Five years ago we were funded to develop the Mothers and Toddlers Program or MTP (R01 DA17294 / Project Period: 8/20/04 - 12/31/09). MTP is the first parenting intervention developed for substance abusing mothers that is based on the principles of attachment theory. It is also the only parenting intervention for substance abusing mothers that has led to improvement in maternal caregiving sensitivity and responsiveness to infant and toddler distress in observed lab-based interactions. We now have all the research materials we need to conduct a Stage II randomized clinical trial. Materials include: the MTP treatment manual, instructions for conducting PEP - the comparison intervention, treatment fidelity scales and manual, MTP therapist training program, outcome assessments and measures. We have also completed a randomized clinical trial - a preliminary test of the efficacy of MTP in comparison with the Parent Education Program (PEP), an individual supportive comparison intervention. Outcome data from the intention-to-treat sample of 47 randomized subjects shows that MTP led to greater improvement than PEP in all targeted parenting outcomes (capacity for reflective functioning, quality of maternal representations and caregiving behavior) and global psychiatric distress. Having met the objectives of the Stage I investigation and having evidence of MTP's feasibility and promise, we now seek to conduct a formal definitive efficacy test of MTP in a full-scale Stage II randomized trial. In the Stage II investigation, we will: (1) Introduce new measures of dyadic adjustment and child attachment, (2) Add an 18 week follow up period to test for sustained treatment effects, (3) Measure major constructs (reflective functioning, representations, dyadic adjustment, and child attachment) when they are expected to change, (4) Examine temporal mechanisms of change proposed in the MTP treatment model (5) Determine whether improvements in dyadic adjustment reduces incidence of relapse, (6) Broaden the MTP therapist pool by training four new therapists and (7) Broaden the coding pool by training 3 additional coders per measure. One hundred and fifty mothers caring for children ages 12 to 24 months of age will be recruited from outpatient substance abuse treatment services at the APT Foundation into the intention-to-treat sample and will be randomized to 12 weeks of MTP vs. PEP and followed for 33 weeks. .

Public Health Relevance

As a group, mothers with substance abuse disorders are at high risk for maladaptive parenting practices that have lasting implications for children and families --- and society, which bears much of the cost for future educational and medical services. This project aims to evaluate a parenting intervention that has shown promise for improving the parenting practices and mental health among women seeking treatment for their substance use disorders. The evaluation and dissemination of effective parenting interventions for this population has the potential to prevent the transmission of psychological and medical problems to future generations.

National Institute of Health (NIH)
National Institute on Drug Abuse (NIDA)
Research Project (R01)
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Psychosocial Development, Risk and Prevention Study Section (PDRP)
Program Officer
Chambers, Jessica Campbell
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Yale University
Schools of Medicine
New Haven
United States
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Suchman, Nancy E; DeCoste, Cindy; Castiglioni, Nicole et al. (2010) The Mothers and Toddlers Program, an attachment-based parenting intervention for substance using women: post-treatment results from a randomized clinical pilot. Attach Hum Dev 12:483-504
Suchman, Nancy E; DeCoste, Cindy; Leigh, Denise et al. (2010) Reflective functioning in mothers with drug use disorders: implications for dyadic interactions with infants and toddlers. Attach Hum Dev 12:567-85
Borelli, Jessica L; Luthar, Suniya S; Suchman, Nancy E (2010) Discrepancies in perceptions of maternal aggression: implications for children of methadone-maintained mothers. Am J Orthopsychiatry 80:412-21
Suchman, Nancy; Decoste, Cindy; Castiglioni, Nicole et al. (2008) THE MOTHERS AND TODDLERS PROGRAM: Preliminary Findings From an Attachment-Based Parenting Intervention for Substance-Abusing Mothers. Psychoanal Psychol 25:499-517
Suchman, Nancy; McMahon, Thomas; Decoste, Cindy et al. (2008) Ego development, psychopathology, and parenting problems in substance-abusing mothers. Am J Orthopsychiatry 78:20-8
Suchman, Nancy; Pajulo, Marjukka; Decoste, Cindy et al. (2006) Parenting Interventions for Drug-Dependent Mothers and Their Young Children: The Case for an Attachment-Based Approach. Fam Relat 55:211-226