Social and emotional functioning in infants prenatally exposed to drugs: use of a semi-structured interview

Authors: Kathleen A. Platzman, Claire Coles, Kim Bard, Josephine Brown, and Mary Ellen Lynch

Prenatal exposure to drugs is associated with many conditions known to place a child at risk for developmental, social and emotional difficulties such as disease, prematurity, sub-optimal caretaking, poverty, exposure to violence, neglect, and maternal psychopathology. Our study, "The Maternal Substance Abuse Project", focused on developmental functioning in infants prenatally exposed to alcohol, cocaine, marijuana, and/or tobacco. We looked at several aspects of the physical, social and emotional world of infants in the first two years of life. We tested infants and mothers/caretakers, and observed infants while they played, ate, and interacted with mothers/caretakers and project staff.

One question we addressed was whether we could gather information about infants’ lives through the use of a semi-structured interview of the mothers/caretakers. The interview we developed was based on theoretical perspectives, diagnostic criteria, and our own clinical knowledge and experience with women who abuse drugs prenatally. Our ultimate goals were to create a reliable and systematic way of ascertaining infants’ functioning through interview with mothers/caretakers, and to provide a rich description and understanding of several aspects of infants’ lives. Within this interview we asked questions about the caregiving environment, family structure, paternal/male involvement, continuity of caretaking, sleeping/eating habits, social/emotional status, activity level, caretaker concerns, and health/medical care. Several of the answers from this instrument were grouped into cluster scores in five areas (Caregiving Instability/Inadequacy, Caregiver Routine, Self-Regulation, Feeding and Sleeping).

Drug-exposed infants differed from non-exposed infants along several lines:

Drug-using mothers tended to be older and more impoverished than non-users. Drug exposed infants had less optimal scores on the Caregiver Instability Cluster (e.g. no necessary baby supplies, frequent separations from the caretaker.) And on the Sleeping Cluster (e.g. frequent night wakings, irregular sleeping schedule). There was also a drug effect for the Feeding Cluster (e.g. no regular eating schedule, possible eating disorder), which interacted with the age of the infant, with drug-exposed infants experiencing more problematic feeding situations at the age of two, but not before.

Based on this study, we feel that interviewing caretakers’ of prenatally exposed infants can offer important insights into the quality of their lives. Furthermore, it offers an important avenue into understanding where difficulties are, and ultimately where and how these young families can be supported and helped.