Cumulative environmental risk in substance abusing women: early intervention, parenting stress, child abuse potential and child development

OBJECTIVE: To assess the relationship between cumulative environmental risks and early intervention, parenting attitudes, potential for child abuse and child development in substance abusing mothers. METHOD: We studied 161 substance-abusing women, from a randomized longitudinal study of a home based early intervention, who had custody of their children through 18 months. The intervention group received weekly home visits in the first 6 months and biweekly visits from 6 to 18 months. Parenting stress and child abuse potential were assessed at 6 and 18 months postpartum. Children's mental and motor development (Bayley MDI and PDI) and language development (REEL) were assessed at 6, 12, and 18 months postpartum. Ten maternal risk factors were assessed: maternal depression, domestic violence, nondomestic violence, family size, incarceration, no significant other in home, negative life events, psychiatric problems, homelessness, and severity of drug use. Level of risk was recoded into four categories (2 or less, 3, 4, and 5 or more), which had adequate cell sizes for repeated measures analysis. DATA ANALYSIS: Repeated measures analyses were run to examine how level of risk and group (intervention or control) were related to parenting stress, child abuse potential, and children's mental, motor and language development over time. RESULTS: Parenting stress and child abuse potential were higher for women with five risks or more compared with women who had four or fewer risks; children's mental, motor, and language development were not related to level of risk. Children in the intervention group had significantly higher scores on the PDI at 6 and 18 months (107.4 vs. 103.6 and 101.1 vs. 97.2) and had marginally better scores on the MDI at 6 and 12 months (107.7 vs. 104.2 and 103.6 vs. 100.1), compared to the control group. CONCLUSION: Compared to drug-abusing women with fewer than five risks, women with five or more risks found parenting more stressful and indicated greater inclination towards abusive and neglectful behavior, placing their infants at increased risk for poor parenting, abuse and neglect. Early home-based intervention in high-risk families may be beneficial to infant development.     

Mothers' time with infant and time in employment as predictors of mother-child relationships and children's early development

This study tested predictions from economic and developmental theories that maternal time with an infant is important for mother-child relationships and children's development, using time-use diaries for mothers of 7- to 8-month-old infants from the National Institute of Child Health and Human Development Study of Early Child Care (N = 1,053). Employment reduced time with infants, but mothers compensated for some work time by decreasing time in other activities. With family and maternal characteristics controlled, time with infants predicted high Home Observation for Measurement of the Environment (HOME) scores and maternal sensitivity, but bore little relation to children's engagement with mothers, secure attachment, social behavior, or cognitive performance from 15 to 36 months. Mothers who spent more time at work had higher HOME scores. Maternal time with infants may reflect maternal characteristics that affect both time allocation and maternal behavior.     

Use of the Bayley Scales to characterize abilities of premature infants

The Bayley Scales of Infant Development were administered to 92 white, middle-class infants, half of them premature and half full-term, at 1 year of age from term to determine whether this instrument is useful in characterizing the abilities of premature infants. Although both full-term and premature infants achieved mental and motor development scores within the average range, full-term infants attained significantly higher scores on both the Mental and Motor Scales. Both groups scored significantly lower on motor than mental functioning; however, the difference was significantly greater for premature infants. As a group, premature infants also evidenced greater variability in their performance on both the Mental and Motor Scales, and they showed greater intra-individual variability in performance of motor ability. Furthermore, premature infants were less likely to succeed on items testing eye-hand coordination, imitation, and vocalization. Preselected perinatal risk variables accounted for a significant amount of variance in both mental and motor ability of premature infants.     

Coping and Psychological Distress in Mothers of Very Low Birth Weight Young Children

Objective. This study sought to increase understanding of relations among coping strategies, sociodemographic variables, and psychological distress in mothers of high-risk (HR) and low-risk (LR) very low birth weight (VLBW; < 1,500g) infants. Design. The sample (N = 199) consisted of 77 mothers of HR VLBW infants, 43 mothers of LR VLBW infants, and a control group of 79 mothers of healthy, term infants. Data were collected with self-report questionnaires at birth and at 24 months postpartum. Relations among infant medical risk, multiple birth, maternal race, social class, and maternal coping were investigated. Hierarchical regression analyses were used to identify predictors of maternal psychological distress and to determine whether coping differentially moderated maternal psychological distress across groups. Results. Infant medical risk, social support, and maternal coping independently predicted maternal psychological distress. Mothers of HR VLBW infants reported significantly greater psychological distress than mothers of LR VLBW or term infants. Greater use of avoidant and express emotions coping predicted higher psychological distress for all mothers. Greater use of humor coping had a buffering effect, reducing distress only for mothers of HR VLBW infants. Maternal coping scores were related to maternal race and social class, rather than to severity of infant medical risk. Conclusions. Sociocultural sources of resiliency, as well as biological risk factors, should be considered when developing strategies to enhance coping and parenting in HR populations.     

Does Infant Carrying Promote Attachment? An Experimental Study of the Effects of Increased Physical Contact on the Development of Attachment

This study was designed to test the hypothesis that increased physical contact, experimentally induced, would promote greater maternal responsiveness and more secure attachment between infant and mother. Low-SES mothers of newborn infants were randomly assigned to an experimental group (n = 23) that received soft baby carriers (more physical contact) or to a control group (n = 26) that received infants seats (less contact). Using a transitional probability analysis of a play session at 31/2 months, it was demonstrated that mothers in the experimental group were more contingently responsive than control mothers to their infants' vocalizations. When the infants were 13 months old, the Ainsworth Strange Situation was administered. Significantly more experimental than control infants were securely attached to their mothers. We infer from these results that for low-income, inner-city mothers, there may be a causal relation between increased physical contact, achieved through early carrying in a soft baby carrier, and subsequent security of attachment between infant and mother.     

The development of abused and high-risk infants in different treatment modalities: residential versus in-home care

This paper outlines the Parental Stress Center (PSC) residential treatment program and its evaluation study, specifically focusing on the developmental status of infants in treatment. The Bayley scores for mental/motor development are given for a subgroup of 20 deprived infants admitted to the residential center and for two matched groups. One comparison group consisted of similarly deprived infants, the other of normal infants. The groups, tested three times, showed few differences either among the three groups at each time period or within each group over the three time periods. The most significant between-group difference was in motor scores at time 2, with both PSC infants and problem comparison infants scoring significantly below the normal comparison infants. The decline of motor scores of the PSC infants was probably attributable to the physical restrictions of the nursery. By the final testing at age 1, these scores had improved, and again there were no group differences. The results indicate that despite the use of multiple caregivers, the deprived infants admitted to residential care kept pace with similar babies in other treatment modalities. The overall high scores when compared to other research data indicate the decided worth of early intervention.     

Joint attention and infant toy exploration: effects of Down syndrome and prematurity

12-month-old infants with Down syndrome (n = 14) and mental and motor age-matched high-risk preterm infants (n = 14) were studied with respect to their ability to attend to and explore their environment in interactions with their mothers. The effectiveness of particular maternal attention-directing techniques in modifying infant responses to toys was expected to vary across the 2 infant groups. In general, higher-level responses to toys were expected to be associated with mother's attempts to maintain rather than redirect the child's attention and the mother's use of structured verbal and nonverbal attention-directing techniques. Results indicated that mothers of the 2 groups of infants used different attention-directing strategies, and their use of particular strategies was differentially related to the attentional capacity of the 2 groups. Differences in the infants' responses to particular maternal strategies were related to the amount of structure provided and to the demands placed on their capacity to shift attention between objects. Fewer specific maternal techniques for directing attention elicited higher-level play behavior from the Down syndrome infants, compared to the preterm group.     

The Timing of Prenatal Exposure to Maternal Cortisol and Psychosocial Stress Is Associated With Human Infant Cognitive Development

The consequences of prenatal maternal stress for development were examined in 125 full-term infants at 3, 6, and 12 months of age. Maternal cortisol and psychological state were evaluated 5 times during pregnancy. Exposure to elevated concentrations of cortisol early in gestation was associated with a slower rate of development over the 1st year and lower mental development scores at 12 months. Elevated levels of maternal cortisol late in gestation, however, were associated with accelerated cognitive development and higher scores at 12 months. Elevated levels of maternal pregnancy-specific anxiety early in pregnancy were independently associated with lower 12-month mental development scores. These data suggest that maternal cortisol and pregnancy-specific anxiety have programming influences on the developing fetus.     

Physiological effects of infant exposure to environmental tobacco smoke: a passive observation study

This study explored infant physiologic responses of exposure to environmental tobacco smoke (ETS) using a longitudinal passive observation study with a control group. Fifteen smoking and 15 non-smoking mothers were initially contacted in hospital maternity units, with home visits made when their infants were 2, 4, and 6 weeks old. Exposure to ETS was measured using infant urinary nicotine and cotinine levels. The physiologic effects of infant ETS exposure were measured by rectal temperature, pulse rate, respiratory rate, blood pressure, and oxygen saturation. The smoking mothers in this sample were poorer, had less education, and were less likely to be married than the mothers who did not smoke. At birth, the infants of smoking mothers had higher diastolic blood pressure than infants of non-smoking mothers (p < .008). Mothers who smoke cigarettes should be educated that maternal smoking behavior can affect an infant's cardiovascular function. Parents should also be counseled about the risks of smoking in close proximity and/or in an enclosed space with an infant, especially in a motor vehicle.     

Dyads at risk: methadone-maintained women and their four-month-old infants

As part of a longitudinal study of offspring born to substance abusers, we videotaped 17 methadone-exposed and 23 comparison 4-month-old infants interacting with their mothers. Using a scale we developed, we rated communicative functioning in dyadic interaction and related mothers' interactive performance to their psychological and psychosocial resources and infants' interactive performance to their motor functioning as assessed on the Bayley Infant Behavior Record. We found, cutting across drug groups, that mothers who performed poorly on interaction were likely to have poor maternal resources and that infants showing poor communicative functioning were likely to show problematic motor functioning--namely, greater tension and poorer coordination relative to activity level; it was the opposite for mothers or infants who communicated well. Methadone was only one among several risk factors affecting interaction.     

Generational boundary dissolution between mothers and their preschool children: a relationship systems approach

A particular perspective on relationship systems served as the basis for this research. Postulates within this perspective include qualitative aspects of relationships are stable over time, and there are lawful relations among relationships within the same system. Previously, a concept of seductive mother-toddler relationships was initially validated. From the theory surrounding this concept, later forms of this pattern were conceived, and a hypothesis concerning complementary mother-daughter relationships was formulated. In the present research we showed first that the pattern of "seductiveness" was stable, though transformed, from 24 to 42 months. Second, the same mothers were not found to be seductive with male or female siblings. Third, mothers who showed the seductive pattern (almost always with boys) were, as predicted, hostile toward their daughters in a particular way ("derision"). 2 other scales used at 42 months ("nonresponsive intimacy" and "generational boundaries") were elevated for target mother-male dyads and not for mother-daughter pairs. In fact, mothers who were seductive with sons were rated significantly lower on the intimacy scale when seen with daughters than were control mothers. It is suggested that maternal relationships across siblings are coherent, however distinct, and that these connections derive from the totality of the mother's relationship history.     

Effects of Early and Recent Maternal Employment on Children from Low-Income Families

The effects of early maternal employment (employment during the child's first 3 years) and recent maternal employment (employment during the previous 3 years) on 189 second-grade children from low-income families were examined. Maternal employment was related to a number of selection factors. In comparison to mothers who were not employed, employed mothers scored higher on a mental aptitude test and were more highly educated. Both early and recent maternal employment were also associated with measures of the current family functioning: there was less poverty and higher HOME environment scores when mothers were employed. Hierarchical multiple regressions showed that children's math achievement was positively predicted by early maternal employment and children's reading achievement was positively predicted by recent maternal employment, even after controlling for selection effects and current family environment. These results are discussed in terms of possible mechanisms by which maternal employment may affect children's development.     

Pilot study of a program delivered within the regular service system in Germany: Effect of a short-term attachment-based intervention on maternal sensitivity in mothers at risk for child abuse and neglect

This pilot study examined the effectiveness of a short-term attachment-based intervention, the Ulm Model, in a German population at risk for child abuse and neglect. The intervention used home visits and video feedback to promote maternal sensitivity, and was implemented by trained staff within the health care and youth welfare systems. Mothers in the control group (n = 33) received standard services only, while those in the intervention group (n = 63) additionally the Ulm Model intervention. The outcomes measured were maternal sensitivity, as assessed by the CARE-Index at pre-intervention, after the last session, and at about 6 and 12 months of age; and infant socio-emotional development, as assessed by the ET6-6 development test at about 6 and 12 months of age. The moderating effects on treatment outcomes of two variables were examined: risk for child abuse (moderate vs. high) and type of maternal attachment representation (secure vs. insecure). Among participants at moderate risk for child abuse, no differences were found between the intervention group and control group in either maternal sensitivity or infant development. Among those considered high risk, mothers in the intervention group showed a significant increase in maternal sensitivity from pre- to post-intervention; however, no group differences were seen at follow-up. There were some indications that infants of mothers in the intervention group showed better emotional development. The variable of maternal attachment representation was not a significant moderator for the intervention effect, but post hoc analysis indicated that the mean sensitivity of secure mothers was significant higher at the 6-month follow-up.     

Predicting IQ from mother-infant interactions.

Longitudinal observations of maternal and infant characteristics were used to investigate the consequences of early day-care intervention for infants at high risk for intellectual retardation due to sociocultural factors. High-risk infants and their mothers were compared on social and intellectual characteristics with a control group not enrolled in an intervention program and with a random sample of mother-child dyads from the general population. Results from group comparisons indicated that mothers of high-risk infants in a day-care intervention group interacted with their infants in ways quite similar to mother of high-risk infants who were not enrolled in the intervention program. Both high-risk groups differed from the general population of mothers on interaction and attitudinal measures. Changes across time on the measures taken were roughly parallel from all three groups. Multiple regression analyses using maternal variables and mother-infant interactional variables to predict 36-month Stanford-Binet scores for the high-risk samples indicated that children's intelligence was predictable from previous maternal behaviors and attitudes, particularly for the control group, and that early day-care intervention apparently had altered the predictiveness of some maternal factors.     

Child abuse potential among mothers of substance-exposed and nonexposed infants and toddlers

OBJECTIVE: The purpose of this longitudinal study was to determine whether there were differences in child abuse potential among mothers who were nonusers, drug users who accepted treatment, and drug users who rejected offers of treatment, over the first 2 years of their children's lives. METHOD: Participants were mothers of 140 infants, classified into Nonuser (n = 48), Treatment (n = 72), or Refuser (n = 20) groups. The Child Abuse Potential (CAP) Inventory [Milner, J. S. 1980. The Child Abuse Potential Inventory: Manual. Webster, NC: Psytec Corporation] was administered when infants were 4, 9, 12, 18, and 24 months. RESULTS: Results of mixed-model analyses of variances showed no group differences on CAP Inventory abuse scale scores. There were significant group differences in lie scale scores on the CAP Inventory, such that lie scale scores for the Nonuser group were significantly higher than lie scale scores for the Treatment group. CONCLUSIONS: Overall, results support the position that low-income women with many risk factors in their lives are at high risk for potential child abuse, but that their drug use status and drug treatment status does not differentiate them from their nonuser peers from a similar social and demographic background.     

Effects of atypical patterns of fetal growth on newborn (NBAS) behavior

Newborn infants who showed anthropometric signs of atypical patterns of fetal growth were compared with infants of appropriate growth on the Neonatal Behavioral Assessment Scale (NBAS) and on recently developed supplementary items. The sample consisted of lower-socioeconomic-status families in San Juan, Puerto Rico, and included teenage and older mothers. Infants with atypical patterns of fetal growth showed lower scores than did infants of appropriate growth on the NBAS orientation, motor, and reflex clusters and on 15 of the 18 supplementary scores. Gestational age was covaried and showed independent effects on 6 items. Differential effects on measures of state and autonomic function were also found when the effects of the ponderal index were held constant. The results suggested that neonatal behavior is related to multiple indices of fetal growth patterns that may indicate early versus late nutritional insult. Supplementary NBAS items do not improve the discriminability of the NBAS but may help explain the basis for observed group differences.     

Parental perceived control over caregiving and its relationship to parent-infant interaction

In this sample of 66 dual-earner mothers and fathers and their 1-year-old infants, associations among parental ratings of infant difficulty, parental perceived control over caregiving outcomes, and parental sensitive and directive behavior were examined during a triadic free-play session in the home. Perceived infant difficulty was related to maternal directiveness for mothers with low perceived control. Fathers with low perceived control exhibited more directiveness, regardless of their ratings of infant difficulty. For both mothers and fathers, there was a negative association between sensitivity and directiveness but no association between sensitive behavior and parental perceived control. Although parents scored similarly overall on various other measures, mothers with low perceived control demonstrated more categorical thinking about children's development than other mothers.     

The social ecology and early parenting of Caucasian adolescent mothers

Social characteristics, maternal behaviors, and the home environments of Caucasian adolescent and nonadolescent mothers were investigated in a sample of 50 primiparous low- and middle-class women and their 4-month-old infants. The mothers were interviewed about their child-care network and about stressful life events that may have occurred since the infant's birth. The HOME inventory was completed and videotapes of 2 hours of home observations were coded to assess maternal proximity, verbalizations, activity, and physical contact with the infant. Interview data indicated that adolescent mothers relied more frequently on other teenagers and other network members for help in child care than nonadolescent mothers. In addition, they also received more frequent support from their mothers and less frequent help from their partner's and partner's mother and siblings than nonadolescent mothers. During the home visit, they were less verbal with their infants and scored significantly lower on the Responsiveness and Maternal Involvement subscales as well as on the total HOME inventory; these results were replicated on subgroups matched for socioeconomic status, emphasizing the unique social context and parenting practices of teenage mothers.     

Promoting Mother–Infant Book Sharing and Infant Attention and Language Development in an Impoverished South African Population: A Pilot Study

The low rates of child literacy in South Africa are cause for considerable concern. Research from the developed world shows that parental sharing of picture books with infants and young children is beneficial for child language and cognitive development, as well as literacy skills. We conducted a pilot study to examine whether such benefits might extend to an impoverished community in South Africa, by evaluating the impact of training mothers in book sharing with their 14–18 month old infants. Seventeen mothers received book sharing training; and 13 mothers did not, but instead received a comparison training in toy play. We assessed the mothers’ behavior during both book sharing and toy play before and after training, and we also assessed infant attention and language. Mothers receiving book sharing training engaged well with it, and they also benefited from it; thus, compared to the comparison group mothers, they became more sensitive, more facilitating, and more elaborative with their infants during book sharing, and they also became more sensitive to their infants during toy play. In addition, infants whose mothers received the book sharing training showed greater benefits than the comparison group infants in both their attention and language. Training in book sharing for families living in conditions of marked socio-economic adversity in South Africa has the potential to be of considerable benefit to child developmental progress. A large scale controlled trial is required to confirm this.     

The effect of manipulating maternal behavior during an interaction on three- and six-month-olds' affect and attention

3 studies were designed to examine the "still-face" paradigm, in which mothers stared at their 3- or 6-month-olds for a brief, still-face period interposed between 2 periods of normal face-to-face interaction. 6-month-olds decreased smiling and gazing at their mothers and grimaced more during the still-face period relative to the other periods; no period effects occurred in a no-change control group (Studies 1 and 2). Similar results were obtained when mothers and their infants observed and interacted with each other over closed-circuit color television monitors (Study 3). Moreover, the same relative decline in the infants' visual attention and positive affect during the still-face period occurred to a change in mothers' facial display (a televised, prerecorded, still face vs. a televised, live, interacting face) regardless of the presence or absence of their interactive voices (sound on the infants' monitor turned on or off). 3-month-olds exhibited a significant still-face effect, but only when maternal touch was a part of the manipulation (Study 1 vs. 2); therefore, the televised procedure was not conducted. The still-face effect is a robust phenomenon, produced with either "live" or "televised" procedures, both of which offer promising techniques for examining models of socioemotional perception/understanding of infants.