Attachment in substance-exposed toddlers: The role of caregiving and exposure.

Prenatal substance exposure is linked to adverse outcomes in children. Some adverse outcomes may result from insecure attachment and low-quality caregiving rather than from substance exposure. Little is known about the caregiving of polysubstance-using mothers. To address this, low-income mothers (n = 41) with their substance-exposed 12-month-olds were compared with a nonexposed group case-matched for other risk factors. Maternal sensitivity and involvement were analyzed from 2 hr of videotaped interaction. Attachment was assessed using the Attachment Q-Set. Attachment security and quality of caregiving were quite low for both groups, with no significant differences. In addition, regression analyses revealed that quality of caregiving predicted attachment, but amount of alcohol and cocaine exposure did not. These results suggest that among toddlers with social risk, substance exposure may not predict insecure attachment. Previous research linking attachment to exposure may be better explained by low-quality caregiving. Implications are that substance-exposed children, and nonexposed children with comparable social risk, are likely to need intervention to enhance maternal sensitivity and involvement to improve psychiatric outcomes.