affect about 10 percent of all mothers and 20 percent of poor mothers (Dickstein et al., 1998). Depressed mothers are more likely to respond to their children with withdrawal, diminished energy, or emotion or to express feelings of hostility and rejection toward their children (Frankel and Harmon, 1996; Field, 1995). Depression appears to be a robust influence irrespective of family income (Miller, 1997; Radziszewska et al., 1996).

Reviews of observational studies suggest that children of depressed mothers compared with those of nondepressed mothers are more likely to show higher levels of aggression, sociobehavioral problems including poorer peer relations and reduced ability for self-control, and poorer school performance (e.g., Cummings and Davies, 1994). Other reviews have found that children of depressed parents are at substantially greater risk to develop depression themselves (Downey and Coyne, 1990). Not all children of depressed mothers manifest adverse outcomes (Cummings and Davies, 1994), leading to the hypothesis that the adverse effects of maternal depression are most evident when compounded by other sources of stress, such as physical abuse, marital discord, and substance abuse (Seifer, 1996; Sameroff and Fiese, 1989). Numerous studies have documented a positive relationship between parental stress levels and rates of child abuse and neglect (Sachs et al., 1999; Hall et al., 1991; Luttenbacher, 2002; Wind and Silvern, 1994; Rodriguez and Green, 1997).

Parental Substance Abuse. Many studies have documented associations between maternal alcoholism and child developmental outcomes. In one study, drinking by female caregivers predicted a less cohesive and organized family environment and higher levels of domestic violence (Jester et al., 2000). Parental substance use also affects a parent’s ability to nurture and supervise. Although in the past women have been less likely than men to use illicit substances, rates have been increasing in women (National Institute of Justice, 1989; Ebrahim and Gfroerer, 2003).

Environmental tobacco smoke has been shown to cause many different health effects in exposed children, including cancer, asthma, increased severity of respiratory syncytial virus, and increased incidence of ear infections (U.S. Environmental Protection Agency, 1992). Parental tobacco use is one factor associated with children’s starting to smoke (Nichols et al., 2004; Andersen et al., 2004). Recent studies also demonstrate an interaction between maternal smoking and genetic predisposition to increased rates of attention deficit hyperactivity disorder in children (Kahn et al., 2003).

Maternal infant bonding appears to be key mechanism; a recent review of 23 articles showed that 14 found recognizable negative impacts on maternal-child interactions among substance-abusing mothers, and three found a dose-response relationship with impact or an accentuation of impact related to continued substance use postnatally (Johnson, 2001).



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