[Psychosocial care in institutional neonatology in Germany: a quantitative-empirical inventory from the medical professionals' perspective]. / Die psychosoziale Versorgung in der Neonatologie in Deutschland: Eine quantitativ-empirische Bestandsaufnahme aus ärztlicher Perspektive.

BACKGROUND: The available studies concerning the long-term development of preterm infants emphasise the protective significance of the parents. As a consequence, concomitant psychosocial support for parents during the neonatal period aiming at moderating the adverse effects of the critical incident "premature birth" is deemed to be imperative. The aim of this study is to assess the supply of psychosocial services in neonatal care units as viewed by medical professionals in Germany. METHODS: A representative questionnaire-based survey in German neonatal care units was undertaken. A descriptive evaluation was made of frequency distributions, comparison of means between former West German and former East German states and levels of neonatal care (levels I-III). RESULTS: The time-budget available for parent consultation is considered insufficient by approximately one third (31.9%) of the medical personnel, 22.2% of the interviewees felt this task to be excessively demanding. As a standard, the option for cooperation with a qualified psychosocial consultant is available in 67.0% of the neonatal care units. 95.7% of the medical personnel consider this cooperation a desirable support; 97.9% consider interdisciplinary cooperation in neonatology a desirable option in general. CONCLUSIONS: Additional time for parent consultation is desirable and necessary. Psychosocial services should be extended and provided for in neonatal care units and appropriate financial and personnel resources should be made available. DISCUSSION: In many neonatal care units there is an awareness for the benefits of an appreciative, family-centred atmosphere as well as interdisciplinary cooperation. This is a favourable starting point for research efforts concerning further inquiries into implementation standards of family-centred, concomitant consultation.

Mothers seeing their VLBW infants within 3 h after birth are more likely to establish a secure attachment behavior: evidence of a sensitive period with preterm infants?

OBJECTIVE: Close contact of mother and child in the first hours after birth is essential for the establishment of a secure attachment behavior in term infants. To date, studies investigating whether a 'sensitive period' also exists for very low birth weight (VLBW) preterm infants are lacking. STUDY DESIGN: Attachment patterns of 62 VLBW infants were assessed using the 'strange situation' setting and correlated with the time mothers saw their child for the first time. Furthermore, maternal and infant covariates possibly influencing the attachment behavior were analyzed. As maternal factors the mother's age, social status and pregnancy history were recorded and at three time points (time 1, 2 and 3 (t-1, t-2 and t-3)), a semi-structured interview, a depression and a social support questionnaire were performed. As infant factors neonatal basic data, ventilation time and length of hospital stay were recorded. Disease severity was scored using the clinical risk index for babies, score for neonatal acute physiology (SNAP), SNAP perinatal extension and nursery neurobiological risk score. At time points t-2 and t-3, the infants were examined using the second edition of Bayley scales of infant development. RESULTS: In all, 53.2% of the children showed a secure, 33.9% an insecure-avoidant, 3.2% an insecure-ambivalent and 9.7% an insecure-disorganized attachment behavior. Preterm infants whose mothers had seen them within 3 h after birth had a higher rate of secure attachment than preterm infants with no early contact (76 versus 41%, P=0.009). Firstborns showed a significantly higher rate of insecure attachment behavior (93 versus 67%, P=0.01). No influence on attachment behavior was shown for any other maternal or infant factor. CONCLUSIONS: Our results support the hypothesis that the first hours after birth are a 'sensitive period' for the development of attachment behavior in VLBW infants. When a mother is enabled to see her infant shortly after birth, the 'sensitive period' right after birth may be used to help forming an important basis for the secure attachment of the preterm infant.

[Specificity hypothesis of a theory of mind deficit in early childhood autism]. / Zur Spezifitätshypothese eines Theory-of-Mind Defizits beim Frühkindlichen Autismus.

OBJECTIVES: In order to test the hypothesis that a theory of mind deficit is specific for autism, the present study presents the first replication of the Sally-Anne test (Baron-Cohen, Leslie & Frith, 1985) in the German-speaking countries. METHODS: The Sally-Anne test was administered to 16 autistic, 24 probands with Down's syndrome and 20 normal preschool prosands. The intelligence of the autistic group and that with Down's syndrome was measured by the CPM/SPM. In addition, the ADI-R was used with the principal caregivers of the autistic and Down's syndrome subjects. RESULTS: With regard to the clinical diagnosis, theory of mind deficit turned out to be not specific for autism. Six of 16 (37.5%) autistic subjects passed the theory of mind tasks. Thus performance in the autistic group surpassed that of both control groups. Out of 16 autistic subjects, autism could be confirmed in only 8 on the basis of the ADI-R diagnostic criteria, only one of whom showed a theory of mind. The autistic individuals with a theory of mind differed significantly in their mean IQ from those without this ability. CONCLUSIONS: Spectrum and specificity of a theory of mind deficit in autism remain controversial. For further research it seems important to administer the ADI-R during the diagnostic process. The findings suggest that the clinical diagnosis of autism is not precise enough to distinguish between autism and nonautistic mental handicap.