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National Institute on Alcohol Abuse and Alcoholism No.
9 PH 288 July 1990
Children of Alcoholics: Are They Different?
An estimated 6.6 million children under the age of 18 years
live in households with at least one alcoholic parent (1). Current research
findings suggest that these children are at risk for a range of cognitive,
emotional, and behavioral problems. In addition, genetic studies indicate
that alcoholism tends to run in families and that a genetic vulnerability
for alcoholism exists (2,3,4). Yet, some investigators also report that
many children from alcoholic homes develop neither psychopathology nor
alcoholism. This Alcohol Alert focuses on three major research
questions concerning children of alcoholics (COAs): 1 ) What contributes
to resilience in some COAs; 2) Do COAs differ from children of non alcoholic
(nonCOAs); and 3) Are the differences specifically related to parental
alcoholism, or are they similar to characteristics observed in children
whose parents have other illnesses?
Before summarizing the research findings on these
questions, it should be said that many studies of COAs have been plagued
by methodological issues. For example, the composition of the sample chosen
for a study can affect the study results significantly. Yet, many COA
studies use a biased sample selection of children in treatment or in trouble.
In addition, studies often are conducted without the benefit of matched
control groups. The absence of control groups makes it difficult to generalize
results from treatment samples to nontreatment populations. Children of
various ages and developmental stages frequently are grouped in one sample,
and the developmental differences within the group are ignored. Another
problem is that because few longitudinal studies have been performed,
it is difficult to know whether the observed problems are impairments
or are developmental delays. In addition, the effect of such factors as
marital conflict and the severity of parental drinking on the development
of problems should be considered. All of these limitations can affect
the outcome of the study. The studies cited below are not free of these
methodological problems, but they are the best that we have.
While research findings suggest that some children
suffer negative consequences due to parental alcoholism, a larger proportion
of COAs function well and do not develop serious problems. In a longitudinal
study of COAs born on the island of Kauai, Werner (5) reported that, although
41 percent of the children developed serious coping problems by 18 years
of age, 59 percent did not develop problems. These resilient children
shared several characteristics that contributed to their success, including
the ability to obtain positive attention from other people, adequate communication
skills, average intelligence, a caring attitude, a desire to achieve,
and a belief in self-help.
Studies comparing COAs and nonCOAs have suggested
that, although the two groups differ in a variety of psychosocial areas,
differences in cognitive performance are observed most frequently. Cognitive
function in COAs has been examined by many researchers because it is an
important element needed for adaptation at all stages of development;
it can be measured uniformly across developmental stages; and it often
is associated with the symptoms of alcoholism. Ervin and her colleagues
(6) found that Full IQ, performance (a measure of abstract and conceptual
reasoning), and verbal scores were lower among a sample of children raised
by alcoholic fathers than among children raised by nonalcoholic fathers.
Gabrielli and Mednick (7) reported similar results for verbal and Full
IQ tests, but not for performance tests. In a study comparing COAs and
nonCOAs whose families were educated and whose parents lived i n the home,
Bennett and colleagues (8) found that children from alcoholic families
had lower IQ, arithmetic, reading, and verbal scores. Despite the lower
scores, however, COAs performed within normal ranges for intelligence
tests in each of these studies.
It is important to note that cognitive competence
can vary with the instrument used to measure performance as well as with
the individual who is evaluating function. Johnson and Rolf (9) compared
the academic abilities and cognitive function of COAs and nonCOAs from
nondisadvantaged backgrounds and found no differences between the groups.
The investigators noted, however, that the children with alcoholic parents
underestimated their own competence. In addition, the mothers of COAs
underrated their children's abilities. The mothers' and children's perceptions
of abilities may affect the children's motivation, self-esteem, and future
performance.
School-aged children of alcoholic parents often have
academic problems. Academic performance may be a better measure than IQ
of the effect of living with an alcoholic parent. School records indicate
that COAs experience such academic difficulties as repeating grades, failing
to graduate from high school, and requiring referrals to school psychologists
(10,11). Although cognitive deficits in COAs may account, in part, for
their poor academic performance, motivational difficulties or the stress
of the home environment also may contribute to their problems in school.
Studies comparing COAs with nonCOAs also have found
that parental alcoholism is linked to a number of psychological disorders
in children. Divorce, parental anxiety or affective disorders, or undesirable
changes in the family or in life situations can add to the negative effect
of parental alcoholism on children's emotional functioning (12,13).
The results of several studies have shown that children
from alcoholic families report higher levels of depression and anxiety
and exhibit more symptoms of generalized stress (i.e., low self-esteem)
than do children from nonalcoholic families (12,13,14,15). In addition,
COAs often express a feeling of lack of control over their environment.
A recent study by Rolf and colleagues (16) noted that COAs show more depressive
affect than nonCOAs and that their self-reports of depression are measured
more frequently on the extreme end of the scale.
Moos and Billings (13) found that the emotional stress
of parental drinking on children lessens when parents stop drinking. These
investigators assessed emotional problems in children from families of
relapsed alcoholics, children from families with a recovering parent,
and children from families with no alcohol problem. Although the children
of relapsed alcoholics reported higher levels of anxiety and depression
than children from the homes with no alcohol problem, emotional functioning
was similar among the children of recovering and normal parents.
Finally, children from homes with alcoholic parents
often demonstrate behavioral problems. Study findings suggest that these
children exhibit such problems as lying, stealing, fighting, truancy,
and school behavior problems, and they often are diagnosed as having conduct
disorders (17). Teachers have rated COAs as significantly more overactive
and impulsive than nonCOAs (11,18). COAs also appear to be at greater
risk for delinquency and school truancy (12,19,20). Several investigators
have reported an association between the incidence of diagnosed conduct
disorders and parental alcohol abuse (21 ,22,23). However, other problems
associated with alcoholism (e.g., depression among the alcoholic parents
and divorce) also may contribute to conduct problems and disorders among
COAs.
The alcoholic family's home environment and the manner
in which family members interact may contribute to the risk for the problems
observed among COAs. Although alcoholic families are a heterogeneous group,
g roup common characteristics have been identified. Families of alcoholics
have lower levels of family cohesion, expressiveness, independence, and
intellectual orientation and higher levels of conflict compared with nonalcoholic
families (13,24,25,26). Some characteristics, however, are not specific
to alcoholic families: Impaired problem-solving ability and hostile communication
are observed both in alcoholic families and in families with problems
other than alcohol (27). Moreover, the characteristics of families with
recovering alcoholic members and of families with no alcoholic members
do not differ significantly, suggesting that a parent's continued drinking
may be responsible for the disruption of family life in an alcoholic home
(13).
The family environment also may affect transmission
of alcoholism to COAs. Children with alcoholic parents are less likely
to become alcoholics as adults when their parents consistently set and
follow through on plans and maintain such rituals as holidays and regular
mealtimes (28).
Interestingly, the problems of COAs may not be specific
to this population. In a review of research on children whose mothers
were schizophrenic, Garmezy (29) reported that, like COAs, these children
had cognitive deficits. In particular, they had a limited ability to maintain
attention and to perceive relevant stimuli. Children at high risk for
schizophrenia revealed a more negative self-image. The family environment
also may influence the risk for schizophrenia; children of schizophrenic
parents--whose home environment is turbulent--have an increased risk for
developing schizophrenia.
Research on COAs is still in its infancy. Many studies
suggest that a variety of differences exist between children of alcoholics
and children of nonalcoholics and these differences occur at all ages.
However, because of the limitations of the methodology and the inadequate
number of comprehensive studies, research findings cannot be generalized
to all children who grow up with alcoholic parents.
Children of Alcoholics: Are They Different? A Commentary
by
NIAAA Director Enoch Gordis, M.D.
The children of alcoholics (COA) movement follows in the
rich tradition of many popular movements that have focused public and
professional attention on the problems of a vulnerable group. This movement
has provided valuable information on the social and psychological problems
experienced by many COAs, based on the observations of counselors, clinicians,
school personnel, and others. These observations offer scientists an important
starting point as they carefully design studies that seek to define the
factors that may increase risk and the factors that may protect COAs from
negative consequences.
In considering COAs, it is important to remember
that, although there is a genetic component to the vulnerability to alcoholism,
COA issues are not related primarily to alcoholism itself but to the social
and psychological dysfunction that may result from growing up in an alcoholic
home.
Selection bias and specificity are two important
research issues. Selection bias means that conclusions based on clinical
samples are likely to overestimate the extent of the problems, because
only the most troubled come for treatment. The question of specificity
is this: Are the problems described in COAs specific for parental alcoholism,
or do they occur as often in other dysfunctional families? If the latter
is true, then alcohol-specific mechanisms may not account for the problems
in COAs. Further. if all children from dysfunctional homes are at equal
risk, then all are entitled to the benefits of any public policy designed
to help children from troubled homes.
References
(1) RUSSELL, M.; Henderson, C.; and Blume, S.B.
Children of Alcoholics A Review of the Literature. New York: Children
of Alcoholics Foundation, Inc., 1984. (2 ) KAIJ, L. Alcoholism
in Twins. Studies on the Etiology and Sequels of Abuse of Alcohol. Stockholm:
Almqvist & Wiksell Publishers, 1960. (3) CLONINGER, C.R.; Bohman,
M.; and Sigvardsson, S. Inheritance of alcohol abuse. Archives of General
Psychiatry 38:861-868, 1981. (4) GOODWIN, D.W.; Schulsinger,
F.; Hermansen, L.; Guze, S.B.; and Winokur, G. Alcohol problems in adoptees
raised apart from alcoholic biological parents. Archives of General
Psychiatry 28:238-243,1973. (5) WERNER, E.E.; Resilient offspring
of alcoholics: A longitudinal study from birth to age 18. Journal of
Studies on Alcohol 47(1) 34-40, 1986. (6) ERVIN, C.S.; Little,
R.E.; Streissguth, A.P.; and Beck, D.E. Alcoholic fathering and its relation
to child's intellectual development: A pilot investigation. Alcoholism:
Clinical and Experimental Research 8(4):362-365, 1984. (7)
GABRIELLI, W.F., JR., & Mednick, S.A. Intellectual performance
in children of alcoholics. Journal of Nervous and Mental Disease 171(7):444-447,1983.
(8) BENNETT, L.A.; Wolin, S.J.; and Reiss, D. Cognitive, behavioral,
and emotional problems among school-age children of alcoholic parents.
American Journal of Psychiatry 145(2):185-190,1988. (9) JOHNSON,
J.L., & Rolt, J.E. Cognitive functioning in children from alcoholic
and non-alcoholic families. British Journal of Addiction 83:849-857,
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D.W. A prospective study of young men at high risk for alcoholism: School
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in the offspring of alcoholic parents. Journal of the American Academy
of Child Psychiatry 23(4):465-471, 1984. (22) MERIKANGAS, K.R.;
Weissman, M.M.; Prusoff, B.A.; Pauls, D.L.; and Leckman, J.F. Depressives
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deBlois, C.S.; and Singer, S. Alcoholism and hyperactivity revisited;
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CLAIR, D., & Genest, M. Variables associated with the adjustment
of offspring of alcoholic fathers. Journal of Studies on Alcohol 48(4):345-355,
1986. (25) FILSTEAD, W.J.; McElfresh, O.; and Anderson,
C. Comparing the family environments of alcoholic and "normal" families.
Journal of Alcohol and Drug Education 26(2):24-31, 1981. (26)
MOOS, R.H., & Moos, B.S. The process of recovery from alcoholism:
Company functioning in families of alcoholics and matched control families
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A.G.; Kessler, M.; Gomberg, C.A.; and Weiner, S. Marital conflict
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sessions. Journal of Studies on Alcohol 40(3):183-195. 1979. (28)
WOLIN, S.J.; Bennett, L.A.; Noonan, D.L.; and Teitelbaum, M.A.
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(29) GARMEZY, N. Children at risk: The search for the antecedents
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Schizophrenia Bulletin 9:55-125, 1974.
ACKNOWLEDGMENTS: The National Institute on Alcohol
Abuse and Alcoholism wishes to acknowledge the following individuals who
have contributed their time and expertise to the development of the Alcohol
Alert series over the past 2 years: John Allen, Ph.D.; Loran
D. Archer; Gerald Brown, M.D.; Fulton Caldwell, Ph.D.; Mary Dufour, M.D.,
M.P.H.; Michael Eckardt, Ph.D.; Terry Freeman; Richard Fuller, M.D.; Bridget
Grant, Ph.D.; Thomas Harford, Ph.D.; Brenda Hewitt; Jeannette Johnson,
Ph.D.; Michael J. Lewis, Ph.D.; Markku Linnoila, M.D., Ph.D.; Jane Lockmuller;
Diane Miller; John Noble; H. Laurence Ross, Ph.D.; Barbara Smothers, Ph.D.;
Fred Stinson, Ph.D.; Cate Timmerman; Ken Warren, Ph.D.; Dianne Welsh;
Gerald Williams, D.Ed.; and Terry Zobeck, Ph.D.
All material contained in the Alcohol Alert is in the public
domain and may be used or reproduced without permission from NIAAA. Citation
of the source is appreciated.
Copies of the Alcohol Alert are available free of charge
from the Scientific Communications Branch, Office of Scientific Affairs,
NIAAA, Willco Building, Suite 409, 6000 Executive Boulevard, Bethesda,
MD 20892-7003. Telephone: 301-443-3860.
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Public Health Service * National Institutes of Health
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