Supporting the adolescent mother-infant relationship: trial of a peri-natal attachment intervention

© 2012 Dr. Susan NicolsonThis thesis tested whether a new, brief, peri-natal, attachment intervention, provided to pregnant adolescents in addition to their routine maternity care, would improve the quality of the relationship they were able to form with their infant. The ‘AMPLE’ intervention aimed to prevent some of the significant attachment relationship difficulties and adverse developmental consequences observed among infants of adolescent mothers, by helping pregnant adolescents see their baby as a person during the transition to motherhood. A pre-test, post-test, control group study design was used to test the intervention in a convenience sample of pregnant adolescents recruited from a specialized, multi-cultural service for young women at a large, tertiary, maternity hospital in Melbourne (N = 97). The acceptability of the study was high, with a study participation rate of 82.9% and a completion rate of 75.3%. Among the study completers (n = 73), 35 participants received the intervention in addition to routine care (intervention group) and 38 received care as usual (control group). Receipt of the intervention was associated with significantly better mother-infant interaction, videoed at home at infant age 4 months and coded using the Emotional Availability Scales 4th Edition. Coding of 20-minutes of free play (n = 73) revealed significantly reduced negative maternal behaviours known to adversely affect infant attachment (hostility and intrusiveness) in the intervention group compared with the control group. Coding of 20 minutes of free play followed by a five minute separation-reunion episode (n = 55) revealed significantly increased maternal sensitivity, known to positively influence infant attachment, in addition to reduced maternal hostility and intrusiveness, in the intervention group. The effect sizes were medium to large. The ‘AMPLE’ intervention therefore appears to be an acceptable,affordable and effective means for maternity services to support the adolescent mother-infant relationship. Further research is warranted and should include a cluster randomized controlled trial to confirm the findings and establish causality. The implication of the findings for clinical practice is that the AMPLE intervention could be manualised and offered as part of routine maternity care, with the potential to positively influence the developmental trajectory of young mothers and their babies from the beginning