Mother‐Infant Interaction and Maternal Substance Use/Abuse: An Integrative Review of Research Literature in the 1990s

Abstract

Purpose (1) Mother‐infant interaction is crucial for optimal infant development and parenting. In the environment of prenatal substance use/abuse there is potential for both mother and child to present negative interactive behaviors. Recent increased incidence of substance use/abuse by pregnant women in the United States has provoked concern for the infant's outcome in these circumstances. Recent literature does not indicate uniformly dismal outlook for infants born exposed to drugs. In this paper, published research from the 1990s that specifically addressed the relationship between prenatal substance use/abuse and the mother‐infant interaction was examined utilizing the Barnard model of parent‐infant interaction as a guide. Twenty‐three articles matched search criteria and were included in the review. Conclusions (2) The majority of studies (14/23) showed that maternal substance abuse was associated with a recognizably detrimental impact on mother‐child interaction. Six studies did not confirm an adverse effect. Negative impact on the interaction was related to the degree of maternal substance abuse in three studies and to its continuation postnatally in two. Postnatal environment correlated strongly with the quality of mother‐child interaction in the substance‐exposed dyads. Implications (3) Clinical and research implications are described.

Quality of Caregiving in Mothers With Illicit Substance Use: A Systematic Review and Meta-analysis

“…These findings provide a synthesis of the literature on the quality of caregiving in substance-misusing mothers and is the first quantitative analysis of caregiving quality in substance-misusing mothers. 9 Overall, the composite effect size based on the meta-analysis of all 24 studies indicated that maternal sensitivity and child responsiveness were higher in mothers who had not used illicit substances. However, we found considerable heterogeneity that limited meaningful interpretation of the results.…”

“…A test for subgroup differences found that the lower estimate of effect size within the matched subgroup was not statistically significant (Q(1) = 2.57, P = .11). Although heterogeneity within the matched subgroup was reduced, it was not statistically significant (Q(9) = 12.19 (9), P = .20; I 2 = 26%) and heterogeneity within the nonmatched subgroup remained high and statistically significant (Q(5) = 36.82 (5), P < .00001; I 2 = 86%).…”

“…1 Many areas of children’s functioning are compromised, including early interaction with caregivers resulting in elevated rates of insecure and disorganised attachment, 2 , 3 and performance on tests of cognitive functioning 4 – 6 and language. 7 , 8 The compromised caregiving seen in mother-infant dyads 9 has been implicated in poor outcome and high rates of disorganised and insecure attachment. 10 These difficulties extend into childhood with evidence of difficulties in a range of executive functions 11 and higher-than-normal rates of internalising and externalising disorders.…”

“…Substantial variability in sample size, populations studied, and quality of the study design has contributed to mixed findings. An early narrative review of research studies published between 1990 and 1999 by Johnson 9 provided an integrative synthesis of 23 studies in which mother-infant interaction had been measured. Fifteen of these studies were longitudinal or cross-sectional in design and focused on correlational associations between maternal characteristics and quality of caregiving.…”

The state of evidence-based parenting interventions for parents who are substance-involved

“…In turn, the presence of childhood maltreatment, trauma, and psychopathology coupled with substance misuse is associated with parenting deficits (19). Research further suggested that parents who are substance-involved exhibit different parenting behaviors than those who are not substance-involved, with such differences varying with the characteristics of parents' current drug use (see (20) and (21) for reviews). For example, parents who are substance-involved are more likely to exhibit greater parenting stress (22), decreased attentiveness and engagement with their children (23), more authoritarian parenting (24), and dysfunctional or harsh disciplinary practices (25).…”