Maternal Drug Use, Trauma History and Infant Disorganized Attachment

Background and Purpose: 

Theory and research suggest that infants whose mothers have histories of trauma exposure are at risk for displaying disorganized attachment behavior (Main & Hesse, 1990).  Relatively little research has examined the experiences of mothers with complex and severe trauma histories.  This paper will examine, within a sample including mothers in substance-abuse treatment, how varied dimensions of maternal trauma history impact infants’ attachment behavior. 

Methods: 

Subjects include 123 low-income African-American mothers of 12- to 20-month-old infants. Half of the mothers were receiving treatment for heroin addiction, and half were a non-treatment community comparison group.  Infant attachment was assessed using the Strange Situation procedure.  Videotapes were coded by a reliable coder, blinded to information about maternal history, using the Ainsworth three-category (A,B,C) classification system and the Main & Solomon disorganized/disoriented (D) classification system.  Maternal history of trauma was assessed using the Lifetime Traumatic Events Questionnaire (Fullilove et. al., 1993), the Childhood Trauma Questionnaire (Bernstein, et. al., 1994), the Childhood Sexual Abuse Interview (Hien & Miller modifications of Finkelhor & Sgroi, 1985), questions from the National Crime Victim Survey, and the Conflict Tactics Scale (Straus et al, 1996).  In addition, mothers were administered the Adult Attachment Interview to examine representations of their childhood experiences.  The AAI was coded using conventional coding (George, Kaplan & Main, 1985) as well as the Lyons-Ruth, Atwood, Melnick, & Yellin, 2003) coding designed for high-risk populations.

Results:

Infants whose mothers were in treatment for heroin addiction had a higher incidence of disorganized attachment (36.7%) than infants whose mothers were from the community comparison group (19%), and higher mean scores for level of disorganization (4.9 vs. 4.2, on a 9-point scale).  As has been shown in previous literature, substance using women had more pervasive histories of exposure to trauma during childhood and adulthood, including childhood physical abuse, childhood sexual abuse, adult crime victimization, and adult partner violence.

Hierarchic logistic and ordinary least squares regression analyses were computed examining factors associated with disorganized infant attachment classification and level.  Mothers’ experience of abuse during childhood, but not adult trauma, was related to infant disorganized attachment, even after controlling for mother addiction history.  Infant disorganization was related to several features of maternal attachment representations, including maternal global devaluation of attachment, hostility to caregiver, and descriptions of caregiver as helpless.  

Conclusions and Implications:

This study replicates previous research showing that maternal trauma histories are related to infant disorganized attachment.  Findings extend prior research by showing the relatively great impact of mothers’ trauma experiences during childhood, compared to those during adulthood, on their relationships with their infants.  The findings suggest it is important that substance abuse treatment services for women be integrated with services supporting the needs of women as parents and the development of their children.  The salience of women’s representations of their childhood histories, suggests that for those women in addictions treatment with complex trauma histories, therapeutic interventions that examine caregiver mental representations, such as the evidence-based Child Parent Psychotherapy (Lieberman, VanHorn, & GhoshIppen, 2005), might be highly appropriate.