Abstract
Infants born to mothers who are dependent on opioids often have difficulty regulating behavior and physiology at birth. Without sensitive maternal care, these infants are at risk for ongoing problems with self-regulation. Mothers who are dependent on opioids may experience challenges related to their substance use (e.g., unsupportive and/or risky environment, impulse control and reward system problems) that increase the likelihood of insensitive parenting in the absence of effective intervention. In this paper, we describe a home-visiting intervention we have adapted to enhance sensitive, responsive caregiving tailored to the specific needs of mothers with opioid dependence. The original intervention, Attachment and Biobehavioral Catch-up (ABC), was designed for mothers of infants aged 6–24 months who were exposed to early adversity. ABC has been shown to enhance sensitive parenting as well as children's behavioral and biological functioning, with positive outcomes extending into at least middle childhood. Mothers who are opioid dependent need earlier support than provided by ABC because opioid-exposed infants are often vulnerable at birth. The adapted intervention (modified ABC or mABC) includes one prenatal session and one early postnatal session, followed by 10 sessions every 2–3 weeks. In the initial two sessions in particular, mothers are helped to anticipate the challenges of caring for a baby who may be difficult to soothe while nonetheless providing sensitive care. mABC is intended to help mothers see the importance of responding sensitively so as to help infants overcome the developmental risks associated with opioid exposure. Additionally, mABC is structured to support mothers with the challenges of early parenting, especially if the mother herself was not parented sensitively. Throughout, the focus is on helping the mother nurture the distressed infant, attend to the infant's signals, and avoid behaving in overstimulating or intrusive ways. Case examples are presented that highlight both the challenges of working with this population as well as the gains made by mothers.
Highlights
Opioid abuse is a public health emergency of historic proportions, affecting thousands of pregnant and parenting mothers (Clemans-Cope et al, 2019)
The current paper reviews existing interventions designed to enhance parenting quality among opioid-dependent mothers of infants, in addition to reviewing the evidence base of Attachment and Biobehavioral Catch-Up (ABC), a home-visiting intervention model for parents of infants exposed to early adversity
We describe modified Attachment and Biobehavioral Catch-Up, an adaptation of ABC tailored to the needs of this population, designed to enhance parenting sensitivity and in turn promote attachment organization and self-regulation among infants with prenatal opioid exposure
Summary
Opioid abuse is a public health emergency of historic proportions, affecting thousands of pregnant and parenting mothers (Clemans-Cope et al, 2019). Infants exposed to opioids prenatally are at risk for difficulty regulating physiology and behavior, in the vulnerable neonatal period when many infants experience symptoms of withdrawal (Conradt et al, 2018). Sensitive caregiving is critical for helping substance-exposed infants thrive; mothers with opioid use disorders may struggle to parent sensitively in the context of substance-related risk factors including poverty, trauma exposure, alterations in reward processing, and emotional dysregulation. The evidence suggests that sensitive parental care may be especially important for buffering effects of early vulnerability and promoting healthy development among infants prenatally exposed to opioids and other co-occurring substances (Reddy et al, 2017; Conradt et al, 2018; Finger et al, 2018). Variations in observed parenting quality predict social-emotional adjustment among children prenatally exposed to opioids (Bernstein and Hans, 1994; Sarfi et al, 2013; Finger et al, 2018), illustrating the importance of sensitive parenting in this vulnerable population
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