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Table 1 Summary of studies that evaluated parents with opioid use disorder and no other drug use

From: The effects of parental opioid use on the parent–child relationship and children’s developmental and behavioral outcomes: a systematic review of published reports

Study/type Sample size Comparison group Exposure by whom Outcome at age, mother’s or child’s Study focus Findings
[22] /comparative–descriptive study 15 mothers receiving MM and their 15 preschool children 15 NDA mothers and their 15 preschool children Mothers Screening session; sessions 1 and 2 at 2-weeks intervals. Children’s mean age for MM group, 4.3 years; control mean age, 3.8 years Drug Abuse Treatment Referral System; California Psychological Inventory; Parental Attitudes Questionnaire; Minnesota Child Development Inventory; Stanford-Binet Intelligence Scale; Motor Scale of the McCarthy Scales of Children’s Abilities; videotaped mother–child interaction during 2 play sessions using the Interactional Coding System MM mothers struggled with their parenting behaviors in comparison to controls. No differences were noted in parenting attitudes. Children of MM mothers had lower measures of intelligence than controls
[23] /comparative–descriptive study 17 methadone-exposed infants 23 same-age comparison infants Mothers 4 months Communicative functioning in dyadic interaction, motor functioning in infants Mothers with poor interactive skills were likely to have poor maternal resources, and their infants were at increased risk for low communicative functioning and problematic motor functioning. Methadone use was 1 of the risk factors affecting interaction
[24] /comparative–descriptive study 30 methadone-exposed toddlers 44 comparison toddlers Mothers 24 months Mother was instructed to teach the child how to use a toy (focused attention) No difference in focused attention based only on prenatal exposure
[25] /comparative–descriptive study 35 methadone-exposed infants 46 comparison infants Mothers 12 months Separation–reunion procedure, mothers’ perceptions during pregnancy of how bothersome their children will be Less contact-maintaining behavior than controls but similar proximity-seeking behaviors between the two groups. High perceptions of bothersomeness were related to higher scores on contact-maintaining behavior and lower scores on avoidant behavior
[26] /comparative–descriptive study 69 mothers with opioid use disorder participating in methadone treatment with children < 16 years 51 SES-matched comparison mothers Mothers Baseline assessment children’s mean (SD) age for opiate group, 10.0 (3.9) years; control group, 9.6 (4.6) years BASC; Parent–Child Relationship Inventory SES and how mothers perceive their children’s difficult behaviors have a mediating role in parenting strategies for mothers with opioid use disorder. Authors concluded that the level of parental involvement can be directly linked to addiction issues
[27] /comparative–descriptive study 30 toddlers exposed in utero to methadone 42 comparison toddlers Mothers 12 and 24 months Infant attachment behaviors at 12 months, mother and child communication at 24 months, mothers’ perceptions during pregnancy of their children’s bothersomeness No direct correlation between use of methadone and quality of communication between mother and child, correlation was moderated by mother’s idea of infant’s bothersomeness and mediated by infant’s avoidant attachment style
[28] /longitudinal study 144 parents from methadone clinic and 177 children No comparison group Mothers and fathers Children between the ages of 3 and 15 years at baseline and then 6, 12, and 24 months following the intervention. Follow-up interview 14 years later ACEs; parent recovery, parent–child bonding, and family management were measured on basis of child report scales A high likelihood of ACEs and only 3% of children had no other risks than having a parent with opioid use disorder. Of the young adults, 24% met all criteria for functional resilience. The earlier there were behavioral problems, the more significantly reduced were the chances of functional resilience
[29] /comparative–descriptive study 15 opioid-exposed participants in buprenorphine replacement therapy program 15 maternal depression infant dyads and 57 unexposed mother–infant dyads Mothers Second half of first year Bayley MDI; Emotion Availability Scales, 3rd edition Opioid-exposed infants had lowest Bayley-II MDI scores and scored lowest in infant involvement. Opioid-abusing mothers had lowest scores in maternal sensitivity, structuring, and nonintrusiveness. There were more separations from mothers with opioid use disorders in end of first year for their infants and higher risk of physical abuse
[30] /cross-sectional study, part of a larger RCT 99 mothers receiving MM and their children None Mothers Baseline assessment for RCT (children age, 4–16 years) Parent and child versions of Parental Acceptance-Rejection Questionnaire; BASC; Beck Depression Inventory for maternal depression Mothers noted themselves to be less aggressive than their own children’s view of them. Children tended to report both internalizing and externalizing behaviors; their mothers reported only children’s externalizing problems
[31] /comparative–descriptive study 33 heroin-using mothers in opioid maintenance treatment (methadone or buprenorphine) and their toddlers 36 mothers and toddlers in comparison group Mothers Last trimester of pregnancy. After delivery, assessment every third month until 12 months. Follow-up at toddler age 2.5 years Parenting stress index, long version; Hopkins Symptom Checklist-25; videotaped semi-structured play that followed NICHD Study of Early Child Care guidelines; child behavior checklist; Pediatric Quality of Life Inventory (PedsQL; Mapi Research Trust) 4.0 Toddlers in group with opioid use disorders had significantly more perceived problems. After control for factors that could be responsible for developmental outcomes, opioid exposure was not independently responsible for parent–child interaction issues
[32] /comparative–descriptive study 33 heroin-using mothers in opioid maintenance treatment program (methadone or buprenorphine) and their toddlers 36 mothers and toddlers comparison group Mothers 6 months Videotaped semistructured play that followed NICHD Study of Early Child Care guidelines Maternal style that consists of 6 maternal behaviors during free-play was significantly responsible for “dyadic mutuality.” Other factors such as maternal drug use before opioid treatment program, maternal depression, level of parenting stress, and developmental issues of infants significantly affected dyadic mutuality
[33] /comparative–descriptive study 12 opiate-exposed mother-infant dyads from methadone treatment program 33 comparison infants < 1 month old Mothers One-time 30-min recording during feeding at age 0–1 month Nursing Child Assessment Satellite-Training Scale scores Opiate-exposed dyads scored significantly lower in infant subscales of clarity of cues, responsiveness to caregiver, and total score than comparison sample. Parents showed lower sensitivity to infant cues and their contingency score was also significantly lower
  1. ACE adverse childhood experience, BASC Behavioral Assessment System for Children, MDI Mental Development Index, MM methadone maintenance, NDA non-drug-addicted, NICHD National Institute of Child Health and Human Development, RCT randomized clinical trial, SES socioeconomic status