Child- and family-related contextual factors

Child- and family-related contextual and situational factors can influence child development together with early risks, by either protecting or predisposing children to negative effects of early adversity (Sameroff, 2010). In this study, we analyze the role of two such potential moderators in the association between early maternal mental health and child development. First, child’s gender has been suggested to play a role in the association between parental mental health and child development, due to potential greater vulnerability of boys. Second, family’s former infertility and conception through assisted reproductive treatment (ART) might increase the

likelihood of negative consequences of early parental problems on children, due to specific family vulnerabilities.

4.5.1 Child’s gender

Several studies suggest that pre- and postnatal parental mental health problems affect more strongly the mental health and development of boys, compared to girls (Brand

& Brennan, 2009; Ramchandani et al., 2005). As an example, Carter and Garrity-Rokous (2001) found that maternal pre- and postnatal depressive symptoms predicted behavior problems in toddler boys, but not in girls. Hay and colleagues (2008) found a connection between maternal postpartum depression and adolescent intelligence, but the effect was stronger among boys. However, some other studies have not found any gender effects in the association between early parental mental health and child development (e.g. Cornish et al., 2005; Van den Bergh & Marcoen, 2004).

The possible gender differences are likely to be explained by biological factors, by early mother-infant interaction and/or by gender-specific psychological symptoms. First, compared to females, male fetuses are biologically more vulnerable to adversity (Cieslik & Waszak, 2001; Mueller & Bale, 2008), and the development of boys is more susceptible to neurophysiological problems (Bauermeister et al., 2007). Second, studies on the quality of mother-infant interaction suggest that mothers with depressive symptoms communicate less with their sons than with their daughters (Murray, Kempton, Woolgar, & Hooper, 1993). Finally, boys are found to show more externalizing symptoms such as aggression both in early childhood (Winsler & Wallace, 2002) and in adolescence (Card, Stucky, Sawalani, & Little, 2008). From early adolescence on, girls typically show more internalizing symptoms of depression and anxiety (Crawford, Cohen, Midlarsky, & Brook, 2001; Kistner, 2009). According to Hay et al. (2001), boys may react to maternal mental health problems earlier than girls, but the gender-differences get smaller towards adolescence. This dissertation study examines whether the maternal pre- and postnatal mental health problems differently affect the mental health and development of boys and girls.

4.5.2 Family’s former infertility

To our knowledge, no studies on the impact of parental mental health on children have been conducted among ART families. However, one might speculate ART children to be particularly susceptible to early family-related risks, such as parental mental health problems, due to genetic and early medical vulnerabilities. First, infertility itself can be related to genetic differences or health of the couple that undergoes the ART, and this could directly impact the child (Raatikainen, Kuivasaari-Pirinen, Hippelainen, & Heinonen, 2012). Second, the reproductive treatment can negatively impact early embryological processes such as methylation patterns, leading to epigenetic alterations in the child (Winston & Hardy, 2002).

Third, complications associated with ART pregnancies can negatively impact child development. For instance, low birthweight infants are at increased risk of later ADHD symptoms as well as behavioral, social and cognitive developmental problems (Ben Amor et al., 2005; Latimer et al., 2012; Tideman, Marsal, & Ley, 2007).

Despite these suggested mechanisms, no significant developmental differences have been documented between ART and NC children and adolescents (for a review see Hart & Norman, 2013). Instead, studies have reported similar intellectual performances, cognitive information processing, attention, and visual-motor functioning (Carson et al., 2011; Leunens, Celestin-Westreich, Bonduelle, Liebaers,

& Ponjaert-Kristoffersen, 2008; Punamäki et al., 2016; Wagenaar et al., 2008). For instance, Carson et al. (2011) compared expressive language abilities between 3-year-old ART and NC children, and reported even better skills among ART children. The effect was, however, reduced after adjusting for a range of confounding and mediating factors, and the authors concluded that ART children’s cognitive development was similar to that of NC children.

Studies on ART children’s mental health have reported more conflicting results. Some studies have found comparable or even better outcomes for ART children. For instance, Barnes et al. (2004) found no differences in emotional and behavioral problems between five-year-old ART and NC children, and Wagenaar et al. (2009) reported even fewer externalizing symptoms among 9-18-year-old ART children. Other studies have instead suggested a slightly increased risk for mental health problems among ART children (Bay, Mortensen, Hvidtjorn, & Kesmodel, 2013; Hart & Norman, 2013; Källen et al., 2011). For instance, Bay et al. (2013) reported a small but systematically increased risk of a range of mental health and neuropsychiatric problems among 8-17 year-old ART children, including

internalizing and externalizing symptoms as well as autism spectrum disorders.

Similarly, Källen et al. (2011) showed a slightly increased risk of ADHD in ART compared to NC children.

Within our study sample, the ART and NC children did not differ regarding mental health or social and cognitive development in the middle childhood (Punamäki et al., 2016). Interestingly, however, some gender-specific group differences were found. In particular, the ART boys showed lower levels of cognitive problems than the NC boys, whereas the ART girls showed higher levels of cognitive problems than the NC girls. Furthermore, whereas the NC boys showed more externalizing symptoms and social and cognitive developmental problems than the NC girls, these typical gender differences were not found in the ART-group. These results suggest possible existence of unique developmental processes among ART boys and girls. This dissertation study extends the research of ART children’s mental health and development to children whose mothers and fathers suffered from early mental health problems. We investigate, whether and how early parental mental health symptoms predict child mental health and development differently among ART and NC families.