Intervening with Opioid-Dependent Mothers Living in Poverty: Effects on Mothers' and Infants' Behavioral and Biological Regulation

近年来，阿片类药物的使用急剧增加，生活在非洲的妇女使用率特别高。 贫穷。母亲使用阿片类药物加上贫困使儿童极易受到一系列疾病的影响。 发展自我监管能力的短期和长期挑战。在婴儿期，自我的挑战- 调节可以在依恋行为、自主神经调节中看到问题。 系统活动和类固醇激素的产生。敏感的育儿方式对于 这样的孩子。如果没有干预，许多阿片类药物依赖母亲所生的孩子不太可能 接受敏感的养育。需要早期干预，帮助这些母亲提供敏感的 尽管面临物质使用的挑战，但仍需护理。在这个项目中，我们将评估房屋的功效 为生活贫困的阿片类药物依赖母亲制定的访问方案。母亲对 药物辅助治疗阿片类药物依赖在其妊娠晚期将 随机分配到这个适应性家访计划，修改的依恋和生物行为追赶 (mABC：N=100），或相同持续时间和频率的控制条件（修改的 家庭发展教育，或mDEF：N=100）。我们将评估mABC是否 干预涉及所谓的治疗机制，母体敏感性。第二，我们检查 干预是否对婴儿调节皮质醇的产生、自主神经功能 神经系统活动和依恋第三，我们研究是否母亲的敏感性介导 干预对婴儿结局的影响。一个探索性的目的是检查干预是否改变了 母亲的神经活动与婴儿对药物的奖励性质有关。父母敏感性 将在产前、1周龄、3月龄、6月龄和12月龄婴儿时进行评估， 将在产前和12个月大的婴儿时评估母体神经活动。婴儿皮质醇会 在3、6和12个月时进行评估，在6和12个月时进行自主神经系统调节， 年龄，12个月时的附着力。mABC干预预计将影响儿童的行为和 生物学结果，这些影响由母体敏感性介导。

Opioid use has increased dramatically in recent years, with rates especially high among women living in poverty. Maternal opioid use combined with poverty renders children highly vulnerable to a host of short- and long-term challenges developing self-regulatory capabilities. In infancy, challenges in self- regulation can be seen in problems in the regulation of attachment behaviors, autonomic nervous system activity, and production of steroid hormones. Sensitive parenting is especially important for such children. Without intervention, many children born to opioid dependent mothers are unlikely to receive sensitive parenting. Early intervention is needed that helps these mothers provide sensitive care despite the challenges of substance use. In this project, we will assess the efficacy of a home visiting program adapted for mothers with opioid dependence who are living in poverty. Mothers on medication assisted treatment for opioid dependence during their third trimester of pregnancy will be randomized to this adapted home visiting program, modified Attachment and Biobehavioral Catch-up (mABC: N=100), or to a control condition of the same duration and frequency (modified Developmental education for Families, or mDEF: N=100). We will assess whether the mABC intervention engages the purported treatment mechanism, maternal sensitivity. Second, we examine whether the intervention has positive effects on infants’ regulation of cortisol production, autonomic nervous system activity, and attachment. Third, we examine whether maternal sensitivity mediates intervention effects on infant outcomes. An exploratory aim examines whether the intervention alters maternal neural activity related to the rewarding nature of babies versus drugs. Parental sensitivity will be assessed prenatally, and at infant ages of 1 week, and 3, 6, and 12 months of age, and maternal neural activity will be assessed prenatally and at infant age of 12 months. Infant cortisol will be assessed at 3, 6, and 12 months, autonomic nervous system regulation at 6 and 12 months of age, and attachment at 12 months. The mABC intervention is expected to affect child behavioral and biological outcomes with these effects mediated by maternal sensitivity.