Adjustment and attachment in urban children of mothers with substance use, HIV, and mental health problems

Mothers with substance use problems often have co-occurring high rates of mental health problems. These co-occurring problems have been implicated in a number of child psychological outcomes. Maternal HIV infection also confers risk. However, some children experience good outcomes despite exposure to adversity, and children's attachment security possibly interacts with stressors to mitigate the likelihood of maladjustment. Secondary analyses was performed to examine the relationships among mothers' substance use, HIV status, and depressive and anxious symptoms and child attachment in 78 mothers and 95 low-income, urban teens (mean age 14.8 years, 56.8% male) who participated in an intervention for HIV-infected and uninfected mothers with alcohol and drug problems. The influence of maternal problems on child adjustment (internalizing, externalizing, and total symptoms) was assessed using multilevel modeling. This study's hypotheses predicted that (a) children of polysubstance users exhibit higher levels of adjustment problems than children of problem drinkers, (b) an increased likelihood of adjustment problems was related to multiple maternal problems, and (c) the effects of multiple maternal problems on child adjustment would be stronger for children with an insecure attachment style. Linear mixed model results demonstrate that, overall, sample children did not report significant adjustment difficulties despite their exposure to number of maternal risk factors. However, children of polysubstance users reported significantly higher levels of externalizing problems (p<.05) than children of problem drinkers. Older children, particularly adolescent girls, reported more externalizing difficulties than younger children. Mothers' anxiety yielded a significant negative effect (p<.001) on child adjustment. Mothers' depressive symptoms and HIV infection were not associated with child outcomes. Lastly, mean adjustment scores of children of problem drinkers and those of polysubstance users did not differ based on a secure attachment style. These findings suggest that, even within complex family profiles, mothers' polysubstance use and anxiety can have significant independent effects on child adjustment. However, after accounting for their influence, a substantial portion of variance in the data remained unexplained by this study's hypotheses tests, suggesting that unexplored maternal factors continue to exert considerable impact on internalizing and externalizing symptoms in youth.