Maternal Breastfeeding Experiences and Neonatal Breastfeeding Behaviors of Children Later Diagnosed with Autism.

摘要

The two studies presented here describe neonatal breastfeeding as a measure of neonatal processing. The first paper describes the theoretical framework which guides both studies, the Biobehavioral Conception of Neonatal Processing. The first paper also reviews the state of the science for the measurement of neonatal processing, neonatal neurobehavioral organization (NNBO). The second paper is the first study to describe breastfeeding behaviors, a measure of NNBO, of children later diagnosed with Autism Spectrum Disorder (ASD).;The first study describes the Biobehavioral Conception of Neonatal Processing theoretical framework, reviews the science of NNBO biobehavioral measures, and provides a short summary of a descriptive study using breastfeeding as an NNBO measure. The Biobehavioral Conception of Neonatal Processing uses three concepts, a neonate, the environment (maternal factors) and the neonatal mental system. Neonatal processing occurs within the neonatal mental system. The mental system may be assessed by NNBO biobehaviors, specifically breastfeeding. Breastfeeding and other NNBO biobehavioral measures of sleep/wake states, vagal tone and heart rate variability, neurophysiological measures of eventrelated potential of brain activity, and nutritive sucking and sucking patterns of bottle feeding literature is reviewed. NNBO biobehavioral measures have been found to be predictive of developmental outcomes. Breastfeeding, however, as an NNBO biobehavioral measure, has limited research as a predictive measure for cognitive and social outcomes. A short summary describes maternal breastfeeding experiences of mothers of children later diagnosed with ASD using the Biobehavioral Conception of Neonatal Processing as a guide. Mothers described their breastfeeding experiences and their neonate's breastfeeding behaviors. Many of the neonates' breastfeeding behaviors were described as demonstrating an atypical breastfeeding pattern, “insatiable feeding”, which may reflect early alteration in processing.;The second paper applies the Biobehavioral Conception of Neonatal Processing in a retrospective study. The study describes the maternal breastfeeding experiences during the first month after delivery of mothers who breastfed children later diagnosed with ASD. Mothers were interviewed in their homes, offices, libraries, at local shopping malls and restaurants. The interview used three measures created from the three major concepts within the Biobehavioral Conception of Neonatal Processing: a maternal socio-environmental questionnaire, a semi-structured interview, and a post-interview summary.;Participants were a convenience sample of 20 mothers (13 primiparas, 7 multiparas). Maternal age range was 28–60 years of age (M = 43.3, SD = 9.6). Two mothers had more than one son diagnosed with ASD. One mother had two sons and the second mother had three sons diagnosed with ASD for a total sample of 23 breastfed neonates. All 23 children had been full term neonates (38–42 weeks gestation) with birth weight > 2500 grams, diagnosed with ASD between ages of 18 months to 11 years of age (M = 4.3, SD = 2.4) and age range at the time of the maternal interview was 5–35 years of age (M = 11.5, SD = 7.6).;Mothers described three types of breastfeeding experiences affected by the maternal environmental factor of professional support. One mother's experience overlapped between the first and second group. The first group (n=4) recalled breastfeeding success with no or limited professional support. The second group (n = 11) breastfed successfully after receiving positive professional support (one mother overlapped with group one), and the third group (n = 6) had variable success with breastfeeding after receiving unfavorable professional support. Support provided to the second and third groups was given for inexperience, anatomical barriers and neonates that demonstrated an “insatiable feeding”, i.e., frequent vigorous feeding without ceasing after satiation.;The mothers of neonates later diagnosed with ASD described having similar breastfeeding experiences and challenges compared to the typically developing population. The mothers of neonates also described a triad of neonatal breastfeeding behaviors that merit future research, “insatiable feeding”, a vigorous suck that did not stop with satiation, diminished social interaction, and > 70th percentile for weight for many of the infants during the first year.;Taken together, these findings support using the Biobehavioral Conception of Neonatal Processing to guide future studies using NNBO biobehavioral measures. The findings also support future research to quantify the breastfeeding behavior of “insatiable feeding” for a potential screening tool for neonates at-risk for ASD.