Alcoholic family marital heterogeneity aggregates different child behavior problems both pre- and postseparation.

Children of alcoholics (COAs) are at risk for elevated internalizing and externalizing symptoms. Yet, little is known about the familial and behavioral adjustments of COAs following parental separation. Using an ecological-transactional framework, we examined how multiple risk factors contributed to the formation of different alcoholic family structures and how living in heterogeneous family structures affected COAs' behavioral problems. The Michigan Longitudinal Study, a multiwave study on initially intact alcoholic and control families with preschool-age children (n = 503), was used to evaluate outcomes of offspring, when families either remained intact or were separated when the child was aged 12-14. Alcoholic families who later transitioned into stepfamilies were characterized with higher paternal antisociality, marital aggression, and serious family crises than alcoholic families that remained intact. COAs in stepfamilies (but not in single-parent families) exhibited higher levels of internalizing and externalizing symptoms in preadolescence compared with those in alcoholic intact families, in part because of elevated behavioral risk at age 3. Structural equation modeling indicated that the aggregated risk of stepfamily residence directly related to COAs' internalizing and indirectly related to COAs' externalizing problems, partially mediated by family stressors. Findings suggest targeting COAs in separated families for early intervention.

BOYS, EARLY RISK FACTORS FOR ALCOHOL PROBLEMS, AND THE DEVELOPMENT OF THE SELF: AN INTERCONNECTED MATRIX.

Alcohol-use disorders are a major public health issue worldwide. Although drinking and problematic alcohol use usually begins during adolescence, developmental origins of the disorder can be traced back to infancy and early childhood. Identification of early risk factors is essential to understanding developmental origins. Using data from the Michigan Longitudinal Study, an ongoing, prospective, high-risk family study, this article summarizes findings of family context and functioning of both children and parents. We draw attention to the development of the self, an understudied aspect of very young children being reared in alcoholic families that exacerbates exposure to high childhood adverse experiences. We also provide evidence demonstrating that young boys are embedded in a dynamic system of genes, epigenetic processes, brain organization, family dynamics, peers, community, and culture that strengthens risky developmental pathways if nothing is done to intervene during infancy and early childhood.

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.

Changes in women's alcoholic, antisocial, and depressive symptomatology over 12 years: a multilevel network of individual, familial, and neighborhood influences.

In a sample of 273 adult women and their families, we examined the effects of women's psychopathology history, their social support, their husbands' and children's symptomatology, family stress, and neighborhood environment on their alcohol problems, antisocial behavior, and depression over a 12-year period during their 30s and early 40s. Women's alcohol problems and antisocial behavior decreased but their depression symptoms increased over time. Women's disorder history and their partners' parallel symptomatology were associated with their symptoms. For women's antisocial behavior, their own history of alcoholism and their partners' alcohol problems were also significant risk factors. Higher levels of social support were associated with lower levels of depression in women. Children's externalizing behavior was positively correlated with their mothers' alcohol problems and antisocial behavior, whereas children's internalizing behavior was positively correlated with their mothers' depression. Neighborhood residential instability was associated with higher levels of alcoholic and depressive symptomatology in women. Intervention efforts might target women with young children by improving social support, educational or professional training opportunity, access to family counseling, and neighborhood environment.

Intergenerational transmission of neuropsychological executive functioning.

Relationships between parent and child executive functioning were examined, controlling for the critical potential confound of IQ, in a family study involving 434 children (130 girls and 304 boys) and 376 parents from 204 community recruited families at high risk for the development of substance use disorder. Structural equation modeling found evidence of separate executive functioning and intelligence (IQ) latent variables. Mother's and father's executive functioning were associated with child's executive functioning (beta = 0.34 for father-child and 0.51 for mother-child), independently of parental IQ, which as expected was associated with child's IQ (beta = 0.52 for father-child and 0.54 for mother-child). Familial correlations also showed a significant relationship of executive functioning between parents and offspring. These findings clarify that key elements of the executive functioning construct are reliably differentiable from IQ, and are transmitted in families. This work supports the utility of the construct of executive function in further study of the mechanisms and etiology of externalizing psychopathologies.

Sleep and behavioral control in earlier life predicted resilience in young adulthood: A prospective study of children of alcoholics and controls.

AIMS: Children of alcoholics (COAs) are at higher risk for developing an alcohol use disorder and substance-related problems than non-COAs. This study examined (i) the relationships between sleep rhythmicity in childhood (aged 3-5) and behavioral control in adolescence (aged 9-14) and (ii) whether sleep rhythmicity and behavioral control predicted resilience in COAs in emerging adulthood (aged 21-26). Resilience was defined as successful adaptation in spite of adversity. Resilience among COAs was operationalized in three different ways (i) absence of alcohol disorder diagnoses, (ii) absence of alcohol and drug related problems, (iii) a continuous latent variable measured by depressive symptoms, work satisfaction and relationship satisfaction. DESIGN: A prospective, longitudinal study of children assessed from early childhood (ages 3-5) to emerging adulthood (ages 21-26). SETTING: A community study of families at high risk for alcoholism and matched controls conducted in a 4-county area in the Midwest. PARTICIPANTS: 715 children (75% children of alcoholics, 29% female). MEASUREMENT: Data on sleep were gathered by the Dimensions of Temperament Survey (DOTS) and Child Behavior Checklist. Behavioral Control was measured by Child and Adult Q-sort. Substance use data were collected by Drinking and Drug History - Youth form. FINDINGS: Structural equation modeling analyses indicated that higher rhythmicity of sleep, lower level of tiredness and infrequent sleep difficulties predicted higher behavioral control in adolescence, which in turn predicted two resilience outcomes in young adulthood. Behavioral control significantly mediated the effect of childhood sleep rhythmicity and resilience. No group differences between COAs and controls were found. CONCLUSIONS: Good sleep and higher self-regulation act as resource factors for young adults, regardless of parent alcoholism status.

Specificity of executive functioning and processing speed problems in common psychopathology.

OBJECTIVE: Interest continues in neuropsychological measures as cross-disorder intermediate phenotypes in understanding psychopathology. A central question concerns their specificity versus generalizability to particular forms of psychopathology, particularly for executive functioning (EF) and response speed. Three conceptual models examining these relationships were tested to clarify this picture at different levels in the diagnostic hierarchy. METHOD: Participants (total n = 641, age 18-60) yielded complete structured diagnostic interviews and a neuropsychological test battery comprising measures of executive function, processing speed, and IQ. Repeated measures multivariate analysis of variance, linear regression, and structural equation modeling (SEM) were used to test (a) a specificity model, which proposes that individual disorders are associated with component EF processes and speed; (b) a severity model, which proposes that the total number of comorbid disorders explain poor EF and/or slow speed; and (c) a higher-order dimensional model, which proposes that internalizing versus externalizing disorders are differentially related to EF or speed. RESULTS: EF effects were best explained by a specificity model, with distinct aspects of EF related to attention deficit hyperactivity disorder versus antisocial substance use disorders. Speed, on the other hand, emerged as a general indicator of externalizing psychopathology in the dimensional model, as well as overall severity of psychopathology in the severity model. CONCLUSIONS: Granular approaches are likely to be most productive for linking EF to psychopathology, whereas response speed has underused potential as an endophenotype for psychopathology liability. Results are discussed in terms of an integrated conceptualization of neuropsychological processes and putative neural systems involved in general and specific aspects of psychopathology. (PsycINFO Database Record

Poor response inhibition as a predictor of problem drinking and illicit drug use in adolescents at risk for alcoholism and other substance use disorders.

OBJECTIVE: To evaluate the predictive power of executive functions, in particular, response inhibition, in relation to alcohol-related problems and illicit drug use in adolescence. METHOD: A total of 498 children from 275 families from a longitudinal high-risk study completed executive function measures in early and late adolescence and lifetime drinking and drug-related ratings at multiple time points including late adolescence (ages 15-17). Multi-informant measures of attention-deficit/hyperactivity disorder and conduct disorder were obtained in early childhood (ages 3-5), middle childhood, and adolescence. RESULTS: In multilevel models, poor response inhibition predicted aggregate alcohol-related problems, the number of illicit drugs used, and comorbid alcohol and drug use (but not the number of drug-related problems), independently of IQ, parental alcoholism and antisocial personality disorder, child attention-deficit/hyperactivity disorder and conduct symptoms, or age. Multivariate models explained 8% to 20% of residual variance in outcome scores. The incremental predictive power of response inhibition was modest, explaining about 1% of the variance in most outcomes, but more than 9% of the residual variance in problem outcomes within the highest risk families. Other measured executive functions did not independently predict substance use onset. CONCLUSION: Models of alcoholism and other drug risks that invoke executive functions may benefit from specifying response inhibition as an incremental component.

Smoking is associated with neurocognitive deficits in alcoholism.

BACKGROUND: Impaired problem solving, visual-spatial processing, memory, and cognitive proficiency are consequences of severe alcoholism. Smoking is much more prevalent among alcoholics than the general population, yet the possible neurocognitive effects of cigarette smoking in alcoholism have not been studied, despite evidence that long-term smoking is associated with neurocognitive deficits. OBJECTIVE: Determine whether smoking contributes to neurocognitive deficits associated with alcoholism. DESIGN: Neurocognitive function was examined in a community-recruited (n=172) sample of men. Alcohol problems/alcoholism were measured by the lifetime alcohol problems score (LAPS), DSM-IV diagnosis, and monthly drinking rate. Smoking was measured in pack-years. Neurocognitive function was measured with IQ (short version of WAIS-R), and cognitive proficiency (fast, accurate performance). RESULTS: Both alcoholism and smoking were negatively correlated with neurocognitive function. When alcoholism and smoking were included in regression models, smoking remained a significant predictor for both measures, but alcoholism remained significant only for IQ. CONCLUSIONS: Both smoking and alcoholism were related to neurocognitive function. Smoking may explain some of the relationship between alcoholism and neurocognitive function, perhaps especially for measures that focus on proficiency. Future studies are necessary to more fully understand the effects of smoking on neurocognitive function in alcoholism.

Normative Symbol Digit Modalities Test performance in a community-based sample.

The Symbol Digit Modalities Test is a substitution task that is the inverse of the Digit Symbol Test. The familiar task of filling numbers in boxes, and the availability of an oral administration, make this a popular screening instrument for brain impairment. Normative data were previously reported for a variety of clinical groups, but complete information on non-clinical samples across age, education, gender, and socioeconomic status is limited. The present study examines the performance of a community-dwelling control sample across age, education, gender, and income groupings. In a multivariate model, these four variables did not impact test performance. These results support the utilization of the SDMT as a robust screening test for adult neuropsychological impairment.

Social competence in children of alcoholic parents over time.

In the current study, the authors tested the hypothesis that children of alcoholic parents (COAs) show deficits in social competence that begin in early childhood and escalate through middle adolescence. Teachers, parents, and children reported on the social competence of COAs and matched controls in a community sample assessed from ages 6 to 15. Hierarchical linear growth models revealed different patterns of change in social competence across development as a function of the reporter of various indicators of competence. Moreover, female COAs showed deficits in social competence in early childhood that receded in adolescence and that varied across subtypes of parent alcoholism. Implications of these findings for understanding the development of social competence in children, and at-risk children in particular, are discussed.

Individual and partner predictors of recovery from alcohol-use disorder over a nine-year interval: findings from a community sample of alcoholic married men.

OBJECTIVE: Numerous studies have focused on the predictors of recovery in persons with alcohol use disorder (AUD). Most have been retrospective and have measured only predictors of short-term recovery after the completion of treatment. This prospective study evaluates the role of psychological and social factors in a community sample of both alcoholics and their partners in predicting recovery over a 9-year interval. METHOD: Alcoholic diagnostic status and life functioning of 134 community-recruited, initially coupled men meeting criteria for a 3-year Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, AUD diagnosis at baseline were assessed over the 9-year period. Their partners also were assessed. Prediction involved comparing those who still had an AUD diagnosis at 9-year follow-up against those who no longer met AUD criteria. RESULTS: Predictors of recovery included number of experiences with treatment, education, number of years of intervening recovery over the follow-up period, partner baseline AUD status and partner's social support network. Alcoholics' initial severity of drinking did not predict long-term outcome. Furthermore, recovered men's partners decreased their AUD in the interim, whereas nonremitters' partners increased their AUD. The findings highlight the transitions in and out of AUD, with 62% of the men having stable drinking patterns of either remission or unremitting AUD diagnosis over the entire follow-up period. CONCLUSIONS: This study demonstrated the importance of interpersonal factors in maintaining AUD or promoting recovery. Consideration of partner characteristics and the marital context as factors in the recovery process is essential. Future research should examine the predictors of recovery in women, in adolescents and in racial groups other than white.

Neuropsychological executive functioning in children at elevated risk for alcoholism: findings in early adolescence.

One component of individual risk for alcoholism may involve cognitive vulnerabilities prodromal to alcoholism onset. This prospective study of 198 boys followed between 3 and 14 years of age evaluated neurocognitive functioning across three groups who varied in familial risk for future alcoholism. Measures of intelligence, reward-response, and a battery of neuropsychological executive and cognitive inhibitory measures were used. Executive functioning weaknesses were greater in families with alcoholism but no antisocial comorbidity. IQ and reward-response weaknesses were associated with familial antisocial alcoholism. Executive function effects were clearest for response inhibition, response speed, and symbol-digit modalities. Results suggest that executive deficits are not part of the highest risk, antisocial pathway to alcoholism but that some executive function weaknesses may contribute to a secondary risk pathway.

Gender differences in the developmental risk of onset of alcohol, nicotine, and marijuana use and the effects of nicotine and marijuana use on alcohol outcomes.

OBJECTIVE: This study aimed to (a) characterize gender-specific risk of onset of alcohol, nicotine, and marijuana use developmentally; (b) investigate the effects of early-onset status and frequency of nicotine and marijuana use on alcohol outcomes, controlling for the effects of alcohol use; and (c) examine gender differences in the developmental trajectories of alcohol outcomes and the effects of nicotine and marijuana use on alcohol outcomes. METHOD: This study conducted secondary analysis on a longitudinal study that recruited at-risk youth through fathers' drunk-driving records and door-to-door canvassing in the midwestern United States. The sample included 160 female-male sibling pairs who were assessed on substance use and Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, diagnosis from early childhood to young adulthood. RESULTS: Although males were at higher risk for being early-onset alcohol users, females tended to be at higher risk for initiating marijuana use at younger ages. When early onset and amount of alcohol use were controlled for, early onset of nicotine and marijuana use did not contribute to alcohol outcomes, but frequencies of nicotine and marijuana use did. We also found the associations of quantity/frequency of alcohol and marijuana use with drinking problems to be stronger among females than among males. CONCLUSIONS: Higher frequencies of nicotine and marijuana use may contribute to worse alcohol outcomes above and beyond the effect of alcohol use. Females tend to be at higher risk than males for initiating marijuana use and meeting an alcohol use disorder diagnosis at younger ages as well as being more vulnerable to a negative impact of alcohol and marijuana use.

Theory of mind among young adult children from alcoholic families.

OBJECTIVE: Given the evidence that several cognitive and emotional functions are impaired in adult alcohol-dependent patients and the possibility that some of these deficits are transmitted to their children, the objective of the present study was to test the hypothesis that the perception of complex mental states would be reduced in young adults from families with a positive family history of alcohol dependence. It was also anticipated that social-perceptual deficits would confer unique predictive ability beyond that shared with other cognitive risk factors for alcohol dependence and/or substance use risk. METHOD: Data from 301 youth ages 18-21 years, recruited from an ongoing community longitudinal study of alcoholic and matched control families, were analyzed. Family history of alcohol dependence as well as alcohol-dependence diagnosis in the youth was based on diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. A substance use risk factor measured early problem alcohol/other drug use. The perception of mental states was measured with the computerized version of the Reading the Mind in the Eyes Test (RMET). RESULTS: Children of alcohol-dependent parents did not show impairment in the mental states perception task, nor did social perception skills predict alcohol dependence in the youth. Correlational analysis performed between RMET and the substance use risk factor showed no significant association between the variables. CONCLUSIONS: The study results do not confirm the hypothesis that behaviorally measured social perception impairment is more prevalent in the children of alcohol-dependent parents. In addition, social-perceptual deficits were not a unique marker of either alcohol dependence or high risk for alcohol dependence in this young adult sample.

Developmental emergence of alcohol use disorder symptoms and their potential as early indicators for progression to alcohol dependence in a high risk sample: a longitudinal study from childhood to early adulthood.

This study characterized developmental emergence of individual alcohol use disorder (AUD) symptoms, and evaluated their ability as early indicators of progression into alcohol dependence (AD), conditional upon gender, parental alcohol dependence, early onset of drinking, and level of delinquent behavior at onset. The two parameters of interest were (a) likelihood of specific AUD symptom appearance once drinking has begun, and (b) primacy of symptom appearance as an indicator of likelihood for eventual move into diagnosis. We analyzed prospective data from a community sample of high risk youth from childhood to early adulthood. Symptoms that were at higher probability of being experienced at drinking onset and that could serve as good indicators for the early stage of disease progression were: persistent desire or unsuccessful efforts to control alcohol use (AD4), and continued use despite having persistent or recurrent interpersonal problems (AA4). Tolerance (AD1) may serve as an indicator for the intermediate stage of progression. Young people tended to be at an elevated risk for developing AD6 (activities given up), AD7 (physical/psychological problems), and AA3 (legal problems) in later years so these symptoms may be good indicators for later stages of progression. In addition to being male, an early onset drinker, or high in delinquent behavior, drinkers who experienced AA4 or AD1 as first symptoms were at higher risk for progression to AD. We also identified two high risk clusters: late onset drinkers with AA4 as first symptom, and children of alcoholics with AD1 as first symptom.

Parental alcohol involvement and adolescent alcohol expectancies predict alcohol involvement in male adolescents.

Current models of adolescent drinking behavior hypothesize that alcohol expectancies mediate the effects of other proximal and distal risk factors. This longitudinal study tested the hypothesis that the effects of parental alcohol involvement on their children's drinking behavior in mid-adolescence are mediated by the children's alcohol expectancies in early adolescence. A sample of 148 initially 9-11 year old boys and their parents from a high-risk population and a contrast group of community families completed measures of drinking behavior and alcohol expectancies over a 6-year interval. We analyzed data from middle childhood (M age = 10.4 years), early adolescence (M age = 13.5 years), and mid-adolescence (M age = 16.5 years). The sample was restricted only to adolescents who had begun to drink by mid-adolescence. Results from zero-inflated Poisson regression analyses showed that 1) maternal drinking during their children's middle childhood predicted number of drinking days in middle adolescence; 2) negative and positive alcohol expectancies in early adolescence predicted odds of any intoxication in middle adolescence; and 3) paternal alcoholism during their children's middle childhood and adolescents' alcohol expectancies in early adolescence predicted frequency of intoxication in middle adolescence. Contrary to predictions, child alcohol expectancies did not mediate the effects of parental alcohol involvement in this high-risk sample. Different aspects of parental alcohol involvement, along with early adolescent alcohol expectancies, independently predicted adolescent drinking behavior in middle adolescence. Alternative pathways for the influence of maternal and paternal alcohol involvement and implications for expectancy models of adolescent drinking behavior were discussed.

Parent, family, and neighborhood effects on the development of child substance use and other psychopathology from preschool to the start of adulthood.

OBJECTIVE: We examined the long-term effects of childhood familial and neighborhood risk on adolescent substance use and psychiatric symptomatology. METHOD: This study used data from an ongoing 2-decade long study that recruited alcoholic and neighborhood control families through fathers' drunk-driving records and door-to-door canvassing in a four county area. The sample included 220 male, initially 3- to 5-year-old children of the participant families, who received in-home assessments at baseline and thereafter at 3-year intervals. Parental lifetime psychopathology and offspring symptomatology at ages 18-20 were assessed by semistructured diagnostic interviews. Census tract variables were used to indicate neighborhood characteristics. RESULTS: The isomorphic parental symptomatology predicted offspring psychopathology. For marijuana-use disorder, major depressive disorder, and nicotine dependence, the other parental comorbidities were also significant predictors. Neighborhood residential instability in childhood contributed to the development of late adolescent alcohol-use disorder, marijuana-use disorder, major depressive disorder, antisocial personality disorder, and nicotine-dependence symptomatology. Although lower family socioeconomic status in childhood contributed to more adolescent marijuana-use disorder, major depressive disorder, and nicotine-dependence symptoms, neighborhood socioeconomic status did not predict adolescent psychopathology. Longitudinal changes in neighborhood environments from early childhood to adolescence had significant effects on alcohol-use disorder, marijuana-use disorder, and major depressive disorder symptoms in late adolescence. A higher frequency of family mobility from early childhood to adolescence predicted more nicotine-dependence symptoms in late adolescence. CONCLUSIONS: Findings indicate that parental psychopathology, family socioeconomic status, and neighborhood residential instability are all important risk factors for the development of substance-use disorder and other comorbid psychopathology. Intervention programming might effectively use these early parental psychopathology indicators to identify risk and might target community activity to stabilize the social environment and provide youth services to counteract the effects of family transience.

Effects of alcoholism severity and smoking on executive neurocognitive function.

AIMS: Neurocognitive deficits in chronic alcoholic men are well documented. Impairments include memory, visual-spatial processing, problem solving and executive function. The cause of impairment could include direct effects of alcohol toxicity, pre-existing cognitive deficits that predispose towards substance abuse, comorbid psychiatric disorders and abuse of substances other than alcohol. Cigarette smoking occurs at higher rates in alcoholism and has been linked to poor cognitive performance, yet the effects of smoking on cognitive function in alcoholism are often ignored. We examined whether chronic alcoholism and chronic smoking have effects on executive function. METHODS: Alcoholism and smoking were examined in a community-recruited sample of alcoholic and non-alcoholic men (n = 240) using standard neuropsychological and reaction-time measures of executive function. Alcoholism was measured as the average level of alcoholism diagnoses across the study duration (12 years). Smoking was measured in pack-years. RESULTS: Both alcoholism and smoking were correlated negatively with a composite executive function score. For component measures, alcoholism was correlated negatively with a broad range of measures, whereas smoking was correlated negatively with measures that emphasize response speed. In regression analyses, both smoking and alcoholism were significant predictors of executive function composite. However, when IQ is included in the regression analyses, alcoholism severity is no longer significant. CONCLUSIONS: Both smoking and alcoholism were related to executive function. However, the effect of alcoholism was not independent of IQ, suggesting a generalized effect, perhaps affecting a wide range of cognitive abilities of which executive function is a component. On the other hand, the effect of smoking on measures relying on response speed were independent of IQ, suggesting a more specific processing speed deficit associated with chronic smoking.

Temperament pathways to childhood disruptive behavior and adolescent substance abuse: testing a cascade model.

Temperament traits may increase risk for developmental psychopathology like Attention-Deficit/Hyperactivity Disorder (ADHD) and disruptive behaviors during childhood, as well as predisposing to substance abuse during adolescence. In the current study, a cascade model of trait pathways to adolescent substance abuse was examined. Component hypotheses were that (a) maladaptive traits would increase risk for inattention/hyperactivity, (b) inattention/hyperactivity would increase risk for disruptive behaviors, and (c) disruptive behaviors would lead to adolescent substance abuse. Participants were 674 children (486 boys) from 321 families in an ongoing, longitudinal high risk study that began when children were 3 years old. Temperament traits assessed were reactive control, resiliency, and negative emotionality, using examiner ratings on the California Q-Sort. Parent, teacher, and self ratings of inattention/hyperactivity, disruptive behaviors, and substance abuse were also obtained. Low levels of childhood reactive control, but not resiliency or negative emotionality, were associated with adolescent substance abuse, mediated by disruptive behaviors. Using a cascade model, family risk for substance abuse was partially mediated by reactive control, inattention/hyperactivity, and disruptive behavior. Some, but not all, temperament traits in childhood were related to adolescent substance abuse; these effects were mediated via inattentive/hyperactive and disruptive behaviors.