Search

Mothers who use substances often experience gender‐based and structural inequities that can jeopardize maternal and family wellness. Instability in the availability of services, particularly during public health crises (e.g., COVID‐19 pandemic), often results in changes in population health needs/funding/services, which may magnify experiences of disadvantage. Limited research has focused on times of change/crisis and its impact on maternal and family wellness. We examined the experiences of structural disadvantage, service access, and well‐being among mothers who use or formerly used substances during the first year of the COVID‐19 pandemic. Semi‐structured interviews were conducted with 26 mothers with current or past engagement in outpatient substance use treatment programs for pregnant and parenting women in Ontario, Canada. Transcripts were analysed using reflexive thematic analysis, revealing that instability of services and decreased access to/quality of informal and formal relationships often magnified the mental and affective toll of stressors, both pre‐existing and new. The impact on well‐being appeared to be greater for families who were actively engaged with child protective services. Findings are discussed in relation to literature examining systemic and societal factors that perpetuate gender‐based and structural inequities experienced by mothers with lived and living histories of substance use. The potential impact of changes in public health service delivery requires thoughtful and proactive attention for and by all stakeholders, including integrated attention across systems (e.g., health, social, education) that provide services to support maternal and family well‐being. [ABSTRACT FROM AUTHOR]

Background: Substance use in pregnancy raises concern given its potential teratogenic effects. Given the unique needs of parenting people and the potential impact for developing children, specialized substance use treatment programs are increasingly being implemented for this population. Substance use treatment is associated with more positive neonatal outcomes compared with no treatment, however treatment models vary limiting our understanding of key treatment components/modelsFew studies have explored the influence of treatment model type (i.e., integrated treatments designed for pregnant clients compared with standard treatment models) and no studies have examined the influence of treatment model on neonatal outcomes using Canadian data. Method: We conducted a population‐based cohort study of clients who were pregnant when initiating integrated (n = 564) and standard (n = 320) substance use treatment programs in Ontario, Canada. Results: Neonatal outcomes did not significantly differ by treatment type (integrated or standard), with rates of adverse neonatal outcomes higher than published rates for the general population, despite receipt of adequate levels of prenatal care. While this suggests no significant impact of treatment, it is notable that as a group, clients engaged in integrated treatment presented with more risk factors for adverse neonatal outcomes than those in standard treatment. While we controlled for these risks in our analyses, this may have obscured their influence in relation to treatment type. Conclusion: Findings underscore the need for more nuanced research that considers the influence of client factors in interaction with treatment type. Pregnant clients engaged in any form of substance use treatment are at higher risk of having children who experience adverse neonatal outcomes. This underscores the urgent need for further investment in services and research to support maternal and neonatal health before and during pregnancy, as well as long‐term service models that support women and children beyond the perinatal and early childhood periods. [ABSTRACT FROM AUTHOR]

Background: Integrated treatment programs (those that include on-site pregnancy-, parenting-, or child-related services with addiction services) were developed to break the intergenerational cycle of addiction, potential child maltreatment, and poor outcomes for children. Objectives: To examine the impact and effects of integrated programs for women with substance abuse issues and their children, we performed a systematic review of studies published from 1990 to 2011. Methods: Literature search strategies included online bibliographic database searches, checking printed sources, and requests to researchers. Studies were included if all participants were mothers with substance abuse problems at baseline; the treatment program included at least 1 specific substance use treatment and at least 1 parenting or child treatment service; the study design was randomized, quasi-experimental, or cohort; and there were quantitative data on child outcomes. We summarized data on child development, growth, and emotional and behavioral outcomes. Results: Thirteen studies (2 randomized trials, 3 quasi-experimental studies, 8 cohort studies; N = 775 children) were included in the review. Most studies using pre-post design indicated improvements in child development (with small to large effects, ds = 0.007-1.132) and emotional and behavioral functioning (with most available effect sizes being large, ds = 0.652-1.132). Comparison group studies revealed higher scores for infants of women in integrated programs than those not in treatment, with regard to development and most growth parameters (length, weight, and head circumference; with all available effect sizes being large, ds = 1.16-2.48). In studies comparing integrated to non-integrated programs, most improvements in emotional and behavioral functioning favored integrated programs and, where available, most effect sizes indicated that this advantage was small (ds = 0.22-0.45). Conclusions: Available evidence supports integrated programs, as findings suggest that they are associated with improvements in child development, growth, and emotional and behavioral functioning. More research is required comparing integrated to non-integrated programs. This review highlights the need for improved methodology, study quality, and reporting to improve our understanding of how best to meet the needs of children of women with substance abuse issues. (Contains 3 tables and 1 figure.)

Children with genetic syndromes offer a unique opportunity to combine genetic and environmental approaches to the study of aggression. Children with genetic syndromes associated with developmental delay are at increased risk for behavior problems, but little is known about risk and resilience factors. In this study, we examined maternal sensitivity of mothers of children with Down syndrome using home observations when their children were 2, 3, and 5 years old, and relations with maternal reports and observations of overt aggression at school at age 5. Maternal sensitivity at ages 2 and 3 years did not significantly predict child aggression at age 5, but low maternal sensitivity at age 5 was significantly related to overt aggression at both home and school. By replicating and extending earlier work, this study informs developmental theory and identifies an important maternal variable related to aggression in children with Down syndrome. (Contains 1 table.)

Across cultures, approximately one third of people with drug dependence are women of child-bearing age. There is emerging evidence regarding the effectiveness of integrating pregnancy, parenting, and child development services with addiction services. In 2007, we conducted a national survey of addiction agencies serving women to provide preliminary information on available services. Approximately one half of the program managers reported providing some type of pregnancy-, parenting-, or child-related services, the majority of which were external referrals, and very few agencies provided any services for children under 5 years. These findings indicate a gap in services in Canada. Reliable data on services for women with substance use issues and their children is essential to ensure appropriate resource allocation. Program managers reported preferring to receive practice-related research information through face-to-face contact, information which will be helpful to knowledge translation efforts.

Numerous studies show that children's language ability is related to false-belief understanding. However, there is considerable variation in the size of the correlation reported. Using data from 104 studies (N=8,891), this meta-analysis determines the strength of the relation in children under age 7 and examines moderators that may account for the variability across studies--including aspect of language ability assessed, type of false-belief task used, and direction of effect. The results indicate a moderate to large effect size overall that remains significant when age is controlled. Receptive vocabulary measures had weaker relations than measures of general language. Stronger effects were found from earlier language to later false belief than the reverse. Significant differences were not found among types of false-belief task.

A study involving four children (ages 4-7) with developmental disabilities and severe opposition behaviors found that use of reinforcement for compliance in isolation was ineffective in bringing about significant improvement in child compliance. The addition of a graduated request hierarchy appeared to be associated with substantial changes in child compliance. (Contains references.) (Author/CR)

To purchase or authenticate to the full-text of this article, please visit this link: http://dx.doi.org/10.1111/j.1467-8624.2007.01018.x Byline: Karen Milligan (1), Janet Wilde Astington (1), Lisa Ain Dack (1) Abstract: Numerous studies show that children's language ability is related to false-belief understanding. However, there is considerable variation in the size of the correlation reported. Using data from 104 studies (N=8,891), this meta-analysis determines the strength of the relation in children under age 7 and examines moderators that may account for the variability across studies-including aspect of language ability assessed, type of false-belief task used, and direction of effect. The results indicate a moderate to large effect size overall that remains significant when age is controlled. Receptive vocabulary measures had weaker relations than measures of general language. Stronger effects were found from earlier language to later false belief than the reverse. Significant differences were not found among types of false-belief task. Author Affiliation: (1)University of Toronto Article note: Correspondence concerning this article should be addressed to Karen Milligan, The Credit Valley Hospital, Child and Family Services, 2200 Eglinton Avenue W., Mississauga, ON L5M 2N1. Electronic mail may be sent to kmilligan@oise.utoronto.ca.

The universal experience of COVID-19 and its associated public health response presents an opportunity to see inequities that exist within our population when accessing community services and supports. In this article, we cast a spotlight on one group who is at risk for experiencing such inequity: women with problematic substance use who are pregnant or parenting. Motherhood offers an opportunity for development of the self, child and family and can be pivotal in helping women to address challenges they and their family may be experiencing. This is a shared opportunity and requires communities to see these families in their complexity of strengths and needs and to support them on this journey. The pandemic has uncovered inequities in our systems of care and barriers faced by families. As the pandemic situation improves, citizens and communities must resist the temptation to push aside the evidence of social disparity and challenge and engage in social action and change. This may help us to develop policies, services, and attitudes that promote well-being in equitable, accessible, and empowering ways to support rather than hinder mothers, children, and families as they work to realize their life goals. [ABSTRACT FROM AUTHOR]

Abstract Background Implementation of evidence-based practices in real-world settings is a complex process impacted by many factors, including intervention, dissemination, service provider, and organizational characteristics. Efforts to improve knowledge translation have resulted in greater attention to these factors. Researcher attention to the applicability of findings to applied settings also has increased. Much less attention, however, has been paid to intervention feasibility, an issue important to applied settings. Methods In a systematic review of 121documents regarding integrated treatment programs for women with substance abuse issues and their children, we examined the presence of feasibility-related information. Specifically, we analysed study descriptions for information regarding feasibility factors in six domains (intervention, practitioner, client, service delivery, organizational, and service system). Results On average, fewer than half of the 25 feasibility details assessed were included in the documents. Most documents included some information describing the participating clients, the services offered as part of the intervention, the location of services, and the expected length of stay or number of sessions. Only approximately half of the documents included specific information about the treatment model. Few documents indicated whether the intervention was manualized or whether the intervention was preceded by a standardized screening or assessment process. Very few provided information about the core intervention features versus the features open to local adaptation, or the staff experience or training required to deliver the intervention. Conclusions As has been found in reviews of intervention studies in other fields, our findings revealed that most documents provide some client and intervention information, but few documents provided sufficient information to fully evaluate feasibility. We consider possible explanations for the paucity of feasibility information and provide suggestions for better reporting to promote diffusion of evidence-based practices.

Abstract Background Integrated treatment programs (those that include on-site pregnancy-, parenting-, or child-related services with addiction services) were developed to break the intergenerational cycle of addiction, dysfunctional parenting, and poor outcomes for mothers and children, yet there has been no systematic review of studies of parenting outcomes. Objectives As part of larger systematic review to examine the effectiveness of integrated programs for mothers with substance abuse issues, we performed a systematic review of studies published from 1990 to 2011 with data on parenting outcomes. Methods Literature search strategies included online bibliographic database searches, checking printed sources, and requests to researchers. Studies were included if all participants were mothers with substance abuse problems at baseline, the treatment program included at least one specific substance use treatment and at least one parenting or child service, and there were quantitative data on parenting outcomes. We summarized data on parenting skills and capacity outcomes. Results There were 24 cohort studies, 3 quasi-experimental studies, and 4 randomized trials. In the three randomized trials comparing integrated programs to addiction treatment-as-usual (N = 419), most improvements in parenting skills favored integrated programs and most effect sizes indicated that this advantage was small, ds = -0.02 to 0.94. Results for child protection services involvement did not differ by group. In the three studies that examined factors associated with treatment effects, parenting improvements were associated with attachment-based parenting interventions, children residing in the treatment facility, and improvements in maternal mental health. Conclusions This is the first systematic review of studies evaluating the effectiveness of integrated programs on parenting. The limited available evidence supports integrated programs, as findings suggest that they are associated with improvements in parenting skills. However, more research is required comparing integrated programs to addiction treatment-as-usual. This review highlights the need for improved methodology, study quality, and reporting to improve our understanding of how best to meet the parenting needs of women with substance abuse issues.

Abstract Background The rate of women with substance abuse issues is increasing. Women present with a unique constellation of risk factors and presenting needs, which may include specific needs in their role as mothers. Numerous integrated programs (those with substance use treatment and pregnancy, parenting, or child services) have been developed to specifically meet the needs of pregnant and parenting women with substance abuse issues. This synthesis and meta-analysis reviews research in this important and growing area of treatment. Methods We searched PsycINFO, MedLine, PubMed, Web of Science, EMBASE, Proquest Dissertations, Sociological Abstracts, and CINAHL and compiled a database of 21 studies (2 randomized trials, 9 quasi-experimental studies, 10 cohort studies) of integrated programs published between 1990 and 2007 with outcome data on maternal substance use. Data were summarized and where possible, meta-analyses were performed, using standardized mean differences (d) effect size estimates. Results In the two studies comparing integrated programs to no treatment, effect sizes for urine toxicology and percent using substances significantly favored integrated programs and ranged from 0.18 to 1.41. Studies examining changes in maternal substance use from beginning to end of treatment were statistically significant and medium sized. More specifically, in the five studies measuring severity of drug and alcohol use, the average effect sizes were 0.64 and 0.40, respectively. In the four cohort studies of days of use, the average effect size was 0.52. Of studies comparing integrated to non-integrated programs, four studies assessed urine toxicology and two assessed self-reported abstinence. Overall effect sizes for each measure were not statistically significant (d = -0.09 and 0.22, respectively). Conclusions Findings suggest that integrated programs are effective in reducing maternal substance use. However, integrated programs were not significantly more effective than non-integrated programs. Policy implications are discussed with specific attention to the need for funding of high quality randomized control trials and improved reporting practices.

Abstract Background There is a need for services that effectively and comprehensively address the complex needs of women with substance use issues and their children. A growing body of literature supports the relevance of integrated treatment programs that offer a wide range of services in centralized settings. Quantitative studies suggest that these programs are associated with positive outcomes. A qualitative meta-synthesis was conducted to provide insight into the processes that contribute to recovery in integrated programs and women's perceptions of benefits for themselves and their children. Methods A comprehensive search of published and unpublished literature to August 2009 was carried out for narrative reports of women's experiences and perceptions of integrated treatment programs. Eligibility for inclusion in the meta-synthesis was determined using defined criteria. Quality assessment was then conducted. Qualitative data and interpretations were extracted from studies of adequate quality, and were synthesized using a systematic and iterative process to create themes and overarching concepts. Results A total of 15 documents were included in the meta-synthesis. Women experienced a number of psychosocial processes during treatment that played a role in their recovery and contributed to favourable outcomes. These included: development of a sense of self; development of personal agency; giving and receiving of social support; engagement with program staff; self-disclosure of challenges, feelings, and past experiences; recognizing patterns of destructive behaviour; and goal setting. A final process, the motivating presence of children, sustained women in their recovery journeys. Perceived outcomes included benefits for maternal and child well-being, and enhanced parenting capacity. Conclusion A number of distinct but interconnected processes emerged as being important to women's addiction recovery. Women experienced individual growth and transformative learning that led to a higher quality of life and improved interactions with their children. The findings support the need for programs to adopt practices that focus on improving maternal health and social functioning in an environment characterized by empowerment, safety, and connections. Women's relationships with their children require particular attention as positive parenting practices and family relationships can alter predispositions toward substance use later in life, thereby impacting favourably on the cycle of addiction and dysfunctional parenting.

Objective: Youth with ADHD and comorbid anxiety (ADHD+ANX) experience increased social and academic impairment compared with youth with ADHD without anxiety (ADHD). Group differences in attentional and impulse control may underlie this increased impairment. Examination of group differences using behavioral measures of attentional and impulse control has yielded inconsistent findings. This study explored group differences using event-related potentials (ERPs), which provide neural information concerning early information processing. Method: ERPs (early frontal positivity [EFP], N2) were collected while youth aged 11 to 17 with ADHD (n = 31) and ADHD+ANX (n = 35) completed a visual and an auditory computer task. Results: Compared with the ADHD group, the ADHD+ANX group exhibited larger N2 amplitudes to no-go stimuli and larger EFP amplitudes to target auditory stimuli, with variable attention allocation to nontarget stimuli. Conclusion: The addition of anxiety to ADHD appears to alter early attentional processing, which may be an important aspect of this comorbidity. [ABSTRACT FROM AUTHOR]

Women with problematic substance use are frequently referred to interventions to promote positive parenting. Parenting interventions that attend to the unique risks faced by this population may enhance engagement and outcomes. While reviews of extant parenting interventions in the research literature have been undertaken, no studies have examined parenting interventions being implemented in community practice and the extent to which these are informed by current research. We systematically compared parenting interventions offered in 12 maternal substance use treatment programs in one Canadian province with those described in the research literature (K = 21). Few parenting interventions were replicated, either within or across the two samples. However, parenting interventions within both samples were largely similar in their objectives. Across both research and community samples, approximately half of the interventions were developed or adapted for a problematic substance use population. Parenting knowledge, psychosocial risk, and maternal emotional regulation were most commonly addressed. Risks pertaining to the impact of drug craving and substance-related changes in neurobiology associted with parenting were less commonly addressed. Findings highlight current strengths and limitations of parenting interventions within research and community settings, with recommendations offered for future research and knowledge translation. [ABSTRACT FROM AUTHOR]

Objective: Fetal alcohol spectrum disorders (FASD) and Attention-Deficit/Hyperactivity Disorder (ADHD) are associated with a range of neurocognitive impairments. Executive functioning deficits are a hallmark feature of both disorders. Method: The present meta-analysis was undertaken to disentangle the behavioral phenotype of FASD and ADHD by quantitatively differentiating executive functioning differences between these two groups. The current meta-analysis reviews 15 studies comparing children and adolescents with FASD and ADHD to typically developing (TD) samples, on a variety of executive function measures. Results: Results indicate that when compared with TD samples, FASD and ADHD samples demonstrate significant executive function deficits (d = 0.82 and d = 0.55, respectively). In addition, FASD samples experience significantly greater deficits when compared with ADHD samples (d = 0.25). Results were moderated by IQ and socioeconomic status. Conclusion: These findings further our understanding of the cognitive differences between FASD and ADHD samples and have the potential to influence future basic research, assessment, and intervention. [ABSTRACT FROM AUTHOR]