The purpose of this study was to examine the impact of maternal cocaine use on mother-child interactions measured longitudinally during the preschool years. Findings suggest that mothers who used cocaine during pregnancy and their prenatally exposed children had less optimal quality of maternal-child interactions compared to mother-child dyads with no history of prenatal cocaine exposure. The estimated effects of PCE on the overall quality of maternal-child interactions at the age 3 and 5-year visits were similar in magnitude and were not significantly diminished with statistical adjustment for child sex, child’s age at exam and covariates measured at the time of delivery. Study results also suggest prenatal cocaine effects on specific facets of mother-child interaction at age 5, with greater maternal intrusiveness, higher levels of boundary dissolution, as well as greater child noncompliance in PCE dyads compared to NCE dyads.
Maternal cocaine use during the year prior to the 3 and/or 5-year study visit also negatively impacted the overall quality of mother-child interaction. PCE dyads with past-year maternal cocaine use had significantly lower Egeland summary scores compared to children with neither PCE nor past-year maternal cocaine exposure. With past-year maternal cocaine use in the model, PCE’s impact on maternal-child interaction was no longer statistically significant. This suggests the impact of maternal cocaine use on maternal-child interaction may be greatest when the mother uses cocaine during pregnancy and continues her drug use into the early childhood years. It is also possible the direct effect of PCE on maternal-child interaction was diminished due to a loss of statistical power related to the division of PCE children into two categories (those with and without past-year maternal cocaine use). These results remained stable with the addition of confounding variables into the model, with the exception of past-year maternal alcohol, tobacco and marijuana use. Due to significant interdependence among the maternal past-year substance use variables, it may be difficult to statistically separate the unique effects of maternal cocaine use on maternal-child interaction.
Current results are in line with our prior published findings on maternal-child interaction at age 3 and provide additional evidence of enduring PCE-effects on maternal-child interaction through the preschool years.12
We previously found PCE-associated differences in overall mother-child interaction during videotaped semi-structured free-play at age 3, with the greatest impairments noted in dyads where the mother reported past-year cocaine use. Additionally, as reported in Johnson et al.,12
multivariate profile analysis of maternal-child interaction data at 3-years follow-up revealed higher levels of maternal intrusiveness and hostility, poorer quality of instruction, lower levels of maternal confidence, and reduced child persistence among PCE dyads compared to NCE dyads. In the current study, PCE-associated differences were noted on maternal intrusiveness, boundary dissolution and child compliance at age 5. Although the estimates for other subscales did not reach statistical significance, Egeland subscales such as maternal hostility showed a trend and likely contributed to the PCE-associated differences in the overall quality of maternal-child interaction measured by the Egeland total score. Differences in results between 3- and 5-year Egeland facets may be due in part to the unreliability of individual subscales to reflect developmental changes in mother-child interaction across the preschool period. Overall, findings from this study are consistent with other studies associating maternal cocaine use during pregnancy and early childhood with greater maternal hostility and insensitivity and less responsive and more intrusive interaction styles.1,4–6
The current study offers numerous methodological advantages over previous studies including a large sample size, prospective enrollment at birth, a demographically similar comparison group, excellent cohort retention, and verification of prenatal drug exposure by bioassays. It is also one of the few longitudinal investigations examining maternal-child interaction at more than one time-point during the preschool period. The use of advanced multivariate longitudinal modeling techniques, (i.e. GLM/GEE) allowed for the estimation of the impact of PCE on maternal-child interaction while statistically adjusting for prenatal exposure to other drugs or potentially confounding influences. Additionally, mother-child interactions were assessed using standardized direct observational methods rather than through maternal self-report or agency reports of child abuse and neglect. Raters were blind to prenatal drug status and maternal reports of past-year drug and alcohol use were collected by interviewers who were not involved in the administration or evaluation of the mother-child interaction activities.
Important methodological characteristics and limitations of the MPCS have been summarized in prior publications.12,13,20
The current report relied on maternal self-report for the assessment of past-year maternal substance use. Although procedures were established to encourage valid reporting (i.e. the use of trained interviewers and the attainment of a federal certificate of confidentiality), poor maternal recall or the stigma associated with illicit drug use may have resulted in underreporting of maternal drug use. Also, the sample for this paper was restricted to children who remained with their biological mothers at the 3- and/or 5-year visits, potentially excluding children who might have been more heavily cocaine-exposed and as a result removed from the care of their mother. Such sampling procedures may have lead to an underestimation of PCE-associated effects on maternal-child interaction.
The current investigation further supports the link between maternal prenatal and postnatal cocaine use and quality of maternal-child interaction during the preschool years. Quality of early parent-child interactions has been shown to impact child socio-emotional, developmental and academic, and behavioral outcomes. Medical and mental health professionals should be aware of the potential interactive impact of prenatal cocaine exposure and ongoing maternal substance use on maternal-child interaction. PCE has been associated with poorer state regulation and arousal modulation in infancy,20
and with greater attention,21
and in some studies, behavioral problems during childhood,23
which have the potential to influence mother-child interaction.2,6
Substance-using mothers who have comorbid psychopathology, high levels of stress, and ineffective parenting skills may have greater difficulties understanding and responding appropriately to infant cues, particularly in infants who may be poorly regulated.2,24
Other associated parenting and environmental factors may also be important in explaining variability in mother-child interactions. Maternal cocaine use has been associated with higher rates of parental neglect and abuse, mental health issues, family instability and exposure to violence.25
Consequently, interventions should not only target ongoing maternal substance use, but the individual and cumulative effects of environmental, social, and emotional factors associated with maternal substance use on maternal-child interactions. In a review of the literature, Suchman et al.,26
examined interventions aimed at improving maternal-child interaction among mothers with a history of substance use and/or abuse and found that the most promising programs were comprehensive, intensive and addressed multiple aspects of the caregiving environment. In general, few interventions targeting maternal-child interactions among substance-using women and their children have been systematically evaluated; however, programs that include motivational engagement strategies and target maternal responsiveness have been shown to be successful in improving maternal behavior and the overall quality of the parent-child attachment relationship.26,27
While such research begins to identify specific components that can be incorporated into prevention and intervention efforts, ongoing research is needed to examine the underlying causes and long-term consequences of PCE-associated differences in maternal-child interactions, the impact of targeted interventions, and the application of this knowledge to other populations.