| Summary: | Infant regulatory problems (crying, sleeping, feeding) are a common concern for parents and practitioners. Although there is now good evidence of the long-term adverse influences of infant regulatory problems on mental health, in particular if they co-occur together (multiple regulatory problems), important gaps remain regarding the precursors of regulatory problems. In particular, it is unclear whether and how sensitive parenting and/or neurodevelopmental vulnerability are involved in the development of multiple regulatory problems. Furthermore, do regulatory problems impair the development of the infants’ relationship to their mothers, i.e. attachment? This thesis explores neurodevelopmental vulnerability and sensitive parenting as precursors of multiple regulatory problems, and whether multiple regulatory problems increase the likelihood of insecure and/or disorganised attachment. The thesis consists of four studies and uses preterm birth as a natural model to assess neurodevelopmental vulnerability due to the interruption caused by preterm birth on the key processes of brain development. Study 1, a meta-analysis, explored the relationship between neurodevelopmental vulnerability and maternal sensitivity by comparing maternal sensitivity in preterm and full-term infants. Findings indicate that having an infant with neurodevelopmental vulnerability does not alter mothers’ sensitive parenting. In Study 2, using the Growth of at risk Infants (GAIN) study, the effect of neurodevelopmental vulnerability on regulatory problems across the first 18 months was investigated. Very preterm/very low birth weight infants experienced more multiple regulatory problems at term and 18 months compared to full-term infants. In Study 3, the longitudinal relationship between neurodevelopmental vulnerability, maternal sensitivity and multiple regulatory problems across infancy was explored allowing for reciprocal associations between maternal sensitivity and multiple regulatory problems across infancy. Both maternal sensitivity and multiple regulatory problems were moderately persistent from term to 18 months. Consistent with our previous findings, it was revealed that neurodevelopmental vulnerability had an enduring impact on multiple regulatory problems. On the other hand, maternal sensitivity at term had only a short-term negative impact on multiple regulatory problems at 3 months. No evidence for a reciprocal influence of maternal sensitivity and multiple regulatory problems was found. Finally, Study 4 examined whether early multiple regulatory problems at 3 and 6 months increase the likelihood of insecure and/or disorganised attachment. Findings revealed that multiple regulatory problems as early as 3 months increased the risk of both insecure and in particular, disorganised attachment at 18 months. In conclusion, neurodevelopmental vulnerability increases the risk of multiple regulatory problems, which are moderately persistent across the first 18 months of life. Furthermore, multiple regulatory problems do not impair maternal sensitivity but have adverse effects on the infants’ relationship with their mothers by increasing the risk of insecure and disorganised attachment. Clinicians should be aware that multiple regulatory problems are a significant potential risk factor for poorer infant-mother relationship.
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