Kinder opiatabhängiger Mütter - Ein Überblick

 

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Zusammenfassung

Kinder von opiatabhängigen Müttern stellen eine besondere Hochrisikogruppe dar. Kinder, die nach der Entbindung zu einem großen Prozentsatz einen Opiatentzug durchmachen, treffen auf eine durch eigene traumatisierende Erfahrungen, Abhängigkeitserkrankung und schwere psychische Probleme in ihrer Erziehungskompetenz erheblich eingeschränkte Mutter, die meist unter extrem ungünstigen psychosozialen Bedingungen lebt.

Die in der vorliegenden Literaturübersicht zusammengefassten Längsschnittuntersuchungen beschreiben übereinstimmend in den ersten Lebensjahren der Kinder opiatabhängiger Mütter Wachstumsretardierungen sowie Wahrneh- mungs- und Interaktionsstörungen. Die intellektuelle Entwicklung scheint nicht beeinträchtigt, in manchen Untersuchungen finden sich jedoch Hinweise auf Sprachentwicklungsverzögerungen. Im Schulalter zeigen sich in allen Studien erhöhte Aggressivität und Impulsivität, Störungen im Sozialverhalten, Schulprobleme, Delinquenz und früher Alkohol- und Drogenkonsum.

Eine umfassende interdisziplinäre Betreuung der Frauen ab der Schwangerschaft einschließlich Substitution, Beratung, Anleitung und aufsuchenden Hilfen ist unbedingt erforderlich und kann die Gesamtprognose entscheidend verbessern.

Children of Opiate-Addicted Mothers - a Review

Children of opiate-addicts constitute a special high-risk group. Most of these children (between 40 and 95 pct.) develop within the first weeks pp. a so-called „neonatal abstinence syndrome” (NAS) which shows a well documented dosage- effect-relationship. First descriptions of NAS in children of morphine-addicted mothers were reported from Berlin in 1930. In reviewing the past three decades of literature on the development of children of opiate-addicted mothers the hypothesis can be formulated, that a mixture of neonatal abstinence effects (with irritability, heightened arousal, and distractibility) with their postnatal environmental-interactive sequelae and a lack of familial coping resources may lead to the development of hypercinetic-attention deficit-syndromes and conduct disorders at school age resulting in serious school problems.

Studies on children of drug-addicts at school age agree in the following trends: In standardised intelligence tests children of drug-addicts show no significant difference to controls in total-IQ but lower verbal IQ’s and to a far greater extent conduct disorders and school-problems. They show more impulsivity, aggression and attention-problems as well as a variety of other externalising behaviour problems as indicated by CBCL scores within the clinical range.

Methadone treatment may be an important factor in stabilising the psycho-social situation of pregnant addicts. Results from our study at Frankfurt University Hospital show clearly, that methadone-maintained mothers lived in more stable socio-economic conditions than heroin-addicted women, and they cared significantly better for their babies. Reports from different experimental interventions or home-based intervention programs with families of substance abusers indicate positive changes in parenting skills, parental drug use, and family management.

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Dr. med. Ekkehart D. Englert

Klinik für Kinder- und Jugendpsychiatrie und Psychotherapie

HELIOS Klinikum Erfurt Klinikum Erfurt

Nordhäuser Straße 74

99089 Erfurt

Email: EEnglert@erfurt.helios-kliniken.de