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
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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
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& Mednick, S.A. Intellectual performance in children of alcoholics.
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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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