Clinical trials of parent training programs for substance abusing mothers have shown limited success in improving parent-child relationships or children's psychosocial adjustment. One reason parent training programs have not succeeded may be their lack of attention to emotional aspects of the parent-child relationship, especially mothers' capacity to recognize children's emotional needs within a developmental context and respond to them in an emotionally available way. Attachment research has shown that the emotional quality of the parent-child relationship is a strong predictor of child adjustment and mothers can improve bonding by learning to recognize children's emotional cues and their own emotional responses in the parenting role. Recently we piloted an intervention - Emotionally-Responsive Parenting (ERP) -for mothers in drug treatment. In a pre-pilot study with 43 primarily cocaine-dependent mothers, mothers enrolled in ERP showed (1) significant improvement in their capacity to recognize emotional states (their own and their children's, and (2) better attendance, retention, and compliance than mothers enrolled in TAU. In this study we will (1) complete a near-final therapist manual, (2) develop a therapist training program and adherence competence rating scales, (3) conduct a randomized pilot study of the ERP manual with 60 mothers of children ages 2-4 to evaluate the efficacy, feasibility, and acceptability of ERP vs. Parent Training (control), and (4) examine the impact of process and moderator variables on outcome in preparation for a larger, Stage II efficacy trial. Directly targeted outcomes will be mothers': (1) recognition of children's emotional needs and capacities, (2) capacity to monitor children's thoughts and feelings and their influence on behavior, and (3) maternal thoughts and feelings about the parenting relationship. Indirectly targeted outcomes will be mothers' (1) sensitivity and emotional availability during parenting interactions, (2) psychiatric symptoms, (3) daily functioning, (4) drug and alcohol use, and (5) children's psychosocial adjustment.
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