Twin and Triplet Psychology

A Professional Guide to Working with Multiples

Audrey Sandbank

• Publisher: Routledge
• Year: 2003
• ISBN:
  9781134670215
• Edition: 1
• Topic: Psychology
• Subtopic: Psychotherapy
• Index: Psychology

Information on the special needs and natures of twins and multiples is often difficult for professionals to obtain. Twin and Triplet Psychology fills this gap, helping professionals to be better-equipped to offer advice to parents and twins alike.
Examining the psychology of twinship throughout the lifespan, the book includes chapters on:
* twins in-utero temperament development and inter-twin behaviour before and after birth
* antenatal and postnatal influences on family relationships
* twins with special needs
* the death of a twin
* twins in secondary school and adolescence.

1
Introduction
The importance of understanding the psychology of twin and triplet relationships

Audrey C.Sandbank

Social change

There has been a steady increase in the number of live multiple births in the developed nations over the last few years due to healthier populations, medical advances and fertility treatment, and social changes which have led many women to delay starting their families or continuing to bear children at a later age—there has been found to be a direct correlation between the age of the mother and the chance that she will conceive dizygotic (DZ), non-identical, twins (Lazar et al. 1981). Correspondingly, there has been a growing public interest in multiples and an awareness by professionals that they need to be better equipped to offer help and advice to parents and twins alike. This book collects the accumulated knowledge of leading professionals on the subject of multiples and how they may differ in their needs from singletons in the current social environment.

Many of the aspects concerning twins which are treated in detail throughout the book are reflected by Associate Professor Dr Britta Alin Akerman in Chapter 7, dealing with triplets. Unfortunately we have not been able to cover quads or quins but the reader should be able to extrapolate from the information presented here. In Chapter 9 Dr John Buckler also covers the subject of triplets in his specialised treatment of growth and development and in Chapter 5 Dr Elizabeth Bryan includes triplets in her statistics on the risk of cerebral palsy. She also points out that monozygotic (MZ) pairs are more at risk than DZ and this includes identical members of higher multiple groups. As the numbers increase, so also do the risks.

Separate and shared environments

Comprehensive studies of MZ twins who have been reared both apart and together (Bouchard et al. 1990) have demonstrated that our genes account for appoximately half of the development of most psychological traits with non-shared environment contributing to the rest, i.e. prenatal and perinatal differences, birthweight and birthorder, individual friends and school experiences. IQ has been shown to be much more gene dependent and recent Swedish studies have shown that this increases with age and that 80-year-olds are more alike in this respect than the younger age groups (McClearn et al. 1997). Why then, it may be asked, at least in the case of MZ twins, do we need a book on twin and triplet psychology?

Professor David Hay convincingly points out (Chapter 8) that even in the case of MZ twins, we need to be aware of the importance of the non-shared and shared environment as twins (or triplets) go through life, the former creating differences between MZ twins, the latter sometimes making DZ twins more alike, sometimes less alike. This is even more noticeable if they are identical di-chorionic twins (MZDC) as discussed by Dr Alessandra Piontelli in Chapter 2. First, as Piontelli has shown with the use of ultrasound, there are physical differences in utero that may favour one or other of the twin pair and the intra-uterine environment itself is modified by the behaviour of the fetus. There are also differences in activity patterns which are predictors of postnatal differences. Jane Spillman (Chapter 3), as well as Piontelli (Chapter 2), Åkerman (Chapter 7) and Buckler (Chapter 9), have demonstrated that inequality in the intra-uterine environment has an effect on each twin or triplet, leading to differences between the two. Prenatal and perinatal factors which may sometimes lead to one twin or triplet having special needs are discussed by Elizabeth Bryan in Chapter 5. Bryan reminds us with sensitivity that their are implications for every member of the family, particularly the co-twin, and gives some thoughtful advice on management based on her experience of those attending her twins clinics which have been a lifeline for many parents. Buckler (Chapter 9) demonstrates that growth is strongly genetically controlled with ‘a significant role for environmental factors’ and that any disadvantages that twins may have per se as regards growth are usually ironed out by the time they reach adulthood.

The unshared environmental component results in subtle differences which may be exaggerated or depressed depending on the twins themselves and those around them. Spillman (Chapter 3) shows how birthweight differences may lead to unequal bonding and a preference for the heavier baby, resulting in behavioural and even IQ differences. Research reported by Hay in Chapter 9 shows that some differences perceived by parents may have little foundation in fact and owe more to labelling, birthweight, or more importantly, which twin came home from hospital first, and these perceived differences tend to persist.

Family relationships

In Chapter 10 the Editor, Audrey Sandbank, points out that those closest to MZ twins find it easiest to detect small differences which may influence outside relationships and eventually partners. Sandbank also looks at the separation issue from a psychodynamic point of view and at the possible pitfalls in adolescence. Hay looks at adolescence rather more pragmatically from the educational perspective in Chapter 8.

Contrary to the popular view, twins do not simply consist of the MZ population. DZ twins, with all their normal sibling differences, most notably in the case of DZos (opposite sex) twins, need to have their twinness taken into account. MZ twins also need to have their individuality and separate identity acknowledged. When both twins have most of their traits in common, and even when they are no more alike than any two brothers or sisters, the psychology of the couple requires to be taken into consideration, as Sandbank (Chapter 10) and Hay (Chapter 8) point out, not least when separation looms or even death occurs. Bryan (Chapter 11) tells us how the death of a twin at any age is a trauma which those of us who are singletons may never fully understand, which is why, she says, it is so important for twins to help twins. It was for this reason that Bryan set up the Lone Twin Network for twins who have lost a co-twin. They are able to share their feelings with others and discover that they are not unique, and find help and support. Bryan also emphasises the importance of the sympathetic treatment and counselling of mothers who have lost a twin prenatally or perinatally, particularly if they have had to make the choice of selectively reducing the number of fetuses.

In Chapter 3, Spillman, a midwife and veteran researcher into the effect on the family not only of the arrival but also the news of the arrival of twins or more, gives us an insight into the emotional impact on parents and its subsequent effect on parent—twin relationships. This, as we can see from Chapters 8 and 10, may have long-term effects. She suggests that adequate counselling for those undergoing infertility treatment and for all those expecting multiples, an awareness of their needs through pregnancy, birth and afterwards, can greatly improve the well-being of the families. She emphasises the important role of self-help organisations and those supporting professionals in disseminating information. Akerman also gives us a thoughtful overview of this area, but more from the psychodynamic point of view, and includes many firsthand accounts. She does give us background medical information, for, as she points out, having triplets is a very different experience from having a singleton, or even twins. (It is not within the brief of this book to cover fully the biological or obstetric aspects of twinning which are more than adequately covered in other works.)

Åkerman, Hay and Sandbank all mention the problems for mothers (and fathers) who lose their special role when their multiples grow up and Bryan (Chapters 11 and 5) makes the same point more poignantly if one or more babies die, or the ‘perfect’ pair is lost through disability. The mother may try to maintain the fiction of ‘normal’ twinship inappropriately to the detriment of both members of the pair. In the UK, Tamba offers various support groups including ‘special needs’ and ‘bereavement’. Sharing experiences with others is seen as the most valuable help that can be offered, as well as acknowledging that those who have lost a twin still have the right to be under the ‘multiple’ umbrella.

Education

All twins and those involved in their care require us, the professionals, to be aware of what will make their path through life a little easier. All the contributors to this book have demonstrated their dedication to this cause, none more so than Pat Preedy who, in Chapter 6, draws attention to the benefits which would be derived from an education policy on twins and also that twins themselves should have a voice. As a head teacher she is well aware of the importance of the right educational environment in getting the best out of the young children in her care, and the results of her pupils testify to her methods. Faced with a large influx of twins she at once set herself to discover what their particular needs might be, recognising that these might be different from those of singletons. Following in the path which Hay in Australia has trod for the past twenty years she was able to replicate some of his pioneering research. Hay himself (Chapter 8) has given us an impressive overview of his work, and of the subject, and is now breaking new ground in examining the problems of ADHD in twins and singletons.

Åkerman (Chapter 7) has given education policy in Sweden a high priority for triplets—there are so many more choices to be made! Bryan also reminds us (Chapter 5) that physical disability is not necessarily linked to mental disability and, importantly, that any perceived differences may be due to timing of milestones or diversity of gifts, particularly in the case of DZ pairs where the children will differ in the same way as any two siblings in a family.

The nature/nurture question is one that Dr Kay Mogford-Bevan rigorously explores in Chapter 4 on language and encourages us not to overlook the possibility of a shared language disorder when looking at language delay in twins, or possibly a disorder in only one if one twin appears to be dominant in the use of language. At the same time, she looks at the twin situation and how we can best encourage the development of language, an area which Preedy highlights from the point of view of education in Chapter 6 and Hay in Chapter 8, where he also looks at the ADHD connection. Mogford-Bevan points out that being a twin may not lead to language delay at all, but may even give some twins an advantage. Akerman also looks at language delay in triplets in Chapter 7.

Telepathy

Some readers may be disappointed that we have not covered the vexed question of telepathy, but, so far as the editor is aware, there is no evidence, on the standard method of testing, that twins are any more telepathic than the rest of the population. The fact that so many report amazing coincidences and synchronicity of events, whether together or apart (Sommer et al. 1961) may, as the Minnesota study seems to show (Bouchard et al. 1990), owe more to their genes than it does to telepathy. However, there is plenty of anecdotal evidence of telepathic experiences, particularly if one twin is in pain or danger. To dismiss these as of no importance is to deny the very real experiences that many twins have had and which are by no means confined to MZ twins but have also been reported by DZss and DZos twins.

Playfair (1999) suggests that researchers have been doing the wrong kind of experiments and that they should be designed to fit the type of experiences that twins themselves report where the sender appears to do more than transmit an image, but actually influences the physiology of the receiver. This effect is rarely reported by other than close relations, and one will view results of further research with interest.

References

Bouchard, T.J., Lykken, D.T., McGue, M., Segal, N.L. and Tellegen, A. (1990) ‘Sources of human psychological differences: the Minnesota study of twins reared apart’, Science 250, 223–228.

Lazar, P., Berger, C. and Hemon, D. (1981) ‘Preconceptual prediction of twin pregnancies’ in Twin Research 3, Twin Biology and Multiple Pregnancy, ed. W.Nance, pp. 175–181. New York, Alan R.Liss.

McClearn, G.E., Johansson, B., Berg, S., Pedersen, N.L., Ahern, F., Petrill, S.A. and Plomin, R. (1997) ‘Substantial genetic influence on cognitive abilities in twins 80 or more years old’, Science 276, 1560–1562.

Playfair, G. (1999) ‘Telepathy and identical twins’, Journal of the Society for Psychical Research 63(854), 86–89.

Sommer, R., Osmond, H. and Pancyr, L. (1961) ‘Selection of twins for ESP experimentation’, International Journal of Parapsychology 3, 55–73.

2
Twins in utero
Temperament development and intertwin behaviour before and after birth

Alessandra Piontelli

Myths and facts

Many myths, legends and popular beliefs have always grown around the intra-uterine life of twins. In the public imagination their shared life during pregnancy has frequently been fantasised as being a specially animated and already social affair.

Fights abound from Esau and Jacob struggling for their birthright, to Rebecca, Isaac’s wife, sensing her children battling in utero ‘and the children struggled together within her’ (Genesis 25). But we also hear about twins entertaining each other in all sorts of ways and being generally involved in adult and complex social interchanges which clearly only belong to life after birth. Such legends die hard. Even recently, intentional fights and kisses in utero have been ‘scientifically’ described.

Until fairly recently the study of human behaviour was necessarily limited to postnatal life, and the dramatic event of birth marked the limit beyond which it was impossible to observe the infant. The advent of ultrasound towards the middle of the 1970s, has opened a window into prenatal life. Ultrasounds are primarily of clinical importance and it was mainly their use in clinical practice which permitted fetal medicine to develop into a well-established, autonomous field. In all respects the fetus has now become a patient in its own right.

Ultrasounds are of special clinical relevance in twin pregnancies. Such pregnancies, being generally considered at risk, often need frequent monitoring and are usually subject to repeated ultrasonographic examinations.

However, ultrasounds are not only of purely clinical importance. Albeit with various limitations, they have made it feasible to observe and investigate the spontaneous behaviour of the undisturbed fetus within its natural environment. The studies by Prechtl (1984), De Vries et al. (1982, 1985, 1988), Manning et al. (1979) and several others have all given us fundamental knowledge of behavioural ‘developmental milestones’ (Birnholz et al. 1978) in utero. A wealth of data about fetal competencies is now available and rapidly accumulating. Neverth...

Table of contents

• Cover Page
• Title Page
• Copyright Page
• Illustrations
• Contributors
• Foreword
• 1: Introduction: The importance of understanding the psychology of twin and triplet relationships
• 2: Twins in utero: Temperament development and intertwin behaviour before and after birth
• 3 Antenatal and postnatal influences on family relationships
• 4: Twins and their language development
• 5: Twins with special needs
• 6: Meeting the educational needs of pre-school and primary aged twins and higher multiples
• 7: The psychology of triplets
• 8: Adolescent twins and secondary schooling
• 9: Growth and development of twins
• 10: Personality, identity and family relationships
• 11: The death of a twin
• Useful addresses