No abstract

Quality of attachment, disorganization in attachment, and the contribution of caregiver interactions in the home were investigated for infants prenatally exposed to PCP and cocaine and their caregivers. The drug-exposed infants were compared with infants of similar ethnicity, socioeconomic status (SES), and living in the same geographical area of the city with non-substance-abusing mothers. The majority of drug-exposed infants were insecurely attached to their caregivers and did not differ in the percentage of security in the three caregiving environments in which the infants were growing up: biologic mother care, kinship care, or foster mother care. The majority of drug-exposed children were disorganized. Change in caregivers during the first year was not found to be related to the rate of insecurity in any of the caregiving environments. The majority of the non-drug-exposed comparison infants were securely attached, and only a small percentage were disorganized. The high incidence of insecurity in the drug-exposed group is discussed in relation to maternal and environmental circumstances that can alter the assumption of security in attachment for the majority of children and caregivers toward insecurity in attachment.

Prenatally drug-exposed toddlers were compared to preterm toddlers of similar low socioeconomic status, ethnicity, and single-parent households on intellectual functioning, quality of play, and security of attachment to the primary caregiver. The drug-exposed toddlers had significantly lower developmental scores, less representational play, and the majority had insecure, disorganized, avoidant attachments. In all areas investigated, the prenatally drug-exposed toddlers showed more subtle behavioral deficits within each domain. Although developmental quotients were within the average range, they were significantly lower than the preterm comparison group and did not adequately represent the more evident deficits seen through play in an unstructured situation. Unstructured assessments that required the child's initiation, goal setting, and follow-through were more revealing of developmental disorganization within and among domains than were adult structured assessments such as developmental tests. While modest differences were seen in structured tasks, the marked differences between the drug-exposed and preterm groups were most evident in the unstructured tasks. The lack of coherence across developmental domains was illustrated by the large difference between developmental quotient scores and the poor performance in the cognitive representional competencies demonstrated in play. Insecurity and disorganization in attachment were found to compromise further the development of the drug-exposed toddlers.

No abstract