ABSTRACT | PDF

RESEARCH

 

A comparative study on behavioural problems in children of alcohol dependent parents

Harsh Raj, Krishan Kumar¹, Vinod Kumar Sinha², Rajeev Dogra³

Psychiatric Social Worker, Pennsylvania, USA

¹Clinical Psychologist, State Institute of Mental Health, Post Graduate Institute of Medical Sciences, Rohtak, India

²Professor, Department of Psychiatry, Central Institute of Psychiatry, Ranchi, India

³Associate Professor, Department of Psychiatry, Post Graduate Institute of Medical Sciences, Rohtak, India

Abstract

Background:There is a tremendous increase in the pace and stress of life which may be the reason to increase the need for alcohol intake as a stabilizer for working class and causes tendency to alcohol dependency in long run process; which creates harm not only to the person who intakes alcohol persistently but also produces agony to family members. When one or both the parents are alcohol-dependent, usually children are the victims of behavioral abnormality.

Material and methods: A group of 60 children of four to 18 years of both sex of parents, who consume alcohol regularly (in experimental group) and those who don’t consume (control group), was collected.

Results:The mean age of children of alcohol dependents (COADs) was 13.13 ± 4.42 (Mean ± SD) years where as that of non-COADs was 11.80 ± 4.17 (Mean ± SD). COAD group was significantly more educated than the control group. COAD group (21.30 ± 15.48, Mean ± SD) had significantly higher totalChild Behavior Checklist (CBCL) scores as compared to the non-COAD counterparts (5.63 ± 4.42, Mean ± SD). There were significant differences in both groups for selected CBCL items. Girls have significantly more internalizing behavioral problems e.g. feels dizzy. Externalizing problems, especially conduct problems are represented more in boys than girls of alcohol dependents.

Conclusion:It has been found that the prevalence of behavior problems in the children of alcohol dependents (COADs) was higher whereas in non-COADs it was much lesser.

 

Raj H, Kumar K, Sinha VK, Dogra R. A comparative study on behavioural problems in children of alcohol dependent parents. Dysphrenia. 2012;3:137-43. Epub 2012 Jan 27.

 

Keywords: Sociodemography. Education. Internatisation. Externalisation.

Correspondence: keshusony@rediffmail.com

Received on 6 January 2012. Accepted on 27 January 2012.

Introduction

Behavioral or emotional problem is manifestation of extremely difficult and challenging behaviors that are outside the norm according to age; characterized by oppositional defiant disorder (ODD), conduct disorder (CD) and attention deficit hyperactivity disorder (ADHD). It adversely affects educational performance, including academic, social, vocational or personal skills.[1] It is estimated that 6.6 million children of age under 18 years live in the family with at least one alcohol-dependent parent.[2] In addition, genetic studies indicate that alcoholism tends to run in families, generation after generation; so that a genetic vulnerability for alcoholism exists.[3-5] Children of alcohol dependents (COADs) reported to have an elevated risk for externalizing, attention problem, aggression and delinquency[6] and conduct of antisocial personality disorder.[7,8] Other research[1] suggests that these children are at risk for a range of cognitive, emotional, and behavioral problems. Longitudinal research suggests that these behavioral problems are robust predictors of future alcohol-dependency or other addiction-disorders.[9] The results of several studies have shown that children from alcohol dependent 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-alcohol dependent families.[10,11] But some investigator also stated that many children from alcohol dependent homes develop neither psychopathology nor alcoholism.[12]

Common behavioral manifestation of children of alcohol-dependents: Child and adolescent psychiatrists know these children are at greater risk for having emotional problems than children of non alcohol-dependent parents. COADs are commonly victim of negligence or abuse. Living with chronic alcoholics, can create stress to all family members, but reaction of the various members of family may be different. The COPDs’ behavioral pattern depends more on the level of resiliency of their non-alcoholic parent than alcohol dependent one. Children living with a non-recovering alcohol dependent parent score lower on intellectual-cultural orientation, family cohesion, active-recreational orientation, and independence. Their growth may be hampered according to desirable manner of development.[13]

Children of alcohol dependents score lower on tests measuring verbal ability—COADs tend to score lower on tests that measure cognitive and verbal skills. Their ability to express themselves may be impaired, which can affect their school performance, peer relationships, ability to develop and sustain intimate relationships, and hamper performance on job interviews. Low verbal scores, however, should not imply that COADs are intellectually impaired.[14]

Children of alcohol dependents often have difficulties in school—COADs are more likely to be raised by parents with poorer cognitive abilities and in an environment lacking stimulation. Preschool aged COADs exhibited poorer language and reasoning skills than did non-COADs. COADs are more likely to be truant, drop out of school, repeat grades, or be referred to a school counselor, or psychologist especially due to low self-concept. They may have difficulty bonding with teachers, other students and school; they may experience anxiety related to performance; or they may be afraid of failure.[15,16]

Children of alcohol dependents have greater difficulty with abstraction and conceptual reasoning—COADs might require very concrete explanations and instructions. Due to continuous fighting, arguments and conflicts; the child is robbed of attention, consistent discipline and a trustworthy environment. The family conflicts are painful to the child who is not only physically but also psychologically pushed aside. 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] Some theorists[17] have examined trajectories of disruptive behavior problems from preschool to early adolescence in 302 boys from a community-recruited sample of high-risk families. Growth modeling showed that paternal alcoholism was associated with elevated levels of son’s disruptive behavior problem.[17]

Barnow et al.[18] aimed to evaluate the prevalence of externalizing symptoms, such as attention problems, aggression and delinquency in the offspring of alcohol dependents. A total of 146 children were divided into three groups (group 1, n=28), one or two (group 2, n=103) and three or more (group 3, n=15) first or second-degree relatives with an alcohol use disorder. Result and conclusion showed that the children of group 3 had significantly higher values for the child behavior checklist scales of attention and delinquent behavioral problems.

Furtado et al.[19],  in the Manheim Study of Risk Children, an ongoing prospective study of high risks, the data of 219 children (26 COADs and 195 non COADs), were analyzed from birth to the age of 11 years. Results showed a significantly higher rate of symptoms and disorder were found in children of alcoholic fathers from the age of two years onwards. Finally in the conclusion it has been noted that, the children of alcoholic fathers represent a group at risk for early onset of psychiatric problems and are deserving of more attention in prevention and early intervention programs.

Some scientists[20] investigated that, there are subtypes of Antisocial Personality Disorder (ASPD) as manifested by distinctive symptom profiles or by associations with alcohol or other drug dependence or other psychiatric disorders. Bucholz et al.[20] collected data on 38 symptoms of ASPD (including childhood conduct disorder) from parents, their relatives and controls recruited for the collective study on the genetics of alcoholism which were analyzed using lateral class analysis. Overall, findings from both men and women did not support the existence of subtypes of ASPD but rather indicated a disorder distributed on a severity spectrum.[20]

Some study[21] showed structural equation modeling to test the hypothesis that parental distress would mediate the relations between parental lifetime alcohol and physical health and child behavior problems. Participants were 182 alcohol-involved families and 83 matched controls with three to five years old biological sons. Results showed that sons of parents with alcohol and physical health problems at elevated risk for behavior problems, partly related to the increased levels of distress their parents are experiencing.  

Hill et al.[22] examined the relative importance of prenatal exposure to cigarettes and alcohol and familial/genetic susceptibility for alcohol dependence in the etiology of childhood psychopathology. A longitudinal prospective study of 150 children/adolescents (51.3% male), who were at either high or low risk for developing alcohol dependence because of their familial loading for alcoholism, provided multiple diagnostic assessments (N=318) of these subjects. Results indicated that internalizing and externalizing disorders were found to be associated with familial loading for alcoholism and parental exposure to cigarettes and alcohol.

Conners et al.[23] examined the association between prenatal alcohol exposures and self-report of depressive symptoms in five to six years old children. Higher levels of prenatal alcohol exposure were hypothesized to be associated with endorsement of a greater number of depressive symptoms in children. It was also hypothesized that maternal depression would contribute independently to outcome. Finally the children as well as current drinking practices were postulated to mediate the relationship between prenatal alcohol exposure and child depressive symptoms. Forty one mother child dyads who had been followed longitudinally since the children were one year of age completed self-report questionnaires for maternal and child depression. Results revealed that prenatal alcohol exposure, maternal depression and child gender seemed to be highly associated with child depressive symptoms. Girls who had higher level of prenatal alcohol exposure and whose mother acknowledged higher levels of depression endorsed the highest number of depressive symptoms.

Method

The present study has been done with the objectives:

1. To identify behavioral problems in children of alcohol dependent parents.

2. To prepare a self-help group for wives of alcohol dependent to share their problems.

3. To make the family members aware of behavioral problems in their children.

4. To make them avail the facility of awareness regarding substance abuse in De-Addiction.

The study was conducted at Central Institute of Psychiatry, Ranchi, India during 2004-05.

Sampling: A group of 60 children of four to 18 years of both sex of parents, who consume alcohol regularly (in experimental group) and those who don’t consume (control group), was collected. Children with psychiatric illness or of mental retardation were excluded.

Tools:

1. Sociodemographic data sheet.

2. General Health Questionnaire-5 (GHQ- 5).[24]

3. Alcohol Use Disorder Inventory Tool (AUDIT).[25]

4. Child Behavior Checklist (CBCL).[26]

Procedure of data collection: Prior permission was taken from the parents of the experimental and control groups. The parents of experimental group, who consumes alcohol regularly was screened for alcohol dependence, using the AUDIT, as well as the parents who were diagnosed as Alcohol Dependence Syndrome according to the tenth revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-10)[27] diagnostic criteria were also taken for the study and were further assessed using the GHQ-5. In the control group, the children were matched with age, sex, and socioeconomic status and the non-alcohol dependent parents and parents were assessed using the GHQ-5. Then to both the experimental and control group (60 children), a description of the items in the checklist (CBCL) was provided. 

Statistical analysis: Statistical Package for Social Sciences for Windows Version 11.1 was used in this study. Descriptive statistics, Klomogrov-Smirnov Test to estimate the characteristics of the sample; t-test, Z-test, and Pearson’s r analysis were applied as per their basic assumptions.

Results

Table 1 describes the demographic variables, which shows that out of a total sample size of 30 children in experimental group, 18 were males (60 %) and 12 were females (40%), while in control group, 11 were males (36.7%) and 19 were females (63%). All the children in the experimental group were Christians and belonged to ST category, while in control group 12 (40%) belonged to Hinduism, 11 (36.7%) children belonged to Muslim religion (36.7%), and five (16.7%) belonged to ‘others’ group (tribal community). The differences being significant in statistical terms. In control group, nearly two-thirds of children belonged to OBC category. Nearly half of the experimental group (31 [51.7%]) children have less than three siblings whereas in control group, 29 (48.7%) have more than three siblings.

Table 1. Group differences in demographic variables

Item		Alcohol dependent (N =30) n (%)	Non alcohol dependent (N =30) n (%)	c2	p
Sex	Male	18(60.0)	11(36.7)	3.27	0.60
	Female	12(40.0)	19 (63.3)
Religion	Hindu	-	12(40.0)	5.26	.000***
	Muslim	-	11(36.7)
	Christian	30(100.0)	2(6.7)
	Others	-	5(16.7)
Category	General	-	2(6.7)	37.29	.00***
	OBC	-	20(66.7)
	SC	-	1(3.3)
	ST	30(100.0)	7(23.3)
Socioeconomic status	High	-	-	-	-
	Middle	-	-
	Low	30(100.0)	30(100.0)
Family type	Joint	2(6.7)	-	1.439	.155
	Nuclear	28(93.3)	30(100.0)
Siblings	Less than 3	16(53.33)	14(46.66)	.766	.447
	More than 3	14(46.66)	16(53.33)

* p ≤ 0.05; ** p ≤ 0.01; ***p ≤ 0.001

Table 2. Differences between children of alcohol dependent (COAD) and non-alcohol dependent (Non-COAD) for continuous variables

Item	COAD (N=30) (Mean ± SD)	Non-COAD (N=30) (Mean ± SD)	t	p
Age	13.13±4.42	11.80±4.17	1.20	1.33
Education	7.53±3.01	5.63±3.63	2.20	.031*
Total CBCL scores	21.30±15.48	5.63±4.42	5.21	.000

*p ≤ 0.05

Table 2 shows the mean age of COAD was 13.13 ± 4.42 (Mean ± SD) years where as that of non-COAD was 11.80 ± 4.17 (Mean ± SD). The table also shows that COAD group was significantly more educated than the control group. Importantly, COAD group (21.30 ± 15.48, Mean ± SD) had significantly higher total CBCL scores as compared to the non-COAD counterparts (5.63 ± 4.42, Mean ± SD).

The Chi Square (c2) matrixshows (table 3) significant differences in both groups (COAD and non-COAD) for selected CBCL items. No significant differences were observed between the two groups for other CBCL items (101). Notably, none of the CBCL items were found to have a significantly higher representation in non-COAD as compared to COAD group.

Table 4shows significant differences of summary scores on CBCL, in both the groups. In all these summary scores, COADs scored high in comparison to non-COADs. It also reveals that there is significant difference in both the groups at 0.01 and 0.05 levels. That reflects more behavioral problems in COADs group in comparison to non-COADs.

Table 3. Group differences for selected CBCL items between COAD and non-COAD

CBCL items	Variable no. in CBCL	c2	p
Acts too young for his/her age	1	13.93	.001***
Argues a lot	3	13.60	.003**
Can’t concentrate, and can’t pay attention for long time	10	7.76	.020*
Refuses to talk	65	6.06	.031*
Repeats certain acts and over compulsion	66	6.66	.036*
Steals at homes	81	5.47	.006**
Stubborn, sullen, or irritable	86	5.09	.007**
Sudden change in mood or feelings	87	6.44	.004**
Talks or walks in sleep	92	5.45	.00**
Talks too much	93	10.65	.005**
Unhappy, sad or depressed	103	10.52	.005
Withdrawn doesn’t get involved with others	111	21.09	.000***

* p ≤ 0.05; ** p ≤ 0.01; ***p ≤ 0.001

Table 4. Differences in CBCL summary scores in COAD and non-COAD groups

CBCL summary Scores	COAD (N=30) (Mean ± SD)	Non-COAD (N=30) (Mean ± SD)	t	p
Externalizing behavior	6.70±5.89	1.83±2.64	4.12	0.00***
Internalizing behavior	7.23±5.42	1.60±1.61	5.45	0.00***
Social problems	0.96±1.15	0.10±. 30	3.96	0.00***
Thought problems	3.33±. 182	.50±1.16	2.16	0.04**
Attention problems	2.60±2.58	0.33±1.12	4.41	0.00***

*p ≤ 0.05; ** p ≤ 0.01; ***p ≤ 0.001

Table 5. Gender differences in behavioral problems across total sample

Variables		Gender (n=60)		c2	p
		Boys (n=29) N (%)	Girls (n=31) N (%)
Fears certain animals, situations or places	Very true	3 (100)	-	4.95	.08
	Somewhat true	-	3 (100)
	Not true	27 (49.1)	28 (50.9)
Feels dizzy	Very true	-	3 (100)	6.01	.05*
	Somewhat true	3 (100)
	Not true	26 (48.1)	28 (51.9)
Sleep more than most children during day or night	Very true	3 (33.3)	6 (66.7)	5.13	.07
	Somewhat true	4 (100)	-
	Not true	22 (46.8)	25 (53.2
Steals at homes	Very true	2  (100)	-	8.41	.01**
	Somewhat true	5 (100)	-
	Not true	22 (41.5)	31 (58.5)
Uses alcohol or drugs	Very true	5 (83.3)	1(16.7)	5.83	.05*
	Somewhat true	2(100)	-
	Not true	22(42.3)	30(57.7)

*p ≤ 0.05; ** p ≤ 0.01; ***p ≤ 0.001

Table 5shows gender differences in CBCL items for the total sample. Girls have significantly more internalizing behavioral problems e.g. feels dizzy. On the other hand boys show significantly more externalizing behavior such as (steals at homes, use of alcohol or drugs).

Table 6. Gender differences in selected CBCL variables in children of alcohol dependents

Variables		Gender (n=60)		c2	p
		Boys (n=18) N (%)	Girls (n=12) N (%)
Cruel to animals	Very true	-	2 (100)	3.21	.07
	Somewhat true	-	-
	Not true	18 (64.3)	10 (35.7)
Steals at homes	Very true	1 (100)	-	5.00	.08
	Somewhat true	5 (100)	-
	Not true	12 (50)	12 (50)
Sulks a lot	Very true	-	2 (100)	3.21	.07
	Somewhat true	-	-
	Not true	18 (64.3)	10 (35.7)
Threatens people	Very true	-	2  (100)	5.00	.08
	Somewhat true	-	1 (100)
	Not true	18 (66.7)	9 (33.3)
Trouble sleeping	Very true	-	2 (100)	3.21	.05*
	Somewhat true	-	-
	Not true	18 (64.3)	10 (35.7)

* p ≤ 0.05

Table 6 shows externalizing problems, especially conduct problems to be represented more in boys than girls of alcohol dependents, and the differences show positive trends towards significant differences.

Table 7. Gender differences in summary scores of CBCL in COAD

Variables	Boys (N=18) (Mean ± SD)	Girls (N=12) (Mean ± SD)	t	p
Externalizing behavior	6.33±5.19	7.25±7.02	.041	0.68
Internalizing behavior	7.94±5.40	6.17±5.52	0.88	0.39
Social problems	0.89±1.13	1.08±1.24	0.44	0.66
Thought problems	0.56±1.38	0.42±0.79	0.31	0.76
Attention problems	2.83±2.71	2.25±2.45	0.60	0.55

*p ≤ 0.05, ** p ≤ 0.05

Table 7 shows that although there are significant differences in individual items, the mean total scores as represented by various domains do not show any significant differences.

Discussion

All the children of alcohol dependents belonged to scheduled tribe category and more than sixty percent belonged to one form of reserved category or the other. This finding is similar to a previous study from the same institute,[28] which found socio-cultural influences to have an important bearing towards alcohol intake i.e. alcohol drinking was found to be more culturally acceptable in the tribal population.

Externalizing problems include rule-breaking behavior (e.g. breaks rules, lacks guilt, bad friends, lies, steals, swears, truant, uses drugs, etc.), aggressive behaviors (e.g. argues a lot, defiant, mean, destroys things explosive, has temper, loud, threatens etc.). This study is in agreement with previous studies,[21] which show significantly higher externalizing problems in children of alcohol dependent population than those of non-alcohol dependents.

Internalizing behavior problems include anxious/depressed mood (e.g. cries a lot, numerous fears, nervous, worries, feels worthless, self-conscious, feels too guilty, etc.), having a depressed mood and being withdrawn (e.g. enjoys little, shy, timid, sad, lacks energy, likes to be alone etc.) and having somatic complaints (e.g. feels dizzy, overtired, aches, headaches, nausea, eye problems, stomach problems etc.). As observed in previous studies,[29] this study shows significantly higher internalizing problems in children of alcohol dependent population than those of non-alcohol dependents.

Behavioral problems in the social domain include being dependent on others, poor interpersonal relationship, gets teased a lot, not liked by others, overweight and preference to play with younger children. This study shows significantly higher social problems in children of alcohol dependent population than those of non-alcohol dependents. In the present study the COADs score higher in social problems compared to the non COADs, who scored much lesser.

Attention problems include attention and concentration problems, being confused, restless and hyperactive, excessive day dreaming, impulsive behavior, being tense and poor academic performance. This study is in agreement with previous studies,[30] which show significantly higher attention problems in children of alcohol dependent population than those of non-alcohol dependents. In this domain, COADs scored higher in thought and attention problemscompared to the non-COADs.

Excessive drinking by one or more family member results in several negative consequences for others in the family, especially for the wife and children of the male drinker. These effects are particularly serious for poor families. Much of the family income may be used to buy alcohol, wages may decline and the drinker may eventually lose his job. In such a situation, other family members including children are forced into work, often in low paid, hazardous jobs. Children may be unable to continue their schooling and may also suffer from nutritional deficiencies because there is not enough to eat at home. Poverty and lack of proper education are important factors contributing to increased behavioral problems.[31]

A study[32] examined possible risk factors associated with child adjustment in a sample of alcohol abusing fathers in Norway. Important risk factors that emerged from the study included socioeconomic status, severity of the fathers’ alcohol abuse, parental psychological problems, and family functioning. Although socioeconomic status was controlled in the present study, the wider impact of social problems contributing to increased behavioral problems in COAD cannot be ignored.

Interestingly, a study that underlines socioeconomic status as one of the determinants of behavioral problems in children of alcohol dependents, observed that factors such as low socioeconomic status and familial comorbidity if controlled, children from high-risk families with a multi-generational history of alcoholism or alcohol abuse, had similar rates of childhood disorders, when contrasted with low-risk children from community control families.[33] The home environment of alcohol dependent families is one of much conflict, abuse and neglect and violent acts among siblings.[33] Research indicates that child’s pathway into risk for later alcohol use is not simply mediated by parental alcoholism and parental alcoholism influences adolescent substance use through several different pathways including stress, negative affects and decreased parental monitoring.[33]

Also, children of alcohol dependents are more likely to be raised by parents with poorer cognitive abilities and in an environment lacking stimulation. A lack of stimulation in the rearing environment may account in part for the pattern of failure found in COADs compared with non- COADs.[34] A previous study has shown that the homes of the “disturbed children” are characterized by greater exposure to the effects of parental drinking, more parent child conflict and less parent-child interaction than the homes of the children who received no diagnoses. The child rearing practices of alcohol dependent fathers are more likely to be rejecting, harsh and neglecting.[35] Thus, poor parenting may be one of the contributor factors for increased behavioral problems in children of alcohol dependent population. Results of several studies have shown that children from alcohol dependent 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-COADs mainly because of poor coping strategies.[36]

Conclusions

The prevalence of behavior problems in COADs was found to be higher whereas in non-COADs it was much lesser. Prevalence of behavior problems was found to be high in Christian tribals, compared to Hindu and Muslim population. Religion, socioeconomic status and cultural factors have significant association with the prevalence of behavior problems. Most of the COADs have high scores in both internalizing and externalizing behavior problems; whereas non-COADs scored less in both the areas. Maximum numbers of males have internalizing problems whereas females have high scores in externalizing problems. There are significant differences in domain of, social problems, thought problems and attention problems in both the groups but COADs group scored high in all the domains. That shows high behavior problems in COADs compared to non-COADs.

 

Further reading

Dogra R, Kumar K, Kotia BL. Addictive behaviour: aetiology and treatment. Dysphrenia. 2012;3:119-25.

 

 

References

1. Bennett LA, Wolin SJ, Reiss D. Cognitive, behavioral, and emotional problems among school-age children of alcoholic parents. Am J Psychiatry. 1988;145:185-90.

2. Kantor GK, Straus MA. Substance abuse as a precipitant of wife abuse victimizations. Am J Drug Alcohol Abuse. 1989;15:173-89.

3. Kaij L. Alcoholism in twins studies on the etiology and sequels of abuse of alcohol.  Stockholm: Almqvist & Wiksell Publishers; 1960.

4. Cloninger CR, Bohman M, Sigvardsson S. Inheritance of alcohol abuse. Cross-fostering analysis of adopted men. Arch Gen Psychiatry. 1981;38:861-8.

5. Goodwin DW, Schulsinger F, Hermansen L, Guze SB, Winokur G. Alcohol problems in adoptees raised apart from alcoholic biological parents. Arch Gen Psychiatry. 1973;28:238-43.

6. Martin ED, Sher KJ. Family history of alcoholism, alcohol use disorders and the five-factor model of personality. J Stud Alcohol. 1994;55:81-90.

7. Jacob T, Johnson S. Parenting influences on the development of alcohol abuse and dependence. Alcohol Health Res World. 1997;21:204-9.

8. Hesselbrock MN, Hesselbrock VM. Relationship of family history, antisocial personality disorder and personality traits in young men at risk for alcoholism. J Stud Alcohol. 1992;53:619-25.

9. Clark DB, Parker AM, Lynch KG. Psychopathology and substance-related problems during early adolescence: a survival analysis. J Clin Child Psychol. 1999;28:333-41.

10. Anderson E, Quast W. Young children in alcoholic families: a mental health needs-assessment intervention/prevention strategy. J Prim Prev. 1983;3:174-87.

11. Prewett MJ, Spence R, Chaknis M. Attribution of causality by children with alcoholic parents. Int J Addict. 1981;16:367-70.

12. Miller D, Jang M. Children of alcoholics: a 20-year longitudinal study. Soc Work Res Abstr 1977;13:23-9.

13. Billings AG, Kessler M, Gomberg CA, Weiner S. Marital conflict resolution of alcoholic and nonalcoholic couples during drinking and nondrinking sessions. J Stud Alcohol. 1979;40:183-95.

14. Ervin CS, Little RE, Streissguth AP, Beck DE. Alcoholic fathering and its relation to child's intellectual development: a pilot investigation. Alcohol Clin Exp Res. 1984;8:362-5.

15. Fine EQ, Yudin LW, Holmes J, Heinemann S. Behavioral disorders in children with parental alcoholism. Ann N Y Acad Sci. 1976;273:507-17.

16. River J. The children of alcoholics: an exploratory study. Child Youth Serv Rev. 1982;4:365-73.

17. Loukas A, Zucker RA, Fitzgerald HE, Krull JL. Developmental trajectories of disruptive behavior problems among sons of alcoholics: effects of parent psychopathology, family conflict, and child undercontrol. J Abnorm Psychol. 2003;112:119-31.

18. Barnow S, Schuckit M, Smith TL, Preuss U, Danko G. The relationship between the family density of alcoholism and externalizing symptoms among 146 children. Alcohol Alcohol. 2002;37:383-7.

19. Furtado EF, Laucht M, Schmidt MH. Psychological symptoms in children of alcoholic fathers. Z Kinder Jugendpsychiatr Psychother. 2002;30:241-50.

20. Bucholz KK, Hesselbrock VM, Heath AC, Kramer JR, Schuckit MA. A latent class analysis of antisocial personality disorder symptom data from a multi-centre family study of alcoholism. Addiction. 2000;95:553-67.

21. Loukas A, Fitzgerald HE, Zucker RA, von Eye A. Parental alcoholism and co-occurring antisocial behavior: prospective relationships to externalizing behavior problems in their young sons. J Abnorm Child Psychol. 2001;29:91-106.

22. Hill SY, Lowers L, Locke-Wellman J, Shen SA. Maternal smoking and drinking during pregnancy and the risk for child and adolescent psychiatric disorders. J Stud Alcohol. 2000;61:661-8.

23. Conners NA, Bradley RH, Mansell LW, Liu JY, Roberts TJ, Burgdorf K, et al. Children of mothers with serious substance abuse problems: an accumulation of risks. Am J Drug Alcohol Abuse. 2003;29:743-58.

24. Goldberg D, Williams P. A user’s guide to the General Health Questionnaire. Windsor: NFER-Nelson; 1988.

25.Babor TF, De La Fuente JR, Saunders J, Grant M. AUDIT: The Alcohol Use Disorder Identification Test: guidelines for use in primary health care. Geneva: Substance Abuse Department, World Health Organization, 1992.

26. Achenbach TM. Manual for the child behavior checklist/4-18 &1991 profile. Burlington, VT: University of Vermont, Department of Psychiatry; 1991.

27. World Health Organization. International Statistical Classification of Diseases and Related Health Problems. 10th rev. Geneva: World Health Organization; 1992.

28. Akhouri GP. A socio cultural study of drinking pattern & attitude towards alcohol intake of group-D staff of CIP. M. Phil dissertation. Ranchi, India: Ranchi University; 1998.

29. Puttler LI, Zucker RA, Fitzgerald HE, Bingham CR. Behavioral outcomes among children of alcoholics during the early and middle childhood years: familial subtype variations. Alcohol Clin Exp Res. 1998;22:1962-72.

30. Casas-Gil MJ, Navarro-Guzman JI. School characteristics among children of alcoholic parents. Psychol Rep. 2002;90:341-8.

31. Kost KA, Smyth NJ. Two strikes against them? Exploring the influence of a history of poverty and growing up in an alcoholic family on alcohol problems and income.J Soc Serv Res. 2002;28:23-52.

32. Javo C, Heyerdahl S, Rønning JA. Parent reports of child behavior problems in young Sami children: a cross-cultural comparison. Eur Child Adolesc Psychiatry. 2000;9:202-11.

33. Fuller BE, Chermack ST, Cruise KA, Kirsch E, Fitzgerald HE, Zucker RA. Predictors of aggression across three generations among sons of alcoholics: relationships involving grandparental and parental alcoholism, child aggression, marital aggression and parenting practices. J Stud Alcohol. 2003;64:472-83.

34. Schuckit MA, Chiles JA. Family history as a diagnostic aid in two samples of adolescents. J Nerv Ment Dis. 1978;166:165-76.

35. Moos RH, Moos BS. The process of recovery from alcoholism: III. Comparing functioning in families of alcoholics and matched control families. J Stud Alcohol. 1984;45:111-8.

36. Barnow S, Lucht M, Freyberger HJ. Alcohol problems in adolescence with reference to high risk children of alcoholic parents. Results of a family study in Mecklenburg Vorpommern. Nervenarzt. 2002;73:671-9. 

 

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

Nach oben