title: Twins conceived using assisted reproduction: parent mental health, family relationships and child adjustment at middle childhood.
abstract: OBJECTIVE
  Compared with singletons, what is the parent mental health, parent-child and couple relationship satisfaction, and child adjustment of 6- to 12-year-old assisted reproduction technology (ART) twins and their families?
  
  
  CONCLUSIONS
  There are no differences between 6- and 12-year-old ART twin and singleton families in parent mental health or family relationships; however, twins had significantly fewer behavior and attention problems than singletons in middle childhood.
  
  
  BACKGROUND
  When ART twins are younger than 5 years old, parents have more mental health difficulties and poorer parent-child relationship quality, and no differences have been found in ART twin and singletons' psychosocial adjustment. However, studies have only examined the implications of ART twin status in families with infant and toddler aged children.
  
  
  METHODS
  A cross-sectional study of 300 6-12-year-old ART children (n = 124 twins and n = 176 singletons) from 206 families at a reproductive endocrinology clinic in the USA.
  
  
  METHODS
  Patients from one clinic with a child born between 1998 and 2004 were invited to participate in an online survey (82% recruitment rate). Participants provided information on each 6- to 12-year-old ART child in the family, and responded to questions on parent mental health, family relationships and child adjustment.
  
  
  RESULTS
  There were no differences in parent mental health or family relationships in families with 6- to 12-year-old ART twins versus singletons. However, twins (M = 2.40, SE = 0.35) had significantly fewer behavior problems than singletons (M = 3.47, SE = 0.36; F(1, 201) = 4.54, b = 1.08, P < 0.05). Twins (M = 1.86, SD = 0.23) also had fewer attention problems than singletons (M = 2.64, SD = 0.23; F(1, 156) = 5.75, b = 0.78, P < 0.05). Results also suggest that full-term twins had significantly fewer attention problems (M = 1.37, SE = 0.33; F(1, 222) = 2.65, P = 0.05) than premature twins (M = 2.32, SE = 0.32, b = 0.95, P < 0.05), full-term singletons (M = 2.25, SE = 0.21, b = 0.88, P < 0.05) and premature singletons (M = 2.84, SE = 0.49, b = 1.47, P = 0.01). There were no significant differences between the other groups.
  
  
  CONCLUSIONS
  Although the response rate is high (82%) and family demographics are representative of US ART patients, patients are from one US clinic. Responses also are from one family member and may be subject to social desirability biases. Additionally, our data did not include identification of monozygotic and dizygotic twins.
  
  
  CONCLUSIONS
  Studies on infant and toddler ART twins suggest these families have parents with more mental health difficulties and lower parent-child relationship quality than singleton families. This study indicates the negative effects of twin status may have ameliorated by middle childhood, and twins may even have more optimum psychosocial adjustment than singletons in this developmental period.
  
  
  BACKGROUND
  This research is based on a collaborative research effort supported by University of Minnesota Agriculture Experiment Station Project Number MN-52-107, a University of Minnesota Grant-in-Aid of Research, Artistry and Scholarship grant, a University of Minnesota College of Education and Human Development Research Development Investment Grant and the M. Janice Hogan Fellowship. The authors of this article have no commercial or corporate interests to declare.
authors.affiliation: Department of Family Social Science, University of Minnesota, St Paul, MN, USA and02584@umn.edu.
authors.forename: Kayla N
authors.initials: KN
authors.lastname: Anderson
authors.affiliation: Department of Social Work, Augsburg College, Minneapolis, MN, USA.
authors.forename: Bibiana D
authors.initials: BD
authors.lastname: Koh
authors.affiliation: Department of Counseling and Community Psychology, St. Cloud State University, St. Cloud, MN, USA.
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Connor
authors.affiliation: Department of Communication Studies, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Ascan F
authors.initials: AF
authors.lastname: Koerner
authors.affiliation: Department of Obstetrics, Gynecology and Women's Health, University of Minnesota, Minneapolis, MN, USA.
authors.forename: Mark
authors.initials: M
authors.lastname: Damario
authors.affiliation: Department of Family Social Science, University of Minnesota, St Paul, MN, USA.
authors.forename: Martha A
authors.initials: MA
authors.lastname: Rueter
mesh_terms: D000223:Adaptation, Psychological; D001288:Attention; D002648:Child; D002652:Child Behavior; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008603:Mental Health; D010287:Parent-Child Relations; D010290:Parents / Q000523:psychology*; D011247:Pregnancy; D059285:Pregnancy, Twin; D027724:Reproductive Techniques, Assisted; D014427:Twins / Q000523:psychology*
keywords: assisted reproduction technologies; family relationships; mental health; psychosocial adjustment; twins