Multiple interventions have been developed to improve the caregiver–child relationship as a buffer to the effects of early life adversity and toxic stress. However, relatively few studies have evaluated the long-term effects of these early childhood interventions, particularly on parenting and childhood behaviors. Here we describe the early school-age follow-up results of a randomized controlled trial of Minding the Baby ® (MTB), a reflective, attachment-based, trauma-informed, preventive home-visiting intervention for first-time mothers and their infants. Results indicate that mothers who participated in MTB are less likely to show impaired mentalizing compared to control mothers two to eight years after the intervention ended. Additionally, MTB mothers have lower levels of hostile and coercive parenting, and their children have lower total and externalizing problem behavior scores when compared to controls at follow-up. We discuss our findings in terms of their contribution to understanding the long-term parenting and childhood socio-emotional developmental effects of early preventive interventions for stressed populations.

In this article, we describe the results of the second phase of a randomized controlled trial of Minding the Baby (MTB), an interdisciplinary reflective parenting intervention for infants and their families. Young first-time mothers living in underserved, poor, urban communities received intensive home visiting services from a nurse and social worker team for 27 months, from pregnancy to the child's second birthday. Results indicate that MTB mothers' levels of reflective functioning was more likely to increase over the course of the intervention than were those of control group mothers. Likewise, infants in the MTB group were significantly more likely to be securely attached, and significantly less likely to be disorganized, than infants in the control group. We discuss our findings in terms of their contribution to understanding the impacts and import of intensive intervention with vulnerable families during the earliest stages of parenthood in preventing the intergenerational transmission of disrupted relationships and insecure attachment.

Mothers with histories of alcohol and drug addiction have shown greater difficulty parenting young children than mothers with no history of substance misuse. This study was the second randomized clinical trial testing the efficacy of Mothering From the Inside Out (MIO), a 12-week mentalization-based individual therapy designed to address psychological deficits commonly associated with chronic substance use that also interfere with the capacity to parent young children. Eighty-seven mothers caring for a child between 11 and 60 months of age were randomly assigned to receive 12 sessions of MIO versus 12 sessions of parent education (PE), a psychoeducation active control comparison. Maternal reflective functioning, representations of caregiving, mother–child interaction quality, and child attachment were evaluated at baseline and posttreatment and 3-month follow-up. Mother–child interaction quality was assessed again at 12-month follow-up. In comparison with PE mothers, MIO mothers demonstrated a higher capacity for reflective functioning and representational coherence at posttreatment and 3-month follow-up. At 12-month follow-up, compared to PE cohorts, MIO mothers demonstrated greater sensitivity, their children showed greater involvement, and MIO dyads showed greater reciprocity. As addiction severity increased, MIO also appeared to serve as a protective factor for maternal reflective functioning, quality of mother–child interactions, and child attachment status. Results demonstrate the promise of mentalization-based interventions provided concomitant with addiction treatment for mothers and their young children.

Prenatal cocaine exposure may affect developing stress response systems in youth, potentially creating risk for substance use in adolescence. Further, pathways from prenatal risk to future substance use may differ for girls versus boys. The present longitudinal study examined multiple biobehavioral measures, including heart rate, blood pressure, emotion, and salivary cortisol and salivary alpha amylase (sAA), in response to a stressor in 193 low-income 14- to 17-year-olds, half of whom were prenatally cocaine exposed (PCE). Youth's lifetime substance use was assessed with self-report, interview, and urine toxicology/breathalyzer at Time 1 and at Time 2 (6–12 months later). PCE × Gender interactions were found predicting anxiety, anger, and sadness responses to the stressor, with PCE girls showing heightened responses as compared to PCE boys on these indicators. Stress Response × Gender interactions were found predicting Time 2 substance use in youth (controlling for Time 1 use) for sAA and sadness; for girls, heightened sadness responses predicted substance use, but for boys, dampened sAA responses predicted substance use. Findings suggest distinct biobehavioral stress response risk profiles for boys and girls, with heightened arousal for girls and blunted arousal for boys associated with prenatal risk and future substance use outcomes.

This study investigated relations between drug exposure, particularly cocaine, and infants' regulation of arousal in response to novelty. Sixty-three infants — 36 cocaine exposed and 27 non-cocaine exposed — participated at 3 months of age in a novel-repeat stimulus presentation procedure. Arousal was operationalized in terms of infant behavioral state, affective expressiveness, and attention to the stimulus. Infants were tested and infant behaviors were scored by experimenters blind to the drug exposure status of the infant. There were no differences between the two groups in baseline behavioral state or affective expression before the presentation of novel stimuli. Compared to the non-cocaine-exposed group, infants exposed prenatally to cocaine and other drugs were more likely to exhibit a crying state and to display negative affect on novel stimulus presentations. There were no group differences in the amount of looking toward the stimulus. Both groups showed less crying and negative affect when stimuli were presented a second time, but decrements were consistently greater for the cocaine-exposed group. These results obtained when group differences were controlled for sociodemographic and perinatal variables. Sources of differences in the regulation of arousal in cocaine-exposed and non-cocainc-exposed infants are discussed, and impairments in the regulation of arousal in cocaine-exposed infants are considered in a framework of predictive implications for children's social and cognitive development.

Gaze behavior was assessed in 20 autistic individuels and in an age- and mental-age-matched mentally retarded control group. A time-sample technique was used to collect frequency of gaze directed at staff, at task, and elsewhere (at other) in familiar educational settings as subjects interacted with familiar staff and engaged in familiar educational activities. Gaze behaviors were sampled in each of three interactional conditions defined by staff-subject ratio. Significant effects of the intensity of the interactional condition were observed for both groups. Overall autistic subjects were more likely to look elsewhere than the matched control cases and looked less at staff during one-to-one interaction. Relationships to age, developmental level, and other measures are discussed.