Prenatal substance exposure and mother-child separations: A cumulative risk model

This study examined developmental outcomes of substance-exposed children using a cumulative risk model in a sample of 55 mother-child dyads. The first objective was to provide an in-depth description of the pre- and postnatal caregiving environment of children who have substance-using mothers. It was hypothesized that the profile would describe children who live in multi-risk, multi-stressed contexts. The children presented here experienced risk in the prenatal environment through exposure to drugs and alcohol and in the postnatal environment through intergenerational cycles of poverty, trauma, psychopathology, and substance use. The second objective was to examine the association of mother-child separations with children's development and to explore the level of cumulative risk in the pre- and postnatal caregiving environment in this relationship, as it was hypothesized to be a moderator. The results indicated that when cumulative risk within the caregiving environment is high (5–9 risk factors) and there are frequent mother-child separations, children may be better supported and protected in alternate care situations as child development outcomes were higher in these cases. There was no relationship between separations and child development outcomes for the low-risk group; however, level of cumulative risk did not moderate the relationship between the variables. The third objective was to explore the association of the quality of mother-child interactions with children's development and to describe the role of mother-child separations in this relationship, as it was hypothesized to be a moderator. A moderating relationship was established; within the low-separations group, high quality mother-child interactions were related to high developmental outcome scores. There was no significant relationship between the quality of mother-child interactions and child development outcomes in the high-separations group. This result suggested that when children have fewer than 30 days of separations from their mothers and that interactions within the dyad are positive, child development outcomes can be fostered. Clinical implications in regards to a multi-systemic intervention for these mothers and children were discussed.