1 KAYLA N. ANDERSON 1 MARTHA A. RUETER 2 JENNIFER J. CONNOR 1 UNIVERSITY OF MINNESOTA – TWIN CITIES 2 ST. CLOUD STATE UNIVERSITY Twin Families: When Parental Conformity Relates to Positive Child Outcomes

Why Twins? Twin rate: from 0.01 to 3.41% of all births (ASRM, 2012)  Predominantly due to infertility treatment growth (like IVF)  20 (Europe; ESHRE, 2014 ) to 30% (US; CDC, 2014 ) of IVF births = twins.  This is more than 20X the rate of twins in the general population Compared to singletons, twins’ early environments…  …Aren’t good. This may be particularly true in IVF twin births.  60% of IVF twins premature; 53% low birth weight (SART, 2014)  Relative to singletons, twin parents have higher rates of parenting stress, anxiety & depression, and have poorer early parenting skills (Olivennes et al., 2005; Thorpe et al., 2003; Vilksa & Unkila-Kallio, 2010; Holditch-Davis et al., 1999) (In singletons), these issues are related to worse child psychosocial adjustment.

Why Twins? Head scratcher: Twins have better psychosocial adjustment than singletons by middle childhood (Anderson et al., 2014; Pulkkinen et al., 2003; Robbers et al., 2010; Moilanen et al., 1999).  Why is this? No one knows. Do twin family resources have different effects on family (and indirectly child) outcomes relative to singletons? (Anderson et al., 2014; Boss, 2002; McCubbin, 1979; Hill, 1958). In twin families, parents may have high expectations for conformity to their rules to maintain order and reduce household chaos (Garel et al., 1997; Jenkins & Coker, 2010).

This Study! Two goals:  Do parental conformity expectations have different effects on family outcomes, such as parent-child relationship satisfaction, in twin and singleton families?  Does the moderating effect of parental conformity expectations by twin status indirectly explain differences in twins’ and singletons’ psychosocial adjustment?

Study Participants 198 families; – 12 year old kids 126 twins (63 pairs); 162 singletons 86% location, 82% participation rate All IVF kids born between University of Minnesota Reproductive Medicine Center Patient records (mother)

Study Participants IVF: High income, highly educated, predominantly White Kids: 54% female; M age = % Twin Birth Rate

Study Measures Study ConceptMeasurement Twin Status0 = Singleton; 1 = Twin Parent-child Relationship SatisfactionAdaptation of Huston MOQ Relationship Measure (Huston & Vangelisti, 1991; Caughlin & Afifi, 2004) Parental Conformity ExpectationsConformity subscale: Revised Family Communication Patterns Questionnaire (Ritchie & Fitzpatrick, 1990) Child Psychosocial AdjustmentChild Behavior Checklist: Internalizing, Externalizing, & Attention Problems subscales (Achenbach & Rescorla, 2001) Covariates: Parent emotional state ( Adult Self Report Anxious Depressed Scale; Achenbach & Rescorla, 2003 ), age & education; child sex, age & prematurity status (1 = premature, 0 = not premature)

Statistical Model Twin Status Parent-child Relationship Satisfaction Child Adjustment Parental Conformity Expectations P. Emotional State P. Education P. Emotional State P. Education P. Age C. Age C. Sex C. Premature Indirect effects from the interaction (twin status X conformity) & child adjustment were modeled.

Child (Twin vs. Singleton) Emotional Problems Twin Status Parent-child Relationship Satisfaction Emotional Problems Parental Conformity Expectations β=-0.35, p <.001 β=0.16, p=0.015 Indirect effect interaction  emotional adjustment: β= -0.06, p = Indirect effect interaction  emotional adjustment: β= -0.06, p = Model Fit  2 =6.43, df = 6, p =0.38 SRMR = 0.01 CFI = 0.99  2 = 1.14, df = 5, p > 0.05 TLI = 0.98PC RS R 2 =.14 (p=.017) RMSEA = 0.02EP R 2 =.24 (p<.001)

Child (Twin vs. Singleton) Behavior Problems Twin Status Parent-child Relationship Satisfaction Behavior Problems Parental Conformity Expectations β=-0.53, p <.001 β=0.14, p=0.028 Indirect effect interaction  behavioral adjustment: β= -0.06, p = Indirect effect interaction  behavioral adjustment: β= -0.06, p = Model Fit  2 =3.56, df = 6, p =0.74 SRMR = 0.01 CFI = 1.00  2 = 0.94, df = 5, p > 0.05 TLI = 1.07PC RS R 2 =.14 (p=.019) RMSEA = 0.00EP R 2 =.39 (p<.001) Twin Status  Behavior Problems: β=-0.17, p <.001

Child (Twin vs. Singleton) Attention Problems Twin Status Parent-child Relationship Satisfaction Attention Problems Parental Conformity Expectations β=-0.45, p <.001 β=0.15, p=0.020 Indirect effect interaction  attention problems: β= -0.07, p = Indirect effect interaction  attention problems: β= -0.07, p = Model Fit  2 =1.13 df = 6, p =0.98 SRMR = 0.00 CFI = 1.00  2 = 0.67, df = 5, p > 0.05 TLI = 1.17PC RS R 2 =.13 (p=.019) RMSEA = 0.00EP R 2 =.29 (p<.001) Twin Status  Attention Problems: β=-0.20, p <.001

Twin Status*Parental Conformity Expectations Low conformity: Twins had negative relationship with satisfaction,    -0.19, p =.013 High conformity: Twins have positive relationship with satisfaction,  = 2.71, p =.010 Low conformity: Twins had negative relationship with satisfaction,    -0.19, p =.013 High conformity: Twins have positive relationship with satisfaction,  = 2.71, p =.010

Conclusions & Future Directions Parental conformity expectations do have different effects on family outcomes (parent-child relationship satisfaction) in twin and singleton families.  What other family resources may have different effects?  What else of we know about singletons can’t be exactly applied to twin populations? Different effects of conformity*twin status indirectly (partially) explain twins’ more positive adjustment  What other factors explain twins’ more positive adjustment. How does this relate to what we know about early cognitive development in twins? (twins worse; Olivennes et al., 2005; Thorpe et al., 2003; Rutter et al., 2003)

Conclusions & Future Directions How might this be the same or different in twins born without medical assistance?  What IVF specific factors should be examined that might be different from general population twins? What might this look like in adolescence? When is it that the shift in adjustment occurs, and when is it that family environments stop being detrimental to twins and shift to being more helpful?  Parenting and relationship factors linked to poor twin and parent outcomes in early childhood (Thorpe et al., 2003; Baor & Soskolne, 2012).

Contact & Acknowledgements Contact: Kayla Anderson, Funding:  Olson Marriage & Family Fellowship  Minnesota Agricultural Experiment Station  UMN Grant-in-Aid of Research  UMN College of Education & Human Development Investment Grant

References 1. Achenbach TM, Rescorla LA. Manual for the ASEBA school-age forms & profiles University of Vermont, Research Center for Children, Youth, & Families, Burlington, VT. 2. Achenbach TM, Rescorla LA. Manual for the ASEBA Adult Forms & Profiles University of Vermont, Research Center for Children, Youth, & Families, Burlington, VT. 3. Anderson KN, Koh BD, Connor JJ, Koerner AF, Damario M, Rueter MA. Twins conceived using assisted reproduction: Parent mental health, family relationships, and child adjustment at middle childhood. Hum Reprod 2014; 29: Anderson KN, Rueter MA, Connor JJ (November, 2014). Families with Twins Developmental Stress Theory. Presented at the National Council on Family Relations Theory Construction & Research Methodology Workshop, Baltimore, MD. 5. American Society for Reproductive Medicine. Multiple gestation associated with infertility therapy: an American Society for Reproductive Medicine practice committee opinion. Fertil Steril. 2012; 97: Baor L, Sosklone, V. Mothers of IVF twins: the mediating role of employment and social coping resources in maternal stress. Women and Health. 2012: 52: Boss P. Family Stress Management Sage Publications, Thousand Oaks, CA. 8. Caughlin JP, Afifi TD. When is topic avoidance unsatisfying? Examining moderators of the association between avoidance and dissatisfaction. Human Communication Research. 2004; 30: Centers for Disease Control. Assisted reproductive technology national summary report Accessed July 25, European Society for Human Reproduction and Embryology. ART fact sheet. legal/art-fact-sheet.aspx. Accessed September 18, legal/art-fact-sheet.aspx 11. Garel M, Salobir C, Blondel B. (1997). Psychological consequences of having triplets: a 4-year follow-up study. Fertil Steril 1997; 67: Hill R. Genetic features of families under stress. Social Casework. 1958; 49:

References 1. Holditch-Davis D, Roberts D, Sandelowski M. Early parental interactions with and perceptions of multiple birth infants. J Adv Nurs. 1999; 30: Huston TL, Vangelisti AL. Socioemotional behavior and satisfaction in marital relationships. J Pers Soc Psychol 1991; 61: Jenkins DA, Coker R. Coping with triplets: perspectives from parents during the first four years. Health & Social Work 2010; 35: McCubbin HI. Integrating coping behavior in family stress theory. J Marriage Fam 1979; 41: Moilanen I, Linna SL, Ebeling H, Kumpulaninen K, Tamminen T, Piha J, Almqvist F. Are twins’ behavioural/emotional problems different from singletons’? Eur Child Adoles Psy 1999; 8: Olivennes F, Golombok S, Ramogida C, Rust J, The Follow-Up Team. Behavioral and cognitive development as well as family functioning of twins conceived by assisted reproduction: findings from a large population study. Fertil Steril 2005; 84: Pulkkinen L, Vaalamo I, Hietala R, Kaprio J, Rose RJ. Peer reports of adaptive behavior in twins and singletons: is twinship a risk or an advantage? Twin Research 2003; 6: Ritchie D, Fitzpatrick, MA. Family communication patterns: measuring intrapersonal perceptions of interpersonal relationships. Communication Research 1990; 17: Robbers SCC, Bartels M, van Oort FVA, van Beijsterveldt CEM, van der Ende J, Verhulst FC, Boomsma DI, Hulzink AC. A twin-singleton comparison of developmental trajectories of externalizing and internalizing problems in 6-to 12-year-old children. Twin Research and Hum Genet 2010; 13: Society for Assisted Reproductive Technology. Multiple pregnancy. Accessed July Thorpe K, Rutter M, Greenwood R. Twins as a natural experiment to study the causes of mild language delay: II: Family interaction risk factors. J Child Psychol Psyc 2003; 44: Vilska S, Unkila-Kallio L. Mental health of parents of twins conceived via assisted reproductive technology. Curr Opin Obstet Gyn 2010; 22: