Creating Capacity for Coregulation and Empathy: A Quantitative Study of Toddlers With a History of Substance Exposure and Their Adoptive Parents

Abstract

Date Presented 03/26/20

This research studied a developmental and relationship-based intervention that provided parents with the capacity to co-regulate their toddlers and support their development of empathy. This intervention was provided to mothers who have adopted toddlers with a history of substance exposure or neonatal abstinence syndrome (NAS). As rates of children with substance exposure and NAS increase, OTs will find interventions such as this one useful and effective in helping these children and their families.

Primary Author and Speaker: Sara Clancey

PURPOSE: Oftentimes, children who were born to mothers who have substance use disorder are placed in foster care at birth and are subsequently adopted. The families who adopt these children often struggle with the many health and developmental challenges the children have as a result of their in-utero substance exposure. Parents become overwhelmed and express frustration at the lack of support they receive once the adoption is final. Many of these children become eligible for Part C early intervention programs and the families are often provided services by an occupational therapist. Because of these concerns, the first aim of this study is to conduct research on effective interventions that can be used by occupational therapists to support the adoptive parents and provide them with the capacities to support regulation and social emotional development in their adopted children. The second aim is to explore how the adoptive parents’ ability to provide co-regulation to their children supports the development of empathy in toddlers who have a history of substance exposure.

The purpose of this experimental study was to determine if using a DIR/Floortime® (Developmental, Individual Differences and Relationships) based training module with adoptive parents would result in improved self-regulation and empathy of the toddler with a diagnosis of NAS or substance exposure.

The following research questions were used to guide this study: Will the DIR/Floortime® based parent module improve responsiveness (including affection, responsiveness, encouragement and teaching) among adoptive mothers?

Will the application of a DIR/Floortime® based parent module facilitate the capacity for self-regulation and empathy in a toddler with a history of substance exposure that has been adopted?

This study was a single case research design with multiple baselines across behaviors. Purposive sampling was used to recruit participants for this study. A recruitment letter describing both the study and potential participants was given to providers of early intervention home visiting programs, CASA volunteers, and to a foster and adoptive parent support group. The inclusion and exclusion criteria included: children who were between 15-30 months old with either a diagnosis of Neonatal Abstinence Syndrome (NAS) or who were substance exposed in utero.

METHOD: The Parenting Interactions with Children: Checklist of Observations Linked to Outcomes (PICCOLO™), the Empathy Questionnaire (EmQue) and the Greenspan Social-Emotional Growth Chart (SEGC) from the Bayley-III™ were all used as pre and post measures. Weekly visits were completed both pre- and post-intervention. During these visits observations of the parents interacting with their children were completed and videotaped. These were then coded to determine the level of responsiveness among the mothers.

RESULTS: The data are still being analyzed, but preliminary information indicate that the DIR/FLOORTIME® intervention improved responsiveness among adoptive mothers.

CONCLUSION: Over the past few years, the number of children with substance exposure in utero has increased dramatically. The findings from this study suggest there is a positive effect of using the DIR/FLOORTIME® based intervention with adoptive parents to support their toddler’s regulation and further develop pro-social skills such as empathy. The impact of these findings are important to the practice of occupational therapy in early intervention. These are methods and strategies that can be used by OTs practicing in the area of EI for children who have been substance exposed and their caregivers.

References

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