Insecure attachment and internalizing behavior problems in growth discordant identical twins

Early Human Development, vol. 174, pp. 105679

Abstract

BACKGROUND: Psychosocial development in monochorionic (MC) twins born after selective fetal growth restriction (sFGR) has been unreported to date, despite its importance for daily functioning and future relationships. AIMS: To investigate psychosocial development, attachment and school functioning in MC twins with sFGR and compare outcomes with the general population and between smaller and larger twins. STUDY DESIGN: Observational cohort study. SUBJECTS: MC twins with sFGR (defined as a birth weight discordance ≥20 %) born between 2002 and 2017 and aged 3-17 years. OUTCOME MEASURES: Multiple parent report questionnaires: the Child Behavior Checklist (social-emotional development and behavior), the (Early) Childhood Behavior Questionnaire Very Short Form (temperament), the Attachment Insecurity Screening Inventory (attachment) and a school functioning questionnaire. RESULTS: Median age for the 48 twin pairs was 11 (interquartile range (IQR) 8-13) years. Attachment insecurity for both twins was higher than in the general population for ambivalence/resistance (34 % (21/62) vs. 16 %, p = 0.024) and total attachment insecurity (35 % (22/62) vs. 16 %, p = 0.016). Smaller twins had more internalizing behavioral problems, i.e. negative emotions and behaviors turned inwards (22 % (10/46) vs. 11 % (5/46), p = 0.021) and a higher negative affect, i.e. more likely to experience negative emotions (3.2 (2.9-3.7) vs. 2.9 (2.2-3.2), p = 0.009) than larger twins, as well as a lower secondary school level (p = 0.031). CONCLUSION: MC twins with sFGR have more ambivalent/resistant attachment insecurity following the complicated pregnancy course. Smaller twins have a tendency towards negative emotions and internalizing behaviors compared to larger twins, indicating an increased sensitivity for depression and anxiety.

Authors 8

1. Sophie G. Groene corresponding Aachen Molecular Epidemiology Department of Biomedical Data Sciences Neonatology Department of Pediatrics, Leiden University Medical Center

   Leiden University Medical Center · Willem-Alexander Kinderziekenhuis

   Affiliation as printed

   Neonatology, Willem-Alexander Children's Hospital, Dept. of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands; Molecular Epidemiology, Dept. of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands. Electronic address: S.G.Groene@lumc.nl

   Molecular Epidemiology, Dept. of Biomedical Data Sciences, Leiden University Medical Center, Leiden, the Netherlands

   Neonatology, Willem-Alexander Children's Hospital, Dept. of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands

2. Lisette Jansen Aachen Department of Medical Psychology

   Leiden University Medical Center

   Affiliation as printed

   Dept. of Medical Psychology, Leiden University Medical Center, Leiden, the Netherlands

3. Ratna N.G.B. Tan Aachen Neonatology Department of Pediatrics, Leiden University Medical Center

   Leiden University Medical Center · Willem-Alexander Kinderziekenhuis

   Affiliation as printed

   Neonatology, Willem-Alexander Children's Hospital, Dept. of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands

4. Sylke Jeanne Steggerda Aachen Neonatology Department of Pediatrics, Leiden University Medical Center

   Leiden University Medical Center · Willem-Alexander Kinderziekenhuis

   Affiliation as printed

   Neonatology, Willem-Alexander Children's Hospital, Dept. of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands

5. Monique C. Haak Aachen Fetal Therapy Department of Obstetrics, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Fetal Therapy, Dept. of Obstetrics, Leiden University Medical Center, Leiden, the Netherlands

6. Arno A.W. Roest Aachen Pediatric Cardiology Department of Pediatrics, Leiden University Medical Center

   Leiden University Medical Center · Willem-Alexander Kinderziekenhuis

   Affiliation as printed

   Pediatric Cardiology, Willem-Alexander Children's Hospital, Dept. of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands

7. Enrico Lopriore Aachen Neonatology Department of Pediatrics, Leiden University Medical Center

   Leiden University Medical Center · Willem-Alexander Kinderziekenhuis

   Affiliation as printed

   Neonatology, Willem-Alexander Children's Hospital, Dept. of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands

8. Jeanine M.M. van Klink Aachen Neonatology Department of Pediatrics, Leiden University Medical Center

   Leiden University Medical Center · Willem-Alexander Kinderziekenhuis

   Affiliation as printed

   Neonatology, Willem-Alexander Children's Hospital, Dept. of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands