Behavior Problems In Children with Substance Using Parents: The Forgotten Connection to Parenting Practices

Background and Purpose: The media, the child welfare system, and the public schools have all expressed considerable concern about behavior problems in children whose mothers abuse drugs. Although often those problems are attributed to prenatal exposure to substances, a variety of factors may be present in the family environments of young children whose parents abuse drugs. Furthermore, all too often it is assumed that these children will be “bad actors,” and attention has focused on externalizing problems while ignoring potential internalizing problems such as anxiety and depression. This paper explores the prevalence of behavior problems in young children whose mothers seek substance abuse treatment for opioid dependence, and the factors associated with both externalizing and internalizing problems.

Methods: Families were recruited through all six of the public methadone maintenance clinics in a major urban area. The sample included 149 3-to-5-year-old African American children and their biological mothers. Child behavior problems were assessed through mother report on the Child Behavior Checklist and through observer ratings of videotaped behavior during interaction. Parenting behavior was also observed during videotaped interaction, and the home environment was assessed through the HOME scale.

Results: Mother reports and observations revealed great variability in child behavior from highly competent to highly problematic. Mother CBCL report suggested that children's level of behavior problems was on average elevated compared to CBCL norms, with respect to both externalizing and internalizing problems. Hierarchic regression was used to analyze data. After controlling for a variety of sociodemographic and psychosocial factors, child externalizing problems, both as reported by the mother and as noted by the observer, were associated with low levels of maternal sensitive responsiveness and with high levels of harsh parenting. Child internalizing problems, both as reported by the mother and as observed, were associated with low levels of maternal sensitive responsiveness and with a lack of stimulation in the home. Prenatal drug use and maternal psychopathology were related to mother report, but not examiner observation, of child behavior problems.

Conclusions and Implications: Given that a large research literature suggests that early childhood behavior problems often are at the beginning of a trajectory of increasingly serious conduct problems, the behavior problems of young children from substance using families should not be ignored. Since children's internalizing and externalizing problem behaviors are associated with parenting behaviors, women who seek treatment for substance abuse should be offered support in their parenting. Although many in-patient and out-patient substance-abuse treatment programs offer parenting classes or groups, these typically focus on childcare practices or discipline practices such as spanking. For children at greatest risk, parenting interventions should include non-stigmatizing, evidence-based, interventions targeted specifically at helping parents become sensitive and responsive to their children's cues during interaction and responding appropriately to disruptive behavior.