Abstract:
Methadone maintenance is the standard treatment given to pregnant opiatedependent
women in New Zealand and worldwide, despite reported
associations between maternal methadone maintenance and both short and
long term negative effects upon offspring. The greater cost of illicit opiates in
terms of social and teratogenic effects justifies continued methadone
maintenance to minimise harm to opiate-dependent. women and their infants.
Deficits in cognitive and social-emotional development for children of
methadone maintained mothers have been attributed to a combination of biological, environmental and psychosocial risks.
This study is an extension of an existing short longitudinal study on the effects
of methadone maintenance on the fetus, the neonate and the infant. It
investigates the effect of methadone maintenance on social emotional
development, through the medium of mother-infant interaction, using the
transactional model of development. Environmental and psychosocial risks are
experienced indirectly in early infancy, primarily filtered through parents and
caregivers. The contribution of infants, in turn, feeds back to the parents to
shape their behaviour.
Sixteen methadone maintained mother infant dyads, and 37 comparison dyads
were observed during six minutes of videotaped social exchanges. Dyads had
two play encounters, intended to elicit positive affect, and one mildly stressful encounter where mothers restrained their infants' arms. The instructions,
equipment used and setting were all standardised, to facilitate comparison of
mother and infant behaviours. Both maternal and infant contribution to social
encounters was systematically observed and recorded using global
measurement scales, while the investigator remained blind to methadone
status.
Mothers in both methadone maintained and non-maintained groups received
similar scores on most items measuring aspects of mother-infant interaction. In
mothers, methadone maintenance was associated with lower observer ratings
of quality in verbal interaction and amount of responsiveness. In infants,
methadone exposure was associated with lower quality of object engagement
and increased negative vocalisation during play. A measure of additive risk did
not appear to contribute over and above methadone status to predicting higher
or lower ratings of behaviour on these items.