Behavioral Control Dynamics and Developmental Outcomes in Infants Prenatally Exposed to Cocaine
Abstract: This study longitudinally examined the associations between mother-infant interactions at 15 months and behavioral and cognitive outcomes at 36 months of age in a sample of at-risk, young children. Participants for the current study were 58 infants/toddlers prenatally exposed to cocaine and their maternal caregivers. These infants were from a low socioeconomic status background and were part of an intervention setting. When the children were 12, 15, and 36 months, they participated in research sessions with th… Show more
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Psychosocial, pharmacological, and legal interventions for improving the psychosocial outcomes of children with substance misusing parents: A systematic review
BackgroundParental substance misuse is a pervasive risk factor for a range of detrimental outcomes for children across the life course. While a variety of interventions have been developed for this population, the existing evidence‐base requires consolidation and consideration of the comparative effectiveness of different interventions to facilitate evidence‐informed decisions between different intervention approaches.ObjectivesThis review aimed to use network meta‐analysis to synthesise the comparative effectiveness of psychosocial, legal, and pharmacological interventions for improving outcomes for children with substance misusing parents. Network meta‐analysis was not possible; however, we synthesised the effects of a broad range of interventions on child psychosocial outcomes. Another aim was to examine potential moderators of the effects, yet this was also not possible due to data limitations. A secondary objective was to qualitatively synthesise economic, treatment completion, and treatment acceptability information for included studies.Search MethodsSearches were performed in November 2020 and again in April 2021. Encompassing multiple disciplines, we searched 34 databases, 58 grey literature repositories, and 10 trial registers. Supplementary hand searches were conducted on 11 journals, along with harvesting the references of all included studies and existing reviews, and forward citation searching each report of all included studies. Study authors were contacted to obtain missing data.Selection CriteriaEligible studies included randomised and quasi‐experimental evaluations of psychosocial, pharmacological, and/or legal interventions using either a placebo, no treatment, waitlist control, treatment‐as‐usual, or alternative treatment as a comparison condition. Study participants needed to be comprised of families with children under the age of 18 with one or more currently substance‐misusing parents (or caregivers). Studies were required to evaluate the eligible intervention using a child‐focused psychosocial outcome. If reported in eligible studies, the following secondary outcomes were also synthesised in the review: cost‐effectiveness, treatment completion, length of time in treatment and acceptability of treatment (e.g., participant perspectives of the intervention). There were no restrictions placed on publication status or geographic location, however only research written in English was included.Data Collection and AnalysisStandard methodological procedures were followed across all stages of the review, as guided by the published protocol for the review (Eggins et al., 2020). Due to the inability to conduct network meta‐analyses, random effects pairwise meta‐analyses with inverse variance were used to synthesise effects when two or more studies with conceptually similar interventions and outcomes were available. Results of the meta‐analyses are displayed in forest plots, and separate analyses are provided for conceptually distinct outcomes and time‐points of measurement. Sensitivity analyses are used to explore possible sources of heterogeneity in the absence of sufficient studies to conduct subgroup analyses.Main Results99 studies (reported in 231 documents) met review inclusion criteria, encompassing 22,213 participants. Most studies were conducted in the United States (k = 76), almost half were randomised controlled trials (k = 46), and the most common comparator was treatment‐as‐usual (k = 50). Interventions were evaluated using a large range of child psychosocial outcomes which broadly fell under: (a) child welfare; (b) child development; (c) child emotional and behavioural; and (d) educational domains. Intervention models were rarely only legal or pharmacological in nature, with most studies evaluating integrated psychosocial treatments with either pharmacology, coordinated health care, case‐management, and/or judicial or child welfare oversight and coordination. Thirty‐six meta‐analyses and 227 single effect sizes were used to appraise the effectiveness of included interventions, based on 68 studies with sufficient data for effect size calculation. The size and direction of the effects varied across interventions, type of outcomes, and time‐point of measurement. Twenty‐seven meta‐analyses and 186 single effect sizes suggested null effects. Only five single effect size estimates based on three studies indicated negative effects including: higher depressive and somatisation symptoms (parent‐report), hopelessness (child‐report), educational achievement difficulties (parent‐report), and substantiated child protection reports for those engaged with interventions versus treatment‐as‐usual or no treatment. Nine meta‐analyses and 36 single study effect estimates suggest that psychosocial, pharmacological and/or legal interventions have a positive effect on a range of specific child welfare, developmental, and emotional/behavioural outcomes for children. The risk of bias varied across domains and studies, which further lowers confidence in the results. Based on a subset of included studies, treatment completion tends to vary, yet cost‐benefits can be achieved when intervening with children whose parents misuse substances.Authors' ConclusionsDespite a large body of evaluation evidence, disparate outcomes, and missing data precluded analyses to formally examine the comparative effectiveness of psychosocial, legal, and pharmacological interventions for improving outcomes for children with substance misusing parents. The large amount of unreported (missing) data meant that many effect estimates were underpowered due to single studies and small sample sizes. The review findings suggest that interventions for families affected by parental substance misuse can be effective when they holistically address multiple domains such as parent wellbeing/mental health, parenting, children's wellbeing, and/or other factors impacting family wellbeing (e.g., housing).
Psychosocial, pharmacological, and legal interventions for improving the psychosocial outcomes of children with substance misusing parents: A systematic review
BackgroundParental substance misuse is a pervasive risk factor for a range of detrimental outcomes for children across the life course. While a variety of interventions have been developed for this population, the existing evidence‐base requires consolidation and consideration of the comparative effectiveness of different interventions to facilitate evidence‐informed decisions between different intervention approaches.ObjectivesThis review aimed to use network meta‐analysis to synthesise the comparative effectiveness of psychosocial, legal, and pharmacological interventions for improving outcomes for children with substance misusing parents. Network meta‐analysis was not possible; however, we synthesised the effects of a broad range of interventions on child psychosocial outcomes. Another aim was to examine potential moderators of the effects, yet this was also not possible due to data limitations. A secondary objective was to qualitatively synthesise economic, treatment completion, and treatment acceptability information for included studies.Search MethodsSearches were performed in November 2020 and again in April 2021. Encompassing multiple disciplines, we searched 34 databases, 58 grey literature repositories, and 10 trial registers. Supplementary hand searches were conducted on 11 journals, along with harvesting the references of all included studies and existing reviews, and forward citation searching each report of all included studies. Study authors were contacted to obtain missing data.Selection CriteriaEligible studies included randomised and quasi‐experimental evaluations of psychosocial, pharmacological, and/or legal interventions using either a placebo, no treatment, waitlist control, treatment‐as‐usual, or alternative treatment as a comparison condition. Study participants needed to be comprised of families with children under the age of 18 with one or more currently substance‐misusing parents (or caregivers). Studies were required to evaluate the eligible intervention using a child‐focused psychosocial outcome. If reported in eligible studies, the following secondary outcomes were also synthesised in the review: cost‐effectiveness, treatment completion, length of time in treatment and acceptability of treatment (e.g., participant perspectives of the intervention). There were no restrictions placed on publication status or geographic location, however only research written in English was included.Data Collection and AnalysisStandard methodological procedures were followed across all stages of the review, as guided by the published protocol for the review (Eggins et al., 2020). Due to the inability to conduct network meta‐analyses, random effects pairwise meta‐analyses with inverse variance were used to synthesise effects when two or more studies with conceptually similar interventions and outcomes were available. Results of the meta‐analyses are displayed in forest plots, and separate analyses are provided for conceptually distinct outcomes and time‐points of measurement. Sensitivity analyses are used to explore possible sources of heterogeneity in the absence of sufficient studies to conduct subgroup analyses.Main Results99 studies (reported in 231 documents) met review inclusion criteria, encompassing 22,213 participants. Most studies were conducted in the United States (k = 76), almost half were randomised controlled trials (k = 46), and the most common comparator was treatment‐as‐usual (k = 50). Interventions were evaluated using a large range of child psychosocial outcomes which broadly fell under: (a) child welfare; (b) child development; (c) child emotional and behavioural; and (d) educational domains. Intervention models were rarely only legal or pharmacological in nature, with most studies evaluating integrated psychosocial treatments with either pharmacology, coordinated health care, case‐management, and/or judicial or child welfare oversight and coordination. Thirty‐six meta‐analyses and 227 single effect sizes were used to appraise the effectiveness of included interventions, based on 68 studies with sufficient data for effect size calculation. The size and direction of the effects varied across interventions, type of outcomes, and time‐point of measurement. Twenty‐seven meta‐analyses and 186 single effect sizes suggested null effects. Only five single effect size estimates based on three studies indicated negative effects including: higher depressive and somatisation symptoms (parent‐report), hopelessness (child‐report), educational achievement difficulties (parent‐report), and substantiated child protection reports for those engaged with interventions versus treatment‐as‐usual or no treatment. Nine meta‐analyses and 36 single study effect estimates suggest that psychosocial, pharmacological and/or legal interventions have a positive effect on a range of specific child welfare, developmental, and emotional/behavioural outcomes for children. The risk of bias varied across domains and studies, which further lowers confidence in the results. Based on a subset of included studies, treatment completion tends to vary, yet cost‐benefits can be achieved when intervening with children whose parents misuse substances.Authors' ConclusionsDespite a large body of evaluation evidence, disparate outcomes, and missing data precluded analyses to formally examine the comparative effectiveness of psychosocial, legal, and pharmacological interventions for improving outcomes for children with substance misusing parents. The large amount of unreported (missing) data meant that many effect estimates were underpowered due to single studies and small sample sizes. The review findings suggest that interventions for families affected by parental substance misuse can be effective when they holistically address multiple domains such as parent wellbeing/mental health, parenting, children's wellbeing, and/or other factors impacting family wellbeing (e.g., housing).
This study examined the role of maternal psychopathology and maternal warmth as mediators of the association between prenatal cocaine and other substance exposure and toddler behavior problems. It was also hypothesized that infant cortisol reactivity and environmental risk may moderate these associations. Participants were 220 caregiver–infant dyads (119 cocaine exposed, 101 not cocaine exposed; 49% boys). Mother–infant dyads were recruited at delivery with assessments at 4–8 weeks and 7, 13, and 18 months of child ages. Results yielded no direct associations between prenatal cocaine/other substance exposure and toddler behavior problems, but significant indirect associations between prenatal cigarette/alcohol exposure and toddler behavior problems at 18 months. With regard to moderation, results indicated an indirect association between prenatal cocaine exposure and toddler behavior problems via lower maternal warmth for children with higher, but not lower, cortisol reactivity at 7 months. Results suggest potential pathways to toddler behavior problems among children at high biological risk.
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