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Children of alcoholics
All children of alcoholics are affected by their parents’ drinking. Problems can develop such as: withdrawal, crying, illness, sexual abuse, aggression, delinquency, and drug and alcohol abuse. Academic performance deteriorates, and there could be problems with anti-social behaviour, school environment problems, etc.

Alcoholism is a family illness and years of living with an alcoholic are almost sure to make any wife [husband/partner] or child neurotic.

CHILDREN OF ALCOHOLICS: ARE THEY DIFFERENT?
Within the US, 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 behavioural 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 or alcoholism. This paper concentrates on three major research questions concerning children of alcoholics (COA’s).

  1. What contributes to resilience in some COA’s
  2. 1. Do COA’s differ from children of non alcoholic (non-COA’s); 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 COA’s have been plagued by methodological issues. For example, the composition of the sample chosen for 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 non-treatment 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.

SERIOUS COPING SKILLS
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 COA’s function well and do not develop serious problems. Ina longitudinal study of COA’s 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 compared COA’s and non-COA’s have suggested that, although the two groups differ in a variety of psychological areas, differences in cognitive performance are observed most frequently. Cognitive function in COA’s 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.

LOWER IQ, VERBAL SCORES
Ervin and his 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 non-alcoholic fathers. Gabrielli and Mednick (7) reported similar results for verbal and Full IQ tests, but not for performance tests.

In a study comparing COA’s and non-COA’s whose families were educated and whose parents lived in 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, COA’s 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 COA’s and non-COA’s from non-disadvantaged 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 COA’s 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 COA’s 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 COA’s 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.

HIGHER DEPRESSION, ANXIETY
Studies comparing COA’s with non-COA’s 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 non-alcoholic families (12,13,14,15). In addition, COA’s often express a feeling of lack of control over their environment. A recent study by Rolf and colleagues (16) noted that COA’s show more depressive affect than non-COA’s 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 behavioural problems. Study findings suggest that these children exhibit such problems as lying, stealing, fighting, truancy, and school behavioural problems, and they often are diagnosed as having conduct disorders (17). Teachers have rated COA’s as significantly more overactive and impulsive than non-COA’s (11,18).

GREATER DELINQUENCY, TRUANCY
COA’s 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 COA’s.

The alcoholic family’s home environment and the manner in which family members interact may contribute to the risk for the problems observed among COA’s. Although alcoholic families are a heterogeneous group, group 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 non-alcoholic 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 parents’ 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 COA’s. 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).

NEGATIVE SELF-IMAGE
Interestingly, the problems of COA’s may not be specific to this population. In a review of research on children whose mothers were schizophrenic, Garmeza (29) reported that, like COA’s, 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 from schizophrenia; children of schizophrenic parents – whose home environment is turbulent – have an increased risk of developing schizophrenia.

Research on COA’s is still in its infancy. Many studies suggest that a variety of differences exist between children of alcoholics and children on non-alcoholics and these differences occur at all ages.

However, because of the limitations of the methodology and the inadequate numbers of comprehensive studies, research findings cannot be generalized to all children who grow up with alcoholic parents.

ADULT CHILDREN OF ALCOHOLICS: ARE THEY DIFFERENT? A COMMENTARY BY NIAAA DIRECTOR ENOCH GORDIS, M.D.
The adult children of alcoholics (ACOA) 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 COA’s, based on the observations of counsellors, 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 COA’s from negative consequences.

In considering ACOA’s, it is important to remember that, although there is a genetic component to the vulnerability of alcoholism, ACOA 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 COA’s 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 COA’s. 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.

BIBLIOGRAPHY:

  • RUSSELL,M.: Henderson,C,: and Blume,S.B. Children of alcoholics a review of the literature. New York: Children of Alcoholics Foundation, Inc., (1998).
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