Lars and Stan

In One and the Same Abigail crisscrosses the country and travels the world to explore the relationship between twins, which can range from passionate to bitterly resentful. She interviews football stars Tiki and Ronde Barber, who admit their twinship comes before their marriages; bawdy, self-proclaimed “twin ambassadors” who have created a media business around their twinness;  sisters who stopped speaking for three years; and brothers whose shared genetic anomaly wrought unspeakable tragedy. She explores the new science of epigenetics, which shows how the same DNA can yield different results—a moody twin, a happy twin, one who gets cancer, one who doesn’t. She speaks to the twins experts and tries to answer the question parents of twins ask most: Is it better to encourage their closeness or separateness?

Threaded throughout One and the Same are Abigail’s own memories of a buoyant childhood growing up with her twin sister and best friend, Robin. “The Pogrebin Twins” were outgoing, cheerful and hammy, very much alike, and effortlessly close. But hey don’t have the same intimacy anymore, and Abigail traces the bittersweet process of growing apart from someone she thinks of as part of herself.

This is a riveting portrait of twin life by an accomplished journalist who exposes twinship from the inside. It yields fascinating truths about how we become who we are and about the struggle for singularity that defines us all.

http://www.amazon.com/One-Same-Identical-Everyones-Struggle/dp/B005Q6GNFY/ref=sr_1_1?ie=UTF8&qid=1352910792&sr=8-1&keywords=one+and+the+same

Twinspiration for Twinparents will be published later this  year. I am still looking for great twin pictures for my e-book. Please send your pictures to suzanne@twinsvideoblog.com

More information about my book will be posted on this website.

ICOMBO Newsletter Jan 2013

Daan and Jesse

Hannah and Eva

The International Council of Multiple Birth Organisations (ICOMBO) believes that multiples, just like other children, have the right to be respected and treated as individuals with their own needs, preferences and dislikes. This week the ICOMBO will focus on the educational needs of multiples: How do we navigate our multiples through the education system? Will our school allow us a voice in the placement of our children – will the multiples be kept together, or will they be separated? How do we encourage their unique bond while treating each child as an individual?

ICOMBO strongly believes that decisions about classroom placement of multiples should be made annually, on a case-by-case basis, in consultation with the parents and if age appropriate, the children concerned. “We believe that blanket policies on this issue are inappropriate. We support each and every multiple birth family in their quest to find the best educational outcome for their children and wish you well in your journey”.

For further information, visit the ICOMBO website http://icombo.org/international-awareness-week-2012/

Max and Porter

Results of twin studies

In recent years, several scientific studies have looked at the effect of separating twins at school on school performance and behavior (Van Leeuwen, 2005; Webbink, 2007; Polderman, 2010). The main conclusions of these studies were:

Entering primary school (age 5):

• Separated twins generally show more internalizing problems (such as anxiety and feelings of insecurity) compared to non-separated twins.
• The school performances of non-separated twins are generally higher than the school performances of separated twins.

By the end of primary school (age 12):

• There are no differences in levels of behavioural problems (internalizing nor externalizing) between separated and non-separated twins.
• There is no difference in school performance between separated and non-separated twins.

(for more detailed information on these studies, please have a look at www.twinspiratie.nl)

This means that, looking at the school performances and behavioural problems of twin children, it seems that keeping twins together when they enter primary school generally has at least a shorter term positive influence on the development of the children, both academically and emotionally.

Jim and Sam made their start at primary school at the age of 4. The school wanted to place the boys in separate classrooms, but at the request of their parents they agreed to make an exception. The boys were allowed to start in the same classroom, so they could get used to school together. After the first bank holiday Jim and Sam are being separated. According to the teacher; “they really cling together, so it would be better if they are separated and learn to cope on their own. Just like singletons”. The parents don’t agree, but school goes ahead anyway. Because of their twin policy.

Sam does not seem to suffer much from the separation. He mingles easily with the children in his classroom and does well academically. This is in stark contrast with Jim, who exhibits fearful behavior: he does not seek contact with other children and has suffered from psychosomatic problems such as headaches, pain in his stomach and wetting his pants. Besides that, Jim also scored low on all tests measuring math and reading skills. The teacher advises the parents to see a psychologist because she thinks that Jim is autistic. After extensive research (psychological examination and the Wechsler IQ test for children) the psychologist concludes that Jim has an average level of intelligence. A developmental disorder such as autism is out of the question. According to the psychologist, the psychosocial problems of Jim are probably connected to the separation at school, since Jim only shows this behavior in the school situation. Based on interviews with Jim and Sam, their teachers and their parents the psychologist advises the school to place Jim and Sam back together again.

How twins develop

Most teachers have little knowledge about the development of twins. The special relationship between twin children is rarely acknowledged. Problems related to the separation of twin children at school are often being associated with autism. Parents of twins complain that their opinion about what is in the best interest of their children isn’t taken into account. Teachers tend to think that they have all the expertise at school. Parents need to step back, although they feel the need to have a say in what’s good for their children.

Teachers think that separating twins at school is beneficial for their personal development. But what is often overlooked is that the development of twins children differs from that of singletons. Most twins show diffferences in their language, personal, social and emotional development. Therefore, standards such as those used at school are not always suitable for behavior and performance assessment for twins.

Language Development

Compared with singletons twins generally start to talk later and during the first years of their lives they have a smaller vocabulary and their phrases are shorter and less complex. In addition, 40 percent of twins exibit some form of autonomous language (a private language between them). Twins with large language deficiencies can benefit from additional support (Thorpe et al, 2003).

Tip: Study both language production and language comprehension. For most twins, the language comprehension is much better developed than the language production.

The idea that a separation at school ‘forces’ the children to talk, does not always give the desired result. Especially for twins with a particular close bond, a forced separation can have traumatic effects. The language development can stagnate if the kids miss each other too much, sometimes even regressing to the point where the twins stop talking completely.

Tip: Use a role model: encourage a verbally strong classmate to play with the twins to stimulate their language development.

Social and emotional development

The situation in which twin children grow up differs from that of singletons. During the frist years of their lives most twins spend all their time together. This makes them somewhat socially privileged. Compared with singletons, most twins can play together with other children very well. They have learned to share, discuss, consider one anothers needs and wait their turn.At the same time most twins are strongly focused on each other. They are less likely to seek contact with other children, because there is no need to. This does not make them less capable of playing with other children. But because they largely fulfill each others needs, twins tend to stick together.

Tip: Encourage twin children to mingle with other children.

Growing up as twins has also some disadvantages. The comparison and competition between twins is many times stronger than between ordinary siblings. Dominance, power struggles and rivalries can play a major role in a twin family situation. To what extent these things play a role, can vary between twins and differ per situation. While one twin can be the dominant one at home, the other twin can have this role at school.

Tip: Assist twins to properly assert themselves: a dominant child must learn to give more space to the other and a docile child must learn to be more in the limelight.

In some extreme situations twins argue excessively. If that is the case it can be better to separate the twins at school.

Stand on their own two feet

Twins have a special relationship with each other. During the first years of their lives they have been close together. As the grow older they need to separate from each other. Singletons also need to separate from their parents in order to learn and stand on their own two feet. But for twins this is a more complex process, because they need to learn to separate from each other as well. Most twins are not completely separated by the time they enter primary school. They may still need each other for emotional support or have difficulties in saying goodbye to their parents.

Tip: Allow twin children to sit next to each other whenever they feel like it.

Twins should get enough space to separate from each other in their own way. Forcing their separation can lead to behavioral problems. This behavior can be misinterpreted, where some teachers even advise parents of twins to ask for psychological help (see the example at the beginning of this article).

Together or apart?

For parents of twins it can be difficult to determine whether their children would be better of placed in the same or different classrooms. On one hand it feels unnatural to haved them separated at school, but on the other hand, parents fear that their children’s development is hindered when they share the same classroom.

There are many considerations when we think about separation. The discussion should focus on the question whether the twins can support each other at school. Does that mean that twins should stay together, so they can help each other out? Or are they better off being separated, so they can learn to cope with problem situations?

All twins are different

It is important to realize that all twins are different. Also every child is different. What can be a good reason for one child to stay together at school, could meanwhile be a good enough reaon for the other one to get separated.

Here is a summary of the main arguments that play a role:

• Twins keep an eye on each other. This has to do with loyalty. For most twin children the presence of the other means safety. Sometimes their functioning in the classroom can be hindered, if the children constantly keep an eye on each other.
• Twins are being compared. If twins share the same classroom, there will be more comparisons. By the teacher, by their classmates and by themselves. This can have a stimulating effect, for it can encourage twins to work harder. But if one child is always performing better, it can cause negative feelings such as insecurity for the other child.
• Twins have their own story. Twin children will gain different experiences. They are two different children with their own character, so they will react differently to their environment. Even if they share the same environment. So twins will always have their own story, whether they are in separate classrooms or not.
• Twins make their own friends. Twins placed in different classrooms will obviously play with other children. If twins share the same classroom, they will both interact with other children and with each other. For the majority of the twins the presence of the other twin does not prevent friendships with other children. In very few cases twins get isolated within the group. But remember, most twin children are best friends.
• Twins seek support from each other as they feel insecure. At school there can be situations that makes certain children feel unsafe, for example if there is a substitute teacher. It can be comforting if the children can find support from each other.
• Twins are loyal to each other and they help each other when needed. The loyalty between twins is generally stronger than the mutual loyalty between friends. Twins can feel responsible for each other and feel the need to help each other solve problems. This can be both an advantage or a disadvantage.
• Purely practical: drop off and pick up. It makes it much easier and less stressfull for the parents if the children share the same classroom. The drop off and pick up from school runs less chaotic and there is more time and attention for the children in the classroom. For school activities in which parents are invited or needed, it is also much easier if the children are together.

Separating twins requires careful consideration and consultation with parents. The needs of the children should be considered carefully, both at individual level and from the point of view of their twinship.

When in doubt, I highly recommend to have twin children start together. Just give them a chance. If it doesn’t work out, you can always decide to have the children separated later on. Also, decisions in this area should never be irreversible. Sometimes, things work out different than expected. Flexibility is the keyword for both parents and teachers.

References

Leeuwen, M. van, e.a. (2005). Effects of twin separation in primary school. Twin Res Hum Genet. Volume 8, Number 4, pp. 384–391

Polderman, T.J.C,. e.a. (2010). No effect of classroom sharing on educational achievement in twins: a prospective, longitudinal cohort study. J Epidemiol Community Health

Thorpe, K. e.a. (2003). Twins as a natural experiment to study the cause of mild language delay: II: Family interaction risk factors. Journal of child psychology and psychiatry, 44-3, 342-355.

Webbink, D. e.a. (2007). Does sharing the same classroom in school improve cognitive abilities of twins? Twin Res Hum Genet. Volume 10 Number 4 pp. 573–58

http://www.tweelingenregister.nl/

http://www.twinsandmultiples.org/

http://www.twinspiratie.nl/

http://twinsvideoblog.com

Chang and Eng: ‘Siamese twins’

The name Siamese Twins is derived from conjoined twins Chang and Eng Bunker (1811-1874) from Siam, nowadays called Thailand. Chang and Eng were born with attached body parts: the sides of their abdomens were attached to each other by a tube with a length of 22 centimeters and a diameter of 4 centimeters. With current surgical techniques, they could easily have been separated, but at that time this was impossible . Because of their striking appearance they received worldwide fame as circus performers. They got married to the sisters Sallie and Adelaide Yat and together they had 21 children. One morning after waking up, Chang discovered that Eng had died beside him in bed, and after several hours he was also deceased.

The occurrence of conjoined twins

Siamese twins are genetically identical and thus always of the same sex. They develop from the same fertilized egg and have a shared amniotic sac and placenta. Siamese twins are created when the fertilized egg splits too late. Normally, a fertilized egg splits into two separate embryos within 12 days after conception. If the split occurs within 3 to 4 days, the embryos have separate placentas. In most cases the egg splits in between day 4 and day 8, leading to a shared placenta. If the separation occurs later than 8 days, various complications can occur, like shared body parts.

There are different types of Siamese Twins:

• Thoraco-omphalopagus (28%): the bodies are fused at the height of the chest. These twins usually have a shared heart. Sometimes they also have a common liver or a piece of the digestive tract shared;
• Thoracopagus (18.5%): upper bodies are fused to the abdomen. The heart is always involved in these cases;
• Omphalopagus (10%): upper bodies are fused together below the chest. In this case, the two bodies have separate hearts. However, there are shared organs, such as the liver, the diaphragm or a part of the digestive tract;
• Parasitic twins (10%): Siamese twins in which the bodies are not equally developed. One of the bodies is less developed, and therefore depending on the other body in order to survive;
• Craniopagus (6%): the bodies are separated, but the skulls are connected. The skulls can be fused in several ways: at the back of the head, the front of the head, or the side of the head, but not on the face or the base of the skull.

Other, rare, forms include:

• Cephalopagus: Siamese twins with two faces, one on either side of a joint head. The top of the body is shared, while the bottom of the body is separated. These twins usually do not survive because of the fusion of the brains;
• Synecephalus: twins with a single head and face with four ears and two bodies;
• Cephalothoracopagus: these twins have a shared head and torso. There are two faces on different sides of the head, or sometimes a single face with an enlarged head;
• Xiphopagus: upper bodies are connected between the navel and the breastbone. In most cases, there are no shared organs except sometimes the liver (like Chang and Eng);
• Ischiopagus: the lower part of the bodies is shared, with the ends of the backbone of the two bodies are connected in and angle of 180 ˚. These twins have four arms, three or four legs and a shared anus and genitals;
• Omphalo-Ischiopagus: these are connected like the Ischiopagus twins, but with the face towards each other and a shared (lower) stomach;
• Papapagus: twins side-by-side fused with a shared (lower) stomach. Dithoracic parapagus twins have a shared pelvis and a shared (lower) stomach, but a separate upper body. Diprosopic parapagus twins have a shared torso and one head with two faces. Dicephalic parapagus twins have one torso, two heads and one, two or three arms;
• Craniopagus papsiticus: As craniopagus, but with a second head at the other head is grown together;
• Pygopagus (Iliopagus): two bodies back-to-back are grown near the buttocks.

How common is it?

The birth of conjoined twins is rare: about one in 50,000 to 100,000 births. Yet we even fewer of them, because most (40-60%) conjoined twins are stillborn or die within a day (35%). The survival rate is somewhere between 5 and 25%, though even then many conjoined twins do not make the first year.

Most surviving conjoined twins are female. According to 600 publications from the last 50 years about 70% of all conjoined twins were female and about 20% were male. Of the remaining 10%, the sex was unknown. The reason why there are more female Siamese twins is not entirely clear. Scientist think that it has to do with a greater vulnerability during pregnancy for the male sex. Also there might be an increase of the Turner Syndrome in which the Y chromosome disappears and a boy as a girl is born (X0 instead of XY). Another possible explanation is that for girls it might be more common that the egg splits too late.

Quality of life

After birth, parents and physicians have to deal with the complex question whether and when it is possible to separate the children. These choices are not only of medical relevance, but also an ethical problem. Each separation has inherent risks. The risk of complications is usually great and there is a low likelihood both children will survive. In some cases this means that the weakest child’s life must be sacrificed if the conjoined state of living together is unsustainable. The ethical questions obviously have to deal with the the quality of life of the children. Parents and doctors can have different views on that.

The separation of Siamese twins

Because the surgical separation of Siamese twins is often a very risky procedure, a careful balance must be made regarding the health risks of the twins. Doctors will have to try and estimate what will be the best moment for the children to be separated. Survival rates increase as the children grow older, and usually we wait until after the first six months to do the procedure. Sometimes it is not possible to wait this long, for example if one of the children dies, or when the health of one or both children is endangered.

Modern techniques, such as ultrasound, have increased the likelihood of success of separation surgery. It is of vital importance to know exactly which organs are shared. The liver is the only internal organ that can be split between the two children. This is not possible for any of the other organs. The survival rate after surgery depends on the type of Siamese twins. For example, for twins with connected backbone there is a 68% chance of successful separation, while there are no known cases in which twins with a shared ventricle are successfully being separated.

After separation, most twins need intensive rehabilitation. Often their spines are misaligned and many twins have a hard time bending over or sitting upright. They literally need to learn to stand on their own feet.

References

Segal, viz (1999). Entwined Lives. Twins and What They tell us about human behavior. Plume, New York.

http://nl.wikipedia.org/wiki/Siamese_tweeling
http://en.wikipedia.org/wiki/Conjoined_twins
http://www.umm.edu/conjoined_twins/facts.htm

As scientific subjects, virtual twins provide a rich pool of material for researchers tackling the nature-versus-nurture question. Raised together essentially from birth, or at least since infancy, virtual twins may be genetic strangers, but they share an environment from an early point in life.

In a classic example of virtual twinning, a couple makes arrangements to adopt after struggling to have children, and then becomes pregnant. Rather than backing out of the adoption, the parents may choose to adopt as well as giving birth, giving their birth-child an adopted sibling. Virtual twins can also be created through adoption, with parents adopting two children of different parentage. Many researchers like to focus specifically on virtual twins adopted at a very young age, rather than older children adopted together.

For people interested in the nature vs. nurture argument, virtual twins can provide some interesting food for thought. Researchers who believe that environment plays a larger role than genetics would expect virtual twins to be very similar, since they are raised in the same environment. Studies suggest that they have fewer similarities than true genetic siblings, however, which suggests that genetics plays a heavy role in human development.

Although it is difficult to quantify the phenomenon, researchers say that virtual twins are an increasingly common result of Americans having children later in life, facing fertility issues and forming families through a patchwork of channels: adoptions, surrogate births, natural pregnancies and fertility treatments, which can lead to multiple births. Many parents, having struggled with infertility for years, pursue several avenues at once to increase their chances of having at least one child. If two adoptions or an adoption and a pregnancy work out at about the same time, the stage is set for virtual twins.

Peggi Ignagni of Oberlin, Ohio, had been trying to become pregnant for nine years when she and her husband, Tony, applied for a foster-care license, hoping they could adopt an infant after taking him into foster care. They got Nickholas when he was 3 days old but decided to proceed with in vitro fertilization, fearing that they might not be able to keep the boy. The fertility treatment worked, and Ignagni became pregnant with triplets who were born eight months after Nickholas. She and her husband, who owns a medical device company, now have four 6-year-olds. “At least they were all potty-trained within the same week,” she said.

In another case, Sara was adopted at birth by Deborah and Dave Curry, who are both retired from the Navy. The couple had tried having children for almost four years before they arranged for a private adoption. Deborah Curry became pregnant with Julie a month after Sara’s birth mother chose them as parents. When they left the hospital with Sara, they were stopped by a security guard and asked to explain why they were leaving with a newborn when Deborah Curry was obviously still pregnant.

http://articles.chicagotribune.com/2008-09-28/features/0809241414_1_identical-twins-twin-studies-center-virtual

Max and Porter, identical or fraternal?

In a new British study, researchers interviewed 1,302 parents of same-sex twins who had been told by health care professionals whether their children were fraternal or identical. Based on parental questionnaires and DNA analysis where available, the researchers classified 651 of the pairs as identical and 621 as fraternal. For 30 pairs, there was not enough information to decide.

They found that 191 couples — 14.7 percent — were misinformed about their babies, with 179 parents of identical twins mistakenly told that their twins were fraternal and 12 parents of fraternal twins told they were identical.

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0025239

Bradley and Yairo were born June 29, 2010

Further research could help us answer the question how genetics and the environment play a role in the variation in incidence of twin births across developing countries.