Quality of attachment, disorganization in attachment, and the contribution of caregiver interactions in the home were investigated for infants prenatally exposed to PCP and cocaine and their caregivers. The drug-exposed infants were compared with infants of similar ethnicity, socioeconomic status (SES), and living in the same geographical area of the city with non-substance-abusing mothers. The majority of drug-exposed infants were insecurely attached to their caregivers and did not differ in the percentage of security in the three caregiving environments in which the infants were growing up: biologic mother care, kinship care, or foster mother care. The majority of drug-exposed children were disorganized. Change in caregivers during the first year was not found to be related to the rate of insecurity in any of the caregiving environments. The majority of the non-drug-exposed comparison infants were securely attached, and only a small percentage were disorganized. The high incidence of insecurity in the drug-exposed group is discussed in relation to maternal and environmental circumstances that can alter the assumption of security in attachment for the majority of children and caregivers toward insecurity in attachment.

The relation between caregiver intrusiveness and the quality of attachment was tested among 51 prenatally drug-exposed toddlers and their primary caregivers. Biological mothers and kinship/foster caregivers neither differed as to caregiver intrusiveness nor as to their toddlers' attachment security and attachment organization. Insecure and disorganized/disoriented attachments were found to be more prevalent in this sample than in normal samples. In keeping with recent findings in non-drug-abusing samples (Isabella & Belsky, 1991; Lyons-Ruth, Repacholi, McLeod, & Silva, 1991), more caregivers of toddlers with avoidant or disorganized/disoriented attachments were found to be intrusive than caregivers of toddlers with secure or resistant attachments.

Prenatally drug-exposed toddlers were compared to preterm toddlers of similar low socioeconomic status, ethnicity, and single-parent households on intellectual functioning, quality of play, and security of attachment to the primary caregiver. The drug-exposed toddlers had significantly lower developmental scores, less representational play, and the majority had insecure, disorganized, avoidant attachments. In all areas investigated, the prenatally drug-exposed toddlers showed more subtle behavioral deficits within each domain. Although developmental quotients were within the average range, they were significantly lower than the preterm comparison group and did not adequately represent the more evident deficits seen through play in an unstructured situation. Unstructured assessments that required the child's initiation, goal setting, and follow-through were more revealing of developmental disorganization within and among domains than were adult structured assessments such as developmental tests. While modest differences were seen in structured tasks, the marked differences between the drug-exposed and preterm groups were most evident in the unstructured tasks. The lack of coherence across developmental domains was illustrated by the large difference between developmental quotient scores and the poor performance in the cognitive representional competencies demonstrated in play. Insecurity and disorganization in attachment were found to compromise further the development of the drug-exposed toddlers.

The purpose of this study is to examine the relationships among maternal psychopathology, early sensitive caregiving, and security of attachment in a sample of cocaine-using women from environments with high contextual risks that include poverty, low educational attainment, minority status, and single parenthood. Thirty-five women and their offspring participated in the study. Maternal psychopathology, including Axis I and Axis II disorders, was assessed during the prenatal period via a selfreport clinical measure. Maternal sensitivity was assessed at 1 month and 6 months postdelivery through rating scales. At 18 months postdelivery, toddlers' attachment to their mothers was assessed via the Strange Situation procedure. Also at 18 months, mothers' level of depression was assessed via a depression inventory. Maternal psychopathology during pregnancy was found to be associated with both early caregiving and attachment. Mothers demonstrating clinical levels of particular Axis II disorders provided less sensitive caregiving, and had toddlers who were more likely to be disorganized/disoriented in their attachments. For Axis I disorders, only clinical levels of prenatal dysthymia were found to be associated with a greater likelihood of secure attachment.RESUMEN: El propósito de este estudio es examinar las relaciones entre la sicopatología materna, las sensibles formas de prestar cuidado el principio, y la seguridad de la unión afectiva en un grupo-muestra de mujeres que usan cocaína y que provienen de ambientes con altos riesgos contextuales, entre los cuales se incluye la pobreza, los bajos logros educacionales, la condición de minoría étnica, y el ser madres solteras. En el estudio participaron 35 mujeres y sus niños. La sicopatología materna-trastornos de Axis I y Axis II-fue evaluada durante el período prenatal por medio de una medida clínica autodeclarativa. La sensibilidad materna fue evaluada al mes y a los seis meses del parto por medio de escalas de puntuación. A los 18 meses después del parto, la unión afectiva de los infantes para con sus madres fue evaluada por medio del procedimiento de la Situación Extraña. También a los 18 meses, se evaluó el nivel de depresión de las madres a través de un inventario apropiado para la depresión. Se determinó que la sicopatología materna durante el embarazo estaba asociada tanto con las primeras manifestaciones del cuidado como la unión afectiva. Las madres que demostraron niveles clínicos de específicos trastornos de Axis II prestaban un cuidado menos sensible y tenían infantes que estaban más propensos a la desorganización y desorientación en la unión afectiva. En cuanto a los trastornos de Axis I, sólo se encontró que los niveles clínicos de distemia estaban asociados con una mayor probabilidad de unión afectiva segura. Psychopathology and Attachments • 317RÉ SUMÉ : Le but de cette étude est d'examiner les liens entre la psychopathologie maternelle, le soin sensible très tôt apporté à l'enfant, et la sécurité de l'attachement chez un groupe de femmes adonné...

Randomized controlled trials documented effectiveness of the Legacy model over time while allowing for implementation adaptations by 2 different sites. Broadly disseminable, parent-focused prevention models such as Legacy have potential for public health impact. These investments in prevention might reduce the need for later intervention strategies.