In addition, genetic studies indicate that alcoholism tends to
run in families and that a genetic vulnerability for alcoholism
exists (2,3,4).  Yet, some investigators also report that many
children from alcoholic homes develop neither psychopathology nor
alcoholism.

This Alcohol Alert focuses on three major research questions 
concerning children of alcoholics (COAs):

1. What contributes to resilience in some COAs?
2. Do COAs differ from children of nonalcoholics (nonCOAs)?
3. Are the differences specifically related to parental 
alcoholism, or are they similar to characteristics observed in
children whose parents have other illnesses?

Before summarizing the research findings on these questions, it
should be said that many studies of COAs have been plagued by
methodological issues.

For example, the composition of the sample chosen for a study can
affect the study results significantly.  Yet, many COA studies
use a biased sample selection of children in treatment or in
trouble.

In addition, studies often are conducted without the benefit of
matched control groups.  The absence of control groups makes it
difficult to generalize results from treatment samples to
nontreatment populations.

Children of various ages and developmental stages frequently are
grouped in one sample, and the developmental differences within
the group are ignored.

Another problem is that because few longitudinal studies have
been performed, it is difficult to know whether the observed
problems are impairments or are developmental delays.

In addition, the effect of such factors as marital conflict and 
the severity of parental drinking on the development of problems
should be considered.

All of these limitations can affect the outcome of the study. 
The studies cited below are not free of these methodological
problems, but they are the best that we have.

While research findings suggest that some children suffer
negative consequences due to parental alcoholism, a larger
proportion of COAs function well and do not develop serious
problems.

In a longitudinal study of COAs born on the island of
Kauai,  Werner (5) reported that, although 41  percent of the
children developed serious coping problems by 18 years of age,
59 percent did not develop problems.

These resilient children shared several characteristics that
contributed to their success, including the ability to obtain
positive attention from other people, adequate communication
skills, average intelligence, a caring attitude, a desire to 
achieve, and a belief in self-help.

Studies comparing COAs and nonCOAs have suggested that, although
the two groups differ in a variety of psychosocial areas,
differences in cognitive performance are observed most
frequently.

Cognitive function in COAs has been examined by many researchers
because it is an important element needed for adaptation at all
stages of development; it can be measured uniformly across
developmental stages; and it often is associated with the
symptoms of alcoholism.

Ervin and her colleagues (6) found that Full IQ, performance (a
measure of abstract and conceptual reasoning), and verbal scores
were lower among a sample of children raised by alcoholic fathers
than among children raised by nonalcoholic fathers.

Gabrielli and Mednick (7) reported similar results for verbal and
Full IQ tests, but not for performance tests.

In a study comparing COAs and nonCOAs whose families were
educated and whose parents lived in the home, Bennett and
colleagues (8) found that children from alcoholic families had
lower IQ, arithmetic, reading, and verbal scores.  Despite the
lower scores, however, COAs  performed within normal ranges for
intelligence tests in each of these studies.

It is important to note that cognitive competence can vary with
the  instrument used to measure performance as well as with the
individual who is evaluating function.

Johnson and Rolf (9) compared the academic abilities and
cognitive function of COAs and nonCOAs from nondisadvantaged 
backgrounds and found no differences between the groups.  The
investigators noted, however, that the children with alcoholic
parents underestimated their own competence.

In addition, the mothers of COAs underrated their children's
abilities.  The mother's and children's perceptions of abilities 
may affect the children's motivation, self-esteem, and future
performance.

School-aged children of alcoholic parents often have academic
problems.   Academic performance may be a better measure than IQ
of the effect of living with an alcoholic parent.

School records indicate that COAs experience such academic
difficulties as repeating grades, failing to graduate from high
school, and requiring referrals to school psychologists (10,11). 

Although cognitive deficits in COAs may account, in part, for 
their poor academic performance, motivational difficulties or the
stress of  the home environment also may contribute to their
problems in school.

Studies comparing COAs with nonCOAs also have found that parental
alcoholism is linked to a number of psychological disorders in
children.   Divorce, parental anxiety or affective disorders, or
undesirable changes in the family or in life situations can add
to the negative effect of parental alcoholism on children's
emotional functioning (12,13).

The results of several studies have shown that children from
alcoholic families report higher levels of depression and anxiety
and exhibit more symptoms of generalized stress (i.e., low
self-esteem) than do children  from nonalcoholic families
(12,13,14,15).

In addition, COAs often express a feeling of lack of control over
their environment.  A recent study by Rolf and colleagues (16)
noted that COAs show more depressive affect than  nonCOAs and
that their self-reports of depression are measured more 
frequently on the extreme end of the scale.

Moos and Billings (13) found that the emotional stress of
parental drinking on children lessens when parents stop
drinking.  These investigators assessed emotional problems in
children from families of relapsed alcoholics, children from
families with a recovering parent, and children from families
with no alcohol problem.

Although the children of relapsed alcoholics reported higher
levels of anxiety and depression than children from the homes
with no alcohol problem, emotional functioning was similar among
the children of recovering and normal parents.

Finally, children from homes with alcoholic parents often
demonstrate behavioral problems.  Study findings suggest that
these children exhibit such problems as lying, stealing,
fighting, truancy, and school behavior  problems, and they often
are diagnosed as having conduct disorders (17).

Teachers have rated COAs as significantly more overactive and
impulsive than nonCOAs (11,18).  COAs also appear to be at
greater risk for delinquency and school truancy (12,19,20). 

Several investigators have reported an association between the
incidence of diagnosed conduct disorders and parental alcohol
abuse (21,22,23). However, other problems associated with
alcoholism (e.g., depression among the alcoholic parents  and
divorce) also may contribute to conduct problems and disorders
among  COAs.

The alcoholic family's home environment and the manner in which
family members interact may contribute to the risk for the
problems observed among COAs.

Although alcoholic families are a heterogeneous group, some
common  characteristics have been identified.  Families of
alcoholics have lower levels of family cohesion, expressiveness,
independence, and intellectual orientation and higher levels of
conflict compared with nonalcoholic families (13,24,25,26).

Some characteristics, however, are not specific to  alcoholic
families: Impaired problem-solving ability and hostile 
communication are observed both in alcoholic families and in
families with  problems other than alcohol (27).

Moreover, the characteristics of families with recovering
alcoholic members and of families with no alcoholic members do
not differ significantly, suggesting that a parent's continued
drinking may be responsible for the disruption of family life in 
an alcoholic home (13).

The family environment also may affect transmission of alcoholism
to COAs.   Children with alcoholic parents are less likely to
become alcoholics as adults when their parents consistently set
and follow through on plans and maintain such rituals as
holidays and regular mealtimes (28). 

Interestingly, the problems of COAs may not be specific to this
population.   In a review of research on children whose mothers
were schizophrenic, Garmezy (29) reported that, like COAs, these
children had cognitive deficits. In particular, they had a
limited ability to maintain attention and to perceive relevant
stimuli.

Children at high risk for schizophrenia revealed a more negative
self-image.  The family environment also may  influence the risk
for schizophrenia; children of schizophrenic parents -  whose
home environment is turbulent - have an increased risk for
developing schizophrenia.

Research on COAs is still in its infancy.  Many studies suggest
that a  variety of differences exist between children of
alcoholics and children of nonalcoholics and these differences 
occur at all ages.  However, because of the limitations of the
methodology and the inadequate number of comprehensive studies,
research findings cannot be generalized to all children who grow
up with alcoholic parents.

A Commentary by NIAAA Director Enoch Gordis, M.D.

The children of alcoholics (COA) movement follows in the
tradition of many popular movements that have focused public and
professional attention on  the problems of a vulnerable group. 

This movement has provided valuable information on the social
and psychological problems experienced by many COAs, based on
the observations of counselors, clinicians, school personnel,
and others.

These observations offer scientists an important starting point
as they carefully design studies that seek to define the factors
that may increase risk and the factors that may protect COAs from

negative consequences. 

In considering COAs, it is important to remember that, although
there is a genetic component to the vulnerability to alcoholism,
COA issues are not related primarily to alcoholism itself but to
the social and psychological dysfunction that may result from
growing up in an alcoholic home.  Selection bias and specificity
are two important research issues. 

Selection bias means that conclusions based on clinical samples
are likely to overestimate the extent of the problems, because
only the most troubled come for treatment.

The question of specificity is this: Are the problems described
in COAs specific for parental alcoholism or do they occur as 
often in other dysfunctional families?  If the latter is true,
then alcohol-specific mechanisms may not account for the problems
in COAs.

Further, if all children from dysfunctional homes are at equal
risk, then all are entitled to the benefits of any public policy
designed to help children from troubled homes.

References

(1) RUSSELL, M.; Henderson, C.; and Blume, S.B.  Children of
Alcoholics: A Review of the Literature.  New York: Children of
Alcoholics Foundation,  Inc., 1984.

(2) KAIJ, L.  Alcoholism in Twins.  Studies on the Etiology and
Sequels of Abuse of Alcohol.  Stockholm: Almqvist & Wiksell
Publishers, 1960.

(3) CLONINGER, C.R.; Bohman, M.; and Sigvardsson, S. 
Inheritance of alcohol abuse.  Archives of General Psychiatry
38:861-868, 1981.

(4) GOODWIN, D.W.; Schulsinger, F.; Hermansen, L.; Guze, S.B.;
and Winokur, G.  Alcohol problems in adoptees raised apart from
alcoholic biological parents.  Archives of General Psychiatry
28:238-243, 1973.

(5) WERNER, E.E.  Resilient offspring of alcoholics: A
longitudinal study from birth to age 18.  Journal of Studies on
Alcohol 47(1):34-40, 1986.

(6) ERVIN, C.S.; Little, R.E.; Streissguth, A.P.; and Beck,
D.E.  Alcoholic fathering and its relation to child s
intellectual development: A pilot investigation.  Alcoholism:
Clinical and Experimental Research 8(4):362-365, 1984.

(7) GABRIELLI, W.F., JR., & Mednick, S.A.  Intellectual
performance in children of alcoholics.  Journal of Nervous and
Mental Disease 171(7):444-447, 1983.

(8)  BENNETT, L.A.; Wolin, S.J.; and Reiss, D.  Cognitive,
behavioral, and emotional problems among school-age children of
alcoholic parents.  American Journal of Psychiatry
145(2):185-190, 1988.

(9) JOHNSON, J.L., & Rolf, J.E.  Cognitive functioning in
children from alcoholic and non-alcoholic families.  British
Journal of Addiction 83:849-857, 1988.

(10) MILLER, D., & Jang, M.  Children of alcoholics: A 20-year 
longitudinal study.  Social Work Research & Abstracts 13:23-29,
1977.

(11) KNOP, J.; Teasdale, T.W.; Schulsinger, F.; and Goodwin,
D.W.  A prospective study of young men at high risk for
alcoholism: School behavior and achievement.  Journal of Studies
on Alcohol 46(4):273-278, 1985.

(12) SCHUCKIT, M.A., & Chiles, J.A.  Family history as a
diagnostic aid in two samples of adolescents.  Journal of Nervous
and Mental Disease 166(3):165-176, 1978.

(13) MOOS, R.H., & Billings, A.G.  Children of alcoholics
during the recovery process: Alcoholic and matched control
families. Addictive Behaviors 7:155-163, 1982.

(14) ANDERSON, E., & Quast, W.  Young children in alcoholic
families: A mental health needs-assessment and an
intervention/prevention strategy.  Journal of Primary Prevention
3:(3)174-187, 1983.

(15) PREWETT, M.J.; Spence, R.; and Chaknis, M.  Attribution of
causality by children with alcoholic parents.  International
Journal of the Addictions 16(2):367-370, 1981.

(16) ROLF, J.E.; Johnson, J.L.; Israel, E.; Baldwin, J.; and
Chandra, A.  Depressive affect in school-aged children of
alcoholics.  British Journal of Addiction 83:841-848, 1988.

(17) WEST, M.O., & Prinz, R.J.  Parental alcoholism and
childhood psychopathology.  Psychological Bulletin
102(2):204-218, 1987.

(18) BELL, B., & Cohen, R.  The Bristol Social Adjustment
Guide: Comparison between the offspring of alcoholic and
non-alcoholic mothers.  British Journal of Clinical Psychology
20:93-95, 1981.

(19) FINE, E.W.; Yudin, L.W.; Holmes, J.; and Heinemann, S. 
Behavioral disorders in children with parental alcoholism. 
Annals of the New York Academy of Sciences 273:507-517, 1976.

(20) RIMMER, J.  The children of alcoholics: An exploratory
study.  Children and Youth Services Review 4:365-373, 1982.

(21)  STEINHAUSEN, H.-C.; Gobel, D.; and Nestler, V. 
Psychopathology in the offspring of alcoholic parents.  Journal
of the American Academy of Child Psychiatry 23(4):465-471, 1984.

(22) MERIKANGAS, K.R.; Weissman, M.M.; Prusoff, B.A.; Pauls,
D.L.; and Leckman, J.F.  Depressives with secondary alcoholism:
Psychiatric disorders in offspring.  Journal of Studies on
Alcohol 46(3):199-204, 1985.

(23) STEWART, M.A.; deBlois, C.S.; and Singer, S.  Alcoholism
and hyperactivity revisited: A preliminary report.  In: Galanter,
M., ed. Currents in Alcoholism.  Volume V.  New York: Grune &
Stratton, 1979.  pp. 349-357.

(24) CLAIR, D., & Genest, M.  Variables associated with the
adjustment of offspring of alcoholic fathers.  Journal of Studies
on Alcohol 48(4):345-355, 1986.

(25) FILSTEAD, W.J.; McElfresh, O.; and Anderson, C.  Comparing
the family environments of alcoholic and "normal" families. 
Journal of Alcohol and Drug Education 26(2):24-31, 1981.

(26) MOOS, R.H., & Moos, B.S.  The process of recovery from
alcoholism: Comparing functioning in families of alcoholics and
matched control families.  Journal of Studies on Alcohol
45(2):111-118, 1984.

(27) BILLINGS, A.G.; Kessler, M.; Gomberg, C.A.; and Weiner, S.
Marital conflict resolution of alcoholic and nonalcoholic couples
during drinking and non-drinking sessions.  Journal of Studies on
Alcohol 40(3):183-195, 1979.

(28) WOLIN, S.J.; Bennett, L.A.; Noonan, D.L.; and Teitelbaum,
M.A.  Disrupted family rituals: A factor in the intergenerational
transmission of alcoholism.  Journal of Studies on Alcohol
41(3):199-214, 1980.

(29) GARMEZY, N.  Children at risk: The search for the
antecedents of schizophrenia.  Part II: Ongoing research
programs, issues, and intervention.  Schizophrenia Bulletin
9:55-125, 1974.

ACKNOWLEDGMENTS:  The National Institute on Alcohol Abuse and
Alcoholism wishes to acknowlege the following individuals who
have contributed their time and expertise to the development of
the Alcohol Alert series over the past 2 years:  John Allen,
Ph.D.; Loran D. Archer; Gerald Brown, M.D.; Fulton Caldwell,
Ph.D.; Mary Dufour, M.D., M.P.H.; Michael Eckardt, Ph.D.; 
Terry Freeman; Richard Fuller, M.D.; Bridget Grant, Ph.D.; Thomas
Harford, Ph.D.; Brenda Hewitt; Jeannette Johnson, Ph.D.; Michael
J. Lewis, Ph.D.; Markku Linnoila, M.D., Ph.D.; Jane Lockmuller;
Diane Miller; John Noble; H. Laurence Ross, Ph.D.; Barbara
Smothers, Ph.D.; Fred Stinson, Ph.D.; Cate Timmerman; Ken Warren,
Ph.D.; Dianne Welsh; Gerald Williams, D.Ed.; and Terry Zobeck,
Ph.D.

Source: NIAAA, ALCOHOL ALERT, No. 9, July 1990

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