Maternal pre- and postnatal substance use and attachment in young children: A systematic review and meta-analysis

Abstract

Maternal substance use has often been associated with insecure and disorganized child attachment. We evaluated this association with a meta-analysis of young children and, further, systematically reviewed mediating and moderating factors between maternal substance use and child attachment. We performed a systematic database search of quantitative English language studies on child attachment that included substance-using mothers and their children below 6 years of age. Eleven studies (N = 1,841) met the inclusion criteria and were included in the meta-analysis of attachment security and seven (N = 1,589) studies were included in the meta-analysis of attachment disorganization. We found that maternal substance use was negatively associated with secure attachment in children, but the effect size was small (r = −.10). The association with disorganized attachment was not significant (r = .15). Related to moderating and mediating factors (k = 6), we found evidence on the role of teratogenic and sociological factors on child attachment. Most importantly, the impact of cumulative risks was vital. However, literature was scarce, and studies varied in risk of bias, leaving many unanswered questions on other potential factors underlying the development of attachment in these high-risk children. We discuss the results considering clinical implications and future directions.

Therapeutic Process of Change During Participation in the Parents Under Pressure Program for a Cohort of Parents Who Misuse Substances

“…Yet parental substance misuse is commonly comorbid with other mental health difficulties and psychosocial stressors (Canfield et al, 2021;Nair et al, 2003) which can also undermine parenting capacity (Seay & Kohl, 2015;Siqveland & Moe, 2014). This, in turn, reduces parental emotional availability and the overall quality of the parent-child relationship (Biringen et al, 2014;Hyysalo et al, 2021), often leading to poor child and family outcomes (Hser et al, 2015;Stith et al, 2009).…”

Prenatal tobacco, tobacco–cannabis coexposure, and child emotion regulation: The role of child autonomic functioning and sensitive parenting.

“…Postnatal substance exposure directly influences children's regulation through secondhand smoke exposure to tobacco and cannabis (Posis et al, 2019). Postnatal substance exposure can affect child ER through mechanisms such as insecure maternal-child attachment (for a meta-analysis, see Hyysalo et al, 2022). Specifically, prenatal substance exposure increases infant irritability, reduces soothability, and has been associated with vague interaction cues from the mother (Hyysalo et al, 2022).…”

“…Postnatal substance exposure can affect child ER through mechanisms such as insecure maternal–child attachment (for a meta-analysis, see Hyysalo et al, 2022). Specifically, prenatal substance exposure increases infant irritability, reduces soothability, and has been associated with vague interaction cues from the mother (Hyysalo et al, 2022). Postnatally, substance use can alter maternal neural pathways associated with infant–child communication, which may make maternal interactions with their children less rewarding and more stressful (Hyysalo et al, 2022).…”

“…Specifically, prenatal substance exposure increases infant irritability, reduces soothability, and has been associated with vague interaction cues from the mother (Hyysalo et al, 2022). Postnatally, substance use can alter maternal neural pathways associated with infant–child communication, which may make maternal interactions with their children less rewarding and more stressful (Hyysalo et al, 2022). Finally, substance use is associated with greater mental health problems and negative parenting behaviors that affect parent–child attachment (Hyysalo et al, 2022).…”

“…Postnatally, substance use can alter maternal neural pathways associated with infant–child communication, which may make maternal interactions with their children less rewarding and more stressful (Hyysalo et al, 2022). Finally, substance use is associated with greater mental health problems and negative parenting behaviors that affect parent–child attachment (Hyysalo et al, 2022). Therefore, it is important to examine the impact of postnatal substance exposure over and above prenatal exposure for children with exposure.…”