This paper explores the parenting of drug-dependent women and the contributions of comorbid psychopathology to their parenting. A sample of 32 children whose mothers were dependent on opioid drugs during pregnancy and 37 children whose mothers were not drug users were followed from birth to middle childhood. Multivariate regression analyses were conducted contrasting whether maternal substance abuse or psychopathology was more closely linked to parenting behaviors and continuity in parenting over time. Maternal drug dependence was related to whether mothers were able to remain primary caregivers for their children over time, even after controlling for psychopathology. Maternal drug use was related to unresponsive and negative parenting behavior during mother–infant interaction, but this relation was largely accounted for by the effects of comorbid maternal psychopathology on parenting, particularly symptoms of antisocial and related personality disorders. For those children whose mothers continued to care for them into middle childhood, perceptions of their mothers as rejecting were related to maternal antisocial personality and maternal depression. Substance-abuse treatment for women should be integrated with interventions addressing their mental health and parenting needs.

OBJECTIVES: Despite recent efforts to increase breastfeeding, young African American mothers continue to breastfeed at low rates, and commonly introduce complementary foods earlier than recommended. This study examines the effects of a community doula home visiting intervention on infant feeding practices among young mothers.METHODS: Low-income, African American mothers (n = 248) under age 22 years participated in a randomized trial of a community doula intervention. Intervention-group mothers received services from paraprofessional doulas: specialized home visitors trained as childbirth educators and lactation counselors. Doulas provided home visits from pregnancy through 3 months postpartum, and support during childbirth. Control-group mothers received usual prenatal care. Data were obtained from medical records and maternal interviews at birth and 4 months postpartum.RESULTS: Intent-to-treat analyses showed that doula-group mothers attempted breastfeeding at a higher rate than control-group mothers (64% vs 50%; P = .02) and were more likely to breastfeed longer than 6 weeks (29% vs 17%; P = .04), although few mothers still breastfed at 4 months. The intervention also impacted mothers' cereal/solid food introduction (P = .008): fewer doula-group mothers introduced complementary foods before 6 weeks of age (6% vs 18%), while more waited until at least 4 months (21% vs 13%) compared with control-group mothers.CONCLUSIONS: Community doulas may be effective in helping young mothers meet breastfeeding and healthy feeding guidelines. The intervention' s success may lie in the relationship that develops between doula and mother based on shared cultural background and months of prenatal home visiting, and the doula' s presence at the birth, where she supports early breastfeeding experiences. Pediatrics 2013;132: S160-S166

Doulas, whose traditional role is to support women during labor and delivery, are being increasingly utilized within community-based programs where a primary goal is supporting mother-infant relationships. The present study investigated the effect of doula services on parenting among young, low-income mothers. A total of 248 pregnant women were randomly assigned to receive either doula services or routine medical and social services. The doulas provided prenatal home visitation, support during labor and delivery, and 3 months of postpartum home visitation. Parenting was assessed through video recordings of mother-infant interaction at 4, 12, and 24 months of child age and maternal report of parenting attitudes and stress. Intent-to-treat analyses showed that mothers who had received doula services endorsed more child-centered parenting values, showed more positive engagement with their infants, and were more likely to respond to infant distress at 4 months. Their infants were less likely to show visible upset during observed interactions. Most effects of the program on parent and child behavior faded over time. Community doula intervention is a promising practice for supporting parenting and parent-infant interaction. Integration of doulas into longer term home-visiting models might sustain the early impact of doula services and enhance parenting services offered by traditional home-visiting programs.

The purpose of this longitudinal study was to examine changes in young mothers' depressive symptoms from pregnancy through the first two postpartum years and how supportive relationships with key individuals were related to mothers' depressive symptoms over time. Data were collected from young, low-income African American mothers (N = 248) during pregnancy and at 4, 12, and 24 months postpartum. Hierarchical Linear Modeling (HLM) analyses revealed that depressive symptoms were highest during pregnancy and declined through 24 months postpartum. Supportive relationships with the father of the baby and the mother's parent figure were related to lower levels of depressive symptoms. Although the association between father support and the mother's depressive symptoms remained consistent over time, support from the parent figure became increasingly more important during the young mother's transition to parenting. Further analyses also revealed that the association between support and depressive symptoms depended on other aspects of these relationships. Greater support from the baby's father was only related to fewer depressive symptoms for mothers who were partnered with the father of the baby. Greater support from the parent figure was only related to fewer depressive symptoms for mothers who were coresiding with the parent. Finally, having a repeat pregnancy during the early postpartum years was related to higher levels of depressive symptoms during the subsequent pregnancy. These findings suggest that screening and interventions for depression in young mothers should begin during pregnancy and include a focus on her proximal social relationships.

Investigations of the childhood antecedents of adult schizophrenia may clarify our understanding of the etiology of the disease, provide guidelines for meaningful classification of subtypes of schizophrenic illness, point to strategies for identifying those individuals in need for early intervention, and suggest appropriate techniques for early intervention. Among the more salient characteristics of schizophrenic illness are disturbances in interpersonal relations, especially withdrawal from normal social interaction.