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CORK Bibliography: Children of Alcoholics

38 citations. 2008 to present

Prepared: June 2010

Albrecht W. Re: Maternal smoking, alcohol, and coffee use during pregnancy and son's risk of testicular cancer. (editorial). European Urology 57(2): 357-358, 2010. (4 refs.)

Anda RF; Dong MX; Brown DW; Felitti VJ; Giles WH; Perry GS et al. The relationship of adverse childhood experiences to a history of premature death of family members. BMC Public Health 9(article 106), 2009

Background: To assess the association between adverse childhood experiences (ACEs), including childhood abuse and neglect, and serious household dysfunction, and premature death of a family member. Because ACEs increase the risk for many of the leading causes of death in adults and tend to be familial and intergenerational, we hypothesized that persons who report having more ACEs would be more likely to have family members at risk of premature death. Methods: We used data from 17,337 adult health plan members who completed a survey about 10 types of ACEs and whether a family member died before age 65. The prevalence of family member premature death and its association with ACEs were assessed. Results: Family members of respondents who experienced any type of ACEs were more likely to have elevated prevalence for premature death relative to those of respondents without such experience ( p < 0.01). The highest risk occurred among those who reported having been physically neglected and living with substance abusing or criminal family members during childhood. A powerful graded relationship between the number of ACEs and premature mortality in the family was observed for all age groups, and comparison between groups reporting 0 ACE and >= 4 ACEs yielded an OR of 1.8 (95% Cl, 1.6-2.0). Conclusion: Adverse childhood experiences may be an indicator of a chaotic family environment that results in an increased risk of premature death among family members.

Aragon AS; Kalberg WO; Buckley D; Barela-Scott LM; Tabachnick BG; May PA. Neuropsychological study of FASD in a sample of American Indian children: Processing simple versus complex information. Alcoholism: Clinical and Experimental Research 32(12): 2136-2148, 2008. (57 refs.)

Although a large body of literature exists on cognitive functioning in alcohol-exposed children, it is unclear if there is a signature neuropsychological profile in children with Fetal Alcohol Spectrum Disorders (FASD). This study assesses cognitive functioning in children with FASD from several American Indian reservations in the Northern Plains States, and it applies a hierarchical model of simple versus complex information processing to further examine cognitive function. We hypothesized that complex tests would discriminate between children with FASD and culturally similar controls, while children with FASD would perform similar to controls on relatively simple tests. Our sample includes 32 control children and 24 children with a form of FASD [fetal alcohol syndrome (FAS) = 10, partial fetal alcohol syndrome (PFAS) = 14]. The test battery measures general cognitive ability, verbal fluency, executive functioning, memory, and fine-motor skills. Many of the neuropsychological tests produced results consistent with a hierarchical model of simple versus complex processing. The complexity of the tests was determined "a priori" based on the number of cognitive processes involved in them. Multidimensional scaling was used to statistically analyze the accuracy of classifying the neurocognitive tests into a simple versus complex dichotomy. Hierarchical logistic regression models were then used to define the contribution made by complex versus simple tests in predicting the significant differences between children with FASD and controls. Complex test items discriminated better than simple test items. The tests that conformed well to the model were the Verbal Fluency, Progressive Planning Test (PPT), the Lhermitte memory tasks, and the Grooved Pegboard Test (GPT). The FASD-grouped children, when compared with controls, demonstrated impaired performance on letter fluency, while their performance was similar on category fluency. On the more complex PPT trials (problems 5 to 8), as well as the Lhermitte logical tasks, the FASD group performed the worst. The differential performance between children with FASD and controls was evident across various neuropsychological measures. The children with FASD performed significantly more poorly on the complex tasks than did the controls. The identification of a neurobehavioral profile in children with prenatal alcohol exposure will help clinicians identify and diagnose children with FASD.

Bjork JM; Knutson B; Hommer DW. Incentive-elicited striatal activation in adolescent children of alcoholics. Addiction 103(8): 1308-1319, 2008. (51 refs.)

Aims: Deficient recruitment of motivational circuitry by non-drug rewards has been postulated as a pre-morbid risk factor for substance dependence (SD). We tested whether parental alcoholism, which confers risk of SD, is correlated with altered recruitment of ventral striatum (VS) by non-drug rewards in adolescence. Design: During functional magnetic resonance imaging, adolescent children of alcoholics (COA; age 12-16 years) with no psychiatric disorders (including substance abuse) and similarly aged children with no risk factors responded to targets to win or avoid losing $0, $0.20, $1, $5 or a variable amount (ranging from $0.20 to $5). Results: In general, brain activation by either reward anticipation or outcome notification did not differ between COA and age/gender-matched controls. Cue-elicited reward anticipation activated portions of VS in both COA and controls. In nucleus accumbens (NAcc), signal change increased with anticipated reward magnitude (with intermediate recruitment by variable incentives) but not with loss magnitudes. Reward deliveries activated the NAcc and mesofrontal cortex in both COA and controls. Losses activated anterior insula bilaterally in both groups, with more extensive right anterior insula activation by losses in controls. NAcc signal change during anticipation of maximum rewards (relative to non-reward) correlated positively with both Brief Sensation-Seeking Scale scores and with self-reported excitement in response to maximum reward cues (relative to cues for non-reward). Conclusions: Among adolescents with no psychiatric disorders, incentive-elicited VS activation may relate more to individual differences in sensation-seeking personality than to presence of parental alcoholism alone. Future research could focus on adolescents with behavior disorders or additional risk factors.

Brook JS; Saar NS; Brook DW. Developmental pathways from parental substance use to childhood academic achievement. American Journal on Addictions 19(3): 270-276, 2010. (58 refs.)

This cross-sectional study examined the pathways to childhood academic achievement in 209 African American and Puerto Rican children and their mothers. There were three pathways to childhood academic achievement: (a) the mother-child relationship and the child's personality mediated between low parental substance use and childhood academic achievement; (b) the child's personality mediated between high parental education and childhood academic achievement; and (c) there was a direct relationship between the child's gender and childhood academic achievement. Policy and clinical implications suggest the importance of increasing educational opportunities for all parents by providing substance use treatment and self-esteem workshops.

Brown DW; Anda RF; Tiemeier H; Felitti VJ; Edwards VJ; Croft JB et al. Adverse childhood experiences and the risk of premature mortality. American Journal of Preventive Medicine 37(5): 389-396, 2009. (27 refs.)

Background: Strong, graded relationships between exposure to childhood traumatic stressors and numerous negative health behaviors and outcomes, healthcare utilization, and overall health status inspired the question of whether these adverse childhood experiences (ACEs) are associated with premature death during adulthood. Purpose: This study aims to determine whether ACEs are associated with an increased risk of premature death during adulthood. Methods: Baseline survey data on health behaviors, health status, and exposure to ACEs were collected from 1.7,337 adults aged >18 years during 1995-1997. The ACEs included abuse (emotional, physical, sexual); witnessing domestic violence; parental separation or divorce; and growing up in a household where members were mentally ill, substance abusers, or sent to prison. The ACE score (an integer count of the eight categories of ACEs) was used as a measure of cumulative exposure to traumatic stress during childhood. Deaths were identified during follow-up assessments (between baseline appointment date and December 31, 2006) using mortality records obtained from a search of the National Death Index. Expected years of life lost (YLL) and years of potential life lost (YPLL) were computed using standard methods. The relative risk of death from all causes at age <= 65), cars and at age <= 75 years was estimated across the number of categories of ACEs using multivaribale-adjusted Cox proportional hazards regression. Analysis was conducted during January-February 2009. Results: Overall, 1539 people died during follow-up; the crude death rate was 91.0 per 1000; the age-adjusted rate was 54.7 per 1000. People with six or more ACEs died nearly 20 years earlier on average than those without ACEs (60.6 years, 95% CI = 56.2, 65.1, vs 79.1 years, 95% CI = 78.4, 79.9). Average YLL per death was nearly three times greater among people with six or more ACEs (25.2 years) than those without ACEs (9.2 years). Roughly one third (n = 526) of those who died during follow-up were aged <= 75 years at the time of death, accounting for 4792 YPLL. After multivariable adjustment, adults with six or more ACEs were 1.7 (95% CI = 1.06, 2.83) times more likely to die when aged <= 75 years and 2.4 (95% CI = 1.30, 4.39) times more likely to die when aged <= 65 years. Conclusions: ACEs are associated with an increased risk of premature death, although a graded increase in the risk of premature death was not observed across the number of categories of ACEs. The increase in risk was only partly explained by documented ACE-related health and social problems, suggesting other possible mechanisms by which ACEs may contribute to premature death.

Carter VB. Factors predicting placement of urban American Indian/Alaskan Natives into out-of-home care. Children and Youth Services Review 32(5): 657-663, 2010. (52 refs.)

American Indian/Alaskan Native children have disproportionately been placed into out-of-home care compared to White children in the child welfare system What were the factors that child protective set vices (CPS) workers considered when deciding to remove a child from the home? Utilizing data from the National Survey of Child and Adolescent Well-Being, this study examined out-of-home care factors for 2215 urban American Indian/Alaskan Native (AI/AN) and White children. In the urban sample, children from White families were younger and were more likely to be investigated for lack of supervision, while AI/AN families were investigated for physical neglect. In the placement regression models, urban AI/AN children came from homes where caregivers had greater alcohol, drug and mental health problems. Decisions by CPS workers to place AI/AN children may have been influenced by racial bias. A CPS system that acknowledges culture and race may reduce overrepresentation in placement. Efforts to work with AI/AN families prior to a child's removal may prove to be beneficial and less expensive.

Cavazos-Rehg PA; Spitznagel EL; Bucholz KK; Nurnberger J; Edenberg HJ; Kramer JR et al. Predictors of sexual debut at age 16 or younger. Archives of Sexual Behavior 39(3): 664-673, 2010. (52 refs.)

The present study examined the extent to which variables within the self system (i.e., symptoms of alcohol dependence and conduct disorder, gender, race, and metropolitan status) and the familial system (i.e., having an alcohol dependent biological parent or second-degree relative, religious background, educational background of parents, and being born to a teenage mother) were associated with sexual debut at 16 years old or earlier. Participants were 1,054 biological relatives, aged 18-25 years, of alcohol dependent probands who participated in the Collaborative Study on the Genetics of Alcoholism project. Comparison participants (N = 234) without alcohol dependent biological parents were also evaluated. Clinical and sociodemographic variables were assessed by structured, personal interviews. Parental history of alcohol dependence was evaluated by direct interview of parents in most cases and family history in uninterviewed parents. In a multivariate survival analysis, increased risk of becoming sexually active at 16 years of age or earlier was significantly associated with 6 of the 10 predictor variables, including race, one or more alcohol dependence symptoms, and/or one or more conduct disorder symptoms. Having an alcohol dependent biological parent or second-degree relative (e.g., aunt, uncle, or grandparent), educational background of mother, and being born to a teenage mother were also significantly associated with increased risk. These results provide evidence that specific variables in the self and familial systems of influence are important in predicting sexual debut at 16 years old or earlier.

Corte C; Zucker RA. Self-concept disturbances: Cognitive vulnerability for early drinking and early drunkenness in adolescents at high risk for alcohol problems. Addictive Behaviors 33(10): 1282-1290, 2008. (39 refs.)

We tested the hypotheses that adolescents with few positive and many negative self-schemas would drink and get drunk earlier than adolescents with many positive and few negative self-schemas. Adolescents (N=264) from an ongoing prospective family study of alcoholism [Zucker, R. A., Fitzgerald, H., Refior, S., Puttler, L. Pallas, D., & Ellis, D. (2000). The clinical and social ecology of childhood for children of alcoholics: Description of a study and implications for a differentiated social policy. In H. Fitzgerald, B. Lester, & B. Zuckerman (Eds.), Children of addiction: Research, health, and policy issues (pp. 109-141). New York, NY: Routledge Falmer] were assessed at ages 12 to 14 and again at ages 15 to 17. When considering the combined effects of the number of positive and negative self-schemas, antisociality, and parental alcoholism on drinking outcomes, the number of negative self-schemas directly predicted early drinking onset, whereas the number of positive self-schemas moderated the effects of antisociality on early drunkenness. Moreover, although self-concept properties at baseline did not differentiate level of alcohol involvement at follow-up in mid-adolescence, they did distinguish earlier from later age of onset among those who initiated, with effects tending to be somewhat stronger for boys than girls. Self-schemas appear to be an additional risk factor in the pathway to problem alcohol involvement in adolescence, above and beyond the contributions of such known risk factors as antisocial behavior and parental alcoholism.

Coyle JP; Nochajski T; Maguin E; Safyer A; DeWit D; Macdonald S. An exploratory study of the nature of family resilience in families affected by parental alcohol abuse. Journal of Family Issues 30(12): 1606-1623, 2009. (51 refs.)

Resilient families are able to adapt to adversities, but the nature of family resilience is not well understood. This study examines patterns of family functioning that may protect families from the negative impact of alcohol abuse. Naturally occurring patterns of family functioning are identified and associations between these patterns and parenting, current parental alcohol use, recent family stressful events, supportive relationships outside the family, and demographic characteristics are assessed. Cross-sectional data are analyzed from racially diverse American and Canadian families (N = 674) who have at least one parent with an alcohol abuse problem and a child between ages 9 and 12 years. Cluster analyses derived from family functioning indicators are used to identify naturally occurring family patterns. Multivariate assessments evaluated relationships between family functioning clusters and potentially influencing factors. The study results reveal a continuum of family functioning associated with parenting, child's perception of teacher caring, and race.

Diaz R; Gual A; Garcia M; Arnau J; Pascual F; Canuelo B et al. Children of alcoholics in Spain: From risk to pathology. Social Psychiatry and Psychiatric Epidemiology 43(1): 1-10, 2008. (68 refs.)

Objective To identify the possible risk factors and negative outcomes associated with parental alcoholism. A secondary aim was to determine the influence of the family density of alcoholism on children of alcoholics' (COAs) psychological functioning. Method A multisite epidemiological study was conducted in 8 Spanish cities, recruiting a total sample of 371 COAs (whose parents were in contact with alcohol treatment centers and accepted to participate in this study) and 147 controls (from schools in the same localities as COAs). Both groups were 6-17 years old and received a comprehensive evaluation of mental disorders (no symptoms, subclinical symptoms or clinical diagnosis for each disorder; according to DSM-IV criteria); alcohol and other substance use (none, occasional, regular and risky consumption); school achievement (low, middle and high) and other academic performance indicators (WISC-R Information and Arithmetic subtests, school support activities and failed subjects and courses). Lastly, several cognitive functions were measured by the WISC-R Similarities, Block Design and Digit Symbol subtests, the Toulouse-Pieron test and the Stroop test. Logistic regression methods were used to compare both groups and a linear regression model was used to determine the influence of the family density of alcoholism. The following confounding variables were controlled for: age, gender, socio-economic status and family cohesion. Results: Children of alcoholics' were twice as likely as controls to present subclinical symptoms and four times more likely than controls to have a definite diagnosis of any mental disorder. More specifically, COAs had a significantly higher risk than controls of attention deficit disorder/hyperactivity, depression, phobias, enuresis and tics. COAs also tended to have more symptoms of generalized anxiety disorder. COAs had worse results on all the cognitive tests used and their risk of low school achievement was nine times higher than that of controls. Family density of alcoholism was significantly related to several psychiatric disorders and to low academic and cognitive performance in these children. Conclusion: Children of alcoholics' whose parents are in contact with treatment centers in Spain constitute a target group for selective prevention, as they have a higher risk of different negative outcomes, which mainly include attention disorders and other cognitive deficits, depression and anxiety.

Dwyer JG. A consitutional birthright: The State, parentage, and the rights of newborn persons. UCLA Law Review 56(4): 755-835, 2009. (75 refs.)

State parentage laws, dictating who a newborn child's first legal parents will be, have been the subject of constitutional challenges in several U.S. Supreme Court and many lower court decisions. All of those decisions, however, have focused on constitutional rights of adults (especially unwed biological fathers) who wish to become, or to avoid becoming, legal parents. Neither courts nor legal scholars have considered whether the children have any constitutional rights that constrain legislatures and courts in deciding which adults will be their legal parents. If a state enacted a parentage law that said, for example, that any child born to a birth mother who already had two children would be placed in a parent-child relationship at birth with applicants for adoption rather than with the birth mother, would that infringe on any constitutional right of the child? Or would the birth mother be the only person with standing to challenge the law? Such a law would be purely hypothetical in the U.S. (though not far from reality in some other parts of the world). But the actual current parentage laws in the United States, which confer legal parent status in almost all instances on biological parents, with no regard for fitness, also have a seriously adverse affect on a subset of children-specifically, children whose birth parents are manifestly unfit to raise children, as evidenced by serious child maltreatment histories, criminal records, substance abuse, mental illness, and/or imprisonment. This Article is the first to consider whether states violate a constitutional right of some children when their parentage laws consign the children to legal relationships with, and into the custody of, adults whom the state knows to be unfit. It identifies opportunities for children's advocates to advance constitutional challenges to state parentage laws as applied to newborn offspring of adults unfit to parent, and it presents a robust legal theory to underwrite such challenges.

Eiden RD; Molnar DS; Colder C; Edwards EP; Leonard KE. A conceptual model predicting internalizing problems in middle childhood among children of alcoholic and nonalcoholic fathers: The role of marital aggression. Journal of Studies on Alcohol and Drugs 70(5): 741-750, 2009. (43 refs.)

Objective: The purpose of this study was to test a conceptual model predicting children's anxiety/depression in middle childhood in a community sample of children with parents who had alcohol problems (n = 112) and those without alcohol problems (n = 101). The conceptual model examined the role of parents' alcohol diagnoses, depression, and antisocial behavior among parents of children ages 12 months to kindergarten age in predicting marital aggression and parental aggravation. Higher levels of marital aggression and parental aggravation were hypothesized to predict children's depression/anxiety within time (18 months to kindergarten age and, prospectively, to age during fourth grade). Method: The sample was recruited front New York State birth records when the children were 12 months old. Assessments were conducted at 12, 18, 24, and 36 months; at kindergarten age; and during fourth grade, Results: Children with alcoholic fathers had higher depression/anxiety scores according to parental reports but not self-reports. Structural equations modeling was largely supportive of the conceptual model. Fathers' alcoholism was associated with higher child anxiety via greater levels of marital aggression among families with alcohol problems. Results also indicated that there was a significant indirect association between parents' depression symptoms and child anxiety via marital aggression. Conclusions: The results highlight the nested nature of risk characteristics in alcoholic families and the important role of marital aggression in predicting children's anxiety/depression. Interventions targeting both parents' alcohol problems and associated marital aggression are likely to provide the dual benefits of improving family interactions and lowering risk of children's internalizing behavior problems.

Embregts PJCM. Residential treatment following outpatient treatment for children with mild to borderline intellectual disabilities: A study of child and family characteristics. Research in Developmental Disabilities 30(5): 1062-1067, 2009

In this study, the question was explored whether children with a mild intellectual disability (MID) who were placed in residential treatment following outpatient treatment differ significantly on child and family characteristics from children with MID and not placed in residential treatment following outpatient treatment. The records of the children were examined with respect to various child and family characteristics. Retrospective case analyses were thus undertaken. The results showed those children placed in residential treatment to have experienced significantly more often a traumatic event than the other children. Those children placed in residential treatment had received significantly fewer months of outpatient treatment than those not placed in residential treatment. Finally, there were significantly more children placed in residential treatment having educationally incapable parents or parents with alcohol/drug problems and/or psychiatric problems than in the other group. The findings are discussed in light of a disturbed balance between the support needs and means of the family which can lead to placement of a child in a residential treatment. The possibilities of a multisystemic model for outpatient treatment are discussed.

Gilbert RE. Ronald Reagan's presidency: The impact of an alcoholic parent. Political Psychology 29(5): 737-765, 2008. (101 refs.)

Ronald Reagan enjoyed a successful political career. Nevertheless, his political life was affected dramatically by the fact that he was the son of an alcoholic parent. Alcoholic parents leave deep marks on their children's lives, even after those children become adults. As president of the United States, Reagan clearly demonstrated these marks. He was aloof and distant, was often a disengaged leader, showed inordinate loyalty to associates even when such loyalty became problematic, was prone to live in a world of make-believe, married compulsive women, and craved approval and applause. Each of these behavioral characteristics was part of the psychological legacy left to this president by his long-dead alcoholic father. Some of them damaged his presidency greatly; others, however, may well have assisted it.

Heitzeg MM; Nigg JT; Yau WYW; Zubieta JK; Zucker RA. Affective circuitry and risk for alcoholism in late adolescence: Differences in frontostriatal responses between vulnerable and resilient children of alcoholic parents. Alcoholism: Clinical and Experimental Research 32(3): 414-426, 2008. (89 refs.)

Background: Children of alcoholics (COAs) are at elevated risk for alcohol use disorders (AUD), yet not all COAs will develop AUD. The 2 primary aims of this study were to identify neural activation mechanisms that may mark protection or vulnerability to AUD in COAs and to map the same activation patterns in relation to risk behavior (externalizing or internalizing behavior). Methods: Twenty-two adolescent COAs were recruited from an ongoing community longitudinal study of alcoholic and matched control families. They were categorized as either vulnerable (n = 11) or resilient (n = 11) based on the level of problem drinking over the course of adolescence. Six other adolescents with no parental history of alcoholism, and no evidence of their own problem drinking were recruited from the same study and labeled as low-risk controls. Valenced words were presented to the participants in a passive viewing task during functional magnetic resonance imaging. Activation to negative versus neutral words and positive versus neutral words were compared between groups. Behavior problems were assessed with the Youth Self-Report (YSR). Results: The resilient COA group had more activation of the orbital frontal gyrus (OFG), bilaterally, and left insula/putamen than the control and vulnerable groups, in response to emotional stimuli. In contrast, the vulnerable group had more activation of the dorsomedial prefrontal cortex and less activation of the ventral striatum and extended amygdala, bilaterally, to emotional stimuli than the control and resilient groups. The vulnerable group had more externalizing behaviors which correlated with increased dorsomedial prefrontal activation and decreased ventral striatal and extended amygdala activation. Conclusions: These results are consistent with dissociable patterns of neural activation underlying risk and resiliency in COAs. We propose that the pattern observed in the resilient COAs represents an active emotional monitoring function, which may be a protective factor in this group. On the other hand, the vulnerable group displayed a pattern consistent with active suppression of affective responses, perhaps resulting in the inability to engage adaptively with emotional stimuli.

Hussong A; Bauer D; Chassin L. Telescoped trajectories from alcohol initiation to disorder in children of alcoholic parents. Journal of Abnormal Psychology 117(1): 63-78, 2008. (58 refs.)

The current study tested whether and why children of alcoholics (COAs) showed telescoped (adolescent) drinking initiation-to-disorder trajectories as compared with non-COAs. Using longitudinal data from a community-based sample, the authors confirmed through survival analyses that COAs progressed more quickly from initial adolescent alcohol use to the onset of disorder than do matched controls. Similar risks for telescoping were evident in COAs whose parents were actively symptomatic versus those whose parents had been previously diagnosed. Stronger telescoping effects were observed for COAs whose parents showed comorbidity for either depression or antisocial personality disorder. Both greater externalizing symptoms and more frequent, heavier drinking patterns at initiation failed to explain COAs' risk for telescoping, although externalizing symptoms were a unique predictor of telescoping. This risk for telescoping was also evident for drug disorders. These findings characterize a risky course of drinking in COAs and raise important questions concerning the underlying mechanisms and consequences of telescoping in COAs.

Hussong AM; Cai L; Curran PJ; Flora DB; Chassin LA; Zucker RA. Disaggregating the distal, proximal, and time-varying effects of parent alcoholism on children's internalizing symptoms. Journal of Abnormal Child Psychology 36(3): 335-346, 2008. (49 refs.)

We tested whether children show greater internalizing symptoms when their parents are actively abusing alcohol. In an integrative data analysis, we combined observations over ages 2 through 17 from two longitudinal studies of children of alcoholic parents and matched controls recruited from the community. Using a mixed modeling approach, we tested whether children showed elevated mother- and child-reported internalizing symptoms (a) at the same time that parents showed alcohol-related consequences (time-varying effects), (b) if parents showed greater alcohol-related consequences during the study period (proximal effects), and (c) if parents had a lifetime diagnosis of alcoholism that predated the study period (distal effects). No support for time-varying effects was found; proximal effects of mothers' alcohol-related consequences on child-reported internalizing symptoms were found and distal effects of mother and father alcoholism predicted greater internalizing symptoms among children of alcoholic parents. Implications for the time-embedded relations between parent alcoholism and children's internalizing symptoms are discussed.

Johnson EC. When a student does not want to be in school: A reading of Paulo Freire through family alcoholism discourse. Qualitative Inquiry 15(7): 1287-1289, 2009. (1 refs.)

As Richardson reminds us, "People make sense of their lives, for the most part, in terms of specific events." The author develops a set of poems based on his autoethnography study on Children of Alcoholics (COA). As the author reads Paulo Freire through alcoholism discourse, he creates a link between COA and his own school experiences. While the author questions his desire for education, he continues to excel in his studies to overcome particular life obstacles. To raise awareness for all educators, his postmodern work attempts to show the dimensions of family alcoholism and how it might impact ones views of their own schooling experience.

Katz G; Lazcano-Ponce E. Intellectual disability: Definition, etiological factors, classification, diagnosis, treatment and prognosis. (review). Salud Publica de Mexico 50(Supplement 2): s132-s141, 2008. (57 refs.)

Etiology and classification: Causal factors related with cognitive disability are multiples and can be classified as follows: Genetic, acquired (congenital and developmental), environmental and sociocultural. Likewise, in relation to the classification, cognitive disability has as a common denominator a subnormal intellectual functioning level; nevertheless, the extent to which an individual is unable to face the demands established by society for the individual's age group has brought about four degrees of severity: Mild, moderate, severe and profound. Diagnostic: The clinical history must put an emphasis on healthcare during the prenatal, perinatal and postnatal period and include the results of all previous studies, including a genealogical tree for at least three generations and an intentional search for family antecedents of mental delay, psychiatric illnesses and congenital abnormalities. The physical exam should focus on secondary abnormalities and congenital malformations, somatometric measurements and neurological and behavioral phenotype evaluations. If it is not feasible to establish a clinical diagnosis, it is necessary to conduct high-resolution cytogenetic studies in addition to metabolic clinical evaluations. In the next step, if no abnormal data are identified, submicroscopic chromosomal disorders are evaluated. Prognosis: Intellectual disability is not curable; and yet, the prognostic in general terms is good when using the emotional wellbeing of the individual as a parameter. Conclusions: Intellectual disability should be treated in a comprehensive manner. Nevertheless, currently, the fundamental task and perhaps the only one that applies is the detection of the limitation and abilities as a function of subjects' age and expectations for the future, with the only goal being to provide the support necessary for each one of the dimensions or areas in which the person's life is expressed and exposed.

Institute Nacional Salud Publica

King KM; Chassin L. Adolescent stressors, psychopathology, and young adult substance dependence: A prospective study. Journal of Studies on Alcohol and Drugs 69(5): 629-638, 2008. (67 refs.)

Objective: There is much theory, but sparse empirical evidence, supporting the notion that internalizing symptoms and negative affect are the mechanism by which exposure to stressful life events influence the development of substance-use disorders in adolescence and young adulthood. However, many empirical studies have shown that, in addition to elevations in internalizing symptoms, exposure to stressful life events also produces elevations in externalizing behaviors and conduct problems, which are important risk factors for substance-use disorders. The current study tested adolescent externalizing and internalizing symptoms as competitive mediators of the effects of stressors on young adult drug dependence. Method: Data from an ongoing study of children of alcoholics (n = 223) and matched controls (n = 204) were collected in two annual interviews in adolescence and two follow-ups in young adulthood. Results: Experiencing stressful life events during adolescence led to increases in both externalizing and internalizing symptoms, but only externalizing symptoms mediated the later effects of adolescent stressors on young adult drug dependence. Conclusions: These findings suggest that understanding how stressors produce elevations in behavioral problems may provide important insights into understanding how broad environmental risk factors lead to substance dependence and suggests that processes other than affect regulation may operate in the pathway from the experiences of stressors to substance use and disorder.

Klostermann K; Kelley ML. Alcoholism and intimate partner violence: Effects on children's psychosocial adjustment. (review). International Journal of Environmental Research and Public Health 6(12): 3156-3168, 2009. (82 refs.)

It is widely recognized that alcoholism and relationship violence often have serious consequences for adults; however, children living with alcoholic parents are susceptible to the deleterious familial environments these caregivers frequently create. Given the prevalence of IPV among patients entering substance abuse treatment, coupled with the negative familial consequences associated with these types of behavior, this review explores what have been, to this point, two divergent lines of research: (a) the effects of parental alcoholism on children, and (b) the effects of children's exposure to intimate partner violence. In this article, the interrelationship between alcoholism and IPV is examined, with an emphasis on the developmental impact of these behaviors (individually and together) on children living in the home and offers recommendations for future research directions.

Lam WK; Fals-Stewart W; Kelley ML. Effects of parent skills training with behavioral couples therapy for alcoholism on children: A randomized clinical pilot trial. Addictive Behaviors 33(8): 1076-1080, 2008. (18 refs.)

This pilot study examined preliminary effects of Parent Skills Training with Behavioral Couples Therapy on children's behavioral functioning. Participants were men (N = 30) entering outpatient alcohol treatment, their female partners, and a custodial child between 8 and 12 years of age. Couples were randomly assigned to one of three equally intensive conditions: (a) Parent Skills with Behavioral Couples Therapy (PSBCT), (b) BCT (without parent training), and (c) Individual-Based Treatment (IBT; without couples-based or parent skills interventions). Parents completed measures of child externalizing and internalizing behaviors at pretreatment, posttreatment, 6- and 12-month follow up; children completed self-reports of internalizing symptoms at each assessment. Only PSBCT participants reported significant effects on all child measures throughout the 12-month follow up. PSBCT showed medium to large effects in child functioning relative to IBT, and small to medium effects relative to BCT from baseline through follow up. Effect sizes suggest clinically meaningful differences between PSBCT and both BCT and IBT that warrant further empirical evaluation of BCT with parent training for alcohol-abusing men and their partners.

Lee HH; Cranford JA. Does resilience moderate the associations between parental problem drinking and adolescents' internalizing and externalizing behaviors? A study of Korean adolescents. Drug and Alcohol Dependence 96(3): 213-221, 2008. (61 refs.)

Background: This study examined the main and interactive effects of parental problem drinking and resilience on problem (externalizing and internalizing) behaviors among Korean adolescents. Methods: Data were collected from 482 adolescents (mean age = 14.4 years, 57% girls) from four middle schools in two urban areas in Korea. A revised version of Kim's measure (2003) and Hyun's Problems Behaviors Profiles (2000) were employed to measure resilience and internalizing and externalizing behaviors, respectively. Results: Hierarchical multiple regression analyses showed that parental problem drinking was directly associated with externalizing and internalizing behaviors. Further, the effects of parental problem drinking on both outcomes were moderated by resilience, such that the negative effects of parental problem drinking decreased in magnitude as resilience increased. Simple slope analyses showed that (1) the effects of parental problem drinking on externalizing behaviors were significant only at low levels of resilience and (2) the effects of parental problem drinking on internalizing behaviors were significant at low and average levels of resilience. Conclusions: Resilience may confer some protection against the adverse effects of parental problem drinking among Korean adolescents, but these protective effects are small in magnitude. Results highlight the importance of further research on culture-specific dimensions of resilience among Korean Children of Alcoholics (COAs).

Manning V; Best DW; Faulkner N; Titherington E. New estimates of the number of children living with substance misusing parents: Results from UK National Household Surveys. BMC Public Health 9(377), 2009. (38 refs.)

Background: The existing estimates of there being 250,000 - 350,000 children of problem drug users in the UK (ACMD, 2003) and 780,000 - 1.3 million children of adults with an alcohol problem (AHRSE, 2004) are extrapolations of treatment data alone or estimates from other countries, hence updated, local and broader estimates are needed. Methods: The current work identifies profiles where the risk of harm to children could be increased by patterns of parental substance use and generates new estimates following secondary analysis of five UK national household surveys. Results: The Health Survey for England (HSfE) and General Household Survey (GHS) (both 2004) generated consistent estimates - around 30% of children under-16 years (3.3-3.5 million) in the UK lived with at least one binge drinking parent, 8% with at least two binge drinkers and 4% with a lone (binge drinking) parent. The National Psychiatric Morbidity Survey (NPMS) indicated that in 2000, 22% (2.6 million) lived with a hazardous drinker and 6% (705,000) with a dependent drinker. The British Crime Survey (2004) and NPMS (2000) indicated that 8% (up to 978,000) of children lived with an adult who had used illicit drugs within that year, 2% (up to 256,000) with a class A drug user and 7% (up to 873,000) with a class C drug user. Around 335,000 children lived with a drug dependent user, 72,000 with an injecting drug user, 72,000 with a drug user in treatment and 108,000 with an adult who had overdosed. Elevated or cumulative risk of harm may have existed for the 3.6% (around 430,000) children in the UK who lived with a problem drinker who also used drugs and 4% (half a million) where problem drinking co-existed with mental health problems. Stronger indicators of harm emerged from the Scottish Crime Survey (2000), according to which 1% of children (around 12,000 children) had witnessed force being used against an adult in the household by their partner whilst drinking alcohol and 0.6% (almost 6000 children) whilst using drugs. Conclusion: Whilst harm from parental substance use is not inevitable, the number of children living with substance misusing parents exceeds earlier estimates. Widespread patterns of binge drinking and recreational drug use may expose children to sub-optimal care and substance-using role models. Implications for policy, practice and research are discussed.

Maxson RT; Yuma-Guerrero P; von Sternberg K; Lawson KA; Johnson KMK; Brown J et al. Screening for risky alcohol use among caregivers of pediatric trauma patients: A pilot study. Journal of Trauma, Injury, Infection and Critical Care 67(1, Supplement S): S37-S42, 2009. (28 refs.)

Background: Injury is the leading cause of death for children and has been linked to caregiver drinking. Screening and brief intervention for risky drinking has been successful in adult trauma centers but has not been evaluated in caregivers of pediatric trauma patients. The purpose of this study was to investigate a pilot screening process for risky drinking caregivers, to determine rates of risky alcohol use, and to assess potential relationships between risky drinking and child safety behaviors. Methods: Caregivers of pediatric trauma patients were screened by trained injury prevention educators. The screening assessed risky drinking, tobacco and illicit drug use, and child safety behaviors. Data were analyzed using descriptive analysis, frequency comparisons, and univariate logistic regression. Results: Over 7 months, 295 caregivers were screened; 32.5% (n = 96) screened positive for risky alcohol use. For 173 injured children, one caregiver was screened, and for 61 children, two caregivers were screened. In the one-caregiver group, 29% (n = 50) screened positive for risky drinking. For the two-caregiver group, in 18% (n = 11) of the cases, both caregivers screened positive, whereas in 39% (n = 24) only one caregiver screened positive. Males were more likely to screen positive (p < 0.01). Relationships between reported child safety behaviors and risky drinking were of interest, but not statistically significant. Conclusions: The results of our study demonstrate that a substantial number of caregivers of pediatric trauma patients will self-report risky drinking behaviors, and therefore, an opportunity exists for these families to receive the benefits of screening and brief intervention programs in pediatric trauma care settings.

McLaughlin KA; Green JG; Gruber MJ; Sampson NA; Zaslavsky AM; Kessler RC. Childhood adversities and adult psychiatric disorders in the National Comorbidity Survey Replication. II Associations with persistence of DSM-IV Disorders. Archives of General Psychiatry 67(2): 124-132, 2010. (53 refs.)

Context: Although significant associations of childhood adversities (CAs) with adult mental disorders have been widely documented, associations of CAs with onset and persistence of disorders have not been distinguished. This distinction is important for conceptual and practical purposes. Objective: To examine the multivariate associations of 12 retrospectively reported CAs with persistence of adult DSM-IV disorders in the National Comorbidity Survey Replication. Design: Cross-sectional community survey. Setting: Household population in the United States. Participants: Nationally representative sample of 5692 adults. Main Outcome Measures: Recency of episodes was assessed separately for each of 20 lifetime DSM-IV mood, anxiety, disruptive behavior, and substance use disorders in respondents with a lifetime history of these disorders using the Composite International Diagnostic Interview. Predictors of persistence were examined using backward recurrence survival models to predict time since most recent episode controlling for age at onset and time since onset. Results: The CAs involving maladaptive family functioning (parental mental illness, substance use disorder, criminality, family violence, physical and sexual abuse, and neglect) but not other CAs were significantly but modestly related to persistence of mood, substance abuse, and anxiety disorders. Number of maladaptive family functioning CAs had statistically significant, but again substantively modest, subadditive associations with the same outcomes. Exposure to multiple other CAs was significantly associated with persistence of mood and anxiety disorders. Associations remained statistically significant throughout the life course, although the substantive size of associations indicated by simulations showing time to most recent episode would increase by only 1.6% (from a mean of 8.3 years to a mean of 8.4 years) in the absence of CAs. Conclusions: The overall statistically significant associations of CAs with adult DSM-IV/Composite International Diagnostic Interview disorders are due largely to component associations with onsets rather than with persistence, indirectly suggesting that the greatest focus of public health attention on CAs should be aimed at primary rather than secondary prevention.

Namkoong K; Cheon KA; Kim JW; Jun JY; Lee JY. Association study of dopamine D2, D4 receptor gene, GABAA receptor beta subunit gene, serotonin transporter gene polymorphism with children of alcoholics in Korea: A preliminary study. Alcohol 42(2): 77-81, 2008. (22 refs.)

The studies on the genetic risk factors of the children of alcoholics (COAs) are still in an early stage. The Al allele of the dopamine receptor 2 gene (DRD2) may be associated with positive alcohol expectancy of the COAs. In addition, several researchers reported that the COAs might be associated with the GABA(A) receptor beta 3 subunit gene (GABRB3) and serotonin transporter gene (5-HTTLPR). In this study, we investigated the association of the polymorphism of the DRD2, Doparmine D4 receptor gene (DRD4), GABRB3, 5-HTTLPR with the COAs. Twenty-two COAs and 23 age and sex-matched control children were included for the genetic study (children of nonAlcoholics; nonCOAs). All COAs aged 6-18 were recruited and selected from family of alcoholic patients in Alcohol Clinic of the University hospital. The genotyping of the DRD2, DRD4, GABRB3, 5-HTTLPR was carried out. We used the Chi-square method for evaluating the association of genetic polymorphic allelic status with the COAs. The frequency of the A1+ allele at DRD2 in the COAs was significantly higher than nonCOAs. Significant association between the genotype at DRD4 and the COAs was found. The G1 - alleles of the GABRB3 in COAs were significantly higher than nonCOAs. However, no association of the polymorphic alleles of the 5-HTTLPR with the COAs was found. We found that the children of alcoholics had a significantly increased number of risk alleles of candidate genes of alcohol drinking expectancy. Despite of several limitations, this study provides some preliminary information on the risk and protective factors associated with the COAs, which can be used as a foundation for prevention and intervention of future psychopathology.

Office of Applied Studies, Substance Abuse and Mental Health Administration. The NSDUH Report: Children Living with Substance-Dependent or Substance-Abusing Parents: 2002 to 2007. (April 16, 2009). Rockville MD: Substance Abuse and Mental Health Administration, 2009. (6 refs.)

Parental substance dependence and abuse can have profound effects on children, including child abuse and neglect, injuries and deaths related to motor vehicle accidents, and increased odds that the children will become substance dependent or abusers themselves. Up-to-date estimates of the number of children living with substance-dependent or substance-abusing parents are needed for planning both adult treatment and prevention efforts and programs that support and protect affected children. Summary: Combined data from 2002 to 2007 indicate that over 8.3 million children under 18 years of age (11.9 percent) lived with at least one parent who was dependent on or abused alcohol or an illicit drug during the past year. Of these, almost 7.3 million (10.3 percent) lived with a parent who was dependent on or abused alcohol, and about 2.1 million (3.0 percent) lived with a parent who was dependent on or abused illicit drugs. About 5.4 million children under 18 years of age lived with a father who met the criteria for past year substance dependence or abuse, and 3.4 million lived with a mother who met the criteria.

Public Domain

Ohannessian CM. Does technology use moderate the relationship between parental alcoholism and adolescent alcohol and cigarette use? Addictive Behaviors 34(6-7): 606-609, 2009. (23 refs.)

The primary goals of this study were to examine the associations between technology use and alcohol and cigarette use during adolescence and to explore whether technology use moderates the relationship between parental alcoholism and substance use (alcohol and cigarette use). The sample included 328 14-16 year-old adolescent boys and girls. The adolescents completed a battery of self-report questionnaires which included measures that assessed their substance use, their use of technology, and their parents' alcohol use (including alcoholism). Results indicated that adolescents who had an alcoholic parent reported relatively higher levels of alcohol consumption. Heavier use of technology (particularly text messaging, e-mailing/IMing, and watching television) also was related to earlier and heavier substance use during adolescence. Moreover, these effects tended to be more pronounced in adolescents with an alcoholic parent. Results from this study suggest that high levels of technology use during adolescence may be related to an increased risk of alcohol and cigarette use, particularly for children of alcoholic parents (COAs).

Ohannessian CM. Media use and adolescent psychological adjustment: An examination of gender differences. Journal of Child and Family Studies 18(5): 582-593, 2009. (55 refs.)

This study examined media use and psychological adjustment (as indicated by depression and anxiety symptomatology) in a sample of 328 14- to 16-year-old adolescents. Primary goals of the study were to explore whether media use differs by gender, whether media use is related to adolescent psychological problems, and whether media use moderates the relationship between parental alcoholism and adolescent psychological adjustment. Adolescents were surveyed in the spring of 2006, and again one year later. Gender differences in media use were observed with boys spending more time playing video games than girls and girls spending more time talking on the phone than boys. Strikingly, none of the types of media examined was associated with depression or anxiety. Moreover, media use acted as a protective factor for boys. Boys who spent relatively more time playing video games and watching television had the lowest levels of anxiety, especially those from alcoholic homes. The opposite pattern emerged for girls.

Ohannessian CM; Hesselbrock VM. A comparison of three vulnerability models for the onset of use in a high-risk sample. Journal of Studies on Alcohol and Drugs 69(1): 75-84, 2008. (50 refs.)

Objective: The purpose of this prospective study was to compare the following three vulnerability models for early-onset substance use in a high-risk sample: the deviance proneness model, the negative affect regulation model, and a comprehensive model including both delinquency and negative affect. Method: The sample included 249 15- to 19-year-old adolescents (57% children of alcoholics) and their fathers, all of whom were seen at follow-up 5 years later. At both times of measurement, participants completed a clinical psychiatric interview and a battery of self-report questionnaires assessing temperament, negative affect, delinquency, and substance use. Results: Although all of the models fit the data well, the deviance proneness model was parsimonious and provided the best fit. Delinquency played a significant mediating role, whereas negative affect did not. Moreover, negative affect and delinquency were not significantly related to one another. Conclusions: Results from this study suggest that the deviance proneness model may be a more useful theoretical framework than the negative affect regulation model or a comprehensive model when examining the onset of substance use, particularly in a high-risk sample.

Ohannessian CM; Hesselbrock VM. Paternal alcoholism and youth substance abuse: The indirect effects of negative affect, conduct problems, and risk taking. Journal of Adolescent Health 42(2): 198-200, 2008. (10 refs.)

This longitudinal study followed 200 adolescents into early adulthood to explore the potential mediating roles that hostility, sadness, conduct problems, and risk-taking play in the relationship between paternal alcoholism and substance abuse. Results indicated that paternal alcoholism predicted hostility; in turn, hostility predicted risk taking, which predicted substance abuse.

Piasecki TM; Slutske WS; Wood PK; Hunt-Carter EE. Frequency and correlates of diary-measured hangoverlike experiences in a college sample. Psychology of Addictive Behaviors 24(1): 163-169, 2010. (35 refs.)

A sample of college students, oversampled for smoking (N = 127, 43% smokers), monitored their daily experiences using electronic diaries over 14 days. We examined the frequency and correlates of liberally defined hangoverlike experiences (HLEs) using data from 1,595 person-days (1,325 after abstention from drinking and 270 after drinking, including 125 HLEs). More than 40% of the sample reported at least one HLE, and nearly half of all drinking episodes were followed by HLE. Endorsement of HLE was more likely as the number of drinks increased and was associated with modest elevations of hangover symptoms. Gender did not predict rates of overall HLE endorsement, but male students were less likely than female students to report an HLE after a drinking episode and showed a weaker relation between number of drinks and HLE. Smokers were more likely to report HLE, but there was no evidence that smoking status was associated with increased HLE susceptibility. Self-reported parental alcohol problems were associated with more frequent HLE and incrementally predicted HLE endorsement when number of drinks was covaried. The findings suggest that HLE is a common outcome of college drinking and attest to the feasibility of using electronic diaries to assess its episode- and person-level correlates.

Redelinghuys J; Dar K. A survey of parents receiving treatment for substance dependence: The impact on their children. Journal of Substance Use 13(1): 37-48, 2008. (51 refs.)

Aims: To screen for the presence of psychiatric problems in the children of substance dependent parents admitted for detoxification and to collect information about the children's involvement with other services. We also sought parental views about the risk of their children developing substance misuse problems and where they would seek help for them. Design: Prospective cross-sectional survey. Setting: In-patient detoxification unit, West London. Participants: Sixty-six parents who had 152 children participated in the study. Measurements: A specifically designed 'Parents Questionnaire' and the Strength and Difficulties Questionnaire (SDQ) were used to elicit information from the parents and screen for psychiatric morbidity in their children. Findings: The SDQ data was all within the normal range with 24.6% of the children having had Social Services involved in their care at some point. Four parents reported children with substance misuse problems and one reported a child with a psychotic illness. Forty-one per cent of the parents were concerned about their children developing future substance misuse problems. Only 10% of parents would contact Child and Adolescent Mental Health or Paediatrics services to seek help, and nearly half wouldn't contact Substance Misuse Services in this regard. Conclusions: There is an urgent need for more research focusing on the impact of parental substance use on children. In particular, the impact of paternal substance abuse and the continuing impact of parental misuse on older children require investigation. Current and future service provision needs greater integration between different agencies and better training of staff. Improved professional awareness can help reduce stigma and allay the misconceptions held by some parents. This would support effective prevention and treatment strategies.

Tall K; Kolves K; Sisask M; Varnik A. Do survivors respond differently when alcohol abuse complicates suicide? Findings from the psychological autopsy study in Estonia. Drug and Alcohol Dependence 95(1/2): 129-133, 2008. (22 refs.)

Background: When a person with alcohol use disorder commits suicide, do the immediate family members (parents, spouses, and children) react differently from the relatives of non-alcohol-related suicides? Methods: From a series of 427 psychological autopsies conducted in Estonia we selected 261 cases of suicide where the key informants were close relatives. Of the 261 suicides, 148 met the DSM-IV criteria for alcohol use disorder (alcohol abuse and alcohol dependence), while 113 did not. Unconditional logistic regression was used to estimate the association in terms of emotions. Results: The spouses of alcohol misusing suicides were significantly more likely to react with anger than those when alcohol did not complicate the picture (adjusted OR = 3.8, 95% CI = 1.4-0.4). The children of persons with alcohol use disorder, who committed suicide were less likely to feel guilty (adjusted OR = 0.2, 95% CI = 0.1-0.8) or abandoned (adjusted OR = 0.2, 95% Cl = 0.1-0.7) than children of non-alcohol-related suicide victims. There were no statistically significant differences in surviving parents' emotions. Conclusions: Alcohol use disorder before suicide changes affective responses in spouses and children who are left behind. Bereavement counsellors should be alert for complex grief and mourning responses among this group of suicide survivors.

Tarokh L; Carskadon MA. Sleep electroencephalogram in children with a parental history of alcohol abuse/dependence. Journal of Sleep Research 19(Supplement 1): 165-174, 2010. (51 refs.)

We examined the sleep electroencephalogram (EEG) in 9- and 10-year-old children with (PH+) and without (PH-) a parental history of alcohol abuse/dependence to determine whether sleep disturbances associated with alcohol precede the onset of alcohol use. Participants: slept on a fixed sleep schedule that ensured at least a 10-h time in bed for 1 week before an adaptation and baseline night. Data were collected in a four-bed sleep research laboratory. Thirty healthy boys and girls aged 9 or 10 years were classified as either PH+ or PH- based on DSM-IV criteria applied to structured parental interviews. All-night polysomnography was performed, sleep data were scored visually in 30-s epochs, and EEG power spectra were calculated for each epoch. All-night EEG spectra were calculated for rapid eye movement (REM) and non-REM (NREM) sleep, and cycle-by-cycle spectra were calculated for NREM sleep. The two groups did not differ on any sleep stage variable. All-night analyses revealed normalized power in the delta band and spindle range were lower in PH+ children. Within NREM sleep cycles PH+ children exhibited less normalized power in the delta band and spindle range compared with PH- children. This effect occurred in the first four cycles and was most pronounced in the first sleep cycle of the night. We found no signs of sleep disruption in sleep stages for PH+ children. Sleep EEG spectral differences, however, suggest that certain circuits responsible for 'protecting' sleep may be impaired in PH+ children, which may lead to disrupted sleep later in life.

Taylor A; Toner P; Templeton L; Velleman R. Parental alcohol misuse in complex families: The implications for engagement. British Journal of Social Work 38(5): 843-864, 2008. (55 refs.)

The impact of chronic parental alcohol misuse on both parenting and child welfare is being increasingly recognized, with such problems featuring in a significant proportion of families in which there are identified child-care concerns. There is a growing body of research which suggests that there are often particular difficulties in gaining access to such families, with effective engagement seen as central to appropriate intervention and to assessing childrens welfare in these situations. Establishing and sustaining engagement may be particularly problematic where these families experience a constellation of impacting pressures, of which alcohol and/or drug misuse is a central component. This article explores some of the challenges of reaching children and parents in such circumstances. Based on research that included a wider evaluation of a specialist service for children and families in which alcohol is a problem, a sample of families who dropped out of contact are presented and discussed. The authors suggest that particular responses to engaging such families are needed and identify the challenges in gaining access to children in such circumstances.

Templeton L; Velleman R; Hardy E; Boon S. Young people living with parental alcohol misuse and parental violence: 'No-one has ever asked me how I feel in any of this'. Journal of Substance Use 14(3-4): 139-150, 2009. (30 refs.)

Young people are adversely affected by negative family experiences, but there is a gap in knowledge when the commonly co-existing issues of parental alcohol misuse and parental domestic abuse are considered. Research which talks directly to the young people living in such circumstances is therefore needed. As part of a Europe-wide research study, eight young people aged 12-18 years from five families in England were interviewed about their experiences of living with parental alcohol misuse and violence. Strong links emerged between parental drinking and domestic abuse, with verbal aggression common, and frequent and physical violence less frequent, but of equal concern. The young people had tried and were trying a range of strategies to try and cope with their home environments, and faced an ongoing battle in working out what to do for the best. Support from family, friends, and professionals was discussed, but the young people generally had mixed views about what help they had received and the support that they would have liked. The paper discusses what the findings might mean in terms of the practice and policy response to children living in risky family environments.

Trim RS; Chassin L. Neighborhood socioeconomic status effects on adolescent alcohol outcomes using growth models: Exploring the role of parental alcoholism. Journal of Studies on Alcohol and Drugs 69(5): 639-648, 2008. (54 refs.)

Objective: There is conflicting evidence regarding the impact of neighborhood socioeconomic status (SES) on adolescent alcohol use. The current study tested whether the prospective effects of neighborhood SES on adolescent alcohol outcomes varied across parental alcoholism subgroups. Method: Data from a group of adolescents (N = 361) from an ongoing longitudinal study of children of alcoholics (COAs) and matched controls were collected at three initial annual assessments. Latent growth models were estimated with a range of related time-invariant and time-varying predictors. Results: Among non-COAs, higher neighborhood SES predicted increased rates in alcohol use and consequences, whereas among COAs, lower neighborhood SES was predictive of increased rates in alcohol use and marginally predicted rates of consequences. There were also time-specific effects of family mobility on alcohol outcomes. Conclusions: The current study provides evidence for differential effects of neighborhood SES on adolescent alcohol use and consequences for non-COAs and COAs. The group differences found in this study may help explain the equivocal findings from previous neighborhood studies, which may use samples with an unmeasured mix of high- and low-risk adolescents. Future research should identify pathways to alcohol use and problems for high- and low-risk adolescents living in neighborhoods that span the range of the socioeconomic spectrum.

Waldron M; Martin NG; Heath AC. Parental alcoholism and offspring behavior problems: Findings in Australian children of twins. Twin Research and Human Genetics 12(5): 433-440, 2009. (47 refs.)

We examine the impact of rearing by an alcoholic parent on risk for child behavior problems using data on 2492 offspring drawn from two ongoing studies of children of female and male same- and opposite-sex twin pairs. Results of regression models predicting child behavior problems from parent and co-twin lifetime history of alcohol use disorder (AUD) provide support for genetic but not environmental transmission of externalizing and a measure of total problem behaviors. Results for internalizing behavior were inconclusive with respect to transmission of risk.