Effects of an attachment-based intervention on autonomic regulation among opioid-exposed infants

Prenatal Opioid Exposure and Maternal-Infant Coregulation as Indicators of Early Infant Neurodevelopment

BACKGROUND

Little is known about the short- and long-term effects of prenatal opioid exposure on infant neurodevelopment. Infants with neonatal opioid withdrawal syndrome (NOWS) are often admitted to neonatal intensive care units (NICU) where the development of coregulation between mothers and infants is easily disrupted. Understanding early mother-infant coregulation is needed to guide intervention strategies for these high-risk mother-infant dyads.

PURPOSE

Explore the impact of prenatal opioid exposure on mother-infant coregulation, as an indicator of early infant neurodevelopment, in response to a standardized stress experiment, the Still Face Paradigm (SFP).

METHODS

A prospective cohort design was used to enroll opioid-exposed (N = 11) and non-exposed (N = 13) mother-infant dyads, when infants discharged from the NICU were 6 to 9 months. Dyadic heart rate variability (HRV) data were used as a measure of coregulation and were recorded using heart rate monitors during the 3 phases of the SFP: (a) baseline, (b) still-face, or flat affect, and (c) reunion. We conducted analyses to determine differences within the HRV dyad profiles.

RESULTS

HRV profiles differed between the 2 study groups. In the opioid-exposed group: (a) infants exhibited more irregular autonomic processes, (b) mothers had higher HRV baselines, and (c) there was an overall dysregulation between mothers and infants compared to the non-opioid exposed group.

IMPLICATIONS FOR PRACTICE AND RESEARCH

These differences may suggest that prenatal opioid exposure contributes to difficulty with dyadic co-regulation which may negatively impact early infant neurodevelopment. Additional research is needed to better understand the role of prenatal opioid exposure in infant neurodevelopment.

Using randomized controlled trials to ask questions regarding developmental psychopathology: A tribute to Dante Cicchetti

Dante Cicchetti, the architect of developmental psychopathology, has influenced so many of us in profound ways. One of his many contributions was in demonstrating the power of randomized controlled trials (RCTs) to study the effects of Child-Parent Psychotherapy (CPP). These RCTs have shed light on causal mechanisms in development. Following Cicchetti and colleagues' work, we designed a brief home visiting program, Attachment and Biobehavioral Catch-up (ABC), to help parents respond in sensitive, nurturing ways, so as to enhance children's attachment and self-regulatory capabilities. In the current study, we assessed adolescents' reports of the closeness of their relationships with their mothers 12 years after their mothers completed the intervention. A total of 142 adolescents participated (47 randomized to ABC, 45 randomized to a control intervention, and 50 from a low-risk comparison group). Adolescents whose mothers had been randomized to ABC reported closer relationships with their mothers than adolescents randomized to the control condition, with significant differences seen on approval, support, companionship, and emotional support subscales. Consistent with Cicchetti et al.'s work, these results provide powerful evidence of the long-term effects of an early parenting intervention.

Effects of prenatal opioid exposure on infant sympathetic and parasympathetic nervous system activity

Prenatal opioid exposure has been associated with developmental problems, including autonomic nervous system dysregulation. However, little is known about the effects of prenatal opioid exposure on the autonomic nervous system beyond the first days of life, particularly across both the parasympathetic and sympathetic branches, and when accounting for exposure to other substances. The present study examined the effects of prenatal exposure to opioid agonist therapy (OAT, e.g., methadone) and other opioids on infant autonomic nervous system activity at rest and in response to a social stressor (the Still-Face Paradigm) at six months among 86 infants varying in prenatal opioid and other substance exposure. Results indicated that OAT and other opioids have unique effects on the developing autonomic nervous system that may further depend on subtype (i.e., methadone versus buprenorphine) and timing in gestation. Results are discussed in the context of theoretical models of the developing stress response system.