Mothers' alcohol and other drug problems and their punitiveness toward their children

Interventions to Reduce Parental Substance Use, Domestic Violence and Mental Health Problems, and Their Impacts Upon Children's Well-Being: A Systematic Review of Reviews and Evidence Mapping

INTRODUCTION

Children exposed to parental intimate partner violence and abuse, mental illness, and substance use experience a range of problems which may persist into adulthood. These risks often co-occur and interact with structural factors such as poverty. Despite increasing evidence, it remains unclear how best to improve outcomes for children and families experiencing these adversities and address the complex issues they face.

AIMS AND METHODS

Systematic review of systematic reviews. We searched international literature databases for systematic reviews, from inception to 2021, to provide an evidence overview of the range and effectiveness of interventions to support children and families where these parental risk factors had been identified.

RESULTS

Sixty-two systematic reviews were included. The majority (n = 59) focused on interventions designed to address single risk factors. Reviews mostly focused on parental mental health (n = 38) and included psychological interventions or parenting-training for mothers. Only two reviews assessed interventions to address all three risk factors in combination and assessed structural interventions. Evidence indicates that families affected by parental mental health problems may be best served by integrated interventions combining therapeutic interventions for parents with parent skills training. Upstream interventions such as income supplementation and welfare reform were demonstrated to reduce the impacts of family adversity.

CONCLUSION

Most intervention approaches focus on mitigating individual psychological harms and seek to address risk factors in isolation, which presents potentially significant gaps in intervention evidence. These interventions may not address the cumulative impacts of co-occurring risks, or social factors that may compound adversities.

Long-term Effects of Adolescent Substance Use Prevention on Participants, Partners, and their Children: Resiliency and Outcomes 15 Years Later During the COVID-19 Pandemic

We examined whether participation in adolescent substance use prevention programming can enhance long-term resilience into adulthood such that individuals were better able to cope with adversities during the initial months of the COVID-19 pandemic, yielding benefits for the individuals, their partners/spouses, and children; 197 adults (28-30 years old) who entered the PROSPER randomized trial of substance use prevention programming as 6th graders and subsequently had become parents-and 128 of their partners-participated in two waves of long-term follow-up data collection. Respondents completed questionnaires on substance use, adjustment, parenting quality, and children's mood and behavior problems 15 years after baseline, and again via an online survey in the first three months of the COVID-19 pandemic. Results were mixed, with some indications of better adjustment of PROSPER intervention compared to control participants during the early phase of the pandemic (less increase in alcohol use and less decrease in parenting warmth) and their children (lower levels of externalizing and internalizing problems) but several null results as well (no differences in other substance use behaviors, other parenting measures, or parent depression). Adolescent substance use prevention programs can foster long-term individual and interpersonal resilience factors that allow participants-as well as their children-to adapt and cope with unforeseen periods of acute stress and adversity with less deterioration in health and well-being.

Maltreatment of Children With Disabilities

Over the past decade, there have been widespread efforts to raise awareness about maltreatment of children. Pediatric providers have received education about factors that make a child more vulnerable to being abused and neglected. The purpose of this clinical report is to ensure that children with disabilities are recognized as a population at increased risk for maltreatment. This report updates the 2007 American Academy of Pediatrics clinical report "Maltreatment of Children With Disabilities." Since 2007, new information has expanded our understanding of the incidence of abuse in this vulnerable population. There is now information about which children with disabilities are at greatest risk for maltreatment because not all disabling conditions confer the same risks of abuse or neglect. This updated report will serve as a resource for pediatricians and others who care for children with disabilities and offers guidance on risks for subpopulations of children with disabilities who are at particularly high risk of abuse and neglect. The report will also discuss ways in which the medical home can aid in early identification and intervene when abuse and neglect are suspected. It will also describe community resources and preventive strategies that may reduce the risk of abuse and neglect.

Association Between Mothers' Alcohol Use Histories and Deficient Parenting in an Economically Disadvantaged Sample

OBJECTIVE

Problematic maternal alcohol use confers risk for child maltreatment, though the effect on specific aspects of parenting is unclear. This study examined concurrent and prospective links among maternal alcohol use history, care neglect, supervisory neglect, and harsh or inconsistent discipline.

METHOD

Multimethod multisource data were utilized to assess deficient parenting in 311 economically disadvantaged mothers at high risk of child maltreatment. Structural equation modeling was used to test hypothesized relations.

RESULTS

Maternal history of alcohol use was associated with more inconsistent discipline and higher levels of subsequent supervisory neglect. Secondary analyses among two-parent families found that paternal substance misuse was associated with maternal care neglect and poor supervision.

CONCLUSIONS

Among low socioeconomic status families, maternal alcohol use increases the risk of inconsistent discipline and inadequate supervision. Inconsistent discipline may also lead to punitive parenting practices. Given the potential effect of paternal substance use on maternal parenting, findings highlight the importance of screening all caregivers for substance use in child welfare and research contexts to clarify when and how to intervene most effectively.

Pathways From Parental Substance Use to Child Internalizing and Externalizing Behaviors in a Child Protective Services Sample

This study examines the role of mediation in the pathway from parental substance use to children developing child internalizing and externalizing behaviors. Using the National Survey of Child and Adolescent Well-Being II, a random half sample (i.e., split-half approach) of children aged 18 months to 17 years who remained in the home following a child welfare investigation (N = 1,633) was used to examine direct and mediated pathways from parental self-reported alcohol and drug use to, separately, parent report of child internalizing and externalizing behaviors. Four parallel mediators were examined: child-reported exposure to violence, child-reported parental monitoring, parent-reported harsh physical discipline, and parent-reported emotional maltreatment. The strongest models for both parental alcohol and drug use to internalizing and externalizing behaviors were single-mediator models through emotional maltreatment. Results suggest emotional maltreatment is a crucial intervention target for families with substance use disorders. Parenting interventions must also strengthen parent-child relationships in order to be effective at improving child outcomes.

Maternal alcohol dependence and harsh caregiving across parenting contexts: The moderating role of child negative emotionality

Parental alcohol dependence is a significant risk factor for harsh caregiving behaviors; however, it is unknown whether and how harsh caregiving changes over time and across parenting contexts for alcohol-dependent mothers. Furthermore, to our knowledge, no studies have examined whether and how distinct dimensions of child characteristics, such as negative emotionality modulate harsh caregiving among alcohol-dependent mothers. Guided by parenting process models, the present study examined how two distinct domains of children's negative emotionality-fear and frustration-moderate the association between maternal alcohol dependence and maternal harshness across discipline and free-play contexts. A high-risk sample of 201 mothers and their two-year-old children were studied over a one-year period. Results from latent difference score analyses indicated that harsh parenting among alcohol-dependent mothers increased over time in the more stressful discipline context, but not in the parent-child play context. This effect was maintained even after controlling for other parenting risk factors, including other forms of maternal psychopathology. Furthermore, this increase in harsh parenting was specific to alcohol-dependent mothers whose children were displaying high levels of anger and frustration. Findings provide support for specificity in conceptualizations of child negative emotionality and parenting contexts as potential determinants of maladaptive caregiving among alcohol-dependent mothers.

The Association Between Adverse Child Health, Psychological, Educational and Social Outcomes, and Nondependent Parental Substance: A Rapid Evidence Assessment

BACKGROUND

Between 5% and 30% of children in high-income countries live with a substance misusing parent, the majority of which is below dependent levels. However, little is understood about the impact of nondependent parental substance misuse upon children.

METHODS

We searched the international literature using rigorous systematic methods to identify studies examining parental substance misuse and adverse outcomes in children. The inclusion criteria were cross-sectional, longitudinal, case-control, and cohort studies; of children aged 0-18 years whose parents are high-risk substance misusers; reporting on their health, psychological, substance use, educational, and social outcomes.

RESULTS

We identified 36 papers (from 33 unique studies), most of which were assessed as being of medium to high methodological quality (N= 28). Parental nondependent substance misuse was found to be associated with adversity in children, with strong evidence of an association with externalizing difficulties (N = 7 papers, all finding an association) and substance use (N = 23 papers, all finding an association) in adolescents and some evidence of adverse health outcomes in early childhood (N = 6/8 papers finding an association). There is less evidence of an association between parental substance misuse and adverse educational and social outcomes. The body of evidence was largest for parental alcohol misuse, with research examining the impact of parental illicit drug use being limited.

CONCLUSION

Methodological limitations restrict our ability to make causal inference. Nonetheless, the prevalence of adverse outcomes in children whose parents are nondependent substance misusers highlights the need for practitioners to intervene with this population before a parent has developed substance dependency.

Testing the cycle of maltreatment hypothesis: Meta-analytic evidence of the intergenerational transmission of child maltreatment

It has long been claimed that "maltreatment begets maltreatment," that is, a parent's history of maltreatment increases the risk that his or her child will also suffer maltreatment. However, significant methodological concerns have been raised regarding evidence supporting this assertion, with some arguing that the association weakens in samples with higher methodological rigor. In the current study, the intergenerational transmission of maltreatment hypothesis is examined in 142 studies (149 samples; 227,918 dyads) that underwent a methodological quality review, as well as data extraction on a number of potential moderator variables. Results reveal a modest association of intergenerational maltreatment (k = 80; d = 0.45, 95% confidence interval; CI [0.37, 0.54]). Support for the intergenerational transmission of specific maltreatment types was also observed (neglect: k = 13, d = 0.24, 95% CI [0.11, 0.37]; physical abuse: k = 61, d = 0.41, 95% CI [0.33, 0.49]; emotional abuse: k = 18, d = 0.57, 95% CI [0.43, 0.71]; sexual abuse: k = 18, d = 0.39, 95% CI [0.24, 0.55]). Methodological quality only emerged as a significant moderator of the intergenerational transmission of physical abuse, with a weakening of effect sizes as methodological rigor increased. Evidence from this meta-analysis confirms the cycle of maltreatment hypothesis, although effect sizes were modest. Future research should focus on deepening understanding of mechanisms of transmission, as well as identifying protective factors that can effectively break the cycle of maltreatment.

Parental Risk Factors among Children with Reactive Attachment Disorder Referred to Specialized Services: A Nationwide Population-Based Study

This nationwide population-based register study examined the family and parental risk factors associated with offspring reactive attachment disorder (RAD). We identified 614 children diagnosed with RAD from the Finnish Care Register for Health Care and each case was matched with four controls. Univariate and multivariate models examined the associations between risk factors and RAD. In the multivariate model, offspring RAD was associated with only mother, only father and both parents having psychiatric diagnoses. Increased odds were observed for maternal smoking during pregnancy, single motherhood and paternal age ≥ 45 years. This study provides information on several parental adversities and offspring RAD that have important implications for public health, when planning early prevention and interventions in infant mental health.

Co-Occurring Trajectory of Mothers' Substance Use and Psychological Control and Children's Behavior Problems: The Effects of a Family Systems Intervention

This study examined the effects of a family systems therapy (Ecologically-Based Family Therapy [EBFT]) on the co-occurring trajectory of mothers' substance use and psychological control, and its association with children's problem behaviors. Participants included 183 mothers with a substance use disorder who had at least one biological child in their care. Mothers were randomly assigned to one of the three intervention conditions: EBFT-home, n = 62; EBFT-office, n = 61; or Women's Health Education, n = 60. Participants were assessed at baseline, 3, 6, 12, and 18 months post-baseline. A dual-trajectory class growth analysis identified three groups of mothers in regard to their change trajectories. The majority of the mothers exhibited a synchronous decrease in substance use and psychological control (n = 107). In all, 46 mothers exhibited a synchronous increase in substance use and psychological control. For the remaining 30 mothers, substance use and psychological control remained stable. Mothers in the family therapy condition were more likely to show reduced substance use and psychological control compared to mothers in the control condition. Moreover, children with mothers who showed decreased substance use and psychological control exhibited lower levels of problem behaviors compared to children with mothers showing increased substance use and psychological control. The findings provide evidence for the effectiveness of family systems therapy, EBFT, in treating mothers' substance use, improving parenting behaviors, and subsequently improving child behavioral outcomes.

Comparison of Characteristics of Female Drivers with Single and Multiple DUI Convictions

BACKGROUND

Women are increasingly involved in drunk driving and fatal crashes, yet except for the screening performed in criminal justice settings, little is known about their life context, psychiatric histories, and family backgrounds. This study describes a sample of women with histories of arrest for driving under the influence of alcohol (DUI) who were interviewed outside a criminal justice setting and contrasts women with single versus multiple DUI convictions.

METHODS

Women with recent documented histories of DUI participated in a study of women's health behaviors. Thirty-six women with 1 DUI and 62 with 2 or more DUIs participated in a diagnostic telephone interview which assessed demographics, alcohol use and problems, psychiatric problems, treatment, and partner violence.

RESULTS

The sample overall had high rates of co-occurring psychiatric problems, parental alcohol problems, early sexual and physical abuse, and head injuries. Alcohol use severity and the prevalence of head injuries and partner alcohol problems were significantly higher among women with multiple DUIs than women with a single DUI. Measures reflecting life context, such as marital status, number of children, and childhood trauma, were not associated with number of DUIs.

CONCLUSIONS

Findings suggest that DUI recidivism in women is accounted for primarily by AUD severity and is not influenced by previous life events such as partner violence, psychiatric problems, and family context such as divorce/separation or number of children. Multiple DUIs in women may mark an alcohol severity threshold beyond which few factors account for additional risk.

Substance abuse treatment engagement among mothers: Perceptions of the parenting role and agency-related motivators and inhibitors

This qualitative study explored 1) the parenting role as a motivator and inhibitor to engaging in substance abuse treatment and 2) parenting-related, agency-imposed barriers and facilitators to substance abuse treatment engagement. Nine focus groups (n=45) were conducted with current and former male and female recipients of treatment services in one south eastern state. Using inductive thematic analysis, transcripts were analyzed to identify key themes related to parenting. Females were overrepresented in our groups and were more vocal than males regarding issues of parenting as these related to treatment. Among mothers, motivations for treatment related to parenting included involvement with child protective services and the desire to be a better parent. Inhibitors for treatment included anxiety over separation from child, debilitating guilt, and parenting demands. Facilitators for participation included mother-child residential programs, services for children, concrete support, and advocacy and emotional support. Barriers for participation included decreased access to the child and barriers specific to mother-child residential programs. To enhance treatment engagement among parents, providers can address agency-level barriers and draw upon the parenting role as intrinsic motivation for change. Policies and services are needed that promote flexibility, choice, and support parents to engage in treatment services.

Parental Alcohol Use, Parenting, and Child On-Time Development

This study examined whether parental alcohol use in adolescence, adulthood, and, for mothers, during pregnancy was related to their young children's functioning in terms of their on-time development as indicated by the number of developmental areas in which children experienced delay. Observed parenting practices and family socioeconomic status were tested as potential explanatory mechanisms of these links. Data came from the surveys and videotaped observations of a community sample of 123 biological parents and their 1-5 year old children followed longitudinally. Results suggest that the negative association between parental alcohol use and children's development operates primarily through fathers' alcohol use. Additionally, father's adolescent regular alcohol use predicted the family's low SES, which in turn predicted less-skilled maternal parenting practices and children's developmental delay.

Attachment Theory and Maternal Drug Addiction: The Contribution to Parenting Interventions

Children's emotional and relational development can be negatively influenced by maternal substance abuse, particularly through a dysfunctional caregiving environment. Attachment Theory offers a privileged framework to analyze how drug addiction can affect the quality of adult attachment style, parenting attitudes and behaviors toward the child, and how it can have a detrimental effect on the co-construction of the attachment bond by the mother and the infant. Several studies, as a matter of fact, have identified a prevalence of insecure patterns among drug-abusing mothers and their children. Many interventions for mothers with Substance Use Disorders have focused on enhancing parental skills, but they have often overlooked the emotional and relational features of the mother-infant bond. Instead, in recent years, a number of protocols have been developed in order to strengthen the relationship between drug-abusing mothers and their children, drawing lessons from Attachment Theory. The present study reviews the literature on the adult and infant attachment style in the context of drug addiction, describing currently available treatment programs that address parenting and specifically focus on the mother-infant bond, relying on Attachment Theory.

Discrepancies in Autonomy and Relatedness Promoting Behaviors of Substance Using Mothers and Their Children: The Effects of a Family Systems Intervention

Parents' and children's autonomy and relatedness behaviors are associated with a wide range of child outcomes. Yet, little is known about how parents and children's autonomy and relatedness behaviors jointly influence child outcomes. The current study captured this joint influence by exploring the longitudinal trajectory of mother-child discrepancies in autonomy and relatedness behaviors and its association with child problem behaviors. The effects of a family systems intervention on the trajectory of mother-child discrepancies were also examined. The sample included 183 substance using mothers and their children (M age = 11.54 years, SD = 2.55, range 8-16; 48 % females). Both the mother and child completed an assessment at baseline, 6- and 18-month post-baseline. A person-centered analysis identified subgroups varying in mother-child discrepancy patterns in their autonomy and relatedness behaviors. The results also showed that participation in the family systems therapy was associated with decreased mother-child discrepancies, and also a synchronous increase in mother's and child's autonomy and relatedness. Additionally, increased mother-child discrepancies and mother-child dyads showing no change in autonomy and relatedness was associated with higher levels of children's problem behaviors. The findings reveal a dynamic process of mother-child discrepancies in autonomy and relatedness behaviors related to child outcomes. The findings also support the effectiveness of the family systems therapy, and highlight the importance of understanding the complexities in family interactions when explaining children's problem behaviors.

Understanding the Roles of Context, Frequency, and Quantity of Alcohol Consumption in Child Physical Abuse: Risks for Mothers and Fathers

INTRODUCTION

Alcohol use is related to child physical abuse, although little is known about gender-specific risks factors. This study examines the relationships between alcohol outlets, context-specific drinking, dose-response drinking and child physical abuse for mothers and fathers.

METHOD

Telephone interviews were conducted with 1,973 female and 1,050 male respondents in 50 California cities. Weighted negative binomial models were used to calculate the frequency of physical abuse in the past year.

RESULTS

Drinking more often at restaurants was related to higher frequency of physical abuse for fathers, while mothers who drank more frequently at bars and parties used physical abuse more often. There were no significant dose-response drinking relationships for fathers. Drinking higher amounts at bars, parties, and restaurants was associated with less frequent physical abuse for mothers.

DISCUSSION

Our findings suggest that a focus on drinking contexts may reveal heightened risk for many mothers who do not consume large amounts of alcohol.

Hugs, Not Hits: Warmth and Spanking as Predictors of Child Social Competence

Many parents believe that spanking is an effective way to promote children's positive behavior, yet few studies have examined spanking and the development of social competence. Using information from 3,279 families with young children who participated in a longitudinal study of urban families, this study tested competing hypotheses regarding whether maternal spanking or maternal warmth predicted increased social competence and decreased child aggression over time and which parent behavior was a stronger predictor of these changes. The frequency of maternal spanking was unrelated to maternal warmth. Findings from cross-lagged path models indicated that spanking was not associated with children's social competence, but spanking predicted increases in child aggression. Conversely, maternal warmth predicted children's greater social competence but was not associated with aggression. Warmth was a significantly stronger predictor of children's social competence than spanking, suggesting that warmth may be a more effective way to promote children's social competence than spanking.

Suicide, Violence and Child Abuse: A Review of the Impact of Alcohol Consumption on Social Problems

The literature on empirical studies of alcohol consumption and its impact on three categories of social problems—suicide, violence, and child abuse—is reviewed. A large literature on alcohol consumption and its impact on suicide and violence comprises empirical studies applying various methods and designs. The rather consistent findings across these studies show that more drinking is associated with a higher risk of experiencing suicidal behavior or violence. Moreover, frequent intoxication seems to be a key factor in alcohol's role in suicide and violence. The empirical studies on alcohol consumption and child abuse are less extensive, the findings are less consistent in demonstrating an association, and many studies have been met with methodological criticism. This is clearly an area where more research, applying various and strong designs, is needed. More knowledge on how and why alcohol consumption is associated with these social problems should also be among future research challenges.

A LONGITUDINAL EXAMINATION OF TODDLERS' BEHAVIORAL CUES AS A FUNCTION OF SUBSTANCE-ABUSING MOTHERS' DISENGAGEMENT

As a group, substance-abusing parents are at risk for maladaptive parenting. The association between substance abuse and parenting may result, in part, from parents' emotional disengagement from the parent-child relationship, which makes perceiving and responding to children's cues more challenging. In this study, we examined whether substance-abusing mothers' levels of disengagement from their relationship with their children (ages 2-44 months), operationalized in two different ways using parenting narratives (representational and linguistic disengagement), prospectively predicted children's engagement and disengagement cues during a structured mother-child interaction. Within a sample of 29 mothers, we tested the hypotheses that greater maternal disengagement at Time 1 would predict a decrease in children's engagement and an increase in children's disengagement at Time 2. Results indicated that representational disengagement predicted a decrease in children's engagement cues whereas linguistic disengagement predicted an increase in children's disengagement cues. Results provide partial support for a reciprocal, iterative process in which mothers and children mutually adjust their emotional and behavioral disengagement with one another.

Behavioral Couples Treatment for Substance Use Disorder: Secondary Effects on the Reduction of Risk for Child Abuse

Risk for child abuse was examined prior to and after behavioral couples treatment (BCT) among 61 couples in which one or both parents were diagnosed with substance use disorder (SUD). All couples were residing with one or more school-age children. Mothers and fathers completed pretreatment, post-intervention, and 6-month post-intervention follow-up assessments. Results of piecewise latent growth models tested whether the number of BCT sessions attended and number of days abstinent from drugs and alcohol influenced relationship satisfaction and its growth over time, and in turn if relationship satisfaction and change in relationship satisfaction influenced risk for child abuse. For both mothers and fathers, attending more BCT sessions lead to a direct increase in relationship satisfaction, which in turn led to stronger reductions in risk for child abuse. This effect was maintained from the post-intervention through the 6-month post-intervention follow-up. For fathers, number of days abstinent significantly influenced reduction in child abuse potential at post-intervention via relationship satisfaction. This indirect effect was not present for mothers. The overall benefits of BCT on mothers' and fathers' risk for child abuse suggest that BCT may have promise in reducing risk for child abuse among couples in which one or both parents have SUD.

Methodological Issues in Assessing the Impact of Prenatal Drug Exposure

Prenatal drug exposure is a common public health concern that can result in perinatal complications, birth defects, and developmental disorders. The growing literature regarding the effects of prenatal exposure to specific drugs such as tobacco, alcohol, cocaine, and heroin is often conflicting and constantly changing. This review discusses several reasons why the effects of prenatal drug exposure are so difficult to determine, including variations in dose, timing, duration of exposure, polydrug use, unreliable measures of drug exposure, latent or “sleeper” effects, genetic factors, and socioenvironmental influences. In addition to providing research guidelines, this review also aims to help clinicians and policy makers to identify the strengths and weaknesses in studies investigating the effects of prenatal drug exposure. This knowledge may be used to make better informed decisions regarding the appropriate treatment for pregnant, drug-dependent women and their children.

Predictors of violence against children in Tamil families in northern Sri Lanka

Children living in post-conflict settings are not only at high risk of developing war-related psychopathology but also of experiencing maltreatment within their families. However, little is known about the mechanisms of the relationship between war and family violence. In order to investigate the variables associated with the experience and perpetration of child maltreatment, we conducted a two-generational study with Tamil families in the North of Sri Lanka, a region affected by war and Tsunami. We interviewed children and the corresponding family dyads and triads with 359 children, 122 mothers, and 88 fathers on the basis of standardized questionnaires to assess their exposure to adverse life experiences and mental health symptoms. Using multivariate regression analyses, we found that the strongest predictors for children's report of victimization were children's exposure to mass trauma and child psychopathology. Mothers' experiences of mass trauma, family violence and partner violence were each significantly related to mother-reported maternal perpetration as well as child-reported victimization. Likewise, all types of traumatic events reported by fathers were significantly related to child-reported victimization and father-reported perpetration. Fathers' alcohol use was the strongest predictor of father-reported paternal perpetration. These findings provide further support for the transmission of mass trauma into family violence, and emphasize the role of child psychopathology as well as alcohol consumption in this relationship.

Modeling risk for child abuse and harsh parenting in families with depressed and substance-abusing parents

Children with substance abusing parents are at considerable risk for child maltreatment. The current study applied an actor-partner interdependence model to examine how father only (n=52) and dual couple (n=33) substance use disorder, as well as their depressive symptomology influenced parents' own (actor effects) and the partner's (partner effects) overreactivity in disciplinary interactions with their children, as well as their risk for child maltreatment. Parents completed the Center for Epidemiologic Studies Depression Scale (CES-D; Radloff, 1977), the overreactivity subscale from the Parenting Scale (Arnold, O'Leary, Wolff, & Acker, 1993), and the Brief Child Abuse Potential Inventory (Ondersma, Chaffin, Mullins, & LeBreton, 2005). Results of multigroup structural equation models revealed that a parent's own report of depressive symptoms predicted their risk for child maltreatment in both father SUD and dual SUD couples. Similarly, a parent's report of their own depressive symptoms predicted their overreactivity in disciplinary encounters both in father SUD and dual SUD couples. In all models, partners' depressive symptoms did not predict their partner's risk for child maltreatment or overreactivity. Findings underscore the importance of a parent's own level of depressive symptoms in their risk for child maltreatment and for engaging in overreactivity during disciplinary episodes.

Interventions to address parenting and parental substance abuse: conceptual and methodological considerations

Parental substance abuse is a serious problem affecting the well-being of children and families. The co-occurrence of parental substance abuse and problematic parenting is recognized as a major public health concern. This review focuses on 21 outcome studies that tested dual treatment of substance abuse and parenting. A summary of theoretical conceptualizations of the connections between substance abuse and parenting provides a backdrop for the review. Outcomes of the dual treatment studies were generally positive with respect to reduction of parental substance use and improvement of parenting. Research in this area varied in methodological rigor and needs to overcome challenges regarding design issues, sampling frame, and complexities inherent in such a high-risk population. This area of work can be strengthened by randomized controlled trials, use of mixed-methods outcome measures, consideration of parent involvement with child protective services, involvement of significant others in treatment, provision of concrete supports for treatment attendance and facilitative public policies.

Maternal mental health and children's internalizing and externalizing behaviors: Beyond maternal substance use disorders

Maternal substance abuse and mental disorders can have adverse impacts on child development. We investigated the impact of maternal mental health on child behaviors based on a long-term follow-up study of mothers and their children approximately 10 years after mothers' admission to drug abuse treatment. Mothers (n=396) were assessed at admission to drug treatment during 2000 to 2002, and at follow-up in 2010-2011. At follow-up, each mother was asked to assess one target child using the Child Behavior Checklist for ages 6-18 (CBCL). Mothers' mental disorder diagnoses were obtained from records maintained by the California Department of Mental Health in 2009. About 46% of mothers had comorbid mental disorders; 27% had depressive disorder, 15% bipolar disorder, 15% adjustment disorder, 13% anxiety disorder, and 6% psychotic disorder. Of these mothers, more than half had two or more mental disorder diagnoses. The average age of the target child was approximately 10 years old (range 6 to 17). Relative to children of mothers without comorbid mental disorders, children were more likely to demonstrate internalizing behaviors if their mothers had comorbid depression/anxiety disorders (OR=2.0, 95%CI:1.0-4.0) or severe mental disorders (psychoses, bipolar) (OR=3.4, 95%CI:1.5-7.6). For externalizing behaviors, family problems was the only significant predictor (OR=3.2, 95%CI:1.7-6.0 for children of mothers with depression/anxiety disorders, OR=3.9, 95%CI:1.9-7.8 for severe mental disorders). Addressing maternal mental disorders (particularly severe mental disorders) and family problems are important for child well-being as these factors were significantly related to emotional and problem behaviors of children.

Spanking of young children: do immigrant and U.S.-born Hispanic parents differ?

Building on prior research showing fewer parenting risk behaviors and lower levels of harsh punishment among less acculturated Hispanic parents, we tested the hypothesis that foreign-born (FB; immigrant) Hispanic parents use less spanking toward children at 3 years and 5 years of age than U.S.-born Hispanic parents. We also examined whether other indicators of acculturation-endorsement of traditional gender norms and religiosity-showed any direct or indirect effects in explaining the hypothesized association. Path model analyses were conducted with a sample of Hispanic mothers (n = 1,089) and fathers (n = 650). Cross-sectional and time lagged path models controlling for a wide range of psychosocial and demographic confounds indicated that, when compared with U.S.-born Hispanic parents, FB Hispanic mothers and fathers used less spanking toward their young children. In cross-sectional analysis only, mothers' greater endorsement of traditional gender norms had small protective effects on spanking. Although fathers' endorsement of traditional gender norms was not a significant direct predictor of spanking, there was a significant indirect effect of nativity status on spanking mediated by endorsement of traditional gender norms. Religiosity showed no relation to spanking for either mothers or fathers. Immigrant status may be an important protective factor that is associated with lower levels of parenting aggression among Hispanic mothers and fathers living in the United States.

Parental cannabis abuse and accidental intoxications in children: prevention by detecting neglectful situations and at-risk families

OBJECTIVES

Cannabis intoxication in toddlers is rare and mostly accidental. Our objectives were to focus on the characteristics and management of children under the age of 6 years who were admitted to our emergency department with cannabis poisoning reported as accidental by parents, and to point out the need to consider accidental cannabis ingestions as an indicator of neglect.

METHODS

The medical records of children hospitalized for cannabis poisoning in a pediatric emergency department from January 2007 to November 2012 were retrospectively evaluated. Data collected included age, sex, drug ingested, source of drug, intentional versus accidental ingestion, pediatric intensive care unit or hospital admission, treatment and length of hospital stay, toxicology results, and rate of child protectives services referral.

RESULTS

Twelve toddlers (4 boys and 8 girls; mean age, 16.6 months) were included. All had ingested cannabis. Their parents reported the ingestion. Seven children experienced drowsiness or hypotonia. Three children were given activated charcoal. Blood screening for cannabinoids, performed in 2 cases, was negative in both, and urine samples were positive in 7 children (70%). All children had favorable outcomes after being hospitalized from 2 to 48 hours. Nine children were referred to social services for further assessment before discharge.

CONCLUSIONS

Cannabis intoxication in children should be reported to child protection services with the aim of prevention, to detect situations of neglect and at-risk families. Legal action against the parents may be considered. Accidental intoxication and caring parents should be no exception to this rule.

Substance-abusing mothers and fathers' willingness to allow their children to receive mental health treatment

The purpose of this study was to examine attitudes of substance-abusing mothers and fathers entering outpatient treatment toward allowing their children to participate in individual- or family-based interventions. Data were collected from a brief anonymous survey completed by adults at intake into a large substance abuse treatment program in western New York. Only one-third of parents reported that they would be willing to allow their children to participate in any form of mental health treatment. Results of chi-square analyses revealed that a significantly greater proportion of mothers reported that they would allow their children to participate in mental health treatment (41%) compared to fathers (28%). Results of logistic regression analyses revealed even after controlling for child age, mothers were more likely than fathers to indicate their willingness to allow their children to receive mental health treatment; however, type of substance abuse (alcohol versus drug abuse) was not associated with parents' willingness to allow their children to receive treatment. Parental reluctance to allow their children to receive individual or family-based treatment is a significant barrier in efforts to intervene with these at-risk children.

Does warmth moderate longitudinal associations between maternal spanking and child aggression in early childhood?

This study examines whether maternal warmth moderates the association between maternal use of spanking and increased child aggression between ages 1 and 5. Participants were 3,279 pairs of mothers and their children from a cohort study of urban families from 20 U.S. cities. Maternal spanking was assessed when the child was 1 year, 3 years, and 5 years of age. Maternal warmth and child aggressive behavior were measured at 3 years and 5 years of age. Models controlled for demographic characteristics (measured at the child's birth), child emotionality (measured at age 1), and maternal psychosocial risk factors (measured when children were 3 years old). Cross-lagged path models examined the within-time and longitudinal associations between spanking and child aggression. Results indicated that maternal spanking at age 1 was associated with higher levels of child aggression at age 3; similarly, maternal spanking at age 3 predicted increases in child aggression by age 5. Maternal warmth when children were 3 years old did not predict changes in child aggression between 3 and 5 years old. Furthermore, maternal warmth did not moderate the association between spanking and increased child aggression over time. Beginning as early as age 1, maternal spanking is predictive of child behavior problems, and maternal warmth does not counteract the negative consequences of the use of spanking.

Alcohol use patterns among postpartum women

While much attention has been paid to women's drinking during pregnancy, few studies address a woman's drinking once she has given birth, which presents potential dangers to herself and her child. This time of transition can be extremely stressful, potentially leading to problem drinking. On the other hand, this new role and change in lifestyle may be protective against alcohol use and abuse. We used the California Women's Health Survey (CWHS), a randomized sample of adult women in California, to compare new mothers' drinking behaviors to other women. In order to obtain a large enough sample to observe trends in subpopulations, we combined CWHS data from years 1997-2008 (n = 28,537 women aged 18-48). We used logistic regression to determine the individual-level characteristics that best predicted the outcomes postpartum and to compare new mothers (those with a child in the household <1 year and pregnant in the last 5 years) to other women for any alcohol use, heavy episodic drinking and number of days of alcohol use. New mothers were significantly less likely to engage in all behavior outcomes after adjustment for race/ethnicity, income, employment, education, age, and marital status, though new mothers who are not married and those in higher income brackets were identified as groups at higher risk of drinking. Although new motherhood could prove to be a risk factor for some women, we found that being a new mother is protective against all measures of drinking.

Understanding the diverse needs of children whose parents abuse substances

In this review, we consider the potential service needs of children of substance abusing parents based on what we know about the risk outcomes faced by these children and the parenting deficits often present in these families. Importantly, our review does not address the etiological role of parental substance abuse in children's negative outcomes but instead we discuss the complex inter-related risk factors that often co-occur with and exacerbate risk associated with parental alcohol and drug use. We first review studies showing the elevated risk that children of substance abusing parents face in general for poorer academic functioning; emotional, behavioral, and social problems; and an earlier onset of substance use, faster acceleration in substance use patterns, and higher rates of alcohol and drug use disorders. We then review studies showing contextual risk factors for children of substance abusing parents, including parenting deficits (less warmth, responsiveness, and physical and verbal engagement as well as harsher and more over-involved interaction styles), greater risk for child maltreatment, and less secure attachment patterns. We conclude with a discussion of future directions for research and guidelines for professionals working with children and their families where parental substance abuse is present.

Effects of cocaine on maternal behavior and neurochemistry

Drug addiction is a chronic relapsing disorder that involves drug seeking and abuse despite the negative social and health consequences. While the potential effects of cocaine on child development have been extensively studied over the last 30 years, few researchers have focused on the effects of cocaine on maternal behavior, which includes offspring care and maternal aggression towards an unfamiliar individual. In humans, maternal cocaine use can lead to child neglect, abuse, and disrupt the mother-child bond. While it has been argued the developmental effects of maternal cocaine use on children were initially overstated, it is clear that disruptions of typical maternal behavior (i.e. postpartum depression, anxiety disorders) are detrimental to the physical and emotional health of offspring. Cocaine use in mothers is commonly associated with psychological disorders, including depression and anxiety, and it is postulated that many of the negative effects of maternal cocaine use on offspring are mediated through changes in maternal behavior. This review will summarize research on cocaine and maternal behavior in animal and human studies, discuss potential mechanisms, and suggest therapeutic strategies for treating cocaine-affected maternal behavior which may improve the physical and behavioral health of both mother and child. The primary objective is to stimulate future communication, cooperation, and collaboration between researchers who use animals and humans to study cocaine and maternal behavior.

The Word Game: an innovative strategy for assessing implicit processes in parents at risk for child physical abuse

OBJECTIVE

Contemporary theories of child physical abuse (CPA) emphasize the proximal role of social cognitive processes (many of which are implicit in nature) in the occurrence of parental aggression. However, methods that allow for the systematic examination of implicit cognitive processes during the course of aggressive interactions are needed. To address this need, the present study was designed to examine the utility of the Word Game, an innovative procedure designed to assess implicit changes in schema accessibility during the course of an interpersonal exchange involving aggressive response options.

METHODS

The game involves a series of competitive reaction time trials which are actually lexical decision making trials designed to determine the accessibility of schema throughout the game. Each parent was led to believe that they were competing against another player with whom they exchanged sound blasts of varying intensities. Participants in the present study were parents who were either low (n=50) or high (n=20) risk for CPA.

RESULTS

Results revealed that high CPA risk parents behaved more aggressively than low CPA risk parents and that provocation augmented the aggressiveness of all participants. Among high CPA risk parents, positive schema became less accessible (whereas negative schema became more accessible) following lost rounds. At the conclusion of the game, high CPA risk parents reported more aggressive motives than low CPA risk parents. Further, aggressive motives significantly mediated the association between CPA risk status and aggressiveness (i.e., mean sound blast selections).

CONCLUSIONS

Collectively, results support the potential utility of the Word Game as a means of advancing the study of social cognitive processes involved in parental aggression.

Paternal psychosocial characteristics and corporal punishment of their 3-year-old children

This study uses data from 2,309 biological fathers who participated in the Fragile Families and Child Well-Being Study (FFCWS) to examine associations between psychosocial characteristics and levels of corporal punishment (CP) toward their 3-year-old children over the past month. Results indicate that 61% of the fathers reported no CP over the past month, 23% reported using CP once or twice, and 16% reported using CP a few times in the past month or more. In multivariate models controlling for important sociodemographic factors as well as characteristics of the child, fathers' parenting stress, major depression, heavy alcohol use, and drug use were significantly associated with greater use of CP, whereas involvement with the child and generalized anxiety disorder were not. Girls were less likely to be the recipient of CP than were boys, and child externalizing behavior problems but not internalizing behavior problems were associated with more CP.

Does accessibility of positive and negative schema vary by child physical abuse risk?

OBJECTIVE

To examine differences in accessibility of positive and negative schema in parents with high and low risk for child physical abuse (CPA).

METHODS

This study combined picture priming and lexical decision making methods to assess the accessibility of positive and negative words following presentation of child and adult faces. The child and adult faces depicted positive, ambiguous, and negative affective valences. The sample included 67 (51 low and 16 high CPA risk) general population parents.

RESULTS

CPA risk status was associated with accessibility of positive/negative words only following priming with faces of the opposite affective valence. More specifically, high CPA risk parents were slower to respond to positive (negative) words following priming with negative (positive) faces. Exploratory analyses indicated that this pattern of findings was more clearly apparent when picture primes involved adult faces.

CONCLUSION

The present findings suggest that high and low CPA risk parents differ in how they process affectively incongruent information. Research is needed to further examine schema accessibility, as well as to examine whether processes involved in attention and affect integration play a role in CPA risk.

A family study of adult twins with and without a history of childhood abuse: stability of retrospective reports of maltreatment and associated family measures

Childhood sexual abuse (CSA) and physical abuse (CPA) are well-established risk-factors for a wide of range of proximal and distal outcomes. The lack of availability of an optimal design for examining abuse and its consequences has resulted in the use of various approaches, each having its own limitations. We describe the Childhood Trauma Study, which ascertained families from a large young adult Australian twin cohort on the basis of twins' responses to screening questions assessing CSA and CPA. We report data from 3407 participants including twins, non-twin siblings, and their parents. Our data demonstrate the feasibility of using a comprehensive assessment to evaluate retrospective history of childhood abuse in an adult sample. We observed that risk for each form of abuse increased incrementally with the number of parents with alcohol problems. Psychometric properties of our measures of CSA and CPA including reasonable long-term stability, construct validity, and evidence of familial corroboration compare favorably with those of other reports in which samples were considerably younger and assessments were repeated over shorter intervals.

Mothers' spanking of 3-year-old children and subsequent risk of children's aggressive behavior

OBJECTIVE

The goal was to examine the association between the use of corporal punishment (CP) against 3-year-old children and subsequent aggressive behavior among those children.

METHODS

Respondents (N = 2461) participated in the Fragile Families and Child Well-being Study (1998-2005), a population-based, birth cohort study of children born in 20 large US cities. Maternal reports of CP, children's aggressive behaviors at 3 and 5 years of age, and a host of key demographic features and potential confounding factors, including maternal child physical maltreatment, psychological maltreatment, and neglect, intimate partner aggression victimization, stress, depression, substance use, and consideration of abortion, were assessed.

RESULTS

Frequent use of CP (ie, mother's use of spanking more than twice in the previous month) when the child was 3 years of age was associated with increased risk for higher levels of child aggression when the child was 5 years of age (adjusted odds ratio: 1.49 [95% confidence interval: 1.2-1.8]; P < .0001), even with controlling for the child's level of aggression at age 3 and the aforementioned potential confounding factors and key demographic features.

CONCLUSIONS

Despite American Academy of Pediatrics recommendations to the contrary, most parents in the United States approve of and have used CP as a form of child discipline. The current findings suggest that even minor forms of CP, such as spanking, increase risk for increased child aggressive behavior. Importantly, these findings cannot be attributed to possible confounding effects of a host of other maternal parenting risk factors.

Relationships among depressive mood symptoms and parent and peer relations in collegiate children of alcoholics

Relationships among adult children of alcoholics (ACOAs) and parent and peer relations and depressive mood were examined among 136 ACOAs and 436 non-ACOAs. As compared to non-ACOAs, ACOAs reported less positive relationships to mothers, fathers, and peers, and more depressive mood; however, more positive relationships to parents and peers significantly reduced the strength of the association between ACOA categorization and depressive mood. Examination of data from ACOAs alone revealed that maternal alcoholism was related to less positive relationships to their mothers and to their peers; however, paternal alcoholism did not predict the quality of the relationship to fathers, mothers, or peers. Attachment to parents and peers and the gender of the alcohol-abusing parent were associated with depressive symptoms among ACOAs.

Depression and anger as risk factors underlying the relationship between maternal substance involvement and child abuse potential

OBJECTIVE

This study examines how emotion regulation deficits in the area of anger arousal and reactivity are associated with child abuse potential in mothers with substance use and depressive disorders in order to identify targeted areas for prevention and treatment.

METHODS

A sample of 152 urban mothers was interviewed on measures of substance use, diagnosis of depression, anger arousal and reactivity, and child abuse potential.

RESULTS

Linear hierarchical regressions revealed that anger arousal and reactivity exceeded diagnostic and demographic variables in predicting maternal child abuse potential. Additionally, anger arousal and reactivity was found to be a partial mediator of the relationship between diagnostic category and child abuse potential.

CONCLUSIONS

Findings are discussed in relation to a multifaceted model of child abuse potential which broadens the existing literature to include an examination of depression and emotion regulation in order to more fully understand how substance use and child abuse potential are linked.

PRACTICE IMPLICATIONS

Models and approaches which help clients to manage and regulate difficult feeling states, specifically anger, could be helpful, and may be most readily applied in such populations.

The Healthy Moms Study: the efficacy of brief alcohol intervention in postpartum women

BACKGROUND

The prevention and treatment of alcohol use disorders among women of reproductive age have been well described. However, there is limited information on women specifically during the postpartum period. This period in a woman's life is a time of transition and it provides an ideal opportunity for primary care providers to intervene.

PURPOSE

The goal of this report was to present the results of a brief alcohol intervention conducted in 34 obstetrical practices with women seeking routine postpartum care.

METHODS

A randomized clinical trial was conducted from 2002 to 2005 in a diverse sample of women located in 15 Wisconsin counties. This report presents 6-month follow-up data.

RESULTS

A total of 8,706 women were screened for high-risk alcohol use during routine postpartum care with 997 (12%) of these women testing positive for at-risk drinking. A total of 235 women met inclusion criteria and were randomized to either "usual care" or "brief intervention." The 4-session intervention was delivered by outpatient obstetrical nurses and research staff. The mean age of the women in the sample was 28, 19.3% were from minority groups, 60.8% were married, 53.2% reported current tobacco use, and 17.9% had used marijuana in the previous 30 days. At the 6 month follow-up appointment, there were significant reductions in mean number of total drinks in the previous 28 days (p < 0.013), number of drinking days (p < 0.024) and heavy drinking days (p < 0.019). In addition to a statistical difference between groups, there was a 19% difference in the mean number of drinks and number of drinking days, and a 36% difference in the number of heavy drinking days in favor of the intervention group.

CONCLUSION

The findings of the Healthy Moms Trial support the implementation of brief alcohol intervention during the postpartum period.

Parental responses to infant crying: the influence of child physical abuse risk and hostile priming

OBJECTIVE

Managing a crying infant is a challenge universally faced by new parents. This study examined whether parental interpretations, feelings, and behaviors following exposure to a 2-minute videotaped segment of a crying infant varied as a function of child physical abuse (CPA) risk and exposure to cues of hostility (i.e., hostile priming).

METHOD

Participants included 84 general population parents (52 low and 32 high CPA risk) with valid and complete protocols. It was predicted that (1) negative trait ratings, (2) feelings of hostility, and (3) ability to modulate grip strength would differ across CPA risk groups (high vs. low) and priming conditions (hostile vs. neutral).

RESULTS

As expected, high, compared to low, CPA risk parents rated the crying infant more negatively and reported higher levels of hostile feelings after watching the crying infant video. Hostile priming independently increased feelings of hostility, such that high CPA risk parents who were primed with hostile words reported higher levels of hostile feelings relative to all other conditions. Hostile priming also was modestly associated with increased use of excessive force when parents attempted to produce a half-strength grip; however this difference was apparent only among high CPA risk parents.

CONCLUSIONS

High, compared to low, CPA risk parents rated the crying infant more negatively and reported higher levels of hostile feelings after watching the crying infant video. Hostile priming independently increased hostile feelings and was modestly associated with use of excessive force in the hand grip task among high CPA risk parents.

Hostility ratings by parents at risk for child abuse: impact of chronic and temporary schema activation

OBJECTIVE

Two studies examined whether accessibility of hostility-related schema influenced ratings of ambiguous child pictures. Based on the social information processing model of child physical abuse (CPA), it was expected that CPA risk status would serve as a proxy for chronic accessibility of hostile schema, while priming procedures were used to manipulate temporary accessibility of hostility-related schema.

METHODS

Participants included 108 parents (79 low and 29 high CPA risk) in Experiment 1 and 88 parents (43 low and 45 high CPA risk) in Experiment 2. Parents were randomly assigned to either hostile or neutral priming conditions. Following the priming procedures, all parents rated pictures that depicted children who appeared ambiguous with regard to the extent to which they were being hostile/cooperative.

RESULTS

In both experiments, high, compared to low, CPA risk parents rated the ambiguous child pictures as more hostile. Further, both supraliminal (Experiment 1) and subliminal (Experiment 2) exposure to hostility-related words independently increased hostility ratings. In both experiments, the influence of chronic and temporary activation of hostile schema was additive and not interactive.

CONCLUSION

Findings from these experiments are consistent with the proposition that high CPA risk parents are more likely to infer hostility in response to ambiguous child cues. Further, accessibility of hostility-related schema in parents increases the likelihood of hostile inferences, which in turn may increase attributions of hostile intent and aggressive parenting behaviors.

The impact of cumulative maternal trauma and diagnosis on parenting behavior

This study examines the relative contributions of cumulative maternal trauma, substance use, depressive and posttraumatic stress diagnoses on parental abuse potential, punitiveness, and psychological and physical aggression in a sample of 176 urban mothers. Participants were categorized into four groups: substance use (n = 41), depressed (n = 40), comorbid (n = 47), and control (n = 48). Participants in the three diagnostic groups reported significantly greater interpersonal trauma exposure than did controls. Hierarchical regressions reveal that cumulative trauma is a significant predictor of all parenting outcomes, even after controlling for demographic and diagnostic variables. Substance use and depression are significantly related to abuse potential, and PTSD is significantly negatively related to physical discipline, with no other significant associations between diagnostic status and parenting outcomes. These findings add to an important growing literature examining the impact of cumulative trauma on parental functioning. Implications for future research and parenting interventions are discussed.

Postpartum and alcohol-related factors associated with the relapse of risky drinking

OBJECTIVE

The purposes of this investigation were (1) to describe postpartum drinking patterns among women who were frequent drinkers before pregnancy and (2) to identify factors correlated with postpartum "risky" drinking among women who were frequent drinkers before pregnancy.

METHOD

Information was gathered through a self-administered questionnaire completed at the postpartum visit and a subsequent face-to-face interview of 381 women, recruited from 35 obstetric/gynecologic clinics throughout Wisconsin, who reported frequent drinking before pregnancy. Multivariate analyses were used to identify correlates of postpartum risky drinking, defined as consuming four or more drinks per occasion (heavy episodic drinking) at least twice in the past 28 days or drinking an average of seven or more drinks per week.

RESULTS

Overall, 37.8% (n = 144) of women reported postpartum risky drinking. Eighteen percent reported heavy episodic drinking only, 5% reported frequent drinking only, and 15% reported both behaviors. Postpartum risky drinkers were more likely than other women to have had a partner who engaged in risky drinking (odds ratio [OR] = 2.6, 95% confidence interval [CI]: 1.5-4.5), to have been unemployed (OR = 3.0, 95% CI: 1.2-7.7), to have smoked following pregnancy (OR = 1.9, 95% CI: 1.0-3.5), and to have consumed alcohol after the recognition of pregnancy (OR = 4.8, 95% CI: 2.2-10.6). Women who breast-fed their child were less likely to report risky drinking (OR = 0.3, 95% CI: 0.2-0.5).

CONCLUSIONS

In the postpartum period, health care providers may want to focus alcohol screening efforts on former frequent drinkers who are smokers, are unemployed, have a partner who is a risky drinker, or are not breast-feeding.

Mother-daughter and father-daughter attachment of college student ACOAs

This 2005 study compared parent-child attachment in 89 American female Adult Children of Alcoholics (ACOAs) as compared to 201 non-ACOAs. Women attended a large university in the southeastern United States. Participants categorized as ACOA on the Children of Alcoholics Screen Test (CAST; Jones, 1983) reported significantly more negative affect and less support from their fathers as indicated on the Parental Attachment Questionnaire (Kenney, 1987). When results were examined by the gender of the alcohol-abusing(1) parent, participants who suspected their fathers were problem drinkers did not differ from non-ACOAs in their attachment to either parent. As compared to non-ACOAs, women who self-identified as daughters of problem-drinking mothers reported poorer attachment both to mothers and fathers.