Effects of prenatal exposure to cocaine in early infancy: Toxic effects on the process of mutual regulation

Abstract

In this paper, recent studies of the effects of prenatal cocaine abuse and other toxic substances on infant behavior and development during early infancy are critically reviewed. The inevitable conclusion from this review is that compromising main effects of single drugs such as cocaine on infant behavior and development have not been reliably established. It is argued that the long‐term developmental outcome of prenatally drug‐exposed infants cannot be fully understood without a thorough consideration of other confounding factors associated with prenatal drug use, such as the quality of the infant's postnatal caregiving environment. Specifically, it is argued that the infant's ability to resolve macro‐level developmental tasks during early infancy such as physiologic and behavioral state regulation, sustained face‐to‐face interaction, and joint attention to objects is primarily determined by dyadic processes at a micro‐level; namely, via the communicative and affective mutually regulated processes established over time by the exposed infant and its caregiver. Critically, these processes are affected both by the biological competence of the infant and by the protective or disruptive role of the caregiving environment. Both caregiver and infant factors associated with cocaine exposure that may disrupt the regulatory capacity of the dyad are described, and illustrations of how resulting dyadic dysregulation may preclude the infant's successful resolution of current and future developmental tasks are provided. Thus it is argued that to understand the effects of cocaine on development we must understand the process of mutual regulation of the cocaine‐exposed dyad. Des études récentes sur les effets de l'abus prénatal de cocaïne et d'autres substances toxiques sur le comportement du nourrisson et le développement durant la toute petite enfance sont examinées de manière critique dans cet article. l'inévitable conclusion à laquelle est parvenu ce travail est que certains effets majeurs compromettants de drogues comme la cocaïne sur le comportement et le développement du nourrisson n'ont pas été sérieusement établis. Nous argumentons que le résultat à long terme en matière de développement de nourrissons prénatalement exposés à la drogue en peut pas ětre complètement compris sans une considération approfondie d'autres facteurs associés a l'utilisation parentale de la drogue ainsi que la qualité de l'environnement post‐natal de mode de soin du nourrisson. De manière plus spécifique, nous argumentons que la capacité du nourrisson à résoudre des těches de développement à un macro‐niveau durant la petite enfance comme par exemple la régulation de l'état physiologique et comportemental, l'interaction těte‐à‐těte soutenue, et l'attention bilatérale à des objets est essentiellement déterminée par des processus dyadiques à un micro‐niveau; c'est‐à‐dire via les processus communicatifs et affectifs réglés mutuellement qui ont été établis au fil du temps par le nourrisson exposé et le mode de soin. Ces processus sont sévèr...

In utero drug exposure and maternal-infant interaction: The complexities of the dyad and their environment

“…Finally, chronic maternal substance use can alter the care-giving environment of the infant, which in turn can have long-term effects on child cognitive and emotional development (Cregler & Mark, 1986). Styles of parenting are determinants of the child's earliest cognitive, social, and emotional development (Beeghly & Tronick, 1994; Bornstein, 1989;Zuckerman, in press). Research studies and clinical services are therefore challenged to address the complex interaction between the biological exposure factor and the social/environmental conditions in which these infants live.…”

Patterns of mother–infant interaction from 3 to 12 months among dyads with substance abuse and psychiatric problems

“…Such difficult relational experiences might result in distorted mental representations of parenting and infant capabilities, which in turn lead to a reduced ability to display sensitive maternal behavior in mother-infant interaction, as well as trouble in interpreting and responding contingently to infant signals (Luthar & Walsh, 1995;Pajulo et al, 2012). Several socioeconomic disadvantages are also commonly associated with maternal substance abuse such as single parenthood, poverty, low education and scant social support (Beeghly & Tronick, 1994;Hans & Jeremy, 2001;Kettinger, Nair, & Schuler, 2000;Nair, Schuler, Black, Kettinger, & Harrington, 2003). Adverse factors that confound with maternal substance abuse problems may alone or collectively interfere both with the mothers' ability to be sensitive caregivers and the infants' postnatal caregiving environment.…”

“…At the same time infants born to mothers with substance abuse problems are often vulnerable due to exposure to drugs, smoking, and stress as well as other adversities during pregnancy (Beeghly & Tronick, 1994;Jansson & Velez, 2011;Moe & Slinning, 2001). This may result in a compromised birth status, as well as regulation difficulties and increased emotional reactivity in the newborn infants (Hans & Jeremy, 2001;Lester & Tronick, 1994).…”

Mutual Regulation in the Context of Inconsolable Crying: Promoting Tolerance to Distress

“…There is evidence (as summarized by Crouch, Skowronski, Milner, & Harris, 2008), that parents who perceive their infant's cries as excessive are more likely to respond abusively, however, since the majority of families with inconsolably crying infants survive these early months safe, healthy, and with secure, responsive parent-infant interactions in place, clearly there is more to consider that the frequency, duration, or intensity of the infant's cry. Parent characteristics that interfere with responsivity in the infant-parent dyad include depression, addiction, and other psychopathology that results in barriers to emotional availability, parent-child intersubjectivity, and parent self-regulation (Beeghly, & Tronick, 1994;Easterbrooks, Biesecker, & Lyons-Ruth, 2000;Kogan & Carter, 1996;Steina et al, 2010;Trevarthen & Aiteken, 2001;Tronick, 2007). Targeting parents who struggle with pathologic obstacles to adaptive dyadic function is a necessary and effective intervention strategy.…”