This paper reports on a study designed to explore factors contributing to better outcomes for substance abusing pregnant and parenting women in residential treatment, and, as a result, contribute to better outcomes for their children. The setting was three live-in units focusing in supporting both abstinence from substances and mother-child relationship. Participants were 18 mother-baby pairs in treatment from perinatal phase to 4 months of child's age. Pilot results demonstrated more sensitive maternal interaction tended to be associated with higher pre-and postnatal reflective functioning and better child developmental scores at 4 months of child's age. Reflective functioning (RF) refers to the essential human capacity to understand behavior in light of underlying mental states and intentions. An indicated conclusion is that enhancement of maternal reflective ability seems an important focus in developing the content and effectiveness of interventions for substance abusing mothers.
Ainsworth, M.D.S., Blehar, M.C., Waters, E., & Wall, S. (1978). Patterns of attachment: assessed in the strange situation and at home. Hillsdale, NJ: Lawrence Erlbaum.
Barth, R.D., & Needell, B. (1996). Outcomes of drug-exposed children four years postadoption. Children and Youth Services Review, 18, 37-56.
Bauman, P., & Levine, S.A. (1986). The development of children of drug addicts. International Journal of Addiction, 21, 849-863.
Bayley, N. (1993). Bayley Scales of Infant Development, 2nd edition (BSID II). San Antonio, TX: Psychological Corporation.
Beeghly, M., & Tro nick, E. Z. (1994). Effects of prenatal exposure to cocaine in early infancy: toxic effects on the process of mutual regulation. Infant Mental Health Journal, 15(2), 158-175.
Blackwell, P., Kirkhart, K., Schmitt, D., & Kaiser, M. (1998). Cocaine/polydrug-affected dyads: implications for infant cognitive development and mother-infant interaction during the first six postnatal months. Journal of Applied Developmental Psychology, 19(2), 235-248.
Brockington, I. (1996). Motherhood and mental illness. New York: Oxford University Press Inc.
Burns, K., Chetnik, L., Burns, W. J., & Clark, R.. (1991). Dyadic disturbances in cocaineabusing mothers and their infants. Journal of Clinical Psychology, 47(2), 316-319.
Burns, K.A., Chetnik, L., Burns, W. J., & Clark, R. (1997). The early relationship of drug abusing mothers and their infants: an assessment at eight to twelve months of age. Journal of Clinical Psychology, 53, 279-287.
Carmichael Olson, H., O'Connor, M., & Fitzgerald, H.E. (2001). Lessons learned from study of the developmental impact of parental alcohol use. Infant Mental Health Journal, 22(3), 271-290.
Cassidy, B., Zoccolillo, M., & Hughes, S. (1996). Psychopathology in adolesecent mothers and its effects on mother-infant interactions: a pilot study. Canadian Journal of Psychiatry, 41, 379-384.
Ciotti, F., Lambruschi, F, Pittino, B., & Crittenden, P. (1998). La valutazione della relatzione precoce madre-bambino in una popolazione di madri con una storia di tossicodipendenza attraverso l'uso del CARE -Index. Psicoterapia Cognitiva e Comportamentale, 4, 53-59.
Cox J.L., Holden J.M., & Sagovsky R. (1987). Detection of postnatal depression. Development of the 10-item Edinburgh Postnatal Depression Scale. British Journal of Psychiatry, 150, 782-786.
Cramer, B., Robert-Tissot, C, Stern, D.N., & Serpa-Rusconi, S. (1990). Outcome evaluation in brief mother-infant psychotherapy: a preliminary report. Infant Mental Health Journal, 11, 278-300.
Crittenden, P. (1992). Children's strategies for coping with adverse home environments. Child Abuse and Neglect: The International Journal, 16, 329-343.
Crittenden, P (2003). Care Index for Infants and Toddlers. Coding manual. Miami, USA: Family Relations Institute.
Crittenden, P, & Bonvillian, J.D. (1984). The effect of maternal risk status on maternal sensitivity to infant cues. American Journal of Orthopsychiatry, 54, 250-262.
Derogatis, L. R. (1993). Brief Symptom Inventory (BSI): administration, scoring and procedures manual, 3d edition. Minneapolis, MN: National Computer Systems.
Eiden, R. (2001). Maternal substance use and mother-infant feeding interactions. Infant Mental Health Journal, 22(4), 497-411.
Fonagy P., Steele, M., Moran, G.S., Steele, H., & Higgitt, A.C. (1991). Measuring the ghosts in the nursery: a summary of the main findings of the Anna Freud Centre/University College London Parent-Child Study. Bulletin of the Anna Freud Center, 14, 115-131.
Fonagy, P, & Target, M. (1996). Playing with reality: theory of mind and the normal development of psychic reality. International Journal of Psychoanalysis, 77, 217-233.
Fonagy, P, Gergely, G., Jurist, E., & Target, M. (2002). Affect regulation, mentalization and the development of the self. New York: Other Press.
Fonagy, P., Steele, H., & Steele, M. (1991). Maternal representations of attachment during pregnancy predict the organization of infant-mother attachment at one year of age. Child Development, 62, 891-905.
Fonagy, P., Steele, M., Steele, H., Leigh, T, Kennedy, R., Mattoon, G., & Target, M. (1995). Attachment, the reflective self and borderline states: the predictive specificity of the Adult Attachment Interview and pathological emotional development. In S. Goldberg, R. Muir, & J. Kerr, (Eds.), Attachment theory: social, developmental and clinical perspectives (pp. 233-278). New York: Analytic Press.
Goyette-Ewing, M., Slade, A., Knoebber, K., Gilliam, W., Truman, S., & Mayes, L. (2002). Parents first: a developmental parenting program. Manual for scoring. Yale Child Study Center, CT, USA.
Grella, CE., Joshi, V., & Hser, Y-I. (2000). Program variation in treatment outcomes among women in residential drug treatment. Evaluation Review, 24(4), 364-383.
Grienenberger, J., Kelly, K., Slade, A. (2005). Maternal reflective functioning, motherinfant affective communication and infant attachment: exploring the link between mental states and observed caregiving behaviour. Attachment and Human Development, 7(3), 299-311.
Hurt, H., Brodsky, N, Betancourt, L., Braitman, L., Malmud, E., & Giannetta, J. (1995). Cocaine-exposed children: follow-up through 30 months. Journal of Developmental and Behavioral Pediatrics, 16, 29-35.
Johnson, A.L., Morrow, CE., Accornero, V.H., Lihua, X., Anthony, J.C, & Bandstra, E. S. (2002). Maternal cocaine use: estimated effects on mother-child play interactions in the preschool period. Developmental and Behavioral Pediatrics, 23(4), 191-202.
Kalland, M. (2001). Kiintymyssuhdeteorian kliininen merkitys. Soveltaminen erityistilanteissa (Clinical relevance of attachment theory. Specific situations). In J. Sinkkonen J. & M. Kalland M. (Eds.), Varhaiset ihmissuhteet ja niiden häiriintyminen (Early human relationships and their disturbances) (pp. 198-233). Helsinki: WSOY.
LaGasse, L. L., Messenger, D., Lester, B.M., Seifer, R., Tronick, E.Z., Bauer, CR., Shankaran, S., Bada, H. S., Wright, L.L., Smeriglio, V.L., Finnegan, L.P., Maza, PL., & Liu, J. (2003). Prenatal drug exposure and maternal and infant feeding behaviour. Archives of Disease in Childhood, 88(5), 391-399.
Leckman, J.F., & Mayes, L. C (1998). Understanding developmental psychopathology: how useful are evolutionary accounts? Journal of American Academy of Child and Adolescent Psychiatry, 37(10), 1011-1021.
Lester, B. M., & Tronick, E.Z. (1994). The effects of prenatal cocaine exposure and child outcome. Infant Mental Health Journal, 15(2), 107-120.
Luthar, S.S., Cushing, G., Merikangas, K.R., & Rounsaville, B.J. (1998). Multiple jeopardy: risk and protective factors among addicted mothers' offspring. Development and Psychopathology, 10(1), 117-136.
Mayes, L., & Truman, S. (2002). Substance abuse and parenting. In M. Bornstein (Ed.), Handbook of parenting, volume 4. Social conditions and applied parenting, 2nd ed. (pp. 329-359). Mahvah, NJ: Lawrence Erlbaum Associates.
Mayes, L., Feldman, R,, Granger, R., Haynes, O., Bornstein, M., & Schottenfeld, R, (1997). The effects of polydrug use with and without cocaine on mother-infant interaction at 3 and 6 months. Infant Behavior and Development, 20(4), 489-502.
Meins, E., Fernyhough, C, Fradley, E., & Tuckey M., 2001. Rethinking maternal sensitivity: Mother's comments on infants' mental processes predict security of attachment at 12 months. Journal of Child Psychology and Psychiatry, 42(5), 647-648
Moe, V., & Slinning, K. (2001). Children prenatally exposed to substances: gender- related differences in outcome from infancy to 3 years of age. Infant Mental Health Journal, 22, 334-350.
Murray D., & Cox J.L. (1990). Screening for depression during pregnancy with the Edinburgh Postnatal Depression Scale (EPDS). Journal of Reproductive and Infant Psychology, 8, 99-107.
Nellis, L., & Gridley, B. (1994). Review of the Bayley Scales of Infant Development , 2nd edition. Journal of School Psychology, 32, 212-219.
Pacquette, D., Bigras, M., Zoccolino, M., Tremblay, R., Labelle, M.-E., & Azar, R. (2001). Comparison de la sensibilite parentale entre des meres adolescentes et des meres adultes peu scolarisees. Revue de Psychoeducation et d'Orientation, 30, 283-298.
Pajulo, M. (2001). Early motherhood at risk: mothers with substance dependency. Doctoral thesis. University of Turku, Finland.
Pajulo, M., Savonlahti, E., Sourander, A., Ahlqvist, S., Helenius, H., & Piha, J. (2001). An early report on the mother-baby interactive capacity of substance-abusing mothers. Journal of Substance Abuse Treatment, 20, 143-151.
Pajulo, M., Suchman, N., Kalland, M., & Mayes, L.C. (2006). Enhancing the effectiveness of residential treatment for substance abusing pregnant and parenting women: focus on maternal reflective functioning and mother-child relationship. Infant Mental Health Journal 27(5), 448-465.
Patino, FL. (1993). Mothers' prenatal attachment history, attachment status and social support satisfaction as predictors of postnatal maternal sensitivity. Dissertation Abstracts International, 53, 3787.
Schechter, D.S., Kaminer, T, Grienenberger, J.F., & Amat, J. (2003). Fits and starts: a motherinfant case-study involving intergenerational violent trauma and pseudoseizures across three generations. Infant Mental Health Journal, 24(5), 510-528.
Schechter, D.S., Zeanah, C, & Myers, M.M. (2002). Negative and distorted maternal attributions among violence-exposed mothers of very young children before and after single-session feedback: are maternal psychopathology and reflective functioning predictive? Paper presented at the meeting of the World Association of Infant MentalHealth, Amsterdam, The Netherlands.
Schuler, M., Nair, P., & Harrington, D. (2003). Developmental outcome of drug-exposed children through 30 months: a comparison of Bayley and Bayley II. Psychological Assessment, 15(3), 435-438.
Seifer, R., & Dickstein, S. (2000). Parental mental illness and infant development. In CH. Zeanah (Ed.) Handbook of infant mental health (pp. 145-160). New York: The Guilford Press,
Slade, A., Bernbach, E., Grienenberger, J., Levy, D.W., & Locker, A. (2002, 2005). The parent development interview and The pregnancy interview. Manual for scoring. Yale Child Study Center, CT, USA.
Slade, A., Grienenberger, J., Bernbach, E., Levy, D., & Locker, A. (2005). Maternal reflective functioning and attachment: considering the transmission gap. Attachment and Human Development, 7(3), 283-298.
Suchman, N., DeCoste, C, Schmitt, N., Legow, N., & Mayes, L. (2007). The Mothers and Toddlers Program: Preliminary findings from an attachment-based parenting intervention for substance abusing mothers. Psychoanalytic Psychology, in press.
Suchman, N.E., Altomare, M., Moller, R, Slade, ?., & Mayes, L. (2003). Emotionally responsive parenting: a new parenting intervention for drug dependent mothers. Paper presented at the Annual Meeting of College on Problems of Drug Dependence. Bal Harbour, FL, USA.
Suchman, N.E., Mayes, L., Conti, J., Slade, A., & Rounsaville, B. (2004). Rethinking parenting interventions for drug dependent mothers: from behavioural management to fostering emotional bonds. Journal of Substance Abuse Treatment, 27, 179-185
Suchman, N.E., McMahon, T.J., Slade, A., & Luthar, S.S. (2005). How early bonding, depression, illicit drug use and perceived support work together to influence drug dependent mothers' caregiving. American Journal of Orthopsychiatry, 75(3), 431-445.
Truman, S.D., Levy, D., & Mayes, L. C. (2004). Reflective functioning as mediator between drug use, parenting stress and child behaviour. Unpublished manuscript.
Ward, M. J., & Carlson, E.A. (1995). The predictive validity of the Adult Attachment Interview for adolescent mothers. Child Development, 66, 69-79.
JOURNAL OF PRENATAL AND PERINATAL PSYCHOLOGY AND HEALTH publishes research and clinical articles from the cutting edge of the science of prenatal and perinatal psychology and health. The journal, published quarterly since 1986, is dedicated to the in-depth exploration human reproduction and pregnancy and the mental and emotional development of the unborn and newborn child.