The Caregiving Environment and Developmental Outcomes of Preterm Infants: Diathesis Stress or Differential Susceptibility Effects? Noa Gueron-Sela and Naama Atzaba-Poria Ben-Gurion University of the Negev Gal Meiri and Kyla Marks Soroka University Medical Center and Ben-Gurion University of the Negev The interactions between premature birth and the caregiving environment on infants’ cognitive and social functioning were examined. Participants were 150 infants (83 preterm, 67 full-term) and their parents. When infants were 6 months old, parents reported on their levels of emotional distress, and triadic family interac- tions were filmed and coded. At 12 months of age, the infants’ cognitive and social functioning was assessed. Prematurity moderated the effects of maternal (but not paternal) emotional distress and triadic interactions on infants’ cognitive and social outcomes. Whereas for cognitive functioning the interactions were consistent with a diathesis–stress approach, for social functioning the interactions were consistent with a differential suscepti- bility approach. The differential effects of the caregiving environment between groups and outcomes are discussed. Preterm births (gestation < 37 weeks) account for 11% of all live births worldwide, ranging from 5% in some European countries, 12.8% in the United States, and up to 18% in some African countries (Blencowe et al., 2012). Accumulating evidence sug- gests that even under low medical-risk conditions, premature birth confers increased risk for poor cog- nitive and social outcomes throughout childhood (e.g., Brummelte, Grunau, Synnes, Whitfield, & Pet- rie-Thomas, 2011). Nevertheless, the risk associated with prematurity is not homogeneous and may depend on the presence of additional factors in chil- dren’s early caregiving environments, which may enhance or alternatively reduce preterm infants’ ini- tial risk conditions (e.g., McManus & Poehlmann, 2012; Shah, Robbins, Coelho, & Poehlmann, 2013). Research has consistently demonstrated that early sensitive, responsive caregiving environments facili- tate preterm infants’ later cognitive and social development (Landry, Smith, Swank, Assel, & Vellet, 2001; McManus & Poehlmann, 2012; Shah et al., 2013). However, it is not known whether a supportive environment reduces the risk associated with prematurity by restoring normative develop- ment or, alternatively, possibly even by promoting functioning above the population-based norms. Furthermore, although previous research implied that preterm infants may be more affected by their caregiving environment than full-term infants (Landry, Smith, & Swank, 2006; Landry et al., 2001), this notion has yet to be tested systemati- cally. This study aimed to address these issues by uncovering the nature of the interactions between infants’ biological risk (preterm vs. full-term birth) and the early caregiving environment in predicting infants’ early cognitive and social outcomes. Cognitive and Social Development of Preterm Infants There is substantial empirical evidence that even under low medical-risk conditions, infants born pre- term score lower than full-term infants on standard cognitive assessments (e.g., Brummelte et al., 2011). For example, a recent study demonstrated that very low birth weight preterm infants with low medical risk exhibited lower cognitive functioning com- pared to full-term infants as early as 18 months of age (Brummelte et al., 2011) and that their cognitive level significantly declined from the age of 8 to 18 months, although no decline was evident among the full-term group (Brummelte et al., 2011). As for social development, infants born preterm tend to exhibit difficulties in early social communication This research was funded by a grant from the Israel Founda- tions Trustees (Grant 87200511). Correspondence concerning this article should be addressed to Noa Gueron-Sela, Department of Psychology, Ben-Gurion University of the Negev, Beer-Sheva 84105, Israel. Electronic mail may be sent to gueron@post.bgu.ac.il. © 2015 The Authors Child Development © 2015 Society for Research in Child Development, Inc. All rights reserved. 0009-3920/2015/8604-0003 DOI: 10.1111/cdev.12359 Child Development, July/August 2015, Volume 86, Number 4, Pages 1014–1030