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Hans SL, Herriott AL, Finger B, Edwards RC, McNeilly CG. Parenting Among Women in Methadone Treatment: Contributions of Mental Health Problems and Violence Exposure. Child Psychiatry Hum Dev 2024; 55:929-942. [PMID: 36308598 DOI: 10.1007/s10578-022-01463-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/12/2022] [Indexed: 11/30/2022]
Abstract
The aim of the current study is to explore factors associated with quality of parenting among women in treatment for opioid use disorders. 150 Black American women with 3-5 year old children were recruited through methadone treatment programs. Parenting representations were assessed through the Working Model of the Child Interview and parenting behavior through video recordings of mother-child interaction. Interviews were used to assess mothers' history of violence exposure and to make DSM diagnoses. Mothers' mood disorder was related to distorted representations and to expressions of concerned affect (anxiety, fear, guilt). Mothers' personality disorder was related to expressions of negative affect (anger and frustration) and inversely related to sensitive parenting behavior. Mothers' experience of family violence during childhood and partner violence during adulthood were related to concerned affect in their representations. Women in treatment for substance use disorder have complex and interconnected needs, including parenting supports and trauma-informed mental health services.
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Affiliation(s)
- Sydney L Hans
- Crown Family School of Social Work, Policy, and Practice, The University of Chicago, 969 E 60th Street, Chicago, IL, 60637, USA.
| | - Anna L Herriott
- Crown Family School of Social Work, Policy, and Practice, The University of Chicago, 969 E 60th Street, Chicago, IL, 60637, USA
| | - Brent Finger
- Department of Psychology, Montana State University, Billings, MT, USA
| | - Renee C Edwards
- Crown Family School of Social Work, Policy, and Practice, The University of Chicago, 969 E 60th Street, Chicago, IL, 60637, USA
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Maylott SE, Conradt E, McGrath M, Knapp EA, Li X, Musci R, Aschner J, Avalos LA, Croen LA, Deoni S, Derefinko K, Elliott A, Hofheimer JA, Leve LD, Madan JC, Mansolf M, Murrison LB, Neiderhiser JM, Ozonoff S, Posner J, Salisbury A, Sathyanarayana S, Schweitzer JB, Seashore C, Stabler ME, Young LW, Ondersma SJ, Lester B. Latent Class Analysis of Prenatal Substance Exposure and Child Behavioral Outcomes. J Pediatr 2023; 260:113468. [PMID: 37182662 PMCID: PMC10524438 DOI: 10.1016/j.jpeds.2023.113468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2022] [Revised: 03/30/2023] [Accepted: 04/21/2023] [Indexed: 05/16/2023]
Abstract
OBJECTIVES To predict behavioral disruptions in middle childhood, we identified latent classes of prenatal substance use. STUDY DESIGN As part of the Environmental influences on Child Health Outcomes Program, we harmonized prenatal substance use data and child behavior outcomes from 2195 women and their 6- to 11-year-old children across 10 cohorts in the US and used latent class-adjusted regression models to predict parent-rated child behavior. RESULTS Three latent classes fit the data: low use (90.5%; n = 1986), primarily using no substances; licit use (6.6%; n = 145), mainly using nicotine with a moderate likelihood of using alcohol and marijuana; and illicit use (2.9%; n = 64), predominantly using illicit substances along with a moderate likelihood of using licit substances. Children exposed to primarily licit substances in utero had greater levels of externalizing behavior than children exposed to low or no substances (P = .001, d = .64). Children exposed to illicit substances in utero showed small but significant elevations in internalizing behavior than children exposed to low or no substances (P < .001, d = .16). CONCLUSIONS The differences in prenatal polysubstance use may increase risk for specific childhood problem behaviors; however, child outcomes appeared comparably adverse for both licit and illicit polysubstance exposure. We highlight the need for similar multicohort, large-scale studies to examine childhood outcomes based on prenatal substance use profiles.
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Affiliation(s)
- Sarah E Maylott
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC; Department of Psychology, University of Utah, Salt Lake City, UT.
| | - Elisabeth Conradt
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC; Department of Psychology, University of Utah, Salt Lake City, UT
| | - Monica McGrath
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Emily A Knapp
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Xiuhong Li
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
| | - Rashelle Musci
- Department of Mental Health, Johns Hopkins School of Public Health, Baltimore, MD
| | - Judy Aschner
- Department of Pediatrics, Hackensack Meridian School of Medicine, Nutley, NJ; Albert Einstein College of Medicine, Bronx, NY
| | - Lyndsay A Avalos
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Lisa A Croen
- Division of Research, Kaiser Permanente Northern California, Oakland, CA
| | - Sean Deoni
- Department of Pediatrics and Department of Diagnostic Imaging, Alpert Medical School of Brown University, Providence, RI
| | - Karen Derefinko
- Department of Preventive Medicine and Department of Pharmacology, Addiction Science, and Toxicology, The University of Tennessee Health Science Center, Memphis, TN
| | - Amy Elliott
- Avera Research Institute and Department of Pediatrics, University of South Dakota School of Medicine, Sioux Falls, SD
| | - Julie A Hofheimer
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Leslie D Leve
- Prevention Science Institute, University of Oregon, Eugene, OR
| | - Juliette C Madan
- Department of Pediatrics, Psychiatry and Epidemiology, Geisel School of Medicine at Dartmouth, Hanover, NH
| | - Maxwell Mansolf
- Department of Medical Social Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL
| | - Liza B Murrison
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH; Division of Asthma Research, Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | - Sally Ozonoff
- Department of Psychiatry and Behavioral Sciences, University of California, Davis, CA
| | - Jonathan Posner
- Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC
| | - Amy Salisbury
- School of Nursing, Virginia Commonwealth University, Richmond, VA
| | - Sheela Sathyanarayana
- Departments of Pediatrics, Environmental and Occupational Health Sciences, and Epidemiology, University of Washington, Seattle, WA; Seattle Children's Research Institute, Seattle, WA
| | - Julie B Schweitzer
- Department of Psychiatry and Behavioral Sciences and the MIND Institute, University of California, Davis, School of Medicine, Sacramento, CA
| | - Carl Seashore
- Department of Pediatrics, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Meagan E Stabler
- Department of Epidemiology, Dartmouth Geisel School of Medicine, Lebanon, NH
| | - Leslie W Young
- Department of Pediatrics, University of Vermont Medical Center, Burlington, VT
| | - Steven J Ondersma
- Division of Public Health and Department of Obstetrics, Gynecology, & Reproductive Biology, Michigan State University, East Lansing, MI
| | - Barry Lester
- Center for the Study of Children at Risk, Departments of Psychiatry and Pediatrics, Alpert Medical School of Brown University and Women and Infants Hospital, Providence, RI
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Heller NA, Logan BA, Shrestha H, Morrison DG, Hayes MJ. Effect of Neonatal Abstinence Syndrome Treatment Status and Maternal Depressive Symptomatology on Maternal Reports of Infant Behaviors. J Pediatr Psychol 2023; 48:583-592. [PMID: 37159522 PMCID: PMC10321377 DOI: 10.1093/jpepsy/jsad023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 04/05/2023] [Accepted: 04/07/2023] [Indexed: 05/11/2023] Open
Abstract
OBJECTIVE The objective of this study is to investigate the effects of maternal perinatal depression symptoms and infant treatment status for neonatal abstinence syndrome (NAS) on maternal perceptions of infant regulatory behavior at 6 weeks of age. METHODS Mothers and their infants (N = 106; 53 dyads) were recruited from a rural, White cohort in Northeast Maine. Mothers in medication-assisted treatment (methadone) and their infants (n = 35 dyads) were divided based on the infant's NAS pharmacological treatment (n = 20, NAS+ group; n = 15, NAS- group) and compared with a demographically similar, nonexposed comparison group (n = 18 dyads; COMP group). At 6 weeks postpartum, mothers reported their depression symptoms Beck Depression Inventory-2nd Edition) and infant regulatory behaviors [Mother and Baby Scales (MABS)]. Infant neurobehavior was assessed during the same visit using the Neonatal Network Neurobehavioral Scale (NNNS). RESULTS Mothers in the NAS+ group showed significantly higher depression scores than the COMP group (p < .05) while the NAS- group did not. Across the sample, mothers with higher depression scores reported higher infant "unsettled-irregularity" MABS scores, regardless of group status. Agreement between maternal reports of infant regulatory behaviors and observer-assessed NNNS summary scares was poor in both the NAS+ and COMP groups. CONCLUSIONS Postpartum women in opioid recovery with infants requiring pharmacological intervention for NAS are more at risk for depression which may adversely influence their perceptions of their infants' regulatory profiles. Unique, targeted attachment interventions may be needed for this population.
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Affiliation(s)
| | - Beth A Logan
- Department of Psychiatry and Behavioral Sciences, Boston Children’s Hospital, USA
| | - Hira Shrestha
- Department of Medical Oncology, Dana-Farber Cancer Institute, USA
| | | | - Marie J Hayes
- Department of Psychology and Graduate School of Biomedical Sciences and Engineering, University of Maine, USA
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Paris R, Herriott AL, Holt M. Parenting stress and competence among mothers of young children with substance use disorders: The roles of trauma and reflective functioning. Infant Ment Health J 2023; 44:228-239. [PMID: 36808618 DOI: 10.1002/imhj.22040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 11/22/2022] [Indexed: 02/22/2023]
Abstract
Posttraumatic stress symptoms are prominent in the lives of parents of young children with substance use disorders (SUD). Parenting experiences, particularly stress and competence, impact parenting behaviors and concomitant child growth and development. Factors that promote positive experiences of parenting, such as parental reflective functioning (PRF), and protect the mother and child from negative outcomes are crucial to understand to develop effective therapeutic interventions. The current US study analyzed baseline data from a parenting intervention evaluation to examine how length of substance misuse, PRF, and trauma symptoms were associated with parenting stress and parenting sense of competence among mothers in treatment for SUDs. Measures included the Addiction Severity Index, PTSD Symptom Scale-Self Report, Parental Reflective Functioning Questionnaire, Parenting Stress Index/Short Form, and Parenting Sense of Competence Scale. The sample included 54 predominantly White mothers with SUDs who had young children. Two multivariate regression analyses found that (1) lower parental reflective functioning and higher posttraumatic stress symptoms were associated with higher parenting stress, and (2) only higher posttraumatic stress symptoms were associated with lower levels of parenting sense of competence. Findings underscore the importance of addressing trauma symptoms and PRF when aiming to improve parenting experiences for women with an SUD.
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Day E, Tach L, Fuzzell L, Mathios E, Kallaher A. The Consequences of Postnatal Parental Opioid Misuse on Child Well-Being: a Scoping Review. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2021. [DOI: 10.1080/1067828x.2021.1971130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Labella MH, Eiden RD, Roben CKP, Dozier M. Adapting an Evidence-Based Home Visiting Intervention for Mothers With Opioid Dependence: Modified Attachment and Biobehavioral Catch-up. Front Psychol 2021; 12:675866. [PMID: 34489793 PMCID: PMC8418066 DOI: 10.3389/fpsyg.2021.675866] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 07/13/2021] [Indexed: 01/10/2023] Open
Abstract
Infants born to mothers who are dependent on opioids often have difficulty regulating behavior and physiology at birth. Without sensitive maternal care, these infants are at risk for ongoing problems with self-regulation. Mothers who are dependent on opioids may experience challenges related to their substance use (e.g., unsupportive and/or risky environment, impulse control and reward system problems) that increase the likelihood of insensitive parenting in the absence of effective intervention. In this paper, we describe a home-visiting intervention we have adapted to enhance sensitive, responsive caregiving tailored to the specific needs of mothers with opioid dependence. The original intervention, Attachment and Biobehavioral Catch-up (ABC), was designed for mothers of infants aged 6-24 months who were exposed to early adversity. ABC has been shown to enhance sensitive parenting as well as children's behavioral and biological functioning, with positive outcomes extending into at least middle childhood. Mothers who are opioid dependent need earlier support than provided by ABC because opioid-exposed infants are often vulnerable at birth. The adapted intervention (modified ABC or mABC) includes one prenatal session and one early postnatal session, followed by 10 sessions every 2-3 weeks. In the initial two sessions in particular, mothers are helped to anticipate the challenges of caring for a baby who may be difficult to soothe while nonetheless providing sensitive care. mABC is intended to help mothers see the importance of responding sensitively so as to help infants overcome the developmental risks associated with opioid exposure. Additionally, mABC is structured to support mothers with the challenges of early parenting, especially if the mother herself was not parented sensitively. Throughout, the focus is on helping the mother nurture the distressed infant, attend to the infant's signals, and avoid behaving in overstimulating or intrusive ways. Case examples are presented that highlight both the challenges of working with this population as well as the gains made by mothers.
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Affiliation(s)
- Madelyn H. Labella
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
| | - Rina D. Eiden
- Department of Psychology, Pennsylvania State University, University Park, PA, United States
| | - Caroline K. P. Roben
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
| | - Mary Dozier
- Department of Psychological and Brain Sciences, University of Delaware, Newark, DE, United States
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Walsh TB, Paris R, Ribaudo J, Gilkerson L. Locating Infant and Early Childhood Mental Health at the Heart of Social Work. SOCIAL WORK 2021; 66:187-196. [PMID: 34179984 DOI: 10.1093/sw/swab022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 04/23/2021] [Indexed: 06/13/2023]
Abstract
Infant and early childhood mental health (IECMH)-an interdisciplinary field dedicated to advancing understanding of early relationships, socioemotional development, and cultural and contextual influences on caregiving-offers essential tools for social workers to support the well-being of infants, toddlers, preschoolers, and their families. Even though social worker Selma Fraiberg was a founder of the field, and social workers are central to the work of assessment and intervention with young children and their caregivers in many settings, few schools of social work offer training in IECMH, and few social workers are familiar with its core principles, scholarship, and intervention approaches. In this article, faculty members from four U.S. social work programs address the vital role of IECMH in social work training, research, and practice as well as issue a call to the field to recover and renew commitment to a practice perspective and knowledge base with roots in social work. Twenty-five years ago, Social Work published a similar call, but the request has gone largely unheeded. The authors examine the changing landscape and argue that it is more important and timelier than ever for social workers to learn and integrate the relationship-based approach to promotion, prevention, intervention, and treatment offered by IECMH.
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Affiliation(s)
- Tova B Walsh
- assistant professor, School of Social Work, University of Wisconsin, 1350 University Avenue, Madison, WI 53706
| | - Ruth Paris
- associate professor and chair, Clinical Practice Department, School of Social Work, Boston University
| | - Julie Ribaudo
- clinical professor, School of Social Work, University of Michigan, Ann Arbor, and doctoral student, School of Social Work, Wayne State University, Detroit
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Schwartz AN, Reyes LM, Meschke LL, Kintziger KW. Prenatal Opioid Exposure and ADHD Childhood Symptoms: A Meta-Analysis. CHILDREN-BASEL 2021; 8:children8020106. [PMID: 33557208 PMCID: PMC7913969 DOI: 10.3390/children8020106] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/28/2021] [Accepted: 01/31/2021] [Indexed: 11/16/2022]
Abstract
To systematically investigate the association between prenatal opioid exposure (POE) and attention-deficit hyperactivity disorder (ADHD) symptoms in children 2-18 years old, studies were searched using PubMed, CINAHL, PsycINFO, and Web of Science from January of 1950 to October of 2019. Inclusion criteria were observational studies reporting ADHD symptoms of children with POE compared with non-exposed children or normative data. The study protocol was registered with PROSPERO: CRD42018115967. Two independent reviewers extracted data on hyperactivity/impulsivity, inattention symptoms, ADHD combined subscale symptoms, and sample characteristics. Of 223 articles screened, seven met the inclusion criteria. Data represent 319 children with POE and 1308 non-exposed children from 4.3 to 11.2 mean years from five countries. POE was positively associated with childhood hyperactivity/impulsivity (d = 1.40; 95% CI, 0.49-2.31; p = 0.003), inattention (d = 1.35; 95% CI, 0.69-2.01; p < 0.0001), and combined ADHD symptoms scores (d = 1.27; 95% CI = 0.79-1.75; p < 0.0001). POE was positively associated with ADHD combined symptom scores at preschool (d = 0.83, 95% CI, 0.57, 1.09; p < 0.0001) and school age (d = 1.45, 95% CI, 0.85 to 2.04; p < 0.0001). Results suggest increased risk of ADHD symptoms during school age. Future research is needed to clarify the relationship between biological, social, and environmental risk and ADHD symptoms for children who experienced POE.
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Affiliation(s)
- Ashlyn N. Schwartz
- The Department of Public Health, The University of Tennessee, Knoxville, TN 37996, USA; (L.L.M.); (K.W.K.)
- Correspondence: ; Tel.: +1-678-447-3930
| | - Lucia M. Reyes
- The Department of Child and Family Studies, The University of Tennessee, Knoxville, TN 37996, USA;
| | - Laurie L. Meschke
- The Department of Public Health, The University of Tennessee, Knoxville, TN 37996, USA; (L.L.M.); (K.W.K.)
| | - Kristina W. Kintziger
- The Department of Public Health, The University of Tennessee, Knoxville, TN 37996, USA; (L.L.M.); (K.W.K.)
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Meulewaeter F, De Pauw SSW, Vanderplasschen W. Mothering, Substance Use Disorders and Intergenerational Trauma Transmission: An Attachment-Based Perspective. Front Psychiatry 2019; 10:728. [PMID: 31681040 PMCID: PMC6813727 DOI: 10.3389/fpsyt.2019.00728] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Accepted: 09/11/2019] [Indexed: 01/23/2023] Open
Abstract
Background: A growing body of research underlines that interpersonal trauma in childhood leads to heightened susceptibility for substance use disorders (SUDs) in later life. Little research has been conducted on parenting experiences of mothers in recovery from substance use, taking into account their own upbringing as a child and the potential aftermath of interpersonal childhood trauma. Methods: Through in-depth qualitative interviews, 23 mothers with SUDs reflected on parenting experiences and parent-child bonding, related to both their children and parents. Interviews were transcribed verbatim and data were analyzed adopting thematic analysis. Results: Throughout the narratives, consequences of trauma on mothers' sense of self and its subsequent impact on parenting arose as salient themes. Five latent mechanisms of intergenerational trauma transmission were identified: 1) early interpersonal childhood trauma experiences in mothers; 2) trauma as a precursor of substance use; 3) substance use as a (self-fooling) enabler of parental functioning; 4) continued substance use impacting parental functioning; and 5) dysfunctional parental functioning and its relational impact upon offspring. Discussion: Findings suggest disruptive attachment can increase the vulnerability for SUDs on the one hand, but can be an expression of underlying trauma on the other, hence serving as a covert mechanism by which trauma can be transmitted across generations. Results indicate the need for preventive, attachment-based and trauma-sensitive interventions targeted at disruptive intergenerational patterns.
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