Kelley Susan J
College of Health and Human Sciences, Georgia State University, University Plaza, Suite 870 ULC, Atlanta, GA 30303-3083, USA.
Child Abuse Negl. 2003 Sep;27(9):993-5. doi: 10.1016/s0145-2134(03)00161-3.
To assess the relationship between cumulative environmental risks and early intervention, parenting attitudes, potential for child abuse and child development in substance abusing mothers.
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.
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.
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.
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.
评估物质滥用母亲中累积环境风险与早期干预、育儿态度、虐待儿童可能性及儿童发育之间的关系。
我们对161名物质滥用女性进行了研究，她们来自一项基于家庭的早期干预随机纵向研究，在18个月内拥有孩子的监护权。干预组在最初6个月每周接受一次家访，6至18个月每两周接受一次家访。在产后6个月和18个月评估育儿压力和虐待儿童可能性。在产后6个月、12个月和18个月评估儿童的智力和运动发育（贝利智力发育指数和心理运动发育指数）以及语言发育（里尔量表）。评估了10项母亲风险因素：母亲抑郁、家庭暴力、非家庭暴力、家庭规模、监禁、家中无重要他人、负面生活事件、精神问题、无家可归以及药物使用严重程度。风险水平重新编码为四类（2及以下、3、4和5及以上），这些类别具有足够的单元格大小用于重复测量分析。
进行重复测量分析，以检验风险水平和组别（干预组或对照组）如何随时间与育儿压力、虐待儿童可能性以及儿童的智力、运动和语言发育相关。
与风险因素为4项及以下的女性相比，风险因素为5项及以上的女性育儿压力和虐待儿童可能性更高；儿童的智力、运动和语言发育与风险水平无关。与对照组相比，干预组儿童在6个月和18个月时的心理运动发育指数得分显著更高（分别为107.4对103.6以及101.1对97.2），在6个月和12个月时的智力发育指数得分略高（分别为107.7对104.2以及103.6对100.1）。
与风险因素少于5项的药物滥用女性相比，风险因素为5项及以上的女性发现育儿压力更大，并表现出更大的虐待和忽视行为倾向，使其婴儿面临不良养育、虐待和忽视的风险增加。对高危家庭进行早期家庭干预可能有益于婴儿发育。
