Caregiver-child interactions during daily activities for children born very low birth weight with and without white matter disorder

Daily activities are the architecture of everyday life in which adult-child interaction is embedded. Occupational therapists are often a part of the support system that assists families of children with developmental delays to enable optimal participation in daily activities. However, our understanding of how caregivers adapt their routines and interactions to facilitate their children's participation is very limited. In particular, research needs to consider how these interactions may he affected by the nature of the activity or task itself.; Two studies examined similarities and differences in the behaviors of 12 dyads in three groups: caregivers and their children born prematurely and very low birth weight with white matter disorder, children born prematurely and very low birthweight without white matter disorder, and fullterm, healthy children. Caregivers and children were videotaped together while dressing and preparing, eating and cleaning up two snacks in a lab setting.; In the first study, a new, investigator-developed behavioral rating system, (Caregiver-Child Rating Scales), was used to examine qualities of caregiver-child interactions. Ten expert clinicians rated three videoclips of the dyads engaging in the dressing and snack activities. Patterns of correlations between three composite ratings of qualities were examined. Raters perceived different patterns of interactions in the three groups suggesting that caregiver interactions may vary according to the children's level of biologic risk or developmental difficulties. For caregivers of children at greatest risk, i.e. with white matter disorder, positive engagement and directiveness were positively correlated, whereas these variables were negatively correlated in caregivers of fullterm children.; The second study used a behavioral coding system, (Occupational Performance Coding System), to examine caregiver assistance and child performance during the activities. Group differences in children's performance suggested that greater developmental risk (based on birth history) was associated with less effective task performance. In turn, within-group variations suggested that parents adapted both the type and frequency of their interactive strategies to facilitate their children's successful participation.; The findings provide insight into caregiver-child adaptations that help sustain child engagement in important activities of their daily lives in the face of varying developmental challenges.