title: Cumulative environmental risk in substance abusing women: early intervention, parenting stress, child abuse potential and child development.
abstract: OBJECTIVE
  To assess the relationship between cumulative environmental risks and early intervention, parenting attitudes, potential for child abuse and child development in substance abusing mothers.
  
  
  METHODS
  We studied 161 substance-abusing women, from a randomized longitudinal study of a home based early intervention, who had custody of their children through 18 months. The intervention group received weekly home visits in the first 6 months and biweekly visits from 6 to 18 months. Parenting stress and child abuse potential were assessed at 6 and 18 months postpartum. Children's mental and motor development (Bayley MDI and PDI) and language development (REEL) were assessed at 6, 12, and 18 months postpartum. Ten maternal risk factors were assessed: maternal depression, domestic violence, nondomestic violence, family size, incarceration, no significant other in home, negative life events, psychiatric problems, homelessness, and severity of drug use. Level of risk was recoded into four categories (2 or less, 3, 4, and 5 or more), which had adequate cell sizes for repeated measures analysis.
  
  
  METHODS
  Repeated measures analyses were run to examine how level of risk and group (intervention or control) were related to parenting stress, child abuse potential, and children's mental, motor and language development over time.
  
  
  RESULTS
  Parenting stress and child abuse potential were higher for women with five risks or more compared with women who had four or fewer risks; children's mental, motor, and language development were not related to level of risk. Children in the intervention group had significantly higher scores on the PDI at 6 and 18 months (107.4 vs. 103.6 and 101.1 vs. 97.2) and had marginally better scores on the MDI at 6 and 12 months (107.7 vs. 104.2 and 103.6 vs. 100.1), compared to the control group.
  
  
  CONCLUSIONS
  Compared to drug-abusing women with fewer than five risks, women with five or more risks found parenting more stressful and indicated greater inclination towards abusive and neglectful behavior, placing their infants at increased risk for poor parenting, abuse and neglect. Early home-based intervention in high-risk families may be beneficial to infant development.
authors.affiliation: Department of Pediatrics, University of Maryland School of Medicine, 655 West Lombard Street, Suite 311, Baltimore, MD 21201, USA.
authors.forename: Prasanna
authors.initials: P
authors.lastname: Nair
authors.forename: Maureen E
authors.initials: ME
authors.lastname: Schuler
authors.forename: Maureen M
authors.initials: MM
authors.lastname: Black
authors.forename: Laurie
authors.initials: L
authors.lastname: Kettinger
authors.forename: Donna
authors.initials: D
authors.lastname: Harrington
mesh_terms: D000328:Adult; D016022:Case-Control Studies; D002649:Child Abuse / Q000517:prevention & control* / Q000523:psychology; D002657:Child Development; D003863:Depression / Q000150:complications; D017831:Diagnosis, Dual (Psychiatry) / Q000523:psychology; D017579:Domestic Violence / Q000523:psychology; D005260:Female; D006699:Home Care Services / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008137:Longitudinal Studies; D009035:Mothers / Q000523:psychology*; D016487:Parenting / Q000523:psychology*; D011569:Psychiatric Status Rating Scales; D012307:Risk Factors; D012931:Social Environment; D013315:Stress, Psychological / Q000150:complications; D019966:Substance-Related Disorders / Q000150:complications / Q000517:prevention & control* / Q000523:psychology*