This proposal will continue following the mother/child dyads recruited into the original study, until the children reach age 7 years.
The specific aims of this proposal is two fold: 1. To evaluate the long term effects of the early maternal/child intervention, on maternal functioning & child development. 2. To assess the effect of fetal drug exposure & post partum environment on child development and behavior. In the initial study we hypothesized that a comprehensive intervention based on a transactional theory which addresses psychosocial issues, functional skills and parenting skills would enhance maternal self esteem, maternal effectiveness, and use of social supports, leading to improved maternal infant attachment, improved infant development and decreased maternal substance use. 296 substance abusing women were recruited, over a 40 month period, from the obstetrical and neonatal services of Univ. of Md. Hospital. 265/296 kept the 2 week postpartum appointment and were randomly assigned to either the intervention or control group. Families recruited into the study group received an in home intervention, weekly 1-6 months, biweekly 7-12 months and monthly for the next 3 years. From 12 to 24 months mothers & infants participated 2 days a week at a community parent support center. To prevent attrition monthly tracking was maintained by an outreach worker for the control group. 225/265 (85%) of the children in the cohort have remained active in the study, and we have longitudinal developmental, health, growth and behavior data on these children and social and drug use history on their mothers. As of January 1998 the children will range in age from 30-70 months. The longitudinal prospective data on mothers include: drug use, treatment readiness, entrance into treatment, maternal depression, parenting stress, child abuse potential, and repeat pregnancy. To be able to separate the effects of fetal drug exposure from environmental factors, a comparison group of 100 five year old children and their mothers will be recruited over a 3 year period, matched to the drug exposed children (Age, sex, race, maternal age and residence) and administered the same tests as the study population at 5 and 7 years of age. If an early parent/child intervention for drug abusing women can improve their health and psychosocial functioning and also reduce adverse consequences to their children, it would help in future planning for services for these high risk families.
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