How Does Substance Exposure Affect Real Child Outcomes?

Background: Parental substance use (SU) is assumed to negatively impact children and is a key risk criterion for child welfare decision-making, including assessment of maltreatment reports, removing children from their parents’ care, reunifying children with their family, or seeking an alternative permanency plan. However, the impacts of parental SU vary in their type, significance, and severity, and child well-being can be conceptualized and operationalized in different ways. Therefore, we conducted a scoping review of the literature to understand the current state of knowledge on the impacts of parental SU on real child outcomes, a term we use to differentiate direct measures of children’s physical, developmental, psychological, and emotional well-being from child welfare system actions.

Design/Methods: Following the PRISMA guidelines, we searched six databases for terms related to children, parents, SU, and child welfare. We obtained a total of 5,859 unique results. Each abstract and full-text was reviewed to ensure that it measured parental substance use (excluding tobacco) in relation to children under the age of 18, where at least one quantitative measure was a direct physical, developmental, psychological, behavioral, or emotional outcome for the child. We included 47 articles in the final sample.

Results: We found that the preponderance of research on the impact of parental SU on children measures a parental behavior or child welfare system action as the primary outcome (i.e., confirmed neglect, child removal). When direct measures of the child were used, we found that psychological, behavioral, and emotional outcomes were most common, with 41 out of 47 articles including at least one outcome of this type. Physical outcomes were present in 13 articles, and developmental outcomes were in 6 studies. While some of the same measures were used to measure the outcomes (e.g. the Child Behavior Checklist for internalizing/externalizing problems), there was also substantial heterogeneity in how outcomes were measured and issues with the same measures being described as measuring different outcomes. We also observed that parental substance use is defined in diverse ways, with 6 studies failing to report how substance exposure was assessed, and most studies did not analyze how the severity of substance exposure impacted children. Nearly a third (n=17) used primary data collected by the authors, while the remaining 30 articles used archival data or secondary datasets, with some articles using the same datasets and similar variables. Finally, relationships between SU and real child outcomes were inconsistent and often not statistically or substantially significant.

Conclusions: Across children’s developmental trajectories, parental SU has the potential to impact children in a variety of ways, but research indicates that these impacts are not always negative nor significant. Results of this scoping review indicate a need for more research that focuses on understanding the direct impacts of parental SU on key dimensions of child well-being rather than on child welfare system actions. Child welfare practice would benefit from a more nuanced understanding of how parental SU impacts children rather than assuming that all children are at risk for negative outcomes due to SU exposure.