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CORK Bibliography: Children of Alcoholics

78 citations. 2006 to present

Prepared: June 2009

Andreas JB; O'Farrell TJ. Alcoholics Anonymous attendance following 12-step treatment participation as a link between alcohol-dependent fathers' treatment involvement and their children's externalizing problems. Journal of Substance Abuse Treatment 36(1): 87-100, 2009. (55 refs.)

We investigated longitudinal associations between alcohol-dependent fathers' 12-step treatment involvement and their children's internalizing and externalizing problems (N = 125, M-age = 9.8 +/- 3.1), testing the hypotheses that fathers' greater treatment involvement would benefit later child behavior and that this effect would be mediated by fathers' posttreatment behaviors. The initial association was established between fathers' treatment involvement and children's externalizing problems only, whereas Structural Equation Modeling (SEM) results supported mediating hypotheses. Fathers' greater treatment involvement predicted children's lower externalizing problems 12 months later, and fathers' posttreatment behaviors mediated this association. Greater treatment involvement predicted greater posttreatment Alcoholics Anonymous attendance, which in turn predicted greater abstinence. Finally, fathers' abstinence was associated with lower externalizing problems in children. Theoretical and practical implications of these findings are discussed.

Andreas JB; O'Farrell TJ. Longitudinal associations between fathers' heavy drinking patterns and children's psychosocial adjustment. Journal of Abnormal Child Psychology 35(1): 1-16, 2007. (37 refs.)

Psychosocial adjustment in children of alcoholics (N = 114) was examined in the year before and at three follow-ups in the 15 months after their alcoholic fathers entered alcoholism treatment, testing the hypothesis that children's adjustment problems will vary over time as a function of their fathers' heavy drinking patterns. Three unique patterns of heavy drinking in alcoholic fathers were identified through cluster analysis. The results demonstrated significant and meaningful associations between these drinking patterns in fathers and adjustment problems in children over time. Overall, children whose fathers remained mostly abstinent following their treatment showed lowest and decreasing adjustment problems, while children whose fathers continued and increased heavy drinking following their treatment showed greatest and increasing adjustment problems over time.

Andreas JB; O'Farrell TJ; Fals-Stewart W. Does individual treatment for alcoholic fathers benefit their children? A longitudinal assessment. Journal of Consulting and Clinical Psychology 74(1): 191-198, 2006. (21 refs.)

Psychosocial adjustment in children of alcoholics (COAs; N = 125) was examined before and at 3 follow-ups in the 15 months after their fathers entered alcoholism treatment. Before their fathers' treatment, COAs exhibited greater overall and clinical-level symptomatology than children from the demographically matched comparison sample, but they improved significantly following their fathers' treatment. Children of stably remitted fathers were similar to their demographic counterparts from the comparison sample and had fewer adjustment problems than children of relapsed fathers, even after accounting for children's baseline adjustment. Thus, COAs' adjustment improved when their fathers received treatment for alcoholism, and fathers' recovery from alcoholism was associated with clinically significant reductions in child problems.

Antolin T; Berman SM; Conner BT; Ozkaragoz TZ; Sheen CL; Ritchie TL et al. D2 dopamine receptor (DRD2) gene, P300, and personality in children of alcoholics. Psychiatry Research 166(2/3): 91-101, 2009. (67 refs.)

The D2 dopamine receptor (DRD2) gene has been associated with alcoholism and other drug use disorders. Reduced P300 amplitude has been noted in individuals with psychiatric disorders. Personality variables are also associated with reduced P300 amplitude. The current study was conducted to determine whether variants of the DRD2 would show differential relationships among P300 amplitude and personality traits. The study consisted of 101 adolescent children of alcoholics; 39 carried the Al+ genotype (Al A1, Al A2) and 62 carried the Al- genotype (A2A2). The Al+ genotype group had higher IQ and Self-Directedness scores than the Al- genotype group. As predicted, the negative relationship between Novelty Seeking and Hann Avoidance was present in A1(-) but not Al+ participants. Additionally, in Al+ but not in Al- participants, there was a negative relationship between Novelty Seeking and Self-Directedness and a positive relationship between P300 amplitude and Cooperativeness. The results suggest that in adolescent children of alcoholics, dopaminergic genetic determinants are critical modifiers of the relationship between neurocognitive and personality endophenotypes proposed as vulnerability markers for substance use disorders.

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.

Arendt RE; Farkas KJ. Maternal alcohol abuse and fetal alcohol spectrum disorder: A life-span perspective. Alcoholism Treatment Quarterly 25(3): 3-20, 2007

Many common misconceptions about prenatal exposure to alcohol still exist in the minds of both the public and professional communities. Many of these misconceptions possess striking similarities to misperceptions about women who abuse alcohol. This paper attempts to do away with some widespread erroneous ideas related to alcohol abuse and its effects. Research results in the areas of drug treatment and developmental outcomes are reviewed and recommendations for service provision to both mothers with alcohol abuse problems and individuals with fetal alcohol spectrum disorder are made.

Barnow S; Schuckit M; Smith T; Spitzer C; Freyberger HJ. Attention problems among children with a positive family history of alcohol abuse or dependence and controls: Prevalence and course for the period from preteen to early teen years. European Addiction Research 13(1): 1-5, 2007. (59 refs.)

This longitudinal study investigated the scope and course of attention problems over a period of time from preteen (ages 7-12 years) to early teen years (ages 13-17 years). We compared symptoms in subjects with and without a family history (FH) of alcohol abuse or dependence from among families without evidence of antisocial personality disorder. Evaluations of attention problems for the offspring were based on the Child Behavior Checklist and a validated semistructured interview carried out with the mother. The findings indicate no higher risk for attention problems and attention-deficit hyperactivity disorder (ADHD)-like symptoms in the children of families with an alcohol use disorder. Regarding the course of problems, the ADHD symptom count tended to decrease over time, especially for children without a FH of alcohol abuse or dependence. Further research will be needed to determine whether results can be replicated with families from different social strata and including subjects with the antisocial personality disorder.

Barnow S; Ulrich I; Grabe HJ; Freyberger HJ; Spitzer C. The influence of parental drinking behaviour and antisocial personality disorder on adolescent behavioural problems: Results of the Greifswalder Family Study. Alcohol and Alcoholism 42(6): 623-628, 2007. (39 refs.)

Aim: Contradictory results have been produced by previous research on the question to what extent do children of alcoholics (COAs) differ in measures of externalizing symptoms from children of non-alcoholic parents. The goal of this study was to determine whether COAs are characterized by more behavioural problems than non-COAs, and also to determine the influence of a paternal antisocial personality disorder (ASPD) in this context. Methods: In this study, 340 children and adolescents between the ages of 11 and 18 years and their parents were included. Of this sample, 76 adolescents showed a positive family history of alcoholism (FHalc) and 47 adolescents a positive history of a paternal ASPD (FHaspd). Externalizing symptoms, which where measured on the basis of maternal ratings and self-assessments, were analysed with a two-factorial MANCOVA with FHalc and FHaspd as independent factors. Results: The results of the MANCOVA revealed that only children with paternal ASPD showed significant higher scores in attentional problems, self-rated aggression/delinquency and disruptive behaviour, while there were no differences for FHalc and the interaction effect. Conclusions: Our findings show that the higher of behavioural problems relates primarily to a higher prevalence in both cases of ASPD among fathers. These results were discussed regarding the mediating role of a paternal ASPD for the differences in behavioural problems in COAs and non-COAs. Furthermore, children with FHalc and/or FHaspd represent high-risk groups and should be the focus of prevention and intervention measures.

Bijttebier P; Goethals E; Ansoms S. Parental drinking as a risk factor for children's maladjustment: The mediating role of family environment. Psychology of Addictive Behaviors 20(2): 126-130, 2006. (30 refs.)

In the present study, the relationships among parental drinking, family environment, and child adjustment is investigated in a community sample of 207 10-14-year-olds. Multiple aspects of perceived family environment (e.g., cohesion, organization, conflict) as well as multiple indicators of adjustment (e.g., negative affect, feelings of competence, self-esteem) are taken into consideration. Parental alcohol problems are found to be associated with low family cohesion, poor family organization, and low global self-worth of the child. A mediational analysis reveals that the relation between parental drinking and low global self-worth is mediated by family cohesion.

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.

Bonder BR; Hulisz D; Marsh S; Bonaguro J. Community-based substance abuse training: Helping children living in families with substance-abusing adults. Substance Abuse 26(3/4): 27-30, 2006

Elementary school staff requested and were provided with strategies for helping students and a resource guide to services for students living with substance-abusing adults. (This is one of a series of 10 case studies.)

Boyd R; Kresnow MJ; Dellinger AM. Alcohol-Impaired Driving and Children in the Household. Family & Community Health 33(2): 167-174, 2009. (22 refs.)

More children in the United States are killed in motor vehicle crashes annually than by any other Cause; nearly a quarter of these deaths involve alcohol. This study examines the national prevalence of alcohol-impaired driving and riding with an alcohol-impaired driver and the association of these behaviors to having at least 1 child in the household. An estimated 2.5 million adult drivers with children living in their households reported that they had been a recent alcohol-impaired driver. Evidence-based approaches, including mass media campaigns and sobriety checkpoints, continue to be critically important public health activities.

Bradford BU; Karnitsching J; Powell LL; Garbutt JC. Rates of ethanol metabolism decrease in sons of alcoholics following a priming dose of ethanol. Alcohol 41(4): 263-270, 2007. (35 refs.)

Rapid changes in rates of ethanol metabolism in response to acute ethanol administration have been observed in animals and humans. To examine whether this phenomenon might vary by risk for alcoholism, 23 young men with a positive family history of alcoholism (family history positive [FHP]) were compared to 15 young men without a family history of alcoholism (family history negative [FHN]). Rates of ethanol metabolism were measured in all subjects first after an initial ethanol dose (0.85 g/kg) and then, several hours later, a second dose (0.3 g/kg), and the two rates were compared. The two groups of subjects were similar in their histories of ethanol consumption. FHP subjects demonstrated faster initial rates of ethanol metabolism, 148 36 mg/kg/h, compared to FHN subjects, 124 18 mg/kg/h, P = .01. However, FHN subjects increased their rate of metabolism by 10 +/- 27% compared to a decrease of -15 +/- 24% in FHP subjects, P = .007. Fifty-two percent of the FHP and none of the FHN subjects exhibited a decline in metabolic rate of 20% or more, P = .0008. Since a significant proportion of FHP subjects exhibited a decrease in the second rate of ethanol metabolism, these preliminary data might help to partly explain why FHP individuals differ in their sensitivity to ethanol and are more likely to develop alcohol dependence.

Chalder M; Elgar FJ; Bennett P. Drinking and motivations to drink among adolescent children of parents with alcohol problems. Alcohol and Alcoholism 41(1): 107-113, 2006. (30 refs.)

Aims: To study the influences of parental alcohol problems on adolescents' alcohol consumption and motivations to drink alcohol. Methods: A community sample of 1744 adolescents from schools in South Wales completed the 6-item Children of Alcoholics Screening Test, Drinking Motives Questionnaire, and survey measures of alcohol consumption. Results: Children of parents with alcohol problems constituted almost one-fifth of the sample group and were found to drink more frequently, more heavily, and more often alone than children of parents without alcohol problems. Parental alcohol problems were also related to internal motives to drink (e.g. coping) in their adolescent children. Across the entire sample, internal motives to drink interacted with parental alcohol problems in predicting alcohol consumption and drinking frequency. Conclusion: Parental alcohol problems appeared to co-exist with an asocial pattern of alcohol consumption in adolescents that involves drinking alone and drinking to feel intoxicated or to forget about problems. In addition to the external, social motives to drink, which are shared by most adolescents, nearly one in five of the adolescents studied reported salient internal motives to drink that tended to coexist with alcohol problems in their parents.

Coffelt NL; Forehand R; Olson AL; Jones DJ; Gaffney CA; Zens MS. A longitudinal examination of the link between parent alcohol problems and youth drinking: The moderating roles of parent and child gender. Addictive Behaviors 31(4): 593-605, 2006. (40 refs.)

The unique and interactive effects of paternal and maternal alcohol problems on the drinking behavior of adolescent girls and boys were investigated. A prospective design was employed to examine changes in youth drinking behavior over a 3-year period in a community-based sample of 695 families. Results revealed that, as maternal alcohol problems increased, the likelihood of adolescent alcohol use increased. Paternal alcohol problems were associated with an increased likelihood of alcohol use for girls only. Findings point to the need for future research to investigate both maternal and paternal alcohol problems in community samples and with a sample size large enough to examine both parent and adolescent gender. Implications for preventive and interventive efforts are considered.

Corte C; Becherer M. Differential effects of maternal and paternal alcoholism and gender on drinking, alcohol-related self-cognition, and psychopathology. Journal of Addictions Nursing 18(4): 175-185, 2007. (47 refs.)

Familial alcoholism is associated with various types of psychopathology in offspring, yet most studies do not differentiate maternal from paternal alcoholism. The purpose of this study was to examine the influence of maternal and paternal alcoholism and gender on alcohol consumption, an alcohol-related self-cognition, and four types of psychopathologic symptoms in young adults. Data were drawn from a study designed to examine the role of the self-concept in alcoholism and recovery. The sample included young adults with a current DSM-IV diagnosis of alcohol dependence (n = 25), those with a history of DSM-IV alcohol dependence who were abstinent for at least 12 months (n = 18), and nonalcoholic controls (n = 23). Regression analyses showed that 1) alcoholism on the paternal side of the family independently predicted drinking behavior and symptoms of social phobia over and above the effects of current alcohol dependence, 2) neither alcoholism on the maternal nor paternal side of the family predicted the alcohol-related self-cognition score, and 3) alcoholism on the maternal side of the family predicted symptoms of major depression, generalized anxiety disorder, and obsessive-compulsive disorder, with women having more major depressive symptoms, and men with alcoholism on the maternal side having more anxiety symptoms. These findings suggest that maternal and paternal alcoholism may confer different risks to the offspring, and that risk may vary depending on the gender of the offspring. Results highlight the importance of examining the effects of maternal and paternal alcoholism separately in research, and have important implications for assessing risk for high levels of alcohol consumption and psychopathology.

Corte C; Becherer M. Differential effects of maternal and paternal alcoholism and gender on drinking, alcohol-related self-cognition, and psychopathology. Journal of Addictions Nursing 18(4): 175-185, 2007. (47 refs.)

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.

Crespi TD; Rueckert QH. Family therapy and children of alcoholics: Implications for continuing education and certification in substance abuse practice. Journal of Child & Adolescent Substance Abuse 15(3): 33-44, 2006. (35 refs.)

Clinicians involved in family therapy are increasingly concerned with the impact of parental alcoholism on individual development and family functioning. With more than 20 million adults raised within an alcoholic family, and with widespread problems associated with parental alcoholism, clinicians providing family treatment have a potentially large number of clients impacted by substance abuse. However, many clinicians lack specialty training. This article reviews the problems associated with parental substance abuse and examines substance abuse certification standards as a blueprint for continuing education and specialty credentialing.

Cronk C; Weiss M. Diagnosis, surveillance and screening for fetal alcohol syndrome spectrum disorders: Methods and dilemmas. (review). International Journal on Disability and Human Development 6(4): 343-359, 2007. (82 refs.)

Fetal Alcohol Spectrum Disorder (FASD) is a prevalent preventable disorder with a significant societal burden related to the cognitive and behavioral disabilities associated with this disorder. This paper reviews the published work on FASD diagnosis, surveillance, and screening programs. Challenges inherent to FASD diagnosis remain and complicate attempts to estimate FAS prevalence. In addition, the drive toward diagnostic accuracy has led to the formulation of screening children at school ages after many disabilities associated with FASD are established. We present the design and selected findings from a regional multi-stage screening project piloted in Wisconsin. Small for gestational age (SGA) newborns with birth head circumference less than 10(th) percentile were selected in the first screening stages. Those meeting these criteria were evaluated for growth, development and FAS facial features at about 2 years of age. Of newborns meeting the initial screening criteria, 30% demonstrated growth deficits and developmental delays at about 2 years of age. Children with any FAS facial feature (of 177 children assessed, n=13 with 2 or 3 facial findings, n=77 with one facial finding) showed greater deficits in growth and a greater proportion were developmentally delayed. The findings demonstrate the potential value of embedding screening for FAS within a multistage screening method to identify infants at risk for any developmental delay. Because this model would be a part of larger population screening for developmental delay, cost efficiencies could be achieved. Problems relating to protection and confidentiality that inevitably accompany screening to identify FASD would also be reduced.

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.

Duncan AE; Scherrer J; Fu Q; Bucholz KK; Heath AC; True WR et al. Exposure to paternal alcoholism does not predict development of alcohol-use disorders in offspring: Evidence from an offspring-of-twins study. Journal of Studies on Alcohol 67(5): 649-656, 2006. (44 refs.)

Objective: Using an offspring-of-twins design, we tested the hypothesis that exposure to paternal alcoholism during the child's first 12 years will increase offspring risk for subsequent alcohol-use disorders (AUD). Method: Structured psychiatric interviews assessed history of psychiatric and substance-use disorders in Vietnam Era Twin Registry fathers (n = 512), their offspring (n = 877), and mothers of the offspring (n = 507). Exposure was defined as the fathers' endorsement of any Diagnostic and Statistical Manual of Mental Disorders (DSM), Fourth Edition, AUD symptom, according to the Lifetime Drinking History assessment (administered in 1999), at any time between offspring ages 0-12 years; all fathers had satisfied DSM, Third Edition, Revised (DSM-III-R), criteria for alcohol dependence in a 1992 diagnostic interview. Cox proportional hazards models were fit to predict time to first symptom of abuse/dependence in offspring. Results: Offspring exposed to paternal alcoholism were significantly more likely to develop an AUD when compared with offspring of nonalcoholic fathers (hazard ratio [HR] = 1.51; 95% confidence interval [CI]: 1.10-2.07). Although offspring unexposed to paternal alcoholism did not significantly differ from control offspring (HR = 1.50, 95% CI: 0.93-2.41), the magnitude of association was similar to that in the exposed offspring. There were no significant differences in AUD between offspring of alcoholics who were exposed and those who were not exposed to paternal alcoholism, as long as fathers had satisfied DSM-III-R criteria for alcohol dependence at some point in their lives. Conclusions: There does not appear to be a relationship between exposure to paternal alcoholism during childhood and development of an AUD in offspring. Genetic and high-risk environmental factors that are correlated with lifetime paternal alcoholism may be stronger predictors of offspring AUD than fathers' problem drinking. Future research should be encouraged, using more comprehensive analyses, to examine the role of family genetic influences and other family environmental influences on offspring alcohol outcomes.

Eiden RD; Edwards EP; Leonard KE. Children's internalization of rules of conduct: Role of parenting in alcoholic families. Psychology of Addictive Behaviors 20(3): 305-315, 2006. (84 refs.)

This study examined the association between fathers' alcoholism and children's internalization of rules of conduct at 2 to 3 years of age. The sample consisted of 220 families (102 without alcoholism, 118 with alcoholism). Results indicated that there was no direct association between fathers' alcoholism and children's internalization measured with a behavioral paradigm at age 3 years. However, the indirect association between fathers' alcoholism and children's behavioral internalization was significant through fathers' sensitivity during play interactions at age 2 years. Children of fathers with alcoholism were rated by their mothers as having lower internalized conduct over the 2- to 3-year period. This direct association was not mediated by parental sensitivity.

Fitzgerald HE; Puttler LI; Refior S; Zucker RA. Family response to children and alcohol. Alcoholism Treatment Quarterly 25(1/2): 11-25, 2007

We describe the Michigan Longitudinal Study (MLS), an etiologic study of family risk for alcoholism over the life course, and provide an overview of findings from the first 12 years of the study. Data suggest that etiology is anchored in family diathesis and shaped by a wide range of experiences that structure differential developmental pathways. One pathway is marked by strong continuity of behavioral dysregulation, evident during the preschool years and continuing through early adolescence. Two discontinuous pathways illustrate the shifting nature of risk and protective factors during early human development. Paternal co-morbid psychopathology, antisocial behavior, and alcoholism, play critical roles not only with respect to parent-child relationships, but also as determinants of family functioning and family stability. Implications for linking prevention efforts to developmental pathways are suggested.

Furtado EF; Laucht M; Schmidt MH. Gender-related pathways for behavior problems in the offspring of alcoholic fathers. Brazilian Journal of Medical and Biological Research 39(5): 659-669, 2006. (40 refs.)

The objective of the present study was to examine gender differences in the influence of paternal alcoholism on children's social-emotional development and to determine whether paternal alcoholism is associated with a greater number of externalizing symptoms in the male offspring. From the Mannheim Study of Risk Children, an ongoing longitudinal study of a high-risk population, the developmental data of 219 children [193 (95 boys and 98 girls) of non-alcoholic fathers, non-COAs, and 26 (14 boys, 12 girls) of alcoholic fathers, COAs] were analyzed from birth to the age of I I years. Paternal alcoholism was defined according to the ICD-10 categories of alcohol dependence and harmful use. Socio-demographic data, cognitive development, number and severity of behavior problems, and gender-related differences in the rates of externalizing and internalizing symptoms were assessed using standardized instruments (IQ tests, Child Behavior Checklist questionnaire and diagnostic interviews). The general linear model analysis revealed a significant overall effect of paternal alcoholism on the number of child psychiatric problems (F = 21.872, d.f. = 1.217, P < 0.001). Beginning at age 2, significantly higher numbers of externalizing symptoms were observed among COAs. In female COAs, a pattern similar to that of the male COAs emerged, with the predominance of delinquent and aggressive behavior. Unlike male COAs, females showed an increase of internalizing symptoms up to age 11 years. Of these, somatic complaints revealed the strongest discriminating effect in 11-year-old females. Children of alcoholic fathers are at high risk for psychopathology. Gender-related differences seem to exist and may contribute to different phenotypes during development from early childhood to adolescence.

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.

Gogineni A; King S; Jackson K; Kramer J; Bucholz K; Chan G et al. Female offspring of alcoholic individuals: Recent findings on alcoholism and psychopathology risks: Symposium presented at the Research Society on Alcoholism, 2004, Vancouver Aruna Gogineni, chair. (editorial). Alcoholism: Clinical and Experimental Research 30(2): 377-387, 2006. (58 refs.)

Griel-Fried B; Teichman M. Ego identity of adolescent children of alcoholics. Journal of Drug Education 37(1): 83-95, 2007. (49 refs.)

The study examines the issue of ego identity among adolescent sons of alcoholic fathers. Forty-four adolescent sons of alcoholic fathers, age of 15-18, constituted the sample. They were drawn from public alcohol treatment center in Israel. The control group included 60 adolescents none of their parents is known as an alcoholic, sampled from integrative schools in the same neighborhood and matched by age. Ego identity was measured by Tzuriel's "Adolescent Ego Identity Scale" (AEIS). It was hypothesized that adolescent children of alcoholics will show lower scores of ego identity and of its dimensions. The hypothesis was not confirmed. To the contrary, adolescent children of alcoholics reported higher scores of "ego identity-total" and of four of the seven ego identity dimensions. One possible explanation is that children of alcoholics are maturing early in age compared to their controls. They have developed different coping strategies that facilitate creating a more "stable" ego identity compared to their peers. Another explaination is that children of alcoholics apply defense mechanisms that enhance the development of an "adaptive self."

Gwynne K; Blick BA; Duffy GM. Pilot evaluation of an early intervention programme for children at risk. Journal of Paediatrics and Child Health 45(3): 118-124, 2009. (51 refs.)

Aim: Children from vulnerable families, where there is social disadvantage, parental mental health problems, substance abuse or domestic violence, are at risk of attention, language, learning and behaviour problems because of poor attachment and lack of stimulation in the early years. Three primary modes of early intervention have been shown to produce sustained improvements in children's health, education and well-being despite these risk factors. This pilot aimed to evaluate the Spilstead Model (SM) of early intervention in Australia, which provides a uniquely integrated model of centre-based care, incorporating all three best-practice approaches. Method: The study targeted all new clients who attended the SM programme over a 12-month period. A battery of standardised clinician and parent-rated measures assessed parent, child and family functioning via pre-post test research design. Results: Results indicated large effect size changes (P < 0.01) in parent/child interaction; reduced parent stress; parental satisfaction; parent confidence; parental capacity; family interactions; child well-being; and total family functioning. A total of 71% of children who presented on initial developmental screening with delays in the clinical range were found to be within the normal range on post-testing; 41% moved from the below average range to scores within the normal range in language development. Parents noted improvements in externalising behaviours of large effect size (1.46). Conclusions: (i) Results were highly positive for both children and parents; (ii) the synergistic nature of the SM may have the potential to maximise outcomes for families via a cumulative programme effect; and (iii) implications for further research were established.

Haber JR; Jacob T. Alcoholism risk moderation by a socio-religious dimension. Journal of Studies on Alcohol and Drugs 68(6): 912-922, 2007. (39 refs.)

Objective: Religious affiliation is inversely associated with the development of alcohol-dependence symptoms in adolescents, but the mechanisms of this effect are unclear. The degree to which religious affiliations accommodate to or differentiate from cultural values may influence attitudes about alcohol use. We hypothesized that, given permissive cultural norms about alcohol in the United States, if a religious affiliation differentiates itself from cultural norms, then high-risk adolescents (those with parents having a history of alcoholism) would exhibit fewer alcohol-dependence symptoms compared with other affiliations and nonreligious adolescents. Method: A sample of female adolescent offspring (N = 3,582) in Missouri was selected. Parental alcoholism and religious affiliation and their interaction were examined as predictors of offspring alcohol-dependence symptoms. Results: Findings indicated that (1) parental alcohol history robustly predicted increased offspring alcohol-dependence symptoms, (2) religious rearing appeared protective (offspring exhibited fewer alcohol-dependence symptoms), (3) religious differentiation accounted for most of the protective effect, (4) other religious variables did not account for the differentiation effect, and (5) black religious adolescents were more frequently raised with differentiating affiliations and exhibited greater protective effects. Conclusions: Results demonstrate that religious differentiation accounts for most of the protective influence of religious affiliation. This may be because religious differences from cultural norms (that include permissive alcohol norms) counteract these social influences given alternative "higher" religious ideals.

Habeych ME; Folan MM; Luna B; Tarter RE. Impaired oculomotor response inhibition in children of alcoholics: The role of attention deficit hyperactivity disorder. Drug and Alcohol Dependence 82(1): 11-17, 2006. (61 refs.)

Objective: The aim of the project was to determine whether children at high risk for alcohol use disorder (AUD) are impaired at performing oculomotor response inhibition tasks sensitive to detecting prefrontal cortex dysfunction. Methods: Three antisaccade tasks were administered to 67 10-12-year-old children having fathers with AUD and 12 children whose fathers had no psychiatric disorder. Results: Children of AUD+ fathers performed similar to children of AUD- fathers on measures of response latency and gain to target. Peak velocity discriminated the two groups On Only one task. Children of AUD+ fathers exhibited a higher rate of prosaccade errors on the most difficult antisaccade task. Within the AUD+ group of men, offspring who qualified for attention deficit hyperactivity disorder (ADHD; N = 13) exhibited more response suppression errors than children Without ADHD on two of three tasks. No differences were observed between children without ADHD whose fathers either qualified for AUD+ or had no psychiatric disorder. Conclusion: Inhibiting a response to a prepotent stimulus in children of AUD+ fathers is circumscribed to ADHD youths. These findings suggest that frontal-striatal mechanisms may underlie the risk for AUD among ADHD children.

Hanson RF; Self-Brown S; Fricker-Elhai A; Kilpatrick DG; Saunders BE; Resnick H. Relations among parental substance use, violence exposure and mental health: The national survey of adolescents. Addictive Behaviors 31(11): 1988-2001, 2006. (42 refs.)

Objective: To study the relations among parental substance use, violence exposure and psychopathology in a nationally representative sample of adolescents. Method: Random digit dialing methodology was used to obtain a nationally representative sample of 4023 adolescents, ages 12-17. Telephone surveys, conducted in 1995, assessed demographics, parental substance use, violence exposure, and three psychiatric disorders: major depressive disorder (MDE), posttraumatic stress disorder (PTSD), and substance abuse/dependence (SA/D). Results: Obtained prevalence rates included: 8.2% for sexual assault, 22.5% for physical assault, and 39.7% for witnessing violence at home or in the community. Substance use by a family member was reported by 18.4% (n = 721) of adolescents, with 50.6% reporting parental alcohol use and 19.1% (n = 138) reporting parental drug use. Consistent with hypotheses, violence exposure and parental substance use, particularly parental alcohol abuse, were independently associated with outcomes. Additionally, parental substance use emerged as a moderator for MDE, PTSD, and SA/D; however, the moderating relations varied according to the outcome variable investigated. Conclusions: Violence-exposed adolescents reporting parental alcohol or drug use had the highest rates of psychiatric diagnoses.

Hansson H; Rundberg J; Zetterlind U; Johnsson KO; Berglund M. Two-year outcome of an intervention program for university students who have parents with alcohol problems: A randomized controlled trial. Alcoholism: Clinical and Experimental Research 31(11): 1927-1933, 2007. (55 refs.)

Background: Only a few intervention studies aiming to change high-risk drinking behavior have involved university students with heredity for alcohol problems. This study evaluated the effects after 2 years on drinking patterns and coping behavior of intervention programs for students with parents with alcohol problems. Method: In total, 82 university students (57 women and 25 men, average age 25 years) with at least 1 parent with alcohol problems were included in the study. The students were randomly assigned to 1 of the 3 programs: (i) alcohol intervention program, (ii) coping intervention program, or (iii) combination program. All the 3 intervention programs were manual based and individually implemented during 2 2-hour sessions, 4 weeks apart. Before the participants were randomly assigned, all were subjected to an individual baseline assessment. This assessment contained both a face-to-face interview and 6 self-completion questionnaires: the Alcohol Use Disorders Identification Test, estimated Blood Alcohol Concentration, Short Index of Problems, the Symptom Checklist-90, Coping with Parents' Abuse Questionnaire, and The Interview Schedule for Social Interaction (ISSI). Follow-up interviews were conducted after 1 and 2 years, respectively. The results after 1 year have previously been reported. Results: All participants finished the baseline assessment, accepted and completed the intervention. Ninety-five percent of the students completed the 24-month follow-up assessment. Only the group receiving the combination program continued to improve their drinking pattern significantly (p < 0.05) from the 12-month follow-up to the 24-month follow-up. The improvements in this group were significantly better than in the other 2 groups. The group receiving only alcohol intervention remained at the level of improvement achieved at the 12-month follow-up. The improvements in coping behavior achieved at the 12-month follow-up remained at the 24-month follow-up for all the 3 groups, i.e., regardless of intervention program. Conclusion: Positive effects of alcohol intervention between 1 and 2 years were found only in the combined intervention group, contrary to the 1-year results with effects of alcohol intervention with or without a combination with coping intervention.

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.

Hennigan KM; O'Keefe M; Noether CD; Rinehart DJ; Russell LA. Through a mother's eyes: Sources of bias when mothers with co-occurring disorders assess their children. Journal of Behavioral Health Services & Research 33(1): 87-104, 2006. (64 refs.)

Mothers are the principal informants on children's emotional and behavioral functioning. Maternal assessments of child functioning can be influenced by a mother's own psychological state. The magnitude and valence of distortion in maternal assessments associated with current maternal mental health and substance abuse symptoms were explored in a clinical sample of 253 mothers with co-occurring disorders and histories of trauma. Analyses estimated the correlation between current maternal symptoms and child assessments after controlling for maternal history of disorders, child's history of service utilization for emotional and behavioral problems, and demographic characteristics. Current maternal psychological distress was associated with more pessimistic assessments on the problem-focused Child Behavior Checklist, whereas current maternal substance abuse problems were associated with more optimistic assessments on both problem-focused and strength-based measures. Clinicians and researchers may choose to take distortion into account when treatment plans or measures of change are based on maternal assessments.

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.

Jones AS. Maternal alcohol abuse/dependence, children's behavior problems, and home environment: Estimates from the National Longitudinal Survey of Youth using propensity score matching. Journal of Studies on Alcohol and Drugs 68(2): 266-275, 2007. (65 refs.)

Objective: Propensity score (PS) matching was used to investigate the relationship between maternal alcohol abuse (AA) and alcohol dependence (AD), based on Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria and three child outcomes: child behavior problems and two characteristics of the child's home environment as measured by the Home Observation and Measurement of the Environment-Short Form, cognitive stimulation and emotional support. Method: A cohort of children (N = 2,193; 49% female) whose mothers were drawn from the 1994 National Longitudinal Survey of Youth were stratified by gender and matched on maternal propensity to exhibit AA or AD. Results: After matching, sons of mothers with AA/ AD had higher behavior problem scores (p <= .05), and daughters of mothers with AA/AD lived in homes with significantly less emotional support (p <= 05) and cognitive stimulation (p :<= .005). Results were robust to alternative specifications of PS regressions. Conclusions: The findings suggest that policies aimed at reducing AA and AD among young adult women with children are justified. PS matched results also suggest that school counselors and mental health providers who encounter young boys with elevated behavior problems should consider maternal AA/AD as one possible causal factor. Future research should be directed toward understanding the trajectory of these outcomes and their sequelae over the child's life cycle and toward developing improved methods of identifying and intervening with at-risk children of both genders and their mothers.

Kable JA; Coles CD; Taddeo E. Socio-cognitive habilitation using the math interactive learning experience program for alcohol-affected children. Alcoholism: Clinical and Experimental Research 31(8): 1425-1434, 2007. (90 refs.)

Background: Fetal alcohol syndrome (FAS) has been recognized as a disabling condition with a significant impact on the neurobehavioral functioning of affected individuals, including cognition, behavior, and academic functioning, but little research has been performed on targeted interventions for these children. Methods: A socio-cognitive habilitative program focused on improving behavior and math functioning in children 3 to 10 years of age (n=61) was developed and evaluated. The intervention provided parental instruction on FAS, advocacy, and behavioral regulation via workshops and interactive math tutoring with children. All families received parental instruction and were then randomly assigned to either the math instruction or standard psychoeducational care groups. Results: Satisfaction with workshops was very high, with over 90% agreeing that trainers were knowledgeable and materials easy to understand and helpful. Significant gains in knowledge were found for information provided in the instructional groups. At posttesting, caregivers reported fewer problem behaviors on the Achenbach Child Behavior Checklist, Internalizing Problem Behavior, Externalizing Problem Behavior, and Total Problem Behavior summary scales. After 5 months, both groups of children demonstrated gains in math knowledge but significantly higher gains were found in the group receiving direct math instruction. The math treatment group was also more likely to demonstrate a gain of over 1 standard deviation on any of the 4 math outcome measures used. Conclusions: These findings suggest that parents of children with fetal alcohol spectrum disorders (FAS(D)) benefit from instruction in understanding their child's alcohol-related neurological damage and strategies to provide positive behavioral supports and that targeted psychoeducational programs may be able to remediate some of the math deficits associated with prenatal alcohol exposure.

Kamarajan C; Porjesz B; Jones K; Chorlian D; Padmanabhapillai A; Rangaswamy M. Event-related oscillations in offspring of alcoholics: Neurocognitive disinhibition as a risk for alcoholism. (review). Biological Psychiatry 59(7): 625-634, 2006. (107 refs.)

Background: Event-related oscillations (EROs) are increasingly being used to assess neurocognitive functioning in normal and clinical populations. The current study compares different frequency activities in offspring of alcoholics (OA) and in normal control subjects (NC) to examine whether the OA group exhibits any abnormality in oscillatory activity while performing a Go/NoGo task. Methods: The S-transform algorithm was employed to decompose the electroencephalographic (EEG) signals into different time-frequency bands, and the oscillatory responses in the P300 time window (300-700 milliseconds) were statistically analyzed in both groups. Results: The OA group manifested significantly decreased activity in delta (1-3 Hz), theta (4-7 Hz), and alpha1 (8-9 Hz) bands during the NoGo condition, as well as reduced delta and theta activity during the Go condition. This reduction was more prominent in the NoGo than in the Go condition. Conclusions: The decreased response in delta, theta, and alpha1 oscillations, especially during the NoGo condition in high-risk individuals, is perhaps suggestive of cognitive and neural disinhibition and may serve as an endophenotypic marker in the development of alcoholism and/or other disinhibitory disorders.

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.

Knopik VS; Heath AC; Jacob T; Slutske WS; Bucholz KK; Madden PAF et al. Maternal alcohol use disorder and offspring ADHD: Disentangling genetic and environmental effects using a children-of-twins design. Psychological Medicine 36(10): 1461-1471, 2006. (56 refs.)

Background. Children of alcoholics are significantly more likely to experience high-risk environmental exposures, including prenatal substance exposure, and are more likely to exhibit externalizing problems [e.g. attention deficit hyperactivity disorder (ADHD)]. While there is evidence that genetic influences and prenatal nicotine and/or alcohol exposure play separate roles in determining risk of ADHD, little has been done on determining the joint roles that genetic risk associated with maternal alcohol use disorder (AUD) and prenatal risk factors play in determining risk of ADHD. Method. Using a children-of-twins design, diagnostic telephone interview data from high-risk families (female monozygotic and dizygotic twins concordant or discordant for AUD as parents) and control families targeted from a large Australian twin cohort were analyzed using logistic regression models. Results. Offspring of twins with a history of AUD, as well as offspring of non-AUD monozygotic twins whose co-twin had AUD, were significantly more likely to exhibit ADHD than offspring of controls. This pattern is consistent with a genetic explanation for the association between maternal AUD and increased offspring risk of ADHD. Adjustment for prenatal smoking, which remained significantly predictive, did not remove the significant genetic association between maternal AUD and offspring ADHD. Conclusions. While maternal smoking during pregnancy probably contributes to the association between maternal AUD and offspring ADHD risk, the evidence for a significant genetic correlation suggests: (i) pleiotropic genetic effects, with some genes that influence risk of AUD also influencing vulnerability to ADHD; or (ii) ADHD is a direct risk-factor for AUD.

Knopik VS; Jacob T; Haber JR; Swenson LP; Howell DN. Paternal alcoholism and offspring ADHD problems: A children of twins design. Twin Research and Human Genetics 12(1): 53-62, 2009. (55 refs.)

Objective: A recent Children-of-Female-Twin design suggests that the association between maternal alcohol use disorder and offspring ADHD is due to a combination of genetic and environmental factors, such as prenatal nicotine exposure. We present here a complementary analysis using a Children-of-Male-Twin design examining the association between paternal alcoholism and offspring attention deficit hyperactivity problems (ADHP). Methods: Children-of-twins design: offspring were classified into 4 groups of varying genetic and environmental risk based on father and co-twin's alcohol dependence status. Results: Univariate results are suggestive of a genetic association between paternal alcohol dependence and broadly defined offspring ADHP. Specifically, offspring of male twins with a history of DSM-III-R alcohol dependence, as well as offspring of non-alcohol dependent monozygotic twins whose co-twin was alcohol dependent, were significantly more likely to exhibit ADHP than control offspring. However, multivariate models show maternal variables independently predicting increased risk for offspring ADHP and significantly decreased support for a genetic mechanism of parent-to-child transmission. Conclusions: In support of earlier work, maternal variables (i.e., maternal ADHD and prenatal exposure) were strongly associated with child ADHP; however, the role of paternal alcohol dependence influences was not definitive. While genetic transmission may be important, the association between paternal alcohol dependence and child ADHP is more likely to be indirect and a result of several pathways.

Kodituwakku PW. Defining the behavioral phenotype in children with fetal alcohol spectrum disorders: A review. Neuroscience and Biobehavioral Reviews 31(2): 192-201, 2007. (82 refs.)

While there exists a large body of literature on cognitive functions in children with prenatal alcohol exposure, it remains undetermined if these children exhibit a unique profile of cognitive-behavioral functioning or a behavioral phenotype. Researchers have consistently found that intellectual functioning, as assessed by IQ tests, of children with prenatal alcohol exposure is deficient. There is increasing evidence that prenatal alcohol exposure is associated with slow information processing and attentional problems, in particular inattentiveness. Studies examining specific cognitive abilities such as language, visual perception, and memory in alcohol-affected children have shown performance decrements associated with increased task complexity. Children with prenatal alcohol exposure have also been found to exhibit significant deficits in daily functional skills or adaptive behavior, with deficits in socialization becoming pronounced during adolescence. The above findings point to the conclusion that a generalized deficit in complex information processing constitutes the central cognitive-behavioral characteristic of children with prenatal alcohol exposure. Researchers have consistently documented that specific brain regions are more affected by alcohol than other regions. The problem of mapping focal anomalies of the brain with a generalized pattern of deficits can be solved by taking developmental processes into consideration.

Kuendig H; Kuntschee E. Family bonding and adolescent alcohol use: Moderating effect of living with excessive drinking parents. Alcohol and Alcoholism 41(4): 464-471, 2006. (47 refs.)

Aims: Excessive parental drinking has been shown to be positively related to adolescent alcohol use and family bonding negatively related. The aim of the present study was to determine if the perception of parental drinking moderates the relationship between family bonding and adolescent alcohol use. Methods: Linear structural equation models for multiple group comparisons were estimated based on a national representative sample of 3448 eight and ninth graders in Switzerland (mean age 14.77; SD 0.89). Results: Adjusted for gender and age, the results confirm that strong family bonds were negatively related to both frequency of alcohol intake and lifetime frequency of drunkenness. Furthermore, a positive link was found with regard to the perception of parental drinking. However, the multiple group comparison revealed that the negative relationship between bonding and adolescent alcohol use was even stronger among adolescents whose parents drink excessively than among those whose parents did not. Conclusions: These results indicate that it may be particularly important for parents in the former category to establish strong family bonds (e.g. by spending free time with their children, listening to their worries) so as to limit adolescent excessive drinking.

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).

Lorber W; Morgan DY; Eisen ML; Barak T; Perez C; Crosbie-Burnett M. Patterns of cohesion in the families of offspring of addicted parents: Examining a nonclinical sample of college students. Psychological Reports 101(3, Part 1): 881-895, 2007. (55 refs.)

This study was designed to examine patterns of family functioning among college students who are offspring of addicted parents. 218 undergraduate psychology students were administered a series of measures assessing family functioning, dissociation, parental addiction, and a history of child abuse. As predicted, offspring of addicted parents reported significantly lower Cohesion in their families of origin (F-1,F-161 = 10.16, p =.002), and described significantly greater dissatisfaction with the cohesion they experienced in their families of origin, when compared to their college peers (F-1.135 = 10.24, p =.002). However, these groups reported comparable Adaptability in their families of origin (F-1,F-161 = 1.74, ns). These data show that, although offspring of addicted parents college students appear to share commonalities with their student peers in terms of the adaptability in their families of origin, they still share some key characteristics with clinical populations of offspring of addicted parents, which distinguish them as a group.

Marshal MP; Molina BSG; Pelham WE; Cheong J. Attention-deficit hyperactivity disorder moderates the life stress pathway to alcohol problems in children of alcoholics. Alcoholism: Clinical and Experimental Research 31(4): 564-574, 2007. (69 refs.)

Background: Parent alcoholism is a well-established risk factor for the development of pathological alcohol involvement in youth, and life stress is considered to be one of the central mechanisms of the parent alcoholism effect; however, little is known about the moderators of the life stress pathway. Attention-deficit hyperactivity disorder (ADHD) has also been shown to predict pathological alcohol involvement, however, little is known about whether or not ADHD interacts with parent alcoholism to increase offspring risk. The goals of this study were to examine stressful life events as mediators of the relationship between parent alcoholism and adolescent pathological alcohol involvement, and to examine whether or not this mediated pathway was stronger for adolescents with ADHD than for adolescents without ADHD. Method: Participants were 142 adolescents with a childhood ADHD diagnosis (probands) and 100 demographically matched control adolescents without childhood ADHD. Probands, controls, and at least 1 parent were interviewed about drinking behavior; probands and controls were interviewed about negative life events. Results: A moderated mediation paradigm was used to test the hypotheses using ordinary least squares regression. Results showed that the relationships between parent alcoholism and 2 of the stress variables ("family" stress and "peer" stress) were significant for probands only, and that stress in the probands mediated the parent alcoholism effect on offspring alcohol involvement. Conclusions: These results provide preliminary support for the hypothesis that offspring characteristics might moderate the life stress pathway to alcoholism, and indicate that ADHD may serve to facilitate the transmission of pathological alcohol use from parent to child.

Moe J; Johnson JL; Wade W. Resilience in children of substance users: In their own words. Substance Use & Misuse 42(2-3): 381-398, 2007. (81 refs.)

Understanding what children of alcoholics and other substance users experience has dominated the scientific literature and popular press for the past several decades. To date, the empirical studies have relied primarily on quantitative data to understand the individual and environmental factors associated with the lives, the developmental trajectories, and the growth of children of alcoholics and other substance users. Many of these studies focus on their risks, and very few of them focus on their strengths. Additionally, very few studies have used qualitative techniques to collect data. While quantitative studies have given us great insight, perhaps we could learn a great deal more if we employed data collection methods which would actually provide us with the child's perception of their strengths, or resilience, and what they think it takes to grow into happy, healthy adults. For this reason, this study presents data from the interviews of 50 children of substance users who present their views on resilience.

Morean ME; Corbin WR; Sinha R; O'Malley SS. Parental history of anxiety and alcohol-use disorders and alcohol expectancies as predictors of alcohol-related problems. Journal of Studies on Alcohol and Drugs 70(2): 227-236, 2009. (68 refs.)

Objective: Research has consistently identified a family history of alcoholism as a risk factor for alcohol-related problems, and global positive expectancies have been found to moderate this association. High rates of comorbidity between alcohol use and anxiety disorders suggest that a family history of anxiety disorders may also increase risk. Further, expectations of negative reinforcement (e.g., tension reduction) have been found to moderate the influence of anxiety-related traits. The current study sought to extend previous research by examining the influence of parental history of alcoholism, anxiety disorders, and the combination, as predictors of alcohol-related problems, Expectancies of global positive changes and tension reduction were hypothesized to moderate the influence of parental history of alcoholism and anxiety, respectively. Method: Direct interviews with parents assessed their history of alcoholism and anxiety for 144 offspring (ages 18-32; 53.5% male) creating four groups: those with a parental history of alcoholism (27.80%), anxiety (22.20%), both alcoholism and anxiety (33.30%), and no history of psychopathology (16.70%). Established measures assessed the offsprings' alcohol expectancies, alcohol use, and alcohol-related problems. Results: Although expected interactions between parental alcoholism and global positive expectancies and between parental anxiety and tension-reduction expectancies were not found, global positive expectancies were associated with alcohol-related problems among the group with parental history of both alcoholism and anxiety. Conclusions: The results suggest that the relation between parental history of alcoholism and global positive expectancies observed in previous studies may be strongest among individuals with a comorbid parental history of alcohol and anxiety disorders. Incorporating expectancies into interventions targeting individuals with a comorbid parental history of alcohol and anxiety disorders may have utility.

Munro CA; McCaul ME; Oswald LM; Wong DF; Zhou Y; Brasic J et al. Striatal dopamine release and family history of alcoholism. Alcoholism: Clinical and Experimental Research 30(7): 1143-1151, 2006. (74 refs.)

Background: The offspring of alcohol-dependent individuals are at increased risk for alcoholism. The present study was designed to determine whether mesolimbic dopamine binding potential (BP), dopamine release, stress hormones, and subjective responses to intravenous amphetamine are different in nonalcoholic offspring from families with a history of alcohol dependence [family history positive (FHP)] than in nonalcoholic offspring without a family history of alcohol dependence [family history negative (FHN)]. Methods: Participants were 41 healthy men and women (11 FHP, 30 FHN; age range 18-29). After completing baseline psychiatric symptom and personality measures, striatal D-2/D-3 dopamine BP and dopamine release in response to an amphetamine challenge were measured with positron emission tomography (PET) using the D-2/D-3 dopamine (DA) receptor radioligand [C-11]raclopride. Binding potential was defined as B-max/KD, percent change in BP from baseline defined dopamine release. During the scans, subjects rated the degree to which they were experiencing each of 10 possible drug effects. Plasma cortisol and growth hormone (GH) were also measured at scheduled intervals during the scans. Results: Neither baseline BP nor dopamine release differed by family history. Similarly, subjective responses to amphetamine did not differ by a family history of alcoholism. Although both cortisol and GH increased following administration of amphetamine, these increases did not differ between family history groups. Conclusions: Using amphetamine to provoke mesolimbic dopamine, we did not show significant differences in dopamine release, subjective responses, or stress hormone measures as a function of family history of alcoholism.

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.

Ohannessian CM; Hesselbrock VM. A comparisonof 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. A finer examination of the role that negative affect plays in the relationship between paternal alcoholism and the onset of alcohol and marijuana use. Journal of Studies on Alcohol and Drugs 70(3): 400-408, 2009. (48 refs.)

Objective: This study was designed to separately examine the relations between four fundamental components of negative affect (sadness, fear, guilt, and hostility) and the onset of substance use. An additional goal was to examine the potential mediating roles that these components of negative affect play in the relationship between paternal alcoholism and the initiation of substance use. Method: The sample included 200 adolescents ages 15-19 years (62% girls; 68% white: 56% children of alcoholics [COAs]) and their fathers. The adolescents were followed up 5 years later when they were in early adulthood. Participants completed a clinical psychiatric interview and self-report questionnaires that assessed negative affect and substance use. Results: Results from structural equation modeling indicated that higher levels of hostility and lower levels of guilt were associated with earlier substance-use initiation. In addition, hostility played an indirect role in the relationship between paternal alcoholism and the onset of marijuana use, with COAs reporting higher hostility levels than non-COAs and higher hostility predicting earlier marijuana use. Conclusions: These results underscore the importance of separately examining different components of negative affect when investigating the role that negative affect plays in substance use.

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.

Ondersma SJ. Introduction to the second special section on substance abuse and child maltreatment. (commentary). Child Maltreatment 12(2): 111-113, 2007. (11 refs.)

Pagano ME; Rende R; Rodriguez BF; Hargraves EL; Moskowitz AT; Keller MB. Impact of parental history of substance use disorders on the clinical course of anxiety disorders. Substance Abuse Treatment, Prevention, and Policy 2: article 13, 2007. (30 refs.)

Background: Among the psychological difficulties seen in children of parents with substance use problems, the anxiety disorders are among the most chronic conditions. Although children of alcoholic parents often struggle with the effects of parental substance use problems long into adulthood, empirical investigations of the influence of parental substance use disorders on the course of anxiety disorders in adult offspring are rare. The purpose of this study was to examine prospectively the relationship between parental substance use disorders and the course of anxiety disorders in adulthood over the course of 12 years. Methods: Data on 618 subjects were derived from the Harvard/Brown Anxiety Research Project (HARP), a longitudinal naturalistic investigation of the clinical course of multiple anxiety disorders. Kaplan-Meier survival estimates were used to calculate probabilities of time to anxiety disorder remission and relapse. Proportional hazards regressions were conducted to determine whether the likelihood of remission and relapse for specific anxiety disorders was lower for those who had a history of parental substance use disorders than for individuals without this parental history. Results: Adults with a history of parental substance use disorders were significantly more likely to be divorced and to have a high school level of education. History of parental substance use disorder was a significant predictor of relapse of social phobia and panic disorders. Conclusion: These findings provide compelling evidence that adult children of parents with substance use disorders are more likely to have relapses of social phobia and panic disorders. Clinicians who treat adults with anxiety disorders should assess parental substance use disorders and dependence histories. Such information may facilitate treatment planning with regards to their patients' level of vulnerability to perceive scrutiny by others in social situations, and ability to maintain a long-term panic-free state.

Park S; Kim H; Kim H. Relationships between parental alcohol abuse and social support, peer substance abuse risk and social support, and substance abuse risk among South Korean adolescents. Adolescence 43(173): 87-99, 2009. (39 refs.)

This study examined the roles played by parental alcohol abuse and social support, peer substance abuse risk and social support, and substance abuse risk among adolescents in South Korea. Participants were adolescents between the ages of 15 and 22 years (mean, 18), residing in Seoul city and in surrounding Kyung-gi Province. Of 259 participants, 41.3% scored 2 or more on the POSIT scale, which suggested they met the problematic criteria for substance abuse risk. Logistic regression results suggested that the influence of social support on substance abuse risk among adolescents depended on the source of support-parents or peers. These findings need to be considered in the development of intervention programs for adolescents at risk for substance abuse.

Peiponen S; Laukkanen E; Korhonen V; Hintikka U; Lehtonen J. The association of parental alcohol abuse and depression with severe emotional and behavioural problems in adolescents: A clinical study. International Journal of Social Psychiatry 52(5): 395-407, 2006. (35 refs.)

Background: Earlier studies have indicated associations between parental psychiatric problems, such as depression, and substance abuse and adolescent problems. Aims: This study aimed to determine whether parental psychiatric problems are associated with problems and problem behaviour in adolescents in a clinical sample. Methods: The study subjects were 70 outpatient adolescents (age 13-18 years, boys 30%) and their parents. The adolescents were assessed using the structural clinical interview for DSM-III-R (SCID) and a semi-structured questionnaire, and the parents were interviewed using a semi-structured questionnaire. Results: Maternal alcohol abuse and depression were associated with serious problems, especially among girls, and paternal alcohol abuse was associated with adolescent health-compromising behaviour. Maternal depression and alcohol abuse had no association with adolescent health-compromising behaviour. Maternal depression without alcohol abuse was associated with the diagnosis of major depressive disorder in adolescents, but not with other adolescent problems, while paternal depression without alcohol abuse was not associated with any adolescent problems. Conclusions: Despite the small study sample, these findings indicate that parental psychiatric problems and alcohol abuse are correlated with adolescent psychological problems and should be considered and assessed when assessing adolescents.

Rangaswamy M; Jones KA; Porjesz B; Chorlian DB; Padmanabhapillai A; Kamarajan C et al. Delta and theta oscillations as risk markers in adolescent offspring of alcoholics. (review). International Journal of Psychophysiology 63(1): 3-15, 2007. (118 refs.)

Background: Visual P300 is consistently lower in alcohol-dependent individuals, their offspring and subjects at risk. Delta and theta event-related oscillations (ERO) are the major contributors to the P300 signal. The total and evoked power in delta and theta bands in the 300 to 700 ins post-stimulus window (corresponding to the zone of P300 maxima) was compared between adolescent offspring of alcoholics (high-risk) and age-matched normal controls (low-risk), to assess the utility of the risk markers. Methods: EEG was recorded during the performance of a visual oddball task. The S-transform algorithm decomposed the EEG signals into different frequency bands and the group differences in total and evoked power in the oscillatory responses during the P300 time window (300 to 700 ins) were analyzed using a multivariate design. Similar analysis was performed on P300 peak amplitude for the target. Results: The high-risk group showed significantly lower parietal post-stimulus evoked and total power in the delta band for targets. A decrease in total power was seen centrally and parietally in the theta band. The P300 peak amplitude in the parietal electrodes was also significantly lower in the high-risk group. Conclusions: The decreased total theta power and total and evoked delta power for visual targets in high risk individuals may serve as an endophenotypic marker in the development of alcoholism and other disinhibitory disorders. The differences seen between the offspring of alcoholics and controls may have a cholinergic basis. The ERO measures appear to be more robust than the P300 amplitude in differentiating the groups.

Schuckit MA; Smith TL; Pierson J; Danko GP; Allen RC; Kreikebaum S. Patterns and correlates of drinking in offspring from the San Diego Prospective Study. Alcoholism: Clinical and Experimental Research 31(10): 1681-1691, 2007. (68 refs.)

The decision among young people to drink is complex and reflects multiple domains of influence. This paper applies the results from a previous test of an externalizing-based model predicting heavy drinking and alcohol problems in the probands from the San Diego Prospective Study to evaluate how similar characteristics relate to the decision to drink in their offspring. Data were generated from multiple sources for 152 offspring with a mean age of 17.2 years. Information on the family histories, personal alcohol and other substance use, socioeconomic stratum, the child's gestational problems, and additional characteristics were gathered from face-to-face interviews with a parent approximately every 5 years between their mid-20s and mid-40s. Data regarding the drinking status and additional variables applicable to the offspring were extracted from the 25-year (T25) epoch of the family evaluations using data supplied directly by the offspring. The relationships of variables to the drinking status in that generation were determined through correlations, regression analyses, and an AMOS-based structural equation model (SEM). Significant correlations to the drinking status in offspring were observed for age, but not for sex. Using age-adjusted backgrounds and data supplied by the offspring at T25, the most robust correlations to the drinking status were seen for a disinhibition measure, peer drinking, expectations of the effects of alcohol, and the history of having worked outside the home. When placed into an SEM, the former 3 variables performed in a manner similar to that observed in the original probands in the prediction of the drinking status, in a model with good fit characteristics. These data from a prospective study support the importance of similar domains across 2 generations in characterizing age-appropriate alcohol-related outcomes.

Shelton A; Harvin S; White J. Substance abuse prevention program for children and adolescents in a community-based clinic. Substance Abuse 26(3/4): 21-25, 2006

This paper describes a community-based substance abuse prevention program utilizing a cognitive-behavioral curriculum for children and adolescents affected by a substance use disorder in a parent or caretaker.

Suchman NE; Rounsaville B; DeCoste C; Luthar S. Parental control, parental warmth, and psychosocial adjustment in a sample of substance-abusing mothers and their school-aged and adolescent children. Journal of Substance Abuse Treatment 32(1): 1-10, 2007. (37 refs.)

Parenting interventions for substance-abusing adults have been broadly based on two approaches, one emphasizing parental control as a means to managing children's behavior and the second emphasizing parental warmth and sensitivity as means to fostering children's psychological development. In this investigation, we examined associations of parental control and parental warmth, respectively, with children's behavioral and psychological adjustment in a sample of 98 women enrolled in methadone maintenance and their school-aged and adolescent children. Using collateral data collected during the baseline phase of a randomized clinical trial (Luthar, S. S., Suchman, N. E., & Altomare, M. [in press). Relational Psychotherapy Mothers Group: A randomized clinical trial for substance abusing mothers [in preparation]), we tested predictions that (a) parental control would be more strongly associated with children's behavioral adjustment and (b) parental warmth would be more strongly associated with children's psychological adjustment. Both predictions were generally confirmed, although some crossover among parenting and child dimensions was also evident. Results support the theoretical stance that parental limit setting and autonomy support, as well as nurturance and involvement, are important factors, respectively, in children's behavioral and psychological adjustment.

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.

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.

Thompson SJ; Maccio EM; Desselle SK; Zittel-Palamara K. Predictors of posttraumatic stress symptoms among runaway youth utilizing two service sectors. Journal of Traumatic Stress 20(4): 553-563, 2007. (37 refs.)

Youth who run away often experience situations that produce symptoms of traumatic distress. This exploratory study assessed predictors of trauma symptomatology among runaway youth who had been admitted to youth emergency shelter services or juvenile detention. Findings demonstrated high levels of trauma-related symptoms for both groups. Worry about family, greater runaway episodes, and living with a father who abused alcohol/drugs significantly predicted higher posttraumatic stress symptoms in detained youth, whereas only worry about family relationships predicted higher trauma symptom scores among youth in emergency shelter care. Findings suggest distressful family life may induce complex emotional responses in youth. Although services to runaway youth must continue to focus on safe, short-term residential care, trauma issues must be acknowledged.

Tracy EM; Martin TC. Children's roles in the social networks of women in substance abuse treatment. Journal of Substance Abuse Treatment 32(1): 81-88, 2007. (48 refs.)

This study examined the status of children and the types of support available from children as reported by women in substance abuse treatment. Findings indicate that children are viewed as sources of social support to women on treatment. Children were viewed as providing as much sobriety support to respondents as that provided by adult network members. In addition, both children living with the respondent and children in the care of others were viewed as providers of specific types of social support. Implications are drawn for practice and research.

Trafton JA; Tracy SW; Oliva EM; Humphreys K. Different components of opioid-substitution treatment predict outcomes of patients with and without a parent with substance-use problems. Journal of Studies on Alcohol and Drugs 68(2): 165-172, 2007. (28 refs.)

Objective: The aim of this study was to determine how the treatment needs and outcomes of polysubstance-using patients entering opioid-substitution treatment (OST) may be affected if the patient had a parent with substance-use problems. Method: This prospective observational study examined outcomes of 255 patients (97% male) entering OST at eight clinics in the Veterans Health Administration. Self-reported substance-use outcomes in the first year of treatment were compared between patients with (n = 121) and without (n = 134) a parent with substance-use problems. The association between receipt of practice guideline-recommended elements of care and treatment outcome was examined. Results: Parent history-positive patients had greater drug use at 6 months, but by 12 months they had reduced their drug use to the same extent as parent history-negative patients. Ongoing methadone (Dolophine, Methadose) maintenance was associated with improved outcomes of drug use in parent history-negative patients; however, parent history-positive patients who ended methadone maintenance reduced drug use as much as those who continued treatment. The association between treatment received and outcome differed in these populations. In parent history-negative patients, reduced severity of substance use at 1 year was predicted solely by receiving methadone for a greater number of days. In parent history-positive patients, reduced severity of substance use was predicted by receiving methadone for fewer days, by greater satisfaction with and receipt of counseling services, and by lesser tendency for providers to encourage a reduction in methadone use. Conclusions: The importance of counseling and medication components of OST may differ depending on family history. For parent history-negative patients, medication maintenance may be more therapeutically necessary.

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.

Tyler KA. A qualitative study of early family histories and transitions of homeless youth. Journal of Interpersonal Violence 21(10): 1385-1393, 2006. (17 refs.)

Using intensive qualitative interviews with 40 homeless youth, this study examined their early family histories for abuse, neglect, and other family problems and the number and types of transitions that youth experienced. Multiple forms of child maltreatment, family alcoholism, drug use, and criminal activity characterized early family histories of many youth. Leaving home because of either running away or being removed by child protective services often resulted in multiple transitions, which regularly included moving from foster care homes to a group home, back to their parents, and then again returning to the streets. Although having experienced family disorganization set youth on trajectories for early independence, there were many unique paths that youth traveled prior to ending up on the streets.

Vanderploeg JJ; Connell CM; Caron C; Saunders L; Katz KH; Tebes JK. The impact of parental alcohol or drug removals on foster care placement experiences: A matched comparison group study. Child Maltreatment 12(2): 125-136, 2007. (46 refs.)

Research has established the coincidence of parental alcohol and other drug (AOD) use and child maltreatment, but few studies have examined the placement experiences and outcomes of children removed because of parental AOD use. The present study examines demographic characteristics and placement experiences of children removed from their homes because of parental AOD use (n = 1,333), first in comparison to the remaining sample of children in foster care (n = 4,554), then in comparison to a matched comparison group of children in foster care who were removed for other reasons (n = 1,333). Relative to the comparison sample, children removed for parental AOD use are less likely to experience co-occurring removal because of neglect and physical or sexual abuse and are more likely to be placed in relative foster care. In addition, these children remain in care longer, experience similar rates of reunification, and have significantly higher rates of adoption.

Viana-Wackermann PC; Furtado EF; Esser G; Schmidt MH; Laucht M. Lower P300 amplitude in eight-year-old offspring of alcoholic fathers with a delinquent history. European Archives of Psychiatry and Clinical Neuroscience 257(4): 211-216, 2007. (46 refs.)

The aim of the present study was to investigate the P300 amplitude as a possible vulnerability marker in children of alcoholic (COA) fathers with and without paternal delinquency. Event-related potentials (ERPs) of 122 children aged 8 years (63 boys, 59 girls) were compared depending on father's alcoholism subtype: 30 COAs without paternal delinquency, 10 COAs with paternal delinquency, and 82 children of non-alcoholic and non-delinquent fathers. ERPs were recorded from Fz, Cz, and Pz, using an auditory oddball paradigm. Sinus tones of 60 dB HL were presented binaurally at 1,000 Hz (standard stimulus) and 2,000 Hz (target stimulus), at a relative frequency ratio of 80:20. Two trial blocks of 250 stimuli each were collected. Results indicated that only COAs with paternal delinquency displayed significant differences from the control group, characterized by reduced P300 amplitude at frontal site and in the second trial block. Thus, the combination of fathers' alcoholism and delinquency was more likely to relate to attenuated P300 amplitude in the offspring than paternal alcoholism alone. Our results suggest that both alcoholic and delinquent family history appear to play a role in P300 amplitude reduction in the offspring.

Westermeyer J; Yoon G; Thuras P. Psychiatric morbidity and parental substance use disorder. American Journal of Drug and Alcohol Abuse 32(4): 607-616, 2006. (26 refs.)

Objective: To assess psychiatric morbidity associated with having no, one, or two parents with Substance Use Disorder (SUD), among patients receiving SUD care. Design: Two measures of psychiatric morbidity included (a) current psychopathology and (b) lifetime use of psychiatric treatment. Settings: Alcohol-drug treatment programs were located in two university medical centers. Subjects: Four hundred ninety-five voluntary patients aged 18 and older and non-adopted. Results: Parental SUD was directly related to (a) more current psychiatric symptoms, both self-rated and psychiatrist-rated and (b) greater likelihood of ever having ever received psychiatric treatment. Among those who had ever received psychiatric care, the number of psychotropic medications was related to parental SUD. Number of admissions, venues, visits/days, and cost of psychiatric care were not associated with parental SUD. Conclusions: Extent of parental SUD was related to increased psychiatric morbidity.

Whitbeck LB; Crawford DM. Gestational risks and psychiatric disorders among indigenous adolescents. Community Mental Health Journal 45(1): 62-72, 2009. (69 refs.)

This study reports on the effects maternal prenatal binge drinking, cigarette smoking, drug use, and pregnancy and birth complications on meeting criteria for psychiatric disorders at ages 10-12 and 13-15 years among 546 Indigenous adolescents from a single culture in the northern Midwest and Canada. Adolescent DSM-IV psychiatric disorders were assessed with the Diagnostic Interview Schedule for Children-Revised (DISC-R). Results indicate that maternal behaviors when pregnant have significant effects on adolescent psychiatric disorders even when controlling for age and gender of adolescent, family per capita income, living in a single mother household, and adolescent reports of mother's positive parenting.

Zetteler JI; Stollery BT; Weinstein AM; Lingford-Hughes AR. Attentional bias for alcohol-related information in adolescents with alcohol-dependent parents. Alcohol and Alcoholism 41(4): 426-430, 2006. (37 refs.)

Aims: to assess the attentional bias for alcohol-related information in adolescents with (n = 15), and without (n = 15), a parental history of alcohol dependence. Methods: participants completed questionnaires assessing depression, weekly alcohol consumption, anxiety, and concerns about alcohol consumption and undertook subliminal and supraliminal computerized Stroop tasks using colour-words, alcohol-related words, and control words. Results: adolescents with alcohol-dependent parents showed supraliminal interference for alcohol-related words. The magnitude of this interference was correlated with higher trait and state anxiety, and lower levels of weekly alcohol consumption. No interference was found on the subliminal alcohol Stroop task. Conclusions: while it is likely that this attentional bias for alcohol-related cues reflects the concerns regarding parental drinking, it is also possible that this might underlie the increased risk of future alcohol dependence in the children of alcohol-dependent parents.

Zhou Q; King KM; Chassin L. The roles of familial alcoholism and adolescent family harmony in young adults' substance dependence disorders: Mediated and moderated relations. Journal of Abnormal Psychology 115(2): 320-331, 2006. (70 refs.)

This study examined the prospective relations among family history density of alcoholism (FHD), adolescent family harmony, and young adults' alcohol and drug dependence. Family harmony was rated by mothers and fathers in adolescence, and young adults' substance dependence diagnoses were obtained through structured interviews. Higher FHD predicted lower adolescent family harmony, which in turn increased young adults' odds of being diagnosed with drug dependence (with and without alcohol dependence) compared to no diagnoses or to alcohol dependence only. Family harmony also interacted with FHD such that the protective effect of family harmony on young adults' drug dependence with or without alcohol dependence decreased as FHD rose, and was nonsignificant at high levels of FHD. The findings suggest the importance of distinguishing among alcohol and drug dependence disorders and examining their differential etiological pathways, and also suggest that the protective effects of harmonious family environments on substance dependence may be limited at high levels of FHD.