Cognitive functioning in children from alcoholic and non-alcoholic families

The Secondary Harms of Parental Substance Use on Children's Educational Outcomes: A Review

Parental substance use, that is alcohol and illicit drugs, can have a deleterious impact on child health and wellbeing. An area that can be affected by parental substance use is the educational outcomes of children. Current reviews of the literature in the field of parental substance use and children's educational outcomes have only identified a small number of studies, and most focus on children's educational attainment. To grasp the available literature, the method from Arksey and O'Malley (2005) was used to identify literature. Studies were included if they were empirical, after 1950, and focused on children's school or educational outcomes. From this, 51 empirical studies were identified which examined the relationship between parental alcohol and illicit drug use on children's educational outcomes. Five main themes emerged which included attainment, behavior and adjustment, attendance, school enjoyment and satisfaction, academic self-concept, along with other miscellaneous outcomes. This paper highlights the main findings of the studies, the gaps in the current literature, and the challenges presented. Recommendations are made for further research and interventions in the areas of parental substance use and child educational outcomes specifically, but also for broader areas of adversity and child wellbeing.

The relationship between structural aspects of self-concept and psychosocial adjustment in adolescents from alcoholic families

Sixty adolescents from alcoholic families living in two large cities in Poland were examined in 2008 and 2009. Richness, stability, and certainty of their self-concepts, as well as levels of school adjustment, anxiety, and depression, were evaluated using a set of questionnaires. In a series of bivariate analyses, the strongest associations found were between richness of the self-concept and the social withdrawal syndrome, and between stability of the self-concept and depression. Both relationships remained significant, using multiple regression models, after controlling for possible confounding factors. Possible explanations and implications for the findings, as well as the study's limitations, are noted and discussed.

Adolescent brain development and underage drinking in the United States: identifying risks of alcohol use in college populations

Alcohol use typically is initiated during adolescence, a period that coincides with critical structural and functional maturation of the brain. Brain maturation and associated improvements in decision making continue into the third decade of life, reaching a plateau within the period referred to as emerging adulthood (18-24 years). This particular period covers that of traditionally aged college students, and includes the age (21 years) when alcohol consumption becomes legal in the United States. This review highlights neurobiological evidence indicating the vulnerabilities of the emerging-adult brain to the effects of alcohol. Factors increasing the risks associated with underage alcohol use include the age group's reduced sensitivity to alcohol sedation and increased sensitivity to alcohol-related disruptions in memory. On the individual level, factors increasing those risks are a positive family history of alcoholism, which has a demonstrated effect on brain structure and function, and emerging comorbid psychiatric conditions. These vulnerabilities-of the age group, in general, as well as of particular individuals-likely contribute to excessive and unsupervised drinking in college students. Discouraging alcohol consumption until neurobiological adulthood is reached is important for minimizing alcohol-related disruptions in brain development and decision-making capacity, and for reducing the negative behavioral consequences associated with underage alcohol use.

Adolescents at risk for alcohol abuse demonstrate altered frontal lobe activation during Stroop performance

BACKGROUND

Children and adolescents, family history positive (FH+) for alcoholism, exhibit differences in brain structure and functional activation when compared to family history negative (FH-) counterparts. Given that frontal brain regions, and associated reciprocal connections with limbic structures, undergo the most dramatic maturational changes during adolescence, the objective of this study was to compare functional brain activation during a frontally mediated test of response inhibition in 32 adolescents separated into low-risk (FH-) and high-risk (FH+) groups.

METHODS

Functional magnetic resonance (fMRI) blood oxygen level-dependent data were acquired at 1.5 Tesla during performance of Stroop Color Naming, Word Reading, and Interference. Preprocessing and statistical analyses, covaried for age, were conducted in SPM99 using a search territory that included superior, middle, and inferior frontal gyri (trigone region), anterior cingulate gyrus (CG), and left and right amygdala.

RESULTS

Significantly greater activation in the fronto-limbic search territory was observed in FH+ relative to FH- subjects during Stroop Interference. In addition, a significant regression between brain activation and family history density was observed, with a greater density being associated with increased activation in regions including middle frontal gyrus (BA9) and CG (BA24).

CONCLUSIONS

These data demonstrate a significant influence of FH status on brain activation during the performance of a response inhibition task, perhaps reflecting a neurobiological vulnerability associated with FH status that may include reduced neuronal efficiency and/or recruitment of additional neuronal resources. These findings are important given that the adolescent developmental period is already associated with reduced inhibitory capacity, even prior to the onset of alcohol use.

The effects of alcohol abuse on children and the partner's capacity to initiate change

This paper identifies the social, psychological and cognitive effects of parental alcohol abuse on children across the lifecycle. While the evidence regarding cognitive effects is mixed, there is ample evidence of negative effects on a range of developmental outcomes. Recent advances in unilateral partner interventions open up one avenue for ameliorating this damage even when the drinker is resistant to change.

Relationship between white matter volume and cognitive performance during adolescence: effects of age, sex and risk for drug use

AIM

Familial drug abuse history has been shown to have an impact on cognitive development during adolescence. The present study examined the relationship between white matter volume and cognitive processing speed in adolescents with and without a familial substance abuse history.

PARTICIPANTS

The sample comprised 33 female and male adolescents stratified by risk (family history positive, FH+) and low-risk (FH-) groups.

MEASUREMENTS

Gray and white matter volumes were measured by segmenting magnetic resonance imaging (MRI) data. The neurocognitive test battery included tests that assessed processing speed, verbal ability and mental flexibility.

FINDINGS

Age-related differences in neuropsychological functioning were seen but did not differ by risk group status, although there was some evidence for an age x gender effect. Information processing speed (digit symbol and Stroop word color naming) was correlated significantly with white matter volume; however, this pattern was observed only in FH- females. Cognitive performance and tissue volumes did not differ significantly between risk groups.

CONCLUSIONS

Age-related differences in neuropsychological functioning were seen that might, in larger samples, prove to be related to risk for substance abuse in adolescents who have not yet initiated drug use.

Paternal alcohol abuse: relationship between child adjustment, parental characteristics, and family functioning

This study examines possible risk factors associated with child adjustment in a sample of children with alcohol abusing fathers in Norway (N = 37). Factors included are socio-economic status, severity of the fathers' alcohol abuse, parental psychological problems, and family functioning. Children of alcohol abusing fathers were found to have more adjustment problems assessed by CBCL compared to a general population sample. The findings further suggest that child adjustment in families with paternal alcohol abuse is the result of an accumulation of risk factors rather than the effects of the paternal alcohol abuse alone. Both general environmental risk factors (psychological problems in the fathers, family climate, family health and conflicts) and environmental factors related to the parental alcohol abuse (severity of the alcohol abuse, the child's level of exposure to the alcohol abuse, changes in routines and rituals due to drinking) were related to child adjustment. The results indicate the need to obtain both parents' assessments of child adjustment, as the fathers' assessment was associated with different risk factors compared to the mothers'.

Preservation of implicit memory in adult children of alcoholics

The authors investigated implicit memory in 21 adult children of alcoholics (ACAs) and 24 control individuals (all college undergraduates) who performed a serial reaction time task (SRT) to evaluate their implicit memory performance and their formation of new associations. Each group was presented with 5 blocks of 100 trials per block in which Blocks 1-4 contained a 10-item repeating sequence; Block 5 was a pseudo-random sequence. The latency difference between Block 4 and Block 5 presumably measure implicit memory. The amount of implicit memory did not differ (in ms) between the ACAs (M = 55 ms) and the controls (M = 67 ms). Implicit memory (at least as measured by the SRT task) appears to be preserved in ACAs.

Cognitive functioning among infants of alcoholic fathers

Although there is considerable evidence that suggests that children of alcoholic fathers are at risk for maladaptive developmental outcomes, there is a large amount of heterogeneity in these outcomes. This study examined this hypothesis using broad measures of mental and language development during the toddler period as a function of fathers' alcoholism and associated risk factors. Participants included 102 families in which the father was alcoholic, 20 families in which the father was alcoholic and the mother was a heavy drinker and 104 control families matched in terms of maternal education, race/ethnicity, child gender, marital status and number of children. Families, in which the mother engaged in significant prenatal drinking or drug use, were excluded. Infants were tested at 12, 18 and 24 months old. Analyses revealed no significant differences between controls and infants of severe alcoholics, antisocial alcoholics, depressed alcoholics or family history positive alcoholics. There were also no differences between controls and infants in families with an alcoholic father/heavy drinking mother. The results suggest that overall mental development was not associated with paternal alcoholism. This raises the possibility that later problems in these areas may reflect more specific cognitive processes or the impact of parenting and behavioral problems among these children.

Parental use of alcohol and children's behavioural health: a household production analysis

This study uses the 1988 National Health Interview Survey (NHIS) data to examine the effects of both heavy and problem drinking as well as moderate or light parental alcohol use on children's behaviour problems. The analysis is formulated within Becker's household production function framework. The production of child behavioural health is estimated using items from the Behavior Problems Index, a battery of 32 questions about behaviour problems which is derived from the Child Behavior Checklist (CBCL), a widely-used parent report instrument. Measures of parents' alcohol consumption are constructed from the NHIS Alcohol Supplement that was administered to one randomly selected adult in each household in 1988. Ordinary least squares (OLS) and two-stage least squares (TSLS) results are presented. The results provide consistent evidence that parental alcohol use is an input with negative marginal product in the production of child behavioural health, regardless of which parent drinks. The magnitude of the effect is generally larger in the TSLS specification. There is also strong evidence of relationships between some family structure variables and child behavioural health and between parental physical health and child behavioural health.

The drinker's children

There is no doubt that growing up in a home where one or both parents misuse alcohol is undesirable. However, it is far less certain that this predicament is responsible for psychological damage to the child in the long term. This paper reviews the literature on the psychological effects on children of parental alcohol misuse and concludes that research needs to move beyond crude comparisons between alcohol-affected and nonalcohol-affected homes to a search for the precise mechanism(s) responsible for mediating any statistical associations between parental drinking and psychological deficits in children.

Alcohol and drug use of inter-city versus rural school age children

The purpose of this study of seventy-nine children was to determine: 1) the prevalence and type of substance use in inter-city and rural eight to twelve-year-old children; and 2) the relationships between child substance use, self-esteem, peer substance use, and family climate. The conceptual framework for the study was a modification of Kumpfer and Turner's Social Ecology Model (1991). Nineteen percent of the children had used alcohol or drugs. Thirty-three percent of the children acknowledged having friends who used substances. Inter-city children reported more alcohol and marijuana use, while the rural children reported more use of inhalants. The responses of both inter-city and rural children also indicated that there were problems with substance use and family violence in the home. Self-esteem and affiliation with drug using peers were significantly correlated with substance use of the child.

Factors in childhood drug and alcohol use: a review of the literature

TOPIC

Drug and alcohol use in children.

PURPOSE

To identify the prevalence of drug and alcohol use in children 12 and younger and the factors associated with this use.

SOURCE

A review of the literature.

CONCLUSIONS

The identified factors include: a) differences in use between boys and girls; b) influence of family members' drug and alcohol use; c) influence of peers; d) the child's self-esteem; and e) the child's knowledge about drug and alcohol use. Awareness by child psychiatric nurses of the identified factors is crucial to prevent, assess, and treat the problem of drug and alcohol use by children.

Children of alcoholic parents. A review

Children of alcoholics are prone to genetic, environmental, and teratogenic risk factors. This review starts by outlining the development risks due to intrauterine exposure to alcohol. Furthermore, the overall findings from genetic research are summarized. A further section deals with the analysis of the environment of the family with an alcoholic parent. Within the section on psychopathology the special links to conduct disorders and delinquency, hyperkinetic disorders, substance abuse, anxiety and depression, and somatic problems are described. Special consideration is also given to the literature dealing with cognitive and neuropsychological functioning in the offspring of alcoholic parents. Finally, the limitations of current knowledge are emphasized.

Implications for the alcohol/drug education specialist working with children of alcoholics: a review of the literature from 1988 to 1992

This article reviews the scientific literature on children of alcoholics (COAs) from 1988 to 1992. First the publications were divided into two classifications: practitioner-oriented and research-oriented literature. Each practitioner-oriented article was evaluated on the following criteria: program description, theoretical model, recommendations substantiated by research, behavioral indicators of COAs, suggestions for intervening, and resource lists. For each of the research-oriented articles, the variables measured, sample source, sample size, and number of COAs in the sample are listed. Additionally, those articles are evaluated for research design, instruments, and analytical techniques. Reviews of early research in this area identified severe methodological limitations across the majority of articles. However, results of this more recent review indicate that research on COAs no longer suffers from previously common methodological weaknesses and sampling biases. The research-based literature also indicated that a larger number of COAs are resilient, which calls into question common assumptions about the inevitable negative effects of familial alcoholism. Alcohol/drug education specialists need to be cognizant of the more recent results on non-clinical samples of COAs in designing and implementing sensitive programs.

The self as mediator in the psychopathology of female children of alcoholics

Theoreticians long have argued for the centrality of strength or poverty of self-definitions in the prediction and understanding of psychopathology. In this research an empirical measure of strength of self-definition was developed based on the work of Hazel Markus. Consistency of self-description and resistance to challenge for this self-description were found to be related to reported alcoholism, trust, and life satisfaction/depression in children of alcoholics. In fact, nearly all variance in life satisfaction and alcoholism differentiating children of alcoholics (COA) from non-COA groups was controlled by the self variables. Clinical and theoretical implications of the significant findings were discussed.

A pilot study of school-age children of men with moderate to severe alcohol dependence: maternal distress and child outcomes

This pilot study examined maternal characteristics and children's internalizing and externalizing problems among 53 families (26 alcohol-dependent men, 27 controls) recruited from the general community in a north-east metropolitan area. Comparisons by family type revealed significant differences in maternal depression, social support, life events and children's anxiety, depression and problem behaviors. Factor analysis and hierarchical multiple regression revealed that a maternal distress factor accounted for significant amounts of variance in child outcome variables in addition to that accounted for by fathers' alcohol dependence symptoms. Future studies of school-age children of alcohol-dependent men should routinely sample indices of maternal distress to improve assessments of children's developmental contexts.

Attributional style in children of substance abusers

This study examined attributional style in children of substance abusers. We hypothesized that children of substance abusers are more likely to develop a depressogenic attributional style. Forty children between the ages of 8 and 14 participated in the study. Twenty children were from families with a history of substance abuse and 20 were from families without such a history. Each child completed self-report measures of depression and attributional style. After controlling for depression and other factors, the results revealed that children of substance abusers had a more depressogenic attributional style than did children without such a family history. Implications of the results for children of substance abusers and for hopelessness theory are discussed.

Activation, attention, and visuospatial learning in adults with and without a family history of alcoholism

While recent evidence shows visuospatial information processing deficits to be present in chronic alcoholics, it remains unclear whether such deficits are present prior to alcohol abuse in persons at risk for developing alcoholism. If present, it is also unclear whether the information processing mechanisms underlying these deficits are the same in alcoholics and persons at risk for alcoholism. This study investigated visuospatial information processing psychophysiological activation in adults with and without a family history of alcoholism. Thirty matched nonalcoholics served as participants. Fifteen persons were from families in which at least one biologic parent and one other relative had a history of alcoholism. Another group of 15 persons had no family history of alcoholism. In addition to displaying atypical patterns of learning-contingent physiological activation, participants with a family history of alcoholism displayed visuospatial learning that was significantly poorer than persons with no family history of alcoholism. The learning and physiological activation displayed by the participants with a family history of alcoholism were similar to those displayed by previously studied alcoholics using a similar learning task. The data suggest that visuospatial learning deficits may reflect an antecedent to, rather than a consequence of, chronic alcohol abuse.

Cognitive functioning, ASP, and family history of alcoholism in young men at risk for alcoholism

Previous research has suggested that individuals with a family history of alcoholism may have cognitive deficits that predate, and possibly predispose, to the onset of alcoholism. However, these deficiencies may result from other factors, e.g., comorbid psychopathology. The current study investigated the neuropsychological functioning of young adult males at high risk for alcohol abuse due to a family history of alcoholism (FH) and/or a personal history of antisocial personality disorder (ASP). A family history of alcoholism (FH+) alone was not associated with neuropsychological impairment. Subjects with ASP, however, exhibited some difficulty with higher level motor control and with verbal concept formation compared with nonASP subjects. No clear pattern of FH x ASP interaction was evident in the measures examined. These findings suggest that previous findings suggesting cognitive deficiencies in FH+ individuals may have been related to a failure to consider co-morbid ASP. The deficits exhibited by the ASP subjects may reflect both reduced inhibitory control and a deficiency in higher level verbal skills. These deficiencies may leave ASP individuals less capable of utilizing higher level language skills to regulate behavior.

School adjustment of children of alcoholic fathers: comparison to normal controls

The present study used objective indices of academic performance to test the hypothesis that children of alcoholic fathers (COA's) have poorer school adjustment than children of nonalcoholic parents (non-COA's). Subjects were 39 children of male alcoholics treated for alcoholism in a VA program and 33 control children whose nonalcoholic parents (matched on demographic indices) reported low marital conflict. The results showed that daughters of alcoholics, but not the sons, showed more variability than controls in their school attendance. There was suggestive evidence that they also missed more school days than controls, with a reversed pattern for the sons of alcoholics. Generally, however, the COA group was not compromised academically and did not show more conduct problems compared to controls. Within the COA group, long-term paternal drinking adjustment (years of problem drinking and total number of hospitalizations for drinking) appeared to be related to poorer GPA, while short-term adjustment (alcohol-related days in jail and number of days drinking in year previous to treatment) were more related to poorer attendance. The results are discussed in terms of the mechanism of the effect of paternal drinking on children's school adjustment and the difficulty in making generalizations about the consequences of being the child of an alcoholic.

Psychologists and children of alcoholic parents

Clinical evidence has pictured children of alcoholic parents as vulnerable physically, emotionally, socially, academically, and at risk for alcoholism. Review of research indicated that some of these clinical insights have been validated, but much more is needed to fill out an accurate picture for psychologists who will be asked to work with them.