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Posted: November 9th, 2023

Adjustment and Attachment in Urban Children of Mothers with Substance Use, HIV, and Mental Health Problems

Adjustment and Attachment in Urban Children of Mothers with Substance Use, HIV, and Mental Health Problems

The well-being of children depends largely on the quality of their attachment to their primary caregivers, usually their mothers. However, some mothers face multiple challenges that may impair their ability to provide adequate care and support for their children. These challenges include substance use, HIV infection, and mental health problems, which often co-occur and have negative impacts on maternal and child outcomes. This paper examines how these maternal factors affect the adjustment and attachment of urban children aged 6 to 11 years, who are at high risk of developmental and behavioral problems.

Substance use, HIV, and mental health problems are prevalent among low-income urban women, especially those from racial and ethnic minority groups. According to the Substance Abuse and Mental Health Services Administration (SAMHSA), in 2019, about 19.3% of women aged 18 or older living in poverty reported past year illicit drug use, compared to 7.7% of women living above the poverty level. Moreover, about 8.5% of women living in poverty reported past year serious mental illness, compared to 5.2% of women living above the poverty level (SAMHSA, 2020). Additionally, women accounted for 19% of the estimated 37.9 million people living with HIV globally in 2018, and most of them were from low- and middle-income countries (UNAIDS, 2019).

These maternal factors can have detrimental effects on children’s adjustment and attachment. Substance use can impair maternal functioning, judgment, and responsiveness, leading to inconsistent, neglectful, or abusive parenting behaviors (Conners et al., 2004). HIV infection can cause physical and psychological distress, stigma, and discrimination, affecting maternal well-being and availability for the child (Murphy et al., 2002). Mental health problems can interfere with maternal mood, cognition, and coping skills, resulting in emotional instability, irritability, or withdrawal from the child (Goodman et al., 2011). These adverse maternal conditions can disrupt the formation of a secure attachment bond between the mother and the child, which is essential for the child’s emotional regulation, social competence, and cognitive development (Bowlby, 1982).

Several studies have examined the effects of these maternal factors on children’s adjustment and attachment, but most of them have focused on one factor at a time or on specific populations (e.g., infants, adolescents). There is a need for more comprehensive and integrative research that considers the co-occurrence and interaction of these factors and their impact on urban children in middle childhood, a critical developmental period that has received less attention. Therefore, this paper aims to address the following research questions:

– How do substance use, HIV infection, and mental health problems affect maternal caregiving behaviors and quality of mother-child relationship?
– How do these maternal factors influence children’s adjustment outcomes, such as internalizing and externalizing problems, academic achievement, and peer relations?
– How do these maternal factors affect children’s attachment security and styles?
– How do children’s adjustment outcomes and attachment security mediate or moderate the relationship between maternal factors and mother-child relationship quality?

To answer these questions, this paper will review the relevant literature on each maternal factor and its impact on children’s adjustment and attachment. Then, it will present a conceptual framework that integrates these factors and their effects on mother-child relationship quality. Finally, it will discuss the implications of this framework for research and practice.


Bowlby, J. (1982). Attachment and loss: Vol. 1. Attachment (2nd ed.). New York: Basic Books.

Conners, N. A., Bradley, R. H., Mansell, L. W., Liu, J. Y., Roberts, T. J., Burgdorf,
K., & Herrell,
J. M. (2004). Children of mothers with serious substance abuse problems: An accumulation of risks. The American Journal of Drug
and Alcohol Abuse,
30(1), 85-100.

S. H., Rouse,
H., Connell,
M., Broth,
R., Hall,
M., & Heyward,
(2011). Maternal depression
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and Family Psychology Review,
14(1), 1-27.

& Steers,
(2002). Health
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35(3), 39-54.

Key substance use
and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health
(HHS Publication No. PEP20-07-01-001, NSDUH Series H-55). Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from


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