Sydney Hans - US grants

Drug addiction is a growing problem among American women, particularly women of childbearing age. It is widely assumed that children born to drug-addicted mothers are at high risk for a variety of problems during childhood and for later drug abuse, but little is known about behavioral characteristics of these children or the types of family environments in which they live. The proposed research will provide a broad range of measures on a sample of approximately 40 low-income black 9-year-old children who were exposed prenatally to methadone and who continue to live in families with their biological mothers. They will be contrasted with a group of children whose mothers never used opioid drugs. Both groups of children were recruited during their mothers' pregnancies. Children will be assessed on a variety of instruments designed to measure general psychiatric and intellectual functioning as well as problems in attention, motor coordination, and conduct disorders. Instruments will include a combination of clinical interviews, questionnaires to parents and teachers, and direct tests of children. Another set of instruments will assess strengths and weaknesses of family environment that might affect child development, including maternal adaptive functioning, drug use, childbearing attitudes, affective style, involvement with child, and control of child; family structures, stresses and supports; and sibling behavior. Because the proposed sample was studied extensively during the children's first two years of life, data can be analyzed to look at patterns of early child behavior, early mother behavior, and early child medical conditions that predict school-age outcome. Such information on child and family development over time will be useful in planning preventive intervention programs for offspring of drug-addicted women that begin during infancy and toddlerhood.

The proposed research will examine a broad range of behavioral variables in a group of Israeli adolescents at high risk for schizophrenia. Forty children with schizophrenic parents will be compared to a group of fifty children whose parents have other mental disorders and forty children with mentally healthy parents. Approximately half of the proposed sample was recruited during their mothers' pregnancies and have been followed longitudinally since infancy as part of the Jerusalem Infant Development Study. The remaining half was recruited and first assessed during school- age. Adolescent follow-up instruments will include measures of information processing and attentional functioning, neuromotor functioning, clinical status, and family environment. The goal of the proposed research is to clarify the growing literature suggesting that children of schizophrenics have neurobehavioral signs which may be markers of vulnerability to later schizophrenic breakdown. The proposed research will attempt to identify with greater specificity than previous work the nature of such neurobehavioral signs, to determine whether they can be observed with continuity during various stages of the life cycle, and to determine how they, in combination with family factors, are related to premorbid symptoms of schizophrenia observed during adolescents.

While there is great public concern about the effects prenatal exposure to illicit drugs may have on the development of children, few studies have followed children with documented exposure histories past the first months of life. It is widely assumed that children born to drug-addicted mothers are at high risk for a variety of problems during childhood and for later drug abuse, but little is known about behavioral characteristics of these children or the types of family environments in which they live. The proposed research involves assessment of a sample of 37 urban African-American 14-year-old children who were exposed prenatally to opioid drugs. They will be contrasted with a demographically similar group of 41 children whose mothers had no history of opioid drug use at the time of their pregnancies. Previous assessments of these children at age 10 suggested that opioid-exposed children -- particularly opioid exposed boys -- showed signs of attention deficit as measured on computerized tasks of sustained attention, despite that the fact that they did not differ from other children in the sample in terms of their general intellectual functioning. In the proposed adolescent follow-up, children will be administered a more extensive battery of clinical neuropsychological assessments of attention to further clarify the nature of the attention problems present in the opioid-exposed children. Additionally, as the children enter the age period of particularly high risk for drug use, sexual activity, and delinquent behavior, a variety of assessments of psychosocial functioning will be administered. Assessments will also be made of the children's social environments and relationships with family members to determine what factors contribute to developmental risk and resiliency in this sample at very high risk. Such information on child and family development over time will be useful in planning preventive intervention programs for offspring of drug-addicted women and other high-risk urban children.

The goal of this study is to better understand the nature of mother-child relationships in dyads where the mother is drug addicted. While considerable effort has been devoted to studying the development of children exposed prenatally to drugs of abuse, little consideration has been given to the risks faced by these children after birth as a consequence of being born to a drug-using mother. Our hypothesis is that the quality of mother-child relationships will be closely related to maternal psychopathology. In particular, we predict that maternal antisocial and related personality disorder will result in unbalanced maternal representations of the child and in insensitive, intrusive, hostile parenting which in turn is reflected in the children's insecure attachments and coercive interactional styles. We predict that maternal depression--in the absence of personality disorder--will be related to more subtle patterns of disengagement from interaction with the child. With a sample of 150 drug-using women and their 30- to 60-month-old children, we plan to document the degree of balance in the mothers' mental representations of their children (Zeanah's Working Model of the Child Interview), the mothers' views about parenting and children (Bavolek's Adult-Adolescent Parenting Inventory), and the quality of actual mother- child interaction in situations that tap different relationship themes (attachment, teaching, socialization, attachment, and engagement in shared routines. Different aspects of the interaction will be rates using Crittenden's Preschool Assessment of Attachment, the Mother-Child Project teaching scales, the Parent Child Observation Guide and event coding to examine processes of maternal control and child compliance. We plan to assess the mothers' current and lifetime DMS-IV psychiatric diagnoses using the SCID and SCID-11 interviews and their current self-reported symptoms using the SCL-90-R. In exploring the major hypotheses we will also give consideration to a system of other variables that might be determinants of maternal psychopathology or non-optimal parental beliefs and behavior. These variables include the mother's history of early care; the mother's history of physical and sexual abuse; the mother's current psychosocial stressors; and the mother's current social support system.

DESCRIPTION: (Applicant's Abstract) The goal of this study is to better understand the nature of infant attachment to mothers who are drug using. Although previous research with small samples has suggested that children prenatally exposed to drugs are at risk for insecure and disorganized attachments, it remains unclear whether this risk derives from teratological or social factors. Such findings are of serious concern due to the close theoretical and empirical links that have been made between disorganized attachment and serious family pathology, including child maltreatment and adjustment problems. We propose to explore the following hypotheses: 1) that there will be an increased incidence of insecure and disorganized attachments in infants whose mothers have histories of serious substance abuse and 2) that the association between substance abuse and attachment can be accounted for by mothers' histories of exposure to trauma. In addition, we will examine the independent and mediating contributions to attachment of maternal dissociative symptoms, maternal resolution of attachment history, parenting behavior and beliefs, and infant temperament. The sample will include 200 12- to 18-month-old infants and their mothers. Half of the mothers will be women with a history of heroin and other substance abuse, recruited form public methadone maintenance programs. Half of the mothers will be selected from a population of families presenting for pediatric care at a community health clinic. Infant attachment will be assessed form the Ainsworth Strange Situation using Main's supplemental disorganized attachment coding category. Maternal substance use and abuse, mental health, parenting, and infant temperament will be assessed using a multi-method approach. If hypotheses are confirmed, they would suggest the need for more comprehensive family interventions for women in substance abuse treatment that include parent-child relationship services, violence counseling, and adult mental health services.

DESCRIPTION (provided by applicant): This SOAR proposal is submitted to expand and strengthen a study that is currently underway with John A. Hartford Foundation funding awarded to the principal investigator, who meets the NIH early stage investigator criteria. This research addresses the alarming increase in the rate of incarceration among women in the United States, its intersection with substance abuse, and its disproportionate impact upon African American and Latina women. The majority of women who are incarcerated resided with their minor children prior to their incarceration and more than half of their children are cared for by a grandparent, disproportionately a grandmother, during their incarceration. A growing body of research suggests that family treatments yield improved treatment engagement and retention, reduced substance use, and improved individual and family functioning in comparison to individual treatment or waitlist conditions for adults with alcohol and substance use disorders. Research has also begun to demonstrate that interventions with incarcerated mothers and their children yield positive psychosocial outcomes, including reduced re-incarceration, but only one known intervention study has included caregiving grandmothers, despite their key familial roles and the potential for their involvement to enhance treatment retention and gains for incarcerated mothers with substance use disorders. This stage Ia/Ib therapy development study draws upon a multigenerational stress-process theoretical framework and principles of community-based participatory research to pursue the following aims: 1)conduct separate focus groups with incarcerated mothers with substance use disorders and grandmothers who are caring for their daughters'children during their incarceration to identify the psychosocial strengths, needs, and service preferences of the mothers, grandmothers and children;2)draw upon gathered focus group data and family systems, cognitive and behavioral theories to design and pilot-test an innovative, culturally- relevant family therapy model;3)recruit 30 incarcerated women who are participating in drug court-referred residential treatment in a county jail to be randomly assigned to treatment as usual (n=15) or to treatment as usual plus the novel family therapy component (n=15) and recruit the mothers of the women participating in the novel family therapy arm to participate in the family therapy component (n=15);4)conduct baseline and post- treatment measurement of family relationships, coping, substance use, incarceration status and HIV risk behaviors among mothers;family relationships, coping, substance use, and psychosocial strain among grandmothers;and behavioral functioning among children;and 5)evaluate the acceptability of the novel family treatment component to the participants. In light of the significant potential for family treatment to reduce mothers'substance use, re-incarceration, and involvement in HIV drug and sexual risk behaviors;to reduce caregiving grandmothers'psychosocial strain and substance use risk, and to strengthen children's behavioral functioning, this study addresses a critical gap in both science and evidence-based practice in this area. PUBLIC HEALTH RELEVANCE: In light of the high prevalence of substance use disorders among women who are incarcerated, the multigenerational effects of maternal incarceration and substance abuse, and the limited family treatment research in this area, this study addresses a critically important gap in science and practice. This study's development of a novel family treatment for incarcerated mothers with substance use disorders and their mothers who are caring for their children during their incarceration holds potential to positively affect several serious public health concerns, including substance abuse, re-incarceration, and HIV drug and sexual risk behaviors among the mothers;biopsychosocial strain and substance use risk among the grandmothers;and behavioral functioning among the children.