THE ROLE OF THE MOTHER-CHILD RELATIONSHIP IN DEVELOPMENTAL OUTCOMES OF INFANTS AND YOUNG CHILDREN WITH AND WITHOUT PRENATAL ALCOHOL EXPOSURE
Main Article Content
Keywords
Prenatal substance exposure, cumulative risk, mother-child relationship, caregiving quality
Abstract
Background
Prenatal alcohol exposure has been associated with deficits in many developmental areas. Effects on developmental outcomes can be exacerbated by cumulative risk across the pre- and postnatal environments. Given that the parent-infant relationship provides the primary context for healthy child development, it is possible that maternal caregiving may play a substantial role in mitigating these effects.
Objectives
To clarify the role of the quality of the mother-child relationship in the relation between cumulative risk and neurodevelopmental outcomes.
Methods
Participants were 40 infants/children and their mothers with substance-use problems who were taking part in an early mental health intervention program. Cumulative risk, across the pre- and postnatal period was measured, and quality of the mother-child relationship was rated based on clinical file reviews and observation of mother-child interactions. Outcome measures were infant/child IQ, and neurobehavioral functioning rated across several developmental domains.
Results
The quality of the mother-child relationship mediated the direct relation between cumulative risk and neurobehavioral functioning, and cumulative risk was related with IQ indirectly through the mother-child relationship.
Conclusions
These findings indicate an important role for quality of the mother-child relationship in determining outcomes for infants and young children of substance-using women, and emphasize the need to consider both the larger context of risk, as well as the mother-child relationship for best intervention outcomes.
References
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10. Mattson SN, Riley EP. A review of neurobehavioral deficits in children with fetal alcohol syndrome or prenatal exposure to alcohol. Alcoholism: Clinical and Experimental Research 1998;22: 279–294.
11. Streissguth AP, O’Malley K. Neuropsychiatric implications and long-term consequences of fetal alcohol spectrum disorders. Seminars in Clinical Neuropsychiatry 2000;5:177–190.
12. Streissguth AP. Offspring effects of prenatal alcohol exposure from birth to 25 years: The Seattle prospective longitudinal study. Journal of Clinical Psychological Medical Settings 2007;14:81–101.
13. Dixon S, Thal D, Potrykus J, Dickson TB, Jacoby J. Early language development in children with prenatal exposure to stimulant drugs. Developmental Neuropsychology 1997;13:371–396.
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17. Cornelius, MD Day, NL. Developmental consequences of prenatal tobacco exposure. Current Opinion in Neurology 2009;22:121–125.
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19. Fried PA, Smith AM. A literature review of the consequences of prenatal marihuana exposure: An emerging theme of a deficiency in aspects of executive function. Neurotoxicology and Teratology 2001;23:1–11.
20. Fried PA, Watkinson B, Gray R. Differential effects on cognitive functioning in 13- to 16- year-olds prenatally exposed to cigarettes and marihuana. Neurotoxicology and Teratology 2003;25: 427–436.
21. Huizink AC, Mulder EJ. Maternal smoking, drinking or cannabis use during pregnancy and neurobehavioral and cognitive functioning in human offspring. Neuroscience and Biobehavioral Reviews 2006;30:24–41.
22. Hunt RW, Tzioumi D, Collins E, Jeffery HE. Adverse neurodevelopment outcome of infants exposed to opiate in-utero. Early Human Development 2008;84:29–35.
23. Pauly JR, Slotkin TA. Maternal tobacco smoking, nicotine replacement and neurobehavioral development. Acta Pædiatrica 2008;97:1331–1337.
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26. Hans SL. Studies of prenatal exposure to drugs: Focusing on parental care of children. Neurotoxicology and Teratology 2002;24:329– 337.
27. Coggins TE, Timler GR, Olswang LB. A state of double jeopardy: impact of prenatal alcohol exposure and adverse environments on the social communicative abilities of school-age children with fetal alcohol spectrum disorder. Language, Speech, And Hearing Services In Schools 2007;38:117–127.
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29. Conners NA, Bradley RH, Mansell LW, Liu JY, Roberts TJ, Burgdorf K, Herrell JM. Children of mothers with serious substance abuse problems: An accumulation of risks. The American Journal of Drug and Alcohol Abuse 2004;30:85–100.
30. Motz M, Leslie M, Pepler, DJ, Moore, TE, Freeman PA. Breaking the cycle: Measures of Progress 1995-2005 [Special Supplement]. Journal of FAS International 2006;4(e22). Retrieved March 2008, from http://www.motherisk.org/JFAS_documents/BT C_JFAS_ReportFINAL.pdf.
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32. Appleyard K, Egeland B, van Dulmen MHM, Sroufe LA. When more is not better: The role of cumulative risk in child behavior outcomes. Journal of Child Psychology and Psychiatry 2005;46: 235–245.
33. Lester BM, Andreozzi L, Appiah L. Substance use during pregnancy: Time for policy to catch up with research. Harm Reduction Journal 2004;1:5.
34. Curran PJ, Chassin L. A longitudinal study of parenting as a protective factor for children of alcoholics. Journal of Studies on Alcohol 1996;57:305–313.
35. Brown JV, Bakeman R, Coles CD, Platzman KA, Lynch ME. Prenatal cocaine exposure: A comparison of 2-year-old children in parental and nonparental care. Child Development 2004; 75: 1282–1295.
36. Singer LT, Hawkins S, Huang J, Davillier M, Baley J. Developmental outcomes and environmental correlates of very low birthweight, cocaine-exposed infants. Early Human Development 2001;64: 91–103.
37. Schuetze P, Lawton D, Eiden R. Prenatal cocaine exposure and infant sleep at 7 months of age: The influence of the caregiving environment. Infant Mental Health Journal 2006; 27:383–404.
38. Murray L, Fiori-Cowley A, Hooper R, Cooper P. The impact of postnatal depression and associated adversity on early mother-infant interactions and later infant outcomes. Child Development 1996;67:2512–2526.
39. Stams GJ, Juffer F, van IJzendoorn MH. Maternal sensitivity, infant attachment, and temperament in early childhood predict adjustment in middle childhood: The case of adopted children and their biologically unrelated parents. Developmental Psychology 2002;38: 806–821.
40. Trentacosta CJ, Hyde LW, Shaw DS, Dishion TJ, Gardner F, Wilson M. The relations among cumulative risk, parenting, and behavior problems during early childhood. Journal of Child Psychology and Psychiatry 2008;49:1211– 1219.
41. Fraser J, Harris-Britt A, Thakkallapalli E, Kurtz- Costes B, Martin S. Emotional availability and psychosocial correlates among mothers in substance-abuse treatment and their young infants. Infant Mental Health Journal 2010;31:1– 15.
42. Biringen Z. The Emotional Availability (EA) Scales. 4th ed. 2008.
43. Crockenberg S, Leerkes E. Infant social and emotional development in family context. In: Zeanah CH, 2nd ed. The Handbook of Infant Mental Health. New York: Guilford. 2000:60– 90.
44. Coles CD, Kable JA, Drews-Botsch C, Falek A. Early identification of risk for effects of prenatal alcohol exposure. Journal of Studies on Alcohol 2000;61:607–616.
45. Harrison PA, Sidebottom AC. Systematic prenatal screening for psychosocial risks. Journal of Health Care for the Poor and Underserved 2008;19:258–276.
46. Seifer R, Sameroff, AJ, Baldwin, CP, Baldwin, A. Child and family factors that ameliorate risk between 4 and 13 years of age. Journal of the American Academy of Child and Adolescent Psychiatry 1992;31:893–903.
47. Zero to Three. Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Revised Edition (DC: 0–3R). Washington: Zero to Three Press, 2005.
48. Chudley AE, Conry J, Cook JL, Loock C, Rosales T, LeBlanc N. Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. Canadian Medical Association Journal 2005; 172(5 suppl): S1–S21.
49. Aoki Y, Zeanah CH, Heller SS, Bakshi S. Parent-infant relationship global assessment scale: A study of its predictive validity. Psychiatry and Clinical Neurosciences 2002;56: 493–497.
50. Thomas JM, Guskin KA. Disruptive behavior in young children: What does it mean? Journal of the American Academy of Child Adolescent Psychiatry 2001;40:44–51.
51. McGraw KO, Wong SP. Forming inferences about some intraclass correlation coefficients. Psychological Methods 1996;1:30-46.
52. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: Conceptual, strategic and statistical considerations. Journal of Personality and Social Psychology 1986;51:1173–1182.
53. Hayes AF. Beyond Baron and Kenny: Statistical mediation analysis in the new millennium. Communication Monographs 2009;76:408–420.
54. MacKinnon DP, Lockwood CM, Hoffman JM, West SG, Sheets V. A comparison of methods to test mediation and other intervening variable effects. Psychological Methods 2002;7:83–104.
55. MacKinnon DP, Lockwood CM, Williams J. Confidence limits for the indirect effect: Distribution of the product and resampling methods. Multivariate Behavioral Research 2004;39:99-128.
56. Preacher KJ, Hayes AF. SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments Computers 2004;36:717– 731.
57. Stansbury K, Gunnar M. Adrenocortical activity and emotion regulation. Monographs of the Society for Research in Child Development 1994;59:108–134.
58. Schore AN. Effects of a secure attachment on right brain development, affect regulation, and infant mental health. Infant Mental Health Journal 2001;22:7–66.
59. Bernier A, Carlson SM, Whipple N. From external regulation to self-regulation: Early parenting precursors of young children's executive functioning. Child Development 2010; 81:326–339.
60. Cole PM, Martin SE, Dennis TA. Emotion regulation as a scientific construct: Challenges and directions for child development research. Child Development 2004;75:317–333.
61. Fox NA. Temperament and Regulation of Emotion in the First Years of Life. Pediatrics 1998;102:1230–1235.
62. Sameroff AJ, Seifer R, Barocas R, Zax M, Greenspan S. Intelligence quotient scores of 4- year-old children: social-environmental risk factors. Pediatrics 1987;79:343–350.
63. Hooper SR, Burchinal MR, Roberts JE, Zeisel S, Neebe EC. Social and family risk factors for infant development at one year: An application of the cumulative risk model. Journal of Applied Developmental Psychology 1998;19:85–96.
64. Bandstra ES, Morrow CE, Mansoor E, Accornero VH. Prenatal drug exposure: Infant and toddler outcomes. Journal of Addictive Diseases 2010;29:245–258.
65. Streissguth AP. Offspring effects of prenatal alcohol exposure from birth to 25 years: The Seattle prospective longitudinal study. Journal of Clinical Psychological Medical Settings 2007; 14:81–101.
66. Anderson KE, Lytton H, Romney DM. Mothers' interactions with normal and conductdisordered boys: Who affects whom? Developmental Psychology 1986;22:604-609.
67. Murray L, Stanley C, Hooper R, King F, Fiori- Cowley A. The role of infant factors in postnatal depression and mother-infant interactions. Developmental Medicine and Child Neurology 2008;38: 109-119.
2. Lester B, Boukydis C, Twomey J. Maternal substance abuse and child outcome. In Zeanah CH, 2nd ed. Handbook of Infant Mental Health. New York: Guilford, 2000:161–175.
3. Jacobson SW, Jacobson JL. Alcohol and drugrelated effects on development: A new emphasis on contextual factors. Infant Mental Health Journal 2001;22:416–430.
4. Carta JJ, Atwater JB, Greenwood CR, McConnell SR, McEvoy MA, Williams R. Effects of cumulative prenatal substance exposure and environmental risks on children's developmental trajectories. Journal of Clinical Child Psychology 2001;30:327–337.
5. Conners NA , Bradley RH, Mansell LW, Liu JY, Roberts TJ, Burgdorf K, Herrell JM. Children of mothers with serious substance abuse problems: An accumulation of risks. The American Journal of Drug and Alcohol Abuse 2004;30:85–100.
6. Coles CD. Prenatal alcohol exposure and human development. In Miller MW, ed. Brain Development: Normal Processes and the Effects of Alcohol and Nicotine. New York: Oxford University Press, 2006:123–142.
7. Brown CW, Olson HC, Croninger RG. Maternal alcohol consumption during pregnancy and infant social, mental, and motor development. Journal of Early Intervention 2010;32:110–126.
8. Streissguth AP, Barr HM, Martin, DC, Herman CS. Effects of maternal alcohol, nicotine, and caffeine use during pregnancy on infant mental and motor development at eight months. Alcoholism: Clinical and Experimental Research 1980;4:152–164.
9. Boris N. Parental substance exposure. In: Zeanah CH, ed. Handbook of Infant Mental Health. New York: The Guilford Press, 2009:171–179.
10. Mattson SN, Riley EP. A review of neurobehavioral deficits in children with fetal alcohol syndrome or prenatal exposure to alcohol. Alcoholism: Clinical and Experimental Research 1998;22: 279–294.
11. Streissguth AP, O’Malley K. Neuropsychiatric implications and long-term consequences of fetal alcohol spectrum disorders. Seminars in Clinical Neuropsychiatry 2000;5:177–190.
12. Streissguth AP. Offspring effects of prenatal alcohol exposure from birth to 25 years: The Seattle prospective longitudinal study. Journal of Clinical Psychological Medical Settings 2007;14:81–101.
13. Dixon S, Thal D, Potrykus J, Dickson TB, Jacoby J. Early language development in children with prenatal exposure to stimulant drugs. Developmental Neuropsychology 1997;13:371–396.
14. Fried PA, O'Connell CM, Watkinson B. Sixtyand seventy-two-month follow-up of children prenatally exposed to marijuana, cigarettes, and alcohol: Cognitive and language assessment. Journal of Developmental and Behavioral Pediatrics 1992;13:383–391.
15. Malakoff ME, Mayes LC, Schottenfeld R, Howell S. Language production in 24-month old inner-city children of cocaine-and-other-drugusing mothers. Journal of Applied Developmental Psychology 1999;20:159–180.
16. Singer LT, Arendt R, Minnes S, Salvator A, Siegel AC, Lewis BA. Developing language skills of cocaine-exposed infants. Pediatrics 2001;107:1057–1064.
17. Cornelius, MD Day, NL. Developmental consequences of prenatal tobacco exposure. Current Opinion in Neurology 2009;22:121–125.
18. Frank DA, Augustyn M, Knight WG, Pell T, Zuckerman B. Growth, development, and behavior in early childhood following prenatal cocaine exposure. Journal of the American Medical Association 2001;285:1613–1625.
19. Fried PA, Smith AM. A literature review of the consequences of prenatal marihuana exposure: An emerging theme of a deficiency in aspects of executive function. Neurotoxicology and Teratology 2001;23:1–11.
20. Fried PA, Watkinson B, Gray R. Differential effects on cognitive functioning in 13- to 16- year-olds prenatally exposed to cigarettes and marihuana. Neurotoxicology and Teratology 2003;25: 427–436.
21. Huizink AC, Mulder EJ. Maternal smoking, drinking or cannabis use during pregnancy and neurobehavioral and cognitive functioning in human offspring. Neuroscience and Biobehavioral Reviews 2006;30:24–41.
22. Hunt RW, Tzioumi D, Collins E, Jeffery HE. Adverse neurodevelopment outcome of infants exposed to opiate in-utero. Early Human Development 2008;84:29–35.
23. Pauly JR, Slotkin TA. Maternal tobacco smoking, nicotine replacement and neurobehavioral development. Acta Pædiatrica 2008;97:1331–1337.
24. Noland JS, Singer LT, Arendt RE, Minnes S, Short EJ, Bearer CF. Executive functioning in preschool-age children prenatally exposed to alcohol, cocaine, and marijuana. Alcoholism: Clinical and Experimental Research 2003;27: 647–656.
25. Noland JS, Singer LT, Mehta SK, Super DM. Prenatal cocaine/polydrug exposure and infant performance on an executive functioning task. Developmental Neuropsychology 2003;24:499– 517.
26. Hans SL. Studies of prenatal exposure to drugs: Focusing on parental care of children. Neurotoxicology and Teratology 2002;24:329– 337.
27. Coggins TE, Timler GR, Olswang LB. A state of double jeopardy: impact of prenatal alcohol exposure and adverse environments on the social communicative abilities of school-age children with fetal alcohol spectrum disorder. Language, Speech, And Hearing Services In Schools 2007;38:117–127.
28. Jester JM, Jacobson SW, Sokol RJ, Tuttles BS, Jacobson JL. The influence of maternal drinking and drug use on the quality of the home environment of school-aged children. Alcoholism: Clinical and Experimental Research 2000;24:1187–1197.
29. Conners NA, Bradley RH, Mansell LW, Liu JY, Roberts TJ, Burgdorf K, Herrell JM. Children of mothers with serious substance abuse problems: An accumulation of risks. The American Journal of Drug and Alcohol Abuse 2004;30:85–100.
30. Motz M, Leslie M, Pepler, DJ, Moore, TE, Freeman PA. Breaking the cycle: Measures of Progress 1995-2005 [Special Supplement]. Journal of FAS International 2006;4(e22). Retrieved March 2008, from http://www.motherisk.org/JFAS_documents/BT C_JFAS_ReportFINAL.pdf.
31. Sameroff AJ, Seifer R, McDonough SC. Contextual contributors to the assessment of infant mental health. In: Del Carmen-Wiggins R, Carter A, eds. Handbook of Infant, Toddler, and Preschool Mental Health Assessment. New York: Oxford University Press, 2004:61-76.
32. Appleyard K, Egeland B, van Dulmen MHM, Sroufe LA. When more is not better: The role of cumulative risk in child behavior outcomes. Journal of Child Psychology and Psychiatry 2005;46: 235–245.
33. Lester BM, Andreozzi L, Appiah L. Substance use during pregnancy: Time for policy to catch up with research. Harm Reduction Journal 2004;1:5.
34. Curran PJ, Chassin L. A longitudinal study of parenting as a protective factor for children of alcoholics. Journal of Studies on Alcohol 1996;57:305–313.
35. Brown JV, Bakeman R, Coles CD, Platzman KA, Lynch ME. Prenatal cocaine exposure: A comparison of 2-year-old children in parental and nonparental care. Child Development 2004; 75: 1282–1295.
36. Singer LT, Hawkins S, Huang J, Davillier M, Baley J. Developmental outcomes and environmental correlates of very low birthweight, cocaine-exposed infants. Early Human Development 2001;64: 91–103.
37. Schuetze P, Lawton D, Eiden R. Prenatal cocaine exposure and infant sleep at 7 months of age: The influence of the caregiving environment. Infant Mental Health Journal 2006; 27:383–404.
38. Murray L, Fiori-Cowley A, Hooper R, Cooper P. The impact of postnatal depression and associated adversity on early mother-infant interactions and later infant outcomes. Child Development 1996;67:2512–2526.
39. Stams GJ, Juffer F, van IJzendoorn MH. Maternal sensitivity, infant attachment, and temperament in early childhood predict adjustment in middle childhood: The case of adopted children and their biologically unrelated parents. Developmental Psychology 2002;38: 806–821.
40. Trentacosta CJ, Hyde LW, Shaw DS, Dishion TJ, Gardner F, Wilson M. The relations among cumulative risk, parenting, and behavior problems during early childhood. Journal of Child Psychology and Psychiatry 2008;49:1211– 1219.
41. Fraser J, Harris-Britt A, Thakkallapalli E, Kurtz- Costes B, Martin S. Emotional availability and psychosocial correlates among mothers in substance-abuse treatment and their young infants. Infant Mental Health Journal 2010;31:1– 15.
42. Biringen Z. The Emotional Availability (EA) Scales. 4th ed. 2008.
43. Crockenberg S, Leerkes E. Infant social and emotional development in family context. In: Zeanah CH, 2nd ed. The Handbook of Infant Mental Health. New York: Guilford. 2000:60– 90.
44. Coles CD, Kable JA, Drews-Botsch C, Falek A. Early identification of risk for effects of prenatal alcohol exposure. Journal of Studies on Alcohol 2000;61:607–616.
45. Harrison PA, Sidebottom AC. Systematic prenatal screening for psychosocial risks. Journal of Health Care for the Poor and Underserved 2008;19:258–276.
46. Seifer R, Sameroff, AJ, Baldwin, CP, Baldwin, A. Child and family factors that ameliorate risk between 4 and 13 years of age. Journal of the American Academy of Child and Adolescent Psychiatry 1992;31:893–903.
47. Zero to Three. Diagnostic Classification of Mental Health and Developmental Disorders of Infancy and Early Childhood: Revised Edition (DC: 0–3R). Washington: Zero to Three Press, 2005.
48. Chudley AE, Conry J, Cook JL, Loock C, Rosales T, LeBlanc N. Fetal alcohol spectrum disorder: Canadian guidelines for diagnosis. Canadian Medical Association Journal 2005; 172(5 suppl): S1–S21.
49. Aoki Y, Zeanah CH, Heller SS, Bakshi S. Parent-infant relationship global assessment scale: A study of its predictive validity. Psychiatry and Clinical Neurosciences 2002;56: 493–497.
50. Thomas JM, Guskin KA. Disruptive behavior in young children: What does it mean? Journal of the American Academy of Child Adolescent Psychiatry 2001;40:44–51.
51. McGraw KO, Wong SP. Forming inferences about some intraclass correlation coefficients. Psychological Methods 1996;1:30-46.
52. Baron RM, Kenny DA. The moderator-mediator variable distinction in social psychological research: Conceptual, strategic and statistical considerations. Journal of Personality and Social Psychology 1986;51:1173–1182.
53. Hayes AF. Beyond Baron and Kenny: Statistical mediation analysis in the new millennium. Communication Monographs 2009;76:408–420.
54. MacKinnon DP, Lockwood CM, Hoffman JM, West SG, Sheets V. A comparison of methods to test mediation and other intervening variable effects. Psychological Methods 2002;7:83–104.
55. MacKinnon DP, Lockwood CM, Williams J. Confidence limits for the indirect effect: Distribution of the product and resampling methods. Multivariate Behavioral Research 2004;39:99-128.
56. Preacher KJ, Hayes AF. SPSS and SAS procedures for estimating indirect effects in simple mediation models. Behavior Research Methods, Instruments Computers 2004;36:717– 731.
57. Stansbury K, Gunnar M. Adrenocortical activity and emotion regulation. Monographs of the Society for Research in Child Development 1994;59:108–134.
58. Schore AN. Effects of a secure attachment on right brain development, affect regulation, and infant mental health. Infant Mental Health Journal 2001;22:7–66.
59. Bernier A, Carlson SM, Whipple N. From external regulation to self-regulation: Early parenting precursors of young children's executive functioning. Child Development 2010; 81:326–339.
60. Cole PM, Martin SE, Dennis TA. Emotion regulation as a scientific construct: Challenges and directions for child development research. Child Development 2004;75:317–333.
61. Fox NA. Temperament and Regulation of Emotion in the First Years of Life. Pediatrics 1998;102:1230–1235.
62. Sameroff AJ, Seifer R, Barocas R, Zax M, Greenspan S. Intelligence quotient scores of 4- year-old children: social-environmental risk factors. Pediatrics 1987;79:343–350.
63. Hooper SR, Burchinal MR, Roberts JE, Zeisel S, Neebe EC. Social and family risk factors for infant development at one year: An application of the cumulative risk model. Journal of Applied Developmental Psychology 1998;19:85–96.
64. Bandstra ES, Morrow CE, Mansoor E, Accornero VH. Prenatal drug exposure: Infant and toddler outcomes. Journal of Addictive Diseases 2010;29:245–258.
65. Streissguth AP. Offspring effects of prenatal alcohol exposure from birth to 25 years: The Seattle prospective longitudinal study. Journal of Clinical Psychological Medical Settings 2007; 14:81–101.
66. Anderson KE, Lytton H, Romney DM. Mothers' interactions with normal and conductdisordered boys: Who affects whom? Developmental Psychology 1986;22:604-609.
67. Murray L, Stanley C, Hooper R, King F, Fiori- Cowley A. The role of infant factors in postnatal depression and mother-infant interactions. Developmental Medicine and Child Neurology 2008;38: 109-119.