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' I n ' " "'3‘" :7.» rt ~. ~ ‘ water, - .4 3’ MlHlSTECGANTA WillIllumulllluwill 1293 00897 8789 Ill) This is to certify that the thesis entitled ATTENTION‘DEFICIT HYPERACTIVITY DISORDER: ONE POSSIBLE EXPRESSION OF A BIOBEHAVIORAL DISREGULATORY MECHANISM IN SONS OF ALCOHOLICS? presented by HAZEN P. HAM has been accepted towards fulfillment of the requirements for M.A. degree in Psychology Major p I es 1ram E. F1 zgerald Date June 8. 1992 0-7639 MS U is an Affirmative Action/Equal Opportunity Institution -——v— -———h___.k _. .— a LIBRARY Mlchtgan State Unwerslty PLACE IN RETURN BOX to remove this checkout from your record. TO AVOID FINES return on or before date due. E DATE DUE V’T I MSU Is An Affirmative Action/Equal Opportunity Institution OW ”3-9.1 ATTENTION-DEFICIT HYPERACTIVITY DISORDER: ONE POSSIBLE EXPRESSION OF A BIOBEHAVIORAL DISREGULATORY MECHANISM IN SONS OF ALCOHOLICS by Hazen P. Ham A THESIS Submitted to Michigan State University in partial fulfillment of the requirements for the degree of MASTER OF ARTS Department of Psychology 1992 occur: alcoho group Analys. at risl rates, may be It is $1 Underly; associat by the c Characte; hierarch: maternal is mo$t p problemat‘ SChool YEE ABSTRACT ATTENTION-DEFICIT HYPERACTIVITY DISORDER: ONE POSSIBLE EXPRESSION OF A BIOBEHAVIORAL DISREGULATORY MECHANISM IN SONS OF ALCOHOLICS by Hazen P. Ham The focus of the present study was to examine the occurrence of ADHD in three- to six-year-old sons of alcoholic/antisocial parents as compared to a similar group of sons of non-alcoholic/non-antisocial parents. Analysis of Variance revealed that for this group of at risk children, ADHD consistently occurred at higher rates, thus supporting the hypothesis that hyperactivity may be a developmental precursor to alcoholism. It is suggested that ADHD may be symptomatic of an underlying biobehavioral disregulatory mechanism associated with alcoholism that is exacerbated by the conflictual rearing environment that frequently characterizes the alcoholic family. Further, hierarchical regression analysis revealed that it is maternal rather than paternal psychopathology that is most predictive of these high risk sons' expression of problematic behaviors (i.e., ADHD), at least in the pre- school years. his pa of th: own at being expres Zucker for the thanks over th Statist PrOfess; PrOfessj Res Noll, an- AlCohol j the Michj ACKNOWLEDGMENTS I gratefully acknowledge Dr. Hiram E. Fitzgerald for his patient assistance and consideration in the preparation of this work, for giving me the encouragement to pursue my own areas of interest, and (as they say back home) for flat being a good friend. Thanks Hi! I would also like to express my appreciation to Drs. Ellen Strommen and Robert Zucker for their considerate review of and recommendations for the manuscript. Lastly, I want to express my deepest thanks to Dr. Linda A. Sullivan for being my constant mentor over the past several years, particularly in the area of statistical analysis and for being a great influence on me professionally and personally as I have embarked upon this profession in psychology research. Research was supported by grants to R. A. Zucker, R. B. N011, and H. E. Fitzgerald from the National Institute on Alcohol Abuse and Alcoholism (AA07065) and by grants from the Michigan Department of Mental Health, Prevention Services Unit. ii LIST 0? TA LIST 0? PI: CHAPTER I. Intr: II. REVII TI A A1 III. HYPO‘ H: H: “I IV- MEEhc SI V' Proce Ir VI. DESig An V 11' ReSul Ch Pr LIST OF TABLES TABLE OF CONTENTS LIST OF FIGURES ................ ......... ....... CHAPTER I. II. III. IV. VI. VII. Introduction ............................. Review of the Literature ..... ............ Temperament/Hyperactivity .......... ...... Alcoholism and ADHD .................. ADHD and Conduct Disorder ......... .. ..... Hypotheses ............................. .. Hypothesis I ...................... .... Hypothesis II ......... . ........ ....... Hypothesis III .............. ‘ .......... Method . .............................. . ...... Subjects ....... ......... ...... ........ Procedure ......OOOOOOOOOOIOOOOOI000...... Instruments . ..... ................... ..... Antisocial Behavior Checklist ..... Lifetime Alcohol Problems Survey .. Demographics Questionnaire ........ Dimensions of Temperament Survey .. Connors Parent Questionnaire ...... Child Behavior Checklist ............ Design ...... ........ . ...... .... ......... . Analyses ... ........ ........ ....... .... Results .................................. Child Problem Behaviors ............... Prevalence of Problem Behaviors .... Co-Morbidity of ADHD and Conduct Disorder ........................... Predictors of Child Problem Behaviors . Multiple Hierarchical Regression Analyses ........................... Predictors of Child Problem Behaviors (Risk) ................ Predictors of Child Problem Behaviors (Control) ............... iii viii 25 25 25 26 27 28 31 34 37 4O 42 42 53 71 73 82 82 90 VIII. Di IX. Su: APPENDIX REF EREN CI VIII. DiSCUSSion O O O O I O O O O O O O O O 00000 O O O O O O O O O O O O O O 0 Incidence of ADHD ..... .. ............... . Delineating the Hyperactive Syndrome ..... Biobehavioral Disregulation: A Possible Explanation ... ........... ..... ..... ... Neurodevelopmental Delay: A Possible Explanation ............................. . Co-Morbidity of ADHD and Conduct Disorder Behaviors .............................. Summary of ADHD Outcomes .......... ....... Parental Predictors of Child Behavioral Outcomes ........................ ....... Possible Direct and Indirect Effects of Alcoholism ..... . ......................... Contextual Factors Involved in the Expression of ADHD ... ........ . ........... IX. Summary ........... . ................... . ..... APPENDIX .. ....................................... . REFERENCES ........................................ iv 106 108 112 115 119 120 123 124 10. 11. 12, 10. 11. 12. LIST OF TABLES Demographic Characteristics of Risk and Control Families O0....00.0.0.0.........OOOOOO0.0.0.0.... 22 Means (M), Standard Deviations (SD), and t-Test Comparisons for Maternal Ratings of Child Problem Behaviors (Connors & CBCL) ...................... 45 Means (M), Standard Deviations (SD), and t-Test Comparisons for Maternal Ratings of ADHD Behaviors (DOTS) 0.0....0.............OOOOOOOOOOOOOOOOOO... 46 Means (M), Standard Deviations (SD), and t-Test Comparisons for Paternal Ratings of Child Problem Behaviors (Connors & CBCL) ...................... 47 Means (M), Standard Deviations (SD), and t-Test Comparisons for Paternal Ratings of ADHD Behaviors (DOTS) ......OOOOOOOOOIOO...0.00.0.0...0......... 48 Means (M), Standard Deviations (SD), and t-Test Comparisons for Parental Ratings of ADHD Behaviors (DOTS) ............OOOOOOOOOOOOOOOOO.........O... 50 Means (M), Standard Deviations (SD), and t-Test Comparisons for Parental Ratings of Child Problem Behaviors (Connors & CBCL) ...................... 51 Means (M), Standard Deviations (SD), and t-Test Comparisons for Maternal Ratings of Child AggreSSion (CBCL) ......OOOOOOOOOOOOOOOO00.00.... 52 Means (M), Standard Deviations (SD), and t-Test Comparisons for Paternal Ratings of Child Aggression (CBCL) ............................... 52 Means (M), Standard Deviations (SD), and t-Test Comparisons for Parental Ratings of Child AggreSSion (CBCL) ............OOIOOOOOOOOOOOOO... 52 Percentages of Sons Meeting Cutoff for ADHD, Conduct Disorder, and Aggression Utilizing Maternal Ratings 00......0.0.0.000.........OOOOOOOOOOOOOOO 67 Means (M), Standard Deviations (SD), and t-Test Comparisons for Parental Alcoholic Problems (LAPS) and Antisocial Behavior Scores .................. 68 13. 14. 15. 16. I7. l8. 19. 20. 21. 22. 23. 24. Cor Chi Cor Chi Cor Chi Cor Chi Hie Boy Uti Sco Hie] Boy: Mate Demc Hiei Boys Uti] and Hie: BOYS Pate 13. 14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. Correlations of Control Maternal Variables With Childvariables (N=32) .....OOOOOOOOOOOOOO0.0.... Correlations of Control Paternal Variables With Child Variables (N=33) .......................... Correlations of Risk Maternal Variables With Child Variables (N=69) .......................... Correlations of Risk Paternal Variables With Childvariables (N=69) ......OOOOOOOOOO...0...... Hierarchical Multiple Regressions for High Risk Boys' Aggressive Problem Behaviors (Connors) Utilizing Maternal LAPS, Antisocial Behavior Scores and Demographic Variables as Predictors .. Hierarchical Multiple Regressions for High Risk Boys' ADHD Problem Behaviors (Connors) Utilizing Maternal LAPS, Antisocial Behavior Scores and Demographic Variables as Predictors ............. Hierarchical Multiple Regressions for High Risk Boys' Aggressive Problem Behaviors (Connors) 77 79 8O 81 84 85 Utilizing Paternal LAPS, Antisocial Behavior Scores and Demographic Variables as Predictors ......... Hierarchical Multiple Regressions for High Risk Boys' ADHD Problem Behaviors (Connors) Utilizing Paternal LAPS, Antisocial Behavior Scores and Demographic Variables as Predictors ............. Hierarchical Multiple Regressions for High Risk Boys' ADHD Problem Behaviors (DOTS) Utilizing Maternal LAPS, Antisocial Behavior Scores and Demographic Variables as Predictors ............. Hierarchical Multiple Regressions for High Risk Boys' ADHD Problem Behaviors (DOTS) Utilizing Paternal LAPS, Antisocial Behavior Scores and Demographic Variables as Predictors ............. Hierarchical Multiple Regressions for Control Boys' ADHD Problem Behaviors (DOTS) Utilizing Maternal LAPS, Antisocial Behavior Scores and Demographic Variables as Predictors ............. Hierarchical Multiple Regressions for Control Boys' Aggressive Problem Behaviors (Connors) Utilizing Maternal LAPS, Antisocial Behavior Scores and Demographic Variables as Predictors .. vi 87 88 89 91 92 93 25. 26. 27. 28. Hierarchical Multiple Regressions for Control Boys' ADHD Problem Behaviors (Connors) Utilizing Maternal LAPS, Antisocial Behavior Scores and Demographic Variables as Predictors ............. Hierarchical Multiple Regressions for Control Boys' Aggressive Problem Behaviors (Connors) Utilizing Paternal LAPS, Antisocial Behavior Scores and Demographic Variables as Predictors .. Hierarchical Multiple Regressions for Control Boys' ADHD Problem Behaviors (Connors) Utilizing Paternal LAPS, Antisocial Behavior Scores and Demographic Variables as Predictors ............. Hierarchical Multiple Regressions for Control Boys' ADHD Problem Behaviors (DOTS) Utilizing Paternal LAPS, Antisocial Behavior Scores and Demographic Variables as Predictors ............. vii 94 95 96 97 10. 11. 12. Din ADI Din ADE Din ADE Con ADH Con ADH Con ADH; Con] A993 Cont A991 Conr A991 Chi] A991 Chi: A991 Chi: A991 10. 11. 12. LIST OF FIGURES Dimensions of Temperament (Maternal Ratings): ADHD and Component Behaviors .................... 54 Dimensions of Temperament (Paternal Ratings): ADHD and Component Behaviors ............... ..... 55 Dimensions of Temperament (Parental Ratings): ADHD and Component Behaviors .................... 56 Connors Parent Questionnaire (Maternal Ratings): ADHD and Component Behaviors ............ ..... ... 57 Connors Parent Questionnaire (Paternal Ratings): ADHD and Component Behaviors .................... 58 Connors Parent Questionnaire (Parental Ratings): ADHD and Component Behaviors .................... 59 Connors Parent Questionnaire (Maternal Ratings): Aggressive Hyperactivity and Conduct Disorder ... 60 Connors Parent Questionnaire (Paternal Ratings): Aggressive Hyperactivity and Conduct Disorder ... 61 Connors Parent Questionnaire (Parental Ratings): Aggressive Hyperactivity and Conduct Disorder ... 62 Child Behavior Checklist (Maternal Ratings): Aggressive Behavior ............................. 63 Child Behavior Checklist (Paternal Ratings): AggreSSive BehaVior ......OOOOOOOOOOOOOOOOOO0.... 64 Child Behavior Checklist (Parental Ratings): Aggressive Behavior ....................... ...... 65 viii Chapter I Introduction Attention Deficit Hyperactivity Disorder (ADHD), more commonly referred to as hyperactivity, is one of the most recurrently exhibited behavioral problems of children referred to mental health professionals. Estimates of its prevalence in school aged children vary greatly, the range being anywhere from 1% to 20% (Barkley, 1981; Safer & Allen, 1976). One of the reasons for variation in the prevalence rate is the inconsistency in criteria for diagnosis as well as the wide variety of labels given to the disorder. Historically, hyperactivity has been referred to as "Minimal Brain Dysfunction", "Hyperactive Child Syndrome", "Attention Deficit Disorder", "Hyperkinesis", and "Hyperkinetic Reaction of Childhood". The nomenclature for hyperactivity has undergone, and continues to undergo, many changes. Differentiations of the disorder continue to be classified and there is a continuous breakdown of more reliably measured subtypes (Windle & Searles, 1990). In the most recent revision of the DSM-III (DSM-III-R), hyperactivity is defined as Attention-deficit Hyperactivity Disorder (ADHD) and is given a more workable definition. The manual describes the general features of the disorder as: "developmentally inappropriate degrees of inattention, impulsiveness, and hyperactivity", with excessive gross 2 motor activity being most prominent in preschoolers (American Psychiatric Association, 1987 p. 50-52). The manual further defines excessive motor behavior as fidgeting, constant manipulating of objects, difficulty remaining seated, excessive jumping about, inability to await turn, difficulty playing quietly. other identifying behavioral characteristics of ADHD are low frustration tolerance, poor emotional control and lability, hyperexcitability, aggressiveness, antisocial behavior, and poor academic progress (a majority of hyperactives repeat at least one grade but have average to above average intelligence) (Baxley & LeBlanc, 1976; Horn & Ialongo, 1988). In this study it was partially our intention, to aid in an attempt at the differentiation and breakdown of subtypes of hyperactivity into what may very well be several syndromes appearing collectively. The primary endeavor of this study was to isolate those biobehavioral characteristics that are currently thought of as being indicative of ADHD, aside from its possible major affiliates Conduct Disorder and/or aggression. Even though the two may actually co-exist, they have been treated separately in the analysis and their individual affects on child outcome and parental psychopathology have been looked at. Tenoera: The most prc childhoc several some as feature one anot Temperan Speed wi one aPpr or a new is distr. 1984). . Child's e the home Chapter II Review of the Literature Temperament[Hyperactivity The specific features of hyperactive behavior that are most prominent in children during late infancy and early childhood (i.e., 3 to 6 years) represent and exemplify several aspects of behavior that have been referred to by some as temperament. One aspect of temperament is that feature of a behavior which distinguishes individuals from one another based on its unique quality and intensity. Temperament has also been characterized as the physical speed with which one executes an act, the manner in which one approaches a task whether it be in a new social context or a new physical environment, and the ease with which one is distracted from the present task (Thomas and Chess, 1984). Thus, temperament applies to a broad spectrum of the child’s everyday activities including responsibilities in the home and at school, to-obeying directives from parents and teachers, and following acceptable social norms. According to past and present research dealing with hyperactive children, there are certain deviations within the aforementioned behavioral situations (i.e., everyday activities, responsibilities at home and school etc.) which, if expressed at certain ages and for certain periods of time, a these d and Che It tempera hyperac parents reoccur: home, pa Tarter 4 temperar for alcc can be c to gene: the majc Elsewher Evaluati alcoholi (1989) f in SeVer higher 1! suggests which is alcoholig manifesta DredispOS time, are indicative of ADHD. In the hyperactive child, these deviations of behavior may be a facet of what Thomas and Chess refer to as temperament. It may be that certain children with specific temperamental traits (in the present investigation hyperactivity) are predisposed to the pathology of the parents when these temperaments are exposed to certain reoccurring environmental situations, for example, a chaotic home, parental substance abuse and/or antisocial behavior. Tarter et a1. (1990) suggest that, "certain childhood temperament characteristics may be associated with the risk for alcoholism." They have observed that sons of alcoholics can be distinguished from sons of non-alcoholics according to general activity levels. Activity levels being one of the major components of temperament as it has here and elsewhere (e.g., Thomas & Chess, 1984) been defined. Evaluating the cognitive differences between sons of alcoholics and non-alcoholics, Tarter, Jacob, and Bremer (1989) found that sons of alcoholics performed more poorly in several areas of cognitive functioning as well as showing higher levels of behavioral tempo. These results, Tarter suggests, are indicative of an anterior cerebral dysfunction which is a favorable proponent for a genetic etiology of alcoholism. Although the observance of these behavioral manifestations of hyperactivity do support a genetic predisposition to certain temperament characteristics the manifestations neither "confirm nor disconfirm a genetic hypothe do lead predisp when th as the So an isol from pa researc 1990). in chil may not "primar due to Childre levels requiri has bee (FUnder Claim t more r e haying ; in the 1 childrei home 11. aggreSSJ zuCker 5 hypothesis" (Tarter et al., 1989). But these observations do lead one to believe that different temperaments may predispose a child to certain deficiencies or pathologies when the child is exposed to the parents' pathology as well as the chaotic environment created by the parents. Some researchers suggest that temperament is not simply an isolated characteristic of the child, but also emerges from parent-child interaction; it is this interaction that researchers' feel little is known about (Fitzgerald et al., 1990). One should bear in mind that the diagnosis of ADHD in children coming from chaotic or inadequate environments may not be warranted if the behavioral disorder is "primarily a function of the chaotic environment" and not due to the child's own psychopathology (APA, 1987). Children reared in environments in which there are high levels of conflict and chaos perform poorly on tasks requiring delay of gratification, and delay of gratification has been shown to have a high relationship to hyperactivity (Funder, Block and Block, 1983). Funder et a1. further claim that boys who are unable to delay gratification appear more restless, fidgety, aggressive and irritable as well as having rapid personal tempo. This will be a consideration in the present study as it has been noted that many of the children in this study have very disorganized and chaotic home lives with fathers who exhibit high levels of aggressive and violent behavior (Fitzgerald, Jones, Maguin, Zucker, & Noll, 1991). MW As was previously stated, many studies have shown a correlation between alcoholism and ADHD postulating this to be one of the primary antecedents for alcoholism in children at risk for alcoholism (Cloninger et al., 1989; Goodwin et al., 1975; Knop et al., 1985; Morrison & Stewart, 1970; Wood, Wender & Reimherr, 1983 Workman-Daniels & Hesslebrock, 1987). However, the methodologies utilized in these and other studies have been for the most part retrospective. There have been few prospective studies focusing on the early manifestations and developmental course of hyperactivity and conduct problems as they relate to the later development of alcoholism (Campbell, Breaux, Ewing, & Szumowski,1986). Therefore, the purpose of this study includes looking at the behavioral disposition of the two groups, comparing them in regards to hyperactive and aggressive behavior as the child is developing and in particular from late infancy to early childhood (i.e., 3 to 6 years). If ADHD is a predisposing factor to alcoholism (especially in high risk populations) it should begin to surface in late infancy and be fully apparent by the age of seven (APA, 1987). It follows that this is the time period in which the child at high risk should begin to be monitored for such behavioral expressions. Recent research on children with alcoholic fathers gives some indication that hyperactivity may be in some way associated with the later development of alcoholism. The beha are more compared hyperact predispo markers : into alc The as a pos genetic - combinat sPeCific will be is here believe and envi (Cloning Goodwin, genetic the eXpr MotrisOn How alcoholi hYPeract markErs . Characte; and dist 7 The behavioral characteristics associated with hyperactivity are more evident in children at high risk for alcoholism as compared with children at low risk. It is possible that hyperactive behavior may exhibit itself in children with a predisposition towards alcoholism and may be one of the markers or precursors present in children who will develop into alcoholics later in life. There is some controversy as to whether hyperactivity as a possible precursor to alcoholism is due strictly to genetic components, environmental influences or a combination of the two. ,The genetic controversy was not specifically the target of the present study, (although it will be discussed later) however, an overview for the reader is here warranted. The alcoholism literature leads one to believe that there needs be a combination of both genetic and environmental factors in the etiology of alcoholism (Cloninger, Bohman, Sigvardsson & von Knorring, 1985; Goodwin, 1971), and many studies support the notion of genetic transmission of hyperactivity in conjunction with the expression of alcoholism (Cantwell, 1972; McMahon, 1981; Morrison, Stewart & Louis, 1973). However, in order to claim that the etiology of alcoholism were a purely genetic one, and possibly hyperactivity as a precursor to alcoholism, biological markers would need be identified. One biological characteristic that is known to be genetically transmitted and distinctive to alcoholics is certain EEG patterns (Gabrie 1982; V as cert and the excessi (Volavk the sub consequ similar youths . to furti the bra abuse (. consist. review : eva1u3t. fathers childrel l‘eVeale< Specifi, task re: stimuli BegleitE (RPS) 1' their a] risk grc (1932) 8 (Gabrielli, Mednick, Volavka, Pollock, Schulsinger & Itil, 1982; Volavka, Pollock, Gabrielli & Mednick, 1985) as well as certain Ekaed Potential (EP) aberrations. Alcoholics and their offspring have a general tendency to show excessive resting Beta activity while non-alcoholics do not (Volavka et al., 1985). The link between hyperactivity and the subsequent development of alcoholism has been noted and consequently, studies utilizing these techniques have noted similarities in brain wave activity between hyperactive youths and adult alcoholics. Recent progress has been made to further support this genetic claim.. Specific areas of the brain that are affected genetically through alcohol abuse (e.g., frontal lobe) have been isolated and are consistent with those areas affected in hyperactives (for a review see Galanter, 1985). For example, several studies evaluating brain EPs in adolescent males with alcoholic fathers (Begleiter, Prjesz & Bihari, 1984) and hyperactive children (Zambelli, Stamm, Matinsky & Loisell, 1977) revealed marked differences in P3 and N1 components. Specifically, there is a diminution of the P3 amplitudes to task relevant targets as well as reduced N1 amplitude to all stimuli in the hyperactive youths. It was noted in the Begleiter et a1. study that Evoked Response Potentials (ERPs) in high risk boys were similar to those found in their alcoholic fathers even though the boys in the high risk group had not started drinking. Gabrielli et a1. (1982) found faster EEGs in children of alcoholics when compare since f exhibit that si while 5 might I indivi< alcoho. drinki: alcoho with f H electr eviden associ alcoho having OffSpr (GOOdw MOrris reVeal been h with S SQCiOp 9 compared to children of non-alcoholics and hypothesized that since faster EEG is heritable this might be one of the exhibited biological antecedents to alcoholism. They argue that since fast EEGs are associated with tension and anxiety while slower EEGs are associated with relaxation, that this might be one of the biobehavioral mechanisms high risk individuals inherit. They further assume that in order for alcoholics to reduce this increased activity they resort to drinking, which in turn slows down brain activity enabling alcoholics to escape the "uncomfortable state associated with fast brain activity" (Gabrielli et al.,1982). However interesting and provocative these electrophysiological findings may be, the most convincing evidence for a genetic basis of alcoholism and its association with hyperactivity is the history of many alcoholics. Self-reports from alcoholic samples report having been hyperactive as children at the same time their offspring are also showing evidence of hyperactive behavior (Goodwin, Schulsinger, Hermanse, Guze & Winkokur, 1975; MorriSon & Stewart, 1970). Many of these investigations reveal that a large majority of parents who report having been hyperactive as children are now psychiatrically ill with specifically high prevalence rates of alcoholism, sociopathy, and hysteria further suggesting a familial relationship to the syndrome (Cloninger et al., 1985). In this fairly recent and classic adoption study, Cloninger and his associates identified and studied two types of alcoho parent. antiso« have a alcoho. an env. furthe: alcoho' biolog abuse crimin; incarc. Type I: In thi: alcohoj reral. suggest that t) $0cial’ M: make tr 10 alcoholics. Type I alcoholics are those whose biological parents revealed mild alcohol abuse and low levels of antisocial behaviors. Type I children were considered to have a genetic background which increases risk for alcoholism in men and when this type of child is raised in an environment characterized by lower SES factors it serves further to increase risk for alcohol abuse. Type II alcoholism on the otherhand, is expressed in those whose biological fathers revealed more extensive levels of alcohol abuse (i.e., requiring more medical treatment) and criminality (i.e., requiring longer and more frequent incarcerations). They found that the heritability rate of Type II alcoholism was about 90% in the sons of these men. In this group of sons they revealed more severe levels of alcohol abuse regardless of the environment they were revealed in. These findings when examined on the whole suggest that alcoholism has a definite genetic component and that this trait is further exacerbated by lower social/emotional rearing environment. Morrison and Stewart (1970) were among the first to make the association between alcoholism and hyperactivity. In an early study they interviewed the parents of 59 hyperactive children and 41 non-hyperactive children. They found twice the incidence of alcoholism in the parents of the hyperactive children when compared to the non-hyperactives, 20% and 10% respectively. Of those parents of the hyperactive children, 12 were hyperactive as youths 2 et a1. men. 0 for alc at the that 50 impulsi done wi of 50 b conparj and obi found 1 hyperac QrOUp ¢ the fa. Statisi SUpPOr. adulth. 11 youths and 6 of the 12 were alcoholic as parents. Goodwin et a1. (1975) reported similar findings in a group of Danish men. Out of a group of 133 men, 14 met diagnostic criteria for alcoholism. The other 119 served as controls. Looking at the childhoods of the 14 alcoholics, these men reported that 50% were hyperactive as youths as well as being impulsive and hot tempered. In some of his earlier work done with hyperactives, Cantwell (1972) studied the fathers of 50 hyperactive boys between the ages of 5 and 9 years comparing them to fathers of 50 normal boys of the same age and obtained results similar to the extant literature. He found twice the incidence of alcoholism in the fathers of hyperactive children (30%) when compared to the control group of fathers (14%) revealing a trend of psychopathy in the fathers of hyperactives. Sociopathic behavior was statistically higher in the alcoholic group which lends some support to the notion that hyperactivity may carryover into adulthood, showing up as aggression and antisocial behavior (Blouin, Bornstein, & Trites, 1978; Weiss & Hechtman, 1986). One study that looked at the frequency of psychiatric disorders in sons of alcoholics found high prevalence rates of ADHD, Conduct Disorder, and Oppositional Defiant Disorder to be higher in children who had either one or both parents who were alcoholic as compared to those who did not (Earls, Reich, Jung & Cloninger, 1988). In this study the authors looked at psychopathology in children as it exists in an alcoholic and psychopathic environment. They found no 12 significant differences in psychopathology when comparing children with alcoholic parents and children with antisocial parents. However, childhood psychopathology was 2 to 3 times greater in families where there was a parent or parents who had both alcoholism and antisocial personality as compared to families where there was neither alcoholism nor antisocial personality in either parents. Earls et a1. insist that antisocial personality coexists with alcoholism and that it is the combination of alcoholism and antisocial personality that predispose the children to psychopathology and possibly to alcoholism - not simply one or the other. Interestingly, there is evidence indicating a strong relationship between alcoholic fathers’ perception of their sons' behavioral problems and ratings of their own antisocial behavior (Fitzgerald, Sullivan, Bruckel, Schneider, Zucker, & Noll, 1989). In alcoholic families it has been seen that the activity level of sons is significantly predicted by levels of fathers’ antisocial behavior and researchers suggest that this may be due to certain socialization and/or biological elements that aid in determining certain temperament traits (Fitzgerald, Sullivan, Gover, Maguin, Zucker, & Noll, 1990). It is the perception of behaviors by alcoholic parents that has been linked conceptually to the etiology of alcoholism. For instance, activity levels in children at low risk appear to be related only to SES, in particular family income and family occupational status, whereas those of high risk 13 children are related to alcoholism and parents' perception of their own (husbands) and their spouses (wives) antisocial behavior (Noll, Zucker, Fitzgerald, & Curtis, 1989). On the other hand, however, Tarter et al. (1985) found no link between alcoholism and hyperactivity in two groups of adolescents both of whom were anti-social. One group was at high risk for alcoholism (having a father who was alcoholic) and the other group was at low risk (the father being nonalcoholic). No significant differences were found in hyperactivity symptomatology between high and low risk groups, concluding that although hyperactivity has been associated with higher risk for alcoholism, hyperactivity does not influence one to become alcoholic more readily than other pathology. Schuckit, Sweeney and Huey (1987) obtained findings similar to those of Tarter et al. They compared a group of young adult sons of alcoholics to a group of sons of nonalcoholic of like sociodemographic status, examining their levels of childhood and adult symptoms of hyperactivity. Inasmuch as no significant differences in hyperactivity levels in childhood or adulthood were found, Schuckit et al. concluded that hyperactivity does not play a causal role in the etiology of alcoholism. Still, other investigators have reported an association between alcoholism and hyperactivity for temperament attributes such as high activity levels, impulsiveness, and poor concentration in high risk offspring (Cloninger et al., 1985; Goodwin et al., 1975; Owings & West, 1987; Workman follow- neurOps psychop differe impulsi of alcc of hype restles fathers Predict Ac limite< tYpes I alcoho. may pri adopter likely n°n~a1. Holler Stewar. Of ado] of who] childrr 14 Workman-Daniels & Hesselbrock, 1987). In a 10 to 15 year follow-up study of sons of alcoholics, Knop (1985), using neuropsychological assessments, teacher evaluations, and psychopathology interviews, found consistently significant differences between the high and low risk groups for impulsivity, restlessness, and verbal deficiency. The sons of alcoholic fathers from this cohort exhibited higher rates of hyperactive behaviors, specifically impulsive and restless behavior, than did the sons of non-alcoholic fathers. This finding, according to Knop, may be of predictive importance in the etiology of alcoholism. Adoption studies have been extremely useful, although limitedly so by virtue of the difficulty in conducting these types of studies, in revealing associations of adult alcoholism and child psychopathology and other factors that may predispose one to alcoholism. It has been shown that adopted sons of alcoholics are as much as four times more likely to become alcoholic than adopted sons of non-alcoholics (Cadoret & Gath, 1978; Goodwin, Schulsinger, Moller, Hermansen, Winokur, & Guze, 1974). Morrison and Stewart (1973) evaluated the psychiatric.status of a group of adopting parents and a group of biological parents both of whom had hyperactive children. Males made up 97% of the children in the biological group and 89% in the adopted group. Biological fathers had significantly higher rates of alcoholism than did adopting fathers and were more likely to be hyperactive as children than were the other male 15 relatives of the adopting fathers. Such findings favor the idea of the heritability of hyperactivity but, as the authors point out, with a co-dependency of alcoholism being a significant interactive factor in its expression. Although these findings point to the heritability of alcoholism in conjunction with certain parental psychopathologies it is beyond the scope of the present study to address in any comprehensive manner a genetic component for the etiology of alcoholism. The current study focuses on the psychopathology in children of alcoholic/antisocial parents, in particular hyperactivity and aggression. These behavioral abnormalities (e.g., hyperactivity, aggression etc.) may be indicative of a biobehavioral disregulatory mechanism and may precede the onset of alcoholism as well as play a role in the latter expression of other psychopathological behavior (e.g., antisocial behavior). This disregulatory mechanism may in fact be a heritable one, however, further and extensive study need be done to ascertain the veracity of such a theory. From the previous review the association between risk for alcohol abuse and several temperament/behavioral attributes that are characteristic of ADHD (i.e., impulsivity, restlessness or excessive motor behavior, poor attention-span and distractibility) can be readily seen. Moreover, it seems evident that a male child of an alcoholic father is likely to exhibit some or all of these temperament attribute predispos of alcohc looked at this big] fashion. oftwper (i.e., 3 comparec and it I Progres m It Often E boys. CODdUC1 from t] 16 attributes and that these attributes might possibly be predisposing factors leading to the subsequent development of alcoholism. As mentioned previously, few studies have looked at the developmental occurrence of hyperactivity in this high risk alcoholic population, except in retrospective fashion. So it was interesting to note the prevalence rate of hyperactive behaviors in older male infants and toddlers (i.e., 3 to 6 years) of alcoholic/antisocial parents as compared to those of non-alcoholic/non-antisocial parents, and it will be interesting to follow their developmental progress into late childhood and adolescence. WW It would appear that children expressing ADHD most often also exhibit Conduct Disorder behaviors - especially boys. The majority of researchers agree that ADHD and Conduct Disorder actually coexist, and the separation of one from the other is most difficult if not impossible (for a comprehensive review see Hinshaw, 1987). Conduct Disorder is a behavioral regime typified by behaviors that violate the basic rights of others and a general abusiveness to peers as well as strangers. While there are those attempting to make a differentiation of the two disorders into separate and discrete syndromes, namely, ADHD or "pure" hyperactivity, and Conduct Disorder, there is also the notion of another syndrome that has been bantered about for many years - that of Attention Deficit Disorder. According to DSM-I connote distract physical Disorder rates an which in social b suggest is impos groups c ConduCt authors exhibite 91011;) Cc YOUth, hl’Peract and impi c“111011): Mattel-11 aggreSS: use by 1 group. (1988), se that (e,g 17 to DSM-III the disorder is exhibited by behaviors that connote the inability to sustain attention and the ease of distractibility in the absence of hyperkinetic or excessive physical behavior. Hyperactivity (ADHD) and Conduct Disorder appear to be linked together in both prevalence rates and by certain definitions of the hyperactive syndrome which insist that hyperactivity contains an aggressive/anti- social behavioral component. As stated earlier, some suggest that the two are mutually inclusive thus, separation is impossible. August et al. (1983) did a follow-up of two groups of hyperactive youth with and without associated conduct problems. The first group consisted of what the authors called "pure" hyperactive youth, meaning they exhibited no aggressive conduct problems, and the second group consisted of "hyperactive-unsocialized aggressive" youth. Those boys originally diagnosed as "purely" hyperactive remained so, exhibiting primarily inattentive and impulsive behavior. The second group of hyperactives co-morbid with conduct problems continued to exhibit inattention and impulsivity but were also significantly more aggressive, noncompliant, antisocial and prone to alcohol use by the age of ten as compared to the purely hyperactive group. In agreement with the hypothesis of Earls et al. (1988), the authors suggest that it is not hyperactivity per se that predisposes one to alcohol abuse or other psychopathologies, but rather the coupling of hyperactivity (e.g., inattention and impulsivity) and Conduct Disorder, partial. influenc Th1 Conduct Items d. and Con: behavio: hyperaC' respect antisoc psychOp. PSYChOp. 18 particularly aggressive and antisocial behavior that influences the etiology of alcoholism. The basis for determining whether a child is ADHD or Conduct Disorder has been based on DSM-III-R criteria. Items directly pertaining to DSM-III-R definition of ADHD and Conduct Disorder have been used to summarize the behavior of the boys under study. The relationship of child hyperactive and antisocial behaviors has been observed with respect to levels of risk for alcoholism and parental antisocial behavior and the ability of the parents psychopathology to predict their own child's psychopathology. e_..1_4 Thi sons of symptoms dominant a high I alcoholi (Connors (DOTS), was made risk on aggressj The Conc assess ( from the DBhaviO: EXEQLhe, Bo: higher . behavio 3229313: Pa: lifetim Chapter III Hypotheses This study examined the behavioral attributes of male sons of alcoholics to see if ADHD, and its associated symptoms, Conduct Disorder, and aggressive behavior are dominant personality/temperament traits of male children in a high risk population for the latter development of alcoholism. Using the Connors Parent Questionnaire (Connors), Dimensions of Temperament Survey for Children (DOTS), and the Child Behavior Checklist (CBCL) an attempt was made to differentiate boys at risk from those not at risk on the basis of ADHD behavior, specifically, ADHD of an aggressive nature vs. ADHD of a more non-aggressive nature. The Conduct Disorder factor from the Connors was used to assess excessive conduct behaviors and the Aggression factor from the CBCL was used to assess excessive aggressive behavior. Hypotheses made were as follows: Hypothesis I Boys in the high risk group would score significantly higher on measures of ADHD, Conduct Disorder and aggressive behaviors than boys in the low risk group. esi I Parental psychopathology (e.g., antisocial behavior and lifetime problem drinking behavior) were assumed to be more 19 signif: Disordt demogri Hypoth' F status signif aggres psycho 20 significant predictors of the high risk sons’ ADHD, Conduct Disorder and aggressive behavior than the various family demographic variables measured. W Family demographic variables (e.g., socio-economic status, family income, and parental education) would be more significant predictors of ADHD, Conduct Disorder and aggressive behavior in the low risk boys than parental psychopathology. Subjects Sui years 01 risk £01 some ca- high le to as t group i neither levels these ( Compar; family grOUp tracts Parent proble Sample Chapter IV Method 531mm Subjects are two groups of boys between 3.0 and 6.0 ' years of age. One group of boys is considered to be at high risk for alcoholism as a result of having a father (and in some cases a mother) who is alcoholic and who also exhibits high levels of antisocial behavior; these will be referred to as the High Risk Group throughout this paper. The other group is considered to be at low risk for alcoholism having neither parent who exhibits signs of alcoholism and where levels of antisocial behavior are comparable with normals; these will be referred to as the Control Group or Comparisons. Boys from both groups came from an intact family at the time of recruitment. Boys in the high risk group (N=69) are from similar, if not the same, census tracts as those in the control group (N=32) but control parents, unlike risk parents, are asymptomatic for alcohol problems (See Table 1 for Demographic characteristics of sample). Alcoholic fathers have been recruited via the district courts in the Mid-Michigan area. Using a population net in the Mid-Michigan area involving four adjacent counties with six district courts, all convicted drunk drivers with a blood alcohol concentration (BAC) of 0.15 percent or higher (or 0.12 percent or higher if this was a second or more 21 Table 1 2811109 I'E \ VE Demogre Fa BC BC Ac. A: Ac. .\ 5=$16, ‘P<.004 22 Table 1 C a ter'sti s o isk a d Control a 'lies High Risk Control (N=69) (N=32) Variable M SD M SD mo h'cs: Family SES' 30.55 14.5 41.77 19.9 lFamily Incomec 6.65 2.0 7.53 1.5 Education Mother (yrs) 12.81 ‘ 1.9 13.12 1.9 Education Father (yrs)b 12.90 2.1 14.27 2.0 Age of Mother 30.25 4.0 30.84 4.6 Age of Father 32.71 5.1 32.94 4.9 Age of Child 4.30 1.1 4.30 1.0 '6=$16,001 - 20,000; 7=$20,001 - 30,000 'p< . 004 l’p< . 002 cp< . 03 document biologic current] at the 1 ”child I from thi and pho staff, to the confide probati number Partici Particf A: matCher neithe: dOOr-t door-t family for an nOnalc °°ntac Chi 1d ’ familj (1.9. . dUQ tc 23 documented drinking related driving problem) who have a biological son between the ages of 3.0 and 6.0 years currently living with them and who are from intact families at the time of first contact, were recruited into a study of "child development and family health." Probation officers from the district courts request permission to release names and phone numbers to our project. When contacted by project staff, respondents are told that the study has no connection to the courts and that all information collected is confidential. Of the total number of men contacted by probation officers, 79% agreed to have,their name and phone number released to the project; of these, 92% agreed to participate. All families in the study are paid for their participation. After a high risk family is recruited into the study, a matched community comparison family whose parents are neither alcoholic nor drug dependent is located using door-to-door canvassing interviews. Canvassers begin a door-to-door search one block away from the alcoholic family, staying within the same census tract, and screening for an age appropriate (+/-6 months match) male child in a nonalcoholic home. To date, 18,232 families have been contacted. Of the 494 families with an age-appropriate male child, 398 agreed to participate. Two hundred-fifteen families were ineligible due to ethnicity, SES, or parentage (i.e., non-biological); 102 were ineligible due to parent alcohol/drug involvement, and 81 were succe: I protoc Feighr Woodru alcoho do not Matern. a Cfitt However manifes alcohol retarda and/or Clarren Co "as use child, for SES with an compara 24 successfully recruited as control subjects. Later data collected as part of the longitudinal protocol insures that each district court father meets Feighner diagnostic criteria (Feighner, Robins, Guze, Woodruff, Winokur, & Munoz, 1972) for probable or definite alcoholism, and that both parents in the comparison family do not make this diagnosis or one of drug dependence. Maternal alcoholism among the high risk families is neither a criterion for inclusion nor exclusion from the study. However, in accord with study screening criteria, no child manifested characteristics required for a diagnosis of fetal alcohol syndrome (i.e., prenatal and/or postnatal growth retardation; apparent central nervous system involvement; and/or characteristic facial dysmorphology) (Sokol & Clarren, 1989). Community canvassing to obtain comparison families was used to control for effects of age and sex of target child, community influences, and as an approximate control for SES. This procedure allows findings from the families with an alcoholic father to be contrasted to an ecologically comparable but non-alcohol/drug abusing population. A numero sessio requir for ea partic sessic m E Circun the be hYPere behavj socio. Antisc the Li and a Chapter V Procedure All families that participated in the project completed numerous questionnaires, interviews, and direct observation sessions. Data collection takes place across 9 sessions, requiring approximately 15 hours for each parent and 7 hours for each target child. All data are gathered at the participants homes with the exception of a video taped session conducted at university facilities. t en 5 Several aspects of the parents behavior and life circumstances were measured and compared to see which were the best predictors for child psychopathology (i.e., hyperactive behaviors and conduct problems): 1) antisocial behavior, 2) problems related to alcohol usage, and 3) socio-economic factors. These were measured by the Antisocial Behavior checklist (ASB; Zucker & Noll, 1980), the Lifetime Alcohol Problems Score (LAPS; Zucker, 1991), and a demographic questionnaire. t soci Be vior check S . The ASB is 46-item revision of an earlier antisocial behavior inventory utilized in the Rutgers Community Study (Zucker & Barron, 1973) that has been modified so that items are also salient for adult antisocial activity. A series of reliability and validity studies with populations ranging from college 25 26 students to prison inmates has shown adequate test retest reliability (.91 over four weeks) and internal reliability (coefficient A = .93) (Zucker & Noll, 1980). The ASB also differentiates between groups of people with varying degrees of antisocial behavior such as inmates versus minor offenders in district courts versus college students (Zucker 8 Noll, 1980), and between alcoholic and non—alcoholic adult males (Fitzgerald, Jones, Maguin, Zucker, & Noll, 1991). Lifetime Alcohol Problems Score. LAPS was the primary drinking variable to be used in the current study. The score is designed to assess differences in the extent of drinking problems over the life course, and is derived from information gained from the administration of the Drinking and Drug History interview (Zucker, Fitzgerald, & Noll, 1990), the Diagnostic Interview Schedule (Robins, Helzer, Croughan, & Ratcliff, 1980), and the short form of the Michigan Alcoholism Screening Test (SMAST) (Selzer, 1971, 1975). The LAPS provides a composite score derived from three component subscores: (a) the primacy component, involving the squared inverse of the age at which the respondent reported first drinking enough to get drunk; (b) the variety component, involving the number of areas in ones lifetime in which drinking problems are reported, and (c) the life percent component, involving a measure of interval between most recent and earliest drinking problems, corrected for current age. Scores are standardized separate This mea problem indicatc difficul 27 separately for males and females within our project sample. This measure is unrelated to current drinking consumption in problem drinking samples and has been shown to be a valid indicator of differences in long term severity of drinking difficulty in a wide variety of areas (zucker, 1991). Qempgraphic Questionnaire. This questionnaire was administered during the first visit, which inquired about self-reported background information (occupation, education, income, years married, number of children in the house, age, etc.) and family of origin (SES, education, etc.). This instrument provided the data from which the demographic items and information about family income etc. were coded. The SES of each parent is established using the occupation based Revised Duncan Socioeconomic Index (TSEIZ; Stevens & Featherman, 1981). Three instruments were administered to the parents of the target child independently to assess temperament, overall behavioral repertoire, and social and emotional functioning: 1) the Child Behavior Checklist (CBCL); 2) the Dimensions of Temperament Survey (DOTS) for children; and 3) the Connors Parent Questionnaire (Connors). From these instruments an assessment of hyperactivity (ADHD), Conduct Disorder and aggressive behavior has been determined based on a constellation of behaviors that constitute these childhood psychopathologies, (e.g., attention span, distractibility, impulsivity, restlessness, excessive physical according pry utilized Lerner, provide temperam gives a sleep 5‘ Span an (Cronba Of infa adults ConsiS' instru reliah A the er There analy: Lerrua °n1y all t. 28 physical activity, abusiveness, irritability etc...) according to DSM-III-R criteria. Dimensipps pr Temperament Survey (QOTS), The DOTS utilized in this study is the 34-item scale reconstructed by Lerner, Palermo, Spiro, & Nesselroade (1982), in order to provide a continuous measure of the components of temperament from late infancy to adulthood. It specifically gives a good measure of activity level for both awake and sleep states as well as providing a measure of attention span and distractibility. Reliability‘coefficients (Cronbach alphas) were obtained on all scales using samples of infants, preschoolers, school-aged children and young adults with only the subscale for reactivity being consistently below .60 (Lerner et al., 1982). The instrument has also demonstrated acceptable test-retest reliability. I A factor analysis of the DOTS was conducted with the entire subject pool of T1 families from the MSUFS. There was a total of 1519 cases used in this analysis. The analysis revealed 8 factors of temperament as compared to Lerners' original 5 factors. The Activity factor was the only factor to remain intact in our analysis and maintain all the items from Lerner's original analysis; this factor was not to be included in the analysis to begin with. The Attention Span/Distractibility factor broke down into two distinct factors, we appropriately named Attention Span and Dist beha‘ stat: (see at a distr. during also r measur factor. Lerner behavic this an behavio and its Regular: analyses Reactivi our anal hYPeract HYP'EI‘act; behaviors Hyperacti more Spec included list) the The t 29 Distractibility. However, due to the fact that these two behaviors appear to be closely linked both conceptually and statistically, in the analysis they were merged together (see Table 1 in Appendix for item list). This factor looks at a child’s ability to maintain an activity without being distracted from it and his/her ability to sustain attention during a task. The Adaptability/Approach-Withdrawal factor also broke down into two neatly formed factors that we felt measured Adaptability and Inhibition; neither of these to factors were of interest in the present study. The factor Lerner labeled Rhythmicity basically measured several behaviors and their regularity of appearance, however, in this analysis it was felt that the strongest rhythmic behavior that appeared from this factor was eating behavior and its regularity; so this factor was labeled Eating Regularity; this factor was also not included in the analyses. The final factor in Lerner’s analysis was labeled Reactivity and this factor broke down into two factors in our analysis; one that tapped items pertaining to hyperactivity (i.e., physical overactivity) labeled Hyperactivity, and the other which measured reactive behaviors which we labeled Reactivity. The factor entitIed Hyperactivity reveals a child's level of physical activity, more specifically if it is excessive or not, and was included in the analysis (see Table 2 in Appendix for item list) the Reactivity factor was not to be used. The two factors selected from the DOTS that were included span/Dis overall DSH-III- in App81 outside drinkin order t reveale consist the ana include Span/D; aDBIYSI 30 included in this study (Hyperactivity and Attention Span/Distractibility) were then combined to obtain an overall rating of ADHD or "pure" hyperactivity following DSM-III-R guidelines (see Table 3 in Appendix for item list in Appendix I). These new factors were compared to several outside variables including scores for problems due to drinking behavior, anti-social behavior and depression in order to assure for parallelism. All of the DOTS factors revealed satisfactory parallelism as well as internal consistency and factor reliability. Cronbach's Alpha for the analysis of the DOTS were .65 and .75 for factors included in this study (Hyperactivity and Attention Span/Distractibility, respectively). A full report on these analyses will be reported on in a different paper. The DOTS is filled out independently by both parents at one of the home visits. Parents are asked to rate their child on the 34 behavioral situations using a 2 point response format. A score of 1 indicates the behavior is "more true than false" with a score 0f 2 being "more false than true." Items are re-coded so that all responses are in the same direction for the behavior then item responses from each factor are summed. Although the original intent of this instrument is to get an assessment of temperament the present study was interested in finding abnormally high levels of undesirable behavior/temperament attributes. Cutoff scores were considered to be met for those boys scoring in the top 10% of the sample. A cutoff score obtained consider The Hype analysis possible items we endorsec receive< he expr. child’s child w because inabilj 31 obtained for a factor is indicative of that behavior and is considered to be abnormally high or in the clinical range. The Hyperactivity factor is the only exception in the analysis. This factor consisted of three (3) items. The possible range for a total score is 0-3; 0 means none of the items were endorsed by parents, 1 means only one item was endorsed, 2 means two items were endorsed and if a child received a score of 3 this indicated that his parents felt he expressed all three of the hyperactive items. If a child's parents endorsed all three items on this factor the child was said to be abnormally overactive. This was done because of the limited range of variability and thus the inability to look at the top 10% of boys in this study. Qpppors Parent Questionnaire. The Connors used in this study is a modified version of the revised 48-item version of Connors original instrument. This modified version is similar to the 48-item version as far as the scales are concerned, however, several items are worded different but only slightly, so it was felt that the items had remained essentially intact. The scale of interest from the Connors for this study, namely, the Hyperactive Index, is the same on all versions of the instrument. The Hyperactive Index is comprised of 10 items from the overall instrument (see Table 4 in Appendix for item list) that are commonly used in both clinical and research settings to make among other things, a diagnosis of hyperactivity (Connors, 1990). childr hyper: reali. of ch hyper hyper affec beha‘ hype' this exhi chil Stuc 48 ; ana the: Thi MSU rev fac ItE be} 19‘ iml 32 1990). The Index provides an empirical assessment of childhood behaviors that are considered indicative of hyperactivity. When used in the research setting it is realized that the index is more generally an overall rating of child psychopathology and not simply a measure of ADHD or hyperactivity. Thus it seems to reveal children who exhibit hyperactivity but also related psychopathology such as high affective states and aggression or, in other words, behaviors that may exemplify aggressive or psychopathic type hyperactivity. The Hyperactive Index will be utilized in this study in an attempt to differentiate children who exhibit this "aggressive hyperactivity" as compared to those children who display ADHD or what is referred to in this study as "pure" hyperactive behaviors. There is adequate reliability and validity of the 48 item version of the instrument; additional factor analysis done by Connors (1985) provided support for the five primary scales as well as the Hyperactivity Index. This instrument was recently re-analyzed by members of the MSUFS using the entire T1 collection (number of cases=986), revealing high levels of reliability on 10 distinctive factors with Cronbach’s Alpha above .61 with one exception. Items taken from the Connors that assess hyperactive behavior (ADHD) were those items that specifically measure levels of hyperactivity, attention span/distractibility, and impulsive behavior, all of which are three behavioral components of the syndrome of interest. Three factors were 33 selected from the Connors to measure hyperactivity. The first was a 4-item factor which looks at a child's motor activity labeled Hyperactive (see Table 5 in Appendix for item list). The second, a 2-item factor measures a child's ability to maintain attention over a period of time as well as assessing his/her distractibility; this factor was labeled Attention Span/Distractibility (see Table 6 in Appendix for item list). The third and final factor for ADHD behaviors taken from the Connors was a 3-item factor looking at a child’s impulsive behaviors labeled Impulsivity (see Table 7 in Appendix for item list). All 3 factors showed internal consistency, reliability and parallelism with Cronbach’s Alpha being .80, .74 & .69 respectively for the factors. As well as providing individual measures for these component behaviors of ADHD, these three factors have been merged, as was the case with the DOTS, to form a final factor that has been called ADHD in that all items pertain to the definition of the disorder as described by most researchers (APA, 1987) (See Table 8 in Appendix for item list). A final factor was used from the Connors that measures Conduct Disorder behaviors (see Table 9 in Appendix for item list). This is one of the factors found in the re- analysis of the 93-item version of the instrument and was used because it was a broad measure of conduct disorder type behaviors corresponding to DSM-III-R criteria (Connors, 1990). This 24-item factor labelled Conduct Disorder had several items that overlapped the Hyperactive Index. These items of “pure“ t gain a t behavior throws l in the 1 felt th factor Th (0'3) w apparer apparer score 1 15 Whit boys f did vi prOble a 9611 by Ac °°mp1 ViSit to'13: rQUr invoi 34 items of overlap that pertain to what are thought to measure "pure" hyperactivity, or ADHD, have been removed so as to gain a more "pure" measure of antisocial/aggressive behaviors typical of Conduct Disorder. One item (#56 - throws him/herself around) from the original factor was not in the present version of the instrument, but it was not felt that this would have any significant effect on the factor which retained the other original items. The child’s behavior is rated on a 4-point scale (0-3) with 0 indicating the behavior is "not at all" apparent to 3 indicating a behavior to‘be "very much" apparent in the child’s behavior. The conventional cutoff score for the Hyperactive Index according to the author is 15 which is 2 standard deviations above the mean, 10% of the boys from the present sample met this criteria. So what we did with the remaining factors used to measure other child problem behaviors was to take those boys scoring in the top 10% on those factors as also being in the clinical range for a particular problem behavior. Child Behavior Checklist (CBCL). The CBCL, developed by Achenbach (1978; Achenbach & Edelbrock, 1983) is completed by both parents independently during the home visit. The first portion of the instrument requires parents to provide information on 20 competence items related to four areas of their child’s functioning: 1) activities, 2) involvement in social organizations, 3) social relations, and 4i 5‘5 nflsthe behaviors addition: provides emotiona scores c measure: evaluat« compete Th parent PSYChoy Becausq Childr interp A with t produc 57 anc Corre; Ede1b} the M; techn prOCQ. group 35 and 4) school performance. The remainder of the instrument asks the parents to rate their child on 118 problem behaviors. Two open-ended items are provided to describe additional problems not specifically listed. The CBCL provides an overall assessment of the child’s social and emotional functioning as well as yielding standardized scores on eight narrow band subscales, (one of which measures aggression), and two broad band subscales that evaluate external and internal psychopathology and social competence. The CBCL is a widely utilized and well standardized parent report that gives a good assessment of child psychopathology (Campbell, Breaux, Ewing & Szumowski, 1986). Because the instrument was normed on 4 to 16 year old children, data of children under the age of 4 will be interpreted with some degree of caution. A program designed to utilize FORTRAN is supplied with the check list for scoring procedures. This program produces total raw scores, total T scores (with a mean near 57 and standard deviation near 5), and intraclass correlations for individual assessments (Achenbach & Edelbrock, 1983; McConaughy & Achenbach, 1988). A member of the MSU Family Study has designed a modified scoring technique that utilizes Achenbach's original scoring procedures and yields overall scores on all factors for groups as well as for individuals. The problem behaviors are rated on a 0-1-2 scale for the ‘ verY 0r SC all ( inclu Table are 51 of a c child inclus; the aft adhere Associa Conduct used th; the reac behavior 2% ADHD ‘ A - H] ‘ In ConduCt E Aggressio 36 for how true the item is for the child currently or within the last 6 months. A score of 2 indicates that the item is very true or often true; a 1 indicates the item is somewhat or sometimes true; and 0 indicates the item is not true at all (McConaughy & Achenbach, 1988). Items selected for inclusion in this study make up the Aggressive Factor (see Table 10 in Appendix for item list). Items from this factor are summed with a raw score of 20 or higher being indicative of a clinical diagnosis of aggression problems (i.e., the child is in the 90th percentile). Items selected from the Connors, CBCL and the DOTS for inclusion in this study (aggressive behavior) have undergone the aforementioned analysis and reliability testing and they adhere to criteria set forth by the American Psychiatric Association in selecting children who may exhibit ADHD and Conduct Disorder. Below is a breakdown of the nomenclature used throughout this paper in order to more readily avail the reader to the various instruments used and the specific behavior measured by each. Erpplgm Behavior to be Measured Instrument 5 Used ADHD DOTS, Connors - Attention Span/Distractibility DOTS, Connors - Hyperactive (Physical Activity) DOTS, Connors - Impulsivity Connors Conduct Disorder Connors Aggression CBCL The State Uni the MSUFE come fro: who there involvinc persistei problems Noll, 8. 1 increase. approxim. themselv. have dif between tethers j Chapter VI Design The present study is a subsidiary study of the Michigan State University Family Study (MSUFS). The specific aim of the MSUFS is to "...trace the development of children who come from homes with alcoholic, drunk-driver fathers, and who therefore are statistically at high risk for problems involving aggression, negative mood, failures in persistence, difficulties in academic performance and problems interacting with other family.members" (Zucker, Noll, & Fitzgerald, 1986). These children are also at increased risk for later development of alcoholism since approximately 25% of male children of alcoholics will themselves become alcoholics and a portion of the rest will have difficulties with drinking behavior. The male child between 3 and 6 years old from these alcoholic/antisocial fathers make up the high risk group in the study, who will be contrasted with a same age group of males considered to be at low risk for alcoholism and antisocial behavior. When possible, comparison subjects are drawn from the same census tracts as the high risk group. The predictive framework of the MSUFS is designed to be consistent from childhood to adulthood. The dysfunctional characteristics of the children under study are presumed to be the "etiologic variables for later alcoholic outcome" (Zucker, 1991). Specific characteristics as set forth by 37 the princ: mneracti tor alcoh parent at between 1 which, a characte elaborat alcohol 1991). Th was ADI Percei' for a} behavi demOg' Anton manii abno: Cons Of E: ale, att 38 the principal investigators are: 1) aggressive and hyperactive behaviors, 2) negative mood, 3) genetic loading for alcoholism, 4) problematic social relationships (between parent and child and child and sibling for the children; between parents, and between parent-child for the parents) which, as development progresses, enhance the characteristics of (1) and (2) above; and 5) a more elaborated, and earlier developed cognitive structure about alcohol and attitudes towards alcohol (Zucker & Fitzgerald, 1991). The specific criterion sought for in the present study was ADHD, Conduct Disorder, and aggressive behavior as perceived by fathers and mothers at differing levels of risk for alcoholism with the predictors being antisocial behavior, problems related to drinking, and specific demographic characteristics, namely, education, ses, and income. The specific purpose of this investigation was manifold in nature: 1) to isolate a constellation of abnormal behaviors that, in keeping with current findings, constitute ADHD according to many researchers in the fields of psychology and medicine as they relate to risk for alcoholism and other parental psychopathology as well as attempting to further delineate the syndrome, 2) to observe Conduct Disorder and/or aggressive behavior as it interacts with the expression of ADHD in a group of boys at high risk for alcoholism, and 3) to observe several parental variables that are suspected to be strong predictors of ADHD. Utilizii specifi stateme childre It factors retrosr attaini is to 1 monitor indicat difficx index ¢ Disordi for va' antISO are no the pr collec A differ th05e (RiSk: sub16< deVelt echs1 39 Utilizing several instruments that effectively target these specific behaviors, it was felt that a more valid and timely statement could be made as to the behavioral status of the children under study. It is impossible to validly establish the predisposing factors of behavioral and/or biological problems in a retrospective fashion. The most efficient means of attaining this type of information on any given population is to look at both high and low risk groups prospectively, monitoring their biobehavioral states. Therefore, behaviors indicative of ADHD namely; impulsivity, attention span difficulties, distractibility, and locomotor activity as an index of hyperactivity and behaviors typical of Conduct Disorder were looked at in a group of children at high risk for various psychopathology (i.e., alcoholism and antisociality) and compared them to a group of children who are not at present at high risk for such. Data utilized in the present study were archival data that have been collected prospectively over the past eight years. As previously stated, the study was an attempt to differentiate children at high risk for alcoholism from those at low risk for alcoholism. The experiment was a two (Risk: hi, 10) by two (Parent: father, mother) between subjects design. Children at high risk for the latter development of alcoholism are so defined by fathers excessive abuse of alcohol, as measured by LAPS, with the majority having a normal consuming mother (i.e., mother does not abus defined washyp< would 0 by the - Analysi An t0 meas aggress Connors and sex speciff Specif: antiso. (LAPS) DemOgr hYpera T behavi analys Proced (antis dem°9r \ .1\:1a diaghc risk . 40 not abuse alcohol)’. Children in the low risk group are so defined by fathers and mothers who do not abuse alcohol. It was hypothesiZed that levels of ADHD and conduct problems would differentiate these two groups of children as measured by the Connors, CBCL, and DOTS. 811311515. Analysis of variance was conducted on the factors used to measure and predict ADHD, Conduct Disorder, and aggression, namely the Connors Hyperactive Index, the Connors Conduct Disorder factor, the CBCL Aggressive factor and several factors from the DOTS and Connors that specifically measure the component behaviors of ADHD. The specific variables were father's and mother's scores on antisocial behavior (ASB), problems due to drinking behavior (LAPS), and demographic characteristics as measured by the Demographic Questionnaire, and also ratings of their sons, hyperactive and conduct/antisocial/aggressive behaviors. The scores for hyperactivity and antisocial/aggressive behavior were subjected to hierarchical multiple regression analysis with ASB, LAPS, and SES variable scores. This procedure served to reveal which parental factors (antisocial behavior, problems due to drinking, or demographic characteristics) most greatly influence the ' A large portion of mothers in the risk group met diagnostic criterion for alcoholism thus further increasing risk status. 41 problem behaviors in there sons. Several of the factors in this study are designed to measure ADHD or the "purely" hyperactive behaviors (i.e., excessive physical activity, attention span, distractibility, and impulsivity) while the Connors Hyperactivity Index attempts to measure hyperactivity and the element of aggressiveness associated with hyperactive behaviors in some hyperactive children, the Conduct Disorder factor is self explanatory and the CBCL aggression factor likewise.- Regression analysis revealed which parental factors may be influencing the "pure" hyperactive behaviors as compared to the more aggressive/hyperactive aspects of the phenomenon, thus allowing differentiation between those who may outgrow their behavioral problems (i.e., those with purely hyperactive behaviors - ADHD) from those whose hyperactivity associated with conduct problems that may progress into adulthood thus more greatly increasing their risk for adult psychopathology (e.g., alcohol abuse and antisocial behavioral problems). Chapter VII ResuIts guild Problem Eehaviprs According to most researchers in the fields of psychology and psychiatry, childhood hyperactivity in its various forms (i.e., "pure" hyperactivity, aggressive hyperactivity vs. non-aggressive hyperactivity, attention deficits, etc.), has prevalence rates ranging anywhere from 1% to 20% (Barkley, 1981; Safer & Allen, 1976). However, according to the DSM-III-R, the national rate is nearer to 3% in prepubertal children, with rates ten times more common in boys than in girls (APA, 1987). In the sample under study, rates of hyperactivity and its various associated behaviors were found to be elevated in sons at risk for alcoholism but lower and somewhat similar in magnitude for controls as occurs in the general population. Boys from both groups were compared on three related child-temperament variables: 1) ADHD and its component behaviors; a) attention span/distractibility, b) impulsivity, and c) hyperactivity or excessive physical behaviors; 2) conduct disorder problem behavior, and 3) general aggressive behavior. Reference will be made to "aggressive hyperactivity" at certain places in the following sections of this study; this term refers to the combination of both ADHD and Conduct Disorder type behaviors as they co-occur in the child's behavioral regime 42 43 and as they are specifically measured by the Connors Hyperactive Index. The Hyperactive Index encompasses children who are not necessarily categorized as "pure" ADHD or "pure" Conduct Disorder. Rather, as noted above, this instrument seems to reveal a combination of ADHD and Conduct Disorder behaviors that may not be separable in some children but may in fact co-exist as early precursors to later more aggressive/violent behavioral expressions. It was assumed in the present study that if ADHD and Conduct Disorder behaviors could be more narrowly defined according to current diagnostic criteria then they might very well appear as separate behavioral disorders and not as highly related to one another as reported by many researchers (see Hinshaw, 1987; Pihl & Peterson, 1991). As will be discussed below this was not the case, in fact rates of co-occurance of the two disorders in this sample of ADHD children were identical to rates found in most other studies. Group x Parent ANOVAs computed for all child behavior variables revealed several main effects for Risk, no main effects for Parent, nor were there any meaningful Interaction effects. Based on results from the Connors Parent Questionnaire (Connors) there were significant effects for ADHD [F(2,198)=4.59,p<.03] and Hyperactivity (i.e., excessive physical activity) [F(2,198)=5.89,p<.02] thus lending support to Hypothesis I. Similar results were found for the factors derived from the Dimensions of Temperament Survey (DOTS) to assess ADHD. A risk effect was 44 found for ADHD [F(2,198)=7.50,p<.01], Hyperactivity [F(2,198)=5.14,p<.03], and Attention Span/Distractibility [F(2,198)=6.26,p<.02] with the sons of alcoholics being rated significantly higher on ADHD behaviors than sons of nonalcoholics, again in support of Hypothesis I. Sons of alcoholics were rated higher on aggressive behaviors than were sons of non-alcoholics, however, the analysis of variance results only approached significance [F(2,198)=3.79,p=.053]. Individual t-tests were conducted.for parental ratings of child behavior in the two groups in order to determine whether or not the risk effects were due to father or mother perceptions. The analysis of the Connors and DOTS factors revealed that the differences between groups on ADHD and its component behaviors as well as aggressive behaviors were due to perceptions of alcoholic fathers not mothers; mother ratings did not significantly differ on any of the child variables between the two groups (Tables 2 and 3). Alcoholic fathers rated their sons on most ADHD behaviors as significantly more problematic compared with ratings of non- alcoholic fathers and their sons. More specifically, alcoholic fathers perceived their sons to be more physically active, as having more attention span/distractibility problems and as displaying more behaviors indicative of ADHD than the non-alcoholic comparison fathers (Tables 4 and 5). The two groups did not differ significantly on Conduct 45 Table 2 Meaps (M), Standard Qeviations (SD)I and t-Test gomparisons a na ' s o 'l P oblem hav' 3 on QBCL) High Risk Control (n=69) (n=32) Variable M Sp M Sp t p Agggpripp 1.45 1.51 1.34 1.26 .34 .73 Impulsivity 2.79 2.19 2.59 1.60 .47 .64 Hyperactivity 3.46 3.16 2.91 2.57 .87 .39 ADHD 7.71 6.07 6.84 4.52 .72 .47 Hyperactive Index 7.00 5.46 6.56 4.29 .40 .69 gppdpgt Disorder 9.76 6.57 10.03 6.29 .19 .85 46 Table 3 Maans (M), Standard Deviations (SD), and t-Test Comparispns for Marernal Rarings of ADHD Behaviors (DOTS) High Risk Control (n=69) (n=32) Variable 11 S12 M SD t e flyparacrive 1.74 1.23 1.28 1.08 1.80 .08 AgtgntiODZDistract 5.69 3.11 4 97 3.07 1.10 .28 AQMQ 7.43 3.88 6.25 3.59 1.46 .15 47 Table 4 e ns M Standard Deviat'ons SD a d t-Test Com a isons {or gaternal Ratings o: Child Problem Behaviors (gonnors & CBCL) High Risk Control (n=69) (n=33) Variable M §2 M £2 E 9 Attention 1.71 1.38 1.21 1.05 1.83 .07 Impulsivity 2.95 2.08 2.36 1.80 1.39 .17 flyperactivity 4.03 3.06 2.48 1.97 2.63 .01 ADHD 8.69 5.79 6.06 3.72 2.38 .02 flyperactive Index 7.78 4.96 6.21 3.76 1.61 .11 anduct Disorder 10.75 5.96 8.63 4.54 1.77 .08 48 Table 5 neans (M). Standard Deviations ISD). for Paternal Ratings of ADHD Behaviors (DOTS) and t-Tegt Comparisons High Risk Control (n=69) (n=33) Variable M 91.3. .11 Q t 19 Hygeractive 1.94 1.09 1 60 1.17 1.40 .16 AgtentionZDistract 6.48 2.76 4.97 2.96 2.51 .01 5mm 8 42 3 46 6.58 3.70 2.45 .02 49 Disorder behaviors or aggressive behaviors as measured by the Connors Conduct Disorder factor (Tables 2 and 4) or the CBCL Aggression factor (Tables 8 and 9) although, alcoholic fathers ratings of their sons' Conduct Disorder and aggression were much higher than those of non-alcoholic fathers and did approach significance levels (Tables 4 and 9). In order to get a family picture of the behavioral perception of the boys under study, we combined both parents scores. When both mother and father ratings were combined (parental perception of problematic behaviors), parents from the alcoholic high risk group rated their sons as significantly higher than non-alcoholic parents rated their sons on hyperactivity, attention span/distractibility, and ADHD as measured by the DOTS (Table 6). Parental perceptions jointly accounted for a significant difference between the two groups on ADHD and Hyperactivity as measured by the Connors (Table 7) and also a significant difference for aggressive behaviors based on the results from the CBCL Aggression factor (Table 10). It should be noted that although the differences between the two groups did not differ statistically for all measures of child psychopathology when rated separately by both parents, boys being reared in the high risk family environments scored higher on all child problem behavior variables (with the exception of maternal ratings of Conduct Disorder) than boys 50 Table 6 Means (M), Standard Deviations (SD), and t-Test Comparisons for Parental Ratings of ADHD Behaviors (DOTS) High Risk Control (n=135) (n=65) Variable - M SD M SD .1; p. flyperagtive 1.83 1 17 1.44 1.13 2.24 .03 AttentionlDistract.6.08 2.96 4-97 2.99 .2.48 .01 AQflD 7.92 3.70 6.42 3.62 2.71 .01 51 Table 7 e ns M Standar Devi t'ons SD and t-Test Com arisons for Parental Ratings of Child Problem Behaviors (Connors & CBCL) High Risk Control (n=135) (n=65) Variable M SD M SD t p Attgntion 1.58 1.45 1.28 1.15 1.47 .14 Impulsivity 2.87 2.13 2.48 1.69 1.31 .19 Hyperactivity 3.74 3.12 2.69 2.27 2.42 .02 AQHQ 8.19 5.93 6.45 4.12 2.14 .03 Hyperactiyg Index 7.39 5.22 6.38 4.00 1.36 .17 Conduct Disorder 10.26 6.62 9.32 4.48 1.01 .31 52 Table 8 Means (M)l Standard Deviations (SD). and t-Test Comparisons for Haterpal Ratings of Child Aggression (CBCL) High Risk . Control (n=69) . (n=32) Variable M SD M 82 t 2 Aggression 12.16 6.75 11.03 5.55 .82 .41 Table 9 Means (M). Standard Deviations (SD). and t-Teet Comparisons for Paternal Ratings of Child Aggression (CBCL) High Risk Control (n=66) (n=33) Variable M §Q M ep p p Aggpession 12.41 6.57 9.79 5.96 1.93 .06 Table 10 Parental Ratings of Child Aggression (CBCL) High Risk Control (n=135) (n=65) Variable M §Q M SQ p p Agggession 12.28 6.63 10.40 5.75 1.96 .05 53 who are currently being reared in the low risk family environments (i.e., low levels of alcohol use and no abuse and low levels of antisocial behavior). The following figures are presented for both father and mother ratings separately and in combination (i.e., parental ratings) in order to depict the consistent trend towards psychopathology that we are seeing in children growing up in this high risk environment (see figures 1 thru 12). Further, these consistently higher scores for the various psychopathic variables lend themselves to the interpretation that a greater propensity towards psychopathology is due to one or more of the heritable/environmental risk factors available in the lives of sons of alcoholic/antisocial parents. Epeyalence of Problem Child Behaviors Even though the significant findings reported above were found for paternal ratings, most studies using self administered questionnaires find that maternal ratings are more reliable indices of their children's behavior. This may be due to the fact that in earlier life the mother, being the primary caregiver for the most part, spends more time with the child both qualitatively as well as quantitatively. Therefore, it was deemed appropriate to use mothers ratings exclusively when looking at prevalence rates of the various psychopathologies under study. Percentages of prevalence of the various behaviors under study can be seen in Table 11. 54 DIMENSIONS OF TEMPERAMENT (Maternal Ratings) ADHD and Component Behaviors D Controls I Risk Risk (N=69) Controls (N=32) Figure 1 55 DIMENSIONS OF TEMPERAMENT (Paternal Ratings) ADHD and Component Behaviors 1o .— ---------------------------------- DControls I Risk Risk ((N=69) Controls (N=33) *p<. 1 **p<.02 Figure 2 56 DIMENSIONS OF TEMPERAMENT (Parental Ratings) ADHD and Component Behaviors 10:] Hypornotlvo" Attontlon/Dlatr-ot‘ ADHD' r 1 Ci Controls .Risk Risk N=135 Controls N=65 *p<.ti1 “p203 ( ) k J Figure 3 57 CONNORS PARENT QUESTIONNAIRE (Maternal Ratings) ADHD and Component Behaviors 1o, ,. ------------------------- 8 .“ .................... 6 if." ---------------------- i 4 . .' ............ 2 O Attontlon I’mp‘ulclvo Hyperactive H ADHD 6 w [:i Controls I Risk Risk (N=69) Controls (N=32) K j Figure 4 __"** 58 CONNORS PARENT QUESTIONNARE (Paternal Ratings) ADHD and Component Behaviors 10- » ' ................... 8 j ......................... ...................... 4.. ........... 2" ......a... " ......m 6......a...‘ ...... [:iControls 598:. Mfgngzontrois (N=33) I Risk Figure 5 —l——"" 59 CONNORS PARENT QUESTIONNAIRE (Parental Ratings) ADHD and Component Behaviors 1o. Attention lmpulelve Hypereotlve' ADHD“ ' DControls Risk <62: 435)o Controls (N= 65) .Risk at P<0 Figure 6 _ 60 CONNORS PARENT QUESTIONNAIRE (Maternal Ratings) Aggressive Hyperactivity and Conduc Disorder 12 1o" D Controls I Risk Risk (N=69) Controls (N=32) Figure 7 61 CONNORS PARENT QUESTIONNARE (Paternal Ratings) Aggressive Hyperactivity and Conduct Disorder 12 1o" Ci Controls . I Risk Risk (N=69) Controls (N=33) Figure 8 62 CONNORS PARENT QUESTIONNAIRE (Parental Ratings) Aggressive Hyperactivity and Conduct Disorder 12 1o" El Controls I Risk Risk (N=135) Controls (N=65) Figure 9 63 CHILD BEHAVIOR CHECKLIST (Maternal Ratings) Aggressive Behavior 14 12 " 10" gggggggggg I:I Controls I Risk Risk (N=69) Controls (N=32) Figure 10 64 CHILD BEHAVIOR CHECKLIST (Paternal Ratings) Aggressive Behavior 14 12" 1o" Aggression” I I:IContro|s Risk 62:66) Controls (N=33) I RISK ap=_ Figure 11 65 CHILD BEHAVIOR CHECKLIST (Parental Ratings) Aggressive Behavior 14 12" 1o" Aggression* I:IControls Risk 6N=135) Controls (N=65) IR'Sk *p<. 5 Figure 12 66 Cutoff scores for the various measures were established based on the standardized cutoff score for the Connors Hyperactive Index as derived by Connors (1990). Based on his standardization studies, Connors came up with a standard cutoff score of 15 for the Hyperactivity Index; a child who meets or exceeds this score is considered to be in the clinical range for hyperactivity. In the current sample the children who met or exceeded this score were in the top ten percent of the group. Insofar as there are no formalized cutoffs for the other factors, and being that the individual factors have been altered so as to better define ADHD and Conduct Disorder behaviors, those children scoring in the top 10% for the other factors on this and the other instruments were also considered to be in the clinical range. Looking at the boys who met or exceeded the cutoffs for the various psychopathologies (Table 11), it can be seen that the majority of them are being reared in families where alcohol abuse and antisociality are exhibited at significantly high levels (see Table 12). Examining Table 11 reveals twice the incidence of ADHD, Hyperactivity, Impulsivity and Aggression in boys being reared in a high risk, alcoholic/antisocial environment as compared to those being reared in a low risk, non-alcoholic/non-antisocial environment. There is a discrepant finding between the results for rates of Attention Span/Distractibility problems 67 Table 11 zezcentages of Sons Meeting Cutoff Scores for ADHD. Qopduct Qisozger and Aggression Utilizing Maternal Ratings Risk Group Control Group (N=69) (N=32) QONNORS Attention 10% 9% Hyperactive 13% 6% Impulsive 13% 6% ADHD 12% 3% HR Index 10% 6% Conduct Disorder 9% 12% QOTS Att/Dist 13% 3% Hyperactivity 41% 19% ADHD 12% 6% CBCL Aggressive 12% 6% 68 Table 12 Meens (M), §tapdard Qeviations (SD)I and t-Test Compagisons go; garental Alcoholic Problems (LAPS) and Antisocial Behavior res Pagent High Risk Control (n=69) (n=32) Variable M fig M g; p p Mmefi LAPS 10.49 2.18 9.15 1.40 3.18 .00 ASB 12.85 8.62 8.34 5.32 2.73 .00 Eathers LAPS 10.49 1.86 7.05 1.38 9.41 .00 ASB 22.61 12.45 11.18 6.20 4.96 .00 69 between the two measures used; the Connors revealed nearly the same rate of occurance for the two groups, whereas the DOTS showed nearly four times the incidence in the high risk group when compared to the control group. This result can probably be attributed to the wider range of responses available for the Connors factor thus increasing the variability of item endorsement. Analysis of the factors from the DOTS selected to assess temperamental characteristics indicative of ADHD yielded some interesting results. As mentioned, four times as many boys in the high risk group exhibited behavior in the problem range for attention span/distractibility and two times as many for ADHD. However, the most interesting finding was the rather large group (one third of the entire sample) of perceived overly active youths in the present sample. Forty-one percent of the risk boys were in this group; over twice the rate (19%) of the boys in the control group. Again it must be pointed out that the range of response is more narrow on the DOTS questionnaire (1=true and 2=fa1se) thus, those boys who had all three items endorsed for this factor were considered to be overly active as perceived by their mothers, whereas, for the Connors Hyperactivity factor, only the top ten percent, as explained above, were considered to be overly active. This rather sizable group of children that met cutoffs for being hyperactive as defined by the DOTS, might not be clinically 70 hyperactive, insofar as pre-school aged children for the most part exhibit what adults might perceive as "inappropriate" levels of activity. However, it does serve to confirm the notion that sons of alcoholics tend to be more physically active than sons of non-alcoholics (e.g., Cantwell, 1975; Jones, 1968; Tarter et al., 1985). Looking at the rates of psychopathology in the two groups from a slightly different perspective yields a more striking comparison between the groups. When we examine only the group of boys who exhibited problem behaviors, the majority of them are being reared in high risk environments where alcoholism and antisocial behavior (as well as other psychopathologies not currently assessed; see Fitzgerald et al., 1991, and Zucker and Barron, 1973) are at significantly higher levels than in the comparison families. For example, of the boys who exhibit ADHD type behaviors in this sample, nearly 90% of them are living in the high risk environment. Similarly, 90% of the boys with attention span difficulties, 82% exhibiting hyperactive and impulsive behaviors, 78% aggressive hyperactive, and 80% exhibiting general aggressive behaviors are also being reared in a high risk environment. Only Conduct Disorder boys revealed no between group differences; a result probably due to the age of boys in this study and the rather small sample size of boys meeting problematic behavioral cutoffs. However, these findings point to the association of alcoholism and 71 hyperactivity, reaffirming that greater levels of risk yield greater levels of problematic behavior. Therefore, in the current sample, considering only abnormal behavior, it appears that risk for alcoholism and antisocial behavior significantly heightens one’s risk for poor behavioral outcome (Earls et al., 1988; Pihl, Peterson & Finn, 1990; Schachar, Rutter, & Smith, 1981). Qe-Morbidity of ADHD and Conduct Disorder Most researchers argue that ADHD and Conduct Disorder occur together in children and some insist that the two behaviors are in fact indicative of one syndrome (Hinshaw, 1987). Based on the Connors ratings, we observed that between 44 and 55 percent of those boys who exhibited ADHD, or "pure" hyperactivity, as it is so defined here, also exhibited Conduct Disorder behavior; nearly identical rates found on average for many studies (cited in Pihl & Petersons review, 1991) and consistent with and well within the 32-92% mean rates of overlap found elsewhere (Sandberg, Wieselberg, and Shaffer, 1980; Stewart, Cummings, Singer, and deBlois, 1981). In addition, of those boys who displayed behavior indicative of Conduct Disorder, 50% simultaneously met cutoff scores for ADHD. A more discrete breakdown of the component behaviors of ADHD revealed that forty percent of those boys who exhibited severe attention span difficulties also reached or exceeded the cutoff for Conduct Disorder, and 55% of boys meeting or exceeding cutoff scores for 72 impulsivity likewise were in this same group of boys with conduct behavior problems. The overly active boys (i.e., hyperactive) had similar, although somewhat lower, incidence of conduct disorder type behaviors (36%) as rated by the Connors Parent Questionnaire. The DOTS factors yielded very similar results. Forty- four percent of those boys exhibiting ADHD also met cutoffs for Conduct Disorder, as did 40% of the boys having attention span/distractibility problems. Among the large group of hyperactive children (n=34), 20% were in thei Conduct Disorder range again revealing an association between Conduct Disorder and ADHD type behaviors although, as will be discussed below, this was a lower rate of overlap than compared with overall ADHD and other ADHD component behaviors (i.e., impulsivity and attention span problems). In summary, of all the boys in the present sample who exhibited one or more of the problem behaviors measured here (n=43), the majority of them are being raised in risk environments (n=34) (i.e., this amounts to 50% of the high risk individuals in the study) and the remaining problem behavior children (n=9) are being raised in the low risk environments (i.e., this amounts to 28% of the controls). This provides confirmation that parental alcoholism (and antisociality) increases a child's chances for a poor behavioral developmental outcome in the pre-school years. And from other research, we expect that such problematic 73 behavior will be exacerbated in later childhood (Campbell, 1987) and adolescence (Blouin et al., 1978; August et al., 1983) so long as children continue to be exposed to parental alcoholism and antisocial behavior (Hinshaw, 1987). Ezedietors of Child Problem Behaviors Hypothesis II predicted that parental scores on antisocial behavior (ASB) and problems related to drinking (LAPS) would be significant predictors of psychopathology for children in the risk group more so than demographic variables, and that demographic variables would be predictors of psychopathology for children in the low risk group more so than problems related to parental drinking and antisocial behavior. To determine whether these hypotheses were correct, multiple hierarchical regressions were conducted. When testing for predictors of child psychopathology in children at high risk, parents’ LAPS and ASB scores were forced into the equation simultaneously and then the variables measuring SES, income and education were forced into the equation. This was based on the presumption that parental psychopathology in the alcoholic/antisocial parents is the primary factor contributing to child psychopathology and that demographic characteristics play a secondary role. On the other hand, for control families, the assumption was that the demographic variables would be more predictive of child psychopathology (i.e., ADHD, Conduct Disorder, and aggressive behavior), since parents 74 are presumed not to be pathological with respect to alcohol abuse or antisocial behavior. Regressions done for control families also contained two hierarchical steps of entry; the first being the demographic variables forced in together, and the second being LAPS and ASB scores forced in together. These assumptions were based on prior findings by Fitzgerald et al. (1990) that: 1) demographic factors were more influential on child activity levels in control families than was parental psychopathology, and 2) that parents in the control group revealed Significantly lower levels of antisocial behavior and problems related to drinking than the risk group. Preliminary correlation analysis revealed that LAPS scores in control families were unrelated to child psychopathology for both mothers and father and that only mothers' antisocial behavior was related to several child variables. As can be seen in Table 13, mothers correlations of LAPS and child variables in the control families are very small and non-significant while interestingly their antisocial behavior scores are highly correlated with several of the child psychopathology ratings. Note also that several relationships between mother ratings of child psychopathology and demographic variables (i.e., mothers education and family income level) were statistically significant as hypothesized. Fathers in the control group, on the other hand, showed no significant correlations 75 index for Variapies in Correlation Tables ent Ps cho atholo Variables LAPS - Lifetime Alcohol Problems Score ASB - Antisocial Behavior Score Eareptal Demographic Variables SES - Socioeconomic Status - Revised Duncan Code ED - Education INCOME - Family Income/Year Eegental Ratings of Child Ppobiem Behaviors Dimensions of Tempegament DHK - Hyperactivity DATT - Attention Difficulties DADHD - Attention-deficit Hyperactivity Disorder Connors Parent Questionnaire CHK - Hyperactivity CATT - Attention Difficulties CIMP - Impulsivity CADHD - Attention-deficit Hyperactivity Disorder CINDX - Hyperactivity Index 76 CINDX - Hyperactivity Index CCD - Conduct Disorder guild Behavior Checklist AGGR - Aggression (CBCL) 77 oo.H-¢m. .05. .m0. ..mv. mm. .12.. mm. ma. oHv. omm.l Hm.l Ho.l 00.255. .mm. 6mm. ..mv. .05. mm. 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The correlation analysis of risk family variables also substantiated, to a point, the rationale for the ordering of variables entered into the regression analyses. Tables 15 and 16 show the correlation coefficients for mother and father ratings of parental psychopathology and demographic variables with child problem behavior variables. Overall, the results were consistent with the hypotheses. Correlations for the mothers’ LAPS and ASB scores were significantly related to child problem behavior ratings while correlations for the fathers were much less so. In this particular sample it has been found that father ratings are significantly higher than mother ratings for both LAPS and ASB, so it was expected that the fathers’ psychopathology would be more related to and thus more predictive of their sons problematic behavior. 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