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Insecure attachment and internalizing behavior problems in growth discordant identical twins
Sophie G Groene1, Lisette Jansen2, Ratna N G B Tan3
1Neonatology, 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.
Insights
Monochorionic twins experiencing selective fetal growth restriction show higher attachment insecurity. Smaller twins within these pairs exhibit more internalizing behaviors and negative emotions, suggesting increased vulnerability to anxiety and depression.
Area of Science:
- Perinatal Medicine
- Developmental Psychology
- Twin Studies
Background:
- Psychosocial development in monochorionic (MC) twins with selective fetal growth restriction (sFGR) remains understudied.
- Understanding these outcomes is crucial for daily functioning and future relationships.
Purpose of the Study:
- To investigate psychosocial development, attachment, and school functioning in MC twins with sFGR.
- To compare outcomes between smaller and larger twins within these pairs and with the general population.
Main Methods:
- An observational cohort study was conducted.
- Parent-report questionnaires assessed behavior, temperament, attachment, and school functioning.
- Participants included MC twins with sFGR (birth weight discordance ≥20%) born between 2002 and 2017, aged 3-17 years.
Main Results:
- Attachment insecurity (ambivalence/resistance and total) was higher in MC twins with sFGR compared to the general population.
- Smaller twins demonstrated more internalizing behaviors and higher negative affect than larger twins.
- Smaller twins also had a lower secondary school level.
Conclusions:
- MC twins with sFGR exhibit increased ambivalent/resistant attachment insecurity due to pregnancy complications.
- Smaller twins show a propensity for negative emotions and internalizing behaviors, indicating heightened sensitivity to depression and anxiety.
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.
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