The Mothers and Toddlers Program: Preliminary findings from an attachment-based parenting intervention for substance-abusing mothers.

Abstract

The authors examined pilot data from an attachment-based parenting intervention for substance-abusing mothers of toddlers (ages 12–36 months). The Mothers and Toddlers Program (MTP) is a 20-week individual therapy intervention that aims to help mothers develop more balanced representations of their children and improve their capacity for reflective functioning (i.e., recognition of the intentional nature of children’s behavior). The authors hypothesized that improvement in maternal representational balance and maternal capacity for reflective functioning would correspond with improvements in maternal behavior with toddlers (e.g., sensitivity to cues, responsiveness to distress, and social–emotional growth fostering) and reduction in maternal psychiatric distress and substance abuse. Eight mothers who completed MTP showed moderate improvements in representational balance and reflective functioning, and these changes corresponded with significant improvements in maternal behaviors with toddlers. The authors also compared MTP completers and noncompleters on sociodemographic and psychosocial indexes and examined the validity of the intervention’s proposed mechanisms of change. Preliminary findings support the importance of attachment mechanisms and indicate that attachment-based interventions may strengthen substance-abusing mothers’ capacities to foster their toddlers’ socioemotional development.

Affective awareness in parenting of fathers with co‐occurring substance abuse and intimate partner violence

“…This type of approach has been effective with mothers struggling with substance use issues and aggression (Slade et al, 2005, Suchman et al, 2008, Toth et al, 2002. Fathers in this sample clearly lacked reflective skills indicating an inability to not only discuss their own emotions and thoughts, but also a limited and often non-existent capacity to think about the emotional experiences of their children.…”

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

“…Traditional substance abuse treatments focus almost exclusively on parents' substance use, rather than on improving parent-young child interactions and/or young child adjustment (12). Evidence-based parenting interventions are a critical adjunctive treatment given that the young children of parents who are substance-involved are at such high risk for a variety of adverse outcomes.…”

“…Certainly, models of mammalian behavior suggested that dopamine, along with other biological mechanisms, activates the neural pathways necessary for parents' motivation to bond with, nurture, and protect offspring, with these parenting behaviors shaping offspring neural and social development (11). Given these mammalian models, it may be that craving substances competes with and impedes substance-involved parents' capacity for positive caregiving (12). Further, repeated exposure to addictive substances likely reduces parents' dopaminergic response to stress, resulting in vulnerability to negative emotions and extreme distress when caring for distressed children.…”

“…Clearly, the youngest children are most vulnerable to the effects of these poor parenting practices (5), thereby requiring the most immediate intervention. Unfortunately, substance abuse treatment for parents is limited in accessibility (29) and focuses almost exclusively on parents' substance misuse, rather than on improving parent-child interactions and/or child adjustment (12). Even when parents who are substance-involved also are receiving child welfare services, there is evidence that the quality and intensity of parenting education programs are variable.…”

“…Within regard to reflective functioning, this intervention addresses mothers' ability to identify and downregulate their own distressing emotions as well as their ability to recognize and empathize with their children's emotions and needs (13,70). In a pilot study examining MTP in a small sample of 14 substance-involved mothers of toddlers who ranged in age from 12 to 36 mo, preliminary pre-postcomparisons indicated that MTP was effective in increasing mothers' reflective functioning, sensitivity to child cues, and responses to child distress (12). These mechanisms of change also improved mothers' depressive symptoms, abstinence from drugs, and responsive caregiving to their children's cues as well as their children's clarity of cues immediately posttreatment and at 6-wk follow-up in a sample of 47 substanceinvolved mothers of young children (i.e., ranging in age from birth to 36 mo) who were randomized to MTP or a parent education program (13,70).…”