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I comportamenti di parenting nel contesto del Disturbo da Uso di Sostanze: implicazioni dei fattori psicopatologici e cognitivi per l’assessment e l’intervento
No full textSubstance Use Disorder (SUD) represents an increasing global risk factor for disability and premature death, with significant economic costs. Nearly 90% of women who struggle with SUD are in child rearing age and maternal SUD is a risk factor for parenting and child development. Besides the direct effects of substance exposure, quality of parenting in the home represents an important mediator of undesired developmental outcomes. Compared to low-risk populations, mothers with SUD show less optimal caregiving behaviors in diverse contexts, being less sensitive and responsive to children’s signals, and more hostile and interfering with their activities. These negative parenting behaviors are linked undesired developmental outcomes and a higher risk to be involved with child protective services. Therefore, quality of parenting behaviors across different domains constitute one of the main targets of investigation in the condition of SUD, to avoid unfavorable developmental outcomes in children though targeted interventions. Furthermore, a wide array of studies shows the relevance of investigating SUD-related characteristics, as co-occurring psychopathology or parental cognitive impairments, to better understand which mechanisms could further detriment quality of parenting in SUD and support/obstacle interventions.
The current thesis focuses on quality of parenting behaviors in the context of maternal SUD, considering the psychopathological and cognitive mechanisms involved, and identifying a possible intervention protocol that could consider these aspects.
The first part of the work provides a general overview of parenting, considering some of the mechanisms involved in the process of taking care in early infancy and childhood. In chapter 1 we discuss the role of parenting behaviors in shaping child development, identifying how their quality can be influenced by cognitive resources or the presence of psychopathological symptoms in the adult.
The second part of the work will focus specifically on parenting in the context of SUD, a high-risk condition for quality of care and for child development. In Chapter 2 we will present an empirical study aimed at investigating quality of parenting behaviors through cluster analysis in mothers with SUD. In chapter 3 we will discuss the results of a study aimed at examining the role of maternal alexithymia, a specific type of psychopathology, on quality of parenting behaviors in mothers with SUD. In the empirical study in Chapter 4 we will report on a longitudinal study investigating the effect of parental psychological symptoms and executive functioning on the development of parent-child relationships during a residential program for drug addiction. In chapter 5 we will present a proposal for a randomized controlled trial aimed at modifying quality of parenting behaviors in mothers with SUD considering the intervening role of cognitive and psychopathological mechanisms.
Finally, in the last section we will provide a general discussion of the topics developed through the work, highlighting some methodological challenges and some empirical and clinical implications based on the results of our empirical studies.
Globally our results confirm that SUD represents a risk condition for parenting and quality of parent-child relationships. Patterns of mother-child interactive behaviors are more likely to present difficulties within this group, but these are subjected to variability. Differences in quality of parenting behaviors are linked to the presence of co-occurring psychopathology and cognitive resources, and these two mechanisms play an important role in the ongoing of interventions. Thus, quality of parenting behaviors should represent one of the main focuses of assessment and intervention in mothers with SUD, but they should be considered also in the light of psychopathology and cognitive functioning.Substance Use Disorder (SUD) represents an increasing global risk factor for disability and premature death, with significant economic costs. Nearly 90% of women who struggle with SUD are in child rearing age and maternal SUD is a risk factor for parenting and child development. Besides the direct effects of substance exposure, quality of parenting in the home represents an important mediator of undesired developmental outcomes. Compared to low-risk populations, mothers with SUD show less optimal caregiving behaviors in diverse contexts, being less sensitive and responsive to children’s signals, and more hostile and interfering with their activities. These negative parenting behaviors are linked undesired developmental outcomes and a higher risk to be involved with child protective services. Therefore, quality of parenting behaviors across different domains constitute one of the main targets of investigation in the condition of SUD, to avoid unfavorable developmental outcomes in children though targeted interventions. Furthermore, a wide array of studies shows the relevance of investigating SUD-related characteristics, as co-occurring psychopathology or parental cognitive impairments, to better understand which mechanisms could further detriment quality of parenting in SUD and support/obstacle interventions.
The current thesis focuses on quality of parenting behaviors in the context of maternal SUD, considering the psychopathological and cognitive mechanisms involved, and identifying a possible intervention protocol that could consider these aspects.
The first part of the work provides a general overview of parenting, considering some of the mechanisms involved in the process of taking care in early infancy and childhood. In chapter 1 we discuss the role of parenting behaviors in shaping child development, identifying how their quality can be influenced by cognitive resources or the presence of psychopathological symptoms in the adult.
The second part of the work will focus specifically on parenting in the context of SUD, a high-risk condition for quality of care and for child development. In Chapter 2 we will present an empirical study aimed at investigating quality of parenting behaviors through cluster analysis in mothers with SUD. In chapter 3 we will discuss the results of a study aimed at examining the role of maternal alexithymia, a specific type of psychopathology, on quality of parenting behaviors in mothers with SUD. In the empirical study in Chapter 4 we will report on a longitudinal study investigating the effect of parental psychological symptoms and executive functioning on the development of parent-child relationships during a residential program for drug addiction. In chapter 5 we will present a proposal for a randomized controlled trial aimed at modifying quality of parenting behaviors in mothers with SUD considering the intervening role of cognitive and psychopathological mechanisms.
Finally, in the last section we will provide a general discussion of the topics developed through the work, highlighting some methodological challenges and some empirical and clinical implications based on the results of our empirical studies.
Globally our results confirm that SUD represents a risk condition for parenting and quality of parent-child relationships. Patterns of mother-child interactive behaviors are more likely to present difficulties within this group, but these are subjected to variability. Differences in quality of parenting behaviors are linked to the presence of co-occurring psychopathology and cognitive resources, and these two mechanisms play an important role in the ongoing of interventions. Thus, quality of parenting behaviors should represent one of the main focuses of assessment and intervention in mothers with SUD, but they should be considered also in the light of psychopathology and cognitive functioning
Maternal Drug Addiction: Influences on mother-child relationship and on early child development.
Full text linkMuch literature has pointed out parental drug addiction as a risk factor at multiple levels for the dyad, affecting parenting quality, child development and more globally the adult-child relationship. Drug addicted mothers are often reported as less sensitive, more intrusive and less able to regulate negative affects during early adult-child interactions. On the other hand, children of addicted mothers are often described as more irritable or more passive. The aim of this research was to investigate longitudinally the quality of adult-child relationship and of child interactive and emotional development in a group of drug addicted mothers and their children prenatally exposed to substances. The study involved 25 mother-child pairs (with children aged between 2 and 24 months) with drug addicted mothers. The dyads were followed for a 15 months-period and assessed regularly (every 3 months) through the application of the Emotional Availability Scales (EAS – Biringen, 2008) to videotaped free play interactions. In this way it has been possible to consider both the mothers’ and the children’s contribution to the development of their relationship.
The results were controversial, showing on one hand changes related only to specific EA dimensions and on the other hand patterns of changes that seemed characteristics of specific patterns of emotional availability. Dyads that initially showed interactions of better quality tended to improve their relationship during time, whereas dyads that exhibited more difficulties at the beginning of the study did not show improvements. Moreover, children of dyads which experienced interactions of better quality showed better interactive and emotional features than children of dyads characterized by more dysfunctional patterns of interaction. Dyads characterized by maternal drug addiction are often reported to be at higher risk for experiencing difficulties during everyday interactions and more likely to be associated to less optimal developmental outcomes. Anyway the results of our study highlight that, despite the condition of drug addiction, experiencing a relationship of good quality could be associated to better mother-child interactions and to more functional interactive and emotional development for children
New perspectives in the study of adult-child bond: Attachment, dyadic emotional availability and the Emotional Availability Scales (EAS)
No full textThe paper aims to introduce the reader to the conceptual frame of emotional availability and to the Emotional Availability Scales (EAS). The term refers to the capacity of the dyad to share an emotional connection in the context of a functional and mutual fulfilling relationship (Biringen & Easterbrooks, 2012). When an emotional available connection is present within the dyad the partners are able to enjoy together, to express genuinely positive emotions and to downregulate negative affects. The construct has a dyadic nature and simultaneously takes into account the intervention of both partners and their reciprocal influences.
The theoretical background of emotional availability finds its main contributions in attachment theory (Bowlby, 1969, 1973; Ainsworth, Blehar, Waters, & Wall, 1978), in the theories of emotions (Emde, 1980; Mahler, Pine & Bergman, 1975) and in systemic and transactional theories (Sameroff & Fiese, 2000). The construct has been operationalized by Biringen (2008) through the EAS, six scales aimed at assessing the global affective quality of adult-child interactive exchanges. Four scales take into account the contribution of the adult (sensitivity, structuring, nonintrusiveness, nonhostility) while the other two focus on the child (responsiveness, involvement of the adult). The EAS have been well validated through the application in different countries and to different samples, clinical, non clinical and with disabilities. As expected, given their theoretical background, they showed associations with quality of infant-mother attachment, adult attachment representations but also with other features of adult-child relationships. The flexibility of the system to different ages and to different settings makes the EAS a useful assessment tool that can be used both in research and in clinical settings.
Special attention in the paper is given to the comparison of emotional availability with attachment theory. The constructs show in fact similarities, such as the importance given to the presence of a sensitive adult, but differences as well. For instance, while the emotional availability conceptual frame focuses more explicitly on emotions, both negative and positive, attachment theory seems to pay more attention to more specific features of the dyad, such as the child’s need for protection and research of physical proximity. Moreover, while emotional availability evaluates interactions, and therefore something that could be more changeable in time, the attachment perspective evaluates a quality of the infant considered to be more stable, although dynamic, i.e. the attachment bond. In this way both paradigms focus on adult-child relationships but highlighting different aspects that taken into account together could lead to a better comprehension of the affective and relational development of the individual. Suggestions for an integrated use of the two theories, and consequent implications, are discussed at the end of the paper
Nuove prospettive nello studio del legame adulto-bambino: Attaccamento, disponibilità emotiva diadica e le Emotional Availability Scales (EAS).
No full textLa disponibilità emotiva riguarda la capacità di condividere in maniera reciproca le proprie emozioni all’interno di una relazione funzionale e mutuamente appagante; il costrutto si rifà in parte ai concetti avanzati dalla teoria dell’attaccamento ma presenta anche notevoli differenze rispetto a questi. Biringen e collaboratori (2008) hanno messo a punto le Emotional Availability Scales (EAS), sei scale volte a cogliere la qualità affettiva globale all’interno degli scambi adulto-bambino. Il presente lavoro si propone come un’introduzione alla cornice teorica della disponibilità emotiva e delle EAS in un’ottica di confronto con il costrutto della sensibilità materna formulato da Mary Aisworth all’interno della teoria dell’attaccamento. Dopo una breve rassegna dei principali studi che hanno impiegato lo strumento di Biringen anche all’interno del frame work dell’attaccamento, viene discussa l’utilità clinica e in ambito di ricerca dello strumento
Intervening on dyads with drug addicted mothers: the contribution of a residential community program in improving dyadic emotional availability.
Full text linkIntroduction: An increasingly larger amount of literature points out the detrimental effects that drug addiction can have both on parenting practices and child development. These dyads seem often characterized by dysfunctional early mother-child interactions which have often been associated to later developmental difficulties. Prompt interventions focused on the relationship seem, thus, necessary to prevent from later undesired outcomes.
Method: The research aimed to assess the effectiveness of a residential community program in improving the quality of the dyadic relationship in a group of drug-addicted mothers and their children prenatally exposed to drugs. Since from admission in Therapeutic Community, the 25 dyads, with children aged between 2 and 24 months, were evaluated every three months during the first 15 months of stay in the facility. 20-minutes free play interactions were videotaped and assessed through the 4th edition of the Emotional Availability Scales (EAS - Biringen, 2008), six scales aimed at evaluating the global affective quality of adult-child emotional exchanges. Results: The results were controversial. Although there were changes in dyadic interactions, these changes seemed to be characteristic only of specific EA dimensions. Moreover, different patterns of mother-child emotional availability resulted associated with different patterns of change, suggesting that improvements resulted more difficult for the dyads that exhibited more difficulties at the beginning of the treatment.
Conclusions: Addicted mothers and their children are at higher risk for experiencing difficulties during everyday interactions. Anyway an adequate sustain provided to the relationship could buffer interactive mismatches, enhancing parenting abilities and favoring better affective regulation. This research provides evidence of the possibility to partially support early mother-child interactions in drug-addicted mothers through a residential community program
Early mother-child interactions in dyads with drug addicted mothers and children prenatally exposed to drugs.
Full text linkIntroduction: Drug addiction is considered a major risk factor for parenting and for child development. Addicted mothers are often described as less sensitive and less able to regulate negative affects during interactions. On the other hand, children prenatally exposed to drugs appear more likely to experience difficulties in interactive emotion regulation. Despite the large amount of studies on the detrimental effects of substance exposure on child development the
outcomes appear sometimes controversial.
Method: The study aimed to compare the quality of early adult-child interactions in a group of drug addicted mothers and their children with a group of unselected dyads. 20 mother-child pairs (children aged between 12 and 36 months) with drug addicted mothers attending a rehabilitation program were coupled with 20 unselected mother-child pairs according to children’s age and gender. 20-minutes mother-child interactions were videotaped during free play and assessed through the 4th edition of the Emotional Availability Scales (Biringen, 2008). The results were then compared in order to identify similarities and differences between the two groups.
Results: The results highlighted differences between the two groups, with “addicted dyads” showing lower scores on emotional availability with respect to the comparison group. Addicted mothers and their children seemed to experience more difficulties during interactions when compared to controls. The groups differed also in term of homogeneity of the scores, with the “addicted” one reporting more heterogeneous scores in the EAS.
Conclusions: Addicted mothers and their children are at higher risk for experiencing difficulties during everyday interactions. Anyway, the range of these difficulties appears highly variable across each case suggesting that some dyads might be more likely to be “protected” from negative interactive consequences associated with the condition of drug dependence. Clinicians should take into account these aspects when programming, implementing and assessing interventions
Interactive features in 0-3 years children exposed to substances in utero.
Full text linkIntroduction: Several studies suggest that children of addicted mothers are a population characterized by structural and somatic changes in development and by cognitive and affective symptoms. Despite the amount of studies on the detrimental effects of substance-exposure on child development, outcomes are still inconsistent particularly on the early interactive-relational development.
Method The research aims to evaluate and monitor the interactive-relational development of children born from drug-addicted mothers from 3th to 24th month of child’s life. The main goal is to identify specific developmental pathways of these children in order to organize the intervention strategies. In this direction, from July 2012 to October 2013, 20 mother-child dyads were observed every three months using the Emotional Availability Scales (Biringen, et al., 1998) in order to assess the quality of the interactive mother-child exchanges in the course of child’s early development and the respective contribution of the mother and the child to the relationship.
Results Results highlight a partially adequate maternal sensitivity and mother’s ability to structure the interaction with the child. Globally, the mothers appear to be able to perceive adequately the child’s cues, but they could not respond sensitively in a consistent way. On the other hand, children’s responsivity to maternal stimuli was sufficiently good. Children show the ability to enjoy being involved in the interaction with the mother and the capacity to adjust and to follow her lead. Finally, children seem to be able to involve the mother in the interaction, addressing her both with verbal and non-verbal cues.
Conclusions Drug addicted babies are “special kids” born from “special mothers”, considering their early experience characterized by multiple biological and psychological alterations that, even though subtle and not always openly evident, are needed to take into account when it comes to program and to implement assessment and treatment interventions
Infant Massage and Quality of Early Mother–Infant Interactions: Are There Associations with Maternal Psychological Wellbeing, Marital Quality, and Social Support?
Full text linkInfant massage programs have proved to be effective in enhancing post-natal development of highly risk infants, such as preterm newborns and drug or HIV exposed children. Less studies have focused on the role of infant massage in supporting the co-construction of early adult–child relationships. In line with this lack of literature, the present paper reports on a pilot study aimed at investigating longitudinally the quality of mother–child interactions, with specific reference to emotional availability (EA), in a group of mother–child pairs involved in infant massage classes. Moreover, associations between mother–child EA, maternal wellbeing, marital adjustment, and social support were also investigated, with the hypothesis to find a link between low maternal distress, high couple satisfaction and high perceived support and interactions of better quality in the dyads. The study involved 20 mothers and their children, aged between 2 and 7 months, who participated to infant massage classes. The assessment took place at
three stages: at the beginning of massage course, at the end of it and at 1-month follow-up. At the first stage of assessment self-report questionnaires were administered to examine the presence of maternal psychiatric symptoms (SCL-90-R), perceived social support (MSPSS), and marital adjustment (Dyadic Adjustment Scale); dyadic interactions were observed and rated with the Emotional Availability Scales (Biringen,
2008) at each stage of data collection. The results showed a significant improvement in the quality of mother–child interactions, between the first and the last evaluation, parallel to the unfolding of the massage program, highlighting a general increase in maternal and child’s EA. The presence of maternal psychological distress resulted associated with less optimal mother–child emotional exchanges, while the hypothesis regarding couple satisfaction and social support influence were not confirmed. These preliminary results, if replicated, seem to sustain the usefulness of infant massage and the importance of focusing on early mother–infant interactions
Parenting and maternal drug addiction: are there associations between the neuropsyhcological functioning and the quality of mother-child interactions?
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