother
and her infant are at risk for problematic development; yet our present
sources of knowledge are limited in number and yield inconclusive find
ings. The primary purpose of this study was to assess the contributions
of the mother's age, perinatal risk status, and socioenvironmental,
medical and educational resources to the prediction of the dimensions of
the mother-infant transaction process and the developmental status of
the infant. A second pxarpose of the study was to ascertain the ability
of the transaction dimensions to predict the mental and psychomotor
development of the infant.
The data were collected in a clinical setting on an age-specific
sample of 77 mothers and their six months-old infants. The mental and
psychomotor development of the infant was evaluated using the 3ayley
Scales of Infant Development. Mother-infant transaction -was analysed
ix


23
Several disciplines have taken issue with the phenomenal number
of pregnancies which have occured during adolescence. The biomedical
explanation of how and why pregnancy occurs is quite well known and
involves the science of human reproduction. From the political, socio
logical and educational perspective we find that a large number of early
pregnancies are also due to young people's lack of knowledge or misin
formation about contraception and a lack of confidential family planning
services made available to them (Klein, 1978; McKendry et al,, 1979).
The psychological and psychosocial antecedents of early pregnancy
are more intricate since we are concerned here with the dimensions of
human sexuality. From this standpoint, early sexual activity and
resultant pregnancy become more comprehensible.
Paulker's (1970) data from a study of girls who became pregnant
out of wedlock suggests that "the girls are not pregnant because they
are different, but are somewhat different because they are pregnant"
(p. 163). Rossi (1968) interpreted this concept in her discussion of
the transition to parenthood and its direct relationship to the intent
of the individuals involved. Rossi stated, "the inception of a pregnancy
... is not always a voluntary decision, for it may be the unintended
consequence of a sexual act that was recreative in intent rather than
procreative" (p. 31).
The question of intent has been explored by Zelnik and Kantner
(1978) in their 1971 and 1976 studies of first pregnancies of women
between the ages of 15 and 19 years of age. Their findings, based on
National Probability Survey statistics, revealed that there has been
little change in the proportion of white teens who become sexually active
and pregnant, each year, but there has been a substantial decline in the
number who delivered. The authors stated that "few who become


49
care, family planning services, social service and nutritional
counseling, a mandatory prenatal and childbirth education
class and an optional infant, parenting and family development
education class. This treatment was received by women who
were 18 years of age and younger and who lived in a five
county area within the Maternal-Infant Care district (Mahan,
Note 2).
13) Shands Teaching Hospital (S.T.H.) High Risk Clinic refers
to care which was specialized for those women identified
as having a high risk pregnancy. Obstetric and neonatal
services were provided and an optional prenatal and child
birth education class was offered to these women.
The Subjects
The population of interest in this study was that of mother-infant
dyads residing in North Central Florida who were served by the College
of Medicine at the University of Florida, Gainesville, Florida. Utiliz
ing the Birth Log (a list of information pertinent to labor and delivery
records) available through the Shands Teaching Hospital, a stratified
sample was drawn (N=250). Stratification was on the basis of mothers'
ages (<15, 16-17, 18-19, 20-24, _>2S years). This method of sampling was
used in order to obtain age specificity lacking in previous research.
This method produced an age-specific sample of invited subjects
who received the appointment letter, reminder postcard and phone call,
as outlined in Appendix A. Socioeconomic and cultural representativity,
while not expected, were additonal results of the sampling procedure
and are presented in Table 7.


47
relationship -- warmth, reciprocity, responsive vocalization,
negative affect and nonresponsive stimulation -- associated
with the mental and psychomotor development of the infant
after controlling for mother's age and education, infant's
sex and birth order, perinatal risk status, yearly income,
ethnicity, social support system and type of prenatal care
and education?
9) Is there a relationship between perinatal risk status and the
mental and psychomotor development of the infant after
controlling for the mothers age and education, the infant's
sex and birth order, yearly income, ethnicity, social support
system and type of prenatal care and education?
Definition of Terms
For the purpose of this study, the following definitions of
terms were used:
1) Infant Development consisted of the composites specified by the
Mental Development Index (MDI) and the Psychomotor Development
Index (PDI) of the Bayley Scales of Infant Development. These
indices reflect the mental, psychomotor, language and socio-
emotional competence of the infant.
2) Mother-Infant Interaction is the categorical identification
of behaviors described in the Beckwith Behavior Scale. These
behaviors were coded from videotaped transaction sequences.
5) Reciprocal/Responsive Behavior is that which is observed to
be directly related to the behavior of another individual.
4) Nonresponsive Behavior is that behavior which is observed


57
(a=.01). The results of this analysis did not support the hypothesis
that the psychomotor development of the infant and the mother-infant
transaction process varied as a function of the age of the mother. The
results of the univariate analyses are presented in Tables IS and 16.
The preceding multivariate multiple regression analysis was
also designed to answer additional questions posed in the study:
Question Five: Is there a positive relationship between the
extent of prenatal care, prenatal and postpartum
parenting education and infant development and
mother-infant transaction at six months?
Question Six: Is there a positive association between the
mother's social support system and transaction and
the infant's development?
The analysis of the multivariate main effects (Table 14) revealed
that the presence of prenatal complications and the type of prenatal care
received by the mother contributed significantly to the prediction of
infant development. The type of prenatal care accounted for 6 percent
of the variance in mental development. The follow-up analysis of the
pairwise comparisons of each type of prenatal care indicated significantly
higher means for infants whose mothers received Teenage Pregnancy Team
care when compared to those receiving treatment by a private physician
and Shands Teaching Hospital High Risk Clinic. The results of the pairwise
comparisons and the adjusted means for each prenatal care group are
presented in Tables 17 and 18. As noted earlier, this question can only
be answered with respect to the association between prenatal care and
the dependent variables. The different types of prenatal care and their


101
Table 24
Means for Prenatal Care Groups after Adjusting for Variance Explained
by Transaction Components and' All Other Independent Variables
Type of Prenatal Care Mental Development Psychomotor Development
Private Physician
108.640
108.005
Public Health Department
132.973
120.406
Maternal Infant Care Clinics
126.882
123.1183
Teenage Pregnancy Team
143.407
127.319
Shands Teaching Hospital
110.742
109.319


121
10. Repetitive verbalizations: brief phrases repeated over and over
for most of a 15-second period.
Infant Behaviors
11. Bid to caregiver: request for help; reach, point, or share;
positive gestures.
12. Vocalization: nondistress vocalization, babbling, gurgling,
cooing.
13. Smiles at mother: not frowning, not grimacing..
14. Self-stimulatory behavior: thumb sucking, extended rocking or
other non-task-oriented or exploratory behavior.
15. Vacant behavior: empty or blank or facial expression; baby
is not interacting with caregiver or environment.
16. Explores: curious visual or manual exploration of environment.
17. Fusses: crying or fussing; not contingent on mother behavior.
Reciprocal Behaviors
18. Maternal positive responding: caregiver responds to infant
positive bid or distress in a positive manner by permitting,
giving, engaging, helping, accepting, etc. Does not include
imitates, elaborates, or amplifies baby's vocalizations or
behaviors.
19.. Maternal negative responses: ignoring or rejecting babys
social bid or on-going activity either verbally or nonverbally.
Examples: not returning a toy that rolls away from infant,
turning away, or stopping a baby's initiations.
20. Maternal ignoring: mother ignores bids or activity of baby.
21. Baby positive responding: baby responds to mother's bid
positively by smiling, reaching,
pointing, vocalizing, etc.


139
Resnick, M. 3., Eitzman, D. V., Nelson, R. M. Egan, E. A., Bucciarelli,
R. L,, Beale, E. F. Development of low birth weight (LBW) infants.
Pediatric Research, 1978, 12 (4), 553.
Rosen, E. J. A psychiatric and psychological study of illegitimate
pregnancy in girls under the age of sixteen, Psychiatric Neurology,
1961, 142(1), 44-60.
Rosen, R. A. H. Pregnancy resolution decision-making among minors.
Paper presented at the Annual meetings of the American Psychological
Association, 1977, San Francisco, California.
Rossi, A. Family development in a changing world. American Journal
of Psychiatry, 1972, 128(9), 1057-1066.
Rossi, A. Transition to parenthood. Journal of Marriage and the
Family, 1968, 20_(1), 26-39.
Russell, C. Transition to parenthood: Problems and gratifications.
Journal of Marriage and the Family, 1974, 36_(2) 294-301.
Ryan, G. M. § Schneider, J. M. Teenage obstetric complications.
Clinical Obstetrics and Gynecology, 1978, 21 (4), 1191-1197.
Sameroff, A. Theoretical and empirical issues in the operationalization
of transactional research. Society for Research in Child Develop
ment 1979.
Schmidt, Wilfred § Hore, Terrence. Some non-verbal aspects of
communication between mothers and their preschool children.
Child Development, 1970, 41_, 889-896.
Semmons, J. P. Implications of teenage pregnancy. Obstetrics and
Gynecology, 1965, 26(1), 77-85.
Stine, D. C., Rider, R. V. § Sweeney, E. School leaving due to
pregnancy in an urban adolescent population. American Journal of
Public Health, 1974, 54(1), 605-614".
Strassberg, Donald, Gabal, Harris 5 Anchor, Kenneth. Patterns of
self-disclosure in parent discussion groups. Small Group Journal,
1976, 7_(3), 369-377.
Terkelson, Care. Making contact: A parent-child communication
skill program. Elementary School Guidance and Counseling,
1976, 11(2), 89-99.
Welcher, D., Mellits, D. $ Hardy, J. A multivariate analysis of
factors affecting psychological performance. Johns Hopkins
Medical Journal, 1971, 129, 19-35.


CHAPTER II
THE REVIEW OF THE RESEARCH
This study was designed to explore the transactional relationship
between the very young mother and her infant and her infant's development.
In order to understand the implications of early parenthood on the
mother and her baby, it is necessary to synthesize the literature from
several sources of knowledge.
The variables which are the focal point of the present study --
prenatal and perinatal risk factors and socioenvironmental, medical
and educational resources -- are presented in this review as they
relate to the sequential development of the adolescent as a mother.
Specific discussions of the role of the extended family and psycho
social influences on the young woman undergoing the transition to
parenthood are presented within the context of each phase of the
transition. These topics are also discussed as they relate to the
development of the child born to a very young mother.
As noted previously, the adolescent undertaking the task of
motherhood faces both a transition from her family of origin to
psychological independence and the transition to the responsibilities
of parenthood. Her relationship with her baby and her baby's growth
can be viewed as a function of the mother's ability to establish
9


This work is lovingly dedicated to my family
for enduring my never-ending adolescence
and most especially, for teaching me
the true meaning of attachment and bonding . .
1979


THE ADOLESCENT MOTHER AND HER INFANT:
CORRELATES OF TRANSACTION AND DEVELOPMENT
By
Julie Anne Hofheiner
A DISSERTATION PRESENTED TO THE GRADUATE COUNCI
OF THE UNIVERSITY OF FLORIDA IN
PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF DOCTOR OF PHILOSOPHY
UNIVERSITY OF FLORIDA
1979


56
aspects of mother-infant transaction. The instrument was originally
constructed for observations of infants and mothers in the home.
Certain variables (such as floor freedom and mutual gaze during
feeding) were not applicable to this investigation. Another issue
which influenced the adaptation was that the scale was constructed
and implemented with preterm infants and their caregivers at one,
three and eight months of age and adapted by Grossman (1979) for
use with infants of six months of age. These considerations were
of importance in this study and were the basis upon which some
original variables were substituted with ones which were more applicable
to the simulated playroom setting in a study of six month olds.
The coding of the videotapes was also adapted so that be
haviors were coded every five seconds or when the behavior changed
rather than every 15 seconds as originally implemented. The rationale
for this adaptation was based on the dynamic characteristics of
mother-infant transaction which necessitated the more precise
analysis of the process as behaviors occur in a five (rather than.15)
second time span.
Interobserver agreement
The issue of reliability--the extent to which measures of be
havior are measured consistently--has been a subject of great concern.
This concept is best clarified by Cronbach and Ra.jartnam (1963) in their
statement: "an investigator asks about the precision or reliability
of a measure because he wishes to generalize from the observation
in hand to some class of observations to which it belongs." (p. 144).


140
Siente, Arel § Crockenberg, Susan. Transition to fatherhood: Lamaze
preparation, adjustment difficulty and the husband wife
relationship. Family Coordinator, 1976, 26(2), 351-367.
Werner, E. E. § Bayley, N. The reliability of Bayleys revised-
scale of mental and motor development during the first year
of life. Child Development, 1966, 37, 39-50.
Wright-Smith, E. The role of the grandmother in adolescent
pregnancy and parenting. Journal of School Health, 1975,
45(5), 278-283.
Young, A. T., Birkman, B. § Rehr, H. Parental influence on pregnant
adolescents. Social Work, 1975, 20(5), 387-391.
Youngs, D., Niebyr, J., Blake, D. Shipp, D., Stanley, J. § King, T.
Experience with an adolescent pregnancy program. Journal of
Obstetrics and Gynecology, 1977, 50(2) 212-216.
Zelnick, M. § Kantner, J. First pregnancies to women aged 15-19:
1976 and 1971. Family Planning Perspectives, 1978, 10(1), 11-20.
Zlatnik, F. J. § Burmeister, L. F. Low gynecologic age: An obstetri
risk factor. American Journal of Obstetrics and Gynecology, 197
128(2), 183-196.


10
equilibrium in these two multidimensional stages of development. The
literature reviewed in this chapter has therefore been selected from
two distinct fields: 1) the study of parent-infant transaction as
it is related to infant development; and 2) the special study of
adolescent parenting.
A review of the research related to young mothers' transactions
with their infants is limited by the fact that there exists but one
observational study to date (Badger.et al., 1973). 'For this reason, non
age-specific studies of the mother-infant relationship and transaction
process as they relate to infant development are presented as a basis
for understanding the process and the aspects which concern the young
mother and her infant. The presentation of this material in such a
manner is based on the assumption that there are certain universal
aspects of mothering and infant development and that these are
generalizadle to the study of adolescent mother-infant transaction.
It is beyond the scope of this study to deal with the many issues
associated with adolescent pregnancy, except as they concern the
role of the mother and her baby's development.
-f
Parent-Child Transaction and Infant Development
The emergence of current information regarding the newborn's
competence and capabilities has been accompanied by investigations
of the earliest years of a child's life and those who play signif
icant roles in the development of the child. The child's concept
of self forms a major basis for the developmental process and has been
thought to be related to early transactions between the newborn and
parent. When the concept of self is viewed as a learned rather than


92
educational programs are discussed in Chapter V.
The data did not support the hypothesis that either perinatal risk
status or the quantity of social support received by the mother was
related to her transactions with her infant or the infant's development.
In addition, it was found that no independent variables contributed
to the prediction of the mother-infant transaction process.
The Prediction of Infant Development
The second multivariate multiple regression analysis was imple
mented in order to ascertain the ability of the transaction components
to predict infant development. This analysis was also directed to
the questions regarding the mother's age and prenatal and perinatal
variables as predictors of infant development when the variance
explained by transaction was partialled out in the model. The second
analysis was designed to answer the following questions:
Question Three: What is the nature of the relationship between
prenatal medical care and development at six
months after controlling for the age and
education of the mother, the sex and birth order
of the infant, ethnic origin, yearly income
and perinatal risk?
Question Four: Which variables contribute predictive information
to the identification of developmental delays
on infant development measures at six months?
Question Eight: Is there a relationship between the age of the
mother and infant development after controlling
for transaction, infant sex and birth order,


95
Table 20
Tests of Significance of
Contribution of Prediction for Both
Dependent Variables Combined
Variable
R
F
P
Mental Development
.45
2.65
.002
Psychomotor Development
.40
2.10
.017


114
basis of this study was a strong belief in the positive characteristics
of the young parent--courage, enthusiasm, adaptability and, above all,
an optimistic view of the future. It is hoped that the results of this
study and the literature presented herein will allow our future efforts
to focus on the qualities of the mother-infant relationship in order
to enhance the development of the infant and strengthen the family.
It is important to remember that these young women have chosen to
continue their pregnancies and undertake the tasks of motherhood.
Remember, too, that most individuals, regardless of age, come to parent
hood relatively unprepared for the responsibilities of caring for and
nurturing another human life. The positive growth and development of
these young parents and their children is dependent upon cur interdis
ciplinary efforts to support them in a comprehensive manner as they grow
together as a family.


116
Name
Address
Telephone
Six Month Assessment
Child and Family Development Evaluation
Julie Hofheimer
Departments of Obstetrics and Gynecology and
Pediatrics
Release Form
Parent's Questionnaire
Bayley Scales of Mental and Motor Development
Videotaped Free-Play
Hobel Assessment of Perinatal Risk
Evaluation Protocol
Mothers will be notified of their appointment by mail one month
prior to test date. They will be mailed the reminder postcard one week
prior to testing and phoned to confirm the appointment two to three
days prior to testing.
Upon arrival in the Pediatric Clinic, they will be brought into the
Developmental Clinic Playroom and the Assessment Specialist will explain
the procedure for the freeplay videotape and Bayley Scales of Infant
Development. Upon agreeing to participate in the study, the mother will
be asked to sign the consent form.
The freeplay situation will be videotaped and the developmental
assessment administered. The Developmental Specialist will then take
the family into the waiting room and explain the results of the assess
ment, show the mother learning activities, which are keyed into she


32
Extending this concept of the parent's social support system to
the adolescent mother-infant relationship has proven to be illuminating
In a cross-cultural study of mothers and their newborns, Brazelton and
Lester (Note 1) compared adolescent mother-infant dyads in Puerto Rico
to those in the rural South. Their findings revealed the supportive
nature of the extended family to be strongly related to both mother-
infant transaction and the behavioral assessment of the neonate.
Perhaps the most in-depth studies of the importance of the
extended family to the adolescent mother-infant relationship are
those of Furstenberg (1976; Furstenberg and Crawford, 1978). His
longitidunal studies showed that most adolescent mothers were "apparent
ly loving, responsible, effective parents" (Chilman, 1979, p. 261) of
young children, especially if the responsibilities of child care
were shared by another adult.
Furstenberg's most recent work explored the family's support in
the early years of parenthood and its relationship to longitudinal
assessments of childrearing attitudes and practices. At the five
year follow-up of a sample of 404 Baltimore families, no differences
in mothers' reports of self confidence or racings of parent-child
interaction were noted among families of differing residential careers
or childcare arrangements. Among those mothers living alone or
apart from the extended family, Furstenberg noted a higher level of
control over the child's behavior and a higher level of interest in
the child. The author concluded that the mother's ability to establish
her own support system independent of the family was an important dimen
sion of her parenting role (1978) and evidenced a willingness to take
responsibility for herself and her child.


129
D.
Cardiac
1.
Major Cardiac Anomalies
IQ
2.
CHF
10
3.
Persistent cyanosis
5
4.
Major cardiac Anomolies
without catheterization
5
5.
Murmur
5
E.
Hematologic Problems
1.
Hyperbilirubinemia, 15
10
2.
Hemorrhagic diathesis
10
3.
Chromosomal anomolies
10
4.
Sepsis
10
3.
Anemia
5
F.
Central Nervous System
i.
CNS depression > 24 hours
10
2.
Seizures
10
3.
CNS depression < 24 hours
5


79
An initial inspection of the cross tabulations revealed
the type of prenatal care to be highly correlated with the type
of prenatal childbirth and postpartum parenting education received
by the mother. The type of prenatal care received by the mother
determined to a great extent the type of educational program she
was offered. As a result, prenatal childbirth education and
parenting education were omitted from further analyses. The
variable "type of prenatal care" contained more information due
to the differences in prenatal and parenting education programs
offered in conjunction with prenatal medical care. The cross
tabulations are presented in Table 11.
The correlation matrix is presented in Table 12 and
indicated that the perinatal risk status of the mother and infant
were not correlated with the presence or absence of prenatal
complications. Complications found among women in this sample
included anemia, toxemia, venereal disease and infection. The
fact that these risk factors were uncorrelated was not expected
due to the fact that the measure of perinatal risk included
preara! complications. It is possible, however, that the
rating system employed by the scale is not useful for studies
which are retrospective in nature. Another possible interpreta
tion is that the scale may not be sensitive to the importance


with enhanced development of the infant. These findings suggest
several considerations for the design of parent and infant-centered
interventions for the young parent family in order to enrich the qual
ity of care and stimulation provided by the adolescent mother and
thus enhance the development of the infant.
XI1


110
four groups, whereas the measures taken on private patients reflect
a more random selection. Another consideration to be taken into account
is the fact that subjects were self-selected into each type of
prenatal care group on the basis of socioeconomic status and geo
graphic location. Consideration of these results should also
be based on the fact that the design of the study was retrospective
and as such, no causal inferences with respect to differences between
groups can be made. No outcomes can be said to be associated with
the prenatal or parenting education components of the models due
to the fact that these variables were excluded from the analyses.
These results do, however, suggest a need for more -controlid'ex
perimental designs which would permit the investigation of the
effects of interdisciplinary service models on the parent-infant
relationship and infant development.
The Prediction of Developmental Risk in Infancy
The results of this study indicated that the young age of
the mother, the presence of prenatal complications and a lack of
responsive vocalizations in the mother-infant transaction process
are associated with negative outcomes in infant development. It
was surprising that no infants in this sample (which consisted of
many low income and/or adolescent mothers) scored at or below 68
(the clinical criterion for delay) on the Bayley Scales of Infant
Development. Several possible explanations of this deserve mention.
One possible cause is that the examiner "tested high." This
consideration, as well as the fact, that the infants participated
in 15 minutes of free play prior to the assessment, may well have


CHAPTER V
DISCUSSION AND IMPLICATIONS
In this study, the most important questions were concerned
with the multidimensional outcomes of early pregnancy and parenting.
The study was designed to explore the relationship of the age of
the mother, prenatal and perinatal factors and socioenvironmental,
medical and educational resources to the dimensions of mother-
infant transaction and the development of the infant. This
research reflects an effort to enhance our understanding of
the young mother and her infant and, as a result, design more appro
priate and comprehensive support services to the young family.
The findings of the study and their implications are discussed
in this chapter.
The Age of the Mother as a Predictor of Infant Development
and Mother-Infant Transaction
The most important questions posed in Chapter I asked "what
are the behavioral characteristics of the very young mother? . .
hew does she relate to her baby and what is the association between
her style of mothering and her babys development?" The questions
addressed several dimensions of early family development.
In the first analysis, which viewed transaction and development
as outcome measures, no variability in mother-infant transaction
was found to be related to mothers age.
106


18
outgrowth of the mutual enhancement of feelings of efficacy (Ainsworth,
1972; Bell, 1974; Brazelton et al., 1975; Klaus and Kennel1, 1975).
The parent's distinctive interpretations of the infant's states of
arousal have been shown to prompt an appropriate response to stimula
tion. The extent to which the behaviors of significant others can be
anticipated from contextual events functions as a determinant of the
quality and extent of the infant's responsive reaction (Goldberg,
1977) The ability of the young mother to interpret the state of her
infant and facilitate appropriate transaction has been questioned by
a number of authors (Hardy et al., 1978; DeLissovoy, 1973) and
was investigated in the present study.
Beckwith et al. (1976) studied the preterm infants' inter
actions with their mothers at one, three and eight months of age
through observations in the families' homes. Her findings indicated
that infants whose Geseil developmental quotient was higher at nine
months spent less time being in routine care at one and three months
and were given more floor freedom at eight months. Higher scores
on sensorimotor measures were associated with mors mutual gazing
during one month observations, with smiling and contingent responses
to distress at three months and general attentiveness at eight months.
Beckwith's (1971) study of maternal attributes and their infant's
I.Q. scores revealed freedom to explore the home, experience with
people other than the mother and the adoptive and natural mothers'
socioeconomic status to be important interaction variables which wrere
related to enhanced development.
Much research has been undertaken which deals with dyadic communica
tion skills in an attempt to trace qualitative interpersonal skills and note


7
The general questions addressed in the study were investigated
as follows:
1) Do infant development and mother-infant transaction vary as
a function of the age of the mother?
2) Is the relationship between the mother's age and each dimension
of transaction and infant development linear after controlling
for all other independent variables?
3) What is the nature of the relationship between prenatal medical
care and development at six months after controlling for all
other independent variables?
4) Which variables contribute predictive information to the
identification of developmental delays on infant development
measures at six months?
5) Is there a positive relationship between the extent of prenatal
and postpartum parenting education and infant development
and mother-infant transaction at six months?
6) Is there a positive relationship between the extent of the
mother's social support system and transaction and the infant's
development?
Summary
The purpose of this study was to investigate the transactional
relationship between the adolescent mother and her infant and the
infant's development. We have reason to believe that the young mother
and her infant are at risk for problematic development; yet our current
sources of information are limited in number and yield inconclusive
findings. This study was designed to explore the unique contributions


Table 25
Means for Prenatal Care Groups
After Adjusting for Variance Explained
by all Independent and Dependent Variables
Type of Prenatal
Care
Mental
Development
Psychomotor
Development
Warmth
Reciprocity
Responsive
Vocalization
Negative
i Affect
Nonresponsive
Stimulation
Private Physician
103.64
108.01
.210
3.90
2.44
2.46
6.26
Public Health Depart
ment
132.97
120.41
5.901
17.28
-1.63
5.98
7.28
Maternal-Infant Care
Project
126.88
123.12
5.70
17.28
-3.25
3.37
5.58
Teenage Pregnancy Team
143.41
127.32
11.56
16.20
-3.49
5.37
7.64
S.T.H. High Risk.
Clinic
110.74
109.32
7.08
8.66
3.73
1.35
5.25


132
Brazelton, T. B., Tronick, E., Adamson, L., As, H. § Wise, S.
Early mother-infant reciprocity. Ciba Foundation Symposium,
1975, 33, 1-220.
Browman, S., Nichols, P. § Kennedy, W. Preschool IQ: Prenatal and
early developmental correlates. New York: Wiley § Sons, 1975.
Bronson, G. Infant's reactions to unfamiliar persons and novel
objects. Monographs of the Society for Research in Child
Development, 1972, _37(3), 1-45.
Butts, J. D. Adolescent sexuality and the impact of teenage
pregnancy from a black perspective. Paper presented at Family
Impact Seminar Conference on Teenage Pregnancy, George Washington
University, 1978.
Campbell, S. Mother-child interaction in reflective, impulsive and
hyperactive children. Developmental Psychology, 1975, 11(6),460-468.
Chilman, C. Adolescent sexuality in a changing American society.
DHEW Publication No: (NIH) 79-1426, Washington, D. C.: U. S.
Government Printing Office, 1979.
Claman, A. D. Reaction of unmarried girls to pregnancy. Canadian
Medical Association Journal, 1969, 101, 328-34.
Clarke-Stewart, A. K. Intervention between mothers and their young
chi1dren. Monographs of the Society for Research in Child Devel
opment, 1973, _38(6-7) 1-109.
Coates, J. Obstetrics in the very young adolescent. American Journal
of Obstetrics and Gynecology, 1970, 108(1), 68-72.
Cob-linear, W. G., Schuiman, H. § Romney, S. L. The termination of
adolescent out of wedlock pregnancy and the prospects for their
primary prevention. American Journal of Obstetrics and Gynecology,
1973, 65(3), 432-444.
Cohen, C., Beckwith, L. § Parmalee, A. Receptive language development
in pre-term children as related to caregiver-child interaction.
Pediatrics, 1978, 61_(1) 17-19.
Crider, E. School-age pregnancy, childbearing and childrearing: A
research review. Dept, of HEW, U.S.O.E. Contract #PQ076271;
November, 1976.
Cronbach, L. J., Gleser, G. C., Nanda, H. S Rajaratnam, N. The
dependability of behavioral measurements: Theory of general!za-
bility for scores and profiles. New York: Wiley and Sons, 1972.
Cronbach, L. J. & Rajartnam, N. A, Theory of general!zability: A
liberalization of reliability theory. British Journal of Statis
tical Psychology, 1963, 16, 137-163.


58
Table 1
Inter-Observer Reliability of
Mother-Infant Transaction Behaviors
Behavior
r
Behavior
r
Mother Behaviors
Baby Explores
.69
Comments
CO
oo
Baby Fusses 1
.00
Commands
.70
Reciprocal Behavior
Criticizes
. 96
Mother's Positive Response
.82
Nonverbal Bid
.67
Mother's Negative Response
**
Initiating Behaviors
.73
Mothers Contingent Ver-
.97
bal/vocalizations
Repetitive Nonverbal Bids
.89
Face to Face Orientation
.88
Staccoto Bursts
1.00
Mother's Ignoring Response
.95
Affectionate Touches
.83
Baby's Positive Response
. 68
Interfering Touches
.19
Baby's Negative Response
k k
Repetitive Verbalizations
1.00
Baby's Contingent Vocal-
k k
Baby Behavior
ization
Bid to Caregiver
.90
Mutual Gaze
kk
Smiles
* *
Baby's Ignoring Response
.81
Vacant Behavior
**
**No correlation computed; one or both ratings evidenced no variability.


11
than an innate phenomenon;, the child's self-concept--appears to develop.
as a function of the growth, process through transactions with people
of significance. Gordon (1966) summarized much about the development
of the Self in infants and young children when he stated:
Their original images of themselves are formed in the family
circle. They develop the notions of who they are in relation
to people around them, particularly through ways in which their
behavior is received by adults who are important (and that)
the origins of self-concept are the results of interactions
with his parents and the meanings he assigns these experiences.
(The Self thus becomes) the motivating and selecting factor of
behavior (and learning) . and is the sum of subjective
judgements he makes with regard to himself and his experiences.
Cp. 74)
In this way, predispositioned feelings about self are conceived and
ramifications for future development become evident.
It becomes important then to turn to the more global studies of
the parent-infant relationship. In this way we may better understand
the development of the adolescent as a mother and the ramifications of
this process for the growth of her child.
How does the mother-infant relationship begin? What is meant
by the terms attachment and bonding and how do they affect future
development? How can we better extend our understanding of these
abstract concepts with more concrete evidence? These questions have
prompted a considerable amount of research concerning the evolution
of the newborn's first experiences within the family (Ainsworth, 1972;
Bell, 1974; Brazelton, 1975; Klaus and Kennell, 1976; Lamb, 1977),
Let us review Brazelton's (1973) discussion of the interrelated
components through which the mother forms the beginning of attachment
to the infant. The stages include: 1) planning the pregnancy; 2) con
firming the pregnancy; 3) accepting the pregnancy; 4) acknowledgement
of fetal movement; 5) acceptance of the fetus as an individual;


I certify that I have read this study and that in my opinion
it conforms to acceptable standards of scholarly presentation and
is fully adequate, in scope and quality, as a dissertation for the
degree of Doctor of Philosophy.
Michael B. Resnick
Assistant Professor of
Pediatrics
I certify that I have read this study and that in my opinion
it conforms to acceptable standards of scholarly presentation and
is fully adequate, in scope and quality, as a dissertation for the
degree of Doctor of Philosophy.
/
Robert S. Soar
Professor of
Foundations of Education
This dissertation was submitted to the Graduate Faculty of the
Department of Curriculum and Instruction in the College of Education
and to the Graduate Council, and was accepted as partial fulfillment
of the requirements for the degree of Doctor of Philosophy.
Augus t, 1979
Dean, Graduate School


To Dr. Patricia Ashton, my appreciation fox her insight
t
in helping me take a step back and look at aethers and babies
from all perspectives. A special thanks, too, for being
such a strong model of all that is soft and feminine, while
at the same time exemplifying scholarship and professionalism
To Dr. Jim Algina, iny thanks for his intuitive assistant
in the analysis of my data. I have especially appreciated
his ability -to tie up the loose ends and so patiently help
ne try to understand some difficult concepts.
Dr. Bob Soar has been continuously supportive. His
sensitive methodological recommendations and interpretations
of my analyses are greatly appreciated.
I would also like to extend my thanks to Drs. Bill
Ware and Maria Llabre for so patiently helping me look at
the world analytically and with high standards of excellence
in research. I am grateful for their support of me in my
most difficult endeavor and for giving me the confidence
to persue a new interest,
To the friends who have stayed by my side, I am
especially grateful for their faith in me and their help
in keeping it all in the proper perspective .... for the
tender understanding and, most of all,
for always being there


Table 4--extended
Self Stimulation
Vacant Behavior
Explores
Fusses
Mother's Positive
Response
Mo then's Negat i ve
Response
ContingentL Verbal
izations
Face to Face Orientation
Maternal Ignoring
Baby's Positive Response
Baby's Negative Response
Contingent Vocalization
Mutual Gaze
Baby Ignoring
Total Percent
of Variance
.023
-.032
.011
.055
-.227
-.202
.017
. 044
.043
. 285
-. 044
-.054
.027
-.056
. 264
-. 041
-.124
-.047
.034
.336
-.048
co
to
O
1
.000
-. 004
.076
.014
.005
.013
12.000
10.200
-.045
.038
-.018
. 122
-.065
.138
-.031
-.078
.005
-. 155
-.043
-.135
-.022
-. 051
-.079
.015
.035
. 168
.286
-.054
-.038
.017
.010
-. 004
.000
-.075
-.043
.001
-.035
.029
.031
.282
-. 008
.305
.026
.012
.071
-.118
.309
-.033
.034
.289
8.900
7.700
7.000


6
of her infant and the infant's ability to participate in a reciprocal
manner.
In summary, the research indicates that the infant is a competent
human beingcapable of responding to and with the environment. The
infant posesses many competencies, yet is unable to perform certain
tasks, and must depend on other individuals for life sustaining and
enhancing functions. The quality of the care provided for the infant
is the vital element which will promote the most positive growth during
the child's first three years of life (Gordon, 1975). HJkat /LmcUn Zn
qu^ZZcm -6 the. quaZZiy ol acut p/iovZdad by the. ozty young motheA.
While the risks of early parenthood are obvious, the strengths of the
young mother have yet to be empirically documented. An assessment
of the strengths and limitations of the mother-infant relationship
and the infant's development will thus contribute toward a more thorough
understanding of their needs and: will make it'.possible 'to design more
comprehensive services for the young family.
Questions Addressed in the Study
The independent variables under investigation in the study are
age of the mother, education of the mother, sex of the infant, birth
order, perinatal risk status, socio-economic status, social support
system, ethnicity and participation in prenatal treatment and childbirth
and parenting education programs. The relationships between and among
the independent and dependent measures of infant development and mother-
infant interaction were investigated by an overall test of no
association between the two sets of variables. Follow-up tests on the
specific variables under investigation indicated the degree* to which
they contributed, to the prediction of developmental outcomes.


26
social disgrace, and the stress of financial burden are feelings which
are shared among all families of pregnant adolescents, regardless
of their cultural origins. The family's reaction to the pregnancy
has been shown to be important to the adolescent's development as a mother.
As has been noted frequently throughout this work, we are concerned
here with the special ways in which mothers and their infants
establish a relationship and grow together. The study of early
parenting involves a unique set of characteristics and stages through
which the young woman must pass.
The first stage following the confirmation of the pregnancy
concerns the decision regarding its resolution. Because the adolescent
often feels guilt, shame, and fear upon the acknowledgement (Furstenberg,
1976) this becomes a critical point in her development as a mother.
The study of this phase in the transition to parenthood has been
synthesized by the three authors who, coming from the different
perspectives of developmental and social psychology, have developed
surprisingly congruent theories. The works of Chi1man (1379),Furstenberg
(1978) 'and Fox (1978) have emphasized the importance of the family (often
referred to as "the family of origin") and especially that the mother-
daughter relationship ha.s perhaps the most pronounced effect on how
the pregnancy is resolved.
Furstenberg (1976) has discussed the impact of the discovery
of the daughter's pregnancy on the family. He found that for three-
fourths of the families he studied, this was the family's first
acknowledgement of the daughters sexuality. The reaction was often
shock and disappointment. This contradicts the often held belief
that early pregnancy and illigitimacy is an acceptable trend among
lower socioeconomic and/or minority cultures. Presser (1974)


105
prenatal, and perinatal factors, and socioenvironraental, medical
and educational resources to mother-infant transaction and infant
development in an age-specific sample. In the first analysis, the
measures of transaction and development were considered to be
outcome measures of early pregnancy and parenting. Mental development was
found to be associated with the age of the mother, the type of
prenatal care received by the mother and prenatal complications.
No variables were found to contribute to the prediction of
infant's psychomotor development and the mother-infant transaction
process.
The second analysis was concerned with the prediction of the
developmental outcomes of the infant. Several variables were found
to be associated with the infant's development. The variables which
were identified as predictors of mental development were: 1) the
age of the mother; 2) the type of prenatal care received by the
mother; and 3) the presence of prenatal complications. Psychomotor
development was found to vary as a function of: 1) responsive
vocalization of the mother-infant transaction process; and 2)
the type of prenatal care received by the mother.
The dimensions of mother-infant transaction were found to
contribute a significant proportion of shared variance to the
infant's psychomotor development. The component of transaction
which contributed a uniquely significant proportion was responsive
vocalization. The results of the study and their implications
for future research and intervention are discussed in Chapter V.


98
Table 22
Tests of Significance of Contribution to the
Prediction of Infant's Psychcmotor Development
Independent
Variable
Regression
Weights
F
P
Warmth
-.1668
.58
.45
Reciprocity
-.0695
.73
.40
Responsive Vocalization
.5752
7.23
<.01
Negative Affect
-.4418
1.65
.20
Nonresponsive Stimulation
.5898
2.25
.14
Mother's Age
1.2720
3.78
.06
Baby's Birth Order
-4.7877
4.57
.04
Ethnicity
-2.1277
. 35
.55
Mother's Education
-1.1858
.84
. 36
Yearly Income
.3642
1.63
.21
Baby's Sex
-6.7385
4.77
.03
Social Support System
.6892
,09
.77
Prenatal Complications
-6.0120
3.08
.08
Risk
.1037
.60
.44


41-
children of adolescents were found to have inadequate outcomes.
At seven years of age, the children of adolescent mothers performed
less well than those of 20-24 year olds on the Weschler Intelligence
Scale for Children (WISC), the Bender-Gestalt Visual-Motor Test and
the Wide Range Achievement Test (WRAT). The children of adolescent
mothers were also found to have negative outcomes related to academic
achievement and repetition of school grades on the twelve year
assessment. Self-concept was measured by the Coopersmith and
Piers-Harris tests. No significant differences were found between the
children of adolescents and those of older mothers.
Hardy et al. (1978) have provided an abundance of valuable
information regarding the long term effects of early motherhood on
the child. The negative developmental outcomes attributed to the age
of the mother are distressing and suggest a need for early and intense
intervention. A major limitation of this study is due to the
lack of empirical evidence about the childrearing practices
of the mothers involved. While other studies using Bayley measures
at eight months have demonstrated that social, language and cognitive
development were empirically demonstrated to be correlated with mother-
infant transaction (Beckwith, 1973; Beckwith et al., 1976),the Hardy et a
(1978) study failed to assess the transaction process in a controlled
situation.
Furstenburg (1976) used interviews, tests and observational
data in a longitudinal study of low-income Black adolescent mothers
and their children. He found no differences on the Preschool Inventory
in the three year old children of 15 year olds when they were compared
to those of mothers of 13 and 19 years of age. He did find significantly
higher scores among children raised by more than one adult. Children


29
The Transactional Relationship Between the Very Young Mother and
Her Infant
The research to date regarding the adolescent mother-infant
relationship is characterized by serious shortcomings. We are presented
with problems in understanding the needs of the young family due to
the fact that: 1) the transactional process has been virtually
unstudied; 2) there is an extremely high degree of controversy in
the research related to adolescent caregiving; and 3) when the rela
tionship has been explored, the sampling has been such that no
comparison to the "of age" mother has been made. Our discussion of
the adolescent mother-infant relationship is thus limited. It is
to this specific gap in our knowledge that the present study was directed.
As has been noted throughout-, the purpose-of 'this study was to
address the questions regarding the behavioral repertoire of the
young mother, An important aspect of early parenting has been
the developmental tasks of adolescence which bear heavily on the
transition to motherhood. Fox (1978) summarized the importance of
several tasks related to parenting which were: 1) resolving feelings
about the family of origin in order to separate and become autonomous;
2) an intense need for closeness and concurrent feelings of being
"smothered"; 3) coming to terms with the "who am I?" question: in
defining one's self; and 4) the establishment of appropriate attach
ments apart from the family. As has been stressed before, these are
often overwhelming.and have been noted to influence the young mother's
relationship with her child.
In a study of adolescent's expectations and attitudes towards
their infants, DeLissovoy (1973) found disturbing charactristics of
the young parents. He noted them to be "an intolerant group impa
tient, insensitive, irritable and prone to use physical punishment


62
predict the mental and psychomotor development of the infant.
In this analysis, mental and psychomotor development were regressed
on mother's age and education, baby's sex and birth order, ethnic
origin, yearly income, social support system, perinatal risk status,
type of prenatal care and the five dimensions of mother-infant
transaction. The multivariate multiple regression analyses were
executed using the General Linear Model program of the Statistical
Analysis System (SAS) (Barr et al., 1976).
Limitations of the Study
The use of videotape analyses in a low-inference observation
record to measure interaction between individuals is subject to the
limitation imposed by the fact that the behavior observed is that
which the adult subject is willing to express in the given situation.
This effect is confounded as well by the atmosphere found within
any medical setting; this often produces anxiety in the mother
and thus affects infant behavior. In an attempt to alleviate
possible stress in the assessment environment the "playroom setting
was simulated in the Pediatric Clinic.
The purpose of an evaluation of infant development at six months
of age is to establish a baseline for use in diagnostic and pre
scriptive protocols regarding the infant's strengths and limitations.
While the information obtained is useful for the identification of
competencies and delays, the scales are unable to predict future
development.
Another limitation is the fact that the families studied were
those who responded to the request and wrere motivated to participate


CHAPTER III
METHODOLOGY
The purpose of this study was to ascertain the contribution of
mother's age, perinatal risk status, and socioenvironmental, medical
and educational resources to the prediction of mother-infant transaction
and the mental and psychomotor development of the infant. The population
from which the sample was drawn consisted of mother-infant dyads who were
served by the College of Medicine at the University of Florida. The sub
jects were stratified on the basis of the age of the mother and were
selected at random from the Birth Log at the Shands Teaching Hospital.
Ninety-two mothers and their six months old infants participated in the
study.
The assessment procedures consisted of a six minute videotape of
mothers and infants in a free play situation and the administration of
the Bayley Scales of Infant Development. Demographic and socioenvironmen-
tai data were obtained from the Child and Family Development Interview
which was developed for use in this study. Following the assessment, a
parent and infant-centered protocol was implemented which was based on
the infant's needs as assessed on the mental and psychomotor scales of
the instrument. The data collection procedures were implemented in the
Pediatric Clinic of Shands Teaching Hospital. The sample, design and the
procedures for data collection and analysis are described in this chapter.
As noted in Chapter I, the questions posed by the study were:
11 Do infant development and mother-infant transaction vary


55
demonstrated a strong relationship to infant development and were the
focal point of this study:
1) The constructive expression of affect (both positive and
negative).
2) The ability of the parent to become in tune perceptually
to the actual world of the infant at varied levels of
cognitive and emotional development.
3) The ability of the parent to interact with the child
in a manner which is responsive to the actual state
of the child as observed and interpreted over time.
The behaviors and their descriptions are presented in Appendix B.
Because of the highly sensitive and potentially ambiguous nature of
the transaction process, it was necessary to pilot the use of the
instrument within the experimental context under investigation
and obtain appropriate estimates of intercoder reliability. A
reliability study was previously implemented with Beckwith by computing
a Pearson Product-Moment Correlation on independent ratings of
two observers. On 18 behavioral categories, the coders were found
to have a mean agreement of r = .92 (Beckwith, 1971; Beckwith et al.,
1976). Similar observational records have been found to have predictive
validity from observational records at nine months to Bayley mental
scores at one year (Gordon, Soar and Jester, 1979; Long, 1979) These
studies assessed transaction among dyads of varied age, develop
mental and socioeconomic status.
The decision was made to adapt the Beckwith Behavior Scale
for use in this study based on several theoretical and practical


Hie following individuals provided assistance throughout, .the
course of the study. The encouragement and enthusiasm proved instru
mental to its success. Their committment gave me the strength to
carry on and I am most appreciative of their help.
Kimberly Bounds
Maria Frankenfield
Francis Graves
Becky Montevideo
Linda Scblosser
Lisa Schiavoni
Susan Shome
Bob Rose
Beth McLaurin
Rutledge Withers
Debbie Roberts
Susan Mock
Beth Clark
Tess Bennett
Imogene Clark
Renee Miller
My thanks are extended, as well, to the staff of the Pediatric
Clinic and the Infant Development Project for their encouragement and
support.
VII


94
Table 19
Results of the Multivariate Significance
Tests of Contributions to the Infant's
Mental and Psychomotor Development
Variable
p*
df
P
Warmth
2.27
2,57
ill
Reciprocity
.53
2,57
.59
Responsive Vocalization
3.72
2,57
. 03
Negative Affect
.92
2,57
. .40
Nonresponsive Stimulation
1.17
2,57
. .32
Mother' s Age
4.05
2,57
.02'
Baby's Birth Order
2.66
2,57
. 08'
Sex of Baby
2.99
2,57
. .06.
Ethnic Origin
.17
2,57
. .84
Mother's Education
1.64
2,57
.20
Yearly Income
2.71
2,57
. .08.'.
Social Support System
1. 19
2,57
.31
Type of Prenatal Care
5.46
3,114
.<.01
Prenatal Complications
4.05
2,57
. .02
Perinatal Risk Status
1.12
2,57
. 33
conversion of Wilks' Criterion to an F statistic


14
and adapted reciprocally in response to feedback from the ether
individual. The sequence of phases which emerged from the observa
tions of the mother-infant dyads comprised: 1) initiation;
2) mutual orientation; 3) greeting; 4) play dialogue; and 5) dis
engagement. This notion of the infant's social self-regulation was
interpreted from intentional explorations -- both cognitive and
affective -- and the mother's ability to enhance the infant's attend
ing to her for important cues.
Lamb (1977) supported the notion that the infant's active parti
cipation is directly related to a sensitivity to signals. He cautioned,
however, that it is as yet unclear whether infants emit behaviors which
elicit a response, or whether they regulate their own behaviors to
engage in reciprocal interaction as a function of their intellectual
competence. The question of the infant's competence in evoking a
response has also been investigated by Sameroff (1979). He suggested
that a distinct feature of the transaction (as opposed to interaction)
model is the recognition given to the infant and the ability of the
infant, to modify the environment. Ainsworth and Bell (1973) acknowledged
the infant's contribution to the transaction process in the state
ment :
Whatever the role may be played by the baby's
characteristics in establishing the initial pattern
of mother-infant interaction, it seems quite clear
that the mother's contribution to the interaction and
the baby's contribution are caught up in an interacting
spiral. It is because of these spiral effects some
"vicious" and some "virtuous" that the variables are so
confounded that it is not possible to distinguish inde
pendent from dependent variables, (p.160)
The relationship between infant competence anu the mother-infant
transaction process remains in need of further exploration.


8
of socioenvironmental, medical and educational variables in order to
increase our understanding of the needs of the young mother and her
infant. As a result, our interdisciplinary efforts to provide comprehen
sive services will be able to become more sensitive to the special needs
of the young family.


124
26 5.7
Rotates wrist.
Credit: if the child rotates his wrist freely in
manipulating toys (cube, rattle, bell).
27 6.0
Sits alone 30 seconds or more. Administer as in
item 17.
Credit: at this level is the child sits alone 30
seconds or more. Note for item 29 whether the
child's back is curved as he leans forward for
support.
28 6.4
Rolls from back to stomach. Administer as in item 19.
Credit: if, under this or any similar situation
during the examination period, the child rolls
from his back onto his stomach.
29 6.6
Sits alone, steadily. Administer as in item 17.
Credit: at this level is the child sits alone
steadily without support and with his back fairly
straight.
30 6.8
Scoops pellet. Administer as in item 25.
Credit: at this level if the child secures the
pellet with a raking or scooping palmar prehension.
Also credit if he passes item 35 or 41.
31 6.9
Sits alone, good coordination. Administer as in item 17.
B. Mental Index
Credit: at this level if the child sits alone
steadily while manipulating toys, turning, or engaging-
in other actions that take his attention away from
the sitting process itself.
69 5.5
Transfers object hand to hand. During the child's
play with the rattle, ring, or other object, observe
whether he changes the object from one hand to the
other.
Credit: if the child transfers an object from one
hand to the other 2 or more times. Do not credit
if this occurs only when the free hand comes into
contact with the object by chance.
70 5.7
Picks up cube deftly and directly. Place a cube on
the table within easy reach of the child. Observe
the manner in which the child picks up the cube.
(Motor Scale items 16, 21, 32 may also be presented
at this time.)
Credit: if the child picks up the cube deftly and directly.


37
Coates, 1970; Grant and Heald, 1970; Hardy, 1971; Youngs et al.
1977; Semmens, 1965). Findings which were consistently documented
by these authors indicated that the infants of young mothers were
at high risk for perinatal, neonatal. and infant mortality. Crider
(1976) cited a North Carolina study of perinatal mortality in an age
specific sample which found that the mortality rate was highest
when mothers were under 15, and declined through the age of 20.
The rate of morbidity (impaired medical and/or developmental
functioning) was also found to increase significantly as the mothers
age decreased. Mother's age and medical risks to the neonate included
respiratory distress syndrome, hyperbilyrubinemia, fetal distress
with anemia, fetal distress with asphyxia (Coates, 1970), low birth-
weight associated with prematurity and low birthweight associated with
small size for gestational age (Crider, 1976).
In studies where a comparison group of "of age" mothers were
included in the designs, we are presented with different findings.
Niswander and Gordon's (1972) discussion of the National Collaborative
Perinatal Study results indicated no significant differences between
mothers under 20 years of age and those over 20 with respect zo
perinatal death. Neonatal death was found to occur significantly
more often when the mother was less than 15 years old. Their data
did not support an association between out of wedlock births and
perinatal risk. Dott and Fort (1976) concurred with the finding that
the "unique medical problems [of the adolescent] are controllable and
do not differ appreciably from older women" (p. 536).
McKendry et ai. (1979) have summarized the limitations of
studies which have regarded the age of mother as a single predictor
of obstetric performance and neonatal status. The authors concluded:


112
of social support would contribute to future investigations and
yield valuable information.
.An analysis of the subscales (language, social, cognitive and
gross and fine motor skills) of the mental and psychomotor scales
would be of assistance in order to make early developmental inter
vention more appropriate for each individual infant and family.
Mother-Infant Transaction as a Predictor of Infant Development
The relationship between mother-infant transaction and
infant development was one of the most important questions in this
study. The findings revealed responsive vocalization to be positively
related to the infant's psychomotor development. The shared
contribution of the mother-infant transaction components was also
found to be related to the infant's psychomotor development.
The results of this study support the idea that the mother-
infant relationship is important to the infant's development of
competence. We also have reason to believe that, more comprehensive
interdisciplinary models of prenatal and perinatal support are
associated with enhanced development of the infant. These findings
suggest several considerations in the design of parent and infant-
centered interventions for the young parent family. There is reason
to believe that early and prolonged intervention with young parents
and their infants can enrich the quality of care and stimulation
provided by the mother and thus enhance the development of her infant.


4
An area of general concern is the lifestyle chosen by the mother
and its implications for the development of the mother, her baby and the
developing family unit. Alternatives chosen by the mothers have included
marrying the father, raising the child alone or living with the extended
family, relatives or friends. The ramifications of the choice of life
styles have been the focal point of several studies which have noted the
"burdens and benefits" of early parenting (Furstenberg, 1978). Negative
outcomes have been related to: 1) a loss of educational and vocational
skills; 2) family impoverishment due to the high incidence of repeated
pregnancies in the adolescent population (Moore, 1978); 3) a 60 percent
divorce rate for pregnant adolescents who marry; 4) a higher degree of
medical complications and risks durinig prenatal and neonatal periods for
mother's lacking in prenatal care (Placek and Jones, 1976); and 5) a
lack of preparation for the parenting role (Crider, 1976; Badger et al.,
1974) resulting in a lack of skills in facilitating parent-child relation
ships, as well as a high degree of suspected child abuse (DeLissovoy, 1973).
The positive outcomes of early parenting are difficult to assess and
often far more difficult to accept. More staggering than the sheer numbers
of young mothers and more perplexing than the risks in questions are the
prevalent attitudes of today's society. The negativism faced by the mother
in the school, professional'environment and community is potentially
ating
than
83.1*1 V
parenthood
itself,
In effs
¡ct,
this
says to
"vnu
J ~
can! t
be a
good mozher
-you're
too yo^-
incri"
If
our
to be
frui
tful,
we must ope
n our mix
ids and
main
tain
a realisti
perspective in order to understand the role of the adolescent as a parent.
The Concept of Parent-Child Transaction and Infant Development
The past decade has witnessed considerable research in the area of
neonatal characteristics with respect to innate competencies and
capabilities. The data indicated that the newborn arrives with two


12
6) birth; 7) seeing the baby; 8) touching the baby; and S) giving
care to the baby.
In view of the findings by Zelnick and Kantner (1978) regarding
the large number of unplanned births to adolescent women, the subse
quent development of feelings of attachment to the infant remains
in question. This is confounded by the fact that the pregnancy is
often confirmed and acknowledged in the second or third trimester.
These factors pose additional threats to the relationship between
the adolescent mother and her infant. The delayed confirmation
and acceptance of the pregnancy have remained unstudied with respect
to their impact on the adolescent mother-infant relationship and
are in need of further exploration.
Wien considered within the framework of social learning and
experiences, the feelings brought by the mother to the first encounter
with her newborn are a product of her identification with her environ
ment, the effects of imitation and modeling, cultural influences,
values and expectations (Klaus and Kennell, 1975). The role of the
very young mother's environment and family of origin has thus been
an important area studied with respect to early pregnancy and parenting.
Fox (1978) notes the family's multifaceted impact on the adolescent as
a social "interactor" which is operationalized through childrearing
styles and by the quality of the relationships between dyads within
the family and among family members.
In studies of maternal-infant attachment, Ainsworth (1972)
has examined the qualitative characteristics of interaction from the
study of separation and has offered some defining attributes of


28
adolescents to that of older women, Baldwin Cl976) has noted a
peak in the rate for 18 and 19 year olds and older women. This
peak occurred during the 1950's and has declined steadily since that
time. The decline has been less extreme for 16-17 year olds. For
the youngest teens (< 15 years), the birth rate has risen. The
comparison of birth rates by race has revealed a striking pattern.
Baldwin noted "the birth and illigitimacy rates are both higher for
black than white teenagers. However, recent rises in birth and
illegitimacy rates in the young reflect changes in the white population.
The birth rate for black teenagers has declined steadily and the
illigitimacy rate is fairly stable (Baldwin, 1978)."
A more recent survey from the final 1977 National Natality
Statistics revealed a surprising trend in the fertility rate of those
mothers below' the age of 18. The fertility rate "declined slightly
for women under 18 [as did the] rates of out-of-wedlock births among
Blacks and whites younger than 15 and among Blacks aged 15-17"[Family
Planning Perspectives, 1979] While this most recent trend is
encouraging, the fact remains that one of every five babies born
today is born to an adolescent mother (Baldwin, 1978) .
The rate of child bearing and its relationship to childrearing
trends has been summarized by the Alan Guttmacher Institute (1976). In
1971, of those adolescents who gave birth out-of-wedlock, 87 percent
kept their babies, five percent sent the baby to live with family
members or friends, and 8 percent gave the baby up for adoption.
This large percentage of infants raised by very young parents has
led to the study of the mother's ability to care for her baby and the
consequences of early parenting on the baby's development.


Table 12
Correlation Matrix of the Independent and Dependent Variables
1 2
3 4
5
6
7
8
9
10
11
12
13
14
15
16
1)
Mother's Age 1.00 -.04
.57 .42
-.18
.68
.58
-.46
.03
-.05
-.01
-.10
-.22
.14
-.09
-.08
2)
Baby's Sex 1.00
-.14 -.02
-.09
.02
-.12
-.04
.00
.22
-.23
-.11
.08
.02
.19
.01
3)
Baby's Birth
Order
1.00 .11
-.12
.08
.20
-.11
-.05
-.23
-.07
.06
.05
-.00
-.03
.09
4)
Family's Ethnic
Origin
1.00
-.04
.37
.51
.30
-.06
.03
-.21
.26
.12
-.18
-.15
-.09
5)
Quality of
Social Support
1.00
-.08
-.05
.39
.00
-.03
-.01
.24
.13
-.13
.00
-.12
6)
Mother's Educa
tion
1.00
.52
-.28
.04
-.04
.12
-04
-.28
. 13
-.07
-.16
7)
Yearly Income
1.00
-.21
.16
.02
-.19
.20
-.04
.13
-.26
-.22
8)
Prenatal Complications
1.00
-.19
-.17
.16
-.18
-.08
-.01
-.08
-.00
9)
Bayley Mental Index
1.00
.34
.16
-.25
-.20
.23
.04
-.00
10)
Bayley Motor Index
1.00
-.13
-.16
-.26
.26
.06
.09
ID
Perinatal Risk Status
1.00
.25
.25
-.22
-.05
-.04
12)
Warmth
1.00
.18
.22
.04
-.14
13)
Reciprocity
1.00
-.01
.07
.10


42
whose parents married early and stayed married had the highest
scores.
In a five year follow-up, Furstenburg (1978' ) compared children
of young mothers to children of older mothers who were in preschools.
He found that children who were cared for by grandparents in the
home scored significantly higher than those who were in preschools.
The author concluded that the child's cognitive ability was enhanced
as a result of the aid his mother received from her parents which
allowed her to become more educated and socioeconomically advanced.
These findings point directly to the long term assets of the mother's
social support system. The study is limited, however, due to small
size of the sample and the lack of a comparison group of nonBlack
families.
Holstrum (1979) studied the intellectual, perceptual-motor,
language and behavioral outcomes of premature infants at three years
of age. Her findings revealed that socioenvironmental and neonatal
variables contribute significantly to the prediction of develop
mental outcomes. Socioenvironmental variables investigated included
mother's age, material resources and amount of social stress. Follow
up simultaneous univariate analyses revealed that the age of the mother
did not contribute to the developmental outcome of three year olds.
Broman, Nichols and Kennedy (1975) studied a sample of 26,760
children born to mothers in the Collaborative Perinatal Project.
They tested the significance of 169 prenatal and developmental
variables in order to ascertain their ability to predict intellectual
performance at four years. Their findings revealed that maternal


108
The findings of this and other studies (Clarke-Stewart, 1973;
Beckwith et al., 1976) have documented the potential of the transac
tion process to enhance infant development. We therefore have support
for the concept of parent and infant-centered approaches to early
intervention. The findings of this study also suggest that the
dimensions of mother-infant transaction generalize across the age of
the mother and that the young mother is as adept in her ability to
facilitate positive transaction whth her infant as her "of age" peer.
The strength of the mother-infant relationship is perhaps one that is
able to be focused on in our attempts to help mothers enhance their
infant's mental competencies. As professionals, there is often little
we can do to modify the immediate socioenvironmental variables and
biological threats due to prenatal complication that relate to infant
development. We can, however, support young mothers in their
transition to parenthood and their development of a transactional reper
toire which is responsive to the infant and thus facilitative of their
babies development.
Prenatal and Perinatal Factors and Socioenvironmental, Medical and
Educational Resources as Predictors of Mother-Infant Transaction and
Infant Development
Previous research regarding early parenting revealed the mother's
social support system and the professional services she receives to
have a relationship both to her development as a mother and her
infant's competence (Furstenburg, 1978; Kot.elchuck, 1979; Brazelton and
Lester, Note 1; Dott and Fort, 1578). These questions


25
19 years. A third approach to this area of study is best summarized
by Cutright (1971) in answer to the question, "who is the pregnant
school-age girl and why is she pregnant?" Cutright answered:
'Why is she pregnant?' To me this question implies a path
ology behind pregnancy, and denies human sexuality. In the
United States we keep trying to find out what kind of people
(in psychological terms) get pregnant out-of-wedlockwhat
could we do if we found an answer? We do not ask of married
women experiencing unwanted pregnancy 'why are you pregnant?'
Yet 20 percent of white and 36 percent of all nonwhite legi
timate births during 1960-1965 were unwanted by the parents.
Rather, we ask what means were available to control conception
and gestation, and then move to devise a program to help
married women control unwanted pregnancy and birth. We infer
nothing pathological when we speak of unwanted pregnancy among
married women, and it is time we do the same for unmarried
pregnant women, (p. 131
The Growth and Development of the Very Young Mother
Now that we have briefly reviewed the background information
regarding pregnancy in adolescence, let us turn to the resolution
of the pregnancy; specifically, the decision to continue the pregnancy
and become a parent. At the onset of this discussion, a clarification
is in order. In many instances, there is no viable choice to be made
by the pregnant teenager. Unless pregnancy is confirmed during the
first twelve weeks of gestation, abortion is no longer an option.
Another constraint is the cultural pressure facing the adolescent
which is quite ambivalent towards abortion. We have reason to believe
this is changing (Hardy, 1978), but to date, there is a general lack
of acceptance of abortion among members of minority cultures. This
lack of acceptance of abortion as a viable alternative to parenthood
should not be construed to mean that minority cultures condone or
accept early pregnancy and parenting in their offspring. To the
contrary, the works of Furstenberg (1976, 1978), Butts (1978), Martinez
(1978), and Wright- Smith ^1975) confirmed that feelings of disappointment,


Table ^--extended
Self Stimulation
Vacant Behavior
Explores
Fusses
Mothers Positive
Response
Mother1s Negative
Response
Contingent Verbal
izations
Face to Face Orientation
Maternal Ignoring
Baby's Positive Response
Baby's Negative Response
Contingent Voca1ization
Mutual Gaze
Baby Ignoring
Total Percent
of Variance
Eigenvalue
. ,0732
-.0841
.0130
.1564
-.6607
-.5153
.0693
-.1080
-.12965
-.7501
-.1764
-.1029
.1332
-.2486
.7599
-.1271
-.3504
-.1266
.0696
.9087
-.0884
-.1213
.0454
-.1026
.0956
.1140
-.0854
.0522
12.0000
10.2000
3.239 2.761
-.0879
.0943
-.0411
.2391
-.1386
. 2819
J
-h*
o
-.1980
.0332
-.3048
-.1023
-.2880
-.1080
-.1469
-.1129
-.0019
.0992
.3814
.6988
-.1321
-.2425
.0921
.0731
-.1198
.0112
-.1952
-.0782
-.0983
-.1038
. 1444
-.0767
.6370
.0318
. 7009
. 0504
-.0535
. 0930
-.2195
.6417
-.1525
. 1202
.6623
8.9000
7.7000
7.0000
2.397
2.072
1.877


analysis were:
i>4
Question One: Do infant development and mother-infant interaction
vary as a function of the age of the mother?
Question Two: Is the relationship between mother's age and each
dimension of transaction and infant development
linear after controlling for all independent
variables?
To test the hypothesis that there would be no relationship between
mother's age and interaction and development, a multivariate multiple
regression analysis was used. In this analysis, the dependent measures
were mental development, psychomotor development, warmth, reciprocity,
responsive vocalization, negative affect and nonresponsive stimulation.
The independent variables were mother's age and education, baby's sex
and birth order, ethnic origin, yearly income, social support system,
prenatal complications, perinatal risk status and type of prenatal care.
The results of the univariate tests of the contribution of each
dependent variable to overall prediction indicated that only mental
development was significant. The results are presented in Table 13. A
visual inspection of the plot of the residuals against the predicted
values of mental development revealed that the data met the assumption
of homoskedasticity (homogeneous error variance around the regression
line) and were appropriate for the analyses.
The tests of significance of the multivariate main effects (Table
1.4) indicated that the age of the mother did not contribute to the overall
prediction of mother-infant transaction and infant development (a-.05),
but did contribute to the prediction of the infant's mental development


63
in the study. Those subjects who were contacted, but did not par
ticipate may differ systematically from those who participated.
A final limitation placed on the study is the ex-post-facto
or correlational nature of the design. While associations and
relationships among the variables can provide useful information,
no inferences of causality can be interpreted from the results
of the study.
Summary
In summary, the data were collected and analyzed in order to
assess the behavioral dimensions of mother-infant transaction and
the mental and psychomotor development of the infant in an age
specific sample. In addition, the study was designed to explore
the mother's age, social support system, perinatal risk status,
prenatal medical care, and participation in childbirth and parenting
education programs in order to assess their contributions to the
prediction of transaction and development at six months. The
results of the analyses are presented and discussed in Chapter IV.



PAGE 1

THE ADOLESCENT MOTHER mi> HER INFANT: CORRELATES OF TRANSACTION AND DEVELOPMENT By Julie .Anne Hofhei^rier A DISSERTAT'ION PPj^SENTED TO THE GR.ADUATE C0L':n1CIL OF THE UNIVERSITY OF FLORIDA IN PARTIAL FULFILLNENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR OF PHILOSOPHYUNIVERSITY OF FLORIDA 1979

PAGE 2

Copyright 1979 by Julie Anne Hofheimer

PAGE 3

This work is lovingly dedicated to my family for enduring my never-ending adolescence and most especially, for teaching me the true meaning of attachment and bonding J.A.H., 19

PAGE 4

If one is to succeed in leading a man to a certain goal, one has to take care to find him where he actually is and to begin there; to be of real help to a person, one must understand more than he does, but in the very first place, one must understand what he understands. Kierkegaarde

PAGE 5

ACKNOWLEDGEMENTS Throughout the course of my doctoral work there have been a number of individuals who have contributed a great deal. It is with a most special appreciation for their sensitivity that I recognize them. The author gratefully acknowledges the contributions of Dr. Charles Mahan and Ms. Marci Hall of the Department of Obstetrics and Gynecology for the support of this study. Appreciation for their cooperation is also extended to Drs Don Eitzman, Michael Resnick and June Holstrum of the Division of Neonatology, Department of Pediatrics, These individuals offered a great deal of sensitivity to this study of mothers and their babies and represent the College of Medicine's humanistic approach to the family. Of most importance to the author were the continued guidance and thoughtful encouragement; the time and care taken in the midst of hectic schedules. It is with heartfelt thanks that appreciation is extended My chairman. Dr. Athol Packer, has my deepest respect and gratitude for his gentle direction and thoughtful guidance. My thank^, too, for his patience in teaching me to reason with feeling and feel with reason. Kis consistent support and open-minded faith in me has been a most important part of my growth. To Dr. Michael Resnick, a special thanks for opening up a whole new v/crld and allowing me to dream dreams and make them come true. I am appreciative, as well, for being given the freedom to explore. It is for all of his creative idealism that I am especially grateful.

PAGE 6

To Br. Patricia Ashton, rxy appreciation fox her irLSight in helping me take a step bs-ck and looK at ^otber^v and babies from ail perspsctivas A special -chanks, too, xcr bsir.g such a strong inc-del of all thai', is ?oft and feminine, U'hile at the same time exenip 1 if y 1 ng s ciio .1 arshi p and prof ess iana lisra To Dr. Jim Algins, my thanks for hi5 intuitive assistance in the analysis of my data. I ha\'^!:i especially appreciated his ability -to tie up the loos(-j ends and so patiently help Lte try to understand some difficult concepts. Dr. Bob Soar has been continuously supportiire. His sensitive methodological recosimendatiorxs and interpretations c£ my analyses are greatly appreciated. I would also like to extend my thanks to Drs. Bill Ware and Mari.a Llabre for so parieiitly helping Eie look at the world analyticaily and with high standards of excellence in research. I am grateful for their support of me in sy most difficult endeavor and for giving me the confidence to persue a new interest. To the friends who have staged by my side, I ani especially grateful for their f^ith in m3 and their help in keeping it all in the proper perspective .... for the tender understanding and, .u-ost of all, for always being there. vi

PAGE 7

Tlie following individuals provided assistance throughout, .the course of the study. The encouragement and enthusiasm proved instrumental to its success. Their coramittment gave roe the strength to cai'ry on and I am most appreciative of their help. Kimberly Bounds Francis Graves Linda Schlosser Susan Shome Beth McLaurin Debbie Roberts Beth Clark Iinogene Clark Maria Frankenfield Becky Montevideo Lisa Schiavoni Bob Rose Rutledge Withers Susan Mock Tess Bennett Renec Mi.ller My thanks are extended, as well, to the staff of the Pediatric Clinic and the Infant Development Project for their encouragement and support. vii

PAGE 8

TABLE OF CONTENTS PAGE ACKNOWLEDGEMENTS :.v ABSTR/VCT ix CHAPTER I. INTRODUCTION 1 Adolescent Family Development 2 The Concept of Parent-Child Transaction and Infant Development 4 Questions Posed by the Study 6 Summary 7 11: THE REVIEW OF THE PJESEARCH ". 9 Parent-Child Transaction and Infant Development 10 Tlie Young Mother and Her Infant 21 Summary 34 III. TOE METHODOLOGY 45 Questions Posed by the Study 45 Definition of Terms 47 The Subjects 49 The Procedure 50 Instrum.entation 52 Statistical A.nalyses 57 Limitations of the Study 62 Summary 63 lY. THE RESULTS 64 The Dimensions of MotherInfant Transaction 64 Description of the Sample 74 Mother's Age^ Perinatal Risk and Socioenvironm.ental Educational and Medical Resources ... S3 The Prediction of Infant Development 92 Summary ........... 104 viii

PAGE 9

TABLE OF CONTENTS Continued PAGE V. DISCUSSION AND IMPLICATIONS 106 The Age of the Mother as a Predictor of Infant Uevelopment and Mother-Infant Transaction 106 Prenatal and Perinatal Factors and Socioenvironmental, Medical and Educational Resources 108 The Prediction of Developmental Risk in Infancy 110 MotherInfant Transaction as a predictor of Infant Development 112 Summary and Conclusions 113 APPENDICES A. PARENTS CONSENT 115 THE ASSESSMENT PROTOCOL 116 CMLD' AND' '.FAMILYDEVELOPMENT' 'QUESTIONNAIRE ... 118 B. DEFINITIONS OF MOTHER AND INFANT BEHAVIORS .... 120 C. BAYLES SCALES OF INFANT :DEVEL0PME-NT 123 D. PER.INA.TAL 'RISKSGA.-LB 126 REFERENCES 131 BIOGRAPHICAL SKETCH 140

PAGE 10

Abstract of Dissertation Presented to the Graduate Council of the University of Florida in Partial Fulfillment of the Requirements for the Degree of Doctor of Philosophy THE ADOLESCENT MOTHER AND HER INFANT: CORRELATES OF TRANSACTION AND DEVELOPMENT By Julie Anne Hofheimer August, 1979 Chairman: Athol B. Packer Major Department: Early Childhood Education The increasing number of births to adolescent mothers has prompted serious concern by professionals attempting to enhance the quality of life for the family. We have reason to believe that the young mother and her infant are at risk for problematic development; yet our present sources of knoivledge are limited in number and yield inconclusive findings. The primary purpose of this study was to assess the contributions of the mother's age, perinatal risk status, and socioenvironmental medical and educational resources to the prediction of the dimensions of the mother-infant transaction process and the developmental status of the infant, A second purpose of the study was to ascertain the ability of the transaction dimensions to predict the mental and psychomotor development of the infant. The data v;ere collected in a clinical setting on an age-specific sample of 77 mothers and their six months-old infants. The mental and psychomotor development of the infant was evaluated using rhe Baylay Scales of Infant Development Mother-infant transaction was analysed

PAGE 11

using the Adapted Beckwith Behavior Scale Demographic and socioenvironmental data were obtained from the Child and Family Developm ent Interview, which was developed for use in this study. In order to reduce the number of variables and define the more global dimensions of mother-infant transaction, a correlation matrix of the 27 variables of the Adapted Beckwith Scale was subjected to a principle components analysis. As a result of this analysis, five dimensions of mother-infant transaction were defined and each subject's composite score was calculated for each of the five rotated components. In the first multivariate multiple regression analysis, the dimensions of mother-infant transaction and the infant's mental and psychomotor developm.ent were considered to be the outcome measures of early pregnancy and parenting. These measures were regressed on mother's age and education, baby's sex and birth order, yearly income, ethnic origin, social support system, perinatal risk status, prenatal complications and the type of prenatal care received by the mother. The follow-up univariate analyses indicated that the age of the mother and the absence of prenatal complications had a positive relationship with the infant's mental development. Tae plots of the residuals evidenced no deviation from linearity. It was concluded that there was a positive linear relationship between these variables and the infant's mental development. The type of prenatal care received by the mother contributed to the prediction of the infant's mental development. Tne follow-up pairwise comparisons of each type of prenatal care indicated significantly higher means for infants whose mothers received Teenage Pregnancy Team care (com.prehensive services) when compared to those groups receiving care from a private physician X

PAGE 12

and Shands Teaching Hospital High Risk Clinic (obstetric care only) T^e daXa did not iuppc-^ut tkt kypothUA^i tliat motliz/i-.cnta.iit t'laiuactlcn vcxjLLzd
PAGE 13

with enhanced development of the infant. These findings suggest several considerations for the design of parent and infant-centered interventions for the young parent fandly in order to enrich the quality of care and stimulation provided by the adolescent mother and thus enhance the development of the infant.

PAGE 14

CE4PTER I INTRODUCTION The emergence of a phenomenal niimber of births to adolescent mothers has prompted serious concern by professionals attempting to enhance the quality of life for the individual and the family. While there exist serveral studies which explore the various aspects of early pregnancy and parenting, very little is knovm about the nature of the relationship between the adolescent mother and her infant and the infant s development IVhat are the characteristics of the very young mother how do her behaviors differ from or simulate those of her "of age" peer? How does she relate to her baby and what are the effects of her style of mothering on her baby and the developing family unit? Ansxvers to these questions pose a challenge to the researcher and are in need of investigation. Such is the task at hand. Most importantly, this study attempts to explore the role of the adolescent as a mother in a.n effort to understand her strengths and limita-cions and their implicaticns for her baby's development. It is the purpose of this study, therefore, to examine the relationship between infant development and mother-infant transaction in the adolescent family. The information obtained as a result of this study will assist professionals by increasing their understanding of the developmental status of the infant and the parenting style of the young mother in order to design more comprehensive programs for the young family. 1

PAGE 15

2 The essence of "comprehensive care" involves a thorough understanding of the adolescent undertaking the tasks of early parenthood. It is through this understanding that our interdisciplinary efforts may become more sensitive to the complex needs of the young mother, her infant and her family. The commitment to quality care implies a change on the part of the professional comjnunity--a change based on empirical evidence which documents the educational and developmental competencies and capabilities of the very young mother. By focusing on the it.ie.ngtki within the family, our efforts will project a more supportive quality. It is this belief in the positive characteristics of young parents --courage, enthusiasm, adaptability and, above all, an optimistic view of the future--that is the philosophy upon which this study is based. Adolescent Family Development: The Scope of the Problem The threatening impact of early parenthood has become a source of great concern in the recent past. In 1976, the Guttmacher Institute reported that about 10 percent of ,^erican adolescents become pregn.ant each year — one million young women, isinety-four percent of these women have chosen to keep their babies, 'vhat happens to these young families remains a challenging question. The early years of parenthood, even under the most optimal circumstances, are commonly viewed as a transitional period — one in \vhich the individual is attempting to establish equilibrium and adjust to the responsibilities of becoming a parent; of caring for another hum.an life (Ro3si, 1968 ; Packer, Resnick, Wilson and Resnick, 19:79}. This can be an extremely stressful period for all members of the fam.ily.

PAGE 16

3 The impact of the transition to parenthood on the individuals involved as it related to future parent-child transaction has been the subject of many current studies, Brazeltcn's (1973) findings suggest critical interrelated components through which the mother forms the beginning of attachment to the infant. The stages include: 1) planning the pregnancy; 2) confirming the pregnancy; 3) accepting the pregnancy; 4) acknowledgement of fetal movement; 5) acceptance of the fetus as an individual; 6) birth; 7} seeing the baby; 8) touching the baby; and 9) giving care to the baby. Russell's (1974) examination of 511 couples and their 6-56 week old infants supports the view that the transition to parenthood is a crisis situation which involves a reorganization of the family's social structure. This change in family relationships was noted to be "bothersome" to new parents. Relevant adaptational factors noted by Russell from self -report checklists were: 1) the pattern of communication which affected the planning of the birth and a positive adjustment to marriage; 2) a high degree of commitment to the parenting role; 3) good maternal health; 4) a nonproblematic baby; and 5) preparation for parenthood. These factors are compounded in magnitude in the developmental tasks of the adolescent mother. Of special concern for the very young mother is her ability to cope with the multidimensional aspects of parenthood and to facilitate positive transactions with her child. The five factors discussed above suggest the need for further exploration as they involve two very specific developmental tasks: 1) the adolescent's acquisition of an independent concept of self; and 2) the parent's role transition from an individual to a member of either a dyad or a triad. W'heji one considers the magnitude of each of these tasks separately and then as occurring simultaneously, the situation of the young mother and her baby becomes potentially m.ore devastating

PAGE 17

An area of general concern is the lifestyle chosen by the mother and its implications for tlie development of the mother, her baby and the developing family unit. Alternatives chosen by the mothers have included marrying the father, raising the child alone or living v/ith the extended family, relatives or friends. Tne ramifications of the choice of lifestyles have been the focal point of several studies which have noted the "burdens and benefits" of early parenting (Furstenberg, 1978} Negative outcomes ha^^e been related to: 1) a loss of educational and vocational skills; 2) family impoverishment due to the high incidence of repeated pregnancies in the adolescent population (Moore, 1978); 3) a 60 percent divorce rate for pregnant adolescents who marry; 4) a higher degree of medical complications and risks during prenatal and neonatal periods for mother's lacking in prenatal care (Placek and Jones, 1976); and 5) a lack of preparation for the parenting role (Crider, 1976; Badger et al., 1974) resui tmg in a lack of skills in facilitating parent-child relationships, as well as a high degree of suspected child abuse (DeLissovoy, 1973). The positive outcomes of early parenting are difficult to assess and often far more difficult to accept. More staggering than the sheer numbers of young mothers and more perplexing than the risks in questions are the prevalent attitudes of today's society. T\\e negativism faced by the mother in the school, professional" environment and community is potentially more devastating than early parenthood itself. In effect, this says to the mother, "you can't be a, good mother-you re too young!" If our efforts are to be fruitful, we must open out minds and maintain a realistic perspective in order to understand the role of the adolescent as a parent. The Concept of Parent-Child Transa ct ion and Infant Development The past decade has witnessed considerable research in the area of neonatal characteristics with respect to innate competencies and capabilities. Vae data indicated that the newborn arrives v\rith two

PAGE 18

5 sequentially integrated systems of readiness (Gordon, 1975) The ability of the sensor)^ system to receive and the central nervous system to process information is referred to as "responsive readiness." From this point, "adaptive readiness" allows the infant to cope with and modify the environment accordingly. It is this reciprocal relationship between the infant and the environment which is described as transaction and which forms the base upon which future development and learning grow. The attachments formed as a result of these first transactions between parent and newborn thus become important to an understanding of development Of primary significance to the newborn are those individuals with whom the first contact is made and a relationship established — the mother, father and other family members. Numerous studies have dealt with the implications of these first bonding experiences--Those which establish the attachment of one individual to another through the unique exchange of sensory stimulation and affective warmth (Ainsworth, 1972; Bell, 1974; Brazelton, 1975; Klaus and Kennell, 1976; Lamb, 1977). The use of direct and videotaped observations of dyadic interaction has been one useful means of exploring the parent-child relationship. The analyses of structural patterns and behavioral components in the observations have indicated that several specific variables are directly related to the infant's language, cognitive, and socioemotional growth (Clark-Stewart, 1973) These variables include affective warmth, face-to-face orientation,, and responsive (rather than directive) behaviors and verbalizations. It is these attributes which are the focal point of this study. Of special interest is the relationship between the mother's ability to interact in a manner which is responsive to the needs and capabilities

PAGE 19

6 of her infant and the infant's ability to participate in a reciprocal manner. In summary, the research indicates that the infant is a competent human being--capable of responding to and with the environment. The infant posesses many competencies, yet is unable to perform certain tasks, and must depend on other individuals for life sustaining and enhancing functions. The quality of the care provided for the infant is the vital element which will promote the most positive growth during the child's first three years of life i^Gordon, 1975). lilkat KmcLLyvs -in qu^-i^on Jji qaaLttif ca^te p/iovJ.dzd by th.a. vzfiy uoang motIie.fi. HTiiie the risks of early parenthood 3.re obvious, the strengths of the young mother have yet zo be empirically documented. An assessment of the strengths and limitations of the mother-infant relationship and the infant's development will thus contribute toward a m.ore thorough understanding of their needs and: will make it '.possible to design mere comprehensive services for the j^oung family. Questions Addressed in the Study The independent variables under investigation in the study are age of the mother, education of the mother, sex of the infant, birth order, perinatal risk status, socio-economic status, social support system, ethnicity and participation in prenatal treatment and childbirth and parenting education programs. The relationships between and among the independent and dependent measures of infant development and motherinfant interaction were investigated by an overall test of no association between the two sets of variables. Follow-up tests on the specific variables under investigation indicated the degreeto which they contributed, to the prediction of developmental outcomes.

PAGE 20

7 The general questions addressed in the study were investigated as follows: Ij Do infant development and mother-infant transaction vary as a function of the age of the mother? 2) Is the relationship between the mother's age and each dimension of transaction and infant development linear after controlling for all other independent variables? 3) What is the nature of the relationship between prenatal medical care and development at six months after controlling for all other independent variables? 4) ftliich variables contribute predictive information to the identification of developmental delays on infant development measures at six months? 5) Is there a positive relationship between the extent of prenatal and postpartum parenting education and infant development and m.otherinfant transaction at six months? 6) Is there a positive relationship between the extent of the m.other 's social support system and transaction and the infant's deveiopm.ent? Summary The purpose of this study was to investigate the transactional relationship between the adolescent mother and her infant and the infant's development. We have reason to believe that the young mother and her infant are at risk for problematic development; yet our current sources of information are limited in number and yield inconclusive findings. This study was designed to explore the unique contributions

PAGE 21

8 of socioenvironmental medical and educational variables in order to increase our understanding of the needs of the young raother and her infant. As a result, our interdisciplinary efforts to provide comprehen sive services will be able to become more sensitive to the special needs of the young family.

PAGE 22

CHAPTER II THE REVIEW OF THE RESEARCH This study was designed to explore the transactional relationship between the very young mother and her infant and her infant's development. In order to understand the implications of early parenthood on the mother and her baby, it is necessary to s>'nthesize the literature from several sources of knowledge. The variables which are the focal point of the present study -prenatal and perinatal risk factors and socioenvironmental medical and educational resources -are presented in this review as they relate to the sequential development of the adolescent as a mother. Specific discussions of the role of the extended family and psychosocial influences on the young woman undergoing the transition to parenthood are presented within the context of each phase of the transition. These topics are also discussed as they relate to the development of the child bom to a very young mother. As noted previously, the adolescent undertaking the task of motherhood faces both a transition from her family of origin to psychological independence and the transition to the responsibilities of parenthood. Her relationship with her baby and her baby's growth can be viewed as a function of the mother's ability to establish 9

PAGE 23

10 equilibrium in these two multidimensional stages of develcprcent The literature reviewed in this chapter has therefore been selected from two distinct fields: 1) the study of parent -infant transaction as it is related to infant development; and 2) the special study of adolescent parenting. A review of the research related to young mothers' transactions with their infants is limited by the fact that there exists but one observational study to date (Badger. et al., 1975). 'For this reason, n age-specific studies of the motherinfant relationship and transaction process as they relate to infant development are presented as a basis for understanding the process and the aspects which concern the young mother and her infant. The presentation of this material in such a manner is based on the assumption that therg are certain universal aspects of mothering and infant development and that these are generalizable to the study of adolescent mother-infant transaction. It is beyond the scope of this study to deal with the many issues associated with adolescent pregnancy, except as they concern the role of the mother and her baby's development. Parent-Child Transaction and Infant Development The emergence of current information regarding the newborn's competence and capabilities has been accompanied by investigations of the earliest years of a child's life and those who play significant roles in the development of the child. The child's concept of self forms a major basis for the developmental process and has been thought to be related to early transactions between the newborn and parent, M'len the concept of self is viewed as a learned rather than

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11 than an innate phenomenon",, the child's self-eoncept-appears to develop' as a furictior. o£ the growth, process through transactions with people of significance. Gordon (1966) summarized much about the development of the Self in infants and young children when he stated: Their original imiages of themselves are formed in the family circle. They develop the notions of who they are in relation to people around them, particularly through ways in which their behavior is received by adults who are important (and that) the origins of self-concept are the results of interactions with his parents and the meanings he assigns these experiences. (The Self thus becomes) the motivating and selecting factor of behavior (and learning) and is the sum of subjective judgements he makes with regard to himself and his experiences, (p. 74) In this way, predispositioned feelings about self are conceived and ramifications for future development become evident. It becomes important then to turn to the more global studies of the parent-infant relationship. In this way we may better understand the development of the adolescent as a mother and the ramifications of this process for the growth of her child. How does the motherinfant relationship begin? iVhat is meant by the terms attachment and bonding and how do they affect future development? How can we better extend our understanding of these abstract concepts with more concrete evidence? These questions have prompted a considerable am.ount of research concerning the evolution of the newborn's first experiences within the family (Ainsworth 1972; Bell, 1974; Brazelton, 1975; Klaus and Kennell, 1976; Lamb, 1977). Let us review Brazeiton's (1973) discussion of the interrelated components through which the mother forms the beginning of attachment to the infant. The stages include: 1) planning the pregnancy; 2) confirming the pregnancy; 3) accepting the pregnancy; 4) acknowledgement of fetal movement; 5) acceptance of the fetus as an individual;

PAGE 25

12 6} birth; 7) seeing the baby; 8) touching the baby; and 9) giving care to the baby. In view of the findings by Zelnick and Kantner (1978) regarding the large number of unplanned births to adolescent women, the subsequent development of feelings of attachment to the infant remains in question. This is confounded by the fact that the pregnancy is often confirmed and acknowledged in the second or third trimester. These factors pose additional threats to the relationship between the adolescent mother and her infant. The delayed confirmation and acceptance of the pregnancy have remained unstudied with respect to their impact on the adolescent mother-infant relationship and are in need of further exploration. Wien considered within the framework of social learning and experiences, the feelings brought by the mother to the first encounter with her newborn are a product of her identification with her environment, the effects of imitation and modeling, cultural influences, values and expectations (Klaus and Kennell, 1975). The role of the very young mother's environment and family of origin has thus been an important area studied with respect to early pregnancy and parenting. Fox (1978) notes the family's multifaceted impact on the adolescent as a social "interactor" which is operationalized through childrearing styles and by the quality of the relationships between dyads within the fa.mily and among family members. In studies of maternal -infant attachment, Ainsworth (1972) has examined the qualitative characteristics of interaction from the study of separation and has offered some defining attributes of

PAGE 26

attachment as a phenomenon. This attachment is viewed as an environmental adaptation evolving from the infant's attempt to gain proximity to the primary caretaker. Attachment differs from dependency in that it involves an affective preference for contact or multisensory stimulation, as opposed to the desire for the fulf illmenr of a physical need. Attachment is initiated through the process of mutual gazing and the establishment of eye contact with the mother. Observations have shovm that gazing is followed by locom.otor approach. Lamb (1974) stressed the need to view these characteristics as a series of interrelated components of behaviors which are uniquely individual expressions and must be viewed as a part of a seo^uence in the transactional process. Behaviors are then clustered to find measurable criteria without threatening attachment as a concept, In an attempt to categorize structural patterns and behavioral components and to quantify optimal maternal behavioral variables, several studies have focused attention on direct and videotaped observations of dyadic interaction. Brazelton et al (1975) stated that "it is through an early system of affective interaction that the development of an infant's identification v/ith cuirure, family and other individuals will be fueled" (p. 80). The study examined twelve pairs of mothers and infants involved in face-to-face interaction over a tv/elve month interval. Beha\dors such as vocalization, head position, direction of gaze, body position, amount of moveisent and handling revealed that the quality of each partner's actions were in direct relationship to the other. The behaviors were viewed as an indication of intentional affectivity and indicated that each partner modified

PAGE 27

14 and adapted reciprocally in response to feedback from the other individual. The sequence of phases which emerged from the observations of the motherinfant dyads comprised: 1) initiation; 2) mutual orientation; 3) greeting; 4) play dialogue; and 5] disengagement. This notion of the infant's social self-regulation was interpreted from intentional explorations -both cognitive and affective -and the mother's ability to enhance the infant's attending to her for important cues. Lamb (1977) supported the notion that the infant's active participation is directly related to a sensitivity to signals. He cautioned, however, that it is as yet unclear whether infants emit behaviors which elicit a response, or whether they regulate their own behaviors to engage in reciprocal interaction as a function of their intellectual competence. The question of the infant's competence in evoking a response has also been investigated by Sameroff (1979). He suggested that a distinct feature of the transaction (as opposed to interaction) model is the recognition given to the infant and the abilit^' of the infant to modify the environment. Ainsworth and Bell (1973) acknowledged the infant's contribution to the transaction process in the statement : Ifhatever the role may be played by the baby's characteristics in establishing the initial pattern of mother-infant interaction, it seems quite clear that the mother's contribution to the interaction and the baby's contribution are caught up in an interacting spiral. It is because of these spiral effects some "vicious" and some "virtuous" that the variables are so confounded that it is not possible to distinguish independent from dependent variable.*;, (p. 160)^ The relationship between infant competence ana the mother-infant transaction process remains in need of further exploration.

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15 Tlie effects of the quality of mother-infant interaction on the development of both mother and infant has been investigated as well. An intensive nine month study of 369 eighteen month olds in repeated observations, interviews and developmental assessments, lends support to a view of social competence in the infant and "a dependence upon its nurturance through reciprocal transactions (Clarke-Stewart, 1973). Findings indicated a significant relationship between maternal stimulation responsiveness, and expression of affection and the child's developmental changes and social, emotional, cognitive, and language competence. The most influential factor was found to be the quality, rather than nonresponsive quantity, of verbal stimulation. Other important factors included the mother's role as an environmental mediator, her expression of positive emotion, and frequency of responsiveness, stimulation, or affectionate behavior as it related to the child's competence. The data suggested that responsiveness to the infant's behavior had a duel effect as it not only reinforcesl specific behavior, "but created an expectancy of control vfithin the infant which generalized to new situations and unfamiliar people" (Clarke-Stewart, 1973, p. 107). Other studies indicated maternal involvement with the neonate imm_ediately after birth as having positive effects on the mother's psychological state and thus her ability to reciprocate responsively (Powell, 1974; Klaus, KenneH and Krause, 1975). The. fact that many adolescents do marry or enlist the support o.f the :f ather necessitates .a.:.l!rief discussion of current -studies which have e plored the importance of the father's role and his transaction with the infant. By means of a self-report questionnaire and interviews, Wante Crockenberg (1976), examined the nature of the transition to fatherhood with respect to the husbandwife relationship and the effect of Lamaze

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16 preparation for childbirth. V^ile it was noted that there existed a high correlation between the husband-wife relationship and total adjustment to perceived changes, medical preparation in childbirth was insignificant in facilitating adjustment after birth, mat appeared meaningful in the transition from dya.d to triad vas the sense of "family" established as a result of the father's participation in the birth. Total adjustment was found to correlate negatively with the disruption of affection and intimacy, a decreasing amount of time spent with the wife, and a discrepancy between the father's expected and actual caretaking role due to breast feeding. This aspect of early marriage and fatherhood has been virtually ignored with respect to early parenting CChilm-a.n, 1979) .. Studies of fathers' involvement have .supported'the importance of the fatherinfant transactional relationship. Parke: and Sav/in's C1976} observations of fathers, both with the mother and alone with the neonate, indicated that the fathers were equally involved in establishing eye contact, holding, vocalizing and touching the infant. Fathers were also successful in caretaking routines, and often exceeded the mother's participation. In the context of feeding and on other measures, fathers were found to be sensitive to infant cues and were able to interpret infant behavior and modify their own behavior in response. It was also noted that farhers touched and vocalized to first-born males more often than to other offspring. Longitudinal studies indicated that those fathers who were given the opportunity to learn and practice skills in the hospital were more involved with infants at six months (Parke and Sawin, 1976). The results of the study on the strength of mother-child and fatherchild attachment supported the father's role in the child's developing

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17 competence (Lamb', 1976b) During unstructured free-play in a laboratory playroom, observations of twelve month olds were used to measure the effects of each parent on the transaction process involving the other parent. The effect of a stranger's presence (a stressful situation) was also investigated in this study. The findings indicated a significant reciprocal effect in the presence of both parents on both mother-infant and father-infant relationships. The infant's affiliation behaviors -smiling, reaching and touching — and interaction during play showed a preference for the father. In a stressful situation, however, primary attachment surfaced and infants under two years of age sought proximity to the mother. Lamb (1976) points out that the results of his two studies should not be used to equate affiliation with attachment as an affective preference for one parent or the other. The findings that early interpersonal transactions are of importance to the young child's development of competence stimulated further investigation into the expanding socialization process. This process has been shown to have a pronounced relationship to total development in infancy and throughout early childhood. The parent-child relationship was shovm to be related to the language, social, emotional and mental development measures of infants who were followed from nine to eighteen months of age (Clarke-Stewart, 1973} Based upon the assumption that the infant is preadapted to selectively attend to stimuli and facilitate adult-infant interaction, numerous studies have explored the notion that reciprocity is an

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18 outgrowth of the mutual enhancement of feelings of efficacy (Ainsworth, 1972; Bell, 1974; Brazelton et al 1975; Klaus and Kennell, 1975). The parent's distinctive interpretations of the infant's states of arousal have been shown to prompt an appropriate response to stimulation. The extent to which the behaviors of significant others can be anticipated from contextual events functions as a determinant of the quality and extent of the infant's responsive reaction (Goldberg, 1977) The ability of the young mother to interpret the state of her infant and facilitate appropriate transaction has been questioned by a number of authors (Hardy et al 1978; DeLissovoy, 1973) and was investigated in the present study. Beckwith et al (1976) studied the preterm infants' interactions with their mothers at one, three and eight months of age through observations in the families' homes. Her findings indicated that infants whose Gesell developmental quotient was higher at nine months spent less time being in routine care at one and three months and were given more floor freedom at eight months. Higher scores on sensorimotor measures were associated with more m.utual gazing during one month observations, with smiling and contingent responses to distress at three months and general attentiveness at eight months. Beckwith 's (1971) study of maternal attributes and their infant's I.Q. scores revealed freedom to explore the home, experience with people other than the mother and the adoptive and natural mothers' socioeconomic status to be important interaction variables which were related to enhanced development. Much research has been undertaken which deals with dyadic communica tion skills in an attempt to trace qualitative interpersonal skills and n

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19 essential characteristics of social reciprocity. From initial attachment bonds, the infant acquires skills in evoking a response and, as a result, '^ an "emotional connectedness" is formed between the infant and others (Bell, 1974; Brazelton at al., 1975). In looking at the quality of interaction of mothers and their young children, we can better understand the impact of the mother-infant relationship in infancy. A recent study of early mother-child verval interaction indicates the mother's capability to adapt her language behavior to cues from the young child. Moerk (1975) found a correlation between the mode, length and complexity of mothers' responsive lan.guage and the child's developmental level. This suggests that the young children's competence is related to their mothers' modeling, explanation, corrective feedback and expansion of their behaviors and ideas. Holtzman's (1974) findings further illustrate this concept of social learning in verbal content which stimulated the child to work through "contextual solutions from within his cognitive repertoire" (p. 34). The nonverbal aspect of interpersonal communication between five year olds and their mothers was explored by Schmidt and Hore (1970). They noted a difference between sopntaneous signals not intended as communication and expressive behavior transformed by the intention to communicate. Their findings show more use of reciprocal glancing and complex language with children of higher socioeconomic status. No significant differences in body contact or closeness were found to be associated with socioeconomic status. Emotional implications of the verbal and nonverbal environment were the subject of investigations done in sequential semi-structured observations of one and two year olds in middle class hom.es (Nelson, 1973) If was found that nondirective parental strategies which were accepting of the child's behavior, including feedback and nonselective

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20 responding, were significa-nt in the facilitation of emotional and language development. Behavioral evidence which supports the effects of encouragement and reflective responsiveness was seen in laboratory observations of mother-child transaction as facilitating attention control, spatial orientation and field-independent cognitive styles (Bronson, 1972; Campbell, 1975). In studies relating infancy to early childhood, the child of between three and five years was seen as able to interpret the level of expressiveness and abstractness and was developmentally verging on the ability to differentiate the "perspective reality orientation" of the partner through increasing empathy and decresing egocentricity [Newman, 1976). Tnis suggested that from early transactions, the young child comes to learn how to affect another individual. Through this process, the infant (and young child) learns as well that the response of another is an expression of feelings and ideas and that these expressions are directly related to the process of interaction. Summary In summary, the development of the child appears to be strongly associated with the quality of the relationship between mother and infant. These studies which have dealt with the concept of transaction clearly demonstrate that the mother-infant relationship is of prime importance to the development of the child. Still, surprisingly little is known about the infants of adolescent mothers. Often our sources of information have been limited in generalizabi lity They do, however, acKfiOwledge: the. -needfor concern regarding the psychosocial, educational and medical risks associated with early chi Idbearing. It is hoped that the consideration of the very young mother in future research will extend our knowledge base. Exploratory studies of the young parent family ivill thus strengthen efforts to improAAe the quality of professional services to the family as a unit and eniiance the quality of life for each individual.

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21 The Young Mother and Her Infant Churchill once said crisis is a dangerous opportunity. If pregnancy in adolescence can be defined as the crisis, what [happens to] the infant may well be the dangerous opportunity (Howard, 1976, p, 247j This "dangerous opportunity" to which Howard referred is one about which very little is known. Hie past decade has given rise to great concern about the increasing numbers of adolescents who become parents each year. We have begun to investigate the medical, social, economic, psychological and educational consequences of early pregnancy and parenting, but surprisingly few studies have dealt with the development of the infants of very young mothers. Even less is knowTi about how the young mother relates to her baby--the strengths and weaknesses in her style of parenting. To date, too few observational studies exist which document her unique repertoire of mothering behaviors. Our present sources of knowledge are thus lacking in relevant information and are limited by a lack of methodological refinement in early research. Before proceeding to a discussion of the research related to early parent inr, it is necessary to explain some of the methodological problems in this area. In two separate reviews of rhe researcii, Crider (1976) and McKendry, et al., (1979) cautioned against the attempt to generalize from existing studies. In many cases, biases in our present sources are due to san^ie selections which were lacking in age specificity and inappropriate methodological procedures. Specifically, the analytical treatment of variables such as socioeconomic status and mothers' age was such that we do not know hovi much each contributes separately to the outcome measures of early pregnancy and parenting. A persistent bias is found when statements

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22 of generalization about the parenting style of adolescents are made without regard to the design of the given study. For example, many authors described negative behaviors of the adolescent parents (DeLissovoy, 1973; Presser, 1974}, but the sampling was such that only adolescents were included. If one is to suggest that young mothers display a higher incidence of dysparenting, it is necessary to include the "of age" mother in the design. Without this inclusion, we are unable to ascertain the relative contribution of mother's age to her style of parenting. A similar constraint is placed on generalization from studies of the infants of adolescent mothers. For this reason limitations will be noted in early research concerning the young mother and her infant. In order to better understand the consequences of early childbearing on the mother and her infant it is necessary to compare the young mother to her "of age" peer. Variables of interest include the trends in birth rates, medical risks to the neonate and follow-up assessments of the infants of adolescents. Tliis review wil 1 therefore address these issues from the perspective of their relationship to the adolescent's role as a mother and the development of her baby. The Etiology of Early Pregnancy In looking realistically at newer research on adolescent parenting. It is evident rhat there are two distinct categories. One is the study of pregnant teenagers and the second is the study of teenage mothers. In other words, thejiz -os a ^txiLLng diU^^encz bPM.ozzn be.aorrUng a pn.zayiant tzzsr^gzJi md bdcoivUng a .te.e.n^gz motii^t. This issue is concerned with the element of choice upon the confirmation of pregTiancy. The individual ofT.en is able to choose whether to; 1) abort or continue the pregn,ancy; and 2) give the baby up for adoption or undertake the tasks of parenthood.

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23 Several disciplines have taken issue with the phencraenal number of pregnancies which have occured during adolescence. The biomedical explanation of how and why pregnancy occurs is quite well known and involves the science of human reproduction. From the political, sociological and educational perspective we find that a large number of early pregnancies are also due to young people's lack of knowledge or misinformation about contraception and a lack of confidential family planning services made available to them (Klein, 1978; McKendry et al., 1979). The psychological and psychosocial antecedents of early pregnancy are more intricate since we are concerned here with the dimensions of human sexuality. From this standpoint, early sexual activity and resultant pregnancy become more comprehensible. Paulker's (1970) data from a study of girls who became pregnant out of wedlock suggests that "the girls are not pregnant because they are different, but are somewhat different because they are pregnant" (p. 163). Rossi (1968) interpreted this concept in her discussion of the transition to parenthood and its direct relationship to the intent of the individuals involved. Rossi stated, "the inception of a pregnancy ... is not always a voluntary decision, for it may be the unintended consequence of a sexual act that was recreative in intent rather than procreative" (p. 31). The question of intent has been explored by Zelnik and Kantner (1978) in their 1971 and 1976 studies of first pregnancies of women between the ages of 15 and 19 years of age. Tlieir findings, based on National Probability Survey statistics, revealed that there has been little change in the proportion of white teens who become sexually active and pregnant each year, but there has been a substantial decline in the number who delivered. The authors stated that "few who become

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24 pregnant do so intentionally, but few who become pregnant use contraception" (p. 11) The black population evidenced little change in the number of first pregnancies and an eight percent decline in premarital intercourse. The authors stated that a discrepancy existed in the number of live births and abortions reported by Blacks which was possibly due to the negative attitude of the culture towards abortion. Blacks were noted to report a higher nvimber of live births and fewer abortions than were actually counted in the National Survey. It is important to note that any information obtained by means of self-report questionnaires and interviews is that which the subject is willing to disclose. Ti-iis limitation is especially relevant to this study due to the extremely personal nature of the questions regarding intent. Regardless of the intent, we are faced with the fact that one million adolescents become pregnant each year (Alan Guttmacher Institute, 1976] Turning to the study of adolescent psychology (or psychopatholog;^, as it may seem), several conflicting studies focus on the personality of the adolescent as an explanation of her sexual behavior. A composite personality profile of the pregnant adolescent is one of a young woman who typically came from a broken home, was sexually active with one partner on a steady basis, reached an early menarche, was sexually impulsive, narcissistic, sociopathic, rejected, isolated, lonely, unsuspecting, and/or unprepared (Kane and Luchenbrugh, 1973; Rosen, 1661; Cobiiner at al 1973; Barglow et al 1967; Malmquist, 1967; Claman, 1969; Gottschalk, 1964). Another view is that "adolescent patients became pregnant being normal adolescents doing normal adolescent things" (Malmquist, 1967). Each of these studies is characterized by a methodological problem in either the use of small samples or the lack of a comparison group of women over the age of

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25 19 years. A third approach to this area of studv is best summarized by Cutright (1971) in answer to the question, "who is the pregnant school -age girl and why is she pregnant?" Cutright answered: 'Why is she pregnant?' To me this question implies a oathology behind pregnancy, and denies human sexuality. In the United States we keep trying to find out what kind of neople Cm psychological terms) get pregnant out-of-wedlock— what could we do if we found an answer? We do not ask of married women experiencing unwanted pregnancy 'why are you pregnant?' Yet 20 percent of white and 56 percent of all nonwhite legitimate births during 1960-1965 were unwanted by the parents. Rather, we ask what means were available to control conception and gestation, and then move to devise a program to help married women control unwanted pregnancy and birth. We infer nothing pathological when we speak of unwanted pregnancy among married women, and it is time we do the same for unmarried pregnant women, (p. l'5^ The Growth and Development of the Very Young Mot her Now that we have briefly reviewed the background information regarding pregnancy in adolescence, let us turn to the resolution of the pregnancy; specifically, the decision to continue the pregnancy and become a parent. At the onset of this discussion, a clarification IS in order. In many instances, there is no viable choice to be made by the pregnant teenager. Unless pregnancy is confirmed during the first twelve weeks of gestation, abortion is no longer an option. Another constraint is the cultural pressure facing the adolescent which is quite ambivalent towards abortion. We have reason to believe this is changing (Hardy, 1978), but to date, there is a general lack of acceptance of abortion among members of minority cultures. This lack of acceptance of abortion as a viable alternative to parenthood should not be construed to mean that minority cultures condone or accept early pregnancy and parenting in their offspring. To the contrary, the works of Furstenberg (1976, 1978), Butts (197S) Martinez (1978), and Wright^ Smith ^975) confirmed that feelings of disappointment.

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26 social disgrace, and the stress or financial burden are feelings which are shared among all families of pregnant adolescents, regardless of their cultural origins. The family's reaction to the pregnancy has been shown to be important to the adolescent's development as a mother. As has been noted frequently throughout this work, we are concerned here with the special ways in which mothers and their infants establish a relationship and grow together. The study of early parenting involves a unique set of characteristics and stages through which the young woman must pass. The first stage following the confirmation of the pregnancy concerns the decision regarding its resolution. Because the adolescent often feels guilt, shame, and fear upon the acknowledgement (Furstenberg, 1976) this becomes a critical point in her development as a mother. The study of this phase in the transition to parenthood has been synthesized by the three authors who, coming from the different perspectives of developmental and social psychology, have developed surprisingly congruent theories. The works of Chi Iman (1979) Furstenberg (1978) and Fox (1978) have emphasized the importance of the family (often referred to as "the family of origin") and especially that the motherdaughter relationship ha^s perhaps the most pronounced effect on how the pregnancy is resolved. Furstenberg (1976) has discussed the impact of the discovery of the daughter's pregnancy on the family. He found that for three fourths of the families he studied, this was the family's first acknowledgement of the daughters sexuality. The reaction was often shock and disappointment. This contradicts the often held belief that early pregnancy and illigitimacy is an acceptable trend among lower socioeconomic and/or minority cultures. Presser (1974)

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27 complemeDted this with her finding that there was an association between early maternal childbearing and the behavior of the daughter. Chilraan (1979) sited the fact that "daughters whose mothers had early pregnancies were more likely to become pregnant as teenagers", (p. As found in her earlier work, "actual maternal behavior is apt to be more influential than stated attitudes and goals for the [developmental outcomes of] children" (p. 209). The influence of the family of origin on the prevention of pregnancy and the use of contraception and abortion has been another area of interest. In general, the authors have concluded that a young girl's decisions both to become sexually active and to use contraception are related to her parent's values and support of her, her relationship with each parent and the degree of connectedness within the family CJessor and Jessor, 1975; Lewis, 1973). Fox (1978) cited the Rosen (1977) finding that, when adolescents consulted their families, the young woman was more likely to continue the pregnancy and keep her baby. In contrast, those who sought abortions rarely consulted their parents The plans implemented by the young mother following the ; decision to continue the pregnancy were discussed by YoLing, Birkman and Rehr (1975). In their study of the role of the mothers of teens who carried their pregnancies to term, the mother was noted to be especially influential in the decision making process. TTie daughters living arrangements, educational plans and child care and childrearing arrangements were those most often influenced by the mother. We can look to the Mational Center for Flealth Statistics for a quantitative summary of those who gave birth during adolescence in order to understand the trends. In comparing the birth rate of

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28 adolescents to that of older women, Baldwin (1976) has noted a peak in the rate for 18 and 19 year olds and older women. This peak occurred during the 1950 's and has declined steadily since that time. The decline has been less extreme for 16-17 year olds. For the youngest teens (< 15 years), the birth rate has risen. The comparison of birth rates by race has revealed a striking pattern. Baldwin noted "the birth and illigitimacy rates are both higher for black than white teenagers. However, recent rises in birth and illegitimacy rates in the young reflect changes in the white population. The birth rate for black teenager? has declined steadily and the illigitimacy rate is fairly stable (Baldwin, 1978)." A more recent survey from the final 1977 National Natality Statistics revealed a surprising trend in the fertility rate of those mothers below the age of 18. The fertility rate "declined slightly for women under 18 [as did the] rates of out-of-wedlock births among Blacks and whites younger than 15 and among Blacks aged 15-17" [Family Planning Perspectives 1979] While this most recent trend is encouraging, the fact remains that one of every five babies born today is bcm to an adolescent mother (Baldwin, 1978) The rate of child bearing and its relationship to childrearing trends has been summarized by the Alan Guttmacher Institute (1976) In 1971, of those adolescents who gave birth out-of-wedlock, 87 percent kept their babies, five percent sent the baby to live with family members or friends, and' 8 percent gave the baby up for adoption. This large percentage of infants raised by very young parents has led to the study of the mother's ability zo care for her baby and the consequences of early parenting on the baby's development.

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29 The Transactional Relationship Between the Very Yo ung Mother and Her Infant — — The research to date regarding the adolescent motherinfant relationship is characterized by serious shortcomings. We are presented with problems in understanding the needs of the young family due to the fact that: 1) the transactional process has been virtually unstudied; 2) there is an extremely high degree of controversy in the research related to adolescent caregiving; and 3) when the relationship has been explored, the sampling has been such that no comparison to the "of age" mother has been made. Our discussion of the adolescent mother-infant relationship is thus limited. It is to this specific gap in our knowledge that the present study was directed. As has been noted thrQughout', the purposeof 'this study was to address the questions regarding the behavioral repertoire of the young mother,— An important aspect of early parenting has been the developmental tasks of adolescence which bear heavily on the transition to motherhood. Fox (197S) summarized the importance of several tasks related to parenting which were: 1) resolving feelings about the family of origin in order to separate and become autonomous; 2) an intense need for closeness and concurrent feelings of being "smothered"; 3) coming to terms with the "who am I?" question in defining one's self; and 4} the establishment of appropriate attachments apart from the family, .As has been stressed before, these are often ovenvhelming and have been noted to influence the young m.other's relationship with her child. — • In a study of adolescent's expectations and attitudes towards their infants, OeLissovoy [1973} found disturbing charactristics of the young parents. He noted them to be "an intolerant group --impatient, insensitive, irritable and prone to use physical punishment

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30 with their children" (p. 22). DeLissovoy also found young parents to have a lack of knowledge about child development and unrealistic expectations of the infant. It was suggested that this lack of knowledge governed the parents' actions to the child and constituted a form of emotional abuse. These findings were based upon interviews conducted during five visits in the homes of 48 adolescent families residing in semirural Pennsylvania. The results prompt a caution regarding their generalizability due to the lack of a comparison group of urban or adult parents (Crider, 1976). The conslusions reached regarding young mothers' inappropriate attitudes and expectations towards her child were discussed from the perspective of its relationship to her intent to becom.e pregnant. In an age-specific sample of 408 urban women (15-29 years) Pressor (197^1) found that almost half of all mothers between fifteen and nineteen vears of age wished they had postponed their first birth. The mothers cited the reason that the infant "restricted their life choices far more than they had anticipated" (p. 13). The author concluded that early first births and resultant child care are in need of more indepth investigation in order to assess their importance to the woman's development as a mother. Klein (1973) supported this notion of the adolescents' having been "less than adequate as nurturing mothers" (p. 1154), and concluded that the lack of knowledge and preparation for parenthood suggested a need for more appropriate interventions Epstein (1979) addressed the lack of knowledge about infant development and its implications for mothering. On prenatal and six months postnatal assessments of 125 mothers in the High Scope Project, teens evidenced a lack of knowledge about the infants' cognitive and socioemotional development. The author noted that "babies were seen as

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31 passive creatures requiring little more than basic caregiving" (p. 64). The expectation of "too little too late" led to her conclusion that because young mothers are unrealistic about what they need to give, they "are likely to miss the gratifications able to be received from a baby" (p. 64). The results of this study provide valuable information regarding the educational needs of young mothers. Again, v/e are unable to ascertain whether or not this lack of knowledge is attributed to youth due to the lack of a comparison group of older mothers. The findings regarding the problematic mothering style of the young mother have led to the often unwarranted conclusion that adolescents are likely to abuse and neglect their children to a significantly greater extent than the "of age" mother. Epstein C1S"9) contrasts her findings of expecting "too little, too late" with the child abuse literature regarding abuser's expectations of "too much, too soon." Crider (1976) noted the fact that most of the child abuse studies have found the infant's birthweight, not the age of the parent, to be significantly related to abuse. Kotelchuck's (1979) most recent investigation into the prediction of pediatric social illness has illum.inated the relative importance of the mother's age in predicting child abuse and dysparenting His findings from a study in Boston revealed the parent's social isolation to be the most significant predictor of inappropriate or abusive T)arenting. In a discriminant analysis which accounted for 40 rsercent of the variance among abusers and nonabusers, the author found all measures of depression and isolation to be significant. No significant relationship was found due to mother's age, iimnediate stress, birth factors or baby temperment.

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32 Extending this concept of the parent's social support system to the adolescent mother-infant relationship has proven to be illuiBinating. In a cross-cultural study of mothers and their newborns, Brazelton and Lester (Note 1) compared adolescent mother-infant dyads in Puerto Rico to those in the rural South. Their findings revealed the supportive nature of the extended family to be strongly related to both motherinfant transaction and the behavioral assessment of the neonate. Perhaps the most in-depth studies of the importance of the extended family to the adolescent mother-infant relationship are those of Furstenberg (1976; Furstenberg and Crawford, 1978). Kis longitidunal studies showed that most adolescent mothers were "apparently loving, responsible, effective parents" (Chilman, 1979, p. 261} of young children, especially if the responsibilities of child care were shared by another adult. Furstenberg' s most recent work explored the family's support in the early years of parenthood and its relationship to longitudinal assessments of childrearing attitudes and practices. At the five year follow-up of a sample of 404 Baltimore families, no differences in mothers' reports of self confidence or raxings of parenx-child interaction were noted among families of differing residential careers or childcare arrangements. Among those mothers living alone or apart from the extended family, Furstenberg noted a higher level of control over the child's behavior ana a higher level of interest in the child. The author concluded that the mother's ability to establish her own support system independent of the family was an im.portant dimension of her parenting role (1978) and evidenced a willingness to take responsibility for herself and her child.

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^6 The impact of the extended family has yet to be explored within the content of varying mothers' ages. This is especially important m view of the large number of single-parent adolescent families. The most recent estimates reveal thar "39 percent of the children whose mothers gave birth before the age of 20 experienced a family breakup by age 15" ( Family Planning Perspectives 1979, p. 115). Intervention Vv'ith Young Mothers and Their Infants In reviewing the outcomes of early parenting with respect to the mother-infant relationship, we are confronted with disturbing findings. Perhaps the most promising results, while few in number, have been the investigations of interventions designed to assist the young mother through her transition to parenthood. In a smaller (N = 39), quasi -experimental evaluation of the effects of weekly mother-infant classes in a pediatric clinic. Badger (1974) found significant gains in mothers' knowledge of infant develo ment, nutritional needs and infant health care. Most promising were the significant increases in mothers' responsiveness to their infants and the infants' increased responsiveness to the mothers. Badger note that the program had a significantly stronger impact on the behaviors of the youngest mothers. In an educational and medical program for adolescents in Syracuse Osofsky and Osofsky (1975; 1978) examined the mother-child relationship among 450 dyads. The authors noted the young mother's warmth, physical interaction and attentiveness to their infants as being a strong foundation upon which interventions v^ere based. They also found a major weakness to be a lack of verbal interaction. 'Arhiie

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34 the study lacked a comparison group of older mothers and adolescents who were given traditional treatment, the findings suggested important areas in need of intervention. Summary Our sources of information remain limited with respect to their methodology, scope and the documented strengths and limitations of early parenting. They do, however, provide an intriguing basis for both future intervention and research designs. In summary, the conflicting results of studies investigating early parenting are inconclusive. We are unable to ascertain whether young parents are any different in their caregiving attitudes, feelings and behaviors than parents who have postponed childrearing. Chilman (1979) systhesized the views of those who are more optimistic when she stated: ^By age 16 or so, most young people are at a higher level of development and integration, but need more time to assess their values, goals and heterosexual relationships. Because child care requires the ability to be nurturant to another, to carry a heavy load of responsibility, to control one's impulses, to make ivise judgments, and to be able to provide the child with a wealth of experiences and firm guidance*, it seems unlikely that younger adolescents would'^on the average, be as effective in their childrearing as older ones. It also seems likely that, on the average, a premarital pregnancy would particularly strain a youthful marriage. On the other hand, 'ages and stages' are far from the whole story in human development and the capacity for parenthood. People who have been 'well-parented' themselves", whose motivations, values, interests and experiences have particularly prepared them to care happily and effectively for children, may be excellent parents, regardless of t.heir ags,^ especially if various support systems are available to then in their own families and in the community, (p. 261) an sober truth, who can be and do all these things? (Chilzian, 1979, p. 26

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35 The Children of Very Young Mothers : Perinatal Risk Factors Thus far, we have discussed early pregnancy and parenting from the perspective of the young mother. Of equal importance are the consequences of early childbearing and childrearing for the infants born to adolescents. Intuitively, we can guess that these infants are at high risk for medical, developmental and educational problems. Several factors have been brought to our attention by Crider (1976) and McKendry et al. (1979) in their reviews of the risks associated with adolescent pregnancy. The increased obstetric and neonatal risk of pregnancy in a physiologically immature woman has been repeatedly documented to have long range ramifications on the developmental outcomes of the infant (Grant and Heald, 1970). Tnis is often complicated by delayed and inadequate prenatal care, poor nutritional status, economic impoverishment, social isolation and emotional stress (McKendry et al., 1979). As with much research on early parenting, the investigations of the relationship between these factors and infant development have revealed inconsistent findings. They do, however, offer relevant information regarding the consequences of early pregnancy and parenting for the infants of young mothers. The most recent investigation of the prenatal, perinatal and neonatal complications associated with adolescent pregnancy was discussed by Ryan and Schneider (1978) at the University of Tennessee Center for the Health Sciences. The authors studied the obstetric -Derformance and the status of the neonate at birth among a predominantly black sample of 222 teens who were 19 years of age or less at delivery. The findings revealed these patients to have high rates of inadequate prenatal care, prenatal complications and complications during labor and delivery. The perinatal death rate was found to be twice that of the general population

PAGE 49

36 The neonatal complications indicated by low Apgar scores (< 5) central nervous system depression, pallor and decreased tone were found to occur significantly more often in babies of adolescent mothers. These findings offer important information to be considered in the assessment of the developmental status of newborns of vei"/ young mothers. A methodological concern should be noted with regard to the author's comparison of their sample's results to a previously unspecified sample of older teens and "of age" mothers. Tlie findings, as discussed above, about perinatal risk and mortalitv of very young (< 16 years) adolescents, have been consistently documented throughout the obstetric and pediatric research (McGanity et al,, 1969; Crider, 1976; Jones and Placek, 1978; Knox, 1971; and iMcKendry et al 1979). Additional obstetric complications of mothers under 16 years of age were found by Knox (1971) Very young adolescents were noted to have a significantly higher incidence of cesearean section births, premature rupture of membranes and prolonged labor. Other obstetric complications summarized by McKendry et al. (1979) and Crider (1976) included abnormal presentations and infections at delivery (McGanity et al., 1969), uterine dysfunction and one day fever (Coates, 1970), and cephalopelvic disproportion (irreg-ular size. or position of the fetus head in relationship to the mother's pelvic structure) (McKendry et al., 1979). These problems have been related to the physiological and gynecological (the time span between the age at menarche and first pregnancy) immaturity of the -other (Zlatnik and Burmeister, 19~7; Erkan, Rimer and Stein, 1972). • The relationship between adolescents' obstetric complications and neonatal risk has been closely studied by several autiiors (Crider, 1976; McKendry et al., 1975; Mecklenburg, 1973; Dott and Fort, 1976:

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37 Coates, 1970; Grant and Heald, 197Q; Hardy, 1971; Youngs et ai 1977; Semmens, 1965). Findings which were consistently dociiraented by these authors indicated that the infants of young mothers were at high risk for perinatal, neonatal, and infant mortality. Crider (1976) cited a North Carolina study of perinatal mortality in an age specific sample which found that the mortality rate tvas highest when mothers were under 15, and declined through the age of 20. : The rate of morbidity (impaired medical and/or developmental functioning) was also found to increase significantly as the mother's age decreased. Mother's age and medical risks to the neonate included respiratory distress syndrome, hyperbilyrubinemia, fetal distress with anemia, fetal distress with asphyxia (Coates, 1970), low birthweight associated with prematurity and low birthweight associated with small size for gestational age (Crider, 1976) In studies where a comparison group of "of age" mothers were included in the designs, we are presented with different findings. Niswander and Gordon's (1972) discussion of the National Collaborative Perinatal Study results indicated no significant differences between mothers under 20 years of age and those over 20 with respect to perinatal death. Neonatal death was found to occur significantly more often when the mother was less than 15 years old. Their data did not support an association between out of wedlock births and perinatal risk. Bott and Fort (1976) concurred with the finding that the "unique medical problems [of the adolescent] are controllable and do not differ appreciably from older women" (p. 536). McKendry et al (1979) have summarized the limitations of studies which have regarded the age of mother as a single predictor of obstetric performance and neonatal status. The authors concluded:

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58 These studies must be read carefully as a result of differences in sample characteristics, the lack of controls, and the inconsistency of terminology. The reader should be especially wary of many review articles that treat these medical conditions as proven fact; ironically, many times these reports base their conclusions on inconclusive findings (Stewart, 1976). However, there appears to be more credence in the proposition that the young girl and her infant are highrisk patients,, than in the proposition that they are not. (p. 23) When variables other than mother's age were analyzed as predictors of perinatal and neonatal status, the findings revealed no significant relationship to the age of the mother. The variables that were consistantly noted to predict obstetric and neonatal outcomes were: 1) nutritional status of the mother; 2) socioeconomic status; 3} quantity of prenatal care; 4) parity (number of prior pregnancies); and 5) spacing of births (McKendry et al loyP; Menken, 1972; Dott and Fort, 1976; Stine, Rider and Sweeny, 1974; Mecklenburg, 1973). As noted earlier by Dott and Fort (1976), many of the nutritional, obstetric and family planning problems of adolescents are "controllable," but control remains dependent upon the professional community's ability to make these services available to young women and the woman's motivation to use them. Dv^yer's (1974) study of 231 12-16 year olds enrolled in a prenatal program found no significant incidences of anemia, toxemia, labor and delivery complications, low Apgar scores or post-partum problems. Premature birth did result in 39 cases, however. Miile D\>7yer's findings are promising and suggest the managability of the adolescent's perinatal outcome, they are based on a study which failed to use a comparison group of older v/omen or those with different prenatal care. Semmen's (1961) study of 12,847 adolescents and nonadolescents who received care in a U.S. Naval Hospital found socioeconomic status, rather than race, raaxital status or age, to be the most

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39 significant predictor of perinatal outcomes. The prematurity rate was identical in the two groups. The only difference was the adolescent's higher incidence of precipitate (less than three hours) labor and resultant fetal damage due to unattended deliveries. The Louisiana Infant Mortality Study (Dott and Fort, 1976) revealed that younger adolescents were less likely to utilize antenatal services and that, when adequate prenatal care was given, the perinatal and neonatal death rate was significantly lower. The authors discussed the role of social and demographic variables in the outcomes of the infants of young women. In the discussion of the roles of social and demographic variables in the outcomes of young women's infants, the authors concluded that "the burden of early motherhood falls most heavily on the offspring infant morbidity and mortality are the greatest risks associated with [early childbearing]" (p. 536). In a report of the Collaborative Perinatal Study at Johns Hopkins Medical Center, Hardy (Welcher et al., 1971) summarized the ramifications of perinatal and neonatal outcomes in her statement: The scope of fetal wastage is two dimensional: 1) in terras '-f perinatal mortality; and 2) in terms of the perinatal insult, which while not sufficiently severe to cause fetal or neonatal death, results in long-term handicapping conditions of the surviving infant--for example, cerebral palsy, mental retardation, congenital malformation, blindness, deafness and other neurological defects, (p. 238) This point was stressed as well by Dallas (1971). He extended Hardy's perinatal risk factors to conclude that "later fetal outcome and intellectual performance are dependent upon the complex interaction o generic, biological and environmental variables" (d. 249).

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40 The ramifications o£ neonatal risk on 'the development of the infants of adolescent mothers has remained relatively unstudied (Guttmacher Institute, 1976). There have been, however, a handful of longitudinal studies of children born to women enrolled in the Collaborative Perinatal Project (Niswander and Gordon, 1972). The followup assessments of these infants included the age of the mother in the design and constitute our main sources of information regarding developmental outcomes of the children of young mothers. Developmental Outcomes of Adolesce nt Pregnancy The earliest and longest follow-up assessments of infants of adolescents were done as part of the Johns Hopkins Child Development Study sponsored by the Collaborative Perinatal Project. For this investigation, Hardy, Welcher, Stanley and Dallas fl978) defined adolescence to be 16 years of age or less at delivery. The sample of 4,557 mother-infant dyads was selected at random in 1964 and followed at a rate of 85-93 percent over a 12 year period. The sample consisted of 706 mothers who were 17 years of age or less at delivery. At birth, there were no significant differences between the under 16 and over 16 groups on perinatal or infant death rates. All risk factors were significantly higher for blacks than for whites. At eight months of age, infants were assessed with the Bay ley Scale s of Infant Development The infants of mothers 20-25 years of age attained significantly higher scores on.. the__ mental scale than those of adolescents. Hardy concluded that this was suggestive cf "more effective childrearing practices" (p, 1224). At four years of age, children were assessed using the Stanford-Binet Intelligence Test for Children, tests of fine and gross motor functioning, the G raham Block Sort Con cept Formation Test, a behavioral profile and psychological i;T?pression. On all measuies, a higher proportion o

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children of adolescents were found to have inadequate outcomes. At seven years of age, the children of adolescent mothers performed less well than those of 20-24 year olds on the We schler Intelligence Scale for Children ( WISC) the Bender-Gestalt Visual-Motor Test and the Wide Range Achievement Test ( WRAT) The children of adolescent mothers were also found to have negative outcomes related to academic achievement and repetition of school grades on the twelve year assessment. Self-concept was measured by the Coopersmith and Piers-Harris tests. No significant differences were found between the children of adolescents and those of older mothers. Hardy et al (1978) have provided an abundance of valuable information regarding the long term effects of early motherhood on the child. The negative developmental outcomes attributed to the age of the mother are distressing and suggest a need for early and intense intervention. A major limitation of this study is due to the lack of empirical evidence about the childrearing practices of the mothers involved. While other studies using Bayley measures at eight months have demonstrated that social, language and cognitive development were empirically demonstrated to be correlated with motherinfant transaction(Beckwith, 1973; Beckwith et al 1976), the Hardy et (1978) study failed to assess the transaction process in a controlled situation. Furstenburg (1976) used interviews, tests and observational data in a longitudinal study of low-income Black adolescent mothers and their children. He found no differences on the Preschool Inventory in Che tliree year old children of 15 year olds when they were compared to those of mothers of 18 and 19 years of age. He did find significantly higher scores among children raised by more than one adult. Children

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whose parents married early and stayed married had the highest scores In a five year follow-up, Furstenburg (1978) compared children of young mothers to children of older mothers who were in ureschools He found that children v/ho were cared for by grandparents in the home scored significantly higher than those who 'rfere in preschools. The author concluded that the child's cognitive ability was enhanced as a result of the aid his mother received from her parents which allowed her to become more educated and socioeconomically advanced. These findings point directly to the long term assets of the morher'j social support system. The study is limited, however, due to small size of the sample and the lack of a comparison group of nonBlack families Holsti-um (1979) studied the intellectual, perceptual-motor, language and behavioral outcomes of premature infants at three years of age. Her findings revealed that socioenvironmental and neonatal variables contribute significantly to the prediction of developmental outcomes. Socioenvironmental variables investigated included mother's age, material resources and amount of social stress. Follow up sim.ultaneous univariate analyses revealed that the age of zhe moth did not contribute to the developmental outcom.e of three year olds. Broman, Nichols and Kennedy (1975) studied a sample of 26,760 children born to m.others in the Collaborative Perinatal Project. They tested the significance of 169 prenatal and developmental variables in order to ascertain their ability to predict intellectual performance at four years. Their findings revealed that maternal

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43 education and socioecnomic status were major contributors to explained variance in preschool IQ scores. The age of the mother was not found to be a significant predictor. Bayley assessments at eight months were found to be predictive of delayed intellectual development in early childhood. These findings are particularly interesting in that they reflect the contributions of the mother's age in a random, rather than age-specific sample. In an age-specific study comparing children of mothers under 18 years (n = 86) to those at age 18 and older (n = 86}, Oppel and Royston (1971) investigated nurturing behavior, family composition, physical, social, and psychological characteristics. Subjects were matched on economic status, birthweight, parity and race. Data were collected at six to eight and ten to twelve years using the 8inet and Wechsler intelligence tests, the Wide Range Achievement Test psychological observations and the Maternal Behavi or Research Instrument At both eight and ten years children not reared by the biological mother were at significantly greater risk on all measures. There was also a significant difference in the child's physical size, which revealed more children of young mothers to fall below the third percentile in height. They also "displayed a trend towards lower weight" (p. 752). No significant differences in intelligence or psychological adjustment were found. Children of adolescents were at a significantly lower reading level, however, and were rated to be mere dependent and distractible Younger mothers were noted to give m.ore independence to the child, were less anxious, had less intense emotional involvement with the child and were less likely to have intellectual interests. The conclusions reached by the

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44 authors are based on thorough documentation. The use of a matched rather than random sample, however, has limited our understanding of the relative contributions of race, socioeconomic status and birthweights. Had these variables been controlled statistically rather than in the experimental design, the results vrauld have been more generalizable. Another limitation of this study is the fact that the data were collected for a purpose other than that for which they were analyzed. In summary, the long range outlook for the child born to a young mother appears quite dismal. Regardless of the methodology, almo every study has documented the intellectual, emotional, educational, developmental and medical risks associated with early pregnancy and parenting. Our only evidence of a more hopeful future for these children comes from those investigations into the role of the mother's support from her family and the professional comjnunity. Our knowledge base is lacking in both the number and scope of studies into the consequences of early parenting for the young mother and her child. It is to this specific gap in our knowledge that the present study was directed.

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CHAPTER III METHODOLOGY The purpose of this study was to ascertain the contribution o£ mother's age, perinatal risk status, and socioenvironmental medical and educational resources to the prediction of mother-infant transaction and the mental and psychomotor development of the infant. The population from which the sample was drawn consisted of mother-infant dyads who were served by the College of Medicine at the University of Florida. The subjects iv-ere stratified on the basis of the sge of the mother and were selected at random from the Birth Log at the Shands Teaching Hospital. Ninety-tiiro mothers and their six months old infants participated in the study. The assessment procedures consisted of a six minute videotape of mothers and infants in a free play situation and the administration of the B ayley Scales of I nfant Development Demographic and socioenvironmental data were obtained from the Child and Family Development Inter^v^iew which was developed for use in this study. Following the assessment, a parent and infant-centered protocol was implemented which was based on the infant's needs as assessed on the mental and psychomotor scales of the instrument. The data collection procedures were implemented in the Pediatric Clinic of Shands Teaching Hospital. The sample, design and the procedures for data collection and analysis are described in this chanter. As noted in Chapter I, the questions posed by th^e study were: 1) Do infant development and mother-infant transaction vary 45

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46 as a function o£ the age of the mother? 2) Is the relationship between mother's age and each dimension of transaction and infant development linear after controlling for mother's education, yearly income, ethnic origin social support system, infant's sex and birth order and type of prenatal care? 3) What is the nature of the relationship between prenatal medical care and development at six months after controlling for all independent variables? 4) Which variables contribute predictive information to the identification of developmental delays on infant development measures at six months? 5) Is there a positive association between the extent of prenatal and postpartum parenting education and infant development at six months? 6) Is there a positive relationship between the extent of the mother's social support system and transaction and the infant's development? In keeping with the exploratory nature of this study, additional questions were investigated. The questions were: 7) Is there a relationship between the age of the mother and infant development after controlling for transaction, infant's sex and birth order, perinatal risk status-, ethnicity, yearly income, social support system and t^'pe of prenatal care and education? 8) Are the transactional behaviors of the motherinfant

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47 relationship — warmth, reciprocity, responsive vocalization, negative affect and nonresponsive stimulation — associated with the mental and psychomotor development of the infant after controlling for mother's age and education, infant's sex and birth order, perinatal risk status, yearly income, ethnicity, social support system and type of prenatal care and education? 9) Is there a relationship between perinatal risk status and the mental and psychomotor development of the infant after controlling for the mother's age and education, the infant's sex and birth order, yearly income, ethnicity, social support system and type of prenatal care and education? Definition of Terms For the purpose of this study, the following definitions of terms were used: 1) Infant Development consisted of the composites specified by the Mental Development Index (MDI) and the Psychomotor Development Index (PDI) of the Bayley Scales of Infant Development Tliese indices reflect the mental, psychomotor, language and socioemotional competence of the infant 2) MotherInfant Interaction is the categorical identification of behaviors described in the Beckw ith Behavior Scale These behaviors were coded from videotaped transaction sequences. 5) Reciprocal /Responsive Behavior is that which is observed to be directly related to the behavior of another individual. 4) Nonresyonsive Behavior is that behavior vAich is observed

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48 to be self-initiated and without regard to the behavior of another individual, 5) MotherInfant Transaction refers to the entire repertoire of interaction behaviors between mother and infant, 6) Developmental Delay refers to a score of 68 or less on either the Mental or Psychomotor Development Index of the Bayley Scales Infant Development 7) High Risk for developmental delay refers to a score between 68 and 84 on either the Mental or Psychomotor Development Index of the Bayley Scales of Infant Development ^i^^ foi" developmental delay refers to a score between 85 and 100 on either the Mental or Psychomotor Development Index of the Bayley Scales of Infant Development S) Prenatal Care by Private Physician refers to those patients who received obstetric treatment from physicians in the Private Diagnostic Clinic at Shands Teaching Hospital. 10) Public Health Department Prenatal Care refers to those who received obstetric care at a public health department clinic. 11) iVfaternalInfant Care Clinic Treatment involved patients in a 13 county area surrounding Gainesville, Florida. These patients received prenatal and postpartum obstetric, neonatal and pediatric care, family planning services, social service and nutritional counseling and optional prenatal childbirth education (Mahan, and Eitzman, Note 5). 12) Teenage Pregnancy Team Care refers to patients who received prenatal and postpartum obstetric, neonatal and pediatric

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49 care, family planning services, social service and nutritional counseling, a mandatory prenatal and childbirth education class and an optional infant, parenting and family development education class. This treatment was received by women who were 18 years of age and younger and who lived in a five county area within the Maternal -Infant Care district (Mahan, Note 2) 13) Shands Teaching Hospital (S.T.H.) High Risk Clinic refers to care which was specialized for those women identified as having a high risk pregnancy. Obstetric and neonatal services were provided and an optional prenatal and childbirth education class was offered to these women. The Subjects The population of interest in this study was that of motherinfant dyads residing in North Central Florida who were served by the College of Medicine at the University of Florida, Gainesville, Florida. Utilizing the Birth Log (a list of information pertinent to labor and delivery records) available through the Shands Teaching Hospital, a stratified sample was draivn (;n=2S0) Stratification was on the basis of mothers' ages (£15, 16-17, 18-19, 20-24, >_25 years). This method of sampling was used in order to obtain age specificity lacking in previous research. This method produced an age-specific sample of invited subjects who received the appointment letter, reminder postcard and phone call, as outlined in Appendix A. Socioeconomic and cultural representativity, while not expected, were additonai results of the sampling procedure and are presented in Table 7.

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50 Of the 250 invited subjects, 92 participated in the study; complete data sets were obtained for 77 of these subjects. This attrition rate is comparable to that found by Resnick et al. (1978). The sample thus represents those subjects who were motivated to participate. Attrition was also due to other variables associated with poi'erty and/or early parenthood such as: 11 lack of trans^ro^ation; 2) conflicting school and work schedules; 3) moving out of the state; and 4) giving the baby up for adoption. Many families traveled as many as 150 miles to participate in the study. During the course of the data collection process, the investigator questioned a random number of subjects as to the reasons for participatin or not participating in the study. Responses included: "I thought I was supposed to come!" "I wanted to see how my baby was doing -if he was doing o.k." ''We don't have a camera and I wanted a picture." "I was worried about my baby's arm, leg/ear." Negative responses included: "My baby's fine and I don't need you to tell me! I'm already pottytraining him." Frequent attempts were made to call each family for whom a phone niuTiber was listed. In three telephone conversations, mothers refused to bring their babies to the clinic. These were private patients who were living in the Gainesville area. A total of 80 families were reached by phone prior to their appointments. Of the families who agreed to come, only 10 did not participate (2.5 percent). Procedure All subjects in the sanrole were contacted by mail to notify them that their babies vvere scheduled for a six month developmental assessment

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51 in the Pediatric Clinic. When the families -often including fathers, friends and extended family members -arrived at the clinic, a brief explanation of the procedures preceeded the assessment. Subjects in the study were informed as to the nature of the developmental testing procedure employed and the purpose of the study. They signed a statement of informed consent, but were not told the variables under investigation in order to prevent bias during the data collection process (Appendix A) Treatment of participants was in accordance with the standards of the American Psychological Association and the Committee for the Protection of Hioman Subjects at the University of Florida. Following an explanation of the procedures, the families were requested to come into the playroom where a mat and toys were available for play. Mothers were encouraged to engage in a brief play period prior to the actual videotaped sequence. The videotaped segment was then recorded as the mothers participated in free play with their infants. The initial play period (and the videotaped play sequence ) was designed to allow the baby to adjust to the environment. Bach family was given the identical assortment of toys for the free play, which included rattles, balls, a mirror and a set of colorful faces. Mothers were told that the purpose of the free play was: 1) to allow the baby to adjust; and 2) to get an idea of how the baby played in an unstructured situation while at ease with the parent. Following the free play session, the examiner engaged in a two to three minute warm-up play period with the baby before administering the Bayley Scale s of Infant Development Th.e parent was informed as to the nature of each task and its purpose in the assessment throughout the

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52 administration of the scales. After the evaluation, the results regard ing the mental, psychomotor, language and socioeinotional growth of the baby were discussed with the parent with respect to age ranges in each area of development. Parent's questions were encouraged and concerns were discussed during all phases of the assessment. Following the assessment, the infant-centered intervention phase proceeded and focused on the specific strengths and limitations observed in the baby. Delayed or problematic development v;as explained and appropriate protocols for remediation were discussed. It was emphasized that many of these delays found at six months could be overcome in a short time with an additional amount of stimulation and prescribed activities. Where applicable, developmental, nutritional and medical referrals were made to the appropriate agencies In all cases, parents were also given a book of educational activities and a photograph of their baby to take with them. Following the assessment, Infant and Family Development Specialist interviewed the mothers to obtain demographic data. This was done in order to insure that the examiner remained naive to the age and prenatal care group of the mother. Instrumentation The Assessment of Infant Development '^'^^ B ayley Scales of Infant Development were chosen as a direct measure of the infarcts' psychomotor and mental abilities. The mental scale measured adaptive and language behavior as evidenced on eye-hand coordination, problem solving, exploratory and manipulative tasks. Also included are linguistic vocalizations and the

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.53 comprehension of coramunication by others. The :Tiotor scale measured gross body control and locomotion and fine motor coordination. Additional features of the instrument were its adaptability to the testing situation and the availability of a trained evaluator. Appropriate features of the test include the test materials, which were highly attractive to infants, and the administration of the test which allows the infant to be held by the mother. Split-half reliability coefficients for the motor and mental scales at six months are reported as .89 and .92, respectively (Bayley, 1969). In their study of test-retest reliability (v/ith eight m.onth olds} Werner and Bayley (1966) noted correlations between first and second assessments of mental and motor development to be .76 and ,75, respectively. These assessments were one week apart. Items involving emerging skills in social and interpersonal development and motor coordination were found to have a test-retest reliability of .76. This issue is especially important in a study of six month olds as this is a critical time for the emergence of several new behaviors. It is therefore necessary to acknowledge that a baby's score at six months could vary greatly from day to day. Inter-observer agreement is another aspect of reliability studied by Werner and Bayley (1966) These coefficients were noted to be "markedly higher" than independent assessments since the same assessment was scored by each observer. Tester-observer reliability was found to be .89 and .93 on mental and motor development, respectively. Exam;ples of items in the scales can be found in Appendix C.

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54 Perinatal Risk Status In order to assess the perinatal (last month of pregnancy through first month of life) risk status of the infant at birth, the Prenatal and Intrapartum Risk Scal e (Hoble et al., 1973) was adapted for use in this retrospective design. This instrument was developed as a system for the prospective analysis of perinatal risks and rates various complications in prenatal (maternal), labor and delivery and neonatal screening characteristics (see Appendix D) Information regarding the risk status of the neonate was obtained from the infant's medical records. MotherInfant Transaction The systematic observation of the transaction process has become a meaningful way to investigate behavioral components of the parent -infant relationship. In order to examine parenting behaviors, a lowinference observation system was used. The measurement of maternal -infant interaction was based on the assumption that reciprocal/responsive behavior can be measured through the use of the Beckwith Behavior Scale The scale was previously used by Beckwith (1976) and Grossman (1979) to analyze parentinfant transaction in two separate studies of one, three, six and eight month old infants and their mothers. Beckwith Behavior Scale consists of 27 behavioral categories, each of which is assigned individually to parent or infant behavior. The behavioral/ categories of the instrument were selected for their appropriate record of "parenting skills" which have consistently

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55 demonstrated a strong relationship to infant development and were the focal point of this study: 1) The constructive expression of affect (both positive and negative) 2} The ability of the parent to become in tune perceptually to the actual world of the infant at varied levels of cognitive and emotional development, 3) The ability of the parent to interact with the child in a manner which is responsive to the actual state of the child as observed and interpreted over time. The behaviors and their descriptions are presented in Appendix B. Because of the highly sensitive and potentially ambiguous nature of the transaction process, it was necessary to pilot the use of the instrument within the experimental context under investigation and obtain appropriate estimates of intercoder reliability. A reliability study was previously implemented with Beckwith by computing a Pearson Product-Moment Correlation on independent ratings of two observers. On 18 behavioral categories, the coders were found to have a mean agreement of r = .92 (Beckwith, 1971; Beckwith et al 1976). Similar observational records have been found to have predictive validity from observational records at nine months to Bayley mental scores at one year (Gordon, Soar and Jester, 1979; Long, 1979) These studies assessed transaction among dyads of varied age, developmental and socioeconomic status. The decision was made to adapt the Beckwith Behavior Scale for use in this study based on several theoretical and practical

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56 aspects of mother-infant transaction. The instrument was originally constructed for observations of infants and mothers in the home. Certain variables (such as floor freedom and mutual gaze during feeding) were not applicable to this investigation. Another issue which influenced the adaptation was that the scale was constructed and implemented with preterm infants and their caregivers at one, three and eight months of age and adapted by Grossman (1979) for use with infants of six months of age. These considerations were of importance in this study and were the basis upon which some original variables were substituted with ones which were more applicable to the simulated playroom setting in a study of six month olds. The coding of the videotapes was also adapted so that behaviors were coded every five seconds or when the behavior changed rather than every 15 seconds as originally implemented. The rationale for this adaptation was based on the dynamic characteristics of mother-infant transaction which necessitated the more precise analysis of the process as behaviors occur in a five (rather than 15) second time span. Interobserver agreement The issue of reliability--the extent to which measures of behavior are measured con3istently--has been a subject of great concern. This concept is best clarified by Cronbach and Rajartnam (1963) in thei statement: "an investigator asks about the precision or reliability of a measure because he wishes to generalize from the observation in hand to some class of observations to which it belongs (p. 144).

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The two observers were selected on the basis of their prior experience in coding parent-infant transaction videotapes. In another study (Eyler, 1979) these observers evidenced skills in analyzing observable behaviors of mothers and their premature newboms and were found to be consistent in their ratings. Training of the coders involved detailed explanations and numerous examples of each behavioral category. The observers were assessed initially and at randoro.ly determined periods throughout the coding process in order to ascertain the extent to which behaviors were rated consistently. Fifteen of the videotapes were coded by both coders. This permitted the assessment of intercoder reliability. Table 1 presents the Pearson Product-Moment Correlations between the frequencies reported by the two coders. In order to reduce the number of variables to be used in subsequent analyses and to represent more global dimensions of mother-infant transaction, a correlation matrix of observation measures was subjected to a Principle-Component analysis using the variraax rotation. The results of these analyses are discussed in detail in Chapter IV. Statistical Analyses The variables under investigation in the study were the age of the mother, the education of the mother, the sex and birth order of the infant, perinatal risk status, yearly income, ethnic origin and t]/-pe of prenatal care. The analyses were designed to assess the contributions of these variables to the prediction of

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58 Table 1 Inter-Observer Reliability of MotherInfant Transaction Behaviors Behavior ienavior Mother Behaviors Coranents .88 Commands .70 Criticizes 95 Nonverbal Bid ,67 Initiating Behaviors .73 Repetitive Nonverbal Bids 89 Staccoto Bursts 1,00 Affectionate Touches .83 Interfering Touches .19 Repetitive Verbalizations 1.00 Baby Behavior Bid to Caregiver .90 Smiles ** Vacant Behavior ** Baby Explores .69 Baby Fusses 1.00 Reciprocal Behavior Mother's Positive Response .82 Mother's Negative Response ** Mother's Contingent Ver.97 bal/vocalizations Face to Face Orientation .88 Mother's Ignoring Response .95 Baby's Positive Response .68 Baby's Negative Response ** Baby's Contingent Vocal** ization Mutual Gaze ** Baby's Ignoring Response .31 '^No correlation computed: one or both ratings evidenced no variability.

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59 Table 2 Means and Standard Deviations for Beckwith Behavior Variables Variable Mean SD Comments 7 .6154 5 .7349 Commands .7564 1 .5474 Criticizes .6923 I .6221 Nonverbal Bids 3 .7051 3 .6328 Initiating Behaviors 13 .0897 5 .2476 Repetitive Nonverbal Bids .0251 .8430 Staccato Bursts .6667 1 .904 Affectionate Touch 1 .7692 .8916 Interfering Touch 1 .9744 2 .2961 Repetitive Verbalizations .2308 ,8046 Bid to Caregiver 6667 1 .1584 Baby's Vocalizations 1. ,6538 2, ,4697 Baby's Smiles ,9487 1 ,9863 Self -Stimulation ,0128 ,1132 Vacant Behavior 0128 Baby Explores 16. 7051 9. 3602 Baby Fusses 1. 0769 '7 1200 Mother's Positive Response 4. 1026 2 9081 Mother's Negative Response 1026 3810 Mother's Contingen;: Vocalizations 1. 1026 1 9177 Face-to-Face Orientation 3 5513 3 6597

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60 Table 2 Cont. Variable Mean SD Mother's Ignoring Response .7564 2.8.108 Baby's Positive Response 12.6538 6.0663 Baby's Negative Response .3333 .8778 Baby's Contingent Vocalization .2179 1.3737 Mutual Gaze .0641 .2945 Baby's Ignoring Response 3.7051 3.6149

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61 motherinfant transaction and infant development as outcome measures of early pregnancy and parenting. In order to reduce the number of variables and represent the more global dimensions of motherinfant transaction in subsequent analyses, a correlation matrix of the 27 behavioral categories was subjected to a Principle Components analysis. As a result of this analysis, five dimensions of motherinfant transaction were defined and each subject's incomplete composite component score was calculated for each of the five components. These calculations were based on the addition of the total number of behaviors which had a positive loading on the component and the subtraction of the number of behaviors which had negative loadings on the component. The reliability of the observers was computed on each of the five component score dimensions using a Pearson Product -Moment Correlation procedure. These analyses were executed using the Statistical Package for the Social Sciences [SPSS) (Nie et al., 1975). In the first multivariate multiple regression analysis, the dimensions of mother-infant transaction and the infant's mental and psychomotor development were considered to be the outcome measures of early pregnancy and parenting. These measures were therefore treatea as dependent variables and were regressed on mother's age and education, baby's sex and birth order, yearly income, ethnic origin, social support -system, perinatal risk status and type of prenatal care The second multivariate multiple regression analysis addressed the question regarding the ability of the transaction components to

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predict the mental and psychomotor deAAelopment of the infant. In this analysis, mental and psychomotor development were regressed on mother's age a.nd education, baby's sex and birth order, ethnic origin, yearly income, social support system, perinatal risk status, type of prenatal care and the five dimensions of mother-infant transaction. The multivariate multiple regression analyses were executed using the General Linear Model program of the Statistical Analysis System (SAS) (Barr et al., 1976). Lim.itations of the S tudy The use of videotape analyses in a lowinference observation record to measure interaction between individuals is subject to the limitation imposed by the fact that the behavior observed is that which the adult subject is willing to express in the given situation. This effect is confounded as well by the atmosphere found within any medical setting; this often produces anxiety in the mother and thus affects infant behavior. In an attempt to alleviate possible stress in the assessment environment the "playroom" setting was simulated in the Pediatric Clinic. The purpose of an evaluation of infant development at six months of age is to establish a baseline for use in diagnostic and prescriptive protocols regarding the infant's strengths and limitations. While the information obtained is useful for the identification of competencies and delays, the scales are unable to predict future development -Another limitation is the fact that the families studied were those who responded to the request and were motivated to participate

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63 in the study. Those subjects who were contacted, but did not participate may differ systematically from those who participated. A final limitation placed on the study is the ex-postfacto or correlational nature of the design. While associations and relationships among the variables can provide useful information, no inferences of causality can be interpreted from the results of the study. Summary In siimmary, the data were collected and analyzed in order ro assess the behavioral dimensions of mother-infant transaction and the mental and psychomotor development of the infant in an age specific sample. In addition, the study was designed lo explore the mother's age, social support system, perinatal risk status, prenatal medical care, and participation in childbirth and parenting education programs in order to assess their contributions to the prediction of transaction and development at six months. The results of the analyses are presented and discussed in Chapter IV.

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CHAPTER IV RESULTS The purpose of this study was exploratory in nature and was based on the fact that relatively little is known about the developmental outcomes of very young mothers and their infants. The analyses were implemented in order to ascertain the contributions of the mother's age, social support system, perinatal risk status, type of prenatal care, type of prenatal childbirth education and t>'pe of parenting education as they related to mothers' transactions with their infants and the infants' development. The questions addressed in this study and the analyses are discussed in this chapter. The Dimensions of MotherInfant Transaction Before proceeding to the analyses which addressed the major questions posed by the study, the dimensions of mother-infant transaction were studied. The nimhev of behaviors in each category of the .'Adapted Beckwith Scale were first tallied for each subject. A correlation matrix of the variables was then subjected to a Principla Components analysis. The analysis yielded eleven components with eigenvalues greater than 1.0. These components accounted for 74 percent of the variance. The components corresponding to the five largest eigenvalues were rotated using the Varimax procedure. The five rotated components 64

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6S accounted for 46 percent of the variance. Table 3 reports the loadings o£ the variables on each component. Table 4 reports the factor score coefficients of the variables. The results of the Principle Components analysis were used to guide the formation of the subjects' composite scores on each of the five components. Variables were included in these scores such that those with factor score coefficients greater than .25 defined the component. In the fifth component, mother s negative responses were included in the composite component score based upon theoretical interpretations of the observed behaviors of the mother-infant transaction process. The total number of tallies per behaviors with positive coefficients were added to calculate each component score. The behaviors which had negative coefficients were subtracted from this sum. This process often resulted in the composite score of a subject on a component being less than or equal to zero. The following formulae were used to calculate the composite scores on each of the five components: Component Score 1 (Warmth) = Affectionate Touches + Smiles + Face-to-face Orientation Component Score 2 (Reciprocity) = Baby's Positive Responses + Mother's Positive Responses + Initiating Bids Baby's Exploratory Behavior Component Score 3 (Responsive Vocalization) Baby's Vocalizations + Mother's Contingent Vocalizations + Baby's Contingent Vocalizations Mother's Nonverbal Bids

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a) o •H > cs a> pa p I C (-1 I Q O c OJ •H O •H Mh M-l o o •H > H W M C C O !-> o g O O -M cj a w p O > C -H +-> o +-> o PL, 05 0 u ^: +-' (D !/) t CM X p c c o o o e o o p c s O H o u •H > 00 o to .-I 00 t t 1 1 1 1 o CT> LO 00 to to .1^ o to o >— 1 o CD OS, J— 1 CM \o to o O o 1—1 I— 1 o: O' o o o I I r 1 I I 1 o o 1— 1 to to I— 1 00 00 00 to to o o O LO 00 o o LO 1— 1 o o o o o CM O I—i I— 1 o CM 1 1 s o •H p I— ( nj u CS N o •H H o 1—1 > o U > o CD p H o > -d o; o CO H tn 5h CD > bO s 3 P M O C •H > p If) tn •H •H -rt O o u •H cd P 13 •H P P > P •H P CD (D O t3 O o o o dj •P C 0 • H o u U cfi l-H pa > (1) p p
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67 00 00 LO 00 CO to c to o o o 1 — O o o o o CO o cn o to 00 o o o 00 to o LO to NO 00 o o o o o o c o CM CM o in 0-1 r— ( LO LO o I— 1 t— 1 t^l 1-0 r-H CO o o to c5 t — 1 o o ^-^ o o o LO o to to to o o CM LO :J0 to LO o 00 o o o 1vC r— 1 vO CO 'ato LO LO •-T to o 1—1 1 — ( c o o to o o o o 1 s to 00 CN to 1 c c O o c o o 'CLO o o o o n UiJ. Oi 0) C "H +-J o o •H rv PL, •p yi (.0 :t3 1 CD P > ^> oj •H u •--1 fH H a; 03 c •!-> P H O > > •n Jj o H T-i o •P > !/; > (L) > o p Si • H CD s o 1 — SI c5 o r; nj 3 M •H •r-i !/! c •(-> CJ c o CO O So a. C/^ iJ '-I c l-J 4-i T) > o 'U a; '/I tj CU P T— ^ o & :.T -J c H O p-G 4J .;_J c a X o o CJ re O UL. lb u

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P fn S O <1> -H C > O Cti 0) u M !/) +4 C P O -M 003 & ^< S ^ *-> o en •p O > PI -H +-> O -1-1 o PL, nj 0) S bO<4-l O Q "4-( u 2: < to +-> PI o 0) -H > ti H Oj (D 1/) M C C -H O O --H PL, Cti e t/i o O (U o C_) Di > •H O O o a> c ,^ O +-> Oh S S fH O [/) 0 3 X CD rl=l PI P> H 0 H > 13 (D t/) E-i CD •H to •H CQ U CD > PI oa to P CD 0 !/) bO CD pa CTj PI 0 PI •H > 03 P> t p •H CD P to 0 •s CTj •H 03 P" •H 0 •H •H •H Pl XI CJ Pl P 1—1 +-> > P 0) CJ CD (D CD • H PJ H Oh ca 'P P> PL, •n u ?-! 0 p> 10 CM O 00 CM CTl 0 to 00 CM 0 r-CM 0 0 00 00 00 CM a o

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o LO 1 — t to CO CnI 00 to cc cc O 1 Ol o OJ 1 r-i 1 to 1 o to Cji CN rH CO CO tn o to O r— f 1 rH ] rH 1 1 1— ( 1 1 — o 00 o CP, CO C71 T 00 I— 1 CO oo o o o cn o — 1 i to 1 1— H 1 o 1 I— to o 1 — 1 •c lO 00 Q 00 CO LTi 1— 1 o lO c Tt c 1 I— ( 1 1 i 1 — 1 1 CM 1 LO o to 'C CM CO to c '0^ to 1 — 1 vO c o o 1— ( r— rH i • • 1 • • I • 1 • f 1—1, o t > 3 'H c o +J 4J s •H ttf 5 !> oa w o 0) z CD 1 "S c 1 VI i/1 'J~l f— S q a; o c fj f-i ~h r+-) o Cj W, H ,B tj o (/I c •H o o CO > tli 69 CO IM 00 to to CD CTl CO r— I to r-H CN o r-[—1 to LO o 1 — 1 o ^ — 1 o o CO II I r-~ ^ rH CO O LO I>1 o to LO to o o Cl o to LO r—H o o r-l o rH o 1 rs, >— 1 tN to t-c\ o lO O r-H 00 o o to OJ O — 1 o LO O o o o o o r-H a\ to 1 I oo CM rH U2 to O c r~ CO CM CN o rH CM CM o CN rH LT pH rH CTl rH rH o II O CM CD SO sO '5o C7i CO LO LOLO LI CC' C~. CO o to to C O c -— ^ o o C^4 I I C"J to CD o C/1 •H uu o J O H rH •H 1-1 ti t/] ST ns CD t O •H o o u > o y 5; Ct CD •H CD r; Cu ^H CO !h CJ CC 0.1 ix. G S' i— < Ct! o H • n — ( r — z: S CD !h O OJ ? i-> C VI H r -~> ch o H> /H '5 P O cci Cj o c^ o H r>H s cs CO E—

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70 Component Score 4 (Negative Affect] = Mother's Commands + Mother's Criticisms + Mother's Interfering Touches + Baby' s Negative Responses Component Score 5 (Nonresponsive Stimulation) = Mother's Staccato Bursts + Mother's Interfering Touches + Baby's Ignoring Responses + Mutual Gaze + Mother's Negative Responses A Pearson Product -Moment Correlation procedure between the frequencies of the original variables and the component scores was implemented. The correlation coefficients are reported in Table 5 and indicated that the individual variables chosen to compute the component scores are highly correlated with the new composites. It also indicated that the variables which should not be correlated with the components were not. These coefficients supported the interpretation of the composites of variables selected to define the dimensions of motherinfant transaction. The reader should recall that 15 of the videotapes were coded by two coders. This permitted the computation of two composite scores for each component of mother-infant transaction and the assessment of interobserver reliability for the composites. The Pearson Product -Moment Correlations between each pair of composite scores are reported in Table 6, The results of this analysis indicated that the two observers were consistent in the coding of the five dimensions of the transaction process.

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71 V) o M o o CO C q-' O ^1 dj •S o u O +3 •H •H cd rH CD ^1 r-H f^ O CJ CD U H >— 1 !h 4-> 'cO > t-, O O •H 1 +J p CJ u 3 1/1 73 O ci5 U !h a. b+-> o 3 !h 03 H-i I Fh :g o CD > •H r; t/1 O -P /— •rt o +J a c^ t/1 o CD !-( s w H c o p u 2 CD > O P CJ CD c SO '-^ O CD '+4 CJ 2 < O CD -H P > +-i C -H Oi OT t <^^ X •H O o fH CJ (D o 1j c ca o r— 1 LD CNl o CO, \0 •o o o r-i CO o 00 o Ln CTl O CXI !>. 00 rH vC O LD o NO 1—4 CO CO CO r-to Ul tn rH rH T— 1 O: rH o CO !7i o CO CO to rH LO 00 i-H rH to to C~-J rH to o 00 rH o O rH o o rH I-H rH o lO 00 o LO CO CO >4J CM to CO 00 LO !^ -t CO o LO tO C^) r-i rH rH O o o rH rH to I — to to IT: p rCD -P 5 rH I> -a 'S 3 'J) CD H •H Fh CD > 33 '~ '/) 'CD c IT to (D Fr 33 m •H CD rH > o H > Cu P CO m t-J Cd •H •H -H O o H CJ M 'd • H P tj H •r-: ("5 C^ ir H S CD •P O fr P P rH c; !> OJ CD u CD G II :d 1 — i H Q, 33 cd J-i "0 O ^5 o <4H CD •H o C_l r T C/3

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72 m K5 o CO cc r-) I— 1 CO 5 O rH C-i o CM 00 o T—f 00 to CO f— 1 o r-i o CO CO in >J2 o 00 i-O cn CO 6 o 1 — o to CO LO CM to 03 to CC 00 r— i r— ( o o r— t r-H O O 1 — i CO ^0 to I— 1 r-5 00 o o r-H c LO to CO rH 00 LO 00 LO LO lO lO CO CO CO !— I o CTi o o I—! o o O t> m CO 00 CO in r— i CO LO LO 1 — 1 o O o 30 o SO O CM CO r-H OD 00 r-.j CO to o \o CO CM 1—1 00 O O i-H CO o cn CO o •J LO CO ?-< t5 o o O to r— 1 r-H O \0 1 o UO lO O CO LO 00 i-H to CO CM CM CO C^-l rM r— 1 r—f oo r-i !— ( rH o o 1 — 1 t LO +-1 C) 1 — i cj — f U "5 CD ca X — s o m U1 on C c Q H i — CU j-j 1 t/1 (/I C3 c CD a) CJ o r-( > •H r— ( •H n' (D J) 4-> i-J fH O O H CIS •H to Si) CD -f— '].> c; •H CD a.) So t'J J) o CD c3 O O 1 — 1 d Q C Co '/) M Sh •H i-i cn r-i 0) 0) 'n VI •H -C CD o 4-) a.) o >s >^ i-J [/) •(-' M f.i •p X; t— +J o cn cj oj o .— ; ca C3

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73 Table 6 Interob server Reliability of MotherInfant Transaction Components Component Warmth 9 i Reciprocity ,97 Responsive Vocalization ,75 Negative Affect 80 Nonresponsive Stimulation .70

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74 Description of the Saiiiple Descriptive statistics and a correlation matrix of the independent and dependent variables were calculated for the sample of 77 mother-infant dyads. Frequency distributions were calculated for the independent and dependent variables and are reported in Tables 7, 8 and 9. The means and standard deviations of the dependent variables are presented in Table 10. An inspection of of the distributions of the measures of perinatal risk indicated that the majority of the sample "was within normal limits at birth. The means and frequency distributions for the measures of infant's mental and psychomotor development indicated that the entire sample was within normal limits of development at six months of age. The means of the sample are considerably higher than those reported in the Bayley Scales of Infant Development Manual (Bayley, 1969). The standard deviations of the sample are equivalent to those reported in the manual. An interpretation of these findings is discussed in Chapter V. Interobserver reliability was then computed by means of a Pearson-Product Moment Correlation on the rotated component scores. The results of this analysis are presented in Table 6. The purpose of the assessment of interobserver reliability was to measure the extent to which the two independent observations of behavior were consistent. From "che results of this analysis it can be seen that the measurement of transaction was consistent across observers

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75 Table 7 Frequency Distributions for Several Independent Variables Variable Frequency Variable Frequency Baby's Sex < 15 c Male 40 16-17 J. Female 37 18-19 1 ^ Baby's Birth Order 20-24 1 o 1st Born 54 > 25 7^ 2nd Born 17 Race 3rd Born S Black 4? 7th Bom I NonBI ack Yearly Income Prenatal Care < $3,000 19 ^ u $3,000 s^5,000 18: Ma tern a I In Fan t T.'^tp Pto i 1 Q .1. .7 S6,000 $10,000 21 Shands Teaching Hospital 13 $11,000 $20,000 15 Public Health Department 9 > $20,000 4 Pt*-! a (=i L _L y CI. C 1 A JO Social Support System iVfo "t" ^ (^T* c P .'"i 1 1 r* Q "t" "1 r\T> 0 Living alone-no asst. \ < 12 years 37 1 Cohab. Support Only 53 12-14 years 15-18 years Prenatal Complications 31 9 2 Cohab. q Income or Chi 1 dear e Asst. 3 Cohab. § Income % Childcarfc Asst. 38 5 Uncomplicated Pregnancy 59 r c^. .LncLLa,i AXblS. uCaLub Presence of Complication in Pregnancy (.i\nemia, Toxemia, Veneral Disease or Infection) 18 1 < 10 Points 10 19 Points 20 40 Points > 40 Points 37 •20 18 2 I

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76 Table 8 Frequency Distributions for MotherInfant Transaction Variable Frequency Warmth 015 69 16-30 7 51-50 1 Reciprocity -25 0 16 125 38 26 52 23 Responsive Vocalizations -20 -10 4 -9-0 47 1-9 23 10-33 3 Negative Affect 0-4 52 5-9 19 10-23 6 Nonresponsive Stimul a t i on 0-4 32 5-9 31 10 19 12 20 57 7

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77 Table § Frequency Distributions for Infant Development Variables Variable Frequency Bayley Scales of Infant Development Mental Development Index < 68 0 68-83 1 84-99 7 100 116 117 132 133+ Physical Development Index < 68 69 83 18 22 29 0 0 84-99 8 100 116 117 132 133+ 24 35 10

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78 Table 10 Means and Standard Deviations for Scores on the Bayley Scales of Infant Development, and the Beckwith Behavior Scale Variable N Mean SD Bayley Scales of Infant Development Bayley Mental Index 77 125 28 19 26 Bayley Psychomotor Index 77 117 64 12 62 Component: Beckwith Behavior Scale Warmth 77 6. 29 6 95 Reciprocity 77 12. 96: 18 16 Responsive Vocalization 77 67 6 58 Negative Affect 77 3. 71 4. 39 Nonresponsive Stimulation 77 5. 55 5. 84

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79 An initial inspection of the cross tabulations revealed the type of prenatal care to be highly correlated with the type of prenatal childbirth and postpartum parenting education received by the mother. The type of prenatal care received by the mother determined to a great extent the type of educational program she was offered. As a result, prenatal childbirth education and parenting education vrere omitted from further analyses. The variable "type of prenatal care" contained more information due to the differences in prenatal and parenting education programs offered in conjunction with prenatal medical care. The cross tabulations are presented in Table 11. The correlation matrix is presented in Table 12 and indicated that the perinatal risk status of the mother and infant were not correlated with the presence or absence of prenatal complications. Complications found among women in this sample included anemia, toxemia, venereal disease and infection. The fact that these risk factors were uncorrelated was not expected due to the fact that the measure of perinatal risk included prenaxai complications. It is possible, however, rhat the rating system employed by the scale is not useful for studies which are retrospective in nature. Another possible interpretation is that the scale may not be sensitive to the importance

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80 I o a be r-l c C C C O o, a, O S >, 5 I T-* o o in "O C Ui o •H ir, t/i o CD o ui to >o c o 1—1 •H •l-J O' CO o o tu en c US' o e. •n t-i 4-1 o Ti w t— i 7—1 fH C 3 •H 'J ti) D > o fH CD rQ a. o 6 T— i >

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m QO O o 5 a. 00 MP o t3 1 CNi 00 (SI o o O 1^ o I t (-!. to & J CM 1 o 1 CM lo 3 ft 1 to o to ca o1 1— 1 1 o 1 1—1 1 00 CM o in 1 00 P U P! T3 •H )— 1 S rH (—1 ,^ iH !/! n •H o P o OS u C p (D o rH rH s s Oj 03 P P X X Oj cd ID (D C fi 1—1 •H
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o o Q 13 O -a CD I I CM O •H o +-> H tsS (-' J— cti ISI i •H •H i-H +J +-> CO o u o > > •H < U) > p; •H o t/) > s •H o +-> CD PL, tri C 0 / N / — \ LO i-H T— 1 I-H

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83 of the many prenatal complications present in adolescent patients. As a result, the presence or absence of prenatal complications was incliided in subsequent analyses. The Relationship of Mother's Age, Perinatal Risk Status an d Socioenvironmental, Medical and Educational Resources To MotherInfant Transaction and Infant Development In keeping with the exploratory purpose of the study which was to obtain information regarding the outcomes of early pregnancy and parenting, a number of hypotheses were tested. Two multivariate analyses were implemented which involved several multiple regression procedures. These analyses, which addressed the ability of the independent variables to predict mother-infant transaction and infant development, were subjected to a conservative critical value in each univariate and multivariate test of significance. The experimentwise alpha rate was set at .05 for the multivariate tests. Using the Bonferroni approach, this v/as divided by the total number of dependent variables such that the criterion for significance was dependent upon the hypothesis being tested. On each univariate follow-up analysis, the criterion for significance was set at .01. Mother's Age as a Predictor of Transaction and Development The questions of utmost importance in this study concerned: 1) the ability of the very young mother to facilitate positive transaction with her baby; and 2} the developmental status of the infants of young mothers. This led to the questions regarding the nature of the relationship between mother's age and transaction and development. The specific questions addressed in the first

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84 analysis were: Question One: Do infant development and motherinfant interaction vary as a function of the age of the mother? Question Two: Is the relationship between mother's age and each dimension of transaction and infant development linear after controlling for all independent variables? To test the hypothesis that there would be no relationship between mother's age and interaction and development, a multivariate multiple regression analysis was used. In this analysis, the dependent measures were mental development, psychomotor development, warmth, reciprocity, responsive vocalization, negative affect and nonresponsive stimulation. The independent variables were mother's age and education, baby's sex and birth order, ethnic origin, yearly income, social support system, prenatal complications, perinatal risk status and type of prenatal care. The results of the univariate tests of the contribution of each dependent variable to overall prediction indicated that only mental development was significant. The results are presented in Table 13. A visual inspection of the plot of the residuals against the predicted values of mental development revealed that the data met the assumption of homoskedasticity (homogeneous error variance around the regression line) and were appropriate for the analyses. Tne tests of significance of the multivariate main effects (Table 1.4) indicated that the age of the mother did not contribute to the overall prediction of mother-infant transaction and infant development (a-. 05), but did contribute to the prediction of the infant's mental development

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85 Table 13' Results of the Univariate Tests of the Contributions of Several Dependent Variables to MotherInfant Transaction and Infant Development Dependent Variable R P Mental Development .34 <.01 Psychomotor Development .27 .06 Warmth .23 .15 Reciprocity .19 .32 Responsive Vocalization .14 .05 Negative Affect .17 .49 Nonresponsive Stimulation .18 .44

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86 Table 14 Results of the Multivariate Significance Tests of Contributions to MotherInfant Transaction and Infant Developinent V u-X X d. L/ J. c F* d£ P Mother's Age 1.45 7,57 .20 Baby's Birth Order 1.07 7,57 .. .40 Baby's Sex 2.05 7,57 .06 Ethnic Origin 1.35 7.57 ,.:25 Social Support System 84 7.57 .36 Mother's Education .93 7.57 .49 Yearly Income 1.81 7,57 : 10 Type of Prenatal Care 1.60 28,206 .03 Prenatal Complications 1.37 7,57 .:23 Perinatal Risk 1.11 7,57 .37 *Transformation of Wilks' Criterion to an F statistic

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S7 (a^.Ol). The results of this analysis did not support the hypothesis that the psychomotor development o£ the infant and the motherinfant transaction process varied as a function of the age of the mother. The results of the univariate analyses are presented in Tables 15 and 16. The preceding multivariate multiple regression analysis was also designed to answer additional questions posed in the study: Question Five: Is there a positive relationship between the extent of prenatal care, prenatal and postpartum parenting education and infant development and motherinfant transaction at six months? Question Six: Is there a positive association between the mother's social support system and transaction and the infant's development? The analysis of the multivariate main effects (Table 14) revealed that the presence of prenatal complications and the t^-pe of prenatal care received by the mother contributed significantly to the prediction of infant development. The type of prenatal care accounted for 6 '.percent of the variance in mental development. The follow-up analysis of the pairwise comparisons of each type of prenatal care indicated significantly higher means for infants whose mothers received Teenage Pregnancy Team care when compared to those receiving treatment by a private physician and Shands Teaching Hospital High Risk Clinic. The results of the pairwise comparisons and the adjusted means for each prenatal care group are presented in Tables 17 and 18. As noted earlier, this question can only be answered with respect to the association between prenatal care and the dependent variables. The different types of prenatal care and their

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88 Table 15 Tests ox Significance of Contribution to the Prediction of Infant's Mental Development Regression Variable Coefficient F Mother's Age 2.57 6.92 .01 Baby's Sex -.92 .04 .84 Baby's Birth Order -5. 85 3.06 .08 Ethnic Origin .65 .02 .90 Mother's Education -3. 50 .07 Yearly Income .76 3.40 ,07 Social Support System 5.86 2.88 .09 Prenatal Complication -13.16 6.54 .01 Perinatal Risk .12 .38 .54

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89 Table 16 Test of Significance of Contribution of Continuous Variables to Prediction of Infant's Psychomotor Development Variable Regression Coefficients F P rio cner s Age 1 09 2.62 .11 Daoy s oex 6 .67 4.81 .03 Baby's Birth Order -4.50 3.46 .07 Ethnic Origin -.83 .06 .81 Mother's Education -1.00 ..S7 .45 Yearly Income .31 1.21 .28 Social Support System 1.14 .23 .63 Prenatal Complications -5.60 2.48 .12 Perinatal Risk .01 .01 .94

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90 Table 17 Pairwise Comparisons of Types of Prenatal Care as Predictors of Infant s^ Mental Development Pair Contrasted Difference Between Means T 18 .59 1 .83 .07 i^rivate i^nysici an-Maternal Infant Care Proj 12 .24 1 .28 .21 Private Physician--Teenage Pregnancy Team 26 .36 2 .68 <.01 Private Physician--S .T.H. High Risk Clinic 2 .14 .23 .82 Public Health-Maternal Infant Care Proj. 6 35 87 .39 Public Health--Teenage Pregnancy Team 7 77 1 04 .30 Public Health--3.T.H. High Risk Clinic 20 73 2 49 .02 Maternal Infant Care Proj --Teenage Preg. Team 14. 12 2 31 .02 Maternal Infant Care Proj --S. T.H. High Risk Clinic 14. 38 n 10 .04 Teenage Pregnancy Team— S. T.H, High Risk Clinic 28. 51 3 94 <.01

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91 Table 18 Mean Mental Development of Infants in Each Prenatal Care Group After Adjusting for Variance Explained by All Other Independent Variables Prenatal Care Group Teenage Pregnancy Team Public Health Department Clinics Maternal -Infant Care Clinics Private Physician S.T.H. High Risk Clinic 140.03 132.26 125.91 113.68 111.52

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92 educational programs are discussed in Chapter V. The data did not support the hy-pothesis that either perinatal risk status or the quantity of social support received by the mother was related to her transactions with her infant or the infant's development. In addition, it was found that no independent variables contributed to the prediction ox the mother-infant transaction process. The Prediction of Infant Development The second multivariate multiple regression analysis was implemented in order to ascertain the ability of the transaction components to predict infant development. This analysis was also directed to the questions regarding the mother's age and prenatal and perinatal variables as predictors of infant development when the variance explained by transaction was partialled out in the model. The second analysis was designed to answer the following questions: Question Three: ^A^hat is the nature of the relationship between prenatal medical care and development at six months after controlling for the age and education of the mother, the sex and birth order of the infant, ethnic origin, yearly income and perinatal risk? Question Four: raich variables contribute predictive information to the identification of developmental delays on infant development measures at six months? Question Eight: Is there a relationship between the age of the mother and infant development after controlling for transaction, infant sex and birth order,

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93 mother's education, perinatal risk status, ethnic origin, yearly income, social support system and type of prenatal care and education? The questions were answered by the second multivariate multiple regression analysis. Mental and psychomotor development were regressed on mother's age and education, infant's sex and birth order, warmth, reciprocity, responsive vocalization, negative affect, nonresponsive stimulation, yearly income, ethnic origin, social support system, perinatal risk status, prenatal complication and type of prenatal care. From the multivariate tests of significance (Table 19 j, it can be seen that the age of the mother, prenatal complications, responsive vocalizations and t>'pe of prenatal care contributed to the overall prediction of infant development (a = ,05), The results of the univariate analyses are presented in Table 20. This represents the contributions of mental and psychomotor development and revealed that both models were significant. A visual inspection of the plots of the residuals indicated that the data met the assumption of horaoskedasticity and were appropriate for the analyses. The follow-up univariate analysis (a=,01) of mental development (Table 21) was consistent with the first analysis and indicated that the age of the m.other had a positive relationship to her infant's mental development. The plot of the residuals against m.other 's age evidenced no deviation from linearity. It was therefore concluded that there was a positive linear relationship between the age of the mother and her baby's mental developm.ent. Mother's age was found to explain 10 percent of the variance in mental development. The regression

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94 Table 19 Results o£ the Multivariate Significance Tests of Contributions to the Infant's Mental and Psychomotor Developraent Variable F* df p.Warmth 2. 27 2,57 .11 Reciprocity .53 2,57 .59 Responsive Vocalization 3. 72 2,57 .03' Negative Affect .92 2,57 .40 Nonresponsive Stimulation 1.17 2,57 ,. 32 Mother's Age 4.05 2,57 .02" Baby's Birth Order 2.66 2,57 .08: Sex of Baby 2.99 2,57 .06. Ethnic Origin .17 2,57 .84 Mother's Education 1.64 2,57 .20 Yearly Income 2.71 ^ 57 .08" Social Support System 1. 19 2,57 3-1 Type of Prenatal Care 3.46 8,114 .<.01 Prenatal Complications 4.05 2,57 .0"2." Perinatal Risk Status 1.12 2,57 33 ^conversion of IVilks' Criterion to an F statistic

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95 Table 20 Tests of Significance of Contribution of Prediction for Both Dependent Variables Combined Variable Mental Development Psychomotor Development .45 .40 2.65 2.10 .002 .017

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96 Table 21 Tests of Significance of Contribution of Continuous Variables to the Prediction of Infant's Mental Development Variable Regression Weights F P Warmth -.6764 4 .57 04 Reciprocity -.1079 .85 36 Responsive Vocalization .5411 3 .06 09 Negative Affect -.4984 1 .00 Nonresponsive Stimulation 1331 35 72 Mother's Age 2.6173 7 67 < 01 Birth Order -5. 8106 22 08 Ethnicity i D^iU 0 10 76 Mother's Education -3.4221 3. 33 .07 Yearly Income .9624 5 46 .02 Sex .0772 00 .99 Social Support System -5.050 2 23 .14 Prenatal Complications -13.976 7 96 <.01 Risk -.292 2. 27 .14

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97 coefficients indicated that for each year of mother's age, the infants differed, on the average, by 2.6 points on the Mental Development Index and by 1.2 points on the Psychomotor Development Index. (Table 22). Question ten was concerned with the relationship between perinatal risk and development at six months. No significant association was found to exist between perinatal risk and either mental or psychomotor development The presence of prenatal complications (anemia, toxemia, infection or venereal disease) was found to have a negative relationship with the infant's mental development and accounted for 12 percent of the variance. No deviations from linearity were evidenced on the plot of the residuals against prenatal complications; it was therefore concluded that there was a negative linear relationship between prenatal complications and mental development. No significant relationship between prenatal complications and psychomotor development was found. Responsive vocalization, the component which included the behaviors baby's vocalizations, mother's contingent vocalizations and baby's contingent vocalizations ,v/as found to have a positive relationship to the infant's psychomotor development and accounted for 11 percent of the variance. No significant relationship was found to exist between responsive vocalization and mental development. TTie type of prenatal care contributed to the prediction of both mental and psychomotor development. Pairwise comparisons of the four groups indicated that the means of those infants whose .mothers received treatment by a private physician scored significantly lower on both mental and psychomotor indices than those who received care

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98 Table 22 Tests of Significance of Contribution to the Prediction of Infant's Psychomotor Development Independent V CLJ. J-CLU C Regression weignts F P Warmth -.1668 .58 .45 Reciprocity -.0695 .73 .40 Responsive Vocalization .5752 7.23 <.01 Negative Affect .4418 1.65 .20 Nonresponsive Stimulation .5898 2.25 .14 Mother's Age 1.2720 5.78 .06 Baby's Birth Order -4.7877 4.57 .04 Ethnicity -2.1277 .35 .55 Mother's Education -1.1858 .84 36 Yearly Income .3642 1.63 .21 Baby's Sex -6. 7385 4.77 .03 Social Support System .6892 ,09 .77 Prenatal Complications -6.0120 3.08 .08 Risk .1037 .60 .44

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99 from Maternal and Infant Care Clinics and the Teenage Pregnancy Team. Significant differences were also found to exist between Maternal and Infant Care Clinic patients and Shands Teaching Hospital High Risk Clinic patients. The mean of the Teenage Pregnancy Team infants was also significantly higher than the infants of Shands Teaching Hospital High Risk Clinic. The pairwise comparisons and the adjusted means are presented in Tables 23 and 24. It should be noted that a discrepancy exists between the results of the first and second analyses with regard to the significance of the type of prenatal care as it related to psychomotor development. An inspection of the adjusted means for each prenatal care group (Table 25) indicated large, but nonsignificant differences on the transaction components. This variance was not accounted for in the first analysis. In the second analysis, partialling out the variance explained by transaction yielded a significance association between the type of prenatal care and the psychomotor development of the infant. The Prediction of Developmental Delay The question regarding delays in infant development could not be answered due to the fact that no infants scored below 68 on either the mental or the psychomotor scale. As a result of this analysis, however, certain variables have been identified which do contribute to the prediction of developmental risk in infancy. The variables which were found to be associated with negative outcomes in mental development were: 1) the young age of the mother; and 2) the presence of complications during pregnancy. Negative outcomes in psychomotor development were associated with a lack of responsive

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iOO I 1 p 03 £ u a, o +- > C Q fn 'h. a, o C S o >^ o J— J) cn 5 r-H (/) 03 •H -P o u OJ C in 03 •H 3 C •H Cti r' > Q O O > t/l c o in 0) C '-M O H S ca a o r-i !/5 c O Ci3 tU S <+-i CJ •H 3 Q +J CD CO O C3 5 o o V CO CO LO CO r-H O to T0"> r-H O O V CO r-. 00 LO LO to o o CD I— ( CM t— t r-H to o .—1 r-H to to r-< O O o CO o o On] t-H rH 1— ( r— 1 CN to r-H CO r-H o \o O O V CO to r-l o o V o o o LO to CO to LO to cri LO 1— 1 to OJ ^^^ IT) to Ol o r-H CJl o to to to LO nH o 00 I— f to \0 o (M 1—1 to •I— 1 O C Cl +-> !U CD fH fH L CO Oh u X CJ Q c 03 i-J t4H ao r~l c CD nj i — t > •H H H 'h fH 03 -P •H &. o 03 CJ C a: 4h CJ CO CD 03 cH I I o: •H CJ CO CD P Ct fH CD p 03 i 1 •p P. 0 -P !h oi fi, CD ; — I 03 V -P ~ o CD U H O — i 'h a. >-. o c 03 fH CD o: tio O c: CD CD C)J3 2 CD CD 3J +J ECO O 1 1 ID J.J p> O C fn CD -p CD P 03 ^03 Ph C_l aj c c=; P +3 tp al 03 ) — i CD O n: r-H o CJ o c •H Clj •H p ^ CD CD ;h 3 _cj Cl H P CJ CD O CJ o; CJ r-H U 03 Pl i2i •H C u Pi t/l H •H 03 c OJ p a. o CD ci) -.--si--^ ^yi' I

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101 Table 2,^ sans for Prenatal Care Groups after Adjusting for Variance Explained by Transaction Components and Ml Other Independent Variables Type of Prenatal Care Mental Develooment Psvchomotor DeveloDment Private Physician Public Health Department Maternal Infant Care Clinics Teenage Pregnancy Team Shands Teaching Hospital 108.640 132. 973 126.882 143.407 110.742 108.005 120.406 123.1183 127.319 109.319

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102 (/I r— t OJ c ca •H •H Cti Cm r-H 3 > O & u [a C en US 5 a. r-1 c CTS < Me i— 1 After by all o CD > d •H O c:; O ct oc 0 ^ CN -i-J O CO > -p H U 4-1 CD 00 a> o < CNI 2 t/i ca o -H tfl ca a; o > CJ o CJ CD C3 O C P 0 9 § o CJ cu X > cn CD cp 0) G ^ O to o r— 4 CN CO o 00 o to >J3 00 C~-J o o cn to CO to LO CN !0 I CO rsj o to CO CO C^a -£) co to I o C^J c^l to C^! to LO OJ LO to to CO CN to i 1 M 0 Q U Eca ca u 0 o Q p J) o •t-j H S rP 1— 1 CO I — 1 o K 0 p 1 — 1 CJ s: CJ 2 0 0 1—! o •I — I • c ca •H o ca X. 'H > r— 1 5 0 f-i rH •H X3 P r; 0 H CJ ^1 iS0 £X t0-}

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103 vocalization in the sotherinfant transaction process. It can be concluded that several of the variables contributed to the prediction of risk in infant development. MotherInfant Transaction as a Predictor of Infant Development One of the fundamental questions investigated in this study concerned the relationship between motherinfant transaction and the mental and psychomotor development of the infant. The question addressed was: Question Nine: Are the transaction components of the mother-infant relationship--warmt?i, reciprocity, responsive vocalization, negative affect, and nonresponsive stimulation-associated with the psychomotor and mental development of the infant after controlling for mother's age and education, baby's sex and birth order, yearly income, ethnic origin, social support system, perinatal risk and type of prenatal care? The preceding analysis was conducted to test the hypothesis that the transaction components predicted mental and psychomotor development in infancy when all other variables were held constant. The analysis involved testing the hypothesis for each dependent variable separarely. The F statistics for mental and psychomotor development were 2.34 and 3.36, respectively and were computed in the

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104 following manner: F = [Sum of Squares (Full Model)-Sum of Squares" (Reduced Model)1/5 Mean Square Error (Full Model) Mental Development F = [4807.1218 2669.8295] / 5 126.9130 = 2.34 Psychomotor Development F = [12660.4948 9552.8869]/ 5 265.0281 = 3.36 The critical value is F (5 ^61,. 025)= 2.74. It was therefore concluded that the shared variance of the mother-infant transactions components-warmth, reciprocity, responsive vocalization, negative affect and nonresponsive stimulation--contributed to the prediction of the infant's psychomotor development, but did not contribute to the prediction of the infant's mental development. Followup tests (Tables 21 and 22} supported only the h>'pothesis that the unique proportion of variance accounted for by responsive vocalization contributed to the prediction of psychomotor development. Responsive vocalization accounted for 11 percent of the variance in psychomotor development. Based on the positive regression weight, it can be concluded that there is a positive relationship between responsive vocalization and the infant's psychomotor development. An examination of the residual plots indicated that the relationship between the two variables was linear. Sumraary The analyses presented in this chapter were designed to ascertain the strength and nature of the relationships of the age of the mother.

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105 prenatal, and perinatal factors, and socioenvironraental medical and educational resources to motherinfant transaction and infant development in an agespecific sample. In the first analysis, the measures of transaction and development were considered to be outcome measures of early pregnancy and parenting. Mental development was found to be associated with the age of the mother, the type of prenatal care received by the mother and prenatal complications. No variables were found to contribute to the prediction of infant's psychomotor development and the mother-infant transaction process The second analysis was concerned with the prediction of the developmental outcomes of the infant. Several variables were found to be associated with the infant's development. The variables which were identified as predictors of mental development were: 1) the age of the mother; 2) the type of prenatal care received by the mother; and 3) the presence of prenatal complications. Psychomotor development was found to vary as a function of: 1} responsive vocalization of the mother-infant transaction process; and 2") the type of prenatal care received by the mother. The dimensions of mother-infant transaction were found to contribute a significant proportion of shared variance to the infant's psychomotor development. The component of transaction which contributed a uniquely significant proportion was responsive vocalization. The results of the study and their implications for future research and intervention are discussed in Chapter V.

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CHAPTER V DISCUSSION AND IMPLICATIONS In this study, the most important questions were concerned with the multidimensional outcomes of early pregnancy and parenting. The study was designed to explore the relationship of the age of the mother, prenatal and perinatal factors and socioenvironmental, medical and educational resources to the dimensions of motherinfant transaction and the development of the infant. This research reflects an effort to enhance our understanding of the young mother and her infant and, as a result, design more appropriate and comprehensive support services to the young family. The findings of the study and their implications are discussed in this chapter. The Age of the Mother as a Predictor of Infant Developme nt and MotherInfant Transact ion The most important questions posed in Chapter I asked "what are the behavioral characteristics of the very young mother? how does she relate to her baby and what is the association between her style of mothering and her baby's development?" The questions addressed several dimensions of early family development. In the first analysis, which viewed transaction and development as outcome measures, no variability in mother-infant transaction was found to be related to mother's a^-e. 106

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107 The age of the mother did, however, contribute to the prediction of her baby's mental development wherx transaction was considered as a dependent variable. The age of the mother was also associated with her baby's mental development when the proportion of variance accounted for by mother-infant transaction was held constant. The data suggested that the infants of younger mothers were less competent on a measure of mental development and that, as mother's age increased, so did the infant's mental development. The problem of multicolinearity could not be dealt with adequately in this study due to the need for an extreme large data set. It is therefore difficult to tease out the unique contributions of mother's age and education, ethnic origin, birth order, yearly income and prenatal complications. For instance, it remains unknovm whether the infant's development is threatened by the fact that the mother is young or if development is threatened by the mother who is prone to problematic pregnancy due to poor nutrition (anemia and toxemia], infection and venereal disease. Specifically, are mothers who are more likely to have complications during pregnancy and have fewer material resources also less able to stimulate the mental development of the infant? The significa7ice of the association found between mother's age and the infant's mental development is in accord with other research concerned with the infants of adolescent mothers (Hardy et al 1978). The implications of ihe present findings indicate a need for early and intense developmental and educational intervention protocols which are designed to enhance the competence of the infants of young mothers in order to prevent long term handicapping conditions.

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108 The findings of this and other studies (Clarke-Stewart, 1973; Beckwith et al., 1975) have documented the potential of the transaction process to enhance infant development. We therefore have support for the concept of parent a.nd infant-centered approaches to early intervention. The findings of this study also suggest that the dimensions of mother-infant transaction generalize across the age of the mother and that the young mother is as adept in her ability to facilitate positive transaction whth her infant as her "of age" peer. The strength of the mother-infant relationship is perhaps one that is able to be focused on in our attempts to help mothers enhance their infant's mental competencies. As professionals, there is often little we can do to modify the immediate socioenvironmental variables and biological threats due to prenatal complication that relate to infant development. We can, however, support young mothers in their transition to parenthood and their development of a transactional repertoire which is responsive to the infant and thus facilitative of their babies' development. Prenatal and Perinatal Factors and Socioenvironmental, Medical and Educational Resources as Predictors of Mother-Infant Transaction and Infant Development Previous research regarding early parenting revealed the mother's social support system and the professional services she receives to have a relationship both to her development as a mother and her infant's competence (Furstenburg, 1973; Kotelchuck, 1979; Brazelton and Lester, iNote 1; Dott and Fort, 1978). These questions

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109 were investigated in this study, as well. The data indicated no significant relationship between the quantity of social support and development and transaction. This was surprising and suggests that perhaps the basis upon which support was quantified-cohabitati income and childcare assistance-was not an appropriate measure of the qualitative aspects of support which have been associated with family development. An additional instrument to assess the qualitative characteristics of the mother's social support system would assist in future studies. The findings indicated the positive association between more comprehensive models of prenatal care and the mental and psychomotor competence of the infants. The most significant differences in infants' mental and psychomotor development were found to exist between prenatal care which offered only obstetric services and those which included either an optional or a mandatory prenatal and childbirth education program. The highest means on infant development were found to be those of infants whose mothers received care in the model which included prenatal and postpartum parenting education as well as social service referral, nutritional and short term crisis counseling (Mahan, Note 2) In interpreting this finding, it is important to note that a considerably larger proportion of the invited sample of the Private Physician care group patients participated in this study than those who received other ty^es of care. This suggests that the measures reflect those of more motivated mothers in the other

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110 four groups J whereas the measures taken on private patients reflect a more random selection. Another consideration to be taken into account is the fact that subjects vere self-selected into each type of prenatal care group on the basis of socioeconomic status and geographic location. Consideration of these results should also be based on the fact that the design of the study was retrospective and as such, no causal inferences with respect to differences between groups can be made. No outcomes can be said to be associated with the prenatal or parenting education components of the models due to the fact that these variables were excluded from the analyses. These results do, however, suggest a need for more controlled -experimental designs which would permit the investigation of the effects of interdisciplinary service models on the parent-infant relationship and infant development. The Prediction of Developmental Risk in Infancy The results of this study indicated that the young age of the mother, the presence of prenatal complications and a lack of responsive vocalizations in the mother-infant transaction process are associated with negative outcomes in infant development. It was surprising that no infants in this sample (which consisted of many low income and/or adolescent mothers) scored at or below 63 (the clinical criterion for delay] on the Bayley Scales of Infant Development Several possible explanations of this deserve mention. One possible cause is that the examiner "tested high." This consideration, as ivell as the fact that the infants participated in 15 minutes of free play prior to the assessment, may well have

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Ill Influenced the infant's level of optimal performance which was stated to be a goal of the assessment (Bavley, 1969). A third consideration is the small niuBber (20 of 250) of high risk infants (those who were bom prematurely or had neonatal complications) who were selected at random as part of the invited sample. Of the 20 high risk infants sampled, four participated in this study. The data were unable to answer the question and the identification of delay in an age specific sample thus remains in need of future investigation. Of benefit to our knowledge base would be the longitudinal assessment of the infants of adolescent parents. That these infants are at risk has been well documented in the literature. The findings presented in this study indicated that differences exist as early as six months of age. It is the subjective opinion of the author that a major factor in the success of patient follow-up lies in the direct communication by telephone to advise them of services offered to the family. In explaining the procedures carefully, questions may be answered and parents m.ay be made to feel that they were "lucky" to be chosen. This approach was used successfully in a seven year follow-up of the Collaborative Perinatal Study (Dallas, 1971). A more thorough assessment battery for long term follcw-up i,vould be an asset as well. The use of the Behavior Profile in the Sayle y Scales of Infant Development and its relationship to motherinfant transaction is another unexplored area of early parenting. The addition of an instriiment to assess qualitative characteristics

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112 of social support would contribute to future investigations and yield valuable information. An analysis of the subscales (language, social, cognitive and gross and fine motor skills) of the mental and psychomotor scales would be of assistance in order to make early developmental intervention more appropriate for each individual infant and family. MotherInfant Transaction as a Predictor of Infant Development The relationship between motherinfant transaction and infant development was one of the most important questions in this study. The findings revealed responsive vocalization to be positively related to the infant's psychomotor development. The shared contribution of the mother-infant transaction components was also found to be related to the infant's psychomotor development. The results of this study support the idea that the motherinfant relationship is important to the infant's development of competence. We also have reason to believe that more comprehensive interdisciplinary models of prenatal and perinatal support are associated with enhanced development of the infant. These findings suggest several considerations in the design of parent and infantcentered interventions for the young parent family. There is reason to believe that early and prolonged intervention with young parents and their infants can enrich the quality of care and stimulation provided by the mother and thus enhance the development of her infant.

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113 Suinmary and Conclusions The findings discussed in this study indicate that there is a need to reach both parent and child at the earliest possible moment and in a most comprehensive approach, for in this way, individuals will be given the opportunity to develop to their maximum potential. Meeting the special needs of the young parent family presents a multifaceted challenge to efforts on the part of the professional coramuntiy. Although the findings of this study do not indicate the extended family to be of importance, a special concern with the adolescent mother is that our efforts must be focused toward not only the young mother, but the father of her baby and the members of their extended families, as well. This was acknowledged in the studies of Furstenberg (1976, 1978) and Kotelchuck (1979) Often tills will mean extensive coordination of all phases of the clinic, school and home-based programs. In this way, the quality of care provided m.ay become more truly comprehensive in nature. At the heart of this approach is the primary prevention of early pregnancy--both repeat and first pregnancies--to individuals who are unprepared for the tasks of parenthood. With the extension of confidential family planning services and curricula designed to deal with the issues of hu.nmn sexuality and family development, ix is anticipated that young people will become more responsible in their sexual activities. Our purpose here was to explore the role of the adolescent as a mother and her baby's development. As noted earlier, the philosophical

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114 basis of this study was a strong belief in the positive characteristics of the young parent --courage, enthusiasm, adaptability and, above all, an optimistic view of the future. It is hoped that the results of this study and the literature presented herein will allow our future efforts to focus on the qualities of the mother-infant relationship in order to enhance the development of the infant and strengthen the family. It is important to remember that these young women have chosen to continue their pregnancies and undertake the tasks of motherhood. Remember, too, that most individuals, regardless of age, come to parenthood relatively unprepared for the responsibilities of caring for and nurturing another human life. The positive grovrth and development of these young parents and their children is dependent upon cur interdisciplinary efforts to support them in a comprehensive manner as they grow together as a family.

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APPENDIX A PARENT CONSENT FORM The first months of life are important as families grow. For this reason, we would like your permission to study how your baby's body and mind are developing. The study involves making a videotape (like a television film) of you and your baby playing and using the Bayley Scales of Infant Development to study your baby's mental and physical abilities. We will be happy to answer any questions before, during or after the study. You will be informed of the results of the study and will be sent a photograph of you and your baby and a book of baby exercises, games and learning activities. We are looking forward to working with you and your family and hope you will agree to be a part of our study. If you will agree to participate, please sign below. In the event of sustaining a physical injury which is proximately caused by this experiment, professional medical care will be provided for me at the J. Hillis Miller Health Center. There will be no charge to me, exclusive of hospital expenses. have read and understood the informed consent statement and give my permission for studying my child and using the information and videotapes for research and teaching purposes. I also realize that I may change my mind and withdraw my permission at any time. Witness Signed Witness Relationship to Child

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116 Name Address Telephone Six Month Assessment Child and Family Development Evaluation Julie Hoflieimer Departments of Obstetrics and Gynecology and Pediatrics ^Release Form Parent's Questionnaire Bayley Scales of Mental and Motor Development Videotaped Free-Play ^Hobel Assessment of Perinatal Risk Evaluation Protocol Mothers will be notified of their appointment by mail one month prior to test date. They will be mailed the reminder postcard one week prior to testing and phoned to confirm the' appointment two to three days prior to testing. Upon arrival in the Pediatric Clinic, they will be brought into the Developmental Clinic Playroom and the Assessment Specialist will explain the procedure for the freeplay videotape and Bayley Scales of Infant Development. Upon agreeing to participate in the study, the mother will be asked to sign the consent form. The freeplay situation will be videotaped and the developmental assessment administered. Tlie Developmental Specialist will then take the family into the waiting room and explain the results of the assessment, show the mother learning activities: which are keyed into the

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117 infant's developmental strengths and weaknesses, and give the mother illustrated descriptions of the activities demonstrated. Following the assessment, mothers will be interviewed to obtain demographic information.

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118 Child and Family Development Questionnaire Six Month Evaluation Julie Hofheimer 1. Hospital Number 5. Mother s Name 2. Date 6. Mother s DOB 5. Baby's Birth Condition 7. Baby s Nam.e 4. Baby's Birth Order 8. Baby s DOB 10. 11, 10. 14, What is your ethnic origin? ^White Am. ^Puerto Rican European Other Black Am. Am. Indian Asian East Indian Cuban Mexican Please State What is your baby's father's ethnic origin? Are you ^married ^Single M living with baby's father living with husband living with 1 or both F parents living with _relative living with friend With whom do you share a home? (Check all that apply) Mate or Husba.nd Father Mother Sister (s) brother (s) children live alone friend (s) with baby iWho helps care for your baby? uncle (s) grandparent (s) aunt (sj in home childcare center friend ^relative In what type of residence do you live? home campus ar>t trailer rooming housing house Kow much school have you completed? Please circle highest level. 1 vocational Degree _:3 D /_ College Grad. 10 attended Jr. College 12 Jr. College Degree Master':s Doctoral or 'egree Prof, uegree

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119 How much school did your baby's father complete? 15. Are you still in school? ^Yes T^yv^ 16, What is your total yearly income? $1,000 ^$2,000 $3,000 _$4,000 ^$5,000 ^$6,000 ^$7,000 ^$8,000 ^$9,000 _$10,000 ^$11,000 ^$12,000 ^$13,000 ^$14-16,000 $16-18,000 ^$18-20,000 ^$20,25,000 ^$25-30,000 $30-40,000 mate or 17. What are your income sources? self-employment husband's employ. food baby's father's AFDC ^!VIC ^stamps your parents /family family private public health 18. Where did you receive prenatal care? physician clinic (please (Please indicate frequency) name) ^MIC Clinic ^STH OB Clinic APT Clinic public 19. Where does your baby receive health care? private health MIC/PEDS Clinic SlTi FEDS Clinic 20. Have your participated in any Parenting Education or Support Program? prenatal ed. class APT Clinic childbirth ed. class friends psychologist or child development ^relative books, TV, newspapers ^church home, economist/social ser\ace ^community ed. Where was this program located? How often did you participate?

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APPENDIX B DEFINITIONS OF MOTHER MD INFANT BEHAVIORS Adapted Beckwith Behavior Scale Maternal Behaviors 1. Comments : positive verbalizations; all positive vocalizations .•-including questions, praises, suggests, focuses verbally. 2. Commands : mother-oriented, directive and forceful verbalizations; clear imperative to initiate action. 3. Criticism : clear request to terminate action or verbalizations which are critical or hostile or derogatory. 4. Nonverbal bids : positive touch, help, facilitate, provide. 5. Initiating behaviors : self-oriented maternal behavior; getting baby's attention in some nonverbal way, actions which direct baby in a different direction rather than extending baby's behavior. 6. Repetitive nonverbal bids : repeating the same or simi labids over and over for several 15-second period. This has a monotonous quality, such as presenting different toys one after the other in a very similar manner. 7. Staccato bursts : rapid bursts of maternal behavior which allow little or no time for infant response. 8. Affectionate touch : kiss, pat, hug, nuzzle, etc, 9. Interfering touch : mother touches baby to distract, inhibit oi^-going ..activity. Includes hitting, moving object from hands, pulling back, etc. 12D

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121 10. Repetitive verbalizations: brief phrases repeated over and over for most of a 15-second period. Infant Behaviors 11. Bid to caregive r: request for help; reach, point, or share; positive gestures12. Vocalization : nondistress vocalization, babbling, gurgling, cooing. 13. Smiles at mother : not frowning, not grimacing., 14. Selfstimulatory behavior : thumb sucking, extended rocking or other non-task-oriented or exploratory behavior. 15. Vacant behavior : empty or blank or facial expression; baby is not interacting with caregiver or environment. 16. Explores : curious visual or manual exploration of environment. 17. Fusses: crying or fussing; not contingent on mother behavior. Reciprocal Behaviors 18. Maternal positive responding : caregiver responds to infant positive bid or distress in a positive manner by permitting, giving, engaging, helping, accepting, etc. Does not include imitates, elaborates, or amplifies baby's vocalizations or behaviors 19.. Maternal negative responses : ignoring or rejecting baby's social bid or on-going activity either verbally or nonverbally. Examples: not returning a toy that rolls away from infant, turning away, or stopping a baby's initiations. 20. Ma ternal ignoring : mother ignores bids or activity of baby. 21. Baby positive respondin g: baby responds to mother's bid positively by smiling, reaching, pointing, vocalizing, etc.

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122 22. Baby's negative responding : baby responds to mother's bid by fussing, crying, turning away, etc. 23. Baby ignoring : ignores bids or activity of mother. 24. Facetoface orientation : mother is in a position facing baby. 25. Mutual gaze : the two faces are in the same vertical and horizontal plane. 26. Mother's contingent verbalization to infant vocalization : mother either imitates or responds vocally to nondistress vocalization by infant. 27. Baby's contingent vocalization : baby either imitates or responds vocally to mother's behavior.

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APPENDIX C BAYLEY SCALES OF INF.aj^IT DEVELOPMENT A. Psychomotor Index Item Age Range Item Presentation 21 4.9 Cube: partial thumb opposition (radial -palmer) With the child seated at the table, place a 1-inch cube within his easy reach. Also credit i£ he passes item 32. Credit: at this level if the child picks up the cube with his thumb partially pooposed to his fingers, using the palm as well as the thumb and fingers 22 5.3 Pulls to sitting position. Stand at the foot of the crib and lean over the child whil he is lying on his back. Give him your thumbs to grasp. With this support, allow him to pull himself to a sitting position and, if he is able, to a full standing position (item 36} Gradually raise your hands as the child pulls, but take care not to do the pulling Credit: if the child pulls himself to a sitting position with the support of your thumbs. 23 5.3 Sits alone momentarily. Administer as in item 17. Credit: at this level if the child sits momentarily without 37ipport 24 5.4 Unilateral reaching. Credit: if the child tends to reach with one hand more often than bimanually (with both hands at once) The hand used need not be consistently either the right or the left. 25 5.6 Attempts to secure pellet. Place a sugar pellet on the table within easy reach of the child. Observe his efforts to pick up the pellet. If necessary, attract his attention to it by motions of the hand, by tapping the table near the pellet, or by making it rock (as in Mental Scale item 52). Credit: at this level if the child makes an effort to pick up the pellet, whether successful or not. 123

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124 26 5.7 Rotates wrist. Credit: if the child rotates his wrist freely in manipulating toys (cube, rattle, bell), 2" 6.0 Sits alone 30 seconds or more. Administer as in item 17. Credit: at this level is the child sits alone 30 seconds or more. Note for item 29 whether the child's back is curved as he leans forward for support 28 6.4 Rolls from back to stomach. Administer as in item 19. Credit: if, under this or any similar situation during the examination period, the child rolls from his back onto his stomach. 29 6.6 Sits alone, steadily. Administer as in item 17. Credit: at this level is the child sits alone steadily without support and v;ith his back fairly straight. 30 6.8 Scoops pellet. Administer as in item 25. Credit: at this level if the child secures the pellet with a raking or scooping palmar prehension. Also credit if he passes item 35 or 41. 6-9 Sits alone, good coordination. Administer as in item 17. Credit: at this level if the child sits alone steadily while manipulating toys, turning, or engaging in other actions that take his attention away from Mental Index "^"^^^ P^^'^^^^ 5.5 Transfers object hand to hand. During the child's play with the rattle, ring, or other object, observe whether he changes the object from one hand to the other. Credit: if the child transfers an object from one hand to the other 2 or more times. Do not credit if this occurs only when the free hand comes into contact with the object by chance. 70 5.7 Picks up cube deftly and directly. Place a cube on the table within easy reach of the child. Observe the manner in which the child picks up the cube. (Motor Scale items 16, 21, 32 may also be presented at this time.) Credit: if the child picks up the cube deftly and directl 31 69

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125 71 5.7 Pulls string: secures ring. Administer as in item 67 Credit: if the child secures the ring as the result of his own efforts, even though there is no evidence of purposive use of the string. ''^ 5.8 Interest in sound production. Observe whether the child intentionally uses objects to make noise. Credit: if the child shows interest in producing sound as such, by banging t03^s ringing the bell, etc. ''^ 5.8 Lifts cup with handle. Administer as in item 63. Credit: if the child lifts the cup by the handle, using one hand predominantly. 5,8 Attends to scribbling. Place a piece of paper on the table in front of the child; then place a crayon on the paper with the tip pointing away from him,. If he makes no effort tctouch the crayon to the paper, take the crayon and scribble plainly with obvious writing gestures. Then give the crayon to the child with directions (by word and gesture) to write. (See also item 95.) Credit: if the child attends to the demonstrated scribbling. ''^ 6.0 Looks for fallen spoon. Administer as in item 62. (Note that items 62 and 75, involving both vision and hearing, are easier than items 86, 38, 91, and 96, which test "object constancy" by vision only.) 76 6,2 77 Credit: if the child definately looks for the fallen spoon by turning and looking to the floor. Playful response to mirror. Administer as in item 53, Credit: if the child plays with the mirror image, with such responses as laughing, patting, banging, playful reaching, leaning toward the image, "mouthing" the mirror, etc. Retains 2 of 3 cubes offered. One at a time, place 3 cubes on the table before the child, allowing him to pick up each one before the next is offered. Observe his behavior when he has a cube in each hand and the third cube is presented. Credit: if the child retains the first 2 cubes after the third is offered. (Often a child fails this by dropping a cube to reach for the third.)

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APPENDIX D PERINATAL RISK SCREENING Calvin Hobel (UCLA) Baby's Name Hospital # Risk Score I. Prenatal Factors 1. Toxemia (moderate to severe) 10 13. Age ^ 35 or £ 1 5 5 Clironic hypertension 10 14, Viral disease 5 3. Mod-severe renal disease 10 15. Anemia 5 4. Eclampsia 10 16. Excessive drug use 5 5 Diabetes 10 17. TB history 5 6. Rh exchange 10 18. Wt 100 or 200 5 Uterine malformation 10 19. Pulffionar>' disease 8. Incompetent cervix 10 20. Flu s}rn,drome 5 9. Abnorm.al fetal position 10 21. Smoking 1 pack/day 1 10. Small pelvis 5 22. AJhilcohol '[ 1 11. Abnormal cervical cytology 10 23. Emotional problem 1 12. Multiple pregnancy 10 24. Infection 1 25 Severs heart disease 10 126

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127 II. Maternal Factors 2. 3. 4. 5, 6. 7. 9. 10, Moderatesevere toxemia Cpreeclampsia) Hydraranios/oligohydr amnios Amnionitis Uterine rupture Mild toxemia PROM 12 hrs. Primary dysfunctional labor Secondary arrest of dilation Demerol 300 mg. MgSo4 25 gm.. 10 10 10 10 5 11. Second state 2-1/2 hours 12. Labor > 20 hours 5 15. Clinical small pelvis 5 14. Medical induction 5 15. Precipitous labor 5 < 3 hours 16. Primary cesarean section 17. Repeat cesarean section 18. Elective induction 19. Prolonged latent phase 20. Uterine tetany 1 21. Pitocin augmentation 1 III. Placental Factors 3. 4. Placenta previa Abruptio placentae Postterm;42 weeks Meconium stained amniotic fluid (dark) 10 10 10 10 4. Meconium stained amniotic fluid (light) 6, Marginal separation

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12-8 1 IV. Fetal Factors 1 X. m Abnormal presentation 10 8 Fetal tachycardia 10 2. Multiple pregnancy 10 30 min. 3. Fetal bradycardia 30 min. 10 9 Operative forceps or vacuum extraction 5 4 Breech delivery total extraction 10 Breech delivery spontaneous or assisted 5 5. Prolapsed cord 10 11 General anesthesia 5 6. Fetal weight < 2500 gms iu 12 Outlet forceps 1 7. Fetal acidosis pH > 7.25 10 15 1 A 14 Shoulder dystocia retal distress 1 10 V. Neonatal Factors A. General B. Respiratory 1. 1000 grains 15 1 RDS 10 2. Apgar 5m = < 5 10 2. Meconium aspiration 10 3. Resusciation 10 3. Congenital pneumonia 10 4. 1000-1500 grams 10 4. Anomalies of respira10 5. Fetal anomalies 10 tory system 6 1500-2000 grams 5 5. Apnea 10 7 Dysraaturity 5 6. Transient tachypnea 5 8. Apgar Im = < 5 5 C. Metabolic Disorders 9. Feeding problem 1 1. Hypoglycemia 10 0. Multiple birth 1 2. Hypocalcemia 10 1. 2 00025 OQ grams 1 ^ 4. 5 6. IIypo/h>'permagnesefflia Hypoparathyroidism Failure to gain weight Jitteriness 5 5 1 1

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129 D. Cardiac 1. Major Cardiac Anomalies IQ 2. CHF 10 3. Persistent cyanosis 5 4. Major cardiac Anomolies 5 without catheterization 5 Murmur 5 E. Hematologic Problems 1. H>'perbilirubinemia, 15 10 2. Hemorrhagic diathesis 10 3. Chromosomal anomolies 10 4. Sepsis 10 5. Anemia 5 F. Central Nervous System 1. CNS depression > 24 hours 10 2. Seizures 10 3. CNS depression < 24 hours 5

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REFERENCE NOTES Brazelton, T. B., Lester, B. A cross-cultural study of adolescent mother -infant interaction and neonatal assessment. Personal communication, 1979. Mahan, Charles S. Teenage pregnancy team project grant proposal (DHEW-NIH), 1978. Mahan, Charles S, and Eitzman, D. V. North Central Florida maternity and infant care project grant proposal (DHEW-PHS), 1978.

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REFERENCES Ainsworth, M. D. Individual differences in the development of some attachment behaviors. Merrill-Palmer Quarterly 1972, 18_, 23-43. Ainsworth, M. D. § Bell, S. D, Some contemporrary patterns of motherinfant interaction in a feeding situation. In Stone, L. J., Smith, H. T,, and Murphy, L. B. (Eds.) The social infant New York: Basic Books, Inc., 1973, 14. Alan Guttmacher Institute. 11 million teenagers: What can be done about the epidemic of adolescent pregnancies in the United Sta t e s ? New York; Planned Parenthood Federation of America, Inc., 1976. Badger, E., Elsass, S. Sutherland, J. Mother training as a means of accelerating child development in a high risk populatio n. Paper presented at Society for Pediatric Research. Washington, D. C May 2, 1974. Baldwin, W. Adolescent pregnancy and childbearing--growing concerns for .-Americans. Population Bulletin 1976, 31_(2) 3-32. Baldwin, W, Statement in Hearings of the Ninetyfith Congress U. S. Government Printing Office, 1978, 3-14. Barglow, P., Barnstein, M. B. Exum, D. B. § Wright, M. K. Some psychiatric aspects of illigitimate pregnancy during early adolescence. American Journal of Orthopsychiatry 1967, 37(2), 256 Barr, A., Goodnight, J., Soil, J. § Helwig, J. Users guide to SAS 1976 Raleigh, N. C: SAS Institute, 1976. Sayley, N. Bayley s ca les of infant development (Manual). New York: The Psychological Corporation, 1969. Beckwith, L. Relationship between attributes of mothers and their infants' IQ scores. C hild Development 1976, 42_, 1083-1097. Beckwith, L. Cohen, S., Capp, C. B., Parmalee, A. H. S Marcy, T. G. Caregiver interation and early cognitive development in preterm infants. Chi 1 d Devs 1 opment 1976, 47, 579-87, Bell, R, Contributions of hiunan infants to caregiving and social interaction in Lews, M.. and Rosenbluni (Eds.) The effect of infant on its caregiver New York: Wiley, 19741 Brazelton, T. B. Effect of maternal e>?pectations on early infant behavior. Early Child Development Care 1973, 2, 259-273. 131

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132 Brazelton, T. B., Tronick, E., Adamson, L., As, H. § Wise, S. Early mother-infant reciprocity. Ciba Foundation Symposium, 1975, 33, 1-220. Brovraan, S., Nichols, P. 5 Kennedy, W. Preschool IQ: Prenatal and early developmental correlates New York: Wiley d, Sons, 1975. Bronson, G. Infant's reactions to unfamiliar persons and novel objects. Monographs of the Society for Research in Child Development 1972, 3_7C3) 1-45. Butts, J, D. Adolescent sexuality and the impact of teena ge pregnancy from a black perspective Paper presented at Family Impact Seminar Conference on Teenage Pregnancy, George Washington University, 1978. Campbell, S, Mother-child interaction in reflective, impulsive and hyperactive children. Developmental Psychology 1975, 11_(6) 460-46 Chilman, C. Adolescent sexuality in a changing American society DKEW Publication No: (NIH) 79-1426, Washington, D. C: 07 S. Government Printing Office, 1979. Ciaman, A. D. Reaction of unmarried girls to pregnancy, Canadian Medical Association Journal 1969, 101, 328-34. Clarke-Stewart, A. K. Intervention between mothers and their young children. Monographs of the Society for Research in Child D evelopment 1973, 38_(6-7) 1-109. Loates, J. Obstetrics in the veiy young adolescent. America n Journal of Obstetrics and Gynecology 1970, 108_(1) 68-72 Coblinear, W. G., Schulman, H. § Romney, S. L. The termination of adolescent out of wedlock pregnancy and the prospects for their primary prevention. American Journal of Ob s tetrics an d Gynecology, 1973, 65(3), 452-444. Cohen, C, Beckwith, L. § Parmalee, A. Receptive language development in pre-term children as related to caregiver-child interaction. Pediatrics 1978, _6iri.l 17-19. Crider, E. School-age pregn a ncy, childbearing and childrearing: A research review Dept. of HEW, U.S.O.E. Contract #P0076271; November, 1976. Cronbach, L. J., Glaser, G. C, Nanda, H. & Rajaratn.ara, N. The dependability of behavioral measur e ments: Th eory of general! zability for scores and profiles New York: WiTey and Sons, l'972 Cronbach, L. J. § Rajartnani, N. A. Theory of generalizability: A liberalization of reliability theory. British Journal of Statistical Psychology, 1963, 16, 137-163.

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153Broman, S., Nichols, ?. Kennedy, W. Preschool IQ: Prenatal and early developmental correlatas Mew York: Wiley & Sons, 1975. Bronson, G. Infant's reactions to unfamiliar persons and novel objects. Monographs of the Society for Research in Child Development 1972, 32(3), 1-45. Butts, J. D. Adolescent sexuality and the impact of teenage pregnancy from a black perspective Paper presented at Family Impact Seminar Conference on Teenage Pregnancy, George Washington University, 1978. Campbell, S. Mother-child interaction in reflective, impulsive and hyperactive children. Developmental Psychology ^ 1975, 11(6), 100-10. Chilman, C. Adolescent sexuality in a changing American society DREW Publication No: (NIH) 79-1426, Washington D, C: U.^S. Government Printing Office, 1979. Claman, A. D. Reaction of unmarried girls to pregnancy. Canadian Medical Association Journal 1969, 101, 328-34. Clarke-Stewart, A. K. Intervention between mothers and their young children. Monographs of the Society for Research in Chil d Development, 1973, 38(6-7) 1-109. Coates, J. Obstetrics in the very young adolescent. American Journal of Obstetrics and Gynecology 1970, 108(1), 270-277. Coblinear, W. G., Schulman, H. Romney, S. L. The termination of adolescent out of wedlock pregnancy and the prospects for their primary prevention. American Journal of Obstetrics and Gynecoloc-y, 1973, ^(3), 432-444. ~ ^ Cohen, C, Beckwith, L. Pariaalee, A.. Receptive language development in pre-term children as related to caregiver-child interaction. Pediatrics 1978, 61_(1) 17-19. Crider, E. School-age pregnancy, childbearing and childrearing: A research review Dept. of Em, U.S.O.E. Contract #P007627T1 November, 1976. Cronbach, L. J., Gleser, G. C, Nanda, H. Rajaratnam, N. The dependabilit:/ of behavioral measurements: Theory of genera lizab ility for scores and profiles New York: Wiley and Sons, 197"2. Cronbach, L. J. & Rajartnam, N. A. Theory of generalizability : A liberalization of reliabilicy theory. British Journal of Statistica l Psychology 1963, _16, 137-163. Cullan, K. J. A six year concrollad trial cf prevention of children's behavior disorders. Journal of Behavioral Pedi atrics, j976 88_(4), 662-666.

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134 Outright, P. mo is the pregnant school aged girl and why is she pregnant? Journal of Marr iage and the Family, 1973/75r41 589-95. ~ — — Dallas, J. Patient follow-up in a long term study. Johns Hopkins Medical Journal 1971, 128, 244-251. DeLissovoy, V. Childcare by adolescent parents. Children Today 1975, 7_(8), 22-25. Dott, A. § Fort, A. Medical and social factors affecting early teenage pregnancy. American Jou rnal of Obstetrics and Gynecology 1976, 125_C4), 532-536: ~ Dwyer, J. Teenage pregnancy. American Journal of Obstetrics ajid Gyriecology, 1974, 111(5} 373-376. ~ Epstein, A. Pregnant teenager's knowledge of infant develop ment. Paper presented at Society for Research in Child Development, San Francisco: Biennial Convention, March, 1979, Erkan, R. Stein, J, A., Heald, P. P. Complications in adolescent pregnancy. Clinical Pediatrics 1972", 1_]_C10), 380-391. Eyler, Fonda D. Assessment and intervention with mothers and their premature newborns Paper presented at Society for Research in Child Development, San Francisco: Biennial Convention March, 1979, Family Planning Perspectives April, 1979. Forbush, J. B. Family involvement in adolescent pare nt programs. Paper presented at Family Impact Seminar Conference' on Teenage Pregnancy, George Washington University, October, 1978, Po^' L. Tlie Family's Role in Adolescent Sexual Behavi or. Paper presented at the Family Impact Seminar Conference on"~Teenage Pregnancy, George Washington University, October, 1978. Furstenbsrg, F, Unplanned parenthood: The social co nsequences of teenage childbearing New York: The Free Press", 1976. Furstenberg, F. Burdens and benefits: The impact of early chi ldbearin g on the famil y! Paper presented at the Family Impact Seminar Conference on Teenage Pregnancy, George Washington University, NICHDONOl -HD-72822 October, 1978^ Fursteriberg, F. S Crawford, A. G. Accommodating early pa renthood: Sources and consequences of family s u pport to the teena ge £tliM^ar3r. Paper presented at Family Impact Seminar Conference on Teenage Pregnancy, George Washington University, October, 1978.

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135 Goldberg, S. Social competency in infancy: A model of parent-child interaction. Merrill -Palmer Quarteriy 1977, 23 (Z) 163-175. Gordon J I. J. Studying the child in schoo l. New York: 1966. Gordon, I. J. C hild stimulation through parent education ERIC Document No. ED 033 912, September, 1969. Gordon, I. J. The infant experience Columbus: Charles E. Merrill Publishing Co. 1975. Gordon, I. J. Parenting, teaching, and child development. Youn? Children 1976, 51_, 173-182. ~ Gordon, I. J., Soar, R. S. Jester, R. E. Instructional strategies in infant stimulation. NIMK Monograph. Washington, D. C. : U. S. Government Printing Office, 1979. Gottschalk, L. Psychosocial factors associated with pregnancy in adolescent girls: A preliminary report. Journal of Nervou<=: Disorders 1964, 138(6), 534-554. Grant, J. § Heald, F. Complications of adolescent pregnancy: A survey of the literature on fetal outcome in adolescence. Clinical Pediatrics, 1970, X^, 569. Grossman, P. Prematurity, poverty related stress and the mother-infant relation Doctoral ffissertation. University of Florida, 1979. Hardy, J. B. Tne Johns Hopkins collaborative project: Factors affecting the growth and development of children. Johns Hopki ns Medical Journal 1971, 123(2) 238-243. Kardy,y., IVelcher, D. Stanley, J., § Dallas, J. Long-range outcome of adolescent pregnancy. Clinical Obs tetrics and Gynecology, 1978, 2^(4), 1215-1232. ~~ ^ Hobel, C. J., Hyvarinen, M. A., Okada, D. M. 5 William, 0. H. Prenatal and intrapartum high-risk screening. American Journal of Obstetri cs and Gyneco lo.g;'/, 1973, 117(1), 1-9. Holstrum, W. J. The prediction of three year developmental status of high risk infants Doctoral Dissertation, University of Florida, 1979. Holtzman, M. The verbal environment provided by mothers for their very young children. Me rrill -P almer Quarterly, 1974 71 (I) 31-42. — ^ Howard, M. Ihe Young Parent Family. In Vaugn & Braze Iton (Eds), iT.e Family: Can It Be Save d? Boston: Yearboek Medical Publishers 1975, 259-255. ~

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136 Huitt, W. G. An analysis of reliability of parent-infant interaction through the use of generalizability theory University of Florida: Doctoral Dissertation, 1978. Jessor, S. L. § Jessor, R. Transition from virginity to nonvirginity among youth: A social -psychological study over time. Developmental Psychology 1975, 473-484. Jones, A. § Placek, P. Teenage women in the U. S. A.: Sex, contraception pregnancy, fertility and maternal and infant health Paper presented at the Family Impact Seminar Conference on Teenage Pregnancy, George Washington University, October, 1978. Kane, F.. § Luchenbruch, P. Adolescent pregnancy: A study of aborters and nonaborters. Am.erican Journal of Orthopsychiatry 1973, 43(5), 674-680. — Klaus, M. § Kennell, J. Maternal-infant bonding St. Louis: C. V. Mosby, Co., 1976. Klaus, M. Kennell, J., & Trause, J. Maternal behavior one year after early and extended postpartum contact. Developmental Medicine and Neurology 1975, 1G_, 40-73. Klein, L. Antecedents of adolescent pregnancy. Clinical Obsterics and G;/necology 1978, 21^(4), 1151-1159. Klein, L. Early teenage pregnancy, contraception and repeat pregnancy. .American Journal of Obstetrics and Gyn.ecolog>% 1974', 120(20), 263-267. Knox, E. Teenage mothers: A pediatric and obstetric group at high risk. Minnesota Medicine 1971, 43_, 701-703. Kot el chuck, M. Pediatric social illness: Prediction and misclassifi cat ion. Paper presented at Society for Research in Child Development, San Francisco: Biennial Convention, 1979. Lamb, M. E. A definition of the concent of attachment. Human Develop ment 1974, r7(5), 376-385. Lamb, M. E. Effect of stress and cohort on mother-father-infant interaction. Developmental Psychology 1976(a), 12(3), 435-443.. Lamb, M. E. Twelve month olds and their parents: Interaction in a laboratory playroom. Developmental Psychology 1976(b), 12_(3), 534-337. Lamb, M. E. A re -examination of the infant's social world. Human Development 1977, 25_, 65-85. Lazar, J. B. & Chapman, J. E. A review of the present status g.nd future research needs of programs to dev e lop parentin g ski 1 Is Interagency Pa:iel for Early CTiildhood Re~search § Developm.ent (Grant #OCOC3107), 1972 Social Research Group, George Washington University, Washington, D. C.

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137 Lewis Robert A. Parents as Peers. Journal of Sex Research 1973, 9_C2}, 156-170. Long. K. 'Flie relationship between parenting styles and infant's task-mastery, exploration and mental and motor development Doctoral Dissertation, University of Florida, 1979. Lynn, D. The father: His role in child development Monterey, CA: Wadsworth Publishing Co., 1974. Lytton, H. Three approaches to the study of parent-child interaction. Journal of Child Psychology and Psychiatry 1973, 14_, 1-17. Malmquist, C P. Mothers with multiple illigitimacies Psychiatric Quarterly 1967, 47, 339-354. Martinez, A. Adolescent pregnancy: The impact on Hispanic adolescents and their families Paper presented at the Family Impact Seminar Conference on Teenage Pre.gnancy, George Washington University, October, 1976. h^cGanity, W. J., Little, H. M. Gozelman, A., Jennings, L. Calhoun, E., § Dawson, E. Pregnancy in the adolescent: Preliminary summary of health status. American Journal of Obstetrics and Gyneco logy. 1969, 103(2), 773-788T McKendry, P., Walters, L. § Johnson, C. Adolescent pregnancy: A review of the literature. The Family Coordinator January 1979, 17-28. Mecklenburg, F. Pregnancy: An adolescent crisis. Minnesota Medicine 1975, 56_, 101-103. Medley, D. M. § f^ixzel, H. E. Measuring classroom behavior by systematic observations. In Gage, M. (Ed.) Handbook of research on teaching Cliicago: Rand McNally. Medvene, A. Early parent-child interaction of educational-vocational and social-emotional clients. Journal of Counseling Psychology 1975, 11_C6), 788-794. Menken, J. Teenage childbearing: Its medical aspects and implications for the United States population. In Crider, E. (Ed.) school -age pregnancy, childbearing and childrearing: A research re view. Dept. of HEW, U.S.O.E. Contract #P0076271, November, 1976"! Moerk, Ernst. Verbal Interaction Between Children and Their Mothers During the Preschool Years. Developmental Psychology 1975, 11(6), 788-794. Moore, K,. Govex'nment policies related to teenage family foi-mat ion and functioning: .An inventory Paper presented at the Faniil}'~rrapact' Seminar Conference on Teenage Pregnancy, George Washington University, October, 197S.

PAGE 151

13S Nelson, K. Structure and strategy in learning to talk. Monographs of the Society for Research in Child Development 1973, 38(1-2), 1-135. Newman, Barbara. Tne Development of social interaction from infancy through adolescence. Small Group Behavio r, 1976, 7_C1), 19-31. Nie, N. H., Hull, C. H. Jenkins, J. G. Steinbrenner K. § Bent, D. Statistical package for the social sciences 2nd Ed New York : McGraw-Kill, 1975. Niswander, K. R. § Gordon, M. The women and their pregnancies. Washington, D. C. : U.S. Government Printing Office, DHEW Publication No. (NTH) 73-379, 1972. Norton, D. Parental age as a factor in pregnancy outcome and child development. Reports on Population--Fainily Planning 1974, 16, 32-34. Olmsted, P. Observational studies of parental teaching behaviors: A review of the literature Gainesville, Fla, : University of Florida, Institute for Development of Human Resources, 1977. Oppel, W. § Royston, A. Teenage birth: Some social, psychological and physical sequelae. American Journal of Public Health 1971, 4, 751-756. Osofsky, H.S Osofsky, J. Adolescents as mothers: An Interdisciplinary approach to a complex problem. Journal of Youth and Adolescence 1973, 2_(3), 233-249. Osofsky, J., § Osofsky, H. Teenage pregnancy: Psychosocial considerations. Clinical Obstetrics and Gynecology 1978, 21 (4) 1160-1173. Packer, A. B., Resnick, M. B. Wilson, J., Resnick, J. L. An elementary school for parents. Young Children 1979, 34(1), 4-12. Parke, R, 5 Sawin, D. The father's role in infancy: A re-evaluation. Family Coordinator 1976, 25_(4) 365-371. Paulker, J. D. Girls pregnant out of wedlock. Journal of Operational Psychology 1970,^ U7), 247-255. Placek, P. ^ Jones, A. Teenage women in the U.S.A.: Sex, contr aception, pregnancy, fertility. Paper presented at the Family Impact Seminar Conference on Teenage Pregnancy, George Washington University, October, 1978. Powell, L. The effect of extra stimulation and maternal involvement on the development of low birth weight infants and maternal behavior. Child Developm ent, 1974, 45, 106-113. Presser, H. B. Early motherhood: I.gnorance or bliss. Fa^nily Planning Perspectives 1974, 6(1), 8-14. '~ ~

PAGE 152

139 Resnick, M. 3., Eitzman, D. V., Nelson, R. M. Egan, E. A., Bucciarelli, R. L, Beale, E. F. Development of low birth weight (LEW) infants. Pediatric Research 1978, 12_C4) 553. Rosen, E. J. A psychiatric and psychological study of illegitimate pregnancy in girls under the age of sixteen. Psychiatric Neurology, 1961, 142(1), 44-60. Rosen, R. A. H. Pregnancy resolution decision-making among minors Paper presented at the Annual meetings of the American Psychological Association, 1977, San Francisco, California. Rossi, A. Family development in a changing world. American Journal of Psychiatry 1972, 128(9), 1057-1066. Rossi, A. Transition to parenthood. Journal of Marriage and the Fami ly, 1968, 20_(1), 26-39. Russell, C. Transition to parenthood: Problems and gratifications. Journal of Marriage and the Family 1974, 56(2) 294-301. Ryan, G. M. § Schneider, J. M. Teenage obstetric complications. Clinical Obstetrics and Gynecology 1978, 21_[4) 1191-1197. Sameroff, A. Theoretical and empirical issues in the operationalization of transactional research. Society for Research in Child Development 1979. ^ Schmidt, Wilfred § Hore, Terrence. Some non-verbal aspects of communication between mothers and their preschool children. Child Development 1970, 41_, 889-896. Semffions, J. P. Tmfilications of teenage pregnancy. Obstetrics and Gynecology 1965, 26(1), 77-85. Stine, D. C, Rider, R. V. § Sweeney, E. School leaving due to pregnancy in an urban adolescent population. American Journal o f Public Health 1974, 54(1), 605-614. ~ Strassberg, Donald, Gabal, Harris § Ajichor, Kenneth. Patterns of self-disclosure in parent discussion grout)s. Small Group Journal, 1976, 7_(3), 369-577. ^ Terkelson, Care. Making contact: A parent-child communication skill program. Elementary School Guidance and Counseling, 1976, 11(2), 89-99": ~ S'/elcher, D. Mellits, D. § Kardy, J. A multivariate analysis of factors affecting psychological performance. Johns Hopki ns Medical Journal 1971, 129, 19-55.

PAGE 153

140 V/ente, Arel 5 Crockenberg, Susan. Transition to fatlierhood: Lamaze preparation, adjustment difficulty and the husband wife relationship. Family Coordinato r, 1976, 26_(2}, 351-367. Werner, E. E. § Bayley, N. The reliability of Bayley's revised scale of mental and motor development during the first year of life. Child Development 1966, 37_, 39-50. Wright-Smith, E. Tae role of the grandmother in adolescent pregnancy and parenting. Journal of School Health 1Q75, 45_C5), 278-283. Young, A. T. Sirkraan, B. § Rehr, H. Parental influence on pregnant adolescents. Social Work 1975, 20_C5), 387-391. Youngs, D., Niebyr, J., Blake, D. Shipp, D. Stanley, J. § King, T. Experience with an adolescent pregnancy program. Journal of Obstetrics and Gynecolog y, 1977, 50(2), 212-216. Zelnick, M. § Kantner, J. First pregnancies to women aged 15-19: 1976: and 1971. Family Planning Perspectives 1978 10_C1) 11-20. Zlatnik, F. J. § Burmeister, L. F. Low gynecologic age: An obstetric risk factor. American Journal of Obstetrics and Gynecology 1977 128(2), 183-196. ^

PAGE 154

B:IOGRAPHieAL SKETCH Julie Anne Hofheimer was born in Jacksonville, Florida, in 1952. Together with her parents, Anne and Norman, and younger brothers, Andy and Gary, she resided in Jacksonville as well as Long Island, New York, and Newton, Massachusetts. She received her B.S. in elementary and early childhood education from Florida State University in 1973 and her M.Ed, in early childhood and elementary education from the University of North Florida in 1975. Julie taught first grade and kindergarten in Orange Park and Jacksonville. She also taught early childhood curriculum at the University of North Florida as an adjunct instructor in the Department of Elementary and Secondary Education. Upon beginning her doctoral program, Julie was a seminar leader in the Childhood Education Program at the University of Florida. From September 1978 until June 1979, Julie served as Infant and Family Development Specialist on the Adolescent Pregnancy Team in the Department of Obstetrics and Gynecology. During this time she also worked as a graduate research assistant in infant development for the Department or Pediatrics, Division of Neonatology. Tliroughout the year, Julie taught and supervised graduate students in Early Childhood and Family Development Education in the Department of Early Childhood Education. Plans for her future remain tentative, but Julie's professional goals include the continuation of research, teaching, and clinical experiences with youiig children and their families. 140

PAGE 155

I certify that I have read this study and that in my opinion it conforms to acceptable standards of scholarly presentation and is fully adequate, in scope and quality, as a dissertation for the degree of Doctor of Philosophy. Athol B. Packer, Chairperson Associate Professor of Curriculum and Instruction I certify that I have read this study and that in my opinion it conforms to acceptable standards of scholarly presentation and is fully adequate, in scope and quality, as a dissertation for the degree of Doctor of Philosophy. James J. Algina Assistant Professor of Foundations of Education I certify that I have read this study and that in my opinion it conforms to acceptable standards of scholarly presentation and is fully adequate, in scope and quality, as a dissertation for the degree of Doctor of Philosophy. Patricia T. Ashtcto Assistant Professor of Foimdations of Education

PAGE 156

I certify that I have read this study and that in my opinion it conforms to acceptable standards of scholarly presentation and is fully adequate, in scope and quality, as a dissertation for the degree of Doctor of Philosophy, I certify that I have read this study and that in my opinion it conforms to acceptable standards of scholarly presentation and is fully adequate, in scope and quality, as a dissertation for the degree of Doctor of Philosophy. This dissertation was submitted to the Graduate Faculty of the Department of Curriculum and Instruction in the College of Education and to the Graduate Council, and was accepted as partial fulfillment of the requirements for the degree of Doctor of Philosophy. August, 1979 Michael B. Resnick Assistant Professor of Pediatrics ./ Robert S. Soar Professor of Foundations of Education Dean, Graduate School

PAGE 157

I 1 i


Table'5
Pearson Product-Moment Correlation Coefficients
of Mother-Infant Transaction Variables with Component Scores
Variable
Component 1
Warmth
Component 2
Reciprocity
Component 3
Responsive
Vocalization
Component 4
Negative
Affect
Component 5
Nonresponsive
Stimulation
Comments
.3136
.0615
. 0218
.1317
-.1392
Commands
. 0973
. 1176
.0197
.6683
-.0460
Criticizes
.0164
. 0154
.1313
. 7327
-.0601
Nonverbal Bids
.2431
-.1447
-.6931
-.1341
-.0979
Init.i.ating Behavior
-.2409
.6588
-.0045
.0588
.3685
Repetitive Nonverbal
Behaviors
-.1443
.1884
-.0468
- .1536
-.1162
Staccato Bursts
-.0034
-.0058
-.1076
. 0176
. 6346
Affeetionate Touch
.7897
. 0656
-.1897
-.0715
.0758
1nterfering Touch
.0007
l
o
^3
-.1074
. 7178
. .5990
Repetitive Verbalization
.1663
. 1372
.0137
.0279
-.0408
Bid to Caregiver
-.1903
-.1273
. 0456
.0679
. 0876
Vocalizations
.1668
-.1149
. 7816
-.0786
-.2180


attachment as a phenomenon. This attachment is viewed as an environ
mental adaptation evolving from the infant's attempt to gain proximity
to the primary caretaker. Attachment differs from dependency in that
it involves an affective preference for contact or multisensory
stimulation3 as opposed to the desire for the fulfillment of a physical
need. Attachment is initiated through the process of mutual gazing and
the establishment of eye contact with the mother. Observations have
shown that gazing is followed by locomotor approach. Lamb (1974)
stressed the need to view these characteristics as a series of inter
related components of behaviors which are uniquely individual expressions
and must be viewed as a part of a sequence in the transactional process.
Behaviors are then clustered to find measurable criteria without
threatening attachment as a concept.
In an attempt to categorize structural patterns and behavioral
components and to quantify optimal maternal behavioral variables,
several studies have focused attention on direct and videotaped observa
tions of dyadic interaction. Brazelton et al. (1975) stated that
"it is through an early system of affective interaction that the develop
ment of an infant's identification with culture, family and other
individuals will be fueled" (p.80). The study examined twelve pairs
of mothers and infants involved in face-to-face interaction over a twelve
month interval. Behaviors such as vocalization, head position,
direction of gaze, body position, amount of movement and handling
revealed that the quality of each partners actions were in direct
relationship to the other. The behaviors were viewed as an indication
of intentional affectivity and indicated that each partner modified


and Shands Teaching Hospital High Risk Clinic (obstetric care only).
The. daXa did. not uppoat the, kypotkeAdA that motkz/i-.infaivt tAanAactd.cn
vaxizd at, a £unction of¡ the. age. o/¡ the, motiieA.
In order to ascertain the ability of the transaction components
to predict the development of the infant, a second multivariate
multiple regression analysis was implemented. The dimensions of
mother-infant transaction were found to contribute a significant
proportion of shared variance to the infant's psychomotor development.
The component of transaction which contributed a uniquely significant
proportion was responsive vocalization.
Based upon the results of the follow-up univariate analyses, the
variables which were identified as predictors of mental development
were: 1) the age of the mother; 2) the type of prenatal care received
by the mother; and 3) the presence of prenatal complications. Psycho
motor development was found to vary as a function of: 1) responsive
vocalization of the mother-infant transaction process; and 2) the
type of prenatal care received by the mother. The regression coef-
ficents indicated that for each year of mother's age, the infants
differed, on the average, by 2.6 points on the Mental Development Index
and by 1.2 points on the Psychomotor Development Index.
The results of this study suggest that the infants of young
mothers are at risk for problematic development and would benefit
from early intervention efforts. The data also supported the idea that
the mother-infant relationship is important to the infant's development
of competence. Based upon the findings presented in this study, we
have reason to believe that more comprehensive interdisciplinary
models of prenatal, perinatal and pediatric support are associated
xi


90
Table 17
Pairwise Comparisons of Types of Prenatal
Care as Predictors of Infant's Mental Development
Pair Contrasted
Difference
Between
Means T
P
Private Physician--Public Health
18.59
1.83
.07
Private Physician-Maternal Infant Care Proj .
12.24
1.28
.21
Private PhysicianTeenage Pregnancy Team
26.36
2.68
<.01
Private PhysicianS .T.H. High Risk Clinic
2.14
.23
.82
Public Health--Maternal Infant Care Proj.
6.35
.87
.39
Public HealthTeenage Pregnancy Team
7.77
1.04
.30
Public HealthS.T.H. High Risk Clinic
20.73
2.49
.02
Maternal Infant Care Proj.Teenage Preg. Team
14.12
2.31
.02
Maternal Infant Care Proj.S.T.H. High Risk
14.38
2.10
.04
Clinic
Teenage Pregnancy TeamS.T.H. High Risk Clinic
28.51
3.94
<.01


119
How much school did your baby's father complete?
15. Are you still in school? Yes No Type
16. What is your total yearly income? $1,000 $2,000 $3,000
$4,000 $5,000 $6,000 $7,000 $8,000 $9,000
$10,000 $11,000 $12,000 $13,000 $14-16,000
$16-18,000 $18-20,000 $20,25,000 $25-30,000
$30-40,000
17.
mate or
What are your income sources? self-employment husband's employ.
AFDC
WIC
food
stamps
baby's father's
your parents /family family
18.
private public health
Where did you receive prenatal care? physician clinic (please
(Please indicate frequency) name)
MIC Clinic
STH OB Clinic
19. Where does your baby receive health care?
APT Clinic
private
public
health
MIC/PEDS Clinic STH PEDS Clinic
0.
Have your participated in any Parenting
prenatal ed. class
childbirth ed. class
psychologist or child development
books, TV, newspapers
home, economist/social service
Education or Support Program?
APT Clinic
friends
relative
church
community ed.
Where was this program located?
How often did you participate?


104
following manner:
F = [Sum of Squares (Full Model)-Sum of Squares (Reduced Model)]/5
Mean Square Error (Full Model)
Mental
Development F = [4807.1218 2669.8295] / 5
126.9150
= 2.54
Psychomotor
Development F = [12660.4948 9552.8869]/ 5
265.0281
= 5.56
The critical value is F ^ ^ 025)= 2.74. It was therefore
concluded that the shared variance of the mother-infant transactions
components--warmth, reciprocity, responsive vocalization, negative
affect and nonresponsive stimulation--contributed to the prediction
of the infant's psychomotor development, but did not contribute
to the prediction of the infant's mental development.
Followup tests (Tables 21 and 22) supported only the hypothesis
that the unique proportion of variance accounted for by responsive
vocalization contributed to the prediction of psychomotor development.
Responsive vocalization accounted for 11 percent of the variance
in psychomotor development. Based on the positive regression
weight, it can be concluded that there is a positive relationship
between responsive vocalization and the infant's psychomotor development.
An examination of the residual plots indicated that the relationship
between the two variables was linear.
Summary
The analyses presented in this chapter were designed to ascertain
the strength and nature of the relationships of the age of the mother,


30
with their children" (p. 22). Delissovoy also found young parents to
have a lack of knowledge about child development and unrealistic
expectations of the infant. It was suggested that this lack of
knowledge governed the parents' actions to the child and constituted
a form of emotional abuse. These findings were based upon interviews
conducted during five visits in the homes of 48 adolescent families
residing in semirural Pennsylvania. The results prompt a caution
regarding their generalizability due to the lack of a comparison group
of urban or adult parents (Crider, 1976).
The conslusions reached regarding young mothers' inappropriate
attitudes and expectations towards her child were discussed from the
perspective of its relationship to her intent to become pregnant. In
an age-specific sample of 408 urban women (15-29 years) Presser (1974)
found that almost half of all mothers between fifteen and nineteen years
of age wished they had postponed their first birth. The mothers cited
the reason that the infant "restricted their life choices far more than
they had anticipated" (p. 13). The author concluded that early first
births and resultant child care are in need of more indepth investigation
in order to assess their importance to the woman's development as a
mother. Klein (1978) supported this notion of the adolescents' having
been "less than adequate as nurturing mothers" (p. 1154), and concluded
that the lack of knowledge and preparation for parenthood suggested a
need for more appropriate interventions.
Epstein (1979) addressed the lack of knowledge about infant develop
ment and its implications for mothering. Cm prenatal and six months
postnatal assessments of 125 mothers in the High Scope Project, teens
evidenced a lack of knowledge about the infants' cognitive and socio-
emotional development. The author noted that "babies were seen as


If one is to succeed in leading a man
to a certain goal, one has to take care
to find him where he actually is and to
begin there; to be of real help to a
person, one must understand more than
he does, but in the very first place,
one must understand what he understands.
Kierkegaar.de


ss
Table 13
Results of the Univariate Tests of the Contributions
of Several Dependent Variables to Mother-
Infant Transaction and Infant Development
Dependent Variable
R
P
Mental Development
.34
A .
O
H-*
Psychomotor Development
.27
.06
Warmth
.23
.15
Reciprocity
.19
.32
Responsive Vocalization
.14
.05
Negative Affect
.17
.49
Nonresponsive Stimulation
.18
.44


113
Summary and Conclusions
The findings discussed in this study indicate that there is
a need to reach both parent and child at the earliest possible
moment and in a most comprehensive approach, for in this way,
individuals will be given the opportunity to develop to their
maximum potential. Meeting the special needs of the young parent
family presents a multifaceted challenge to efforts on the part
of the professional communtiy.
Although the findings of this study do not indicate the
extended family to be of importance, a special concern with the
adolescent mother is that our efforts must be focused toward not only the
young mother, but the father of her baby and the members of their
extended families, as well. This was acknowledged in the studies
of Furstenberg (1976, 1978) and Kotelchuck. (1979). Often tills will
mean extensive coordination of all phases of the clinic, school and
home-based programs. In this way, the quality of care provided
may become more truly comprehensive in nature.
A.t the heart of this approach is the primary prevention of
early pregnancy--both repeat and first pregnancies--to individuals
who are unprepared for the tasks of parenthood. With the extension
of confidential family planning services and curricula designed to
deal with the issues of human sexuality and family development,
ix is anticipated that young people will become more responsible
in their sexual activities.
Our purpose here was to explore the role of the adolescent as
a mother and her baby's development. As noted earlier, the philosophical


Table 4
Factor Score Coefficients of Mother-Infant Behaviors
Variable
Component 1
Warmth
Component 2
Reciprocity
Component 3
Responsive
Vocalization
Component 4
Negative
Affect
Component 5
Nonresponsive
Stimulation
Comments
.137
-.019
-.033
.169
-.087
Commands
.047
.049
.023
.283
-.047
Criticizes
.001
-.005
.036
.321
-.023
Nonverbal Bids
.107
-.148
-.270
-.091
-.081
Initiating Behavior
-.006
.193
.030
.123
.148
Repetitive Nonverbal
Behavior
-.053
.173
-.025
-.084
-.127
Staccato Bursts
.073
-.067
-.030
-.126
.302
Affectionate Touch
.281
-.096
-.111
-.139
.095
Interfering Touch
.008
-.104
-.068
.192
.202
Repetitive Verbalization
.108
.023
-.008
.023
.021
Bid to Caregiver
-.108
-.067
-.005
.005
.071
Vocalizations
.023
-.030
. 345
-.032
.004
Smiles at Mother
-...ag-4 _
-,090
.071
-,070
.052


5
sequentially integrated systems of readiness (Gordon, 1975). The ability
of the sensory system to receive and the central nervous system to
process information is referred to as "responsive readiness." From
this point, "adaptive readiness" allows the infant to cope with and
modify the environment accordingly. It is this reciprocal relationship
between the infant and the environment which is described as transaction
and which forms the base upon which future development and learning grow.
The attachments formed as a result of these first transactions between
parent and newborn thus become important to an understanding of
development.
Of primary significance to the newborn are those individuals with
whom the first contact is made and a relationship establishedthe mother,
father and other family members. Numerous studies have dealt with the
implications of these first bonding experiences--those which establish
the attachment of one individual to another through the unique exchange of
sensory stimulation and affective warmth (Ainsworth, 1972; Bell, 1974;
Brazelton, 1975; Klaus and Kennel1, 1976; Lamb, 1977). The use of direct
and videotaped observations of dyadic interaction has been one useful mean
of exploring the parent-child relationship. The analyses of structural
patterns and behavioral components in the observations have indicated
that several specific variables are directly related to the infant's
language, cognitive, and socioemotional growth (Clark-Stewart, 1973).
These variables include affective warmth, face-to-face orientation,,
and responsive (rather than directive) behaviors and verbalizations.
It is these attributes which are the focal point of this study. Of
special interest is the relationship between the mother's ability to
interact in a manner' which is responsive to the needs and capabilities


118
Child and Family Development Questionnaire
Six Month Evaluation
Julie Hofheimer
1.
Hospital Number
5.
Mother's Name
2.
Date
6.
Mother's DOB
3.
Baby's Birth Condition
7.
Baby's Name
4.
Baby's Birth Order
8.
Baby's DOB
10.
What is your ethnic origin?
White Am. Puerto
Rican
European
Other
Black Am. Asian
Cuban
Please
State
Am. Indian East Indian
Mexican
What is your baby's father's ethnic origin?
living with 1 or both
11.Are you married Single M F parents
living
with baby's
father
living living with
with relative
husband
living with
friend
12.With whom do you share a home?
(Check all that apply)
Mate or
Husband Father brother(s)
Mother Sister(s) children
live alone
with baby
friend (s) uncle(s)
aunt(s)
grandparent(s)
'iWho helps care for your baby?
in home
childcare friend
center
relative
13.In what type of residence do you live? home apt. trailer
campus rooming
housing house
14.How much school have you completed? Please circle highest level.
attended Jr. College
1 2 3 4 5 6 7 8 9 10 .11 12 Jr. College Degree
Vocational
Degree
Masterhs Doctoral or
Prof. Degree
College
Grad.
Degree


39
significant predictor of perinatal outcomes. The prematurity rate
was identical in the two groups. The only difference was the
adolescent's higher incidence of precipitate (less than three hours)
labor and resultant fetal damage due to unattended deliveries.
The Louisiana Infant Mortality Study (Dott and Fort, 1976)
revealed that younger adolescents were less likely to utilize
antenatal services and that, when adequate prenatal care was given,
the perinatal and neonatal death rate was significantly lower. The
authors discussed the role of social and demographic variables in the
outcomes of the infants of young women. In the discussion of the
roles of social and demographic variables in the outcomes of young
women's infants, the authors concluded that "the burden of early
motherhood falls most heavily on the offspring . infant morbidity
and mortality are the greatest risks associated with [early child
bearing]" (p. 536).
In a report of the Collaborative Perinatal Study at Johns Hopkins
Medical Center, Hardy (Welcher et al., 1971) summarized the ramifica
tions of perinatal and neonatal outcomes in her statement:
The scope of fetal wastage is two dimensional: 1) in terras of
perinatal mortality; and 2) in terms of the perinatal insult,
which while not sufficiently severe to cause fetal or neonatal
death, results in long-term handicapping conditions of the
surviving infant--for example, cerebral palsy, mental retarda
tion, congenital malformation, blindness, deafness and other
neurological defects, (p. 238)
This point was stressed as well by Dallas (1971). He extended
Hardy's perinatal risk factors to conclude that, "later fetal outcome
and intellectual performance are dependent upon the complex intera.ction
of genetic, biological and environmental variables" (p. 249).


77
Table 9
Frequency Distributions for
Infant Development Variables
Variable Frequency
Bayley Scales of Infant Development
Mental Development Index
<68 0
68-83 1
84-99 7
100 116 13
117 132 22
133+ 29
Physical Development Index
<68 0
69 83 0
84-99 8
100 116 24
117 132 35
133+
10


109
were investigated in this study, as well. The data indicated no
significant relationship between the quantity of social support
and development and transaction. This was surprising and suggests
that perhaps the basis upon which support was quantified--cohabitation,
income and childcare assistance--was not an appropriate measure of
the qualitative aspects of support which have been associated with
family development. An additional instrument to assess the qualita
tive characteristics of the mother's social support system would
assist in future studies.
The findings indicated the positive association between more
comprehensive models of prenatal care and the mental and psycho
motor competence of the infants. The most significant differences
in infants' mental and psychomotor development were found to exist
between prenatal care which offered only obstetric services and those
which included either an optional or a mandatory prenatal and
childbirth education program. The highest means on infant develop
ment were found to be those of infants whose mothers received care
in the model which included prenatal and postpartum parenting
education as well as social service referral, nutritional and
short term crisis counseling (Mahan, Note 2).
In interpreting this finding, it is important to note
that a considerably larger proportion of the invited sample of the
Private Physician care group patients participated in this study
than those who received other types of care. This suggests that the
measures reflect those of more motivated mothers in the other


17
competence (Lamb',. 1976b:}. During unstructured, free-¡pi ay in a laboratory
playroom, observations of twelve month olds were used to measure
the effects of each parent on the transaction process involving
the other parent. The effect of a stranger's presence (a stressful
situation) was also investigated in this study. The findings indicated
a significant reciprocal effect in the presence of both parents on
both mother-infant and father-infant relationships. The infant's
affiliation behaviors -- smiling, reaching and touching -- and
interaction during play showed a preference for the father. In a
stressful situation, however, primary attachment surfaced and infants
under two years of age sought proximity to the mother. Lamb (1976)
points out that the results of his two studies should not be used to
equate affiliation with attachment as an affective preference for
one parent or the other.
The findings that early interpersonal transactions are of
importance to the young child's development of competence stimulated
further investigation into the expanding socialization process.
This process has been shown to have a pronounced relationship to
total development in infancy and throughout early childhood. The
parent-child relationship was shown to be related to the language,
social, emotional and mental development measures of infants who
were followed from nine to eighteen months of age (Clarke-Stewart,
1973).
Based upon the assumption that the infant is preadapted to
selectively attend to stimuli and facilitate adult-infant interaction,
numerous studies have explored the notion that reciprocity is an


BIOGRAPHICAL SKETCH
Julie Anne Hofheimer was born in Jacksonville, Florida, in 1952.
Together with her parents, Anne and Norman, and younger brothers,
Andy and Gary, she resided in Jacksonville as well as Long Island, New
York, and Newton, Massachusetts. She received her B.S. in elementary
and early childhood education from Florida State University in 1973
and her M. Ed. in early childhood and elementary education from the
University of North Florida in 1975.
Julie taught first grade and kindergarten in Orange Park and
Jacksonville. She also taught early childhood curriculum at the University
of North Florida as an adjunct instructor in the Department of Elementary
and Secondary Education.
Upon beginning her doctoral program, Julie was a seminar leader in
the Childhood Education Program at the University of Florida. From
September 1978 until June 1979, Julie served as Infant and Family
Development Specialist on the Adolescent Pregnancy Team in the Department
of Obstetrics and Gynecology. During this time she also worked as a
graduate research assistant in infant development for the Department of
Pediatrics, Division of Neonatology. Throughout the year, Julie taught
and supervised graduate students in Early Childhood and Family Development
Education in the Department of Early Childhood Education.
Plans for her future remain tentative, but Julies professional goals
include the continuation of research, teaching, and clinical experiences
with young children and their families.
140


TABLE OF CONTENTS Continued
PAGE
V. DISCUSSION AND IMPLICATIONS 106
The Age of the Mother as a Predictor of
Infant Development and Mother-Infant Transaction . 106
Prenatal and Perinatal Factors and Socioenviron-
mental, Medical and Educational Resources 108
The Prediction of Developmental Risk
in Infancy 110
Mother-Infant Transaction as a predictor
of Infant Development 112
Summary and Conclusions 113
APPENDICES
A. PARENTS CONSENT 115
THE ASSESSMENT PROTOCOL 116
CHILD" AND' FAMILY DEVELOPMENT QUESTIONNAIRE ... 118
B. DEFINITIONS OF"MOTHER AND INFANT BEHAVIORS .... 120
C. BAYLES SCALES' OF INFANT -DEVELOPMENT '123
D. PERINATAL 'RISK- SCA-LB 126
REFERENCES 131
BIOGRAPHICAL SKETCH
140


50
Of the 250 invited subjects, 92 participated in the study; complete
data sets were obtained for 77 of these subjects. This attrition rate
is comparable to that found by Resnick et al. (1978). The sample thus
represents those subjects who were motivated to participate. Attrition
was also due to other variables associated with poverty and/or early
parenthood such as: 1) lack of trans^ro^ation; 2) conflicting school
and work schedules; 3) moving out of the state; and 4) giving the
baby up for adoption. Many families traveled as many as 150 miles to
participate in the study.
During the course of the data collection process, the investigator
questioned a random number of subjects as to the reasons for participating
or not participating in the study. Responses included: "I thought I
was supposed to come! "I wanted to see how my baby was doing -- if he
was doing o.k. "We don't have a camera and I wanted a picture." "I
was worried about my baby's arm, leg/ear." Negative responses included:
"My baby's fine and I don't need you to tell me! I'm already potty
training him."
Frequent attempts were made to call each family for whom a phone
number was listed. In three telephone conversations, mothers refused
to bring their babies to the clinic. These were private patients who
were living in the Gainesville area. A total of 80 families were reached
by phone prior to their appointments. Of the families who agreed to
come, only 10 did not participate (2.5 percent).
Procedure
All subjects in the sample were contacted by mail to notify them
that their babies were scheduled for a six month developmental assessment


73
Table 6
Interobserver Reliability of
Mother-Infant Transaction Components
Component r
Warmth .91
Reciprocity .97
Responsive Vocalization ,75
Negative Affect .80
Nonresponsive Stimulation
.70


59
Table 2
Means and Standard Deviations
for Beckwith Behavior Variables
Variable
Mean
SD
Comments
7.6154
5.7349
Commands
.7564
1.5474
Criticizes
.6923
1.6221
Nonverbal Bids
3.7051
3.6328
Initiating Behaviors
13.0897
5.2476
Repetitive Nonverbal Bids
.0251
.8430
Staccato Bursts
.6667
1.904
Affectionate Touch
1.7692
2.8916
Interfering Touch
1.9744
2.2961
Repetitive Verbalizations
.2308
.8046
Bid to Caregiver
. 6667
1.1584
Baby's Vocalizations
1.6538
2.4697
Baby's Smiles
.9487
1.9863
Self-Stimulation
.0128
.1132
Vacant Behavior
.0128
.1132
Baby Explores
16.7051
9.3602
Baby Fusses
1.0769
3.1200
Mother's Positive Response
4.1026
2.9081
Mother's Negative Response
.1026
.3810
Mother's Contingent Vocalizations
1.1026
1.9177
Face-to-Face Orientation
3.5513
3.6597


Copyright 1979
by
Julie Anne Hofheimer


21
The Young Mother and Her Infant
Churchill once said crisis is a dangerous opportunity.
If pregnancy in adolescence can be defined as the
crisis, what [happens to] the infant may well be the
dangerous opportunity.(Howard, 1976, p. 247).
This "dangerous opportunity" to which Howard referred is one about
which very little is known. The past decade has given rise to great
concern about the increasing numbers of adolescents who become
parents each year. We have begun to investigate the medical, social,
economic, psychological and educational consequences of early pregnancy
and parenting, but surprisingly few studies have dealt with the
development of the infants of very young mothers. Even less is
known about how the young mother relates to her baby--the strengths
and weaknesses in her style of parenting. To date, too few observation
al studies exist which document her unique repertoire of mothering
behaviors. Our present sources of knowledge are thus lacking in
relevant information and are limited by a lack of methodological
refinement in early research.
Before proceeding to a discussion of the research related to
early parenting,it is necessary to explain some of the methodological
problems in this area. In two separate reviews of the research,
Crider (1976) and McKendry, et al., (1979) cautioned against the
attempt to generalize from existing studies. In many cases, biases
in our present sources are due to sample selections which were lack
ing in age specificity and inappropriate methodological procedures.
Specifically, the analytical treatment of variables such as socio
economic status and mothers' age was such that we do not know how
much each contributes separately to the outcome measures of early
pregnancy and parenting. A persistent bias is found when statements


86
Table 14
Results of the Multivariate Significance
Tests of Contributions to Mother-Infant
Transaction and Infant Development
Variable
P*
df
P
Mother's Age
1.45
7,57
- .20
Baby's Birth Order
1.07
7,57
.. .40
Baby's Sex
2.05
7,57
, .06
Ethnic Origin
1.35
7.57
. .25
Social Support System
. 84
7.57
. 56
Mother's Education
.93
7.57
. .49
Yearly Income
1.81
7,57
. .10
Type of Prenatal Care
1.60
28,206
. .03
Prenatal Complications
1.37
7,57
. .23
Perinatal Risk
1.11
7,57
. .37
transformation of Wilks' Criterion to an F statistic


APPENDIX B
DEFINITIONS OF MOTHER AND INFANT BEHAVIORS
Adapted Beckwith Behavior Scale
* -
ernal Behaviors
1. Comments: positive verbalizations; all positive vocalizations
'including questions, praises, suggests, focuses verbally.
2. Commands: mother-oriented, directive and forceful verbalizations
clear imperative to initiate action.
3. Criticism: clear request to terminate action or verbalizations
which are critical or hostile or derogatory.
4. Nonverbal bids: positive touch, help, facilitate, provide.
5. Initiating behaviors: self-oriented maternal behavior;
getting baby's attention in some nonverbal way, actions which
direct baby in a different direction rather than extending
baby's behavior.
6. Repetitive nonverbal bids: repeating the same or similar
bids over and over for several 15-second period. This has
a monotonous quality, such as presenting different toys
one after the other in a very similar manner.
7. Staccato bursts: rapid bursts of maternal behavior which
allow little or no time for infant response.
8. Affectionate touch: kiss, pat, hug, nuzzle, etc.
9. Interfering touch: mother touches baby to distract, inhibit
orf-going .activity. Includes hitting, moving object from hands,
pulling back, etc.


36
The neonatal complications indicated by low Apgar scores (_< 5),
central nervous system depression, pallor and decreased tone were
found to occur significantly more often in babies of adolescent mothers.
These findings offer important information to be considered in the
assessment of the developmental status of newborns of very young
mothers. A methodological concern should be noted with regard to the
author's comparison of their sample's results to a previously unspeci
fied sample of older teens and "of age" mothers.
The findings, as discussed above, about perinatal risk and mortality
of very young 16 years) adolescents, have been consistently
documented throughout the obstetric and pediatric research (McGanity
et al,, 1969; Crider, 1976; Jones and Placek, 1978; Knox, 1971; and
McKendry et al., 1979). Additional obstetric complications of
mothers under 16 years of age were found by Knox (1971). Very young
adolescents were noted to have a significantly higher incidence of
cesearean section births, premature rupture- of membranes and prolonged
labor. Other obstetric complications summarized by McKendry et al.
(1979) and Crider (1976) included abnormal presentations and infections
at delivery (McGanity et al., 1969), uterine dysfunction and one day-
fever (Coates, 1970), and cephalopelvic disproportion (irregular size
or position of the fetus head in relationship to the mother's pelvic
structure) (McKendry et al., 1979). These problems have been related
to the physiological and gynecological (the time span between the age
at menarche and first pregnancy) immaturity of the mother (Zlatnik
and Burmeister, 1977; Erkan, Rimer and Stein, 1972).
- The relationship between adolescents' obstetric complications and
neonatal risk has been closely studied by several authors (Crider, 1976;
McKendry et al., 1979; Mecklenburg, 1973; Dott and Fort, 1976;


58
These studies must be read carefully as a result of differ
ences in sample characteristics, the lack of controls, and
the inconsistency of terminology. The reader should be
especially wary of many review articles that treat these
medical conditions as proven fact; ironically, many times
these reports base their conclusions on inconclusive findings
(Stewart, 1976). However, there appears to be more credence
in the proposition that the young girl and her infant are high-
risk . patients > than in the proposition that they are
not. (p. 23) .
When variables other than mother's age were analyzed as predictors of
perinatal and neonatal status, the findings revealed no significant rela
tionship to the age of the mother. The variables that were consistantly
noted to predict obstetric and neonatal outcomes were: 1) nutritional
status of the mother; 2) socioeconomic status; 3) quantity of prenatal
care; 4) parity (number of prior pregnancies); and 5) spacing of births
(McKendry et al. 1979; Menken, 1972; Dott and Fort, 1976; Stine, Rider
and Sweeny, 1974; Mecklenburg, 1973). As noted earlier by Dott and Fort
(1976), many of the nutritional, obstetric and family planning problems
of adolescents are "controllable," but control remains dependent
upon the professional community's ability to make these services
available to young women and the woman's motivation to use them.
Dwyer's (1974) study of 231 12-16 year olds enrolled in a prenatal
program found no significant incidences of anemia, toxemia, labor and
delivery complications, low Apgar scores or post-partum problems. Pre
mature birth did result in 39 cases, however. While Dwyer's findings
are promising and suggest the managability of the adolescent's perinatal
outcome, they are based on a study which failed to use a comparison
group of older women or those with different prenatal care.
Semmens (1961) study of 12,847 adolescents and nonadolescents
who received care in a U.S. Naval Hospital found socioeconomic
status, rather than race, marital status or age, to be the most


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APPENDIX A
PARENT CONSENT FORM
The first months of life are important as families grow. For
this reason, we would like your permission to study how your baby's
body and mind are developing. The study involves making a videotape
(like a television film) of you and your baby playing and using the
Bayley Scales of Infant Development to study your baby's mental and
physical abilities. We will be happy to answer any questions before,
during or after the study. You will be informed of the results of
the study and will be sent a photograph of you and your baby and a
book of baby exercises, games and learning activities.
We are looking forward to working with you and your family and
hope you will agree to be a part of our study. If you will agree to
participate, please sign below.
In the event of sustaining a physical injury which is proximately
caused by this experiment, professional medical care will be provided
for me at the J. Hillis Miller Health Center. There will be no charge
to me, exclusive of hospital expenses.
I, have read and under
stood the informed consent statement and give my permission for studying
my child and using the information and videotapes for research and
teaching purposes. I also realize that I may change my mind and
withdraw my permission at any time.
Witness Signed
Witness Relationship
to Child
115


35
The Children of Very Young Mothers : Perinatal Risk Factors
Thus far, we have discussed early pregnancy and parenting from
the perspective of the young mother. Of equal importance are the
consequences of early childbearing and childrearing for the infants
born to adolescents. Intuitively, we can guess that these infants
are at high risk for medical, developmental and educational problems.
Several factors have been brought to our attention by Crider (1976)
and McKendry et al. (1979) in their reviews of the risks associated
with adolescent pregnancy. The increased obstetric and neonatal risk
of pregnancy in a physiologically immature woman has been repeatedly
documented to have long range ramifications on the developmental
outcomes of the infant (Grant and Heald, 1970). This is often
complicated by delayed and inadequate prenatal care, poor nutritional
status, economic impoverishment, social isolation and emotional stress
(McKendry et al., 1979). As with much research on early parenting,
the investigations of the relationship between these factors and infant
development have revealed inconsistent findings. They do, however,
offer relevant information regarding the consequences of early pregnancy
and parenting for the infants of young mothers.
The most recent investigation of the prenatal, perinatal and neonata
complications associated with adolescent pregnancy was discussed by Ryan
and Schneider (1978) at the University of Tennessee Center for the Health
Sciences. The authors studied the obstetric performance and the status
of the neonate at birth among a predominantly black sample of 222 teens
who were 19 years of age or less at delivery. The findings revealed
these patients to have high rates of inadequate prenatal care, prenatal
complications and complications during labor and delivery. The perinatal
death rate was found to be twice that of the general population.


48
to be self-initiated and without regard to the behavior
of another individual.
5) Mother-Infant Transaction refers to the entire repertoire
of interaction behaviors between mother and infant.
6) Developmental Delay refers to a score of 68 or less on either
the Mental or Psychomotor Development Index of the Bayley
Scales Infant Development.
7) High Risk for developmental delay refers to a score between
68 and 84 on either the Mental or Psychomotor Development
Index of the Bayley Scales of Infant Development.
8) At Risk for developmental delay refers to a score between
85 and 100 on either the Mental or Psychomotor Development
Index of the Bayley Scales of Infant Development.
9) Prenatal Care by Private Physician refers to those patients
who received obstetric treatment from physicians in the
Private Diagnostic Clinic at Shands Teaching Hospital.
10) Public Health Department Prenatal Care refers to those who
received obstetric care at a public health department clinic.
11) Maternal-Infant Care Clinic Treatment involved patients in a
13 county area surrounding Gainesville, Florida. These
patients received prenatal and postpartum obstetric, neonatal
and pediatric care, family planning services, social service
and nutritional counseling and optional prenatal childbirth
education (Mahan and Eitzman, Note 5).
12) Teenage Pregnancy Team Care refers to patients who received
prenatal and postpartum obstetric, neonatal and pediatric


ACKNOWLEDGEMENTS
Throughout the course of my doctoral work there have been a number
of individuals who have contributed a great deal. It is with a most
special appreciation for their sensitivity that I recognize them.
The author gratefully acknowledges the contributions of Dr. Charles
Mahan and Ms. Marci Hall of the Department of Obstetrics and Gynecology
for the support of this study. Appreciation for their cooperation is
also extended to Drs. Don Eitzman, Michael Resnick and June Holstrum
of the Division of Neonatology. Department of Pediatrics. These indivi
duals offered a great deal of sensitivity to this study of mothers and
their babies and represent the College of Medicine's humanistic approach
to the family.
Of most importance to the author were the continued guidance and
thoughtful encouragement; the time and care taken in the midst of
hectic schedules. It is with heartfelt thanks that appreciation is
extended.
My chairman, Dr. Athol Packer, has my deepest respect and grati
tude for his gentle direction and thoughtful guidance. My thanks, too,
for his patience in teaching me to reason with feeling and feel with
reason. His consistent support and open-minded faith in me has been
a most important part of my growth.
To Dr. Michael Resnick, a special thanks for opening up a whole
new world and allowing me to dream dreams and make them come true.
I am appreciative, as well, for being given the freedom to explore.
It is for all of his creative idealism that I am especially grateful,
.v


107
The age of the mother did, however, contribute to the prediction
of her baby's mental development when transaction was considered
as a dependent variable. The age of the mother was also associated
with her baby's mental development when the proportion of variance
accounted for by mother-infant transaction was held constant. The
data suggested that the infants of younger mothers were less competent
on a measure of mental development and that, as mother's age increased,
so did the infant's mental development.
The problem of multicolinearity could not be dealt with
adequately in this study due to the need for an extreme large data set.
It is therefore difficult to tease out the unique contributions of
mother's age and education, ethnic origin, birth order, yearly income
and prenatal complications. For instance, it remains unknown whether
the infant's development is threatened by the fact that the mother is
young or if development is threatened by the mother who is prone to
problematic pregnancy due to poor nutrition (anemia and toxemia),
infection and venereal disease. Specifically, are mothers who are
more likely to have complications during pregnancy and have fewer
material resources also less able to stimulate the mental development
of the infant?
The significance of the association found between mother's age
and the infant's mental development is in accord with other research
concerned with the infants of adolescent mothers (Hardy er al., 1S78).
The implications of rhe present findings indicate a need for early and
intense developmental and educational intervention protocols which are
designed to enhance the competence of the infants of young mothers in
order to prevent long term handicapping conditions.


3
The impact of the transition to parenthood on the individuals
involved as it related to future parent-chiId transaction has been the
subject of many current studies, Brazelton's (1973) findings suggest
critical interrelated components through which the mother forms the
beginning of attachment to the infant. The stages include: 1) plan
ning the pregnancy; 2) confirming the pregnancy; 3) accepting the
pregnancy; 4) acknowledgement of fetal movement; 5) acceptance of the
fetus as an individual; 6) birth; 7) seeing the baby; 8) touching the
baby; and 9) giving care to the baby. Russell's (1974) examination of
511 couples and their 6-56 week old infants supports the view that the
transition to parenthood is a crisis situation which involves a reorga
nization of the family's social structure. This change in family
relationships was noted to be "bothersome" to new parents. Relevant
adaptational factors noted by Russell from self-report checklists were:
1) the pattern of communication which affected the planning of the birth
and a positive adjustment to marriage; 2) a high degree of commitment to
the parenting role; 3) good maternal health; 4) a nonproblematic baby;
and 5) preparation for parenthood. These factors are compounded in
magnitude in the developmental tasks of the adolescent mother.
Of special concern for the very young mother is her ability to cope
with the multidimensional aspects of parenthood and to facilitate positive
transactions with her child. The five factors discussed above suggest
the need for further exploration as they involve two very specific
developmental tasks: 1) the adolescent's acquisition of an independent
concept of self; and 2) the parent's role transition from an individual
to a member of either a dyad or a triad. When one considers the magni
tude of each of these tasks separately and then as occurring simultaneously,
the situation of the young mother and her baby becomes potentially more
devastating.


19
essential characteristics of social reciprocity. From initial attachment
bonds, the infant acquires skills in evoking a response and, as a result,'"crus
an "emotional connectedness" is formed between the infant and others
(Bell, 1974; Brazelton et al., 1975].
In looking at the quality of interaction of mothers and their young
children, we can better understand the impact of the mother-infant rela
tionship in infancy. A recent study of early mother-child verval inter
action indicates the mother's capability to adapt her language behavior
to cues from the young child. Moerk (1975) found a correlation between
the mode, length and complexity of mothers' responsive language and the
child's developmental level. This suggests that the young children's
competence is related to their mothers' modeling, explanation, corrective
feedback and expansion of their behaviors and ideas. Holtzman's (1974)
findings further illustrate this concept of social learning in verbal
content which stimulated the child to work through "contextual solutions
from within his cognitive repertoire" (p. 34). The nonverbal aspect of
interpersonal communication between five year olds and their mothers was
explored by Schmidt and Hore (1970) They noted a difference between
sopntaneous signals not intended as communication and expressive
behavior transformed by the intention to communicate. Their findings show
more use of reciprocal glancing and complex language with children of
higher socioeconomic status. No significant differences in body contact
or closeness were found to be associated with socioeconomic status.
Emotional implications of the verbal and nonverbal environment
were the subject of investigations done in sequential semi-structured
observations of one and two year olds in middle class homes (Nelson,
1973). It was found that nondirective parental strategies which were
accepting of the child's behavior, including feedback and nonselective


136
Huitt, W. G. An analysis of reliability of parent-infant interaction
through the use of generalizability theory. University of
Florida: Doctoral Dissertation, 1978.
Jessor, S. L. § Jessor, R. Transition from virginity to nonvirginity
among youth: A social-psychological study over time. Developmental
Psychology, 1975, 11(4), 473-484.
Jones, A. § Placek, P. Teenage women in the U. S. A.: Sex, contraception
pregnancy, fertility and maternal and infant health. Paper presented
at the Family Impact Seminar Conference on Teenage Pregnancy,
George Washington University, October, 1978.
Kane, F.. § Luchenbruch, P. Adolescent pregnancy: A study of aborters
and nonaborters. American Journal of Orthopsychiatry, 1973, 43(5),
674-680.
Klaus, M. § Kennell, J. Maternal-infant bonding. St. Louis: C. V.
Mosby, Co., 1976.
Klaus, M., Kennell, J., § Trause, J. Maternal behavior one year
after early and extended postpartum contact. Developmental
Medicine and Neurology, 1975, 16, 40-73.
Klein, L. Antecedents of adolescent pregnancy. Clinical Obsterics
and Gynecology, 1978, 21_(4), 1151-1159.
Klein, L. Early teenage pregnancy, contraception and repeat pregnancy.
.American Journal of Obstetrics and Gynecology, 1974, 120(20),
263-267.
Knox, E. Teenage mothers: A pediatric and obstetric group at high
risk. Minnesota Medicine, 1971, 43_, 701-703.
Kotelchuck, M. Pediatric social illness: Prediction and misclassi-
fication. Paper presented at Society for Research in Child
Development, San Francisco: Biennial Convention, 1979.
Lamb, M. E. A definition of the concept of attachment. Human Develop
ment, 1974, _17_(5) 376-385.
Lamb, M. E. Effect of stress and cohort on mother-father-infant
interaction. Developmental Psychology, 1976(a), 12(3), 435-443.
Lamb, M. E. Twelve month olds and their parents: Interaction in a
laboratory playroom. Developmental Psychology, 1976(b), 12(3), 334-3
Lamb, M. E. A re-examination of the infant's social world. Human
Development, 1977, 25_, 65-85.
Lazar, J, B. § Chapman, J, E. A review of the present status and
future research needs of programs to develop parenting skills.
Interagency Panel for Early Childhood Research 6 Development
(Grant #OCOC3107), 1972 Social Research Group, George Washington.
University, Washington, D. C.


comprehension of communication by others. The motor scale measured
gross body control and locomotion and fine motor coordination.
Additional features of the instrument were its adaptability to the
testing situation and the availability of a trained evaluator.
Appropriate features of the test include the test materials, which
were highly attractive to infants, and the administration of the
test which allows the infant to be held by the mother. Split-half
reliability coefficients for the motor and mental scales at six months
are reported as .89 and .92, respectively (Bayley, 1969).
In their study of test-retest reliability (with eight month olds)
Werner and Bayley (1966) noted correlations between first and second
assessments of mental and motor development to be .76 and .75, respec
tively. These assessments were one week apart. Items involving emerging
skills in social and interpersonal development and motor coordination
were found to have a test-retest reliability of .76. This issue is
especially important in a study of six month olds as this is a critical
time for the emergence of several new behaviors. It is therefore
necessary to acknowledge that a baby's score at six months could vary
greatly from day to day.
Inter-observer agreement is another aspect of reliability studied
by Werner and Bayley (1S66). These coefficients were noted to be
"markedly higher" than independent assessments since the same assessment
was scored by each observer. Tester-observer reliability was found to
be .89 and .93 on mental and motor development, respectively.
Examples of items in the scales can be found in Appendix C.


22
of generalization about the parenting style of adolescents are made
without regard to the design of the given study. For example, many
authors described negative behaviors of the adolescent parents
(DeLissovoy, 1973; Presser, 1974), but the sampling was such that only
adolescents were included. If one is to suggest that young mothers
display a higher incidence of dysparenting, it is necessary to include
the "of age" mother in the design. Without this inclusion, we are
unable to ascertain the relative contribution of mothers age to her
style of parenting. A similar constraint is placed on generalization
from studies of the infants of adolescent mothers. For this reason
limitations will be noted in early research concerning the young mother
and her infant.
In order to better understand the consequences of early child
bearing on the mother and her infant it is necessary to compare the
young mother to her "of age" peer. Variables of interest include the
trends in birth rates, medical risks to the neonate and follow-up
assessments of the infants of adolescents. This review wil 1 therefore
address these issues from the perspective of their relationship to
the adolescent's role as a mother and the development of her baby.
The Etiology of Early Pregnancy
In looking realistically at newer research on adolescent parenting,
it is evident that there are two distinct categories. One is the study
of pregnant teenagers and the second is the study of teenage mothers.
In other words, tkeAZ -os a ¡VUklng dLLfztimcz beJwzzn bacmng a
pmgnant te.znc.gzn. ¡2nd bcoining a tzznagz mothzn.. This issue is
concerned with the element of choice upon the confirmation of pregnancy.
The individual often is able to choose whether to: 1) abort or
continue the pregnancy; and 2) give the baby up for adoption or under
take the tasks of parenthood.


passive creatures requiring little more than basic caregiving" (p. 64).
The expectation of "too little -- too late" led to her conclusion that
because young mothers are unrealistic about what they need to give, they
"are likely to miss the gratifications able to be received from a baby"
(p. 64). The results of this study provide valuable information regarding
the educational needs of young mothers. Again, we are unable to ascertain
whether or not this lack of knowledge is attributed to youth due to the
lack of a comparison group of older mothers.
The findings regarding the problematic mothering style of the
young mother have led to the often unwarranted conclusion that
adolescents are likely to abuse and neglect their children to a
significantly greater extent than the "of age" mother. Epstein (1979)
contrasts her findings of expecting "too little, too late" with the child
abuse literature regarding abuser's expectations of "too much, too soon."
Crider (1976) noted the fact that most of the child abuse studies have
found the infant's birthweight, not the age of the parent, to be signifi
cantly related to abuse.
Kotelchuck's (1979) most recent investigation into the prediction
of pediatric social illness has illuminated the relative importance
of the mother's age in predicting child abuse and dysparenting. His
findings from a study in Boston revealed the parent's social isolation
to be the most significant predictor of inappropriate or abusive parent
ing. In a discriminant analysis which accounted for 40 percent of the
variance among abusers and nonabusers, the author found all measures
of depression and isolation to be significant. No significant relation
ship was found due to mothers age,
baby temperment.
immediate stress, birth factors or


CHAPTER IV
RESULTS
The purpose of this study was exploratory in nature and was
based on the fact that relatively little is known about the develop
mental outcomes of very young mothers and their infants. The analyses
were implemented in order to ascertain the contributions of the
mother's age, social support system, perinatal risk status, type of
prenatal care, type of prenatal childbirth education and type of
parenting education as they related to mothers' transactions with
their infants and the infants' development. The questions addressed
in this study and the analyses are discussed in this chapter.
The Dimensions of Mother-Infant Transaction
Before proceeding to the analyses which addressed the major
questions posed by the study, the dimensions of mother-infant
transaction were studied. The number of behaviors in each category
of the Adapted Beckwith Scale were first tallied for each subject.
A correlation matrix of the variables was then subjected to a Principle
Components analysis.
The analysis yielded eleven components with eigenvalues
greater than 1.0. These components accounted for 74 percent of the
variance. The components corresponding to the five largest eigenvalues
were rotated using the Varimax procedure. The five rotated components
64


97
coefficients indicated that for each year of mothers age, the infants
differed, on the average, by 2.6 points on the Mental Development Index
and by 1.2 points on the Psychomotor Development Index.(Table 22).
Question ten was concerned with the relationship between perinatal
risk and development at six months. Mo significant association was
found to exist between perinatal risk and either mental or psychomotor
development.
The presence of prenatal complications (anemia, toxemia, infection or
venereal disease) was found to have a negative relationship with the
infant's mental development and accounted for 12 percent of the variance.
No deviations from linearity were evidenced on the plot of the residuals
against prenatal complications; it was therefore concluded that there
was a negative linear relationship between prenatal complications and
mental development. No significant relationship between prenatal
complications and psychomotor development was found.
Responsive vocalization, the component which included the behaviors
baby's vocalizations, mother's contingent vocalizations and baby's
contingent vocalizations,was found to have a positive relationship
to the infant's psychomotor development and accounted for 11 percent
of the variance. No significant relationship was found to exist between
responsive vocalization and mental development.
The type of prenatal care contributed to the prediction of
both mental and psychomotor development. Pairwise comparisons of the
four groups indicated that the means of those infants whose mothers
received treatment by a private physician scored significantly lower
on both mental and psychomotor indices than those who received care


15
Tlie effects of the quality of mother-infant interaction on the
development of both mother and infant has been investigated as well.
An intensive nine month study of 369 eighteen month olds in repeated
observations, interviews and developmental assessments, lends support
to a view of social competence in the infant and 'a dependence upon
its nurturance through reciprocal transactions (Clarke-Stewart, 1973).
Findings indicated a significant relationship between maternal stimulation,
responsiveness, and expression of affection and the child's developmental
changes and social, emotional, cognitive, and language competence.
The most influential factor was found to be the quality, rather than
nonresponsive quantity, of verbal stimulation. Other important factors
included the mother's role as an environmental mediator, her expression
of positive emotion, and frequency of responsiveness, stimulation, or
affectionate behavior as it related to the child's competence. The
data suggested that responsiveness to the infant's behavior had a duel
effect as it not only reinforced specific behavior, "but created an
expectancy of control within the infant which generalized to new
situations and unfamiliar people" (Clarke-Stewart, 1973, p. 107). Other
studies indicated maternal involvement with the neonate immediately
after birth as having positive effects on the mother's psychological
state and thus her ability to reciprocate responsively (Powell, 1974;
Klaus, Kenneil and Krause, 1975).
The fact that many adolescents do marry or enlist the support of
thetfather necessitates .a.ibti-ef discussion of current-studies which have ex
plored the importance of the father's role and his transaction with
the infant. By means of a self-report questionnaire and interviews, Wente and
Crockenberg (1976), examined the nature of the transition to fatherhood
with respect to the husband-wife relationship and the effect of Lamaze


APPENDIX D
PERINATAL RISK SCREENING
Calvin Hobel (UCLA)
Baby's Name
Hospital # Risk Score
I. Prenatal Factors
1.
Toxemia (moderate to severe)
10
13.
Age 35 or £ 15
5
2
Chronic hypertension
10
14.
Viral disease
5
3.
Mod-severe renal disease
10
15.
Anemia
5
4.
Eclampsia
10
16.
Excessive drug use
5
5.
Diabetes
10
17.
TB history
5
6.
Rh exchange
10
18.
Wt 100 or 200
5
7
Uterine malformation
10
19.
Pulmonary disease
5
8.
Incompetent cervix
10
20.
Flu syndrome
s
9.
Abnormal fetal position
10
21.
Smoking 1 pack/day
1
10.
Small pelvis
5
22.
Ahlcohol
1
11.
Abnormal cervical cytology
10
23.
Emotional problem
1
12.
Multiple pregnancy
10
24.
Infection
1
25.
Severs heart disease
10
126


75
Table 7
Frequency Distributions for Several Independent Variables
Variable Frequency
Variable
Frequency
Mother's Age
Baby's Sex
< 15
5
Male
40
16-17
21
Female
37
18-19
12
Baby's Birth Order
20-24
18
1st Born
54
> 25
21
2nd Born
17
Race
3rd Born
5
Black
42
7th Bom
1
NonBlack
35
Yearly Income
Prenatal Care
< $3,000
19
Teenage Pregnancy Team
20
$3,000 $5,000
18
Maternal Infant Care Proj.
19
56,000 $10,000
21
Shands Teaching Hospital
13
$11,000 $20,000
15
Public Health Department
9
> $20,000
4
Private
16
Social Support System
Mother's Education
0 Living alone-no asst.
1
<12 years
37
I Cohab. Support Only
53
12-14 years
31
2 Cohab. q Income or
38
Childcare Asst.
15-18 years
9
3 Cohab. § Income 8
5
Prenatal Complications
Childcare Asst.
Uncomplicated Pregnancy
59
Perinatal Risk Status
Presence of Complication in
18
< 10 Points
37
Pregnancy (Anemia, Toxemia
Veneral Disease or Infec-
>
10 19 Points
20
tion)
20 40 Points
18
> 40 Points
2


?
The essence of "comprehensive care" involves a thorough under
standing of the adolescent undertaking the tasks of early parenthood.
It is through this understanding that our interdisciplinary efforts
may become more sensitive to the complex needs of the young mother,
her infant and her family. The commitment to quality care implies
a change on the part of the professional community--a change based on
empirical evidence which documents the educational and developmental
competencies and capabilities of the very young mother. By focusing
on the &£A.zngt}i& within the family, our efforts will project a more
supportive quality. It is this belief in the positive characteristics
of young parents--courage, enthusiasm, adaptability and, above all, an
optimistic view of the future--that is the philosophy upon which this
study is based.
Adolescent Family Development: The Scope of the Problem
The threatening impact of early parenthood has become a source of
great concern in the recent past. In 1976, the Guttmacher Institute
reported that about 10 percent of American adolescents become pregnant
each yearone million young women. Ninety-four percent of these
women have chosen to keep their babies. What happens to these young
families remains a challenging question.
The early years of parenthood, even under the most optimal circum
stances, are commonly viewed as a transitional period--one in which the
individual is attempting to establish equilibrium and adjust to the
responsibilities of becoming a parent; of caring for another human
life (Rossi, 1968' ; Packer, Resnick, Wilson.and Resnick, 19:79). This
can be an extremely stressful period for all members of the family.


117
infant's developmental strengths and weaknesses, and give the mother
illustrated descriptions of the activities demonstrated. Following
the assessment, mothers will be interviewed to obtain demographic
information.


The impact of the extended family has yet to be explored within
the content of varying mothers' ages. This is especially important
in view of the large number of single-parent adolescent families.
The most recent estimates reveal that "39 percent of the children
whose mothers gave birth before the age of 20 experienced a family
breakup by age 15" (Family Planning Perspectives, 1979, p. 115).
Intervention With Young Mothers and Their Infants
In reviewing the outcomes of early parenting with respect to
the mother-infant relationship, we are confronted with disturbing
findings. Perhaps the most promising results, while few in number,
have been the investigations of interventions designed to assist the
young mother through her transition to parenthood.
In a smaller (N = 39), quasi-experimental evaluation of the ef
fects of weekly mother-infant classes in a pediatric clinic. Badger
(1974) found significant gains in mothers' knowledge of infant develop
ment, nutritional needs and infant health care. Most promising were
the significant increases in mothers' responsiveness to their infants
and the infants' increased responsiveness to the mothers. Badger noted
that the program had a significantly stronger impact on the behaviors
of the youngest mothers.
In an educational and medical program for adolescents in Syracuse,
Osofsky and Osofsky (1973; 1978) examined the mother-child relation
ship among 450 dyads. The authors noted the young mother's warmth,
physical interaction and attentiveness to their infants as being a
strong foundation upon which interventions were based. They also
found a major weakness to be a lack of verbal interaction. While


responding, were significant in the facilitation of emotional and
language development. Behavioral evidence which supports the effects
of encouragement and reflective responsiveness was seen in laboratory
observations of mother-child transaction as facilitating attention control,
spatial orientation and field-independent cognitive styles (Bronson,
1972; Campbell, 1975). In studies relating infancy to early childhood,
the child of between three and five years was seen as able to interpret
the level of expressiveness and abstractness and was developmentally
verging on the ability to differentiate the "perspective reality orien
tation'1 of the partner through increasing empathy and decxesing egocentri-
city (Newman, 1976). This suggested that from early transactions,
the young child comes to learn how to affect another individual. Through
this process, the infant (and young child) learns as well that the
response of another is an expression of feelings and ideas and that
these expressions are directly related to the process of interaction.
Summary
In summary, the development of the child appears to be strongly
associated with the quality of the relationship between mother and
infant. These studies which have dealt with the concept of transaction
clearly demonstrate that the mother-infant relationship is of prime
importance to the development of the child. Still, surprisingly little
is known about the infants of adolescent mothers. Often our sources
of information have been limited in generalizability. They do, however,
acknowledge .the need'for concern regarding the psychosocial, educational and
medical risks associated with early childbearing. It is hoped that the
consideration of the very young mother in future research will extend
our knowledge base. Exploratory studies of the young parent family will thu
strengthen efforts to improve the quality of professional services to
the family as a unit and enhance the quality of life for each individual.


99
from Maternal and Infant Care Clinics and the Teenage Pregnancy Team.
Significant differences were also found to exist between Maternal and
Infant Care Clinic patients and Shands Teaching Hospital High Risk
Clinic patients. The mean of the Teenage Pregnancy Team infants was
also significantly higher than the infants of Shands Teaching Hospital
High Risk Clinic. The pairwise comparisons and the adjusted means are
presented in Tables 23 and 24.
It should be noted that a discrepancy exists between the results
of the first and second analyses with regard to the significance of
the type of prenatal care as it related to psychomotor development. An
inspection of the adjusted means for each prenatal care group (Table 25)
indicated large, but nonsignificant differences on the transaction
components. This variance was not accounted for in the first analysis.
In the second analysis, partialling out the variance explained by
transaction yielded a significance association between the type of
prenatal care and the psychomotor development of the infant.
The Prediction of Developmental Delay
The question regarding delays in infant development could not
be answered due to the fact that no infants scored below 68 on either
the mental or the psychomotor scale. As a result of this analysis,
however, certain variables have been identified which do contribute
to the prediction of developmental risk in infancy. The variables
which were found to be associated with negative outcomes in mental
development were: 1) the young age of the mother; and 2) the
presence of complications during pregnancy. Negative outcomes in
psychomotor development were associated with a lack of responsive


Table 3
Rotated Factor Matrix of Principle Components:
Regression Weights of Mother-Infant Behaviors
Variable
Component 1
Warmth
Component 2
Reciprocity
Component 3
Responsive
Vocalization
Component 4
Negative
Affect
Component 5
Nonresponsive
Stimulation
Comments
.4484
-.0630
-.0361
.4009
-.2194
Commands
.2038
.0820
.0475
.6401
-.0805
Criticizes
.0761
-.0627
.0789
.7263
-.0225
Nonverbal Bids
.2850
-.3335
-.5379
-.1742
-.2040
Initiating Behavior
-.0522'
.5373
-.0338
.2788
.4015
Repetitive Nonverbal
Behaviors
-.1309
.4443
-.0809
-.2340
-.2235
Staccato Bursts
.0766
-.0762
-.1160
-.2263
.6303
Affectionate Touch
.7288
-.1917
-.2077
-.2407
. 1003
Interfering Touch
-.0203
-.2203
-.1886
.4778
.4687
Repetitive Verbalization
.3008
.0657
-.0185
.0732
.0222
Bid to Caregiver
-.3326
-.1540
-.0277
. 0094
.1825
Vocalizations
.1100
-.1803
.8097
.0789
-.1052
Smiles at Mother
.7040
-.2488
.2168
-.1024
1-. .si-. >1; '-av;' *
-.0254


34
the study lacked a comparison group of older mothers and adolescents
who were given traditional treatment, the findings suggested important
areas in need of intervention.
Summary
Our sources of information remain limited with respect to their
methodology, scope and the documented strengths and limitations of early
parenting. They do, however, provide an intriguing basis for both
future intervention and research designs. In summary, the conflicting
results of studies investigating early parenting are inconclusive.
We are unable to ascertain whether young parents are any different
in their caregiving attitudes, feelings and behaviors than parents
who have postponed childrearing. Chilman (1979) systhesized the views
of those who are more optimistic when she stated:
By age 16 or so, most young people are at a higher level
of development and integration, but need more time to assess
their values, goals and heterosexual relationships. Because
child care requires the ability to be nurturant to another,
to carry a heavy load of responsibility, to control one's
impulses, to make wise judgments, and to be able to provide
the child with a wealth of experiences and firm guidance*,
it seems unlikely that younger adolescents would on the
average, be as effective in their childrearing as older ones.
It also seems likely that, on the average, a premarital
pregnancy would particularly strain a youthful marriage.
On the other hand, 'ages and stages' are far from the
whole story in human development and the capacity for parent
hood. People who have been 'we11-parented' themselves,
whose motivations, values, interests and experiences have
particularly prepared them to care happily and effectively
for children, may be excellent parents, regardless of their
age, especially if various support systems are available
to them in their own families and in the community- (p. 261)
*In sober truth, who can be and do all these things? (Chilman, 1979, p. 261)


Table 5--extended
Self Stimulation
Vacant Behavior
Explores
Fusses
Mother's Positive
Response
Mother's Negative
Response
Contingent Verbali
zations (M)
Face to Face Orientation
Maternal Ignoring
Baby's Positive Response
Baby's Negative Response
Contingent. Vocali zation
Mutual Gaze
Baby Ignoring
. 0433
. 0187
-.0400
.0952
-.4644
-.8397
-.0159
. 0575
. 0187
.6513
1101
-.0162
. 1350
-.2068
.8435
. 1612
-.1301
-.2028
-.1281
.8631
-.1246
-.0436
.0360
-.0348
.0256
. 1218
1281
.1046
.0768
.1555
-.0095
.0993
-.0446
-.0293
. 0605
-.1056
.1184
.2841
-.1262
-.2156
. 1114
-.0857
-.0875
.0163
.1490
.2482
.6794
-.1698
-.2941
.0355
.0842
-.1918
.0383
-.1126
-.0684
.1353
-.1433
. 0460
.0391
.4951
. 1236
.6155
. 0483
.0867
.0014
.0132
.3547
.0938
.1085
.854 4


52
administration of the scales. After the evaluation, the results regard
ing the mental, psychomotor, language and socioemctional growth of the
baby were discussed with the parent with respect to age ranges in
each area of development. Parent's questions were encouraged and
concerns were discussed during all phases of the assessment.
Following the assessment, the infant-centered intervention
phase proceeded and focused on the specific strengths and limitations
observed in the baby. Delayed or problematic development was ex
plained and appropriate protocols for remediation were discussed.
It was emphasized that many of these delays found at six months could
be overcome in a short time with an additional amount of stimulation
and prescribed activities. Where applicable, developmental,
nutritional and medical referrals were made to the appropriate agencies.
In all cases, parents were also given a book of educational activities
and a photograph of their baby to take with them.
Following the assessment, Infant and Family Development Specialists
interviewed the mothers to obtain demographic data. This was done
in order to insure that the examiner remained naive to the age and
prenatal care group of the mother.
Instrumentation
The Assessment of Infant Development
The Bayley Scales of Infant Development were chosen as a direct
measure of the infants' psychomotor and mental abilities. The
mental scale measured adaptive and language behavior as evidenced
on eye-hand coordination, problem solving, exploratory and manipula
tive tasks.
Also included are linguistic vocalizations and the


40
The ramifications of neonatal risk on the development of the
infants of adolescent mothers has remained relatively unstudied
(Guttmacher Institute, 1976). There have been, however, a handful
of longitudinal studies of children born to women enrolled in the
Collaborative Perinatal Project (Niswander and Gordon, 1972). The follow
up assessments of these infants included the age of the mother in the
design and constitute our main sources of information regarding
developmental outcomes of the children of young mothers.
Developmental Outcomes of Adolescent Pregnancy
The earliest and longest follow-up assessments of infants of adoles
cents were done as part of the Johns Hopkins Child Development Study
sponsored by the Collaborative Perinatal Project. For this investigation,
Hardy, Welcher, Stanley and Dallas (1978) defined adolescence to be 16 years
of age or less at delivery. The sample of 4,557 mother-infant dyads was
selected at random in 1964 and followed at a rate of 85-93 percent over a
12 year period. The sample consisted of 706 mothers who were 17 years of
age or less at delivery. At birth, there were no significant differences
betv/een the under 16 and over 16 groups on perinatal or infant death rates.
All risk factors were significantly higher for blacks than for whites.
At eight months of age, infants were assessed with the Eayley Scales
of Infant Development. The infants of mothers 20-25 years of age attained
significantly higher scores on., the ..mental scale than those of adolescents.
Hardy concluded that this was suggestive of "more effective childrearing
practices" (p. 1224). At four years of age, children were assessed using
the Stanford-Binet Intelligence Test for Children, tests of fine and gross
motor functioning, the Graham Block Sort Concept Formation Test, a behavioral
profile and psychological impression. On all measures, a higher proportion of


12'8
IV. Fetal Factors
1. Abnormal presentation
10
8. Fetal tachycardia
10
30 min.
2. Multiple pregnancy
10
9. Operative forceps or
5
3. Fetal bradycardia
10
vacuum extraction
30 min.
10. Breech delivery spon-
5
4. Breech delivery
taneous or assisted
total extraction
11. General anesthesia
5
5. Prolapsed cord
10
12. Outlet forceps
1
6. Fetal weight < 2500 gms.
10
13. Shoulder dystocia
1
7. Fetal acidosis pH > 7.25
10
14. Fetal distress
10
V. Neonatal Factors
A. General
B. Respiratory
1. 1000 grams
15
1. RDS
10
2. Apgar 5m = < 5
10
2. Meconium aspiration
10
3. Resusciation
10
3. Congenital pneumonia
10
4. 1000-1500 grams
10
4. Anomalies of respira-
10
tory system
5. Fetal anomalies
r
5. Apnea
10
6. 1500-2000 grams
5
6. Transient tachypnea
5
7. Dysmaturity
5
C. Metabolic Disorders
S. Apgar 1m = < 5
5
1. Hypoglycmia
10
9. Feeding problem
1
2. Hypocalcemia
10
10. Multiple birth
1
3. Hypo/hypermagnesemia
5
11. 2000-2500 grams
1
¡
4. Hypoparathyroidism
5
5. Failure to gain weight.
1
I
6. Jitteriness
1


Ill
influenced the infant's level of optimal performance which was
stated to be a goal of the assessment (Bayley, 1969). A third
consideration is the small number (20 of 250) of high risk
infants (those who were born prematurely or had neonatal complications)
who were selected at random as part of the invited sample. Of the
20 high risk infants sampled, four participated in this study.
The data were unable to answer the question and the identification
of delay in an age specific sample thus remains in need of future
investigation.
Of benefit to our knowledge base would be the longitudinal
assessment of the infants of adolescent parents. That these infants
are at risk has been well documented in the literature. The findings
presented in this study indicated that differences exist as early as
six months of age. It is the subjective opinion of the author
that a major factor in the success of patient follow-up lies in the
direct communication by telephone to advise them of services offered
to the family. In explaining the procedures carefully, questions
may be answered and parents may be made to feel that they were
"lucky" to be chosen. This approach was used successfully in a
seven year follow-up of the Collaborative Perinatal Study (Dallas, 1971).
A more thorough assessment battery for long term follow-up
;vould be an asset as well. The use of the 3ehavior Profile in the
Bayley Scales of Infant Development and its relationship to mother-
infant transaction is another unexplored area of early parenting.
The addition of an instrument to assess qualitative characteristics


of the many prenatal complications present in adolescent patients.
As a result, the presence or absence of prenatal complications
was included in subsequent analyses.
The Relationship of Mother's Age, Perinatal Risk Status and
Socioenvironmental, Medical and Educational Resources
To Mother-Infant Transaction and Infant Development
In keeping with the exploratory purpose of the study which
was to obtain information regarding the outcomes of early pregnancy
and parenting, a number of hypotheses were tested. Two multivariate
analyses were implemented which involved several multiple regression
procedures. These analyses, which addressed the ability of the
independent variables to predict mother-infant transaction and
infant development, were subjected to a conservative critical value
in each univariate and multivariate test of significance. The
experimentwise alpha rate was set at .05 for the multivariate tests.
Using the Bonferroni approach, this was divided by the total number
of dependent variables such that the criterion for significance was
dependent upon the hypothesis being tested. On each univariate
follow-up analysis, the criterion for significance was set at .01.
Mothers Age as a Predictor of Transaction and Development
The questions of utmost importance in this study concerned:
1) the ability of the very young mother to facilitate positive
transaction with her baby; and 2) the developmental status of the
infants of young mothers. This led to the questions regarding
the nature of the relationship between mother's age and transaction
and development. The specific questions addressed in the first


135
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Gordon, I. J. Child stimulation through parent education. ERIC
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Gordon, I. J. The infant experience. Columbus: Charles E. Merrill
Publishing Co., 1975.
Gordon, I. J. Parenting, teaching, and child development. Young
Children, 1976, 31_, 173-182. "
Gordon, I. J., Soar, R. S., Jester, R. E. Instructional strategies
in infant stimulation. NIMH Monograph. Washington, D. C.: U. S.
Government Printing Office, 1979.
Gottschalk, L. Psychosocial factors associated with pregnancy in-
adolescent girls: A preliminary report. Journal of Nervous
Disorders, 1964, 138(6), 534-554.
Grant, J. § Heald, F. Complications of adolescent pregnancy: A
survey of the literature on fetal outcome in adolescence.
Clinical Pediatrics, 1970, XI, 569.
Grossman, P. Prematurity, poverty related stress and the mother-infant
relation. Doctoral Dissertation, University of Florida, 1979.
Hardy, J. B. Trie Johns Hopkins collaborative project: Factors
affecting the growth and development of children. Johns Hopkins
Medical Journal, 1971, 123(2), 238-243.
Hardy, J., Welcher, D., Stanley, J., 5 Dallas, J. Long-range outcome
of adolescent pregnancy. Clinical Obstetrics and Gynecology,
1978, 21(4), 1215-1232.
Hobel, C. J., Hyvarinen, M. A., Okada, D. M., & William, 0. H. Prenatal
and intrapartum high-risk screening. American Journal of Obstetrics
and Gynecology, 1973, 117(1), 1-9.
Holstrum, W. J. The prediction of three year developmental status
of high risk infants. Doctoral Dissertation, University of
Florida, 1979.
Holtzman, M. The verbal environment provided by mothers for their
very young children. Merrill-Palmer Quarterly, 1974, 21(1),
31-42.
Howard, M. The Young Parent Family. In Vaugn § BraceIton (Eds),
The Family: Can It Be Saved? Boston: Yearbook Medical Publishers,
1976, 259-255. ~


Pages
are
misnumbered
following
this
insert


CHAPTER I
INTRODUCTION
The emergence of a phenomenal number of births to adolescent
mothers has prompted serious concern by professionals attempting to
enhance the quality of life for the individual and the family. While
there exist serveral studies which explore the various aspects of early
pregnancy and parenting, very little is known about the nature of the
relationship between the adolescent mother and her infant and the
infant's development.
What are the characteristics of the very young mother -- how
do her behaviors differ from or simulate those of her "of age" peer?
How does she relate to her baby and what are the effects of her style
of mothering on her baby and the developing family unit? Answers
to these questions pose a challenge to the researcher and are in need
of investigation. Such is the task at hand. Most importantly, this
study attempts to explore the role of the adolescent as a mother in an
effort to understand her strengths and limitations and their implications
for her baby's development.
It is the purpose of this study, therefore, to examine the
relationship between infant development and mother-infant transaction
in the adolescent family. The information obtained as a result of this
study will assist professionals by increasing their understanding of the
developmental status of the infant and the parenting style of the young
mother in order to design more comprehensive programs for the young family.
1


91
Table 18
Mean Mental Development of Infants
in Each Prenatal Care Group After
Adjusting for Variance Explained by All
Other Independent Variables
Prenatal Care Group
Mean
Teenage Pregnancy Team
140.03
Public Health Department Clinics
132.26
Maternal-Infant Care Clinics
125.91
Frivate Physician
113.68
S.T.H. High Risk Clinic
111.52


76
Table 8
Frequency Distributions for
Mother-Infant Transaction
Variable
Frequency
Warmth
0-15
69
16 30
7
31 50
1
J.
Reciprocity
-25 0
16
1-25
38
26 52
23
Responsive Vocalizations
-20 -10
4
-9-0
47
1 9
23
10-33
"7
3
Negative Affect
0-4
52
5-9
19
10 23
6
Nonresponsive Stimulation
0-4
32
5-9
31
IQ 19
12
20 37
2


Perinatal Risk Status
In order to assess the perinatal (last month of pregnancy through
first month of life) risk status of the infant at birth, the Prenatal
and Intrapartum Risk Scale (Hoble et al., 1973) was adapted for use
in this retrospective design. This instrument was developed as a
system for the prospective analysis of perinatal risks and rates
various complications in prenatal (maternal), labor and delivery and
neonatal screening characteristics (see Appendix D). Information
regarding the risk status of the neonate was obtained from the
infant's medical records.
Mother-Infant Transaction
The systematic observation of the transaction process has
become a meaningful way to investigate behavioral components of
the parent-infant relationship.
In order to examine parenting behaviors, a low-inference obser
vation system was used. The measurement of maternal-infant interaction
was based on the assumption that reciprocal/responsive behavior can
be measured through the use of the Beckwith Behavior Scale. The
scale was previously used by Beckwith (1976) and Grossman (1979)
to analyze parent-infant transaction in two separate studies of
one, three, six and eight month old infants and their mothers.
The Beckwith Behavior Scale consists of 27 behavioral categories,
each of which is assigned individually to parent or infant behavior.
The behavioralv categories of the instrument were selected for
their appropriate record of "parenting skills" which have consistently


137
Lewis, Robert A. Parents as Peers. Journal of Sex Research, 1973,
9_(2), 156-170.
Long, K. The relationship between parenting styles and infant's
task-mastery, exploration and mental and motor development.
Doctoral Dissertation, University of Florida, 1979.
Lynn, D. The father: His role in child development. Monterey, CA:
Wadsworth Publishing Co., 1974.
Lytton, H. Three approaches to the study of parent-child interaction.
Journal of Child Psychology and Psychiatry, 1973, 14, 1-17.
Malmquist, C, P. Mothers with multiple illigitimacies. Psychiatric
Quarterly, 1967, 47, 339-354.
Martinez, A. Adolescent pregnancy: The impact on Hispanic adolescents
and their families. Paper presented at the Family Impact Seminar
Conference on Teenage Pregnancy, George Washington University,
October, 1976.
MzGanity, W. J., Little, H. M., Gozelman, A., Jennings, L., Calhoun,
E., £ Dawson, E. Pregnancy in the adolescent: Preliminary summary
of health status. American Journal of Obstetrics and Gynecology,
1969, 103(2), 773-788"! ~
McKendry, P., Walters, L., § Johnson, C. Adolescent pregnancy:
A review of the literature. The Family Coordinator, January
1979, 17-28.
Mecklenburg, F. Pregnancy: An adolescent crisis. Minnesota Medicine,
1973, 56, 101-103.
Medley, D. M. § Mixzel, H. E. Measuring classroom behavior by system
atic observations. In Gage, N. (Ed.) Handbook of research on
teaching. Chicago: Rand McNally.
Medvene, A. Early parent-child interaction of educational-vocational
and social-emotional clients. Journal of Counseling Psychology,
1975, 11_(6), 788-794.
Menken, J. Teenage childbearing: Its medical aspects and implications
for the United States population. In Crider, E. (Ed.) school-age
pregnancy, childbearing and childrearing: A research review.
Dept, of HEW, U.S.O.E. Contract #P0076271, November, 1376.
Moerk, Ernst. Verbal Interaction Between Children and Their Mothers
During the Preschool Years. Developmental Psychology, 1975, 11(6),
788-794.
Moore, K Government policies related to teenage family'formation and
functioning: .An inventory. Paper presented at the Family Impact
Seminar Conference on Teenage Pregnancy, George Washington University,
October, 1978.


96
Table 21
Tests of Significance of Contribution of Continuous
Variables to the Prediction of Infant's Mental Development
Regression
Variable
Weights
F
P
Warmth
-.6764
4.57
.04
Reciprocity
-.1079
.85
. 36
Responsive Vocalization
.5411
3.06
.09
Negative Affect
-.4984
1.00
Nonresponsive Stimulation
. 1331
.35
.72
Mother's Age
2.6173
7.67
<.01
Birth Order
-5.8106
3.22
.08
Ethnicity
-1.6220
0.10
.76
Mother's Education
-3.4221
3. 33
.07
Yearly Income
.9624
5.46
.02
Sex
.0772
.00
.99
Social Support System
-5.050
2.23
.14
Prenatal Complications
-13.976 "
7.96
<.01
Risk
-.292
2.27
.14


134
Cutright, P. Who is the pregnant school aged girl and why is she
pregnant? Journal of Marriage and the Family, 1973, 25(4),
589-96.
Dallas, J. Patient follow-up in a long term study. Johns Hopkins
Medical Journal, 1971, 128, 244-251.
DeLissovoy, V. Childcare by adolescent parents. Children Today,
1973, 7(8), 22-25.
Dott, A. § Fort, A. Medical and social factors affecting early
teenage pregnancy. American Journal of Obstetrics and Gynecology
1976, 125(4), 532-536.
Dwyer, J. Teenage pregnancy. American Journal of Obstetrics and
Gynecology, 1974, 111(3), 373-376.
Epstein, A. Pregnant teenager's knowledge of infant development.
Paper presented at Society for Research in Child Development,
San Francisco: Biennial Convention, March, 1979.
Erkan, R., Stein, J. A., Heald, F. P. Complications in adolescent
pregnancy. Clinical Pediatrics, 1972, 11 (10), 380-391.
Eyler, Fonda D. Assessment and intervention with mothers and their
premature newborns. Paper presented at Society for Research
in Child Development, San Francisco: Biennial Convention,
March, 1979.
Family Planning Perspectives, April, 1979.
Forbush, J. B. Family involvement in adolescent parent programs.
Paper presented at Family Impact Seminar Conference on Teenage
Pregnancy, George Washington University, October, 1978.
Fox, G. L. The Family's Role in Adolescent Sexual Behavior. Paper
presented at the Family Impact Seminar Conference on Teenage
Pregnancy, George Washington University, October, 1978.
Furstenberg, F. Unplanned parenthood: The social consequences of
teenage childbearing. New York: The Free Press, 1976.
Furstenberg, F. Burdens and benefits: The impact of early child
bearing on the family. Paper presented at the Family Impact
Seminar Conference on Teenage Pregnancy, George Washington
University, NICHD0N01-HD-72822, October, 1978.
Furstenberg, F. & Crawford, A. G. Accommodating early parenthood:
Sources and consequences of family support to the teenage
childbearer. Paper presented at Family Impact Seminar Conference
on Teenage Pregnancy, George Washington University, October, 1978


I certify that I have read this study and that in my opinion
it conforms to acceptable standards of scholarly presentation and
is fully adequate, in scope and quality, as a dissertation for the
degree of Doctor of Philosophy.
/
1
Athol B. Packer, Chairperson
Associate Professor of
Curriculum and Instruction
I certify that I have read this study and that in my opinion
it conforms to acceptable standards of scholarly presentation and
is fully adequate, in scope and quality, as a dissertation for the
degree of Doctor of Philosophy.
James J. Algina ,
Assistant Professor of
Foundations of Education
I certify that I have read this study and that in my opinion
it conforms to acceptable standards of scholarly presentation and
is fully adequate, in scope and quality, as a dissertation for the
degree of Doctor of Philosophy.
Patricia T. Ashtdn
Assistant Professor of
Foundations of Education


APPENDIX C
BAYLEY SCALES OF INFANT DEVELOPMENT
A. Psychomotor Index
Item Age Range
Item Presentation
21 4.9
Cube: partial thumb opposition (radial-palmer).
With the child seated at the table, place a 1-inch
cube within his easy reach. Also credit if he
passes item 32.
Credit: at this levelif the child picks up the
cube with his thumb partially pooposed to his
fingers, using the palm as well as the thumb and
fingers.
22 5.3
Pulls to sitting position. Stand at the foot of
the crib and lean over the child whil he is lying
on his back. Give him your thumbs to grasp. With
this support, allow him to pull himself to a sitting
position and, if he is able, to a full standing
position (item 36). Gradually raise your hands as
the child pulls, but take care not to do the pulling
for him.
Credit: if the child pulls himself to a sitting-
position with the support of your thumbs.
23 5.3
Sits alone momentarily. Administer as in item 17.
Credit: at this level if the child sits momentarily
without sijpport.
24 5.4
Unilateral reaching.
Credit: if the child tends to. reach with one hand
more often than bimanually (with both hands at once).
The hand used need not be consistently either the
right or the left.
25 5.6
Attempts to secure pellet. Place a sugar pellet on
the table within easy reach of the child. Observe
his efforts to pick up the pellet. If necessary,
attract his attention to it by motions of the hand,
by tapping the table near the pellet, or by making
it rock (as in Mental Scale item 52).
Credit: at this level if the child makes an effort to
pick up the pellet, whether successful or not.
123


78
Table 10
Means and Standard Deviations for Scores
on the Bayley Scales of Infant
Development, and the Beckwith Behavior Scale
Variable
N
Mean
SD
Bayley Scales of Infant Development
Bayley Mental Index
77
125.28
19.26
Bayley Psychomotor Index
77
117.64
12.62
Component: Beckwith Behavior Scale
Warmth
77
6.29
6.95
Reciprocity
77
12.96
18.16
Responsive Vocalization
77
-. 67
6.58
Negative Affect
77
3.71
4.39
Nonresponsive Stimulation
77
6.55
5.84


TABLE OF CONTENTS
PAGE
ACKNOWLEDGEMENTS : v
ABSTRACT :!x
CHAPTER
I. INTRODUCTION 1
Adolescent Family Development 2
The Concept of Parent-Child Transaction and
Infant Development 4
Questions Posed by the Study 6
Summary 7
III THE REVIEW OF THE RESEARCH '. 9
Parent-Child Transaction and Infant Development 10
The Young Mother and Her Infant 21
Summary 34
III. THE METHODOLOGY 45
Questions Posed by the Study. 45
D Definition of Terms 47
The Subjects 49
* The Procedure 50
' Instrumentation 52
Statistical Analyses 57
Limitations of the Study 62
Summary 63
IV. THE RESULTS 64
The Dimensions of Mother-Infant Transaction ....... 64
Description of the Sample 74
Mother's Age, Perinatal Risk and Socioenvironmental,
Educational and Medical Resources ...... S3
The Prediction of Infant Development 92
Summary 104
viii


46
as a function of the age of the mother?
2) Is the relationship between mother's age and each dimension
of transaction and infant development linear after control
ling for mother's education, yearly income, ethnic origin
social support system, infant's sex and birth order and type
of prenatal care?
3) What is the nature of the relationship between prenatal
medical care and development at six months after controlling
for all independent variables?
4) Which variables contribute predictive information to the
identification of developmental delays on infant development
measures at six months?
5) Is there a positive association between the extent of
prenatal and postpartum parenting education and infant develop
ment at six months?
6) Is there a positive relationship between the extent of the
mother's social support system and transaction and the
infant's development?
In keeping with the exploratory nature of this study, additional
questions were investigated. The questions were:
7) Is there a relationship between the age of the mother and infant
development after controlling for transaction, infant's sex
and birth order, perinatal risk status-, ethnicity, yearly
income, social support system and type of prenatal care and
education?
8) Are the transactional behaviors of the mother-infant


44
authors are based on thorough documentation. The use of a matched
rather than random sample,however, has limited our understanding
of the relative contributions of race, socioeconomic status and
birthweights. Had these variables been controlled statistically
rather than in the experimental design, the results would have been
more generalizable. Another limitation of this study is the fact that
the data were collected for a purpose other than that for which they
were analyzed.
In summary, the long range outlook for the child born to a
young mother appears quite dismal. Regardless of the methodology, almost
every study has documented the intellectual, emotional, educational,
developmental and medical risks associated with early pregnancy and
parenting. Our only evidence of a more hopeful future for these
children comes from those investigations into the role of the
mother's support from her family and the professional community.
Our knowledge base is lacking in both the number and scope of studies
into the consequences of early parenting for the young mother and her
child. It is to this specific gap in our knowledge that the present
study was directed.


88
Table 15
Tests of Significance of Contribution
to the Prediction of Infant's Mental Development
Variable
Regression
Coefficient
F
P
Mother's Age
2.57
6.92
.01
Baby's Sex
-.92
.04
.84
Baby's Birth Order
-5.85
3.06
.08
Ethnic Origin
.65
.02
.90
Mother's Education
-3.50
3.32
.07
Yearly Income
.76
3.40
.07
Social Support System
5.86
2.88
.09
Prenatal Complication
-13.16
6.54
.01
Perinatal Risk
.12
.38
.54


125
71 5.7
72 5.8
73 5.8
74. 5.8
75 6.0
76 6.2
Pulls string: secures ring. Administer as in item 67.
Credit: if the child secures the ring as the result
of his own efforts, even though there is no evidence
of purposive use of the string.
Interest in sound production. Observe whether the
child intentionally uses objects to make noise.
Credit: if the child shows interest in producing
sound as such, by banging toys, ringing the bell, etc.
Lifts cup with handle. Administer as in item 63.
Credit: if the child lifts the cup by the handle,
using one hand predominantly.
Attends to scribbling. Place a piece of paper on
the table in front of the child; then place a
crayon on the paper with the tip pointing away from
him. If he makes no effort tctouch the crayon to
the paper, take the crayon and scribble plainly with
obvious writing gestures. Then give the crayon to
the child with directions (by word and gesture) to
write. (See also item 95.)
Credit: if the child attends to the demonstrated
scribbling.
Looks for fallen spoon. Administer as in item 62.
(Note that items 62 and 75, involving both vision
and hearing, are easier than items 86, 88, 91,
and 96, which test "object constancy" by vision
only.)
Credit: if the child definately looks for the fallen
spoon by turning and looking to the floor.
Playful response to mirror. Administer as in item 53.
Credit: if the child plays with the mirror image,
with such responses as laughing, patting, banging,
playful reaching, leaning toward the image, "mouthing"
the mirror, etc.
Retains 2 of 3 cubes offered. One at a time, place 3
cubes on the table before the child, allowing him to
pick up each one before the next is offered. Observe
his behavior when he has a cube in each hand and
the third cube is presented.
Credit: if the child retains the first 2 cubes after
the third is offered. (Often a child fails this by
dropping a cube to reach for the third.)


27
complemented this with her finding that there was an association between
early maternal childbearing and the behavior of the daughter.
Chilman (1979) sited the fact that "daughters whose mothers had
early pregnancies were more likely to become pregnant as teenagers", (p. 2T09]
As found in her earlier work, "actual maternal behavior is apt to be
more influential than stated attitudes and goals for the [developmental
outcomes of] children" (p. 209).
The influence of the family of origin on the prevention of
pregnancy and the use of contraception and abortion has been another
area of interest. In general, the authors have concluded that a young
girl's decisions both to become sexually active and to use contraception
are related to her parent's values and support of her, her relationship
with each parent and the degree of connectedness within the family
(Jessor and Jessor, 1975; Lewis, 1973). Fox (1978) cited the Rosen
(1977) finding that, when adolescents consulted their families, the
young woman was more likely to continue the pregnancy and keep her
baby. In contrast, those who sought abortions rarely consulted their
parents.
The plans Implemented by the young mother following the
decision to continue the pregnancy were discussed by Young, Birkman
and Rehr (1975). In their study of the role of the mothers of teens
who carried their pregnancies to term, the mother was noted to be
especially influential in the decision making process. The- daughters
living arrangements, educational plans and child care and childrearing
arrangements were those most often influenced by the mother.
We can look to the National Center for Health Statistics for a
quantitative summary of those who gave birth during adolescence in
order to understand the trends. In comparing the birth rate of
A o


Table 12--extended
14) Responsive Vocalization
15) Negative Affect
16) Nonresponsive Stimulation
1.00
.01
-.14
1.00
.39
1.00
00
to


REFERENCE NOTES
1. Brazelton, T. B., Lester, B. A cross-cultural study of
adolescent mother-infant interaction and neonatal
assessment. Personal communication, 1979.
2. Mahan, Charles S. Teenage pregnancy team project grant
proposal (DHEW-NIH), 1978.
3. Mahan, Charles S. and Eitzman, D. V. North Central Florida
maternity and infant care project grant proposal (DHEW-PHS),
1978.
130


89
Table 16
Test of Significance of Contribution of
Continuous Variables to Prediction of Infant's
Psychomotor Development
Variable
Regression
Coefficients
F
P
Mother's Age
1.09
2.62
.11
Baby's Sex
6.67
4.81
.03
Baby's Birth Order
-4.50
3.46
.07
Ethnic Origin
-.83
.06
.81
Mother's Education
-1.00
.57
.45
Yearly Income
.31
1.21
.28
Social Support System
1.14
.23
.63
Prenatal Complications
-5.60
2.48
.12
Perinatal Risk
.01
.01
.94


133
Nelson, K. Structure and strategy in learning to talk. Monographs
of the Society for Research in Child Development, 1973, 38(1-2),
1-135. '
Newman, Barbara. The Development of social interaction from infancy
through adolescence. Small Group Behavior, 1976, 7(1), 19-31.
Nie, N. H., Hull, C. H. Jenkins, J. G., Steinbrenner, K., § Bent, D.
Statistical package for the social sciences, 2nd Ed., New York:
McGraw-Hill, 1975.
Niswander, K. R. 3 Gordon, M. The women and their pregnancies.
Washington, D. C.: U.S. Government Printing Office, DHEW
Publication No. (NIH) 73-379, 1972.
Norton, D. Parental age as a factor in pregnancy outcome and child
development. Reports on Population--Family Planning, 1974, 16,
32-34.
Olmsted, P. Observational studies of parental teaching behaviors:
A review of the literature. Gainesville, Fla. : University of
Florida, Institute for Development of Human Resources, 1977.
Oppel, W. f) Royston, A. Teenage birth: Some social, psychological and
physical sequelae. American Journal of Public Health, 1971,
4, 751-756.
Osofsky, H, § Osofsky, J. Adolescents as mothers: An Interdisciplinary
approach to a complex problem. Journal of Youth and Adolescence,
1973, 2.(3), 233-249.
Osofsky, J., 3 Osofsky, H. Teenage pregnancy: Psychosocial considera
tions. Clinical Obstetrics and Gynecology, 1978, 21 (4), 1160-1173.
Packer, A. B., Resnick, M. B., Wilson, J., Resnick, J. L. An elementary
school for parents. Young Children, 1979, 34_(1), 4-12.
Parke, R. 3 Sawin, D. The father's role in infancy: A re-evaluation.
Family Coordinator, 1976, 25(4), 365-371.
Paulker, J. D. Girls pregnant out of wedlock. Journal of Operational
Psychology, 1970/U7), 247-255.
Places, P. 5 Jones, A. Teenage women in the U.S.A.: Sex, contraception,
pregnancy, fertility. Paper presented at the Family Impact
Seminar Conference on Teenage Pregnancy, George Washington
University, October, 1978.
Powell, L. The effect of extra stimulation and maternal involvement
on the development of low birth weight infants and maternal
behavior. Child Development, 1974, 45_, 106-113.
Presser, H. B. Early motherhood: Ignorance or bliss. Family Planning
Perspectives, 1974, 6(1), 8-14.


93
mother's education, perinatal risk status, ethnic
origin, yearly income, social support system and
type of prenatal care and education?
The questions were answered by the second multivariate multiple
regression analysis. Mental and psychomotor development were regressed
on mother's age and education, infant's sex and birth order, warmth,
reciprocity, responsive vocalization, negative affect, nonresponsive
stimulation, yearly income, ethnic origin, social support system, peri
natal risk status, prenatal complication and type of prenatal care.
From the multivariate tests of significance (Table 190* it can be seen
that the age of the mother, prenatal complications, responsive vocal
izations and type of prenatal care contributed to the overall prediction
of infant development (a = .05).
The results of the univariate analyses are presented in Table 20.
This represents the contributions of mental and psychomotor development
and revealed that both models were significant. A visual inspection
of the plots of the residuals indicated that the data met the assumption
of homoskedasticity and were appropriate for the analyses.
The follow-up univariate analysis (a=.01) of mental development
(Table 21) was consistent with the first analysis and indicated that
the age of the mother had a positive relationship to her infant's mental
development. The plot of the residuals against mother's age evidenced
no deviation from linearity. It was therefore concluded that there
was a positive linear relationship between the age of the mother and
her baby's mental development. Mother's age was found to explain
10 percent of the variance In mental development. The regression


24
pregnant do so intentionally, but few who become pregnant use contracep
tion (p. 11). The black population evidenced little change in the
number of first pregnancies and an eight percent decline in premarital
intercourse. The authors stated that a discrepancy existed in the number
of live births and abortions reported by Blacks which was possibly
due to the negative attitude of the culture towards abortion. Blacks
were noted to report a higher number of live births and fewer abortions
than were actually counted in the National Survey. It is important
to note that any information obtained by means of self-report question
naires and interviews is that which the subject is willing to disclose.
This limitation is especially relevant to this study due to the extremely
personal nature of the questions regarding intent. Regardless of
the intent, we are faced with the fact that one million adolescents
become pregnant each year (Alan Guttmacher Institute, 1976) .
Turning to the study of adolescent psychology (or psychopathology,
as it may seem), several conflicting studies focus on the personality
of the adolescent as an explanation of her sexual behavior. A composite
personality profile of the pregnant adolescent is one of a young woman
who typically came from a broken home, was sexually active with one
partner on a steady basis, reached an early menarche, was sexually
impulsive, narcissistic, sociopathic, rejected, isolated, lonely,
unsuspecting, and/or unprepared (Kane and Luchenbrugh, 1973; Rosen,
1661; Cobliner et al., 1975; Barglow et al., 1967; Malmquist, 1967;
Claman, 1969; Gottschalk, 1964). Another view is that "adolescent
patients became pregnant being normal adolescents doing normal
adolescent things" (Malmquist, 1967) Each of these studies is
characterized by a methodological problem in either the use of small
samples or the lack of a comparison group of women over the age of


60
Table 2 Cont.
Variable
Mean
SD
Mother's Ignoring Response
.7564
2.8108
Baby's Positive Response
12.6538
6.0663
Baby's Negative Response
.5333
.8778
Baby's Contingent Vocalization
.2179
1.3737
Mutual Gaze
.0641
.2945
Baby's Ignoring Response
3.7051
3.6149


74
Description'of the Sample
Descriptive statistics and a correlation matrix of the
independent and dependent variables were calculated for the sample
of 77 mother-infant dyads. Frequency distributions were calculated
for the independent and dependent variables and are reported in
Tables 7, 8 and 9. The means and standard deviations of the
dependent variables are presented in Table 10.
An inspection of of the distributions of the measures
of perinatal risk indicated that the majority of the sample was
within normal limits at birth. The means and frequency distributions
for the measures of infants mental and psychomotor development
indicated that the entire sample was within normal limits of
development at six months of age. The means of the sample are
considerably higher than those reported in the Bayley Scales of
Infant Development Manual (Bayley, 1969). The standard deviations
of the sample are equivalent to those reported in the manual. An
interpretation of these findings is discussed in Chapter V.
Interobserver reliability was then computed by means of a
Pearson-Product Moment Correlation on the rotated component scores.
The results of this analysis are presented in Table 6. The purpose
of the assessment of interobserver reliability was to measure
the extent to which the two independent observations of behavior
were consistent. From the results of this analysis it can be
seen that the measurement of transaction was consistent across
observers.


70
Component Score 4 (Negative Afreet) = Mother's Commands +
Mother's Criticisms + Mothers Interfering
Touches + Baby's Negative Responses
Component Score 5 (Nonresponsive Stimulation) = Mother's
Staccato Bursts + Mother's Interfering Touches +
Baby's Ignoring Responses + Mutual Gaze +
Mother's Negative Responses
A Pearson Product-Moment Correlation procedure between the
frequencies of the original variables and the component scores
was implemented. The correlation coefficients are reported in
Table 5 and indicated that the individual variables chosen to
compute the component scores are highly correlated with the new
composites. It also indicated that the variables which should not
be correlated with the components were not. These coefficients
supported the interpretation of the composites of variables selected
to define the dimensions of mother-infant transaction.
The reader should recall that 15 of the videotapes were coded
by two coders. This permitted the computation of two composite
scores for each component of mother-infant transaction and the
assessment of interobserver reliability for the composites. The
Pearson Product-Moment Correlations between each pair of composite
scores are reported in Table 6. The results of this analysis
indicated that the two observers were consistent in the coding of
the five dimensions of the transaction process.


using the Adapted Beckwith Behavior Scale. Demographic and socioenviron-
mental data were obtained from the Child and Family Development Interview,
which was developed for use in this study.
In order to reduce the number of variables and define the more
global dimensions of mother-infant transaction, a correlation matrix
of the 27 variables of the Adapted Beckwith, Scale was subjected to a
principle components analysis. As a result of this analysis, five
dimensions of mother-infant transaction were defined and each subject's
composite score was calculated for each of the five rotated components.
In the first multivariate multiple regression analysis, the
dimensions of mother-infant transaction and the infant's mental and
psychomotor development were considered to be the outcome measures of
early pregnancy and parenting. These measures were regressed on
mother's age and education, baby's sex and birth order, yearly income,
ethnic origin, social support system, perinatal risk status, prenatal
complications and the type of prenatal care received by the mother.
The follow-up univariate analyses indicated that the age of the
mother and the absence of prenatal complications had a positive
relationship with the infant's mental development. The plots of the
residuals evidenced no deviation from linearity. It was concluded
that there was a positive linear relationship between these variables
and the infant's mental development. The type of prenatal care
received by the mother contributed to the prediction of the infant's
mental development. The follow-up pairwise comparisons of each type
of prenatal care indicated significantly higher means for infants whose
mothers received Teenage Pregnancy Team care (comprehensive services)
when compared to those groups receiving care from a private physician
x


THE ADOLESCENT MOTHER AND HER INFANT:
CORRELATES OF TRANSACTION AND DEVELOPMENT
By
Julie Anne Hofheiner
A DISSERTATION PRESENTED TO THE GRADUATE COUNCI
OF THE UNIVERSITY OF FLORIDA IN
PARTIAL FULFILLMENT OF THE REQUIREMENTS
FOR THE DEGREE OF DOCTOR OF PHILOSOPHY
UNIVERSITY OF FLORIDA
1979

Copyright 1979
by
Julie Anne Hofheimer

This work is lovingly dedicated to my family
for enduring my never-ending adolescence
and most especially, for teaching me
the true meaning of attachment and bonding . .
1979

If one is to succeed in leading a man
to a certain goal, one has to take care
to find him where he actually is and to
begin there; to be of real help to a
person, one must understand more than
he does, but in the very first place,
one must understand what he understands.
Kierkegaar.de

ACKNOWLEDGEMENTS
Throughout the course of my doctoral work there have been a number
of individuals who have contributed a great deal. It is with a most
special appreciation for their sensitivity that I recognize them.
The author gratefully acknowledges the contributions of Dr. Charles
Mahan and Ms. Marci Hall of the Department of Obstetrics and Gynecology
for the support of this study. Appreciation for their cooperation is
also extended to Drs. Don Eitzman, Michael Resnick and June Holstrum
of the Division of Neonatology. Department of Pediatrics. These indivi
duals offered a great deal of sensitivity to this study of mothers and
their babies and represent the College of Medicine's humanistic approach
to the family.
Of most importance to the author were the continued guidance and
thoughtful encouragement; the time and care taken in the midst of
hectic schedules. It is with heartfelt thanks that appreciation is
extended.
My chairman, Dr. Athol Packer, has my deepest respect and grati
tude for his gentle direction and thoughtful guidance. My thanks, too,
for his patience in teaching me to reason with feeling and feel with
reason. His consistent support and open-minded faith in me has been
a most important part of my growth.
To Dr. Michael Resnick, a special thanks for opening up a whole
new world and allowing me to dream dreams and make them come true.
I am appreciative, as well, for being given the freedom to explore.
It is for all of his creative idealism that I am especially grateful,
.v

To Dr. Patricia Ashton, my appreciation fox her insight
t
in helping me take a step back and look at aethers and babies
from all perspectives. A special thanks, too, for being
such a strong model of all that is soft and feminine, while
at the same time exemplifying scholarship and professionalism
To Dr. Jim Algina, iny thanks for his intuitive assistant
in the analysis of my data. I have especially appreciated
his ability -to tie up the loose ends and so patiently help
ne try to understand some difficult concepts.
Dr. Bob Soar has been continuously supportive. His
sensitive methodological recommendations and interpretations
of my analyses are greatly appreciated.
I would also like to extend my thanks to Drs. Bill
Ware and Maria Llabre for so patiently helping me look at
the world analytically and with high standards of excellence
in research. I am grateful for their support of me in my
most difficult endeavor and for giving me the confidence
to persue a new interest,
To the friends who have stayed by my side, I am
especially grateful for their faith in me and their help
in keeping it all in the proper perspective .... for the
tender understanding and, most of all,
for always being there

Hie following individuals provided assistance throughout, .the
course of the study. The encouragement and enthusiasm proved instru
mental to its success. Their committment gave me the strength to
carry on and I am most appreciative of their help.
Kimberly Bounds
Maria Frankenfield
Francis Graves
Becky Montevideo
Linda Scblosser
Lisa Schiavoni
Susan Shome
Bob Rose
Beth McLaurin
Rutledge Withers
Debbie Roberts
Susan Mock
Beth Clark
Tess Bennett
Imogene Clark
Renee Miller
My thanks are extended, as well, to the staff of the Pediatric
Clinic and the Infant Development Project for their encouragement and
support.
VII

TABLE OF CONTENTS
PAGE
ACKNOWLEDGEMENTS : v
ABSTRACT :!x
CHAPTER
I. INTRODUCTION 1
Adolescent Family Development 2
The Concept of Parent-Child Transaction and
Infant Development 4
Questions Posed by the Study 6
Summary 7
III THE REVIEW OF THE RESEARCH '. 9
Parent-Child Transaction and Infant Development 10
The Young Mother and Her Infant 21
Summary 34
III. THE METHODOLOGY 45
Questions Posed by the Study. 45
D Definition of Terms 47
The Subjects 49
* The Procedure 50
' Instrumentation 52
Statistical Analyses 57
Limitations of the Study 62
Summary 63
IV. THE RESULTS 64
The Dimensions of Mother-Infant Transaction ....... 64
Description of the Sample 74
Mother's Age, Perinatal Risk and Socioenvironmental,
Educational and Medical Resources ...... S3
The Prediction of Infant Development 92
Summary 104
viii

TABLE OF CONTENTS Continued
PAGE
V. DISCUSSION AND IMPLICATIONS 106
The Age of the Mother as a Predictor of
Infant Development and Mother-Infant Transaction . 106
Prenatal and Perinatal Factors and Socioenviron-
mental, Medical and Educational Resources 108
The Prediction of Developmental Risk
in Infancy 110
Mother-Infant Transaction as a predictor
of Infant Development 112
Summary and Conclusions 113
APPENDICES
A. PARENTS CONSENT 115
THE ASSESSMENT PROTOCOL 116
CHILD" AND' FAMILY DEVELOPMENT QUESTIONNAIRE ... 118
B. DEFINITIONS OF"MOTHER AND INFANT BEHAVIORS .... 120
C. BAYLES SCALES' OF INFANT -DEVELOPMENT '123
D. PERINATAL 'RISK- SCA-LB 126
REFERENCES 131
BIOGRAPHICAL SKETCH
140

Abstract of Dissertation Presented to the Graduate Council
of the University of Florida in Partial Fulfillment of the Requirements
for the Degree of Doctor of Philosophy
THE ADOLESCENT MOTHER AND HER INFANT:
CORRELATES OF TRANSACTION AND DEVELOPMENT
By
Julie Anne Hofheimer
August, 1979
Chairman: Athol B. Packer
Major Department: Early Childhood Education
The increasing number of births to adolescent mothers has prompted
serious concern by professionals attempting to enhance the quality of
life for the family. We have reason to believe that the young mother
and her infant are at risk for problematic development; yet our present
sources of knowledge are limited in number and yield inconclusive find
ings. The primary purpose of this study was to assess the contributions
of the mother's age, perinatal risk status, and socioenvironmental,
medical and educational resources to the prediction of the dimensions of
the mother-infant transaction process and the developmental status of
the infant. A second pxarpose of the study was to ascertain the ability
of the transaction dimensions to predict the mental and psychomotor
development of the infant.
The data were collected in a clinical setting on an age-specific
sample of 77 mothers and their six months-old infants. The mental and
psychomotor development of the infant was evaluated using the 3ayley
Scales of Infant Development. Mother-infant transaction -was analysed
ix

using the Adapted Beckwith Behavior Scale. Demographic and socioenviron-
mental data were obtained from the Child and Family Development Interview,
which was developed for use in this study.
In order to reduce the number of variables and define the more
global dimensions of mother-infant transaction, a correlation matrix
of the 27 variables of the Adapted Beckwith, Scale was subjected to a
principle components analysis. As a result of this analysis, five
dimensions of mother-infant transaction were defined and each subject's
composite score was calculated for each of the five rotated components.
In the first multivariate multiple regression analysis, the
dimensions of mother-infant transaction and the infant's mental and
psychomotor development were considered to be the outcome measures of
early pregnancy and parenting. These measures were regressed on
mother's age and education, baby's sex and birth order, yearly income,
ethnic origin, social support system, perinatal risk status, prenatal
complications and the type of prenatal care received by the mother.
The follow-up univariate analyses indicated that the age of the
mother and the absence of prenatal complications had a positive
relationship with the infant's mental development. The plots of the
residuals evidenced no deviation from linearity. It was concluded
that there was a positive linear relationship between these variables
and the infant's mental development. The type of prenatal care
received by the mother contributed to the prediction of the infant's
mental development. The follow-up pairwise comparisons of each type
of prenatal care indicated significantly higher means for infants whose
mothers received Teenage Pregnancy Team care (comprehensive services)
when compared to those groups receiving care from a private physician
x

and Shands Teaching Hospital High Risk Clinic (obstetric care only).
The. daXa did. not uppoat the, kypotkeAdA that motkz/i-.infaivt tAanAactd.cn
vaxizd at, a £unction of¡ the. age. o/¡ the, motiieA.
In order to ascertain the ability of the transaction components
to predict the development of the infant, a second multivariate
multiple regression analysis was implemented. The dimensions of
mother-infant transaction were found to contribute a significant
proportion of shared variance to the infant's psychomotor development.
The component of transaction which contributed a uniquely significant
proportion was responsive vocalization.
Based upon the results of the follow-up univariate analyses, the
variables which were identified as predictors of mental development
were: 1) the age of the mother; 2) the type of prenatal care received
by the mother; and 3) the presence of prenatal complications. Psycho
motor development was found to vary as a function of: 1) responsive
vocalization of the mother-infant transaction process; and 2) the
type of prenatal care received by the mother. The regression coef-
ficents indicated that for each year of mother's age, the infants
differed, on the average, by 2.6 points on the Mental Development Index
and by 1.2 points on the Psychomotor Development Index.
The results of this study suggest that the infants of young
mothers are at risk for problematic development and would benefit
from early intervention efforts. The data also supported the idea that
the mother-infant relationship is important to the infant's development
of competence. Based upon the findings presented in this study, we
have reason to believe that more comprehensive interdisciplinary
models of prenatal, perinatal and pediatric support are associated
xi

with enhanced development of the infant. These findings suggest
several considerations for the design of parent and infant-centered
interventions for the young parent family in order to enrich the qual
ity of care and stimulation provided by the adolescent mother and
thus enhance the development of the infant.
XI1

CHAPTER I
INTRODUCTION
The emergence of a phenomenal number of births to adolescent
mothers has prompted serious concern by professionals attempting to
enhance the quality of life for the individual and the family. While
there exist serveral studies which explore the various aspects of early
pregnancy and parenting, very little is known about the nature of the
relationship between the adolescent mother and her infant and the
infant's development.
What are the characteristics of the very young mother -- how
do her behaviors differ from or simulate those of her "of age" peer?
How does she relate to her baby and what are the effects of her style
of mothering on her baby and the developing family unit? Answers
to these questions pose a challenge to the researcher and are in need
of investigation. Such is the task at hand. Most importantly, this
study attempts to explore the role of the adolescent as a mother in an
effort to understand her strengths and limitations and their implications
for her baby's development.
It is the purpose of this study, therefore, to examine the
relationship between infant development and mother-infant transaction
in the adolescent family. The information obtained as a result of this
study will assist professionals by increasing their understanding of the
developmental status of the infant and the parenting style of the young
mother in order to design more comprehensive programs for the young family.
1

?
The essence of "comprehensive care" involves a thorough under
standing of the adolescent undertaking the tasks of early parenthood.
It is through this understanding that our interdisciplinary efforts
may become more sensitive to the complex needs of the young mother,
her infant and her family. The commitment to quality care implies
a change on the part of the professional community--a change based on
empirical evidence which documents the educational and developmental
competencies and capabilities of the very young mother. By focusing
on the &£A.zngt}i& within the family, our efforts will project a more
supportive quality. It is this belief in the positive characteristics
of young parents--courage, enthusiasm, adaptability and, above all, an
optimistic view of the future--that is the philosophy upon which this
study is based.
Adolescent Family Development: The Scope of the Problem
The threatening impact of early parenthood has become a source of
great concern in the recent past. In 1976, the Guttmacher Institute
reported that about 10 percent of American adolescents become pregnant
each yearone million young women. Ninety-four percent of these
women have chosen to keep their babies. What happens to these young
families remains a challenging question.
The early years of parenthood, even under the most optimal circum
stances, are commonly viewed as a transitional period--one in which the
individual is attempting to establish equilibrium and adjust to the
responsibilities of becoming a parent; of caring for another human
life (Rossi, 1968' ; Packer, Resnick, Wilson.and Resnick, 19:79). This
can be an extremely stressful period for all members of the family.

3
The impact of the transition to parenthood on the individuals
involved as it related to future parent-chiId transaction has been the
subject of many current studies, Brazelton's (1973) findings suggest
critical interrelated components through which the mother forms the
beginning of attachment to the infant. The stages include: 1) plan
ning the pregnancy; 2) confirming the pregnancy; 3) accepting the
pregnancy; 4) acknowledgement of fetal movement; 5) acceptance of the
fetus as an individual; 6) birth; 7) seeing the baby; 8) touching the
baby; and 9) giving care to the baby. Russell's (1974) examination of
511 couples and their 6-56 week old infants supports the view that the
transition to parenthood is a crisis situation which involves a reorga
nization of the family's social structure. This change in family
relationships was noted to be "bothersome" to new parents. Relevant
adaptational factors noted by Russell from self-report checklists were:
1) the pattern of communication which affected the planning of the birth
and a positive adjustment to marriage; 2) a high degree of commitment to
the parenting role; 3) good maternal health; 4) a nonproblematic baby;
and 5) preparation for parenthood. These factors are compounded in
magnitude in the developmental tasks of the adolescent mother.
Of special concern for the very young mother is her ability to cope
with the multidimensional aspects of parenthood and to facilitate positive
transactions with her child. The five factors discussed above suggest
the need for further exploration as they involve two very specific
developmental tasks: 1) the adolescent's acquisition of an independent
concept of self; and 2) the parent's role transition from an individual
to a member of either a dyad or a triad. When one considers the magni
tude of each of these tasks separately and then as occurring simultaneously,
the situation of the young mother and her baby becomes potentially more
devastating.

4
An area of general concern is the lifestyle chosen by the mother
and its implications for the development of the mother, her baby and the
developing family unit. Alternatives chosen by the mothers have included
marrying the father, raising the child alone or living with the extended
family, relatives or friends. The ramifications of the choice of life
styles have been the focal point of several studies which have noted the
"burdens and benefits" of early parenting (Furstenberg, 1978). Negative
outcomes have been related to: 1) a loss of educational and vocational
skills; 2) family impoverishment due to the high incidence of repeated
pregnancies in the adolescent population (Moore, 1978); 3) a 60 percent
divorce rate for pregnant adolescents who marry; 4) a higher degree of
medical complications and risks durinig prenatal and neonatal periods for
mother's lacking in prenatal care (Placek and Jones, 1976); and 5) a
lack of preparation for the parenting role (Crider, 1976; Badger et al.,
1974) resulting in a lack of skills in facilitating parent-child relation
ships, as well as a high degree of suspected child abuse (DeLissovoy, 1973).
The positive outcomes of early parenting are difficult to assess and
often far more difficult to accept. More staggering than the sheer numbers
of young mothers and more perplexing than the risks in questions are the
prevalent attitudes of today's society. The negativism faced by the mother
in the school, professional'environment and community is potentially
ating
than
83.1*1 V
parenthood
itself,
In effs
¡ct,
this
says to
"vnu
J ~
can! t
be a
good mozher
-you're
too yo^-
incri"
If
our
to be
frui
tful,
we must ope
n our mix
ids and
main
tain
a realisti
perspective in order to understand the role of the adolescent as a parent.
The Concept of Parent-Child Transaction and Infant Development
The past decade has witnessed considerable research in the area of
neonatal characteristics with respect to innate competencies and
capabilities. The data indicated that the newborn arrives with two

5
sequentially integrated systems of readiness (Gordon, 1975). The ability
of the sensory system to receive and the central nervous system to
process information is referred to as "responsive readiness." From
this point, "adaptive readiness" allows the infant to cope with and
modify the environment accordingly. It is this reciprocal relationship
between the infant and the environment which is described as transaction
and which forms the base upon which future development and learning grow.
The attachments formed as a result of these first transactions between
parent and newborn thus become important to an understanding of
development.
Of primary significance to the newborn are those individuals with
whom the first contact is made and a relationship establishedthe mother,
father and other family members. Numerous studies have dealt with the
implications of these first bonding experiences--those which establish
the attachment of one individual to another through the unique exchange of
sensory stimulation and affective warmth (Ainsworth, 1972; Bell, 1974;
Brazelton, 1975; Klaus and Kennel1, 1976; Lamb, 1977). The use of direct
and videotaped observations of dyadic interaction has been one useful mean
of exploring the parent-child relationship. The analyses of structural
patterns and behavioral components in the observations have indicated
that several specific variables are directly related to the infant's
language, cognitive, and socioemotional growth (Clark-Stewart, 1973).
These variables include affective warmth, face-to-face orientation,,
and responsive (rather than directive) behaviors and verbalizations.
It is these attributes which are the focal point of this study. Of
special interest is the relationship between the mother's ability to
interact in a manner' which is responsive to the needs and capabilities

6
of her infant and the infant's ability to participate in a reciprocal
manner.
In summary, the research indicates that the infant is a competent
human beingcapable of responding to and with the environment. The
infant posesses many competencies, yet is unable to perform certain
tasks, and must depend on other individuals for life sustaining and
enhancing functions. The quality of the care provided for the infant
is the vital element which will promote the most positive growth during
the child's first three years of life (Gordon, 1975). HJkat /LmcUn Zn
qu^ZZcm -6 the. quaZZiy ol acut p/iovZdad by the. ozty young motheA.
While the risks of early parenthood are obvious, the strengths of the
young mother have yet to be empirically documented. An assessment
of the strengths and limitations of the mother-infant relationship
and the infant's development will thus contribute toward a more thorough
understanding of their needs and: will make it'.possible 'to design more
comprehensive services for the young family.
Questions Addressed in the Study
The independent variables under investigation in the study are
age of the mother, education of the mother, sex of the infant, birth
order, perinatal risk status, socio-economic status, social support
system, ethnicity and participation in prenatal treatment and childbirth
and parenting education programs. The relationships between and among
the independent and dependent measures of infant development and mother-
infant interaction were investigated by an overall test of no
association between the two sets of variables. Follow-up tests on the
specific variables under investigation indicated the degree* to which
they contributed, to the prediction of developmental outcomes.

7
The general questions addressed in the study were investigated
as follows:
1) Do infant development and mother-infant transaction vary as
a function of the age of the mother?
2) Is the relationship between the mother's age and each dimension
of transaction and infant development linear after controlling
for all other independent variables?
3) What is the nature of the relationship between prenatal medical
care and development at six months after controlling for all
other independent variables?
4) Which variables contribute predictive information to the
identification of developmental delays on infant development
measures at six months?
5) Is there a positive relationship between the extent of prenatal
and postpartum parenting education and infant development
and mother-infant transaction at six months?
6) Is there a positive relationship between the extent of the
mother's social support system and transaction and the infant's
development?
Summary
The purpose of this study was to investigate the transactional
relationship between the adolescent mother and her infant and the
infant's development. We have reason to believe that the young mother
and her infant are at risk for problematic development; yet our current
sources of information are limited in number and yield inconclusive
findings. This study was designed to explore the unique contributions

8
of socioenvironmental, medical and educational variables in order to
increase our understanding of the needs of the young mother and her
infant. As a result, our interdisciplinary efforts to provide comprehen
sive services will be able to become more sensitive to the special needs
of the young family.

CHAPTER II
THE REVIEW OF THE RESEARCH
This study was designed to explore the transactional relationship
between the very young mother and her infant and her infant's development.
In order to understand the implications of early parenthood on the
mother and her baby, it is necessary to synthesize the literature from
several sources of knowledge.
The variables which are the focal point of the present study --
prenatal and perinatal risk factors and socioenvironmental, medical
and educational resources -- are presented in this review as they
relate to the sequential development of the adolescent as a mother.
Specific discussions of the role of the extended family and psycho
social influences on the young woman undergoing the transition to
parenthood are presented within the context of each phase of the
transition. These topics are also discussed as they relate to the
development of the child born to a very young mother.
As noted previously, the adolescent undertaking the task of
motherhood faces both a transition from her family of origin to
psychological independence and the transition to the responsibilities
of parenthood. Her relationship with her baby and her baby's growth
can be viewed as a function of the mother's ability to establish
9

10
equilibrium in these two multidimensional stages of development. The
literature reviewed in this chapter has therefore been selected from
two distinct fields: 1) the study of parent-infant transaction as
it is related to infant development; and 2) the special study of
adolescent parenting.
A review of the research related to young mothers' transactions
with their infants is limited by the fact that there exists but one
observational study to date (Badger.et al., 1973). 'For this reason, non
age-specific studies of the mother-infant relationship and transaction
process as they relate to infant development are presented as a basis
for understanding the process and the aspects which concern the young
mother and her infant. The presentation of this material in such a
manner is based on the assumption that there are certain universal
aspects of mothering and infant development and that these are
generalizadle to the study of adolescent mother-infant transaction.
It is beyond the scope of this study to deal with the many issues
associated with adolescent pregnancy, except as they concern the
role of the mother and her baby's development.
-f
Parent-Child Transaction and Infant Development
The emergence of current information regarding the newborn's
competence and capabilities has been accompanied by investigations
of the earliest years of a child's life and those who play signif
icant roles in the development of the child. The child's concept
of self forms a major basis for the developmental process and has been
thought to be related to early transactions between the newborn and
parent. When the concept of self is viewed as a learned rather than

11
than an innate phenomenon;, the child's self-concept--appears to develop.
as a function of the growth, process through transactions with people
of significance. Gordon (1966) summarized much about the development
of the Self in infants and young children when he stated:
Their original images of themselves are formed in the family
circle. They develop the notions of who they are in relation
to people around them, particularly through ways in which their
behavior is received by adults who are important (and that)
the origins of self-concept are the results of interactions
with his parents and the meanings he assigns these experiences.
(The Self thus becomes) the motivating and selecting factor of
behavior (and learning) . and is the sum of subjective
judgements he makes with regard to himself and his experiences.
Cp. 74)
In this way, predispositioned feelings about self are conceived and
ramifications for future development become evident.
It becomes important then to turn to the more global studies of
the parent-infant relationship. In this way we may better understand
the development of the adolescent as a mother and the ramifications of
this process for the growth of her child.
How does the mother-infant relationship begin? What is meant
by the terms attachment and bonding and how do they affect future
development? How can we better extend our understanding of these
abstract concepts with more concrete evidence? These questions have
prompted a considerable amount of research concerning the evolution
of the newborn's first experiences within the family (Ainsworth, 1972;
Bell, 1974; Brazelton, 1975; Klaus and Kennell, 1976; Lamb, 1977),
Let us review Brazelton's (1973) discussion of the interrelated
components through which the mother forms the beginning of attachment
to the infant. The stages include: 1) planning the pregnancy; 2) con
firming the pregnancy; 3) accepting the pregnancy; 4) acknowledgement
of fetal movement; 5) acceptance of the fetus as an individual;

12
6) birth; 7) seeing the baby; 8) touching the baby; and S) giving
care to the baby.
In view of the findings by Zelnick and Kantner (1978) regarding
the large number of unplanned births to adolescent women, the subse
quent development of feelings of attachment to the infant remains
in question. This is confounded by the fact that the pregnancy is
often confirmed and acknowledged in the second or third trimester.
These factors pose additional threats to the relationship between
the adolescent mother and her infant. The delayed confirmation
and acceptance of the pregnancy have remained unstudied with respect
to their impact on the adolescent mother-infant relationship and
are in need of further exploration.
Wien considered within the framework of social learning and
experiences, the feelings brought by the mother to the first encounter
with her newborn are a product of her identification with her environ
ment, the effects of imitation and modeling, cultural influences,
values and expectations (Klaus and Kennell, 1975). The role of the
very young mother's environment and family of origin has thus been
an important area studied with respect to early pregnancy and parenting.
Fox (1978) notes the family's multifaceted impact on the adolescent as
a social "interactor" which is operationalized through childrearing
styles and by the quality of the relationships between dyads within
the family and among family members.
In studies of maternal-infant attachment, Ainsworth (1972)
has examined the qualitative characteristics of interaction from the
study of separation and has offered some defining attributes of

attachment as a phenomenon. This attachment is viewed as an environ
mental adaptation evolving from the infant's attempt to gain proximity
to the primary caretaker. Attachment differs from dependency in that
it involves an affective preference for contact or multisensory
stimulation3 as opposed to the desire for the fulfillment of a physical
need. Attachment is initiated through the process of mutual gazing and
the establishment of eye contact with the mother. Observations have
shown that gazing is followed by locomotor approach. Lamb (1974)
stressed the need to view these characteristics as a series of inter
related components of behaviors which are uniquely individual expressions
and must be viewed as a part of a sequence in the transactional process.
Behaviors are then clustered to find measurable criteria without
threatening attachment as a concept.
In an attempt to categorize structural patterns and behavioral
components and to quantify optimal maternal behavioral variables,
several studies have focused attention on direct and videotaped observa
tions of dyadic interaction. Brazelton et al. (1975) stated that
"it is through an early system of affective interaction that the develop
ment of an infant's identification with culture, family and other
individuals will be fueled" (p.80). The study examined twelve pairs
of mothers and infants involved in face-to-face interaction over a twelve
month interval. Behaviors such as vocalization, head position,
direction of gaze, body position, amount of movement and handling
revealed that the quality of each partners actions were in direct
relationship to the other. The behaviors were viewed as an indication
of intentional affectivity and indicated that each partner modified

14
and adapted reciprocally in response to feedback from the ether
individual. The sequence of phases which emerged from the observa
tions of the mother-infant dyads comprised: 1) initiation;
2) mutual orientation; 3) greeting; 4) play dialogue; and 5) dis
engagement. This notion of the infant's social self-regulation was
interpreted from intentional explorations -- both cognitive and
affective -- and the mother's ability to enhance the infant's attend
ing to her for important cues.
Lamb (1977) supported the notion that the infant's active parti
cipation is directly related to a sensitivity to signals. He cautioned,
however, that it is as yet unclear whether infants emit behaviors which
elicit a response, or whether they regulate their own behaviors to
engage in reciprocal interaction as a function of their intellectual
competence. The question of the infant's competence in evoking a
response has also been investigated by Sameroff (1979). He suggested
that a distinct feature of the transaction (as opposed to interaction)
model is the recognition given to the infant and the ability of the
infant, to modify the environment. Ainsworth and Bell (1973) acknowledged
the infant's contribution to the transaction process in the state
ment :
Whatever the role may be played by the baby's
characteristics in establishing the initial pattern
of mother-infant interaction, it seems quite clear
that the mother's contribution to the interaction and
the baby's contribution are caught up in an interacting
spiral. It is because of these spiral effects some
"vicious" and some "virtuous" that the variables are so
confounded that it is not possible to distinguish inde
pendent from dependent variables, (p.160)
The relationship between infant competence anu the mother-infant
transaction process remains in need of further exploration.

15
Tlie effects of the quality of mother-infant interaction on the
development of both mother and infant has been investigated as well.
An intensive nine month study of 369 eighteen month olds in repeated
observations, interviews and developmental assessments, lends support
to a view of social competence in the infant and 'a dependence upon
its nurturance through reciprocal transactions (Clarke-Stewart, 1973).
Findings indicated a significant relationship between maternal stimulation,
responsiveness, and expression of affection and the child's developmental
changes and social, emotional, cognitive, and language competence.
The most influential factor was found to be the quality, rather than
nonresponsive quantity, of verbal stimulation. Other important factors
included the mother's role as an environmental mediator, her expression
of positive emotion, and frequency of responsiveness, stimulation, or
affectionate behavior as it related to the child's competence. The
data suggested that responsiveness to the infant's behavior had a duel
effect as it not only reinforced specific behavior, "but created an
expectancy of control within the infant which generalized to new
situations and unfamiliar people" (Clarke-Stewart, 1973, p. 107). Other
studies indicated maternal involvement with the neonate immediately
after birth as having positive effects on the mother's psychological
state and thus her ability to reciprocate responsively (Powell, 1974;
Klaus, Kenneil and Krause, 1975).
The fact that many adolescents do marry or enlist the support of
thetfather necessitates .a.ibti-ef discussion of current-studies which have ex
plored the importance of the father's role and his transaction with
the infant. By means of a self-report questionnaire and interviews, Wente and
Crockenberg (1976), examined the nature of the transition to fatherhood
with respect to the husband-wife relationship and the effect of Lamaze

16
preparation for childbirth. While it was noted that there existed a
high correlation between the husband-wife relationship and total adjust
ment to perceived changes, medical preparation in childbirth was
insignificant in facilitating adjustment after birth. What appeared
meaningful in the transition from dyad to triad ivas the sense of
"family" established as a result of the father's participation in the
birth. Total adjustment was found to correlate negatively with the disruption
of affection and intimacy, a decreasing amount of time spent with the
wife, and a discrepancy between the father's expected and actual care
taking role due to breast feeding. This aspect of early marriage and
fatherhood has been virtually ignored with respect to early parenting
(Chilman, 1979)
Studies of fathers' involvement have .supported'-the importance of
the father- infant transactional relationship. Parke:and Sawins
(1976) observations of fathers, both with the mother and alone with
the neonate, indicated that the fathers were equally involved in
establishing eye contact, holding, vocalizing and touching the infant.
Fathers were also successful in caretaking routines, and often exceeded
the mother's participation. In the context of feeding and on other
measures, fathers were found to be sensitive to infant cues and were
able to interpret infant behavior and modify their own behavior in
response. It was also noted that fathers touched and vocalized to
first-born males more often than to other offspring. Longitudinal
studies indicated that those fathers who were given the opportunity to
learn and practice skills in the hospital were more involved with
infants at six months (Parke and Sawin, 1976).
The results of the study on the strength of mother-child and father-
child attachment supported the father's role in the child's developing

17
competence (Lamb',. 1976b:}. During unstructured, free-¡pi ay in a laboratory
playroom, observations of twelve month olds were used to measure
the effects of each parent on the transaction process involving
the other parent. The effect of a stranger's presence (a stressful
situation) was also investigated in this study. The findings indicated
a significant reciprocal effect in the presence of both parents on
both mother-infant and father-infant relationships. The infant's
affiliation behaviors -- smiling, reaching and touching -- and
interaction during play showed a preference for the father. In a
stressful situation, however, primary attachment surfaced and infants
under two years of age sought proximity to the mother. Lamb (1976)
points out that the results of his two studies should not be used to
equate affiliation with attachment as an affective preference for
one parent or the other.
The findings that early interpersonal transactions are of
importance to the young child's development of competence stimulated
further investigation into the expanding socialization process.
This process has been shown to have a pronounced relationship to
total development in infancy and throughout early childhood. The
parent-child relationship was shown to be related to the language,
social, emotional and mental development measures of infants who
were followed from nine to eighteen months of age (Clarke-Stewart,
1973).
Based upon the assumption that the infant is preadapted to
selectively attend to stimuli and facilitate adult-infant interaction,
numerous studies have explored the notion that reciprocity is an

18
outgrowth of the mutual enhancement of feelings of efficacy (Ainsworth,
1972; Bell, 1974; Brazelton et al., 1975; Klaus and Kennel1, 1975).
The parent's distinctive interpretations of the infant's states of
arousal have been shown to prompt an appropriate response to stimula
tion. The extent to which the behaviors of significant others can be
anticipated from contextual events functions as a determinant of the
quality and extent of the infant's responsive reaction (Goldberg,
1977) The ability of the young mother to interpret the state of her
infant and facilitate appropriate transaction has been questioned by
a number of authors (Hardy et al., 1978; DeLissovoy, 1973) and
was investigated in the present study.
Beckwith et al. (1976) studied the preterm infants' inter
actions with their mothers at one, three and eight months of age
through observations in the families' homes. Her findings indicated
that infants whose Geseil developmental quotient was higher at nine
months spent less time being in routine care at one and three months
and were given more floor freedom at eight months. Higher scores
on sensorimotor measures were associated with mors mutual gazing
during one month observations, with smiling and contingent responses
to distress at three months and general attentiveness at eight months.
Beckwith's (1971) study of maternal attributes and their infant's
I.Q. scores revealed freedom to explore the home, experience with
people other than the mother and the adoptive and natural mothers'
socioeconomic status to be important interaction variables which wrere
related to enhanced development.
Much research has been undertaken which deals with dyadic communica
tion skills in an attempt to trace qualitative interpersonal skills and note

19
essential characteristics of social reciprocity. From initial attachment
bonds, the infant acquires skills in evoking a response and, as a result,'"crus
an "emotional connectedness" is formed between the infant and others
(Bell, 1974; Brazelton et al., 1975].
In looking at the quality of interaction of mothers and their young
children, we can better understand the impact of the mother-infant rela
tionship in infancy. A recent study of early mother-child verval inter
action indicates the mother's capability to adapt her language behavior
to cues from the young child. Moerk (1975) found a correlation between
the mode, length and complexity of mothers' responsive language and the
child's developmental level. This suggests that the young children's
competence is related to their mothers' modeling, explanation, corrective
feedback and expansion of their behaviors and ideas. Holtzman's (1974)
findings further illustrate this concept of social learning in verbal
content which stimulated the child to work through "contextual solutions
from within his cognitive repertoire" (p. 34). The nonverbal aspect of
interpersonal communication between five year olds and their mothers was
explored by Schmidt and Hore (1970) They noted a difference between
sopntaneous signals not intended as communication and expressive
behavior transformed by the intention to communicate. Their findings show
more use of reciprocal glancing and complex language with children of
higher socioeconomic status. No significant differences in body contact
or closeness were found to be associated with socioeconomic status.
Emotional implications of the verbal and nonverbal environment
were the subject of investigations done in sequential semi-structured
observations of one and two year olds in middle class homes (Nelson,
1973). It was found that nondirective parental strategies which were
accepting of the child's behavior, including feedback and nonselective

responding, were significant in the facilitation of emotional and
language development. Behavioral evidence which supports the effects
of encouragement and reflective responsiveness was seen in laboratory
observations of mother-child transaction as facilitating attention control,
spatial orientation and field-independent cognitive styles (Bronson,
1972; Campbell, 1975). In studies relating infancy to early childhood,
the child of between three and five years was seen as able to interpret
the level of expressiveness and abstractness and was developmentally
verging on the ability to differentiate the "perspective reality orien
tation'1 of the partner through increasing empathy and decxesing egocentri-
city (Newman, 1976). This suggested that from early transactions,
the young child comes to learn how to affect another individual. Through
this process, the infant (and young child) learns as well that the
response of another is an expression of feelings and ideas and that
these expressions are directly related to the process of interaction.
Summary
In summary, the development of the child appears to be strongly
associated with the quality of the relationship between mother and
infant. These studies which have dealt with the concept of transaction
clearly demonstrate that the mother-infant relationship is of prime
importance to the development of the child. Still, surprisingly little
is known about the infants of adolescent mothers. Often our sources
of information have been limited in generalizability. They do, however,
acknowledge .the need'for concern regarding the psychosocial, educational and
medical risks associated with early childbearing. It is hoped that the
consideration of the very young mother in future research will extend
our knowledge base. Exploratory studies of the young parent family will thu
strengthen efforts to improve the quality of professional services to
the family as a unit and enhance the quality of life for each individual.

21
The Young Mother and Her Infant
Churchill once said crisis is a dangerous opportunity.
If pregnancy in adolescence can be defined as the
crisis, what [happens to] the infant may well be the
dangerous opportunity.(Howard, 1976, p. 247).
This "dangerous opportunity" to which Howard referred is one about
which very little is known. The past decade has given rise to great
concern about the increasing numbers of adolescents who become
parents each year. We have begun to investigate the medical, social,
economic, psychological and educational consequences of early pregnancy
and parenting, but surprisingly few studies have dealt with the
development of the infants of very young mothers. Even less is
known about how the young mother relates to her baby--the strengths
and weaknesses in her style of parenting. To date, too few observation
al studies exist which document her unique repertoire of mothering
behaviors. Our present sources of knowledge are thus lacking in
relevant information and are limited by a lack of methodological
refinement in early research.
Before proceeding to a discussion of the research related to
early parenting,it is necessary to explain some of the methodological
problems in this area. In two separate reviews of the research,
Crider (1976) and McKendry, et al., (1979) cautioned against the
attempt to generalize from existing studies. In many cases, biases
in our present sources are due to sample selections which were lack
ing in age specificity and inappropriate methodological procedures.
Specifically, the analytical treatment of variables such as socio
economic status and mothers' age was such that we do not know how
much each contributes separately to the outcome measures of early
pregnancy and parenting. A persistent bias is found when statements

22
of generalization about the parenting style of adolescents are made
without regard to the design of the given study. For example, many
authors described negative behaviors of the adolescent parents
(DeLissovoy, 1973; Presser, 1974), but the sampling was such that only
adolescents were included. If one is to suggest that young mothers
display a higher incidence of dysparenting, it is necessary to include
the "of age" mother in the design. Without this inclusion, we are
unable to ascertain the relative contribution of mothers age to her
style of parenting. A similar constraint is placed on generalization
from studies of the infants of adolescent mothers. For this reason
limitations will be noted in early research concerning the young mother
and her infant.
In order to better understand the consequences of early child
bearing on the mother and her infant it is necessary to compare the
young mother to her "of age" peer. Variables of interest include the
trends in birth rates, medical risks to the neonate and follow-up
assessments of the infants of adolescents. This review wil 1 therefore
address these issues from the perspective of their relationship to
the adolescent's role as a mother and the development of her baby.
The Etiology of Early Pregnancy
In looking realistically at newer research on adolescent parenting,
it is evident that there are two distinct categories. One is the study
of pregnant teenagers and the second is the study of teenage mothers.
In other words, tkeAZ -os a ¡VUklng dLLfztimcz beJwzzn bacmng a
pmgnant te.znc.gzn. ¡2nd bcoining a tzznagz mothzn.. This issue is
concerned with the element of choice upon the confirmation of pregnancy.
The individual often is able to choose whether to: 1) abort or
continue the pregnancy; and 2) give the baby up for adoption or under
take the tasks of parenthood.

23
Several disciplines have taken issue with the phenomenal number
of pregnancies which have occured during adolescence. The biomedical
explanation of how and why pregnancy occurs is quite well known and
involves the science of human reproduction. From the political, socio
logical and educational perspective we find that a large number of early
pregnancies are also due to young people's lack of knowledge or misin
formation about contraception and a lack of confidential family planning
services made available to them (Klein, 1978; McKendry et al,, 1979).
The psychological and psychosocial antecedents of early pregnancy
are more intricate since we are concerned here with the dimensions of
human sexuality. From this standpoint, early sexual activity and
resultant pregnancy become more comprehensible.
Paulker's (1970) data from a study of girls who became pregnant
out of wedlock suggests that "the girls are not pregnant because they
are different, but are somewhat different because they are pregnant"
(p. 163). Rossi (1968) interpreted this concept in her discussion of
the transition to parenthood and its direct relationship to the intent
of the individuals involved. Rossi stated, "the inception of a pregnancy
... is not always a voluntary decision, for it may be the unintended
consequence of a sexual act that was recreative in intent rather than
procreative" (p. 31).
The question of intent has been explored by Zelnik and Kantner
(1978) in their 1971 and 1976 studies of first pregnancies of women
between the ages of 15 and 19 years of age. Their findings, based on
National Probability Survey statistics, revealed that there has been
little change in the proportion of white teens who become sexually active
and pregnant, each year, but there has been a substantial decline in the
number who delivered. The authors stated that "few who become

24
pregnant do so intentionally, but few who become pregnant use contracep
tion (p. 11). The black population evidenced little change in the
number of first pregnancies and an eight percent decline in premarital
intercourse. The authors stated that a discrepancy existed in the number
of live births and abortions reported by Blacks which was possibly
due to the negative attitude of the culture towards abortion. Blacks
were noted to report a higher number of live births and fewer abortions
than were actually counted in the National Survey. It is important
to note that any information obtained by means of self-report question
naires and interviews is that which the subject is willing to disclose.
This limitation is especially relevant to this study due to the extremely
personal nature of the questions regarding intent. Regardless of
the intent, we are faced with the fact that one million adolescents
become pregnant each year (Alan Guttmacher Institute, 1976) .
Turning to the study of adolescent psychology (or psychopathology,
as it may seem), several conflicting studies focus on the personality
of the adolescent as an explanation of her sexual behavior. A composite
personality profile of the pregnant adolescent is one of a young woman
who typically came from a broken home, was sexually active with one
partner on a steady basis, reached an early menarche, was sexually
impulsive, narcissistic, sociopathic, rejected, isolated, lonely,
unsuspecting, and/or unprepared (Kane and Luchenbrugh, 1973; Rosen,
1661; Cobliner et al., 1975; Barglow et al., 1967; Malmquist, 1967;
Claman, 1969; Gottschalk, 1964). Another view is that "adolescent
patients became pregnant being normal adolescents doing normal
adolescent things" (Malmquist, 1967) Each of these studies is
characterized by a methodological problem in either the use of small
samples or the lack of a comparison group of women over the age of

25
19 years. A third approach to this area of study is best summarized
by Cutright (1971) in answer to the question, "who is the pregnant
school-age girl and why is she pregnant?" Cutright answered:
'Why is she pregnant?' To me this question implies a path
ology behind pregnancy, and denies human sexuality. In the
United States we keep trying to find out what kind of people
(in psychological terms) get pregnant out-of-wedlockwhat
could we do if we found an answer? We do not ask of married
women experiencing unwanted pregnancy 'why are you pregnant?'
Yet 20 percent of white and 36 percent of all nonwhite legi
timate births during 1960-1965 were unwanted by the parents.
Rather, we ask what means were available to control conception
and gestation, and then move to devise a program to help
married women control unwanted pregnancy and birth. We infer
nothing pathological when we speak of unwanted pregnancy among
married women, and it is time we do the same for unmarried
pregnant women, (p. 131
The Growth and Development of the Very Young Mother
Now that we have briefly reviewed the background information
regarding pregnancy in adolescence, let us turn to the resolution
of the pregnancy; specifically, the decision to continue the pregnancy
and become a parent. At the onset of this discussion, a clarification
is in order. In many instances, there is no viable choice to be made
by the pregnant teenager. Unless pregnancy is confirmed during the
first twelve weeks of gestation, abortion is no longer an option.
Another constraint is the cultural pressure facing the adolescent
which is quite ambivalent towards abortion. We have reason to believe
this is changing (Hardy, 1978), but to date, there is a general lack
of acceptance of abortion among members of minority cultures. This
lack of acceptance of abortion as a viable alternative to parenthood
should not be construed to mean that minority cultures condone or
accept early pregnancy and parenting in their offspring. To the
contrary, the works of Furstenberg (1976, 1978), Butts (1978), Martinez
(1978), and Wright- Smith ^1975) confirmed that feelings of disappointment,

26
social disgrace, and the stress of financial burden are feelings which
are shared among all families of pregnant adolescents, regardless
of their cultural origins. The family's reaction to the pregnancy
has been shown to be important to the adolescent's development as a mother.
As has been noted frequently throughout this work, we are concerned
here with the special ways in which mothers and their infants
establish a relationship and grow together. The study of early
parenting involves a unique set of characteristics and stages through
which the young woman must pass.
The first stage following the confirmation of the pregnancy
concerns the decision regarding its resolution. Because the adolescent
often feels guilt, shame, and fear upon the acknowledgement (Furstenberg,
1976) this becomes a critical point in her development as a mother.
The study of this phase in the transition to parenthood has been
synthesized by the three authors who, coming from the different
perspectives of developmental and social psychology, have developed
surprisingly congruent theories. The works of Chi1man (1379),Furstenberg
(1978) 'and Fox (1978) have emphasized the importance of the family (often
referred to as "the family of origin") and especially that the mother-
daughter relationship ha.s perhaps the most pronounced effect on how
the pregnancy is resolved.
Furstenberg (1976) has discussed the impact of the discovery
of the daughter's pregnancy on the family. He found that for three-
fourths of the families he studied, this was the family's first
acknowledgement of the daughters sexuality. The reaction was often
shock and disappointment. This contradicts the often held belief
that early pregnancy and illigitimacy is an acceptable trend among
lower socioeconomic and/or minority cultures. Presser (1974)

27
complemented this with her finding that there was an association between
early maternal childbearing and the behavior of the daughter.
Chilman (1979) sited the fact that "daughters whose mothers had
early pregnancies were more likely to become pregnant as teenagers", (p. 2T09]
As found in her earlier work, "actual maternal behavior is apt to be
more influential than stated attitudes and goals for the [developmental
outcomes of] children" (p. 209).
The influence of the family of origin on the prevention of
pregnancy and the use of contraception and abortion has been another
area of interest. In general, the authors have concluded that a young
girl's decisions both to become sexually active and to use contraception
are related to her parent's values and support of her, her relationship
with each parent and the degree of connectedness within the family
(Jessor and Jessor, 1975; Lewis, 1973). Fox (1978) cited the Rosen
(1977) finding that, when adolescents consulted their families, the
young woman was more likely to continue the pregnancy and keep her
baby. In contrast, those who sought abortions rarely consulted their
parents.
The plans Implemented by the young mother following the
decision to continue the pregnancy were discussed by Young, Birkman
and Rehr (1975). In their study of the role of the mothers of teens
who carried their pregnancies to term, the mother was noted to be
especially influential in the decision making process. The- daughters
living arrangements, educational plans and child care and childrearing
arrangements were those most often influenced by the mother.
We can look to the National Center for Health Statistics for a
quantitative summary of those who gave birth during adolescence in
order to understand the trends. In comparing the birth rate of
A o

28
adolescents to that of older women, Baldwin Cl976) has noted a
peak in the rate for 18 and 19 year olds and older women. This
peak occurred during the 1950's and has declined steadily since that
time. The decline has been less extreme for 16-17 year olds. For
the youngest teens (< 15 years), the birth rate has risen. The
comparison of birth rates by race has revealed a striking pattern.
Baldwin noted "the birth and illigitimacy rates are both higher for
black than white teenagers. However, recent rises in birth and
illegitimacy rates in the young reflect changes in the white population.
The birth rate for black teenagers has declined steadily and the
illigitimacy rate is fairly stable (Baldwin, 1978)."
A more recent survey from the final 1977 National Natality
Statistics revealed a surprising trend in the fertility rate of those
mothers below' the age of 18. The fertility rate "declined slightly
for women under 18 [as did the] rates of out-of-wedlock births among
Blacks and whites younger than 15 and among Blacks aged 15-17"[Family
Planning Perspectives, 1979] While this most recent trend is
encouraging, the fact remains that one of every five babies born
today is born to an adolescent mother (Baldwin, 1978) .
The rate of child bearing and its relationship to childrearing
trends has been summarized by the Alan Guttmacher Institute (1976). In
1971, of those adolescents who gave birth out-of-wedlock, 87 percent
kept their babies, five percent sent the baby to live with family
members or friends, and 8 percent gave the baby up for adoption.
This large percentage of infants raised by very young parents has
led to the study of the mother's ability to care for her baby and the
consequences of early parenting on the baby's development.

29
The Transactional Relationship Between the Very Young Mother and
Her Infant
The research to date regarding the adolescent mother-infant
relationship is characterized by serious shortcomings. We are presented
with problems in understanding the needs of the young family due to
the fact that: 1) the transactional process has been virtually
unstudied; 2) there is an extremely high degree of controversy in
the research related to adolescent caregiving; and 3) when the rela
tionship has been explored, the sampling has been such that no
comparison to the "of age" mother has been made. Our discussion of
the adolescent mother-infant relationship is thus limited. It is
to this specific gap in our knowledge that the present study was directed.
As has been noted throughout-, the purpose-of 'this study was to
address the questions regarding the behavioral repertoire of the
young mother, An important aspect of early parenting has been
the developmental tasks of adolescence which bear heavily on the
transition to motherhood. Fox (1978) summarized the importance of
several tasks related to parenting which were: 1) resolving feelings
about the family of origin in order to separate and become autonomous;
2) an intense need for closeness and concurrent feelings of being
"smothered"; 3) coming to terms with the "who am I?" question: in
defining one's self; and 4) the establishment of appropriate attach
ments apart from the family. As has been stressed before, these are
often overwhelming.and have been noted to influence the young mother's
relationship with her child.
In a study of adolescent's expectations and attitudes towards
their infants, DeLissovoy (1973) found disturbing charactristics of
the young parents. He noted them to be "an intolerant group impa
tient, insensitive, irritable and prone to use physical punishment

30
with their children" (p. 22). Delissovoy also found young parents to
have a lack of knowledge about child development and unrealistic
expectations of the infant. It was suggested that this lack of
knowledge governed the parents' actions to the child and constituted
a form of emotional abuse. These findings were based upon interviews
conducted during five visits in the homes of 48 adolescent families
residing in semirural Pennsylvania. The results prompt a caution
regarding their generalizability due to the lack of a comparison group
of urban or adult parents (Crider, 1976).
The conslusions reached regarding young mothers' inappropriate
attitudes and expectations towards her child were discussed from the
perspective of its relationship to her intent to become pregnant. In
an age-specific sample of 408 urban women (15-29 years) Presser (1974)
found that almost half of all mothers between fifteen and nineteen years
of age wished they had postponed their first birth. The mothers cited
the reason that the infant "restricted their life choices far more than
they had anticipated" (p. 13). The author concluded that early first
births and resultant child care are in need of more indepth investigation
in order to assess their importance to the woman's development as a
mother. Klein (1978) supported this notion of the adolescents' having
been "less than adequate as nurturing mothers" (p. 1154), and concluded
that the lack of knowledge and preparation for parenthood suggested a
need for more appropriate interventions.
Epstein (1979) addressed the lack of knowledge about infant develop
ment and its implications for mothering. Cm prenatal and six months
postnatal assessments of 125 mothers in the High Scope Project, teens
evidenced a lack of knowledge about the infants' cognitive and socio-
emotional development. The author noted that "babies were seen as

passive creatures requiring little more than basic caregiving" (p. 64).
The expectation of "too little -- too late" led to her conclusion that
because young mothers are unrealistic about what they need to give, they
"are likely to miss the gratifications able to be received from a baby"
(p. 64). The results of this study provide valuable information regarding
the educational needs of young mothers. Again, we are unable to ascertain
whether or not this lack of knowledge is attributed to youth due to the
lack of a comparison group of older mothers.
The findings regarding the problematic mothering style of the
young mother have led to the often unwarranted conclusion that
adolescents are likely to abuse and neglect their children to a
significantly greater extent than the "of age" mother. Epstein (1979)
contrasts her findings of expecting "too little, too late" with the child
abuse literature regarding abuser's expectations of "too much, too soon."
Crider (1976) noted the fact that most of the child abuse studies have
found the infant's birthweight, not the age of the parent, to be signifi
cantly related to abuse.
Kotelchuck's (1979) most recent investigation into the prediction
of pediatric social illness has illuminated the relative importance
of the mother's age in predicting child abuse and dysparenting. His
findings from a study in Boston revealed the parent's social isolation
to be the most significant predictor of inappropriate or abusive parent
ing. In a discriminant analysis which accounted for 40 percent of the
variance among abusers and nonabusers, the author found all measures
of depression and isolation to be significant. No significant relation
ship was found due to mothers age,
baby temperment.
immediate stress, birth factors or

32
Extending this concept of the parent's social support system to
the adolescent mother-infant relationship has proven to be illuminating
In a cross-cultural study of mothers and their newborns, Brazelton and
Lester (Note 1) compared adolescent mother-infant dyads in Puerto Rico
to those in the rural South. Their findings revealed the supportive
nature of the extended family to be strongly related to both mother-
infant transaction and the behavioral assessment of the neonate.
Perhaps the most in-depth studies of the importance of the
extended family to the adolescent mother-infant relationship are
those of Furstenberg (1976; Furstenberg and Crawford, 1978). His
longitidunal studies showed that most adolescent mothers were "apparent
ly loving, responsible, effective parents" (Chilman, 1979, p. 261) of
young children, especially if the responsibilities of child care
were shared by another adult.
Furstenberg's most recent work explored the family's support in
the early years of parenthood and its relationship to longitudinal
assessments of childrearing attitudes and practices. At the five
year follow-up of a sample of 404 Baltimore families, no differences
in mothers' reports of self confidence or racings of parent-child
interaction were noted among families of differing residential careers
or childcare arrangements. Among those mothers living alone or
apart from the extended family, Furstenberg noted a higher level of
control over the child's behavior and a higher level of interest in
the child. The author concluded that the mother's ability to establish
her own support system independent of the family was an important dimen
sion of her parenting role (1978) and evidenced a willingness to take
responsibility for herself and her child.

The impact of the extended family has yet to be explored within
the content of varying mothers' ages. This is especially important
in view of the large number of single-parent adolescent families.
The most recent estimates reveal that "39 percent of the children
whose mothers gave birth before the age of 20 experienced a family
breakup by age 15" (Family Planning Perspectives, 1979, p. 115).
Intervention With Young Mothers and Their Infants
In reviewing the outcomes of early parenting with respect to
the mother-infant relationship, we are confronted with disturbing
findings. Perhaps the most promising results, while few in number,
have been the investigations of interventions designed to assist the
young mother through her transition to parenthood.
In a smaller (N = 39), quasi-experimental evaluation of the ef
fects of weekly mother-infant classes in a pediatric clinic. Badger
(1974) found significant gains in mothers' knowledge of infant develop
ment, nutritional needs and infant health care. Most promising were
the significant increases in mothers' responsiveness to their infants
and the infants' increased responsiveness to the mothers. Badger noted
that the program had a significantly stronger impact on the behaviors
of the youngest mothers.
In an educational and medical program for adolescents in Syracuse,
Osofsky and Osofsky (1973; 1978) examined the mother-child relation
ship among 450 dyads. The authors noted the young mother's warmth,
physical interaction and attentiveness to their infants as being a
strong foundation upon which interventions were based. They also
found a major weakness to be a lack of verbal interaction. While

34
the study lacked a comparison group of older mothers and adolescents
who were given traditional treatment, the findings suggested important
areas in need of intervention.
Summary
Our sources of information remain limited with respect to their
methodology, scope and the documented strengths and limitations of early
parenting. They do, however, provide an intriguing basis for both
future intervention and research designs. In summary, the conflicting
results of studies investigating early parenting are inconclusive.
We are unable to ascertain whether young parents are any different
in their caregiving attitudes, feelings and behaviors than parents
who have postponed childrearing. Chilman (1979) systhesized the views
of those who are more optimistic when she stated:
By age 16 or so, most young people are at a higher level
of development and integration, but need more time to assess
their values, goals and heterosexual relationships. Because
child care requires the ability to be nurturant to another,
to carry a heavy load of responsibility, to control one's
impulses, to make wise judgments, and to be able to provide
the child with a wealth of experiences and firm guidance*,
it seems unlikely that younger adolescents would on the
average, be as effective in their childrearing as older ones.
It also seems likely that, on the average, a premarital
pregnancy would particularly strain a youthful marriage.
On the other hand, 'ages and stages' are far from the
whole story in human development and the capacity for parent
hood. People who have been 'we11-parented' themselves,
whose motivations, values, interests and experiences have
particularly prepared them to care happily and effectively
for children, may be excellent parents, regardless of their
age, especially if various support systems are available
to them in their own families and in the community- (p. 261)
*In sober truth, who can be and do all these things? (Chilman, 1979, p. 261)

35
The Children of Very Young Mothers : Perinatal Risk Factors
Thus far, we have discussed early pregnancy and parenting from
the perspective of the young mother. Of equal importance are the
consequences of early childbearing and childrearing for the infants
born to adolescents. Intuitively, we can guess that these infants
are at high risk for medical, developmental and educational problems.
Several factors have been brought to our attention by Crider (1976)
and McKendry et al. (1979) in their reviews of the risks associated
with adolescent pregnancy. The increased obstetric and neonatal risk
of pregnancy in a physiologically immature woman has been repeatedly
documented to have long range ramifications on the developmental
outcomes of the infant (Grant and Heald, 1970). This is often
complicated by delayed and inadequate prenatal care, poor nutritional
status, economic impoverishment, social isolation and emotional stress
(McKendry et al., 1979). As with much research on early parenting,
the investigations of the relationship between these factors and infant
development have revealed inconsistent findings. They do, however,
offer relevant information regarding the consequences of early pregnancy
and parenting for the infants of young mothers.
The most recent investigation of the prenatal, perinatal and neonata
complications associated with adolescent pregnancy was discussed by Ryan
and Schneider (1978) at the University of Tennessee Center for the Health
Sciences. The authors studied the obstetric performance and the status
of the neonate at birth among a predominantly black sample of 222 teens
who were 19 years of age or less at delivery. The findings revealed
these patients to have high rates of inadequate prenatal care, prenatal
complications and complications during labor and delivery. The perinatal
death rate was found to be twice that of the general population.

36
The neonatal complications indicated by low Apgar scores (_< 5),
central nervous system depression, pallor and decreased tone were
found to occur significantly more often in babies of adolescent mothers.
These findings offer important information to be considered in the
assessment of the developmental status of newborns of very young
mothers. A methodological concern should be noted with regard to the
author's comparison of their sample's results to a previously unspeci
fied sample of older teens and "of age" mothers.
The findings, as discussed above, about perinatal risk and mortality
of very young 16 years) adolescents, have been consistently
documented throughout the obstetric and pediatric research (McGanity
et al,, 1969; Crider, 1976; Jones and Placek, 1978; Knox, 1971; and
McKendry et al., 1979). Additional obstetric complications of
mothers under 16 years of age were found by Knox (1971). Very young
adolescents were noted to have a significantly higher incidence of
cesearean section births, premature rupture- of membranes and prolonged
labor. Other obstetric complications summarized by McKendry et al.
(1979) and Crider (1976) included abnormal presentations and infections
at delivery (McGanity et al., 1969), uterine dysfunction and one day-
fever (Coates, 1970), and cephalopelvic disproportion (irregular size
or position of the fetus head in relationship to the mother's pelvic
structure) (McKendry et al., 1979). These problems have been related
to the physiological and gynecological (the time span between the age
at menarche and first pregnancy) immaturity of the mother (Zlatnik
and Burmeister, 1977; Erkan, Rimer and Stein, 1972).
- The relationship between adolescents' obstetric complications and
neonatal risk has been closely studied by several authors (Crider, 1976;
McKendry et al., 1979; Mecklenburg, 1973; Dott and Fort, 1976;

37
Coates, 1970; Grant and Heald, 1970; Hardy, 1971; Youngs et al.
1977; Semmens, 1965). Findings which were consistently documented
by these authors indicated that the infants of young mothers were
at high risk for perinatal, neonatal. and infant mortality. Crider
(1976) cited a North Carolina study of perinatal mortality in an age
specific sample which found that the mortality rate was highest
when mothers were under 15, and declined through the age of 20.
The rate of morbidity (impaired medical and/or developmental
functioning) was also found to increase significantly as the mothers
age decreased. Mother's age and medical risks to the neonate included
respiratory distress syndrome, hyperbilyrubinemia, fetal distress
with anemia, fetal distress with asphyxia (Coates, 1970), low birth-
weight associated with prematurity and low birthweight associated with
small size for gestational age (Crider, 1976).
In studies where a comparison group of "of age" mothers were
included in the designs, we are presented with different findings.
Niswander and Gordon's (1972) discussion of the National Collaborative
Perinatal Study results indicated no significant differences between
mothers under 20 years of age and those over 20 with respect zo
perinatal death. Neonatal death was found to occur significantly
more often when the mother was less than 15 years old. Their data
did not support an association between out of wedlock births and
perinatal risk. Dott and Fort (1976) concurred with the finding that
the "unique medical problems [of the adolescent] are controllable and
do not differ appreciably from older women" (p. 536).
McKendry et ai. (1979) have summarized the limitations of
studies which have regarded the age of mother as a single predictor
of obstetric performance and neonatal status. The authors concluded:

58
These studies must be read carefully as a result of differ
ences in sample characteristics, the lack of controls, and
the inconsistency of terminology. The reader should be
especially wary of many review articles that treat these
medical conditions as proven fact; ironically, many times
these reports base their conclusions on inconclusive findings
(Stewart, 1976). However, there appears to be more credence
in the proposition that the young girl and her infant are high-
risk . patients > than in the proposition that they are
not. (p. 23) .
When variables other than mother's age were analyzed as predictors of
perinatal and neonatal status, the findings revealed no significant rela
tionship to the age of the mother. The variables that were consistantly
noted to predict obstetric and neonatal outcomes were: 1) nutritional
status of the mother; 2) socioeconomic status; 3) quantity of prenatal
care; 4) parity (number of prior pregnancies); and 5) spacing of births
(McKendry et al. 1979; Menken, 1972; Dott and Fort, 1976; Stine, Rider
and Sweeny, 1974; Mecklenburg, 1973). As noted earlier by Dott and Fort
(1976), many of the nutritional, obstetric and family planning problems
of adolescents are "controllable," but control remains dependent
upon the professional community's ability to make these services
available to young women and the woman's motivation to use them.
Dwyer's (1974) study of 231 12-16 year olds enrolled in a prenatal
program found no significant incidences of anemia, toxemia, labor and
delivery complications, low Apgar scores or post-partum problems. Pre
mature birth did result in 39 cases, however. While Dwyer's findings
are promising and suggest the managability of the adolescent's perinatal
outcome, they are based on a study which failed to use a comparison
group of older women or those with different prenatal care.
Semmens (1961) study of 12,847 adolescents and nonadolescents
who received care in a U.S. Naval Hospital found socioeconomic
status, rather than race, marital status or age, to be the most

39
significant predictor of perinatal outcomes. The prematurity rate
was identical in the two groups. The only difference was the
adolescent's higher incidence of precipitate (less than three hours)
labor and resultant fetal damage due to unattended deliveries.
The Louisiana Infant Mortality Study (Dott and Fort, 1976)
revealed that younger adolescents were less likely to utilize
antenatal services and that, when adequate prenatal care was given,
the perinatal and neonatal death rate was significantly lower. The
authors discussed the role of social and demographic variables in the
outcomes of the infants of young women. In the discussion of the
roles of social and demographic variables in the outcomes of young
women's infants, the authors concluded that "the burden of early
motherhood falls most heavily on the offspring . infant morbidity
and mortality are the greatest risks associated with [early child
bearing]" (p. 536).
In a report of the Collaborative Perinatal Study at Johns Hopkins
Medical Center, Hardy (Welcher et al., 1971) summarized the ramifica
tions of perinatal and neonatal outcomes in her statement:
The scope of fetal wastage is two dimensional: 1) in terras of
perinatal mortality; and 2) in terms of the perinatal insult,
which while not sufficiently severe to cause fetal or neonatal
death, results in long-term handicapping conditions of the
surviving infant--for example, cerebral palsy, mental retarda
tion, congenital malformation, blindness, deafness and other
neurological defects, (p. 238)
This point was stressed as well by Dallas (1971). He extended
Hardy's perinatal risk factors to conclude that, "later fetal outcome
and intellectual performance are dependent upon the complex intera.ction
of genetic, biological and environmental variables" (p. 249).

40
The ramifications of neonatal risk on the development of the
infants of adolescent mothers has remained relatively unstudied
(Guttmacher Institute, 1976). There have been, however, a handful
of longitudinal studies of children born to women enrolled in the
Collaborative Perinatal Project (Niswander and Gordon, 1972). The follow
up assessments of these infants included the age of the mother in the
design and constitute our main sources of information regarding
developmental outcomes of the children of young mothers.
Developmental Outcomes of Adolescent Pregnancy
The earliest and longest follow-up assessments of infants of adoles
cents were done as part of the Johns Hopkins Child Development Study
sponsored by the Collaborative Perinatal Project. For this investigation,
Hardy, Welcher, Stanley and Dallas (1978) defined adolescence to be 16 years
of age or less at delivery. The sample of 4,557 mother-infant dyads was
selected at random in 1964 and followed at a rate of 85-93 percent over a
12 year period. The sample consisted of 706 mothers who were 17 years of
age or less at delivery. At birth, there were no significant differences
betv/een the under 16 and over 16 groups on perinatal or infant death rates.
All risk factors were significantly higher for blacks than for whites.
At eight months of age, infants were assessed with the Eayley Scales
of Infant Development. The infants of mothers 20-25 years of age attained
significantly higher scores on., the ..mental scale than those of adolescents.
Hardy concluded that this was suggestive of "more effective childrearing
practices" (p. 1224). At four years of age, children were assessed using
the Stanford-Binet Intelligence Test for Children, tests of fine and gross
motor functioning, the Graham Block Sort Concept Formation Test, a behavioral
profile and psychological impression. On all measures, a higher proportion of

41-
children of adolescents were found to have inadequate outcomes.
At seven years of age, the children of adolescent mothers performed
less well than those of 20-24 year olds on the Weschler Intelligence
Scale for Children (WISC), the Bender-Gestalt Visual-Motor Test and
the Wide Range Achievement Test (WRAT). The children of adolescent
mothers were also found to have negative outcomes related to academic
achievement and repetition of school grades on the twelve year
assessment. Self-concept was measured by the Coopersmith and
Piers-Harris tests. No significant differences were found between the
children of adolescents and those of older mothers.
Hardy et al. (1978) have provided an abundance of valuable
information regarding the long term effects of early motherhood on
the child. The negative developmental outcomes attributed to the age
of the mother are distressing and suggest a need for early and intense
intervention. A major limitation of this study is due to the
lack of empirical evidence about the childrearing practices
of the mothers involved. While other studies using Bayley measures
at eight months have demonstrated that social, language and cognitive
development were empirically demonstrated to be correlated with mother-
infant transaction (Beckwith, 1973; Beckwith et al., 1976),the Hardy et a
(1978) study failed to assess the transaction process in a controlled
situation.
Furstenburg (1976) used interviews, tests and observational
data in a longitudinal study of low-income Black adolescent mothers
and their children. He found no differences on the Preschool Inventory
in the three year old children of 15 year olds when they were compared
to those of mothers of 13 and 19 years of age. He did find significantly
higher scores among children raised by more than one adult. Children

42
whose parents married early and stayed married had the highest
scores.
In a five year follow-up, Furstenburg (1978' ) compared children
of young mothers to children of older mothers who were in preschools.
He found that children who were cared for by grandparents in the
home scored significantly higher than those who were in preschools.
The author concluded that the child's cognitive ability was enhanced
as a result of the aid his mother received from her parents which
allowed her to become more educated and socioeconomically advanced.
These findings point directly to the long term assets of the mother's
social support system. The study is limited, however, due to small
size of the sample and the lack of a comparison group of nonBlack
families.
Holstrum (1979) studied the intellectual, perceptual-motor,
language and behavioral outcomes of premature infants at three years
of age. Her findings revealed that socioenvironmental and neonatal
variables contribute significantly to the prediction of develop
mental outcomes. Socioenvironmental variables investigated included
mother's age, material resources and amount of social stress. Follow
up simultaneous univariate analyses revealed that the age of the mother
did not contribute to the developmental outcome of three year olds.
Broman, Nichols and Kennedy (1975) studied a sample of 26,760
children born to mothers in the Collaborative Perinatal Project.
They tested the significance of 169 prenatal and developmental
variables in order to ascertain their ability to predict intellectual
performance at four years. Their findings revealed that maternal

43
education and socioecnomic status were major contributors to explained
variance in preschool IQ scores. The age of the mother was not found
to be a significant predictor. Bayley assessments at eight months
were found to be predictive of delayed intellectual development in
early childhood. These findings are particularly interesting in that
they reflect the contributions of the mother's age in a random, rather
than age-specific sample.
In an age-specific study comparing children of mothers under
18 years (n = 86) to those at age 18 and older (n = 86), Oppel and
Royston (1971) investigated nurturing behavior, family composition,
physical, social, and psychological characteristics. Subjects
were matched on economic status, birthweight, parity and race.
Data were collected at six tc eight and ten to twelve years using the
Binet and Wechsler intelligence tests, the Wide Range Achievement.
Test, psychological observations and the Maternal Behavior Research
Instrument. At both eight and ten years, children not reared by the
biological mother were at significantly greater risk on all measures.
There was also a significant difference in the child's physical size,
which revealed more children of young mothers to fall below the
third percentile in height. They also "displayed a trend towards
lower weight" (p. 752). No significant differences in intelligence
or psychological adjustment were found. Children of adolescents were
at a significantly lower reading level, however, and were rated to be
more dependent and distractible. Younger mothers were noted to
give more independence to the child, were less anxious, had less
intense emotional involvement with the child and were less likely
to have intellectual interests. The conclusions reached by the

44
authors are based on thorough documentation. The use of a matched
rather than random sample,however, has limited our understanding
of the relative contributions of race, socioeconomic status and
birthweights. Had these variables been controlled statistically
rather than in the experimental design, the results would have been
more generalizable. Another limitation of this study is the fact that
the data were collected for a purpose other than that for which they
were analyzed.
In summary, the long range outlook for the child born to a
young mother appears quite dismal. Regardless of the methodology, almost
every study has documented the intellectual, emotional, educational,
developmental and medical risks associated with early pregnancy and
parenting. Our only evidence of a more hopeful future for these
children comes from those investigations into the role of the
mother's support from her family and the professional community.
Our knowledge base is lacking in both the number and scope of studies
into the consequences of early parenting for the young mother and her
child. It is to this specific gap in our knowledge that the present
study was directed.

CHAPTER III
METHODOLOGY
The purpose of this study was to ascertain the contribution of
mother's age, perinatal risk status, and socioenvironmental, medical
and educational resources to the prediction of mother-infant transaction
and the mental and psychomotor development of the infant. The population
from which the sample was drawn consisted of mother-infant dyads who were
served by the College of Medicine at the University of Florida. The sub
jects were stratified on the basis of the age of the mother and were
selected at random from the Birth Log at the Shands Teaching Hospital.
Ninety-two mothers and their six months old infants participated in the
study.
The assessment procedures consisted of a six minute videotape of
mothers and infants in a free play situation and the administration of
the Bayley Scales of Infant Development. Demographic and socioenvironmen-
tai data were obtained from the Child and Family Development Interview
which was developed for use in this study. Following the assessment, a
parent and infant-centered protocol was implemented which was based on
the infant's needs as assessed on the mental and psychomotor scales of
the instrument. The data collection procedures were implemented in the
Pediatric Clinic of Shands Teaching Hospital. The sample, design and the
procedures for data collection and analysis are described in this chapter.
As noted in Chapter I, the questions posed by the study were:
11 Do infant development and mother-infant transaction vary

46
as a function of the age of the mother?
2) Is the relationship between mother's age and each dimension
of transaction and infant development linear after control
ling for mother's education, yearly income, ethnic origin
social support system, infant's sex and birth order and type
of prenatal care?
3) What is the nature of the relationship between prenatal
medical care and development at six months after controlling
for all independent variables?
4) Which variables contribute predictive information to the
identification of developmental delays on infant development
measures at six months?
5) Is there a positive association between the extent of
prenatal and postpartum parenting education and infant develop
ment at six months?
6) Is there a positive relationship between the extent of the
mother's social support system and transaction and the
infant's development?
In keeping with the exploratory nature of this study, additional
questions were investigated. The questions were:
7) Is there a relationship between the age of the mother and infant
development after controlling for transaction, infant's sex
and birth order, perinatal risk status-, ethnicity, yearly
income, social support system and type of prenatal care and
education?
8) Are the transactional behaviors of the mother-infant

47
relationship -- warmth, reciprocity, responsive vocalization,
negative affect and nonresponsive stimulation -- associated
with the mental and psychomotor development of the infant
after controlling for mother's age and education, infant's
sex and birth order, perinatal risk status, yearly income,
ethnicity, social support system and type of prenatal care
and education?
9) Is there a relationship between perinatal risk status and the
mental and psychomotor development of the infant after
controlling for the mothers age and education, the infant's
sex and birth order, yearly income, ethnicity, social support
system and type of prenatal care and education?
Definition of Terms
For the purpose of this study, the following definitions of
terms were used:
1) Infant Development consisted of the composites specified by the
Mental Development Index (MDI) and the Psychomotor Development
Index (PDI) of the Bayley Scales of Infant Development. These
indices reflect the mental, psychomotor, language and socio-
emotional competence of the infant.
2) Mother-Infant Interaction is the categorical identification
of behaviors described in the Beckwith Behavior Scale. These
behaviors were coded from videotaped transaction sequences.
5) Reciprocal/Responsive Behavior is that which is observed to
be directly related to the behavior of another individual.
4) Nonresponsive Behavior is that behavior which is observed

48
to be self-initiated and without regard to the behavior
of another individual.
5) Mother-Infant Transaction refers to the entire repertoire
of interaction behaviors between mother and infant.
6) Developmental Delay refers to a score of 68 or less on either
the Mental or Psychomotor Development Index of the Bayley
Scales Infant Development.
7) High Risk for developmental delay refers to a score between
68 and 84 on either the Mental or Psychomotor Development
Index of the Bayley Scales of Infant Development.
8) At Risk for developmental delay refers to a score between
85 and 100 on either the Mental or Psychomotor Development
Index of the Bayley Scales of Infant Development.
9) Prenatal Care by Private Physician refers to those patients
who received obstetric treatment from physicians in the
Private Diagnostic Clinic at Shands Teaching Hospital.
10) Public Health Department Prenatal Care refers to those who
received obstetric care at a public health department clinic.
11) Maternal-Infant Care Clinic Treatment involved patients in a
13 county area surrounding Gainesville, Florida. These
patients received prenatal and postpartum obstetric, neonatal
and pediatric care, family planning services, social service
and nutritional counseling and optional prenatal childbirth
education (Mahan and Eitzman, Note 5).
12) Teenage Pregnancy Team Care refers to patients who received
prenatal and postpartum obstetric, neonatal and pediatric

49
care, family planning services, social service and nutritional
counseling, a mandatory prenatal and childbirth education
class and an optional infant, parenting and family development
education class. This treatment was received by women who
were 18 years of age and younger and who lived in a five
county area within the Maternal-Infant Care district (Mahan,
Note 2).
13) Shands Teaching Hospital (S.T.H.) High Risk Clinic refers
to care which was specialized for those women identified
as having a high risk pregnancy. Obstetric and neonatal
services were provided and an optional prenatal and child
birth education class was offered to these women.
The Subjects
The population of interest in this study was that of mother-infant
dyads residing in North Central Florida who were served by the College
of Medicine at the University of Florida, Gainesville, Florida. Utiliz
ing the Birth Log (a list of information pertinent to labor and delivery
records) available through the Shands Teaching Hospital, a stratified
sample was drawn (N=250). Stratification was on the basis of mothers'
ages (<15, 16-17, 18-19, 20-24, _>2S years). This method of sampling was
used in order to obtain age specificity lacking in previous research.
This method produced an age-specific sample of invited subjects
who received the appointment letter, reminder postcard and phone call,
as outlined in Appendix A. Socioeconomic and cultural representativity,
while not expected, were additonal results of the sampling procedure
and are presented in Table 7.

50
Of the 250 invited subjects, 92 participated in the study; complete
data sets were obtained for 77 of these subjects. This attrition rate
is comparable to that found by Resnick et al. (1978). The sample thus
represents those subjects who were motivated to participate. Attrition
was also due to other variables associated with poverty and/or early
parenthood such as: 1) lack of trans^ro^ation; 2) conflicting school
and work schedules; 3) moving out of the state; and 4) giving the
baby up for adoption. Many families traveled as many as 150 miles to
participate in the study.
During the course of the data collection process, the investigator
questioned a random number of subjects as to the reasons for participating
or not participating in the study. Responses included: "I thought I
was supposed to come! "I wanted to see how my baby was doing -- if he
was doing o.k. "We don't have a camera and I wanted a picture." "I
was worried about my baby's arm, leg/ear." Negative responses included:
"My baby's fine and I don't need you to tell me! I'm already potty
training him."
Frequent attempts were made to call each family for whom a phone
number was listed. In three telephone conversations, mothers refused
to bring their babies to the clinic. These were private patients who
were living in the Gainesville area. A total of 80 families were reached
by phone prior to their appointments. Of the families who agreed to
come, only 10 did not participate (2.5 percent).
Procedure
All subjects in the sample were contacted by mail to notify them
that their babies were scheduled for a six month developmental assessment

51
in the Pediatric Clinic. When the families -- often including fathers,
friends and extended family members -- arrived at the clinic, a brief
explanation of the procedures preceeded the assessment. Subjects in
the study were informed as to the nature of the developmental testing
procedure employed and the purpose of the study. They signed a statement
of informed consent, but were not told the variables under investigation
in order to prevent bias during the data collection process (Appendix
A). Treatment of participants was in accordance with the standards of
the American Psychological Association and the Committee for the
Protection of Human Subjects at the University of Florida.
Following an explanation of the procedures, the families were
requested to come into the playroom where a mat and toys were available
for play. Mothers were encouraged to engage in a brief play period
prior to the actual videotaped sequence. The videotaped segment was
then recorded as the mothers participated in free play with their
infants. The initial play period (and the videotaped play sequence)
was designed to allow the baby to adjust to the environment. Each family
was given the identical assortment of toys for the free pla.y, which
included rattles, balls, a mirror and a set of colorful faces. Mothers
were told that the purpose of the free play was: 1) to allow the
baby to adjust; and 2) to get an idea of how the baby played in an
unstructured situation while at ease with the parent.
Following the free play session, the examiner engaged in a two to
three minute warm-up play period with the baby before administering the
Bayley Scales of Infant Development. The parent was informed as to the
nature of each task and its purpose in the assessment throughout the

52
administration of the scales. After the evaluation, the results regard
ing the mental, psychomotor, language and socioemctional growth of the
baby were discussed with the parent with respect to age ranges in
each area of development. Parent's questions were encouraged and
concerns were discussed during all phases of the assessment.
Following the assessment, the infant-centered intervention
phase proceeded and focused on the specific strengths and limitations
observed in the baby. Delayed or problematic development was ex
plained and appropriate protocols for remediation were discussed.
It was emphasized that many of these delays found at six months could
be overcome in a short time with an additional amount of stimulation
and prescribed activities. Where applicable, developmental,
nutritional and medical referrals were made to the appropriate agencies.
In all cases, parents were also given a book of educational activities
and a photograph of their baby to take with them.
Following the assessment, Infant and Family Development Specialists
interviewed the mothers to obtain demographic data. This was done
in order to insure that the examiner remained naive to the age and
prenatal care group of the mother.
Instrumentation
The Assessment of Infant Development
The Bayley Scales of Infant Development were chosen as a direct
measure of the infants' psychomotor and mental abilities. The
mental scale measured adaptive and language behavior as evidenced
on eye-hand coordination, problem solving, exploratory and manipula
tive tasks.
Also included are linguistic vocalizations and the

comprehension of communication by others. The motor scale measured
gross body control and locomotion and fine motor coordination.
Additional features of the instrument were its adaptability to the
testing situation and the availability of a trained evaluator.
Appropriate features of the test include the test materials, which
were highly attractive to infants, and the administration of the
test which allows the infant to be held by the mother. Split-half
reliability coefficients for the motor and mental scales at six months
are reported as .89 and .92, respectively (Bayley, 1969).
In their study of test-retest reliability (with eight month olds)
Werner and Bayley (1966) noted correlations between first and second
assessments of mental and motor development to be .76 and .75, respec
tively. These assessments were one week apart. Items involving emerging
skills in social and interpersonal development and motor coordination
were found to have a test-retest reliability of .76. This issue is
especially important in a study of six month olds as this is a critical
time for the emergence of several new behaviors. It is therefore
necessary to acknowledge that a baby's score at six months could vary
greatly from day to day.
Inter-observer agreement is another aspect of reliability studied
by Werner and Bayley (1S66). These coefficients were noted to be
"markedly higher" than independent assessments since the same assessment
was scored by each observer. Tester-observer reliability was found to
be .89 and .93 on mental and motor development, respectively.
Examples of items in the scales can be found in Appendix C.

Perinatal Risk Status
In order to assess the perinatal (last month of pregnancy through
first month of life) risk status of the infant at birth, the Prenatal
and Intrapartum Risk Scale (Hoble et al., 1973) was adapted for use
in this retrospective design. This instrument was developed as a
system for the prospective analysis of perinatal risks and rates
various complications in prenatal (maternal), labor and delivery and
neonatal screening characteristics (see Appendix D). Information
regarding the risk status of the neonate was obtained from the
infant's medical records.
Mother-Infant Transaction
The systematic observation of the transaction process has
become a meaningful way to investigate behavioral components of
the parent-infant relationship.
In order to examine parenting behaviors, a low-inference obser
vation system was used. The measurement of maternal-infant interaction
was based on the assumption that reciprocal/responsive behavior can
be measured through the use of the Beckwith Behavior Scale. The
scale was previously used by Beckwith (1976) and Grossman (1979)
to analyze parent-infant transaction in two separate studies of
one, three, six and eight month old infants and their mothers.
The Beckwith Behavior Scale consists of 27 behavioral categories,
each of which is assigned individually to parent or infant behavior.
The behavioralv categories of the instrument were selected for
their appropriate record of "parenting skills" which have consistently

55
demonstrated a strong relationship to infant development and were the
focal point of this study:
1) The constructive expression of affect (both positive and
negative).
2) The ability of the parent to become in tune perceptually
to the actual world of the infant at varied levels of
cognitive and emotional development.
3) The ability of the parent to interact with the child
in a manner which is responsive to the actual state
of the child as observed and interpreted over time.
The behaviors and their descriptions are presented in Appendix B.
Because of the highly sensitive and potentially ambiguous nature of
the transaction process, it was necessary to pilot the use of the
instrument within the experimental context under investigation
and obtain appropriate estimates of intercoder reliability. A
reliability study was previously implemented with Beckwith by computing
a Pearson Product-Moment Correlation on independent ratings of
two observers. On 18 behavioral categories, the coders were found
to have a mean agreement of r = .92 (Beckwith, 1971; Beckwith et al.,
1976). Similar observational records have been found to have predictive
validity from observational records at nine months to Bayley mental
scores at one year (Gordon, Soar and Jester, 1979; Long, 1979) These
studies assessed transaction among dyads of varied age, develop
mental and socioeconomic status.
The decision was made to adapt the Beckwith Behavior Scale
for use in this study based on several theoretical and practical

56
aspects of mother-infant transaction. The instrument was originally
constructed for observations of infants and mothers in the home.
Certain variables (such as floor freedom and mutual gaze during
feeding) were not applicable to this investigation. Another issue
which influenced the adaptation was that the scale was constructed
and implemented with preterm infants and their caregivers at one,
three and eight months of age and adapted by Grossman (1979) for
use with infants of six months of age. These considerations were
of importance in this study and were the basis upon which some
original variables were substituted with ones which were more applicable
to the simulated playroom setting in a study of six month olds.
The coding of the videotapes was also adapted so that be
haviors were coded every five seconds or when the behavior changed
rather than every 15 seconds as originally implemented. The rationale
for this adaptation was based on the dynamic characteristics of
mother-infant transaction which necessitated the more precise
analysis of the process as behaviors occur in a five (rather than.15)
second time span.
Interobserver agreement
The issue of reliability--the extent to which measures of be
havior are measured consistently--has been a subject of great concern.
This concept is best clarified by Cronbach and Ra.jartnam (1963) in their
statement: "an investigator asks about the precision or reliability
of a measure because he wishes to generalize from the observation
in hand to some class of observations to which it belongs." (p. 144).

The two observers were selected, on the basis of their prior
experience in coding parent-infant transaction videotapes. In
another study (Eyler, 1979) these observers evidenced skills in
analyzing observable behaviors of mothers and their premature new
borns and were found to be consistent in their ratings.
Training of the coders involved detailed explanations and
numerous examples of each behavioral category. The observers were
assessed initially and at randomly determined periods throughout
the coding process in order to ascertain the extent to which
behaviors were rated consistently. Fifteen of the videotapes were
coded by both coders. This permitted the assessment of intercoder
reliability. Table 1 presents the Pearson Product-Moment Correlations
between the frequencies reported by the two coders.
In order to reduce the number of variables to be used in
subsequent analyses and to represent more global dimensions of
mother-infant transaction, a correlation matrix of observation
measures was subjected to a Principle-Component analysis using the
varimax rotation. The results of these analyses are discussed in
detail in Chapter IV.
Statistical Analyses
The variables under investigation in the study were the age
of the mother, the education of the mother, the sex and birth order
of the infant, perinatal risk status, yearly income, ethnic origin
and type of prenatal care. The analyses were designed to assess
the contributions of these variables to the prediction of

58
Table 1
Inter-Observer Reliability of
Mother-Infant Transaction Behaviors
Behavior
r
Behavior
r
Mother Behaviors
Baby Explores
.69
Comments
CO
oo
Baby Fusses 1
.00
Commands
.70
Reciprocal Behavior
Criticizes
. 96
Mother's Positive Response
.82
Nonverbal Bid
.67
Mother's Negative Response
**
Initiating Behaviors
.73
Mothers Contingent Ver-
.97
bal/vocalizations
Repetitive Nonverbal Bids
.89
Face to Face Orientation
.88
Staccoto Bursts
1.00
Mother's Ignoring Response
.95
Affectionate Touches
.83
Baby's Positive Response
. 68
Interfering Touches
.19
Baby's Negative Response
k k
Repetitive Verbalizations
1.00
Baby's Contingent Vocal-
k k
Baby Behavior
ization
Bid to Caregiver
.90
Mutual Gaze
kk
Smiles
* *
Baby's Ignoring Response
.81
Vacant Behavior
**
**No correlation computed; one or both ratings evidenced no variability.

59
Table 2
Means and Standard Deviations
for Beckwith Behavior Variables
Variable
Mean
SD
Comments
7.6154
5.7349
Commands
.7564
1.5474
Criticizes
.6923
1.6221
Nonverbal Bids
3.7051
3.6328
Initiating Behaviors
13.0897
5.2476
Repetitive Nonverbal Bids
.0251
.8430
Staccato Bursts
.6667
1.904
Affectionate Touch
1.7692
2.8916
Interfering Touch
1.9744
2.2961
Repetitive Verbalizations
.2308
.8046
Bid to Caregiver
. 6667
1.1584
Baby's Vocalizations
1.6538
2.4697
Baby's Smiles
.9487
1.9863
Self-Stimulation
.0128
.1132
Vacant Behavior
.0128
.1132
Baby Explores
16.7051
9.3602
Baby Fusses
1.0769
3.1200
Mother's Positive Response
4.1026
2.9081
Mother's Negative Response
.1026
.3810
Mother's Contingent Vocalizations
1.1026
1.9177
Face-to-Face Orientation
3.5513
3.6597

60
Table 2 Cont.
Variable
Mean
SD
Mother's Ignoring Response
.7564
2.8108
Baby's Positive Response
12.6538
6.0663
Baby's Negative Response
.5333
.8778
Baby's Contingent Vocalization
.2179
1.3737
Mutual Gaze
.0641
.2945
Baby's Ignoring Response
3.7051
3.6149

61
mother-infant transaction and infant development as outcome measures
of early pregnancy and parenting.
In order to reduce the number of variables and represent
the more global dimensions of mother-infant transaction in subsequent
analyses, a correlation matrix of the 27 behavioral categories was
subjected to a Principle Components analysis. As a result of this
analysis, five dimensions of mother-infant transaction were defined
and each subject's incomplete composite component score was calculated
for each of the five components. These calculations were based on
the addition of the total number of behaviors which had a positive
loading on the component and the subtraction of the number of
behaviors which had negative loadings on the component. The
reliability of the observers was computed on each of the five com
ponent score dimensions using a Pearson Product-Moment Correlation
procedure. These analyses were executed using the Statistical
Package for the Social Sciences (SPSS) (Nie et al., 1975).
In the first multivariate multiple regression analysis, the
dimensions of mother-infant transaction and the infants mental and
psychomotor development were considered to be the outcome measures
of early pregnancy and parenting. These measures were therefore
treated as dependent variables and were regressed on mother's age
and education, baby's sex and birth order, yearly income, ethnic
origin, social support-system, perinatal risk status and type of
prenatal care.
The second multivariate multiple regression analysis addressed
the question regarding the ability of the transaction components to

62
predict the mental and psychomotor development of the infant.
In this analysis, mental and psychomotor development were regressed
on mother's age and education, baby's sex and birth order, ethnic
origin, yearly income, social support system, perinatal risk status,
type of prenatal care and the five dimensions of mother-infant
transaction. The multivariate multiple regression analyses were
executed using the General Linear Model program of the Statistical
Analysis System (SAS) (Barr et al., 1976).
Limitations of the Study
The use of videotape analyses in a low-inference observation
record to measure interaction between individuals is subject to the
limitation imposed by the fact that the behavior observed is that
which the adult subject is willing to express in the given situation.
This effect is confounded as well by the atmosphere found within
any medical setting; this often produces anxiety in the mother
and thus affects infant behavior. In an attempt to alleviate
possible stress in the assessment environment the "playroom setting
was simulated in the Pediatric Clinic.
The purpose of an evaluation of infant development at six months
of age is to establish a baseline for use in diagnostic and pre
scriptive protocols regarding the infant's strengths and limitations.
While the information obtained is useful for the identification of
competencies and delays, the scales are unable to predict future
development.
Another limitation is the fact that the families studied were
those who responded to the request and wrere motivated to participate

63
in the study. Those subjects who were contacted, but did not par
ticipate may differ systematically from those who participated.
A final limitation placed on the study is the ex-post-facto
or correlational nature of the design. While associations and
relationships among the variables can provide useful information,
no inferences of causality can be interpreted from the results
of the study.
Summary
In summary, the data were collected and analyzed in order to
assess the behavioral dimensions of mother-infant transaction and
the mental and psychomotor development of the infant in an age
specific sample. In addition, the study was designed to explore
the mother's age, social support system, perinatal risk status,
prenatal medical care, and participation in childbirth and parenting
education programs in order to assess their contributions to the
prediction of transaction and development at six months. The
results of the analyses are presented and discussed in Chapter IV.

CHAPTER IV
RESULTS
The purpose of this study was exploratory in nature and was
based on the fact that relatively little is known about the develop
mental outcomes of very young mothers and their infants. The analyses
were implemented in order to ascertain the contributions of the
mother's age, social support system, perinatal risk status, type of
prenatal care, type of prenatal childbirth education and type of
parenting education as they related to mothers' transactions with
their infants and the infants' development. The questions addressed
in this study and the analyses are discussed in this chapter.
The Dimensions of Mother-Infant Transaction
Before proceeding to the analyses which addressed the major
questions posed by the study, the dimensions of mother-infant
transaction were studied. The number of behaviors in each category
of the Adapted Beckwith Scale were first tallied for each subject.
A correlation matrix of the variables was then subjected to a Principle
Components analysis.
The analysis yielded eleven components with eigenvalues
greater than 1.0. These components accounted for 74 percent of the
variance. The components corresponding to the five largest eigenvalues
were rotated using the Varimax procedure. The five rotated components
64

65
accounted for 46 percent of the variance. Table 3 reports the
loadings of the variables on each component. Table 4 reports the
factor score coefficients of the variables.
The results of the Principle Components analysis were used
to guide the formation of the subjects' composite scores on each
of the five components. Variables were included in these scores
such that those with factor score coefficients greater than .25
defined the component. In the fifth component, mother's negative
responses were included in the composite component score based
upon theoretical interpretations of the observed behaviors of the
mother-infant transaction process. The total number of tallies per
behaviors with positive coefficients were added to calculate each
component score. The behaviors which had negative coefficients were
subtracted from this sum. This process often resulted in the com
posite score of a subject on a component being less than or equal to
zero. The following formulae were used to calculate the composite
scores on each of the five components:
Component Score 1 (Warmth) Affectionate Touches +
Smiles + Face-to-face Orientation
Component Score 2 (Reciprocity) = Baby's Positive Responses +
Mother's Positive Responses + Initiating Bids -
Baby's Exploratory Behavior
Component Score 3 (Responsive Vocalization) Baby's Vocali
zations + Mother's Contingent Vocalizations +
Babys Contingent Vocalizations Mother's
Nonverbal Bids

Table 4
Factor Score Coefficients of Mother-Infant Behaviors
Variable
Component 1
Warmth
Component 2
Reciprocity
Component 3
Responsive
Vocalization
Component 4
Negative
Affect
Component 5
Nonresponsive
Stimulation
Comments
.137
-.019
-.033
.169
-.087
Commands
.047
.049
.023
.283
-.047
Criticizes
.001
-.005
.036
.321
-.023
Nonverbal Bids
.107
-.148
-.270
-.091
-.081
Initiating Behavior
-.006
.193
.030
.123
.148
Repetitive Nonverbal
Behavior
-.053
.173
-.025
-.084
-.127
Staccato Bursts
.073
-.067
-.030
-.126
.302
Affectionate Touch
.281
-.096
-.111
-.139
.095
Interfering Touch
.008
-.104
-.068
.192
.202
Repetitive Verbalization
.108
.023
-.008
.023
.021
Bid to Caregiver
-.108
-.067
-.005
.005
.071
Vocalizations
.023
-.030
. 345
-.032
.004
Smiles at Mother
-...ag-4 _
-,090
.071
-,070
.052

Table 4--extended
Self Stimulation
Vacant Behavior
Explores
Fusses
Mother's Positive
Response
Mo then's Negat i ve
Response
ContingentL Verbal
izations
Face to Face Orientation
Maternal Ignoring
Baby's Positive Response
Baby's Negative Response
Contingent Vocalization
Mutual Gaze
Baby Ignoring
Total Percent
of Variance
.023
-.032
.011
.055
-.227
-.202
.017
. 044
.043
. 285
-. 044
-.054
.027
-.056
. 264
-. 041
-.124
-.047
.034
.336
-.048
co
to
O
1
.000
-. 004
.076
.014
.005
.013
12.000
10.200
-.045
.038
-.018
. 122
-.065
.138
-.031
-.078
.005
-. 155
-.043
-.135
-.022
-. 051
-.079
.015
.035
. 168
.286
-.054
-.038
.017
.010
-. 004
.000
-.075
-.043
.001
-.035
.029
.031
.282
-. 008
.305
.026
.012
.071
-.118
.309
-.033
.034
.289
8.900
7.700
7.000

Table 3
Rotated Factor Matrix of Principle Components:
Regression Weights of Mother-Infant Behaviors
Variable
Component 1
Warmth
Component 2
Reciprocity
Component 3
Responsive
Vocalization
Component 4
Negative
Affect
Component 5
Nonresponsive
Stimulation
Comments
.4484
-.0630
-.0361
.4009
-.2194
Commands
.2038
.0820
.0475
.6401
-.0805
Criticizes
.0761
-.0627
.0789
.7263
-.0225
Nonverbal Bids
.2850
-.3335
-.5379
-.1742
-.2040
Initiating Behavior
-.0522'
.5373
-.0338
.2788
.4015
Repetitive Nonverbal
Behaviors
-.1309
.4443
-.0809
-.2340
-.2235
Staccato Bursts
.0766
-.0762
-.1160
-.2263
.6303
Affectionate Touch
.7288
-.1917
-.2077
-.2407
. 1003
Interfering Touch
-.0203
-.2203
-.1886
.4778
.4687
Repetitive Verbalization
.3008
.0657
-.0185
.0732
.0222
Bid to Caregiver
-.3326
-.1540
-.0277
. 0094
.1825
Vocalizations
.1100
-.1803
.8097
.0789
-.1052
Smiles at Mother
.7040
-.2488
.2168
-.1024
1-. .si-. >1; '-av;' *
-.0254

Table ^--extended
Self Stimulation
Vacant Behavior
Explores
Fusses
Mothers Positive
Response
Mother1s Negative
Response
Contingent Verbal
izations
Face to Face Orientation
Maternal Ignoring
Baby's Positive Response
Baby's Negative Response
Contingent Voca1ization
Mutual Gaze
Baby Ignoring
Total Percent
of Variance
Eigenvalue
. ,0732
-.0841
.0130
.1564
-.6607
-.5153
.0693
-.1080
-.12965
-.7501
-.1764
-.1029
.1332
-.2486
.7599
-.1271
-.3504
-.1266
.0696
.9087
-.0884
-.1213
.0454
-.1026
.0956
.1140
-.0854
.0522
12.0000
10.2000
3.239 2.761
-.0879
.0943
-.0411
.2391
-.1386
. 2819
J
-h*
o
-.1980
.0332
-.3048
-.1023
-.2880
-.1080
-.1469
-.1129
-.0019
.0992
.3814
.6988
-.1321
-.2425
.0921
.0731
-.1198
.0112
-.1952
-.0782
-.0983
-.1038
. 1444
-.0767
.6370
.0318
. 7009
. 0504
-.0535
. 0930
-.2195
.6417
-.1525
. 1202
.6623
8.9000
7.7000
7.0000
2.397
2.072
1.877

70
Component Score 4 (Negative Afreet) = Mother's Commands +
Mother's Criticisms + Mothers Interfering
Touches + Baby's Negative Responses
Component Score 5 (Nonresponsive Stimulation) = Mother's
Staccato Bursts + Mother's Interfering Touches +
Baby's Ignoring Responses + Mutual Gaze +
Mother's Negative Responses
A Pearson Product-Moment Correlation procedure between the
frequencies of the original variables and the component scores
was implemented. The correlation coefficients are reported in
Table 5 and indicated that the individual variables chosen to
compute the component scores are highly correlated with the new
composites. It also indicated that the variables which should not
be correlated with the components were not. These coefficients
supported the interpretation of the composites of variables selected
to define the dimensions of mother-infant transaction.
The reader should recall that 15 of the videotapes were coded
by two coders. This permitted the computation of two composite
scores for each component of mother-infant transaction and the
assessment of interobserver reliability for the composites. The
Pearson Product-Moment Correlations between each pair of composite
scores are reported in Table 6. The results of this analysis
indicated that the two observers were consistent in the coding of
the five dimensions of the transaction process.

Table'5
Pearson Product-Moment Correlation Coefficients
of Mother-Infant Transaction Variables with Component Scores
Variable
Component 1
Warmth
Component 2
Reciprocity
Component 3
Responsive
Vocalization
Component 4
Negative
Affect
Component 5
Nonresponsive
Stimulation
Comments
.3136
.0615
. 0218
.1317
-.1392
Commands
. 0973
. 1176
.0197
.6683
-.0460
Criticizes
.0164
. 0154
.1313
. 7327
-.0601
Nonverbal Bids
.2431
-.1447
-.6931
-.1341
-.0979
Init.i.ating Behavior
-.2409
.6588
-.0045
.0588
.3685
Repetitive Nonverbal
Behaviors
-.1443
.1884
-.0468
- .1536
-.1162
Staccato Bursts
-.0034
-.0058
-.1076
. 0176
. 6346
Affeetionate Touch
.7897
. 0656
-.1897
-.0715
.0758
1nterfering Touch
.0007
l
o
^3
-.1074
. 7178
. .5990
Repetitive Verbalization
.1663
. 1372
.0137
.0279
-.0408
Bid to Caregiver
-.1903
-.1273
. 0456
.0679
. 0876
Vocalizations
.1668
-.1149
. 7816
-.0786
-.2180

Table 5--extended
Self Stimulation
Vacant Behavior
Explores
Fusses
Mother's Positive
Response
Mother's Negative
Response
Contingent Verbali
zations (M)
Face to Face Orientation
Maternal Ignoring
Baby's Positive Response
Baby's Negative Response
Contingent. Vocali zation
Mutual Gaze
Baby Ignoring
. 0433
. 0187
-.0400
.0952
-.4644
-.8397
-.0159
. 0575
. 0187
.6513
1101
-.0162
. 1350
-.2068
.8435
. 1612
-.1301
-.2028
-.1281
.8631
-.1246
-.0436
.0360
-.0348
.0256
. 1218
1281
.1046
.0768
.1555
-.0095
.0993
-.0446
-.0293
. 0605
-.1056
.1184
.2841
-.1262
-.2156
. 1114
-.0857
-.0875
.0163
.1490
.2482
.6794
-.1698
-.2941
.0355
.0842
-.1918
.0383
-.1126
-.0684
.1353
-.1433
. 0460
.0391
.4951
. 1236
.6155
. 0483
.0867
.0014
.0132
.3547
.0938
.1085
.854 4

73
Table 6
Interobserver Reliability of
Mother-Infant Transaction Components
Component r
Warmth .91
Reciprocity .97
Responsive Vocalization ,75
Negative Affect .80
Nonresponsive Stimulation
.70

74
Description'of the Sample
Descriptive statistics and a correlation matrix of the
independent and dependent variables were calculated for the sample
of 77 mother-infant dyads. Frequency distributions were calculated
for the independent and dependent variables and are reported in
Tables 7, 8 and 9. The means and standard deviations of the
dependent variables are presented in Table 10.
An inspection of of the distributions of the measures
of perinatal risk indicated that the majority of the sample was
within normal limits at birth. The means and frequency distributions
for the measures of infants mental and psychomotor development
indicated that the entire sample was within normal limits of
development at six months of age. The means of the sample are
considerably higher than those reported in the Bayley Scales of
Infant Development Manual (Bayley, 1969). The standard deviations
of the sample are equivalent to those reported in the manual. An
interpretation of these findings is discussed in Chapter V.
Interobserver reliability was then computed by means of a
Pearson-Product Moment Correlation on the rotated component scores.
The results of this analysis are presented in Table 6. The purpose
of the assessment of interobserver reliability was to measure
the extent to which the two independent observations of behavior
were consistent. From the results of this analysis it can be
seen that the measurement of transaction was consistent across
observers.

75
Table 7
Frequency Distributions for Several Independent Variables
Variable Frequency
Variable
Frequency
Mother's Age
Baby's Sex
< 15
5
Male
40
16-17
21
Female
37
18-19
12
Baby's Birth Order
20-24
18
1st Born
54
> 25
21
2nd Born
17
Race
3rd Born
5
Black
42
7th Bom
1
NonBlack
35
Yearly Income
Prenatal Care
< $3,000
19
Teenage Pregnancy Team
20
$3,000 $5,000
18
Maternal Infant Care Proj.
19
56,000 $10,000
21
Shands Teaching Hospital
13
$11,000 $20,000
15
Public Health Department
9
> $20,000
4
Private
16
Social Support System
Mother's Education
0 Living alone-no asst.
1
<12 years
37
I Cohab. Support Only
53
12-14 years
31
2 Cohab. q Income or
38
Childcare Asst.
15-18 years
9
3 Cohab. § Income 8
5
Prenatal Complications
Childcare Asst.
Uncomplicated Pregnancy
59
Perinatal Risk Status
Presence of Complication in
18
< 10 Points
37
Pregnancy (Anemia, Toxemia
Veneral Disease or Infec-
>
10 19 Points
20
tion)
20 40 Points
18
> 40 Points
2

76
Table 8
Frequency Distributions for
Mother-Infant Transaction
Variable
Frequency
Warmth
0-15
69
16 30
7
31 50
1
J.
Reciprocity
-25 0
16
1-25
38
26 52
23
Responsive Vocalizations
-20 -10
4
-9-0
47
1 9
23
10-33
"7
3
Negative Affect
0-4
52
5-9
19
10 23
6
Nonresponsive Stimulation
0-4
32
5-9
31
IQ 19
12
20 37
2

77
Table 9
Frequency Distributions for
Infant Development Variables
Variable Frequency
Bayley Scales of Infant Development
Mental Development Index
<68 0
68-83 1
84-99 7
100 116 13
117 132 22
133+ 29
Physical Development Index
<68 0
69 83 0
84-99 8
100 116 24
117 132 35
133+
10

78
Table 10
Means and Standard Deviations for Scores
on the Bayley Scales of Infant
Development, and the Beckwith Behavior Scale
Variable
N
Mean
SD
Bayley Scales of Infant Development
Bayley Mental Index
77
125.28
19.26
Bayley Psychomotor Index
77
117.64
12.62
Component: Beckwith Behavior Scale
Warmth
77
6.29
6.95
Reciprocity
77
12.96
18.16
Responsive Vocalization
77
-. 67
6.58
Negative Affect
77
3.71
4.39
Nonresponsive Stimulation
77
6.55
5.84

79
An initial inspection of the cross tabulations revealed
the type of prenatal care to be highly correlated with the type
of prenatal childbirth and postpartum parenting education received
by the mother. The type of prenatal care received by the mother
determined to a great extent the type of educational program she
was offered. As a result, prenatal childbirth education and
parenting education were omitted from further analyses. The
variable "type of prenatal care" contained more information due
to the differences in prenatal and parenting education programs
offered in conjunction with prenatal medical care. The cross
tabulations are presented in Table 11.
The correlation matrix is presented in Table 12 and
indicated that the perinatal risk status of the mother and infant
were not correlated with the presence or absence of prenatal
complications. Complications found among women in this sample
included anemia, toxemia, venereal disease and infection. The
fact that these risk factors were uncorrelated was not expected
due to the fact that the measure of perinatal risk included
preara! complications. It is possible, however, that the
rating system employed by the scale is not useful for studies
which are retrospective in nature. Another possible interpreta
tion is that the scale may not be sensitive to the importance

Cross Tabulations of Type of Prenatal Care,
Prenatal Childbirth Education and Parenting Education
Prenatal
Childbirth
Education
Parenting Education
Type of
Prenatal Care
Teenage
Pregnancy
Team
Materna
Infant
Care
Proj ect
i- S.T.H.
High
Ri s k
Clinic
Scliool Other'
None
Teenage
Pregnancy
Team
* Infant §
Family
Development
Education School
Program
Other
None
Private
Physician 16
9
4
3
3 1
5
7
Public Health
Department 9
2
n
3
6
Maternal-
Infant Care
Project 19
10
l
8
1
6
11
Teenage
Pregnancy
Team 20
18
2
6
1
1
12
S. T. 11. H i gh
Pi sk
Clinic 13
6
7
1
1
11
Infant and Family Development Education Program, Department of Early Childhood Education and Division of
Neonatology, University of Florida (Packer, et al. 1979).

Table 12
Correlation Matrix of the Independent and Dependent Variables
1 2
3 4
5
6
7
8
9
10
11
12
13
14
15
16
1)
Mother's Age 1.00 -.04
.57 .42
-.18
.68
.58
-.46
.03
-.05
-.01
-.10
-.22
.14
-.09
-.08
2)
Baby's Sex 1.00
-.14 -.02
-.09
.02
-.12
-.04
.00
.22
-.23
-.11
.08
.02
.19
.01
3)
Baby's Birth
Order
1.00 .11
-.12
.08
.20
-.11
-.05
-.23
-.07
.06
.05
-.00
-.03
.09
4)
Family's Ethnic
Origin
1.00
-.04
.37
.51
.30
-.06
.03
-.21
.26
.12
-.18
-.15
-.09
5)
Quality of
Social Support
1.00
-.08
-.05
.39
.00
-.03
-.01
.24
.13
-.13
.00
-.12
6)
Mother's Educa
tion
1.00
.52
-.28
.04
-.04
.12
-04
-.28
. 13
-.07
-.16
7)
Yearly Income
1.00
-.21
.16
.02
-.19
.20
-.04
.13
-.26
-.22
8)
Prenatal Complications
1.00
-.19
-.17
.16
-.18
-.08
-.01
-.08
-.00
9)
Bayley Mental Index
1.00
.34
.16
-.25
-.20
.23
.04
-.00
10)
Bayley Motor Index
1.00
-.13
-.16
-.26
.26
.06
.09
ID
Perinatal Risk Status
1.00
.25
.25
-.22
-.05
-.04
12)
Warmth
1.00
.18
.22
.04
-.14
13)
Reciprocity
1.00
-.01
.07
.10

Table 12--extended
14) Responsive Vocalization
15) Negative Affect
16) Nonresponsive Stimulation
1.00
.01
-.14
1.00
.39
1.00
00
to

of the many prenatal complications present in adolescent patients.
As a result, the presence or absence of prenatal complications
was included in subsequent analyses.
The Relationship of Mother's Age, Perinatal Risk Status and
Socioenvironmental, Medical and Educational Resources
To Mother-Infant Transaction and Infant Development
In keeping with the exploratory purpose of the study which
was to obtain information regarding the outcomes of early pregnancy
and parenting, a number of hypotheses were tested. Two multivariate
analyses were implemented which involved several multiple regression
procedures. These analyses, which addressed the ability of the
independent variables to predict mother-infant transaction and
infant development, were subjected to a conservative critical value
in each univariate and multivariate test of significance. The
experimentwise alpha rate was set at .05 for the multivariate tests.
Using the Bonferroni approach, this was divided by the total number
of dependent variables such that the criterion for significance was
dependent upon the hypothesis being tested. On each univariate
follow-up analysis, the criterion for significance was set at .01.
Mothers Age as a Predictor of Transaction and Development
The questions of utmost importance in this study concerned:
1) the ability of the very young mother to facilitate positive
transaction with her baby; and 2) the developmental status of the
infants of young mothers. This led to the questions regarding
the nature of the relationship between mother's age and transaction
and development. The specific questions addressed in the first

analysis were:
i>4
Question One: Do infant development and mother-infant interaction
vary as a function of the age of the mother?
Question Two: Is the relationship between mother's age and each
dimension of transaction and infant development
linear after controlling for all independent
variables?
To test the hypothesis that there would be no relationship between
mother's age and interaction and development, a multivariate multiple
regression analysis was used. In this analysis, the dependent measures
were mental development, psychomotor development, warmth, reciprocity,
responsive vocalization, negative affect and nonresponsive stimulation.
The independent variables were mother's age and education, baby's sex
and birth order, ethnic origin, yearly income, social support system,
prenatal complications, perinatal risk status and type of prenatal care.
The results of the univariate tests of the contribution of each
dependent variable to overall prediction indicated that only mental
development was significant. The results are presented in Table 13. A
visual inspection of the plot of the residuals against the predicted
values of mental development revealed that the data met the assumption
of homoskedasticity (homogeneous error variance around the regression
line) and were appropriate for the analyses.
The tests of significance of the multivariate main effects (Table
1.4) indicated that the age of the mother did not contribute to the overall
prediction of mother-infant transaction and infant development (a-.05),
but did contribute to the prediction of the infant's mental development

ss
Table 13
Results of the Univariate Tests of the Contributions
of Several Dependent Variables to Mother-
Infant Transaction and Infant Development
Dependent Variable
R
P
Mental Development
.34
A .
O
H-*
Psychomotor Development
.27
.06
Warmth
.23
.15
Reciprocity
.19
.32
Responsive Vocalization
.14
.05
Negative Affect
.17
.49
Nonresponsive Stimulation
.18
.44

86
Table 14
Results of the Multivariate Significance
Tests of Contributions to Mother-Infant
Transaction and Infant Development
Variable
P*
df
P
Mother's Age
1.45
7,57
- .20
Baby's Birth Order
1.07
7,57
.. .40
Baby's Sex
2.05
7,57
, .06
Ethnic Origin
1.35
7.57
. .25
Social Support System
. 84
7.57
. 56
Mother's Education
.93
7.57
. .49
Yearly Income
1.81
7,57
. .10
Type of Prenatal Care
1.60
28,206
. .03
Prenatal Complications
1.37
7,57
. .23
Perinatal Risk
1.11
7,57
. .37
transformation of Wilks' Criterion to an F statistic

57
(a=.01). The results of this analysis did not support the hypothesis
that the psychomotor development of the infant and the mother-infant
transaction process varied as a function of the age of the mother. The
results of the univariate analyses are presented in Tables IS and 16.
The preceding multivariate multiple regression analysis was
also designed to answer additional questions posed in the study:
Question Five: Is there a positive relationship between the
extent of prenatal care, prenatal and postpartum
parenting education and infant development and
mother-infant transaction at six months?
Question Six: Is there a positive association between the
mother's social support system and transaction and
the infant's development?
The analysis of the multivariate main effects (Table 14) revealed
that the presence of prenatal complications and the type of prenatal care
received by the mother contributed significantly to the prediction of
infant development. The type of prenatal care accounted for 6 percent
of the variance in mental development. The follow-up analysis of the
pairwise comparisons of each type of prenatal care indicated significantly
higher means for infants whose mothers received Teenage Pregnancy Team
care when compared to those receiving treatment by a private physician
and Shands Teaching Hospital High Risk Clinic. The results of the pairwise
comparisons and the adjusted means for each prenatal care group are
presented in Tables 17 and 18. As noted earlier, this question can only
be answered with respect to the association between prenatal care and
the dependent variables. The different types of prenatal care and their

88
Table 15
Tests of Significance of Contribution
to the Prediction of Infant's Mental Development
Variable
Regression
Coefficient
F
P
Mother's Age
2.57
6.92
.01
Baby's Sex
-.92
.04
.84
Baby's Birth Order
-5.85
3.06
.08
Ethnic Origin
.65
.02
.90
Mother's Education
-3.50
3.32
.07
Yearly Income
.76
3.40
.07
Social Support System
5.86
2.88
.09
Prenatal Complication
-13.16
6.54
.01
Perinatal Risk
.12
.38
.54

89
Table 16
Test of Significance of Contribution of
Continuous Variables to Prediction of Infant's
Psychomotor Development
Variable
Regression
Coefficients
F
P
Mother's Age
1.09
2.62
.11
Baby's Sex
6.67
4.81
.03
Baby's Birth Order
-4.50
3.46
.07
Ethnic Origin
-.83
.06
.81
Mother's Education
-1.00
.57
.45
Yearly Income
.31
1.21
.28
Social Support System
1.14
.23
.63
Prenatal Complications
-5.60
2.48
.12
Perinatal Risk
.01
.01
.94

90
Table 17
Pairwise Comparisons of Types of Prenatal
Care as Predictors of Infant's Mental Development
Pair Contrasted
Difference
Between
Means T
P
Private Physician--Public Health
18.59
1.83
.07
Private Physician-Maternal Infant Care Proj .
12.24
1.28
.21
Private PhysicianTeenage Pregnancy Team
26.36
2.68
<.01
Private PhysicianS .T.H. High Risk Clinic
2.14
.23
.82
Public Health--Maternal Infant Care Proj.
6.35
.87
.39
Public HealthTeenage Pregnancy Team
7.77
1.04
.30
Public HealthS.T.H. High Risk Clinic
20.73
2.49
.02
Maternal Infant Care Proj.Teenage Preg. Team
14.12
2.31
.02
Maternal Infant Care Proj.S.T.H. High Risk
14.38
2.10
.04
Clinic
Teenage Pregnancy TeamS.T.H. High Risk Clinic
28.51
3.94
<.01

91
Table 18
Mean Mental Development of Infants
in Each Prenatal Care Group After
Adjusting for Variance Explained by All
Other Independent Variables
Prenatal Care Group
Mean
Teenage Pregnancy Team
140.03
Public Health Department Clinics
132.26
Maternal-Infant Care Clinics
125.91
Frivate Physician
113.68
S.T.H. High Risk Clinic
111.52

92
educational programs are discussed in Chapter V.
The data did not support the hypothesis that either perinatal risk
status or the quantity of social support received by the mother was
related to her transactions with her infant or the infant's development.
In addition, it was found that no independent variables contributed
to the prediction of the mother-infant transaction process.
The Prediction of Infant Development
The second multivariate multiple regression analysis was imple
mented in order to ascertain the ability of the transaction components
to predict infant development. This analysis was also directed to
the questions regarding the mother's age and prenatal and perinatal
variables as predictors of infant development when the variance
explained by transaction was partialled out in the model. The second
analysis was designed to answer the following questions:
Question Three: What is the nature of the relationship between
prenatal medical care and development at six
months after controlling for the age and
education of the mother, the sex and birth order
of the infant, ethnic origin, yearly income
and perinatal risk?
Question Four: Which variables contribute predictive information
to the identification of developmental delays
on infant development measures at six months?
Question Eight: Is there a relationship between the age of the
mother and infant development after controlling
for transaction, infant sex and birth order,

93
mother's education, perinatal risk status, ethnic
origin, yearly income, social support system and
type of prenatal care and education?
The questions were answered by the second multivariate multiple
regression analysis. Mental and psychomotor development were regressed
on mother's age and education, infant's sex and birth order, warmth,
reciprocity, responsive vocalization, negative affect, nonresponsive
stimulation, yearly income, ethnic origin, social support system, peri
natal risk status, prenatal complication and type of prenatal care.
From the multivariate tests of significance (Table 190* it can be seen
that the age of the mother, prenatal complications, responsive vocal
izations and type of prenatal care contributed to the overall prediction
of infant development (a = .05).
The results of the univariate analyses are presented in Table 20.
This represents the contributions of mental and psychomotor development
and revealed that both models were significant. A visual inspection
of the plots of the residuals indicated that the data met the assumption
of homoskedasticity and were appropriate for the analyses.
The follow-up univariate analysis (a=.01) of mental development
(Table 21) was consistent with the first analysis and indicated that
the age of the mother had a positive relationship to her infant's mental
development. The plot of the residuals against mother's age evidenced
no deviation from linearity. It was therefore concluded that there
was a positive linear relationship between the age of the mother and
her baby's mental development. Mother's age was found to explain
10 percent of the variance In mental development. The regression

94
Table 19
Results of the Multivariate Significance
Tests of Contributions to the Infant's
Mental and Psychomotor Development
Variable
p*
df
P
Warmth
2.27
2,57
ill
Reciprocity
.53
2,57
.59
Responsive Vocalization
3.72
2,57
. 03
Negative Affect
.92
2,57
. .40
Nonresponsive Stimulation
1.17
2,57
. .32
Mother' s Age
4.05
2,57
.02'
Baby's Birth Order
2.66
2,57
. 08'
Sex of Baby
2.99
2,57
. .06.
Ethnic Origin
.17
2,57
. .84
Mother's Education
1.64
2,57
.20
Yearly Income
2.71
2,57
. .08.'.
Social Support System
1. 19
2,57
.31
Type of Prenatal Care
5.46
3,114
.<.01
Prenatal Complications
4.05
2,57
. .02
Perinatal Risk Status
1.12
2,57
. 33
conversion of Wilks' Criterion to an F statistic

95
Table 20
Tests of Significance of
Contribution of Prediction for Both
Dependent Variables Combined
Variable
R
F
P
Mental Development
.45
2.65
.002
Psychomotor Development
.40
2.10
.017

96
Table 21
Tests of Significance of Contribution of Continuous
Variables to the Prediction of Infant's Mental Development
Regression
Variable
Weights
F
P
Warmth
-.6764
4.57
.04
Reciprocity
-.1079
.85
. 36
Responsive Vocalization
.5411
3.06
.09
Negative Affect
-.4984
1.00
Nonresponsive Stimulation
. 1331
.35
.72
Mother's Age
2.6173
7.67
<.01
Birth Order
-5.8106
3.22
.08
Ethnicity
-1.6220
0.10
.76
Mother's Education
-3.4221
3. 33
.07
Yearly Income
.9624
5.46
.02
Sex
.0772
.00
.99
Social Support System
-5.050
2.23
.14
Prenatal Complications
-13.976 "
7.96
<.01
Risk
-.292
2.27
.14

97
coefficients indicated that for each year of mothers age, the infants
differed, on the average, by 2.6 points on the Mental Development Index
and by 1.2 points on the Psychomotor Development Index.(Table 22).
Question ten was concerned with the relationship between perinatal
risk and development at six months. Mo significant association was
found to exist between perinatal risk and either mental or psychomotor
development.
The presence of prenatal complications (anemia, toxemia, infection or
venereal disease) was found to have a negative relationship with the
infant's mental development and accounted for 12 percent of the variance.
No deviations from linearity were evidenced on the plot of the residuals
against prenatal complications; it was therefore concluded that there
was a negative linear relationship between prenatal complications and
mental development. No significant relationship between prenatal
complications and psychomotor development was found.
Responsive vocalization, the component which included the behaviors
baby's vocalizations, mother's contingent vocalizations and baby's
contingent vocalizations,was found to have a positive relationship
to the infant's psychomotor development and accounted for 11 percent
of the variance. No significant relationship was found to exist between
responsive vocalization and mental development.
The type of prenatal care contributed to the prediction of
both mental and psychomotor development. Pairwise comparisons of the
four groups indicated that the means of those infants whose mothers
received treatment by a private physician scored significantly lower
on both mental and psychomotor indices than those who received care

98
Table 22
Tests of Significance of Contribution to the
Prediction of Infant's Psychcmotor Development
Independent
Variable
Regression
Weights
F
P
Warmth
-.1668
.58
.45
Reciprocity
-.0695
.73
.40
Responsive Vocalization
.5752
7.23
<.01
Negative Affect
-.4418
1.65
.20
Nonresponsive Stimulation
.5898
2.25
.14
Mother's Age
1.2720
3.78
.06
Baby's Birth Order
-4.7877
4.57
.04
Ethnicity
-2.1277
. 35
.55
Mother's Education
-1.1858
.84
. 36
Yearly Income
.3642
1.63
.21
Baby's Sex
-6.7385
4.77
.03
Social Support System
.6892
,09
.77
Prenatal Complications
-6.0120
3.08
.08
Risk
.1037
.60
.44

99
from Maternal and Infant Care Clinics and the Teenage Pregnancy Team.
Significant differences were also found to exist between Maternal and
Infant Care Clinic patients and Shands Teaching Hospital High Risk
Clinic patients. The mean of the Teenage Pregnancy Team infants was
also significantly higher than the infants of Shands Teaching Hospital
High Risk Clinic. The pairwise comparisons and the adjusted means are
presented in Tables 23 and 24.
It should be noted that a discrepancy exists between the results
of the first and second analyses with regard to the significance of
the type of prenatal care as it related to psychomotor development. An
inspection of the adjusted means for each prenatal care group (Table 25)
indicated large, but nonsignificant differences on the transaction
components. This variance was not accounted for in the first analysis.
In the second analysis, partialling out the variance explained by
transaction yielded a significance association between the type of
prenatal care and the psychomotor development of the infant.
The Prediction of Developmental Delay
The question regarding delays in infant development could not
be answered due to the fact that no infants scored below 68 on either
the mental or the psychomotor scale. As a result of this analysis,
however, certain variables have been identified which do contribute
to the prediction of developmental risk in infancy. The variables
which were found to be associated with negative outcomes in mental
development were: 1) the young age of the mother; and 2) the
presence of complications during pregnancy. Negative outcomes in
psychomotor development were associated with a lack of responsive

Table 23
Pairwise Comparisons of Type of Prenatal Care
on Infant's Mental and Psychomotor Development
Mental Development Motor Development
Difference Difference T P
Comparison Between Means T P Between Means
Private Physician--Public Health Department
Private Physician-Maternal Infant Care Proj.
Private Physician-Teenage Pregnancy Team
Private PhysicianShands Teaching Hospital
Public Health DepartmentMaternal Infant Care
Project
Public Health Department--Teenage Pregnancy
Team
Public Health DepartmentS.T.II. High Risk Clinic
Maternal Infant Care Project: Teenage Pregnancy
Team
Maternal Infant Care Project: S.T.II. High
Risk Clinic
Teenage Pregnancy: S.T.H. High Risk Clinic
24.33
2.47
.02
12.40
1.82
.07
18.24
1.96
.06
15.11
2.34
.02
34.77
3.57
< .001
19.31
2.87
<.01
2.10
.23
.82
1.31
.21
.84
6.09
.86
.39
2.71
.55
.58
10.43
1.43
. 16
6.91
1.37
.18
22.23
2.66
.01
11.09
1.91
.06
16.53
2.74
<.01
4.20
1.01
.32
16.14
2.35
.02
13.80
2.90
<.0I
32.66
4.59
.001
18.00
3.66
<.001
100

101
Table 24
Means for Prenatal Care Groups after Adjusting for Variance Explained
by Transaction Components and' All Other Independent Variables
Type of Prenatal Care Mental Development Psychomotor Development
Private Physician
108.640
108.005
Public Health Department
132.973
120.406
Maternal Infant Care Clinics
126.882
123.1183
Teenage Pregnancy Team
143.407
127.319
Shands Teaching Hospital
110.742
109.319

Table 25
Means for Prenatal Care Groups
After Adjusting for Variance Explained
by all Independent and Dependent Variables
Type of Prenatal
Care
Mental
Development
Psychomotor
Development
Warmth
Reciprocity
Responsive
Vocalization
Negative
i Affect
Nonresponsive
Stimulation
Private Physician
103.64
108.01
.210
3.90
2.44
2.46
6.26
Public Health Depart
ment
132.97
120.41
5.901
17.28
-1.63
5.98
7.28
Maternal-Infant Care
Project
126.88
123.12
5.70
17.28
-3.25
3.37
5.58
Teenage Pregnancy Team
143.41
127.32
11.56
16.20
-3.49
5.37
7.64
S.T.H. High Risk.
Clinic
110.74
109.32
7.08
8.66
3.73
1.35
5.25

103
vocalization in the mother-infant transaction process. It can be
concluded that several of the variables contributed to the prediction
of risk in infant development.
Mother-Infant Transaction as a Predictor of Infant Development
One of the fundamental questions investigated in this study
concerned the relationship between mother-infant transaction and
the mental and psychomotor development of the infant. The question
addressed was:
Question Nine: Are the transaction components of
the mother-infant relationship--warmth,
reciprocity, responsive vocalization,
negative affect, and nonresponsive
stimulation--associated with the psycho
motor and mental development of the infant
after controlling for mothers age and
education, baby's sex and birth order,
yearly income, ethnic origin, social
support system, perinatal risk and type
of prenatal care?
The preceding analysis was conducted to test the hypothesis
that the transaction components predicted mental and psychomotor
development in infancy when all other variables were held constant.
The analysis involved testing the hypothesis for each dependent
variable separately. The F statistics for mental and psychomotor
development were 2.34 and 3.36, respectively and were computed in the

104
following manner:
F = [Sum of Squares (Full Model)-Sum of Squares (Reduced Model)]/5
Mean Square Error (Full Model)
Mental
Development F = [4807.1218 2669.8295] / 5
126.9150
= 2.54
Psychomotor
Development F = [12660.4948 9552.8869]/ 5
265.0281
= 5.56
The critical value is F ^ ^ 025)= 2.74. It was therefore
concluded that the shared variance of the mother-infant transactions
components--warmth, reciprocity, responsive vocalization, negative
affect and nonresponsive stimulation--contributed to the prediction
of the infant's psychomotor development, but did not contribute
to the prediction of the infant's mental development.
Followup tests (Tables 21 and 22) supported only the hypothesis
that the unique proportion of variance accounted for by responsive
vocalization contributed to the prediction of psychomotor development.
Responsive vocalization accounted for 11 percent of the variance
in psychomotor development. Based on the positive regression
weight, it can be concluded that there is a positive relationship
between responsive vocalization and the infant's psychomotor development.
An examination of the residual plots indicated that the relationship
between the two variables was linear.
Summary
The analyses presented in this chapter were designed to ascertain
the strength and nature of the relationships of the age of the mother,

105
prenatal, and perinatal factors, and socioenvironraental, medical
and educational resources to mother-infant transaction and infant
development in an age-specific sample. In the first analysis, the
measures of transaction and development were considered to be
outcome measures of early pregnancy and parenting. Mental development was
found to be associated with the age of the mother, the type of
prenatal care received by the mother and prenatal complications.
No variables were found to contribute to the prediction of
infant's psychomotor development and the mother-infant transaction
process.
The second analysis was concerned with the prediction of the
developmental outcomes of the infant. Several variables were found
to be associated with the infant's development. The variables which
were identified as predictors of mental development were: 1) the
age of the mother; 2) the type of prenatal care received by the
mother; and 3) the presence of prenatal complications. Psychomotor
development was found to vary as a function of: 1) responsive
vocalization of the mother-infant transaction process; and 2)
the type of prenatal care received by the mother.
The dimensions of mother-infant transaction were found to
contribute a significant proportion of shared variance to the
infant's psychomotor development. The component of transaction
which contributed a uniquely significant proportion was responsive
vocalization. The results of the study and their implications
for future research and intervention are discussed in Chapter V.

CHAPTER V
DISCUSSION AND IMPLICATIONS
In this study, the most important questions were concerned
with the multidimensional outcomes of early pregnancy and parenting.
The study was designed to explore the relationship of the age of
the mother, prenatal and perinatal factors and socioenvironmental,
medical and educational resources to the dimensions of mother-
infant transaction and the development of the infant. This
research reflects an effort to enhance our understanding of
the young mother and her infant and, as a result, design more appro
priate and comprehensive support services to the young family.
The findings of the study and their implications are discussed
in this chapter.
The Age of the Mother as a Predictor of Infant Development
and Mother-Infant Transaction
The most important questions posed in Chapter I asked "what
are the behavioral characteristics of the very young mother? . .
hew does she relate to her baby and what is the association between
her style of mothering and her babys development?" The questions
addressed several dimensions of early family development.
In the first analysis, which viewed transaction and development
as outcome measures, no variability in mother-infant transaction
was found to be related to mothers age.
106

107
The age of the mother did, however, contribute to the prediction
of her baby's mental development when transaction was considered
as a dependent variable. The age of the mother was also associated
with her baby's mental development when the proportion of variance
accounted for by mother-infant transaction was held constant. The
data suggested that the infants of younger mothers were less competent
on a measure of mental development and that, as mother's age increased,
so did the infant's mental development.
The problem of multicolinearity could not be dealt with
adequately in this study due to the need for an extreme large data set.
It is therefore difficult to tease out the unique contributions of
mother's age and education, ethnic origin, birth order, yearly income
and prenatal complications. For instance, it remains unknown whether
the infant's development is threatened by the fact that the mother is
young or if development is threatened by the mother who is prone to
problematic pregnancy due to poor nutrition (anemia and toxemia),
infection and venereal disease. Specifically, are mothers who are
more likely to have complications during pregnancy and have fewer
material resources also less able to stimulate the mental development
of the infant?
The significance of the association found between mother's age
and the infant's mental development is in accord with other research
concerned with the infants of adolescent mothers (Hardy er al., 1S78).
The implications of rhe present findings indicate a need for early and
intense developmental and educational intervention protocols which are
designed to enhance the competence of the infants of young mothers in
order to prevent long term handicapping conditions.

108
The findings of this and other studies (Clarke-Stewart, 1973;
Beckwith et al., 1976) have documented the potential of the transac
tion process to enhance infant development. We therefore have support
for the concept of parent and infant-centered approaches to early
intervention. The findings of this study also suggest that the
dimensions of mother-infant transaction generalize across the age of
the mother and that the young mother is as adept in her ability to
facilitate positive transaction whth her infant as her "of age" peer.
The strength of the mother-infant relationship is perhaps one that is
able to be focused on in our attempts to help mothers enhance their
infant's mental competencies. As professionals, there is often little
we can do to modify the immediate socioenvironmental variables and
biological threats due to prenatal complication that relate to infant
development. We can, however, support young mothers in their
transition to parenthood and their development of a transactional reper
toire which is responsive to the infant and thus facilitative of their
babies development.
Prenatal and Perinatal Factors and Socioenvironmental, Medical and
Educational Resources as Predictors of Mother-Infant Transaction and
Infant Development
Previous research regarding early parenting revealed the mother's
social support system and the professional services she receives to
have a relationship both to her development as a mother and her
infant's competence (Furstenburg, 1978; Kot.elchuck, 1979; Brazelton and
Lester, Note 1; Dott and Fort, 1578). These questions

109
were investigated in this study, as well. The data indicated no
significant relationship between the quantity of social support
and development and transaction. This was surprising and suggests
that perhaps the basis upon which support was quantified--cohabitation,
income and childcare assistance--was not an appropriate measure of
the qualitative aspects of support which have been associated with
family development. An additional instrument to assess the qualita
tive characteristics of the mother's social support system would
assist in future studies.
The findings indicated the positive association between more
comprehensive models of prenatal care and the mental and psycho
motor competence of the infants. The most significant differences
in infants' mental and psychomotor development were found to exist
between prenatal care which offered only obstetric services and those
which included either an optional or a mandatory prenatal and
childbirth education program. The highest means on infant develop
ment were found to be those of infants whose mothers received care
in the model which included prenatal and postpartum parenting
education as well as social service referral, nutritional and
short term crisis counseling (Mahan, Note 2).
In interpreting this finding, it is important to note
that a considerably larger proportion of the invited sample of the
Private Physician care group patients participated in this study
than those who received other types of care. This suggests that the
measures reflect those of more motivated mothers in the other

110
four groups, whereas the measures taken on private patients reflect
a more random selection. Another consideration to be taken into account
is the fact that subjects were self-selected into each type of
prenatal care group on the basis of socioeconomic status and geo
graphic location. Consideration of these results should also
be based on the fact that the design of the study was retrospective
and as such, no causal inferences with respect to differences between
groups can be made. No outcomes can be said to be associated with
the prenatal or parenting education components of the models due
to the fact that these variables were excluded from the analyses.
These results do, however, suggest a need for more -controlid'ex
perimental designs which would permit the investigation of the
effects of interdisciplinary service models on the parent-infant
relationship and infant development.
The Prediction of Developmental Risk in Infancy
The results of this study indicated that the young age of
the mother, the presence of prenatal complications and a lack of
responsive vocalizations in the mother-infant transaction process
are associated with negative outcomes in infant development. It
was surprising that no infants in this sample (which consisted of
many low income and/or adolescent mothers) scored at or below 68
(the clinical criterion for delay) on the Bayley Scales of Infant
Development. Several possible explanations of this deserve mention.
One possible cause is that the examiner "tested high." This
consideration, as well as the fact, that the infants participated
in 15 minutes of free play prior to the assessment, may well have

Ill
influenced the infant's level of optimal performance which was
stated to be a goal of the assessment (Bayley, 1969). A third
consideration is the small number (20 of 250) of high risk
infants (those who were born prematurely or had neonatal complications)
who were selected at random as part of the invited sample. Of the
20 high risk infants sampled, four participated in this study.
The data were unable to answer the question and the identification
of delay in an age specific sample thus remains in need of future
investigation.
Of benefit to our knowledge base would be the longitudinal
assessment of the infants of adolescent parents. That these infants
are at risk has been well documented in the literature. The findings
presented in this study indicated that differences exist as early as
six months of age. It is the subjective opinion of the author
that a major factor in the success of patient follow-up lies in the
direct communication by telephone to advise them of services offered
to the family. In explaining the procedures carefully, questions
may be answered and parents may be made to feel that they were
"lucky" to be chosen. This approach was used successfully in a
seven year follow-up of the Collaborative Perinatal Study (Dallas, 1971).
A more thorough assessment battery for long term follow-up
;vould be an asset as well. The use of the 3ehavior Profile in the
Bayley Scales of Infant Development and its relationship to mother-
infant transaction is another unexplored area of early parenting.
The addition of an instrument to assess qualitative characteristics

112
of social support would contribute to future investigations and
yield valuable information.
.An analysis of the subscales (language, social, cognitive and
gross and fine motor skills) of the mental and psychomotor scales
would be of assistance in order to make early developmental inter
vention more appropriate for each individual infant and family.
Mother-Infant Transaction as a Predictor of Infant Development
The relationship between mother-infant transaction and
infant development was one of the most important questions in this
study. The findings revealed responsive vocalization to be positively
related to the infant's psychomotor development. The shared
contribution of the mother-infant transaction components was also
found to be related to the infant's psychomotor development.
The results of this study support the idea that the mother-
infant relationship is important to the infant's development of
competence. We also have reason to believe that, more comprehensive
interdisciplinary models of prenatal and perinatal support are
associated with enhanced development of the infant. These findings
suggest several considerations in the design of parent and infant-
centered interventions for the young parent family. There is reason
to believe that early and prolonged intervention with young parents
and their infants can enrich the quality of care and stimulation
provided by the mother and thus enhance the development of her infant.

113
Summary and Conclusions
The findings discussed in this study indicate that there is
a need to reach both parent and child at the earliest possible
moment and in a most comprehensive approach, for in this way,
individuals will be given the opportunity to develop to their
maximum potential. Meeting the special needs of the young parent
family presents a multifaceted challenge to efforts on the part
of the professional communtiy.
Although the findings of this study do not indicate the
extended family to be of importance, a special concern with the
adolescent mother is that our efforts must be focused toward not only the
young mother, but the father of her baby and the members of their
extended families, as well. This was acknowledged in the studies
of Furstenberg (1976, 1978) and Kotelchuck. (1979). Often tills will
mean extensive coordination of all phases of the clinic, school and
home-based programs. In this way, the quality of care provided
may become more truly comprehensive in nature.
A.t the heart of this approach is the primary prevention of
early pregnancy--both repeat and first pregnancies--to individuals
who are unprepared for the tasks of parenthood. With the extension
of confidential family planning services and curricula designed to
deal with the issues of human sexuality and family development,
ix is anticipated that young people will become more responsible
in their sexual activities.
Our purpose here was to explore the role of the adolescent as
a mother and her baby's development. As noted earlier, the philosophical

114
basis of this study was a strong belief in the positive characteristics
of the young parent--courage, enthusiasm, adaptability and, above all,
an optimistic view of the future. It is hoped that the results of this
study and the literature presented herein will allow our future efforts
to focus on the qualities of the mother-infant relationship in order
to enhance the development of the infant and strengthen the family.
It is important to remember that these young women have chosen to
continue their pregnancies and undertake the tasks of motherhood.
Remember, too, that most individuals, regardless of age, come to parent
hood relatively unprepared for the responsibilities of caring for and
nurturing another human life. The positive growth and development of
these young parents and their children is dependent upon cur interdis
ciplinary efforts to support them in a comprehensive manner as they grow
together as a family.

APPENDIX A
PARENT CONSENT FORM
The first months of life are important as families grow. For
this reason, we would like your permission to study how your baby's
body and mind are developing. The study involves making a videotape
(like a television film) of you and your baby playing and using the
Bayley Scales of Infant Development to study your baby's mental and
physical abilities. We will be happy to answer any questions before,
during or after the study. You will be informed of the results of
the study and will be sent a photograph of you and your baby and a
book of baby exercises, games and learning activities.
We are looking forward to working with you and your family and
hope you will agree to be a part of our study. If you will agree to
participate, please sign below.
In the event of sustaining a physical injury which is proximately
caused by this experiment, professional medical care will be provided
for me at the J. Hillis Miller Health Center. There will be no charge
to me, exclusive of hospital expenses.
I, have read and under
stood the informed consent statement and give my permission for studying
my child and using the information and videotapes for research and
teaching purposes. I also realize that I may change my mind and
withdraw my permission at any time.
Witness Signed
Witness Relationship
to Child
115

116
Name
Address
Telephone
Six Month Assessment
Child and Family Development Evaluation
Julie Hofheimer
Departments of Obstetrics and Gynecology and
Pediatrics
Release Form
Parent's Questionnaire
Bayley Scales of Mental and Motor Development
Videotaped Free-Play
Hobel Assessment of Perinatal Risk
Evaluation Protocol
Mothers will be notified of their appointment by mail one month
prior to test date. They will be mailed the reminder postcard one week
prior to testing and phoned to confirm the appointment two to three
days prior to testing.
Upon arrival in the Pediatric Clinic, they will be brought into the
Developmental Clinic Playroom and the Assessment Specialist will explain
the procedure for the freeplay videotape and Bayley Scales of Infant
Development. Upon agreeing to participate in the study, the mother will
be asked to sign the consent form.
The freeplay situation will be videotaped and the developmental
assessment administered. The Developmental Specialist will then take
the family into the waiting room and explain the results of the assess
ment, show the mother learning activities, which are keyed into she

117
infant's developmental strengths and weaknesses, and give the mother
illustrated descriptions of the activities demonstrated. Following
the assessment, mothers will be interviewed to obtain demographic
information.

118
Child and Family Development Questionnaire
Six Month Evaluation
Julie Hofheimer
1.
Hospital Number
5.
Mother's Name
2.
Date
6.
Mother's DOB
3.
Baby's Birth Condition
7.
Baby's Name
4.
Baby's Birth Order
8.
Baby's DOB
10.
What is your ethnic origin?
White Am. Puerto
Rican
European
Other
Black Am. Asian
Cuban
Please
State
Am. Indian East Indian
Mexican
What is your baby's father's ethnic origin?
living with 1 or both
11.Are you married Single M F parents
living
with baby's
father
living living with
with relative
husband
living with
friend
12.With whom do you share a home?
(Check all that apply)
Mate or
Husband Father brother(s)
Mother Sister(s) children
live alone
with baby
friend (s) uncle(s)
aunt(s)
grandparent(s)
'iWho helps care for your baby?
in home
childcare friend
center
relative
13.In what type of residence do you live? home apt. trailer
campus rooming
housing house
14.How much school have you completed? Please circle highest level.
attended Jr. College
1 2 3 4 5 6 7 8 9 10 .11 12 Jr. College Degree
Vocational
Degree
Masterhs Doctoral or
Prof. Degree
College
Grad.
Degree

119
How much school did your baby's father complete?
15. Are you still in school? Yes No Type
16. What is your total yearly income? $1,000 $2,000 $3,000
$4,000 $5,000 $6,000 $7,000 $8,000 $9,000
$10,000 $11,000 $12,000 $13,000 $14-16,000
$16-18,000 $18-20,000 $20,25,000 $25-30,000
$30-40,000
17.
mate or
What are your income sources? self-employment husband's employ.
AFDC
WIC
food
stamps
baby's father's
your parents /family family
18.
private public health
Where did you receive prenatal care? physician clinic (please
(Please indicate frequency) name)
MIC Clinic
STH OB Clinic
19. Where does your baby receive health care?
APT Clinic
private
public
health
MIC/PEDS Clinic STH PEDS Clinic
0.
Have your participated in any Parenting
prenatal ed. class
childbirth ed. class
psychologist or child development
books, TV, newspapers
home, economist/social service
Education or Support Program?
APT Clinic
friends
relative
church
community ed.
Where was this program located?
How often did you participate?

APPENDIX B
DEFINITIONS OF MOTHER AND INFANT BEHAVIORS
Adapted Beckwith Behavior Scale
* -
ernal Behaviors
1. Comments: positive verbalizations; all positive vocalizations
'including questions, praises, suggests, focuses verbally.
2. Commands: mother-oriented, directive and forceful verbalizations
clear imperative to initiate action.
3. Criticism: clear request to terminate action or verbalizations
which are critical or hostile or derogatory.
4. Nonverbal bids: positive touch, help, facilitate, provide.
5. Initiating behaviors: self-oriented maternal behavior;
getting baby's attention in some nonverbal way, actions which
direct baby in a different direction rather than extending
baby's behavior.
6. Repetitive nonverbal bids: repeating the same or similar
bids over and over for several 15-second period. This has
a monotonous quality, such as presenting different toys
one after the other in a very similar manner.
7. Staccato bursts: rapid bursts of maternal behavior which
allow little or no time for infant response.
8. Affectionate touch: kiss, pat, hug, nuzzle, etc.
9. Interfering touch: mother touches baby to distract, inhibit
orf-going .activity. Includes hitting, moving object from hands,
pulling back, etc.

121
10. Repetitive verbalizations: brief phrases repeated over and over
for most of a 15-second period.
Infant Behaviors
11. Bid to caregiver: request for help; reach, point, or share;
positive gestures.
12. Vocalization: nondistress vocalization, babbling, gurgling,
cooing.
13. Smiles at mother: not frowning, not grimacing..
14. Self-stimulatory behavior: thumb sucking, extended rocking or
other non-task-oriented or exploratory behavior.
15. Vacant behavior: empty or blank or facial expression; baby
is not interacting with caregiver or environment.
16. Explores: curious visual or manual exploration of environment.
17. Fusses: crying or fussing; not contingent on mother behavior.
Reciprocal Behaviors
18. Maternal positive responding: caregiver responds to infant
positive bid or distress in a positive manner by permitting,
giving, engaging, helping, accepting, etc. Does not include
imitates, elaborates, or amplifies baby's vocalizations or
behaviors.
19.. Maternal negative responses: ignoring or rejecting babys
social bid or on-going activity either verbally or nonverbally.
Examples: not returning a toy that rolls away from infant,
turning away, or stopping a baby's initiations.
20. Maternal ignoring: mother ignores bids or activity of baby.
21. Baby positive responding: baby responds to mother's bid
positively by smiling, reaching,
pointing, vocalizing, etc.

122
22. Baby's negative responding: baby responds to mother's bid
by fussing, crying, turning away, etc.
23. Baby ignoring: ignores bids or activity of mother.
24. Face-to-face orientation: mother is in a position facing
baby.
25. Mutual gaze: the two faces are in the sarnie vertical and
horizontal plane.
26. Mother's contingent verbalization to infant vocalization:
mother either imitates or responds vocally to nondistress
vocalization by infant.
27. Baby's contingent vocalization: baby either imitates or
responds vocally to mother's behavior.

APPENDIX C
BAYLEY SCALES OF INFANT DEVELOPMENT
A. Psychomotor Index
Item Age Range
Item Presentation
21 4.9
Cube: partial thumb opposition (radial-palmer).
With the child seated at the table, place a 1-inch
cube within his easy reach. Also credit if he
passes item 32.
Credit: at this levelif the child picks up the
cube with his thumb partially pooposed to his
fingers, using the palm as well as the thumb and
fingers.
22 5.3
Pulls to sitting position. Stand at the foot of
the crib and lean over the child whil he is lying
on his back. Give him your thumbs to grasp. With
this support, allow him to pull himself to a sitting
position and, if he is able, to a full standing
position (item 36). Gradually raise your hands as
the child pulls, but take care not to do the pulling
for him.
Credit: if the child pulls himself to a sitting-
position with the support of your thumbs.
23 5.3
Sits alone momentarily. Administer as in item 17.
Credit: at this level if the child sits momentarily
without sijpport.
24 5.4
Unilateral reaching.
Credit: if the child tends to. reach with one hand
more often than bimanually (with both hands at once).
The hand used need not be consistently either the
right or the left.
25 5.6
Attempts to secure pellet. Place a sugar pellet on
the table within easy reach of the child. Observe
his efforts to pick up the pellet. If necessary,
attract his attention to it by motions of the hand,
by tapping the table near the pellet, or by making
it rock (as in Mental Scale item 52).
Credit: at this level if the child makes an effort to
pick up the pellet, whether successful or not.
123

124
26 5.7
Rotates wrist.
Credit: if the child rotates his wrist freely in
manipulating toys (cube, rattle, bell).
27 6.0
Sits alone 30 seconds or more. Administer as in
item 17.
Credit: at this level is the child sits alone 30
seconds or more. Note for item 29 whether the
child's back is curved as he leans forward for
support.
28 6.4
Rolls from back to stomach. Administer as in item 19.
Credit: if, under this or any similar situation
during the examination period, the child rolls
from his back onto his stomach.
29 6.6
Sits alone, steadily. Administer as in item 17.
Credit: at this level is the child sits alone
steadily without support and with his back fairly
straight.
30 6.8
Scoops pellet. Administer as in item 25.
Credit: at this level if the child secures the
pellet with a raking or scooping palmar prehension.
Also credit if he passes item 35 or 41.
31 6.9
Sits alone, good coordination. Administer as in item 17.
B. Mental Index
Credit: at this level if the child sits alone
steadily while manipulating toys, turning, or engaging-
in other actions that take his attention away from
the sitting process itself.
69 5.5
Transfers object hand to hand. During the child's
play with the rattle, ring, or other object, observe
whether he changes the object from one hand to the
other.
Credit: if the child transfers an object from one
hand to the other 2 or more times. Do not credit
if this occurs only when the free hand comes into
contact with the object by chance.
70 5.7
Picks up cube deftly and directly. Place a cube on
the table within easy reach of the child. Observe
the manner in which the child picks up the cube.
(Motor Scale items 16, 21, 32 may also be presented
at this time.)
Credit: if the child picks up the cube deftly and directly.

125
71 5.7
72 5.8
73 5.8
74. 5.8
75 6.0
76 6.2
Pulls string: secures ring. Administer as in item 67.
Credit: if the child secures the ring as the result
of his own efforts, even though there is no evidence
of purposive use of the string.
Interest in sound production. Observe whether the
child intentionally uses objects to make noise.
Credit: if the child shows interest in producing
sound as such, by banging toys, ringing the bell, etc.
Lifts cup with handle. Administer as in item 63.
Credit: if the child lifts the cup by the handle,
using one hand predominantly.
Attends to scribbling. Place a piece of paper on
the table in front of the child; then place a
crayon on the paper with the tip pointing away from
him. If he makes no effort tctouch the crayon to
the paper, take the crayon and scribble plainly with
obvious writing gestures. Then give the crayon to
the child with directions (by word and gesture) to
write. (See also item 95.)
Credit: if the child attends to the demonstrated
scribbling.
Looks for fallen spoon. Administer as in item 62.
(Note that items 62 and 75, involving both vision
and hearing, are easier than items 86, 88, 91,
and 96, which test "object constancy" by vision
only.)
Credit: if the child definately looks for the fallen
spoon by turning and looking to the floor.
Playful response to mirror. Administer as in item 53.
Credit: if the child plays with the mirror image,
with such responses as laughing, patting, banging,
playful reaching, leaning toward the image, "mouthing"
the mirror, etc.
Retains 2 of 3 cubes offered. One at a time, place 3
cubes on the table before the child, allowing him to
pick up each one before the next is offered. Observe
his behavior when he has a cube in each hand and
the third cube is presented.
Credit: if the child retains the first 2 cubes after
the third is offered. (Often a child fails this by
dropping a cube to reach for the third.)

APPENDIX D
PERINATAL RISK SCREENING
Calvin Hobel (UCLA)
Baby's Name
Hospital # Risk Score
I. Prenatal Factors
1.
Toxemia (moderate to severe)
10
13.
Age 35 or £ 15
5
2
Chronic hypertension
10
14.
Viral disease
5
3.
Mod-severe renal disease
10
15.
Anemia
5
4.
Eclampsia
10
16.
Excessive drug use
5
5.
Diabetes
10
17.
TB history
5
6.
Rh exchange
10
18.
Wt 100 or 200
5
7
Uterine malformation
10
19.
Pulmonary disease
5
8.
Incompetent cervix
10
20.
Flu syndrome
s
9.
Abnormal fetal position
10
21.
Smoking 1 pack/day
1
10.
Small pelvis
5
22.
Ahlcohol
1
11.
Abnormal cervical cytology
10
23.
Emotional problem
1
12.
Multiple pregnancy
10
24.
Infection
1
25.
Severs heart disease
10
126

127
II. Maternal Factors
T
,
Moderate-severe toxemia
10
11.
Second state 2-1/2
(preeclampsia)
hours
2.
Hydramnios/oligchydramnios
10
12.
Labor > 20 hours
3.
Amnionitis
10
15.
Clinical small pelvis
4.
Uterine rupture
10
14.
Medical induction
5.
Mild toxemia
5
15.
Precipitous labor
< 3 hours
6.
PROM 12 hrs.
n
D
16.
Primary cesarean
7.
Primary dysfunctional
5
section
labor
17.
Repeat cesarean
8.
Secondary arrest of
dilation
5
section
18.
Elective induction
9.
Demerol 300 mg.
5
19.
Prolonged latent phase
10.
MgSo4 25 gm.
5
20.
Uterine tetany
21.
Pitocin augmentation
Ill
Placental Factors
1.
Placenta previa
10
4.
Meconium stained
amniotic fluid (light)
2.
Abruptio placentae
10
6.
Marginal separation
3.
Postterm;42 weeks
10
4.
Meconium stained amni-
otic fluid (dark)
10
5
5
5
5
5
5
5
1
i
1
1
5
i

12'8
IV. Fetal Factors
1. Abnormal presentation
10
8. Fetal tachycardia
10
30 min.
2. Multiple pregnancy
10
9. Operative forceps or
5
3. Fetal bradycardia
10
vacuum extraction
30 min.
10. Breech delivery spon-
5
4. Breech delivery
taneous or assisted
total extraction
11. General anesthesia
5
5. Prolapsed cord
10
12. Outlet forceps
1
6. Fetal weight < 2500 gms.
10
13. Shoulder dystocia
1
7. Fetal acidosis pH > 7.25
10
14. Fetal distress
10
V. Neonatal Factors
A. General
B. Respiratory
1. 1000 grams
15
1. RDS
10
2. Apgar 5m = < 5
10
2. Meconium aspiration
10
3. Resusciation
10
3. Congenital pneumonia
10
4. 1000-1500 grams
10
4. Anomalies of respira-
10
tory system
5. Fetal anomalies
r
5. Apnea
10
6. 1500-2000 grams
5
6. Transient tachypnea
5
7. Dysmaturity
5
C. Metabolic Disorders
S. Apgar 1m = < 5
5
1. Hypoglycmia
10
9. Feeding problem
1
2. Hypocalcemia
10
10. Multiple birth
1
3. Hypo/hypermagnesemia
5
11. 2000-2500 grams
1
¡
4. Hypoparathyroidism
5
5. Failure to gain weight.
1
I
6. Jitteriness
1

129
D.
Cardiac
1.
Major Cardiac Anomalies
IQ
2.
CHF
10
3.
Persistent cyanosis
5
4.
Major cardiac Anomolies
without catheterization
5
5.
Murmur
5
E.
Hematologic Problems
1.
Hyperbilirubinemia, 15
10
2.
Hemorrhagic diathesis
10
3.
Chromosomal anomolies
10
4.
Sepsis
10
3.
Anemia
5
F.
Central Nervous System
i.
CNS depression > 24 hours
10
2.
Seizures
10
3.
CNS depression < 24 hours
5

REFERENCE NOTES
1. Brazelton, T. B., Lester, B. A cross-cultural study of
adolescent mother-infant interaction and neonatal
assessment. Personal communication, 1979.
2. Mahan, Charles S. Teenage pregnancy team project grant
proposal (DHEW-NIH), 1978.
3. Mahan, Charles S. and Eitzman, D. V. North Central Florida
maternity and infant care project grant proposal (DHEW-PHS),
1978.
130

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Pages
are
misnumbered
following
this
insert

BIOGRAPHICAL SKETCH
Julie Anne Hofheimer was born in Jacksonville, Florida, in 1952.
Together with her parents, Anne and Norman, and younger brothers,
Andy and Gary, she resided in Jacksonville as well as Long Island, New
York, and Newton, Massachusetts. She received her B.S. in elementary
and early childhood education from Florida State University in 1973
and her M. Ed. in early childhood and elementary education from the
University of North Florida in 1975.
Julie taught first grade and kindergarten in Orange Park and
Jacksonville. She also taught early childhood curriculum at the University
of North Florida as an adjunct instructor in the Department of Elementary
and Secondary Education.
Upon beginning her doctoral program, Julie was a seminar leader in
the Childhood Education Program at the University of Florida. From
September 1978 until June 1979, Julie served as Infant and Family
Development Specialist on the Adolescent Pregnancy Team in the Department
of Obstetrics and Gynecology. During this time she also worked as a
graduate research assistant in infant development for the Department of
Pediatrics, Division of Neonatology. Throughout the year, Julie taught
and supervised graduate students in Early Childhood and Family Development
Education in the Department of Early Childhood Education.
Plans for her future remain tentative, but Julies professional goals
include the continuation of research, teaching, and clinical experiences
with young children and their families.
140

I certify that I have read this study and that in my opinion
it conforms to acceptable standards of scholarly presentation and
is fully adequate, in scope and quality, as a dissertation for the
degree of Doctor of Philosophy.
/
1
Athol B. Packer, Chairperson
Associate Professor of
Curriculum and Instruction
I certify that I have read this study and that in my opinion
it conforms to acceptable standards of scholarly presentation and
is fully adequate, in scope and quality, as a dissertation for the
degree of Doctor of Philosophy.
James J. Algina ,
Assistant Professor of
Foundations of Education
I certify that I have read this study and that in my opinion
it conforms to acceptable standards of scholarly presentation and
is fully adequate, in scope and quality, as a dissertation for the
degree of Doctor of Philosophy.
Patricia T. Ashtdn
Assistant Professor of
Foundations of Education

I certify that I have read this study and that in my opinion
it conforms to acceptable standards of scholarly presentation and
is fully adequate, in scope and quality, as a dissertation for the
degree of Doctor of Philosophy.
Michael B. Resnick
Assistant Professor of
Pediatrics
I certify that I have read this study and that in my opinion
it conforms to acceptable standards of scholarly presentation and
is fully adequate, in scope and quality, as a dissertation for the
degree of Doctor of Philosophy.
/
Robert S. Soar
Professor of
Foundations of Education
This dissertation was submitted to the Graduate Faculty of the
Department of Curriculum and Instruction in the College of Education
and to the Graduate Council, and was accepted as partial fulfillment
of the requirements for the degree of Doctor of Philosophy.
Augus t, 1979
Dean, Graduate School




Table 23
Pairwise Comparisons of Type of Prenatal Care
on Infant's Mental and Psychomotor Development
Mental Development Motor Development
Difference Difference T P
Comparison Between Means T P Between Means
Private Physician--Public Health Department
Private Physician-Maternal Infant Care Proj.
Private Physician-Teenage Pregnancy Team
Private PhysicianShands Teaching Hospital
Public Health DepartmentMaternal Infant Care
Project
Public Health Department--Teenage Pregnancy
Team
Public Health DepartmentS.T.II. High Risk Clinic
Maternal Infant Care Project: Teenage Pregnancy
Team
Maternal Infant Care Project: S.T.II. High
Risk Clinic
Teenage Pregnancy: S.T.H. High Risk Clinic
24.33
2.47
.02
12.40
1.82
.07
18.24
1.96
.06
15.11
2.34
.02
34.77
3.57
< .001
19.31
2.87
<.01
2.10
.23
.82
1.31
.21
.84
6.09
.86
.39
2.71
.55
.58
10.43
1.43
. 16
6.91
1.37
.18
22.23
2.66
.01
11.09
1.91
.06
16.53
2.74
<.01
4.20
1.01
.32
16.14
2.35
.02
13.80
2.90
<.0I
32.66
4.59
.001
18.00
3.66
<.001
100


51
in the Pediatric Clinic. When the families -- often including fathers,
friends and extended family members -- arrived at the clinic, a brief
explanation of the procedures preceeded the assessment. Subjects in
the study were informed as to the nature of the developmental testing
procedure employed and the purpose of the study. They signed a statement
of informed consent, but were not told the variables under investigation
in order to prevent bias during the data collection process (Appendix
A). Treatment of participants was in accordance with the standards of
the American Psychological Association and the Committee for the
Protection of Human Subjects at the University of Florida.
Following an explanation of the procedures, the families were
requested to come into the playroom where a mat and toys were available
for play. Mothers were encouraged to engage in a brief play period
prior to the actual videotaped sequence. The videotaped segment was
then recorded as the mothers participated in free play with their
infants. The initial play period (and the videotaped play sequence)
was designed to allow the baby to adjust to the environment. Each family
was given the identical assortment of toys for the free pla.y, which
included rattles, balls, a mirror and a set of colorful faces. Mothers
were told that the purpose of the free play was: 1) to allow the
baby to adjust; and 2) to get an idea of how the baby played in an
unstructured situation while at ease with the parent.
Following the free play session, the examiner engaged in a two to
three minute warm-up play period with the baby before administering the
Bayley Scales of Infant Development. The parent was informed as to the
nature of each task and its purpose in the assessment throughout the


Cross Tabulations of Type of Prenatal Care,
Prenatal Childbirth Education and Parenting Education
Prenatal
Childbirth
Education
Parenting Education
Type of
Prenatal Care
Teenage
Pregnancy
Team
Materna
Infant
Care
Proj ect
i- S.T.H.
High
Ri s k
Clinic
Scliool Other'
None
Teenage
Pregnancy
Team
* Infant §
Family
Development
Education School
Program
Other
None
Private
Physician 16
9
4
3
3 1
5
7
Public Health
Department 9
2
n
3
6
Maternal-
Infant Care
Project 19
10
l
8
1
6
11
Teenage
Pregnancy
Team 20
18
2
6
1
1
12
S. T. 11. H i gh
Pi sk
Clinic 13
6
7
1
1
11
Infant and Family Development Education Program, Department of Early Childhood Education and Division of
Neonatology, University of Florida (Packer, et al. 1979).


61
mother-infant transaction and infant development as outcome measures
of early pregnancy and parenting.
In order to reduce the number of variables and represent
the more global dimensions of mother-infant transaction in subsequent
analyses, a correlation matrix of the 27 behavioral categories was
subjected to a Principle Components analysis. As a result of this
analysis, five dimensions of mother-infant transaction were defined
and each subject's incomplete composite component score was calculated
for each of the five components. These calculations were based on
the addition of the total number of behaviors which had a positive
loading on the component and the subtraction of the number of
behaviors which had negative loadings on the component. The
reliability of the observers was computed on each of the five com
ponent score dimensions using a Pearson Product-Moment Correlation
procedure. These analyses were executed using the Statistical
Package for the Social Sciences (SPSS) (Nie et al., 1975).
In the first multivariate multiple regression analysis, the
dimensions of mother-infant transaction and the infants mental and
psychomotor development were considered to be the outcome measures
of early pregnancy and parenting. These measures were therefore
treated as dependent variables and were regressed on mother's age
and education, baby's sex and birth order, yearly income, ethnic
origin, social support-system, perinatal risk status and type of
prenatal care.
The second multivariate multiple regression analysis addressed
the question regarding the ability of the transaction components to


65
accounted for 46 percent of the variance. Table 3 reports the
loadings of the variables on each component. Table 4 reports the
factor score coefficients of the variables.
The results of the Principle Components analysis were used
to guide the formation of the subjects' composite scores on each
of the five components. Variables were included in these scores
such that those with factor score coefficients greater than .25
defined the component. In the fifth component, mother's negative
responses were included in the composite component score based
upon theoretical interpretations of the observed behaviors of the
mother-infant transaction process. The total number of tallies per
behaviors with positive coefficients were added to calculate each
component score. The behaviors which had negative coefficients were
subtracted from this sum. This process often resulted in the com
posite score of a subject on a component being less than or equal to
zero. The following formulae were used to calculate the composite
scores on each of the five components:
Component Score 1 (Warmth) Affectionate Touches +
Smiles + Face-to-face Orientation
Component Score 2 (Reciprocity) = Baby's Positive Responses +
Mother's Positive Responses + Initiating Bids -
Baby's Exploratory Behavior
Component Score 3 (Responsive Vocalization) Baby's Vocali
zations + Mother's Contingent Vocalizations +
Babys Contingent Vocalizations Mother's
Nonverbal Bids


REFERENCES
Ainsworth, M. D. Individual differences in the development of some
attachment behaviors. Merrill-Palmer Quarterly, 1972, 1_8, 23-43.
Ainsworth, M. D. § Bell, S. D. Some contemporrary patterns of mother-
infant interaction in a feeding situation. In Stone, L. J.,
Smith, H. T., and Murphy, L. B. (Eds.) The social infant.
New York: Basic Books, Inc., 1973, 14.
Alan Guttmacher Institute. 11 million teenagers: What can be done
about the epidemic of adolescent pregnancies in the United States?
New York: Planned Parenthood Federation of America, Inc., 1976.
3adger, E., Elsass, S., Sutherland, J. Mother training as a means
of accelerating child development in a high risk population.
Paper presented at Society for Pediatric Research, Washington, D. C
May 2, 1974.
Baldwin, W. Adolescent pregnancy and childbearing--growing concerns
for .Americans. Population Bulletin, 1976, _31_(2), 3-32.
Baldwin, W. Statement in Hearings of the Ninety-fith Congress,
U. S. Government Printing Office, 1978, 3-14.
Barglow, P., Barnstein, M. B., Exum, D. B. § Wright, M. K. Some
psychiatric aspects of illigitimate pregnancy during early
adolescence. American Journal of Orthopsychiatry, 1967, 57_(2) 266
Barr, A., Goodnight, J., Soli, J. 5 Helwig, J. Users guide to SAS 1976.
Raleigh, N. C.: SAS Institute, 1976.
Bayley, N. Bayley scales of infant development (Manual). New York:
The Psychological Corporation, 1969.
Beckwith, L. Relationship between attributes of mothers and their
infants IQ scores. Child Development, 1976, 42, 1083-1097.
Beckwith, L., Cohen, S., Capp, C. B., Parmalee, A. H., § Marcy, T. G.
Caregiver interation and early cognitive development in pre
term infants. Child Development, 1976, 47, 579-87.
Bell, R. Contributions of human infants to caregiving and social
interaction in Lews, M. and Rosenblum (Eds.) The effect of
infant on its caregiver. New York: Wiley, 1974.
Brazelton, T. B. Effect of maternal expectations on early infant
behavior. Early Child Development Care, 1973, 2_, 259-273.
131




The two observers were selected, on the basis of their prior
experience in coding parent-infant transaction videotapes. In
another study (Eyler, 1979) these observers evidenced skills in
analyzing observable behaviors of mothers and their premature new
borns and were found to be consistent in their ratings.
Training of the coders involved detailed explanations and
numerous examples of each behavioral category. The observers were
assessed initially and at randomly determined periods throughout
the coding process in order to ascertain the extent to which
behaviors were rated consistently. Fifteen of the videotapes were
coded by both coders. This permitted the assessment of intercoder
reliability. Table 1 presents the Pearson Product-Moment Correlations
between the frequencies reported by the two coders.
In order to reduce the number of variables to be used in
subsequent analyses and to represent more global dimensions of
mother-infant transaction, a correlation matrix of observation
measures was subjected to a Principle-Component analysis using the
varimax rotation. The results of these analyses are discussed in
detail in Chapter IV.
Statistical Analyses
The variables under investigation in the study were the age
of the mother, the education of the mother, the sex and birth order
of the infant, perinatal risk status, yearly income, ethnic origin
and type of prenatal care. The analyses were designed to assess
the contributions of these variables to the prediction of


16
preparation for childbirth. While it was noted that there existed a
high correlation between the husband-wife relationship and total adjust
ment to perceived changes, medical preparation in childbirth was
insignificant in facilitating adjustment after birth. What appeared
meaningful in the transition from dyad to triad ivas the sense of
"family" established as a result of the father's participation in the
birth. Total adjustment was found to correlate negatively with the disruption
of affection and intimacy, a decreasing amount of time spent with the
wife, and a discrepancy between the father's expected and actual care
taking role due to breast feeding. This aspect of early marriage and
fatherhood has been virtually ignored with respect to early parenting
(Chilman, 1979)
Studies of fathers' involvement have .supported'-the importance of
the father- infant transactional relationship. Parke:and Sawins
(1976) observations of fathers, both with the mother and alone with
the neonate, indicated that the fathers were equally involved in
establishing eye contact, holding, vocalizing and touching the infant.
Fathers were also successful in caretaking routines, and often exceeded
the mother's participation. In the context of feeding and on other
measures, fathers were found to be sensitive to infant cues and were
able to interpret infant behavior and modify their own behavior in
response. It was also noted that fathers touched and vocalized to
first-born males more often than to other offspring. Longitudinal
studies indicated that those fathers who were given the opportunity to
learn and practice skills in the hospital were more involved with
infants at six months (Parke and Sawin, 1976).
The results of the study on the strength of mother-child and father-
child attachment supported the father's role in the child's developing