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，尤其是在生活在 在贫困中。母体阿片类药物的使用加上贫困使儿童非常容易受到 发展自我监管能力的短期和长期挑战。在婴儿期，自我挑战 调节可以在依恋行为的调节中看到问题，自主神经 系统活动和类固醇激素的产生。敏感的父母教育对于 这样的孩子。如果没有干预，许多阿片依赖母亲所生的孩子不太可能 接受敏感的育儿方式。需要早期干预，帮助这些母亲提供敏感的 尽管面临物质使用方面的挑战，但仍应给予关爱。在这个项目中，我们将评估一个家庭的功效 适用于生活贫困的阿片类药物依赖母亲的探访计划。母亲们在上 妊娠晚期阿片类药物依赖的药物辅助治疗 随机参加这一改编的家访计划、改良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 家庭发展教育，或mDEF：n=100)。我们将评估MABC是否 干预涉及到所谓的治疗机制，即母体敏感。第二，我们检查 干预对婴儿自主神经皮质醇生成的调节是否有积极作用 神经系统活动和依恋。第三，我们考察了母性敏感是否在 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会改变 母体神经活动与婴儿对药物的奖赏性质有关。亲代敏感性 将在产前以及1周、3、6和12个月大的婴儿时进行评估，以及 孕妇的神经活动将在产前和12个月大的婴儿时进行评估。婴儿皮质醇将 在3、6和12个月时进行评估，自主神经系统调节在6个月和12个月时进行评估 年龄，以及12个月的依恋。MABC干预预计将影响儿童的行为和 具有这些影响的生物学结果由母亲的敏感性所调节。

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.