015“ g :‘ G's—=1 K “m J'tm F I‘\:5; t per Jay pt.“ ‘it‘fl 25"; (' J ("h {k gaudy; usacuv W-TEIJALE; mace h. now return to remve mam: frum cxrcu‘.¢:":n reccms fink-'8‘”? t9: Mm .«u// 73/ \F 9 '1 3 2" W " © 1980 ROBERT BLUM NOLL All Rights Reserved EARLY ASSESSMENT OF CHILD AND FAMILY VULNERABILITY IN ALCOHOLIC FAMILIES: A PROPOSED METHODOLOGY By Robert Blum Noll A THESIS Submitted to MiChigan State University in partial fulfillment of the requirements for the degree of MASTER OF ARTS Department of Psychology 1980 LEV/C4“ vow ABSTRACT EARLY ASSESSMENT OF CHILD AND FAMILY VULNERABILITY IN ALCOHOLIC FAMILIES: A PROPOSED METHODOLOGY By Robert Blum Noll This work develops the rationale and methodology for a longitudinal study of male children, and their families, who are statistically at high-risk for subsequent develop- ment of alcoholism. The project will identify specific childhood and familial characteristics that precede the onset of alcoholism. These data will provide crucial insights into the etiology of alcoholism and should be invaluable to mental health professionals. Formal data collection begins prior to the child's birth and is described through six years. An eclectic, but conceptually guided approach is employed which utilizes a broad range of psychometrics. Parental variables assessed include psychiatric status, drinking history, marital sat- isfaction, current life stress, etc. Variables assessed in the child include temperament, cognitive development, behavioral problems, etc. Transactions between parents and child are also examined extensively. The overall viewpoint of this work is that alcoholism develops as the result of Robert Blum.Noll transactions between numerous variables--biological, psychological, social, cultural. DEDICATION To Sparky--with his memory a family grows on. ii ACKNOWLEDGMENTS I would like to express my thanks to the members of my committee, Drs. Robert Zucker, Helen Bendict, and Hiram Fitzgerald. A special thanks goes to Robert Zucker, who has provided intellectual and emotional support, but most importantly, his friendship. Finally, I want to thank my family--Hope, Debbie, and David, for their love, patience, and support. iii TABLE LIST OF APPENDICES . . . . . . LIST OF TABLES O O O O O O O 0 LIST OF FIGURES . . . . . . . INTRODUCTION . . . . . . . . . Problems of Definition . . Rationale for Longitudinal OF CONTENTS Design in Research with Statistically High-Risk Children . . . Conceptual Models of the Etiology of Alcoholism . . . . . . . The Jessor Model . . . The Zucker Mbdel . . . REVIEW OF THE LITERATURE . . . Personality Theory as a Conceptual Basis . . . Genetic Studies as a Conceptual Basis . . . Etiological Theories from the Perspective of Longitudinal Data . . . . . . . . . . . Etiological Theories from the Perspective of Cross- Sectional Data . . . . . . . . . . . Summary . . . . . . . . . . . . . . . . . . The Problem . . . . . . . . . . . . . . . . METHOD 0 O O O O O O O O O O O O O O O O O O O 0 Subjects . . . . . . . . . . . . . . . . . . Rationale . . . . . . . . . . . . . . . Initial Contact . . . . . . . . . . . . Selection and Screening . . . . . . . . Procedure . . . . . . . . . . . . . . . . . General . . . . . . . . . . . . . . . . Prenatal Contacts . . . . . . . . . . . Obstetricians . . . . . . . . . . . First home visit . . . . . . . . . . Second home visit . . . . . . . . . Perinatal Contacts . . . . . . . . . . First 10 days of life . . . . . . . One month . . . . . . . . . . . . . iv Page vi vii viii 10 11 17 18 20 25 31 34 35 39 39 39 45 55 57 57 63 63 70 75 80 80 83 Postnatal Contacts Through the Two months . . . . Four months . . . . Six months . . . . . Eight months . . . . Eleven months . . . Contacts From One Year Through Fifteen months . . . Eighteen months . . Twenty-four months . Thirty months . . . Thirty-six months . Contacts From Three Years to Forty-two months . Forty-eight months Sixty months . . . REFERENCES 0 O O O O O O O O O O O O 0 ADDITIONAL REFERENCES . . . . . . . . o o 0 mo 0 o 0 800000 oooxooooo Ye ar K. o o o 0 Years 0 o o o n) o o o APPENDIX H MANUAL FOR OBSTETRICAL COMPLICATIONS APPENDICES A B I 00 ”0’60 2 3L" WC-c 0') Agency Parent Letter . Research Participation Informed Con- sent Form . Medical Information Release Form . School Achievement and Performance Release Form Follow—up Information Form . Modified SMAST . Background Information Questionnaire Manual for Obstetrical Complications Manual for Postnatal Complications Semi-structured Pregnancy Interview with Husband Semi-structured Pregnancy Interview with Wife . Semi-structured Interview Scales Gough Adjective Checklist History of Pregnancy . Antisocial Behavior Checklist Detailed Drinking History Feeding Scales Neonatal Perception Inventory Social Readjustment Rating Scales Four Scales for Rating Caregiver Behavior . . . . . . Work Questionnaire . Child Behavior Checklist vi Page 146 149 151 152 153 154 156 160 170 178 182 185 204 205 208 211 214 215 217 219 220 231 Table O‘U'I-I-‘UDN \l 10 11 LIST OF TABLES Contact Schedule . Estimated Time Requirements for Research Participants Volunteer Requirements Criteria for Drinking Categories Formal Predictions Anticipated Directions of Effect Inter-rater Reliability - Ainsworth Feeding Scales Summary of Strange Situation Procedure . Summary of Strange Situation Classifi- cations Simplified Version of the Chart of Social Behaviors . . . FICS Items Listed by Child Behavior Categories and Consequences Categories Details of Video Tape Sequences vii Page 47 52 58 62 64 66 86 106 109 114 119 125 LIST OF FIGURES Figure Page 1 A Heuristic Model for Changes in Influ- encing Structures Affecting Drinking Behavior over Developmental Time . . . . . 14 viii INTRODUCTION High-risk longitudinal research concerned with the etiology of the major behavioral disorders has become increasingly more prevalent during the past decade (cf. Garmezy, 1974; Hanson, Gottesman, & Meehl, 1977). While the majority of the work has focused upon schizo- phrenia, other types of psychiatric disturbances continue to plague society. Alcohol related problems cost the U.S. economy nearly 43 billion dollars in 1975 and are currently considered to be the fourth most serious health problem in the United States (DHEW, 1978; O'Leary & Wilson, 1975). While schizophrenia occurs in somewhat less than 1% of the overall population (Kramer, 1978; Woodruff, Goodwin, & Guze, 1974), prevalence estimates of the number of severe problem drinkers and alcoholics are 4-6%, or 9.3-10 million persons (Alcoholism & Drug Addiction Research Foundation, 1978; DHEW, 1971, 1978; Haglund & Schuckit, 1977). Primary or secondary problems with alcohol are associated with 50% of first admissions to mental hospitals (Haglund & Schuckit, 1977; Ullmann & Krasner, 1975), and evidence exists which suggests that the extent of the problem is underestimated in this population (McLellan, Druley, & Carson, 1978). Approximately 1 S to 6 million Americans are considered to be alcoholic (Chafetz, 1967, p. 1014; Haglund and Schuckit, 1977). More than 50% of all fatal traffic accidents involve alcohol. The problem seems to be increasing as in 1944, 5 deaths per 1000 were related to cirrhosis; in 1975, 21 deaths per 1000 were related to cirrhosis (Alcoholism and Drug Addiction Research Foundation, 1978); cirrhosis related deaths have increased 36% from 1960 to 1970. Most researchers currently agree that cirrhosis is the result of excessive alcohol consumption combined with the poor diet that frequently accompanies excessive drink- ing (Goodwin, 1976b). Clearly the scope of the problem is great; however, our knowledge of alcoholism, especially its earliest precursors, is limited. The earliest longi- tudinal research to date begins at the age of ten (Zucker, 1976). Problems of Definition A critical issue which high-risk research must address is the validity of the psychiatric diagnosis being utilized (Hanson et al., 1977). Typically research on alcoholism and/or problems directly related to excessive consumption of alcohol has employed varied criterion and/or different psychiatric labels for the same phenomenon. Keller (1972) cogently analyzes the criteria necessary for a behavioral- operational definition and concludes that both excessive drinking and ill effects from the drinking must be present. He states that the notion of alcoholism as a disease is based on an inability to control one's drinking despite the consequences, and defines alcoholism as "a chronic disease manifested by repeated implicative drinking so as to cause injury to the drinker‘s health or to his social or economic functioning" (p. 316). Cahalan (1970) also utilizes a similar operational definition, but concludes that the term "alcoholism" is not useful. Rather he prefers the concept of problem drinking along with a concurrent statement of the type of problems that the drinking has caused. While the philosophical and social consequences of the use of the terms "alcoholic" or "problem drinker" are great (c.f. Cahalan, 1970, for a discussion of this issue), the specific operational definitions employed by Cahalan and Keller vary only slightly. Cahalan (1970) includes frequent intoxication, as measured by frequency of drink- ing and quantity of alcohol consumed, as well as 11 typical problems associated with excessive drinking. These prob- lems include four items associated with the drinking behavior itself, four items connected with interpersonal relations, and three items that could fall into either of the aforementioned classes. Other researchers vary only slightly among themselves in their criterion of frequent intoxication or heavy drinking and utilize similar problem areas to establish a positive alcoholic diagnosis. Kaij (1972) uses the term alcoholism rather than problem drinker and includes four parameters: amount of drinking, social consequences, medical consequences, and presence of addictive symptoms. Other workers include consequences of alcohol abuse, symptoms of addictive drinking, social problems con- sequent to drunkenness, and interpersonal problems related to heavy drinking (Feighner, Robins, Guze, Woodruff, Winokur, and Munoz, 1972; Reich, Robins, Woodruff, Taibleson, Rich, and Cunningham, 1975). A minimum of one positive response in three of four categories is generally required for a diagnosis of alcoholism. Finally, Goodwin and his colleagues define an alcoholic as someone who meets their criterion for heavy drinker and has prob- lems in three of the following four groups. Group 1: marital problems or social disapproval of drinking; Group 2: problems with the job from drinking, traffic arrests, or problems with police related to drinking, Group 3; general pathophysiological indicators of exces- sive alcohol consumption; and Group 4: loss of control or morning drinking (Goodwin, Schulsinger, Hermansen, Guze, and Winokur, 1973). The Goodwin et al. criteria for heavy drinking and alcoholism are similar to those already mentioned. The National Council on Alcoholism established a criterion committee to enumerate criteria necessary for a diagnosis of alcoholism (Criterion Committee, 1972). The scheme for diagnosis is similar to the aforementioned systems; however, this work includes three different diagnostic levels, definite, probable, possible, which depend upon the number of clinical mani- festations of excessive consumption of alcohol and accom- panying problems. The criteria established by the com- mittee for a diagnosis of alcoholism are far more elaborate than any of the aforementioned diagnostic systems. This study will use the terms "problem drinker" and "alcoholic" interchangeably. An attempt will be made to carefully delineate specific diagnostic criteria used by the studies reviewed, as different diagnostic criteria can clearly cause samples and results to vary significantly. Altering the essential diagnostic cri- terion can change results far more significantly than the choice of diagnostic labels. Specific sampling tech- niques and criteria for inclusion of subjects into our study will be extensively discussed in the Methods section. Rationale for Longitudinal Design in Research With Statistically High-Risk Children A myriad of research has retrospectively examined the early life of the alcoholic; these studies attempt to trace the etiology of the disorder. This approach is beset with methodological flaws (cf. Yarrow, Campbell, and Burton, 1970). We are therefore left with a serious gap in the data which consequently diminishes our under- standing of the etiology of alcoholism. The present study attempts to begin to fill this critical gap. By selecting a small sample of neonates, identified as high- risk for subsequent development of alcoholism on the basis of parental characteristics which are known to be associated with disportionately greater numbers of alcoholic offspring, it is hOped that several realistic goals can be achieved. First, we hope to identify specific childhood charac- teristics that precede alcoholism. This would permit earlier identification and allow prevention programs greater long term impact (Zucker, 1974). Secondly, an attempt will be made to quantify the relationship between different predictors and the outcome of alcoholism. That is, by carefully matching high-risk subjects with suitable controls, and also considering factors which render infants high-risk for many other forms of later deviancy, it is hoped that infants can be identified as sepcifically being high-risk for alcoholism. Finally, this high-risk research should begin to answer questions about the etiological roots of alco- holism (see Hanson et al., 1977, for a more complete discussion of the aforementioned goals of high-risk research). The longitudinal approach offers numerous methodo- logical advantages. First, one can examine the effects of various classes of variables on the parents, the child, and their relationship across developmental stages (Kagan, 1964). Just as the differential effects of depression (Weissman, Paykel, and Klerman, 1972), divorce (Hetherington, 1979), and other life events (see Bron- fenbrenner, 1979) have been examined within the context of the family life cycle, the longitudinal method would permit a detailed study of the effects of paternal alco- holism as well as other classes of influence on the developing child who is statistically at risk. Evidence exists (cf. Nylander, 1960) that the effect of parental alcoholism on the child depends upon numerous factors such as personality of both drinking and non-drinking parents, sex of child, age, temperament of child, etc. (see Wilson and Orford, 1978, for a detailed discussion of potentially relevant variables). The longitudinal 8 approach to the study of the etiology of alcoholism allows the researcher to ulitize a transactional model of development (Sameroff, 1975; Sameroff and Chandler, 1975) to follow the growth of the developing child across time, while assessing the effects of numerous classes of influence on the developing organism. Second, the longitudinal method can offer relief from data bias, as well as providing current information that is systematically and uniformly collected. Data collection can occur before subjects suffer from the ravages of the disorder (cf. Mednick and McNeil, 1968). Third, the longitudinal approach would allow a temporal sequence to be established without bias, to ascertain whether other difficulties (i.e., impulsivity, depression, alienation)typicalLyassociated with problem drinking tended to precede the drinking problem, or if the drinking problems were antecedent to other diffi- culties (Cahalan, 1970; DHEW, 1971). This approach would hopefully offer insight into the issue of alco- holism as an illness, and/or alcoholism as a symptom of other illnesses (Schuckit, 1972). While the continuity of data and other advantages already mentioned make high-risk research utilizing a longitudinal design desirable, certain pitfalls central to this method do exist. Achenbach (1978a) cogently discusses problems associated with age, cohort, and time of assessment, carefully noting inherent limitations of longitudinal designs. The results that Nesselroade and Baltes (1974) obtained utilizing a longitudinal- sequential design clearly demonstrated the limitations which Achenbach discusses. Mednick (1978) also discusses problems of the high-risk method with respect to sampling and the inevitable biased selection of cases. He con- cludes that the only alternative would be to assemble a birth cohort of 10,000 and study them intensively for an extended period of time, although even this exhaus- tive project would require replication (cf. Clarke- Stewart, VanderStoep, and Killian, 1979). Due to the exploratory nature of this study, the weaknesses of the longitudinal design as well as its strengths make it an acceptable design. Conceptual Models of the Etiology of Alcoholism Much of the research on alcoholism has been completed without over arching theoretical models serving as a conceptual framework. When a specific orientation was utilized, it typically viewed alcohol problems from a monist perspective. For example, problem drinking has been conceptualized as an attribute of personality (of. Williams, 1976) or the result of nonspecific biological or genetic variables (cf. Goodwin, 1976a). Other workers have viewed problem drinking from the perspective of 10 sociolocultural variables (of. Cahalan, 1970) or as an attribute of specific situational stressors(cf. Snow, 1975) which lead to alcoholism. Recently, work has begun to attempt to integrate the above classes of influence into a model which takes a more broad based perspective. Kissin (1977) cogently points out that a single faceted theory of the etiology of alcoholism is clearly no longer a tenable theoretical position. Only a multi-faceted model which attempts to integrate biological, sociocultural, and personality variables as interacting classes of influence can rea- sonably account for the acquisition of problem drinking behaviors. Two theorists who attempt to develop a model which can account for the acquisition of drinking behaviors and problem drinking per se using a multi-faceted model are Jessor and Zucker. The Jessor Model Richard Jessor and his colleagues (1968, 1973) are specifically concerned with the acquisition of deviant behaviors and their development in youth. Problem drink- ing is one of a host of asocial and antisocial behaviors which Jessor examines under the general rubric of deviant behavior. According to Jessor, behavior is the result of sociocultural and personality variables which Operate simultaneously. These two major classes of variables are each divided into subsystems that in turn are further 11 divided into measurable component elements. For example, Jessor originally divided the personality variable into three substructures: the personal belief structure, the personal control structure, and the perceived oppor- tunity structure. Within the personal belief structure was the individual's general cognitive orientation. Spe- cific variables which Jessor employed to measure this area were locus of control and alienation. While specific component elements within the model have changed as fur- ther work has been completed, the basic model structure has remained consistent. When the model is applied developmentally, Jessor emphasizes the reciprocal influence of major variables and their subsystems across time. One major limitation of the Jessor model is the lack of a specific developmental time frame within which various classes of variables may become more or less salient. A second limitation of the model is that typically the percentage of variance which has been accounted for is 10-55%. Finally, the Jessor model is oriented towards general deviant behavior rather than the specific form it may take, such as excessive drinking. Greater spe- cificity is clearly called for. The Zucker Model The Zucker (1976, 1979) model of develOpment of drinking behavior places emphasis upon problem drinking 12 within the general context of antisocial behavior. Orig- inally Zucker postulated that problem drinking had its origins in disturbed or dysfunctional family relation- ships. Specifically, inadequate satiation of the child's dependency needs as well as disturbed emotional relation- ships among family members were viewed as critical. The final significant component was the parents' failure to provide appropriate discipline and control for the child. Subsequent work on the model has focused on classes of influence as they impact upon the child from both a cross-sectional and longitudinal perspective. Zucker postulates that four major classes of influence have a major impact upon eventual problem drinking behaviors. Class I influences are social and community factors; Class II influences are from family of origin focusing Specifically on child rearing practices and parental personality influences; Class III influences deal pri- marily with peer group socialization factors; and Class H] influences are intra-individual components such as per- sonality, temperament, and physiological factors that may influence predisposition towards excessive alcohol consumption. These four classes of influence are examined longi- tudinally as the salience of each class of variable is postulated to change along with the develOpment of the 13 organism. As can be seen in Figure l, Zucker has hypothe- sized that specific classes of variables may be less relevant during certain developmental time frames, while others are of greater import during the same time frame. While the Zucker model addresses some of the limita— tions inherent to the Jessor work, several problems remain. First, the majority of Zucker's data is generally cross— sectional and was obtained on samples of adolescents. Longitudinal data is essential to test the limitations of the model. Second, while the model postulates various classes of influence ebbing and flowing with development, there is a lack of specificity with respect to exact variables which would precisely assess the global effects of the four classes of influence. The dimensions of this problem become exaggerated when a developmental perspec- tive is taken along with longitudinal methodology. Finally, the general classes of influence are excep- tionally broad based. From the general overall model perspective this limitation is not serious, but as hypotheses become more specific the classes are so broad that inter-class clusters of variables become important. For example, the fourth class of influence, intra indi- vidual, includes personality influences as well as physi- ological. Some workers would argue that these classes of influence deserve separate categories. 1.4 mama .uoxusu Eouh claw H-uaoanoHo>ua uu>o uo«>n:on measuwun unauuouu< nousuusuum meuucoaaucu :« nous-:0 you done: ouuuuuaoz < . mmDUHh noozaduzu >Au«u=«-.uuea / _.I.|ll Ill. _ A30: ucu>oaou uozv" coo—53:5 Amozuummaoa<=mn P. IL oszszn \\\\V 63:33.: Ewan-loo v:- acuauazuouuom “noozpasn< >4a<=mn ozuxzuen -nleJ I want/33 new: 15 While the Zucker model clearly has limitations, its major advantage is the unique application of a devel- opmental perspective to the etiology of problem drinking. The notion that various classes of influence may increase in significance across stages of the life span and at other times lose relevance is common for developmental life span psychologists. This orientation makes the Zucker model easily adaptable to a longitudinal study of children who are statistically a high-risk for sub- sequent development of alcoholism. The present study is a pilot, designed to gather data in an area that has not previously been systemati- cally studied. It begins formal data collection prior to the birth of the offspring, utilizing an eclectic, but conceptually guided approach involving a broad range of methods and instruments, in an attempt to discover the exact dimensions that are most salient (see Parke, 1979). Through the use of observations, both formal and informal, as well as numerous standardized psycho- metric devices, the groundwork will be laid for the even- tual study of a larger group of high-risk subjects in a combined cross-sectional-longitudinal design that could possible have transcontextual validity (weisz, 1978) for the development of alcoholism. The overall viewpoint of this work is that alcoholism develops as the result 16 of transactions between numerous variables--biological, psychological, social, cultural. The developing organism is examined within a larger ecological setting (Bronfen- brenner, 1977), attempting to understand the texture of the transactions between the high-risk child and his environment (Baltes, 1979; Bell, 1979; Brazelton, 1978; Sameroff, 1975, 1978). It is expected that direction of effects may vary during different developmental stages, dependent upon present salient issues for both the spe- cific family and the child (Ainsworth, 1979; Field, 1978; Parke, 1979). Our goal is to identify characteristics of the child, the family, or the dynamic interactions between them, which are clearly high—risk markers for subsequent development of alcoholism as early in life as possible, so that mental health professionals can strive towards prevention rather than rehabilitation. Because this work is a pilot study and problem drinking is more prevalent in males (DHEW, 1971, 1974), this study will focus predominantly on the etiology of excessive drinking in men. REVIEW OF THE LITERATURE Numerous previous studies have attempted to recon- struct the history of the alcoholic in an attempt to understand the development of the disorder. This work has largely focused on the acquisition of retrospective information about the alcoholic's earlier life, rather than sifting through data which had been collected during earlier critical time periods. Major studies within this area can be subsumed into two general subtypes: 1) retrospective research, and 2) longitudinal research which adds on a retrospective dimension in an attempt to acquire information prior to the onset of the study. It is interesting to note at this time that although many of the major psychological (cf. Blum, 1966; Williams, 1976) and/or biological U:f.Goodwin, 1976, Kissin, 1977) theories pertaining to the etiology of alcoholism give credence to the notion that alcoholism is caused by very early developmental events, none of the previous research in this area has begun early enough to examine the criti- cal questions without encountering the serious methodo- logical flaws inherent to retrospective research. Also, the majority of this work has either lacked a basic 17 18 conceptual model or employs a monist model. By examining studies done utilizing the above methods and conscien- tiously avoiding "enlightened historical selectivity" (Nathan and Lansky, 1978) an attempt will be made to select markers which might be indications that an infant is high-risk for subsequent development of alcoholism. Personality Theory as a Conceptual Basis In an extensive clinical study with alcoholics, Blane (1968) attempts to analyze the personality of the alcoholic. This work scrutinizes the personality of the alcoholic and the psychological needs which the drinking helps to satisfy. Blane states that male alco— holics suffer from a conflict between exaggerated depen- dency needs and the gratification of these intensified needs. The vital element which varies from individual to individual is the method of conflict resolution--how the alcoholic resolves the conflict between dependency needs which needs to be fulfilled and a masculine iden- tity which prevents satiation of these needs. According to Blane, alcohol is the solution to the conflict over dependency wishes, since drinking is typically regarded as masculine activity and also provides feelings of comfort and warmth. We are left with the question of how alcoholic men develop the exacerbated dependency need which 19 culminates in the alcoholic experience. Blane (1968) attempts to understand the dynamic personality of the alcoholic, but offers little specific data for under- standing the ontogeny of the alcoholic personality. The strong dependency need apparently originates in earlier childhood experiences; but what specific events are responsible? Extrapolations are carried out by some theorists, moving from the adult alcoholic to hypo- thetical causal agents in earlier life (e.g., White and Watt, 1973). This process is attempted via the acquisition of retrospective information and through deductive logic, although both methods have serious shortcomings. Since the human organism is in its most dependent state as an infant, gradually becoming less and less dependent, it seems obvious that proponents of dependency theory would begin their search for the origin of the exaggerated dependency needs during this earliest period of life. This theoretical orientation to problem drinking places greatest emphasis upon intra- individual influences (Class IV) with secondary implied emphasis upon family of origin influences (Class II). The effects of sociocultural factors (Class I) as well as peer personality and peer socialization (Class III) are not integrated into the dependency hypothesis. While numerous other researchers have examined the personality 20 of the alcoholic (see Williams, 1976, for an excellent review of this literature) in an attempt to uncover hypothesized underlying personality constructs or con- flicts that are unique to the alcoholic population, none have succeeded thus far. Much of this work lacks the conceptual clarity of Blane's clinical research; however, others have completed excellent work on the alcoholic personality, most notably McClelland and his research group. The best of this work is plagued by the same serious methodological problems as Blane's work, therefore it would be pedantic to review this work here. The interested reader is referred to several excellent reviews of this literature (cf. Barry, 1974b; Williams, 1976). Genetic Studies as a Conceptual Basis The juxtaposition of Blane's work with Goodwin's (1976a) comprehensive review gives us another perspec- tive into the alcoholic problem, as Goodwin presents evidence which is contrary to the notion of an alcoholic personality type. Alcoholism is viewed as a family disease, as no previous study of male alcoholics had less than 25-50% of the male relatives also alcoholic (Goodwin et al., 1973; Goodwin, Schulsinger, Knop, Mednick, and Guze, 1977; Gregory, 1960; Schuckit and Haglund, 1977; Winokur, Reich, Remmer, and Pitts, 1970). 21 Why does the affliction with alcoholic addiction seem to run so consistently in families? Further evidence is suggested from one of Goodwin's earlier studies that utilized a Danish sample where subject location and follow—up is easier to achieve (Goodwin et al., 1973). Probands (biological father alcoholic), who were removed from their family during early infancy and raised by families without alcohol problems, were compared to their stepbrothers (biological fathers nonalcoholic). The groups were not different on a large number of dimen- sions (e.g., SES, educational experience, non-alcohol psychiatric illness), but differed significantly with respect to serious alcohol problems. The control group of adoptees surprisingly had more heavy drinkers, while at the same time contained few drinkers who had serious problems as a result of excessive drinking. A subtle, but very important distinction is made between heavy drinking and excessive drinking that causes other prob- lems for the drinker. The conclusion reached from this study is best summarized by the following passage: "Sons of alcoholics were no more likely to become alcoholic if they were reared by their alcoholic parent than if they were separated from their alcoholic parent soon after birth gnd7zeared by nonrelatives" (Goodwin, 1976, Goodwin's work has been sharply criticized by Tolor and Tamerin (1973). First, the assessment of 22 psychopathology in the adoptive parents of both groups was based upon information provided by the adopted sub- jects and was concerned only with gross pathology (seeking treatment). This approach makes it impossible to insure that both groups of parents were equivalent on this crucial dimension. A second major criticism of the work was that the evidence favoring the genetic hypothesis is based solely upon four cases. That is, of the 55 probands, four were hospitalized and definitely diagnosed as alcoholic. While the results were statistically significant, one must consider the practical significance of basing conclusions on four cases. It seems more interesting to wonder about the 51 probands who were not diagnosed as alcoholic. Finally, Goodwin's manner of grouping the data to reflect drinking severity seems highly arbitrary, although it was done in the blind. The slightest alteration of his categories would dra- matically change the results of his work. Also, general criticism of the adoption study method can be made on the grounds that Danish adoptees often (approximately 60%) have some knowledge of their biologic parents (Eldred, Rosenthal, Wender, Ketz, Schulsinger, Welner, Jacobsen, 1976). The precise effect of this contact on subsequent development of alcoholism has not been investigated. Clearly, the work of Goodwin requires replication. 23 Further evidence for the heritability of alcohol problems is advanced by a Swedish study (Kaij, 1960) that compared concordance rates for alcoholism between monozygotic and dyzygotic twins. The identical twins were concordant for alcohol problems in 54% of the cases, while fraternal twins were concordant in 28% of the cases. The twin study method was also utilized in a Finnish study (Partanen, Brunn, and Markkanen, 1966). The main findings of this research were that normal drinking, abstinence, and heavy drinking show some heritable variation, while arrests, signs of addiction, and social complications seem unrelated. The authors differentiate the two groups of variables, the former as actual drinking behaviors and the latter as the social consequences of drinking. These data seem to show that actual drinking behaviors are affected by heritable factors, while the consequences of drinking behavior are not affected. Partanen (1972) concludes on the basis of these data that "innate differences between individuals in their propensities to consume alcohol" (p. 114) clearly exist. It is important to keep this distinction between actual drinking behavior and social consequences for drinking in mind. Although the twin study method has often received criticism (cf. Rosenthal, 1971), it does provide valuable information which can be 24 viewed as a vital first step in the process of under- standing the interplay between genetic and environmental factors (DeFries and Plomin, 1978; Fischbein, 1978). The final study reviewed which presents evidence for the heritability of alcohol problems utilizes the half-sibling method (Rosenthal, 1970). This study by Schuckit, Goodwin, and Winokur (1972) examined primary alcoholics (i.e. those with no other major psychiatric disturbance) who had a half-sibling. A diagnosis of alcoholism was based upon excessive drinking that had caused serious problems with health or social adjustment. This research focused on the relative influence of having a biological parent who was alcoholic versus being reared by an alcoholic parent. While their sample size was small (N = 41), all of their findings indicated that having an alcoholic biologic parent was the most predic- tive factor of an alcoholic outcome in these offspring. Living with an alcoholic parent did not increase the incidence of alcoholism for those half-siblings who did not have a biological alcoholic parent; nor did living with an alcoholic parent increase the incidence of alcoholism for those half-siblings with a biological alcoholic parent. Schuckit et a1. concluded "having an alcoholic parent was the strongest predictor of alco— holism in the half-siblings" (p. 126). Investigations 25 of adopted and nonadopted sons of alcoholics report similar results (Goodwin, Schulsinger, Moller, Hermansen, Winokur, and Guze, 1974). The numerous studies reviewed in this section pur- port that alcoholism is a familial disease with a non- specific genetic component. Utilizing a myriad of complex methods designed to estimate the proportions of variance specifically attributable to genetic factors or environ- mental factors, these researchers conclude that a genetic component plays a significant causal role in the etiology of alcoholism. It is noteworthy, however, that none of these studies identifies the critical genetic mechanisms or specifies the nature of their undoubtably complex interactions with environmental factors (see Gottesman, 1974, for a discussion of this problem). The genetic studies place emphasis exclusively upon intra-individual differences (Class IV) of a biological nature. The effects of sociocultural (Class 1), family of origin (Class II), and peer factors (Class III) are not inte- grated into this model. Etiological Theories from the Perspective of Longitudinal Data Several studies have looked at problem drinking with the specific intent of identification of its pre- cursors (see Zucker, 1976, 1979, for reviews of all 26 longitudinal studies completed). This work follows the course of development across time. As members of the subject pool subsequently have problems associated with drinking, the data that already exists can be care- fully examined to see what commonalities exist between different afflicted individuals. This design (follow- through methodology) avoids the pitfalls already men- tioned with retrospective analysis or extrapolation vis-a-vis deductive logic to assumed earlier events, although the longitudinal method does have several basic limitations that have already been mentioned (for an extensive discussion of the strengths as well as limita— tions of the longitudinal method see pages 7 and 8). The Oakland Growth Study has yielded some interesting information on the earlier life of the problem drinker. The work of Jones (1968) specifically looks at antecedents of drinking patterns in adult males and possible person- ality correlates. The age of first contact with subjects was 10 and the last follow-up at 33. The criterion for diagnosis of problem drinker was extensive interview data in conjunction with a medical examination. Part of this study reports on the pre-problem drinkers in junior high school. Jones discovered that male pre- problem drinkers tended to be extroverts who had a nega- tive attitude towards life. Also they were impulsive 27 in an unpredictable fashion, tending to be dissociative and disorganized. Many of these characteristics remained consistent across time, continuing to manifest themselves when later evaluations were conducted. Within the pro- posed model we employ, these results focus on intra- individual (Class IV) effects. Jones' work produced vital information about the early life of the problem drinker which enhances our understanding of the ontological progress of alcohol problems. Additionally, it yielded some information about the family life of the problem drinker (Jones, 1971). These data are considered to be Class II (family of origin) factors of influence. Specifically, those men who developed drinking problems had mothers who tended to be sour and disagreeable, while at the same time they seemed uninterested in their son. These women disliked their position in life and felt unhappy about their status. Jones (1968) concludes that the men with drinking problems have developed an intense independence- dependence conflict, as a result of earlier familial experiences, which is resolved through the use of alco- hol. She concludes that the combination of under—control and inability to function in a dependent relationship seems to be one which causes men to be highly susceptible to problems with alcohol. Jones has examined two classes 28 of influence within our purported model. Her conclusions fit easily into the theoretical framework of the Zucker model as she postulates that interactions between ClassII variables (family of origin) and Class IV variables (intra-individual) ultimately cause the male to have problems with dependency relationships which leaves him highly susceptible to future problems with alcohol. An extensive examination of alcoholism utilizing data obtained vis-a-vis the longitudinal method is found in McCord and McCord (1960). Their work places emphasis upon the family, the individual, and the interaction between them, examining in detail the environment within which the high-risk child develOps, prior to the overt manifestation of the alcoholic disorder. First contact was when these subjects were 10 or a bit older, and was maintained for over 20 years. All subjects were males and alcoholism was diagnosed on the basis of public records from hospitals, welfare agencies, and courts. According to the McCords, the primary source of alco- holism in males is a dependency conflict. The conflict is the result of permanently heightened dependency needs, which cannot be satisfied because of the male role con- fusion of the child. These data are intra-individual factors (Class IV). The aggression and antisocial behavior commonly manifested by the prealcoholic male 29 (also see Zucker and Barron, 1973) is simply a reaction formation against strongly felt needs to be cared for and nurtured, needs that in turn are experienced as unacceptable (McCord and McCord, 1962). While the height- ened dependency needs remain as the primary contributing factor, the male alcoholic also suffers from role con- fusion. The combination of these two specific elements culminates in alcoholism, rather than some other type of psychopathology. The work of the McCords is unusually rich in its examination of the earlier family life experiences which seem to cause the alcoholic's conflict. They carefully examine potential effects of parental personality and style of discipline (Class II factors) along with the developing child's personality (Class IV factors). Their data suggest that the inferred heightened dependency needs are caused by inconsistent mothering and intense parental conflict. Other factors which are thought to contribute include maternal escapism and maternal deviant behavior. The picture which emerges from their data is that of a male child who gets inconsistently good care. The vascillations between good care and neglect cause the child to always want more. Additionally, because of of the antagonistic maternal attitude towards society, the child never feels completely safe with his 30 relationship to his mother (i.e., if she escapes from other problems, perhaps she's not completely safe for me). These investigators believe that the source of the adult alcoholic's role confusion lies in a number of variables which are intertwined with the child's father. These fathers were found to show more active rejection, punitiveness, escapism, and made low demands of their sons. Thus the paternal model available is the one which is ultimately identified with by the child. These boys are not trained by example or by apprOpriate discipline to accept the responsibilities of an appro- priate male role, and fluctuate between roles, never feeling certain of their identity (see Lamb, 1979, for an excellent discussion of these issues). Ultimately, the child develops a confused self-image. The primary factors which seem to combine to cause the alcoholic solution are inconsistent mothering, maternal deviance, paternal antagonism, and parental escapism. These fac- tors combine to cause the exaggerated dependency needs, the masculine role confusion, and the resulting conflict. While these variables contributed to many types of psychopathology, the McCords feel that this specific combination of complex elements results in alcohol related deviance. 31 The model that the McCords suggest is associated with the following pattern. The family background of the future alcoholic (from 10 onwards) is one of general stress and erratic satisfaction of dependency needs, along with inadequate specification of the male role. The result of this environment is a male who has inten- sified dependency needs along with conflicts over means of satisfying these needs. This specific constellation of elements leaves the male vulnerable to alcoholism rather than other types of psychopathology. While the specific variables assessed by the McCords differ from those of Jones, these researchers postulate similar models. Both hypothesize that the most critical factors are earlier familial factors (Class II) which interact with the developing child's personality (Class IV). These two classes of influence and the interactions between them are hypothesized to cause a specific per- sonality type to develop which is highly susceptible to future drinking problems. Etiological Theories from the Perspective of Cross-Sectional Data Substantial cross-sectional evidence exists which links male adolescent problem drinking with both con- current and presumed earlier antisocial behavior and impulsive activity (Costello, Parsons-Manders, and 32 Schneider, 1978; Demone, 1972; Jessor, Graves, Hanson, and Jessor, 1968; Jessor and Jessor, 1973; Schuckit and Childes, 1978; Williams, 1970; Zucker and Barron, 1973; Zucker and Devoe, 1975). Some of these studies (Demone, 1972; Schuckit and Chiles, 1978; Zucker and Barron, 1973) also found that adolescent males who were already manifesting these types of pathology had dis- turbed affectional relationships within their family structures. An interesting aspect of Zucker and Barron's data was that the mother's drinking patterns were more predictive of the son's drinking behavior than were the father's. Further data on adolescent behaviors has demonstrated that antisocial and impulsive activity can precede future alcohol abuse (Jessor, Collins, and Jessor, 1972; Robins, 1966). Since antisocial behaviors frequently occur along with alcohol abuse and often even precede the alcohol abuse, perhaps a pattern exists which may be utilized by mental health professionals to intervene prior to the actual alcohol abuse. It is interesting to note that nearly all of the work on childhood hyperkinesis includes impulsiveness as an essential component in the syndrome (Cantwell, 1978; Goodwin et al., 1975; Lambert et al., 1976; Rosen- thal and Allen, 1978; Sandoval, 1978; Werry, 1968), although impulsiveness is a very common feature of many 33 psychiatric disorders of childhood (Rutter, 1977). On this basis some have argued that the prealcoholic male manifests the hyperactive child syndrome during middle childhood (Cantwell, 1972, 1978; El-Guebaly and Offord, 1977; Goodwin, Schulsinger, Hermansen, Guze, and Winokur, 1975; Morrison and Stewart, 1971). While some researchers argue that hyperactivity has a genetic etiology with an organic basis (Cadoyet, 1976; Humphries, Kinsbourne, and Swanson, 1978), others argue against an organic and/or genetic basis (see Dubey, 1976; Grinspoon and Singer, 1973). A second major issue is that hyperkinesis lacks a standardized diagnostic definition (Lambert, Windmiller, Sandoval, and Moore, 1976; Loney, in press; Rosenthal and Allen, 1978). Related to the diagnostic issue, the primary or core symptoms of hyperkinesis vary widely. This variation depends upon the source of the data (Langhorne, Loney, Paternite, and Bechtoldt, 1976), the type of measurement employed (Barkley, 1977; Sandoval, 1978), and the item pool utilized (Lahey, Stempniak, Robinson, and Tyroler, 1979; Loney, Langhorne, and Paternite, 1978). The aforementioned limitations must be carefully considered when links between hyper- activity and alcoholism are discussed. Despite the limitations, it is interesting to note that when 76 hyperactive children were followed up into young 34 adulthood, impulsiveness and immature personality dis- turbances remained characteristic (Weiss, Hechtman, Perlman, Hopkins, and Wener, 1979). This work requires replication and further follow-up into the peak period of incidence for onset of alcohol related problems, to ascertain if problem drinking eventually manifests itself subsequent to childhood hyperkinesis. Summary The work discussed thus far provides some leads into the possible etiology of alcoholism, but it is particularly weak in areas that concern behavioral mani- festations occurring prior to age 10 that are the pre- cursors of alcoholism. The earliest longitudinal studies that deal with the ontogeny of alcoholism have not begun until late childhood, and most begin in late adolescence. A second major limitation with the work cited is that only two major classes of influence are integrated into the theoretical models that are developed. Greater emphasis must be placed upon potential sociocultural classes of influence as well as the potential effects of peers. While some of the work that has been reviewed seems to indicate that the first "sensitive period" in the etiology of alcoholism in males might not occur until the child reaches his second or third birthday (i.e., dependency theory), clearly strong evidence has 35 been cited that indicates some hereditary predisposition to alcoholism in males does exist (also see Cotton, 1979; Seixas, 1977). If the genetic hypothesis is correct, the precursors for subsequent alcoholism could be present from birth onwards. All previous attempts at conceptualization of the earliest stages of develop- ment of the prealcoholic male have been done without actual observations and systematic data collection. The Problem The present study is aimed at beginning to fill the critical gap which exists in our understanding of the development of alcoholic disorder. The familial evidence previously discussed, the recurring theme of dependency, and the impulsivity of the alcoholic lead us to the earliest stages of life for answers (also see the Methods section for further discussion of the rationale for data collection beginning prior to birth). This work will serve as a pilot study, attempting to move into new areas to advance our understanding of the alcoholic problem. The aim is to conduct a longi- tudinal study which begins contact during the eighth month of pregmancy. The primary concern is to acquire extensive amounts of information, using a wide variety of techniques such as formal and informal observations, questionnaires, public records, and experimental 36 paradigms. It is hoped that if high-risk markers exist, they will be detected through the use of a conceptually guided, broad-based approach. This work will permit perfection of methodology and a narrowing of feasible hypotheses so that eventually a study can be conducted using a larger group across a broader span of time. Following the model which Zucker proposes, initial focus will be placed upon assessment of factors within the Class II (family) sphere of influence. Assessment will be made of parental psychiatric status placing special emphasis upon appraisal of depressive symptoma- tology, antisocial behavior, hostility, and current levels of alcohol consumption. Additionally marital satisfaction and current stressful life events will be assessed. This initial phase of the project will also include the col- lection of extensive demographic data (Class I, sociocultural). Further data collection during initial phases of the project will be of an exploratory nature. Parental variables that will be surveyed include obstetrical data and current reactions of both parents towards the unborn child. Prenatal influences on both parents will be carefully deliniated as they may potentially affect the child (Class IV). 37 The birth of the child will mark the onset of assess- ment of intra-individual variables (Class IV). Careful examination of early temperament; mood; attachment phe— nomena (both as an attribute of the child and as an interactional phenomena); activity level and its poten- tial precursors and possible successors (i.e., impulsive activity); and general developmental status will be made. This initial focus on intra-individual factors (Class IV) will quickly shift as the child matures to include familial factors (Class II) and assessment of interactions between the mother and her infant during early initial situations (i.e. feeding). As the child develops during the first year of life and thereafter, measures in the aforementioned areas will be repeated. This will permit us to establish the beginnings of a map of both generic develOpmental change as well as presumed central etiological factors which have been suggested by the research on older populations. Data will be analyzed both cross-sectionally and longitudinally. The cross-sectional data analysis will initially compare high-risk families to control families on specific outcome measures (see Methods section, p. 43 for a discussion). More elaborate cross-sectional sta- tistical procedures will be utilized when samples become sufficiently large. For example, it is anticipated that 38 cluster analytic techniques can be utilized when the number of subjects approaches two hundred (see Comrey, 1978), although this will not occur for some time. The longitudinal data analysis will initially com- pare each new subject's data to the data collected on each earlier subject. Thus, as data are collected on new subjects across time, individual cases can be com- pared to one another as in a between subjects design (Mahoney, 1978); the independent variable is the presence or absence of an alcoholic father. These procedures will hopefully reveal that certain specific patterns of results are unique to either high-risk or control families. If reliable data collection is achieved when using this design, then reasonable internal validity will result (see Kazdin, 1978). When sample sizes become large enough, the data can be analyzed with path analysis to attempt to assess directions of effects and inter- actions. Sufficient data to utilize these types of techniques will not be generated for quite some time. METHOD 'SubjeCts Rationale Due to the higher rates of alcoholism among men (DHEW, 1971, 1974), all subjects will be male. Since families will be contacted prior to the birth of the child, those families that have female babies will not be followed after childbirth. While this procedure will make subject acquisition more difficult, it will permit both direct observations of the mother during pregnancy and early observations of the neonate. The research program will begin prior to the birth of the child for several reasons: (1) Considerable evidence suggests that both males and females with a biological alcoholic parent have a substantially increased risk of subsequently becoming alcoholic (see Cotton, 1979, for an excellent review of this literature). While the data indicate that alcoholism is often a familial disorder, insufficient data exists to identify specific etiological mechanisms. Recent evidence found that children of alcoholic parents "show significantly elevated levels of acetaldehyde when exposed to moderate doses of alcohol" (Schuckit & Rayses, 1979, p. 55). Perhaps these high-risk children, from birth 39 40 onwards, manifest subtle.harbingers of future problems (see Schwartz, 1979). (2) McCord and.McCord (1962) found that male alcoho- holics exhibited more overt seeking of comfort, care, and direct guidance than nondeviant controls. These behaviors were categorized by the McCords as dependency behaviors. Since alcoholic males manifested more of these behaviors they concluded that alcoholics are excessively dependent. An interesting aspect of the McCord's data was that the male alcoholics exhibited fewer gygrg dependency behaviors than controls during adolescence (also see Blane & Chafetz, 1971; Jones, 1968). Zucker (1968), using the Gough Femininity Scale, found that heavy drinking adolescent males scored higher on tests of overt masculin- ity, but found no differences on tests of covert mas- culinity. Alcoholics have been found in general to prefer foods that are smooth, bland, rich, soft, and wet, more often than controls. A preference for these type foods was considered an indication of more intense oral passiv- ity (WOlowitz, 1964, 1968). Finally, alcoholics have been found to be perceptually more field dependent than controls (Witkin, Karp, & Goodenough, 1959). These findings generally support the notion that male problem drinkers tend to have problems with developing means for satisfying dependency needs and they resolve this diffi- culty by establishing a facade of independence. The origin of the conflict over satisfying dependency needs 41 could possibly lie in earliest infant attachments (Blane, 1972). Heavy drinking cultures have more oral themes in their folk tales (McClelland, Davis, wanner, & Kalin, 1966) and male adolescents who have drinking problems have more oral themes in their fantasies than nonproblem drinkers (Zucker & Fillmore, 1968). In addition to the oral and dependency themes, psychodynamic conceptualiza- tions of drug dependence emphasizes the narcissistic nature of the problem (Greenspan, 1977; Wurmser, 1977) and/ or the unresolved conflicts between attachment and alien- ation (Barry, 1974a). Drug abuse, including alcohol, is viewed by many clinicians and researchers as a long standing problem in personality maladjustment (Huba, Wingard, & Bentler, 1979). "An impulsive, uninhibited, violent quality characterizes the normal infant, the intoxicated person and the chronic alcoholic" (Barry, 1974b, p. 92). (3) The dramatic rise in the number of studies on the neonate and infant during the past ten years (cf. Sam- eroff, 1978a) has provided a richer and fuller picture of early human development. An ancillary result of this increased research is the availability of a myriad of sophisticated methods (of. Brazelton, 1973) for examining newborns and their parents. These methods can be applied systematically and reliably to study infants who are at higher—risk for subsequent drinking problems. 42 (4) An offshoot of improved research methods has been increasingly fine-grained analyses of neonatal events and their subsequent long-term effects. Brackbill (1977) found that anesthetics given to mothers during delivery can affect autonomic functioning of infants for eight months or longer (also see Friedman, Brackbill, Caron, & Caron, 1978). Transient neonatal symptoms (i.e., restlessness, rigidity, apathy) have recently been found to correlate with loneliness and immaturity in 10 to 12 year olds (Mednick, 1977). Dubey (1976) in his excellent review of organic factors in hyperkinesis concludes that "the presence of higher than normal anomaly scores in hyper- kinetic children does strongly suggest that a subtle deviation in prenatal development can lead to both.minor physical anomalies and behavioral deviance" (p. 360). Some evidence exists indicating that males are less receptive to environmental influences during early infancy and show greater internal stability of behaviors (Yang & Moss, 1978), although Walraven (1974) reported that method of feeding had greater psychobiological significance for males than females. Much of the earlier work in this area has not analyzed male and female data separately. (5) Sarnoff Mednick and his colleagues (1971) cogently point out the need for good perinatal data on infants who are high-risk for schizophrenia. The complexity of Mednick's findings between difficulties in pregnancy, 43 psychiatric status of the mother, type abnormality during neonatal examination, and outcome, suggests that similar results might be found with infants at risk for drinking problems. This type of work has never been undertaken. Four families with male offspring will form the high- risk sample and four families with male offspring will make up a group of normal controls. The choice of normal controls rather than a nonalcoholic psychiatric control group was made to maximize differences between groups (see Keith, Cunderson, Reifman, Buchsbaum, & Mosher, 1976, for an excellent discussion of the issue of appropriate control groups in high-risk research). The large project which will follow this pilot work will include both psychiatric and normal controls to insure that differences are a reflection of the problem with alcohol and not the result of general psychopathology per se. The total number of subjects is being kept very low to facilitate the extensive data collection procedures that will be utilized. Despite the small number of subjects, if all high-risk families differ from the control families on a given outcome, the results will be statistically signi- ficant beyond the .05 level, two-tailed test, using the Fisher Exact Test (Finney, Latscha, Bennet, & Hus, 1963). Probands will be selected on the basis of familial characteristics that render the male neonate at high-risk for alcoholism later in life. There is no paucity of empirical evidence that indicates if the father is 44 alcoholic, male offspring are.more likely to become alcoholic (Cotton, 1979; McCord & McCord, 1960; Goodwin, 1976b). According to Goodwin, no study of male alcoholics has less than 25% of their fathers and brothers alcoholic. Clearly, alcoholism among males seems to run in families. Additionally, later born male offspring are higher-risk for alcoholism.than first born children (Blane & Barry, 1973). A wide variety of sociological, cultural, and psycho- logical factors in addition to the two aforementioned factors have been implicated by investigators as being associated with the development of alcoholism» Such factors as being an American Indian (Baker, 1977; DHEW, 1978), Catholic (DHEW, 1971), maternal resentment of role (McCord & McCord, 1960), paternal antagonism of son (McCord & McCord, 1960; Robins, 1966), absence of adequate supervision over the child (McCord & McCord, 1960; Robins, Bates, & O'Neal, 1962), and intense parental conflict (Ablon, 1976; Hanson & Estes, 1977; Zucker, 1976), to name a few, have been implicated in the etiology of alcoholism. Undoubtedly, alcoholism is a complex problem which has multiple determinants (Zucker, 1979). Extensive examination of the available evidence on the etiology of alcoholism leads us to believe that acquisition of families with alcoholic fathers and older siblings will render the male newborn at sufficiently higher-risk for alcoholism to warrant this research. 45 Initial'Contact The high-risk.families will be contacted via inpatient and outpatient units in the local community (e.g., St. Lawrence AlcoholisulUMit and the local National Council on Alcoholism). Personnel on the staff will be asked to identify alcoholic men whose wives are pregnant, and already have other children. These families will be contacted by the agency via letter (Appendix A) requesting permission to have their names given to the project chairman (RAZ). Contact with the families who give permission will be made prior to the eighth mwnth.of pregnancy, as the formal data collection process will begin at onset of the eighth month of the pregnancy. The control group families will be contacted via the same local obstetrical facilities used by the highrrisk families. As each high-risk family has a male baby, an attempt will be made to match the high-risk family with an appropriate control. No premature infants will be used in this pilot project, since no known evidence exists which links prematurity with subsequent drinking problems. For inclusion into the study, male infants must weigh more than 2500 grams and be more than 38 weeks gestational age (Lubchenco, 1976). Infants with crown to heel length less than 47 cm. (small for dates) will be included in the project, since this concept has only recently received consideration. 46 Matching will be done on the basis of the following variables, listed in order of priority (see Jacob, 1975, for a discussion of the rationale): socioeconomic status of the family (Hollingshead & Redlich, 1957); age of father and mother; ethnic background; and ages and sex of older siblings (see Lewis & Kreitzberg, 1979; Weller & Bell, 1965, for a discussion of the potential significance of birth order and spacing effects). Additional control groups might be employed, in an attempt to isolate specific causes for differences between groups (Jacob, 1975); however, this procedure was not employed since, 1) this is a pilot study, and 2) it would limit the extent of data collection. The choice of a control group with no alcoholism or other types of psychopathology was made to maximize possible differences between high-risk and control families. Potential subject families will be contacted on the phone to insure they are interested in participating in "a developmental study of their prospective child's early years of life". (See Table 1A/B for prospective contact schedule.) Potential subjects will be offered $25 payment for agreeing to participate in the initial screening interview. If interested, the project chairman (RAZ) will schedule a home visit with both parents present. During this visit, they will be informed of the demands the study will make upon their time. While the time demands are large, it is felt that subjects will be 47 TABLE 1A Contact Schedule 1. Screening Process A. Initial Contact (who, where, what) 1. Community agency 2. Mailed form 3. Agency Parent Letter (Appendix A) B. Initial Contact Screening Interview (payment of $25 at conclusion of interview) 1. Research committee chairman - RAZ 2. Home visit 3. Screening questionnaires administered: a. b. c. d. e. f. Research Participation Informed Consent Form - H & W* (Appendix B) Medical Information Release Form - H & W (Appendix C) School Achievement & Performance Release Form - H & W (Appendix D) Follow-up Information Form - H & W (Appendix E) Modified SMAST - H (adopted from Selzer, 1975; Appendix F) Background Information - H & W (Appendix C) II. Prenatal Contacts A. First week of eighth month of pregnancy 1. Clinical graduate student - RBN 2. Physician visit 3. Screening questionnaires distributed (returned by mail): a. b. Manual for Obstetrical Complications (adopted from Littman & Parmalee, 1974; Appendix H) Manual for Postnatal Complications Scale (Littman & Parmalee, 1974; Appendix I) B. First week of eighth month of pregnancy 1. Undergraduate volunteer - HCP 2. Home visit 3. Questionnaires and structured interview: a. b. C. Semi-structured interview with father (Appendix J-l) Semi-structured interview with mother (Appendix J-2) Wakefield Self-Assessment Depression Inventory - H & W (Snaith et al., 1971) *H = Husband, W = Wife C. OOH! (DO: 48 TABLE 1A (cont'd.) Gough ACL - H & W (Gough, 1955; Appendix K) Spanier Dyadic Adjustment Scale - H & W (Spanier, 1976) History of Pregnancy -‘W (Appendix L) California Q-Sort done immediately after~ visit - H & W (Block, 1961) Third week of eighth month of pregnancy 1. Research committee Chairman - RAZ 2. Home visit 3. Questionnaires & structured interview a. b. C. Antisocial Behavior Checklist - H & W (Appendix M) Buss-Durkee Hostilit Inventory - H & W (Buss & Durkee, 1957 Detailed Drinking History - H & W (Cahalan et a1. 1969, Schuckit, 1978; Appendix N) Schedule for Affective Disorders & Sghiiophrenia — H & W'(Spitzer & Endicott, 77 California Q-Sort done immediately after visit - H & W (Block, 1961) III. Perinatal Contact (male offspring) A. Three of four days subsequent to birth 1. Certified examiner 2. Home or hospital visit 3. Neonatal Behavioral Assessment Scales - Infant (Brazelton,1973) Nine or ten days subsequent to birth 1. Certified examiner 2. Home visit 3. Neonatal Behavioral Assessment Scales - Infant (Brazelton, 1973) One month 1. Undergraduate volunteers 2. Home visit 3. Observations and questionnaires a. b. C. Feeding Scales - Mother and Infant (Ainsworth & Bell, 1969; Appendix 0) Neonatal Perception Inventory - H & W (Broussard & Hartner, 1971; Appendix P) Social Readjustment Rating Scales - H & W (adopted from Holmes & Rahe, 1967; Appendix Q) California Q-Sort done immediately after visit - W & H (if present) (Block, 1961) 49 TABLE 1A (cont'd.) IV. Postnatal Contacts through the FirSt Year A. Two months 1. Undergraduate volunteers 2. Laboratory visit 3. Psychophysiological measures and observations a. Fitzgerald Feeding Study (Zucker & Fitzgerald, 1977) b. Feeding Scales - Mother and Infant (Ainsworth & Bell, 1969; Appendix 0) B. Four months 1. Undergraduate volunteers and qualified examiners 2. Home visit 3. Developmental assessment and interview a. Tempgrament Interview - W (Thomas et al., 1963 b. Bayley Scales of Infant Development - Infant (Bayley, 1969) C. Six months 1. Qualified examiner 2. Laboratory visit 3. Fitzgerald Habituation Study (Zucker & Fitzgerald, 1977) D. Eight months 1. Undergraduate volunteers 2. Home visit 3. Observations and questionnaires a. Four Scales for Rating Caregiver Behavior - H & W (Ainsworth et al., 1971; Appendix R) b. Modified version of the Worchester Scale of Social Attainment - H & W (Phillips, 1968; Rudie & McGaughran, 1961; to be developed) V. Contacts: One Year to Three Years A. Fifteen months 1. Undergraduate volunteers 2. Home visit 3. Home Observation for Measurement of the Environment Inventory — Mother & Infant (HOME; Caldwell et al., 1966) 4. California Q-Sort done immediately afrer visit - W (Block, 1961) 50 TABLE lA (cont'd.) Eighteen months 1. Undergraduate volunteers 2. Laboratory visit 3. Strange Situation Procedure - Mother & Infant (SSP; Ainsworth & Wittig, 1969) Twenty-four months 1. Qualified examiners, undergraduate volunteers 2. Home visit 3. Developmental assessment, questionnaires & interview a. Bayley Scales of Infant Development - Infant (Bayley, 1969) b. Social Readjustment Rating Scales - H & W (2nd administration) (ado ted from Holmes & Rahe, 1967; Appendix Q c. Temperament Interview - W (2nd administra- tion) (Thomas et al., 1963) d. Detailed Drinking History - H & W (2nd administration) (Cahalan et al., 1969; Schuckit, 1978; Appendix N) Thirty‘months 1. Clinical graduate student - RBN 2. Home visit 3. Unobtrusive measure: dinner-time audio tape recordings a. Structural Analysis of Social Behavior Model (SASB; Benjamin, 1974) b. Family Interaction Coding System (FICS; Patterson et al., 1969) Thirty-six months 1. Undergraduate volunteer 2. Home visit 3. Home Observation for Measurement of the Environment Inventory - Mother & Infant (2nd)administration) (HOME; Caldwell et al., 1966 4. California Q-Sort done immediately after visit - H & W (Block, 1961) Forty-two months 1. Child clinical graduate student 2. Home visit 3. Assessment of child's attitudes and knowledge of alcoholic beverages (Jahoda & Cramond, 1972) a. Recognition of smells b. Drunkeness story 51 TABLE 1A (cont'd.) VI. Contacts: 'Three‘Years to Six Years A. Forty-eight months 1. Undergraduate volunteers and qualified examiners Laboratory visit Questionnaires, observations, developmental assessment, and structured interview a. Schedule for Affective Disorders and Schizophrenia - H & W (2nd administra- tion) (SADS; Spitzer & Endicott, 1977) b. Social Readjustment Rating Scales - H & W (3rd administration) (adopted from Holmes & Rahe, 1967; Appendix Q) c. Werry-Weiss-Peters Home Activity Rating Scale - H & W (HARS; Werry, 1968) d. Detailed Drinking History - H & W (3rd administration) (Cahalan et al., 1969; Schuckit, 1978; Appendix N) e. Modified version of the Worchester Scale of Social Attainment — H &‘W (2nd admin- istration) (Phillips, 1968; Rudie & McGaughran, 1961; to be developed) Revised Yale Developmental Inventory (YDI) Open-field activity assessment (adopted from Routh et al., 1974) California Q-Sort done immediately after visit by SADS interviewer - H & W (Block, 1961) 00"?! B. Sixty months 1. 2. 3. Undergraduate volunteer/child clinical grad- uate student Home visit . Questionnaires, interview, child assessment a. Child Behavior Checklist - H & W (CBCL; Achenbach, 1978; Appendix T) b. Temperament Interview - W (3rd administra- tion) (Thomas et al., 1963) c. Assessment of child's attitudes and knowledge of alcoholic beverages (Jahoda & Cramond, 1972) 1. Recognition of smells 2. Judgment of photographs 3. Perceived likes and dislikes 4. Concept task 5. Drunkeness film d. California Q-Sort done immediately after visit - H & W (Block, 1961) 52 TABLE 1B Estimated Time Requirements for Research Participants 1. Screening Process A. Initial contact Total time: 1/4 hour B. Initial Contact Screening Interview Total session time: 1-1/2 hours father: 1-1/2 hours (1/2 hour interview & 1 hour forms) mother: 1-1/2 hours (1/2 hour interview & 1 hour forms) II. Prenatal Contacts A. First week of eighth month of pregnancy Total session time: 2 hours father: 2 hours (1 hour interview + 1 hour questionnaires) mother: 2 hours (1 hour interview + 1 hour questionnaires) B. Third week of eighth month of pregnancy Total session time: 2 hours father: 2 hours (1 hour interview + 1 hour questionnaires) mother: 2 hours (1 hour interview + 1 hour questionnaires) III. Perinatal Contacts A. Three or four days subsequent to birth Total session time: 1/2 hour neonate: 1/2 hour (1/2 hour behavior assessment) B. Nine or ten days subsequent to birth Total session time: 1/2 hour neonate: 1/2 hour (1/2 hour behavior assessment) C. One month subsequent to birth Total session time: 2 hours father: 1/2 hour (1/2 hour questionnaires) mother: 2 hours (1-1/2 hours observations + 1/2 hour questionnaires) neonate: 1-1/2 hours (1-1/2 hours observa- tions) IV. 53 TABLE 13 (cont'd.) Postnatal ContaCts Through the First Year A. Two months subsequent to birth Total session time: 1-1/2 hours mother:' 1-1/2 hours (1-1/2 hours observa- tions) infant: 1-1/2 hours (l-1/2 hours observa- tions) B. Four months subsequent to birth Total session time: l-1/4 hours mother: 1-1/4 hours (1-1/4 hour interview) infant: 1/2 hour (1/2 hour developmental assessment) C. Six months subsequent to birth Total session time: 1 hour mother: 1 hour infant: 1 hour (1 hour psychophysiological assessment) D. Eight months subsequent to birth Total session time: 2-1/2 hours father: 2-1/2 hours (2 hours observation + 1/2 hour questionnaires) mother: 2-1/2 hours (2 hours observation + 1/2 hour questionnaires) infant: 2 hours (2 hours observation) E. Eleven months subsequent to birth Total session time: 2-1/2 hours father: 2-1/2 hours (2 hours observation + 1/2 hour questionnaires) mother: 2-1/2 hours (2 hours observation + 1/2 hour questionnaires) infant: 2 hours (2 hours observation) Contacts: One Year to Three Years A. Fifteen months Total session time: 1 hour mother: 1 hour (observations and interview) infant: 1 hour (observations) B. Eighteen months Total session time: 3/4 hour mother: 3/4 hour (3/4 hour observations) infant: 3/4 hour (3/4 hour observations) 54 TABLE 13 (cont'd.) C. Twenty-four months Total session time: 1-3/4 hours father: 1/2 hour (1/2 hour questionnaires) mother: 1-3/4 hours (1-1/4 hour interview + 30 minutes questionnaires) toddler: 3/4 hour (3/4 hour developmental assessment) D. Thirty months Total session time: 1/4 hour father: 1/4 hour (1/4 hour interview) mother: 1/4 hour (1/4 hour interview) E. Thirty-six months Total session time: 1 hour mother: 1 hour (observations and interview) toddler: 1 hour (observations) VI. COntacts: ‘Three Years to Six Years A. Forty-two months Total session time: 1 hour toddler: 1 hour (1 hour developmental assessment) B. Forty-eight months Total session time: 2 hours father: 2 hours (1 hour interview + 1 hour questionnaires) mother: 2 hours (1 hour interview + 1 hour questionnaires) preschooler: 2 hours (1-1/2 hours developmental assessment + 1/2 hour observations) C. Sixty months Total session time: 1-3/4 hours father: 1/2 hour (1/2 hour questionnaires) mother: 1-3/4 hours (1-1/4 hours interview + 30 minutes questionnaires) child: 1-1/2 hour (1-1/2 hour develop- mental assessment) 55 willing to participate since 1) most of the data will be obtained in the home, requiring no change of routine, and 2) significant payments, as incentives, will be offered ($100 per year, to be paid subsequent to each year's participation). At no time during the study will subjects be informed of the specific nature of the problem which the study will investigate. The "cover" will emphasize that the study is primarily interested in child health and development as it relates to family functioning. The only member of the project who will know whether the family is high risk or control is the project chairman (RAZ). Two project coordinators (RBN & HCP) will know the purpose of the study, but will not be informed subjects are high-risk or control. All other project workers will not know the specific purpose of the study, beyond the aforementioned cover story. Selection and Screening During the initial screening interview both parents will be asked to sign consent and information release forms (Appendices B, C, D, E). Fathers and mothers will be asked to complete a modified Short Michigan Alcoholism Screening Test (SMAST; Seltzer, 1971, 1975; Appendix F) and both parents will complete a Background Information Questionnaire (Appendix G). Families will be given $25 for participating in the screening process. 56 The SMAST will be used as the initial alcoholism screening inventory rather than other available instru- ments (cf. Costello & Baillargeon, 1978; MacAndrew, 1965) for several reasons. First, a questionnaire concerning drinking problems is less threatening than an interview. Second, the SMAST has been used more extensively than any other alcoholism screening device and is known to be a reliable and valid instrument. Alternative screening devices have not consistently differentiated alcoholic males from.nona1coholic males (Schwartz & Graham, 1979). Third, the SMAST's coverage of problems resulting from excessive drinking is more broad-based than other alco- holism screening instruments. Social consequences, presence of addictive symptoms, and interpersonal problems are all well covered by the SMAST. Medical problems from excessive drinking are not covered by the SMAST; however, pathophysiological indications of alcohol abuse are often the last manifestations of problem drinking, occur only in a minority of alcoholics, and are not utilized diagnostically as often as behavioral and social symptoms (Barry, 1974a; Jankowski & Drum, 1977). The SMAST has been modified slightly to ascertain if other drugs, in addition to alcohol, are used excessively. Questions regarding other drugs, drawn from a national survey of drug use and abuse (O'Donnell, Voss, Clayton, Slatin, & Room, 1976) have been worded so that in addition to finding if polydrug use is occurring, we will know whether use is 57 more excessive than 90% of the U.S. population or 99% of the U.S. population. Since self-reports of alcoholic's drinking behaviors generally coincide with the reports of collateral informants (Cotton, 1979; Guze, Tunson, Steward, & Picken, 1963; Maisto, Sobell, & Sobell, 1979), the information from the SMAST should be valid. More complete diagnostic information on drinking behavior and its consequences will be obtained later in the data collection process. Minimal risk is anticipated for any of the families participating in the study. We anticipate the repeated visits by sensitive and mature college students will tend to both have a therapeutic effect and mediate differ- ences between groups. Data will have all personal iden- tification removed immediately after collection; coding will be utilized. Codes will be locked in a separate filing cabinet in another office from the raw data. Procedure General Undergraduate students will be utilized to gather most of the empirical data for the study (see Table 2). With one exception (HCP), they will be blind as to the nature of the study, and will only know that the project is concerned with children and their families. They will not be informed that the families belong to different groups. Data collection will be accomplished in the blind when possible. This procedure will prevent research 58 NH Hooucmao> Hon unmauaaaoo aofiumufimw> HeuoH oHHmGCowumoao cowbomMmHumm xnoz H0fi>m£om m Ho>Hwoumo wcwumm you moamom upon 3ow>nouaH ucofimuomaoe .Hm um mmaone ucoaaon>oo H ucmmnH mo mmamom hoazmm meadow wcwumm unmabwnmpmom Hmfioom N mpouam>fiH coaumoohom Hmumcooz moamom mcwpomm monom N unmammmmm< Hmuofi>m£om Hmumcooz hocmswoum mo muoumfim mamom ucoaumnnp< owpmxa Hmwcmmm one ewsoo H >Houao>cH cowmmouaom unmammommMIMHom paowmoxmz Bow>uoucw zocmcwoha pmhsuodhum mwwfimm Mom Hmumwcprw ou pomwmuu mufimw> mo a moow>op unmammomm< mucoaouwmoom Homucmao> N mgm 039 .m.z u Hmcw (mem poflmwamso mco mHmEom Amo\a ose %.m.z a whose (mem powmwamso 039 mamaom Amomv Hooucmao> mco 59 Homucbao> use ucmBuHano cowuwuwmw> HmuoH hafiamm Hum muHmH> mo * Anymoh mv Shoucm>cH uaoaaouw>cm on» no ucoaoHSmmmz How cowum>ummbo oaom Amon a mmuoucH ucmEmHmQEmH .Hm um mmaosH ucoamoao>oo ucmmcH mo mmamom onhmm mnapmooum coaumouwm omamuum moamu oopw> whoom Amnucofi may muoufio>cH uaoficouw>cm onu mo name nmuammmz Mom aowum>Hombo meow saga s mHooououo unoamumeaou whoom mucmhmm £uw3 3mH>umuaH pmuouoouum ouoom Houmwcwspm ou pmawmuu moow>op uaoEmmomm< Ae..ucoov N mam 039 .m.z muomucbao> baseman oumnpmww 039 .m.z mummucsao> 039 .m.z Hocwamxo pofimaamno moo .m.z mummucsao> 039 .m.z mummucbao> 039 60 w Homuch0> Mom ucoBuHaaoo coHumuH0H> Hmuo9 H MHHEmm Mom muama> so 4 Hannah my mowmno>ob oHHoxoon m0 0w00H30cx 0cm mopDuHuum 0.0HH30 m0 uaoammmmm< Amuse» mv mHooououa ucoamuomaou whoom Amuse» mv 3mH> numucH ucofimuoo809 .Hm no mmeon9 umaaxomeo soa>mewm Basso ucofimmommm 90H>Huom pHoHMIcoao whoom anouco>aH Hmucofim0H0>0a mHmw pomH>0m unmachuu< HMHoom m0 mHmom H00 -0050H03 050 m0 aonuo> ponHpoz zhoumHm wcchHHQ pmHHmuom mHmom wcHumm 90H>Huo< 080m muouomummHozwzuhoz monom wcHumm ucmeumsmpmmm HmHoom Amumoh N\Humv mowmu0>ob oHHonoon m0 0wp0H3ocx use 0030 (Hope m.pHH£0 mo uaoammmmm< HouchHEpm ou pochuu 000H>0p ucoammomm< A.e.ucoov N mom ucmpsum oumdpmww 0:0 .m.z whooucmHo> 039 .m.z whoouch0> 039 .m.z HmcHmeo poHMHHMSU moo .m.z HomumsHo> oao .m.z Hooucho> ucopsum oumopmuw moo 61 assistants from."guessing" whether the family is high-risk or control. The use of undergraduates will permit the collection of "blind" data as well as permitting additional data to be gathered without added expenditures. Following the initial contact-screening interview, families agreeing to participate in the study will have the father's SMAST scored. Scores for problem drinking males must be 7 or more; scores for control males must be two or less. Additionally, no control males and their families will be included in the study if their SMAST indicates that any other drug has been used more excessively than 90% of the U.S. population. Mother's scores on the SMAST will not be utilized for either inclusion or exclusion from the project. It is especially crucial to utilize careful and succinct diagnostic criterion for psychiatric categories in high-risk research (Hansen et al., 1977). To insure that high-risk families have alcoholic fathers, the criterion for diagnosis of alcoholism developed by Goodwin et a1. (1973) will be utilized (see Table 3). Inspection of SMAST results will permit initial screening according to Goodwin's criterion until a detailed drinking history is obtained. Since this project is designed as a pilot study, using a broad-based eclectic approach, much data will be collected in numerous areas. Some "predictions" can be made a priori based upon previous research and clinical data. Many of the instruments utilized in this project 62 TABLE 3 Criteria for Drinking Categories Moderate drinker:‘ Neither a teetotaler nor heavy drinker Heavy drinker: For at least 1 year, drank daily & had 6 or more drinks at least 2 or 3 times a month; or drank 6 or more drinks at least once a week for more than 1 year, but reported no problems Problem drinker: a. Meets criteria for heavy drinker b. Had problems from drinking but insufficient in number to meet alcoholism criteria Alcoholic: a. Meets criteria for heavy drinker b. Must have had alcohol problems in at least 3 of following 4 groups: Group 1: Social disapproval of drinking by friends, parents, marital problem from drinking Group 2: Job trouble from drinking, traffic arrests from drinking, other police trouble from drinking Group 3: Frequent blackouts, tremor, withdrawal hallucinations, withdrawal convulsions, delirium tremens Group 4: Loss of control, morning drinking From Goodwin et al., 1973 63 will be explorative, to either_generate new questions or simply provide a framework for a more substantial follow- up research program. All formal predictions are listed in Table 4, as well as being included in the Methods section. Any informal expected differences of a more exploratory nature are listed in Table 5, and will also be discussed in the text of the Methods section. The data collection process is more rigorous and elaborate during early developmental phases, as the patterns of behavior in early infancy, by both infant and parents, typically lack the homeostatis which evolves after the first year of life (Cytryn, 1976; Sander, 1976). Prenatal Contacts Obstetricians. Obstetricians of families who agree to participate and meet SMAST criterion will be contacted during the first week of the eighth month of pregnancy (see Table lA/B). The physicians will be told that the family has agreed to participate in a study; no mention of alcohol will be made. The Manual for Obstetrical Complications (Littman & Parmalee, 1974; Appendix H) and the Manual for Postnatal Complications Scale (Littman & Parmalee, 1974; Appendix I) will be given to the physi- cians to be filled out at the appropriate times and returned to the project via mail. No known evidence to date exists which indicates to us that as neonates, alcoholic males had obstetrical complications or postnatal complications; however, these data have not been carefully whoa Houuaoo m0 mucoumo menu AmHgaoo oHHumos\no30o «Haumoev HHH assesses ca 090A meHuann mo mucouma noo3uob aoHuoochaaoo whoa mucmmaH Houucoo m0 mnonuoa coco mucmmcH meH uanfi mo muonuoa 9b 90H (HHumon pouuoaoHuMHom whoa mucmmcH Houuzoo m0 muonumm asap muanGH meu -ewse mo museumm an ass uHHumon pouuomousMHom whoa _4 anemone smau-ewae mo «.muosuom Bonn H0H>mnob HmHoom _uHuaw pouuomouumHom whoa HHH Ema m0 HH me< co .HMHoomHucm .uopuoch huHHmaowHoo mm pomoomep musmmaH meHnans m0 muonumm whoa momeHHmE Houuaoo 0H pouuooou coHuomMmHuMm Houmon mGOHuoHpmhm coHuommmHumm HmuHHmE mucmumm m0 muHHmnomHoo mucoumo mo zuHHmcomuoa mHmocmep oHuumHnoxma mHmoanHp oHuumHnozmo coHuomMmHDMm HmuHHmE mooom ucofimmomm< wooHuoHpoum Hmehom q MHm<9 Homo: mmGH quHHumom moxusaummsm huouco>nH huHHHumom ooxunmummsm umHonono H0H3m£om HmHoomHua< choH£o0NH£om can nymphomHm 0>Huoowm< How oHDponom monom ucoaumanp< 0Hpmmn HoHammm ucofibnumcH 65 HHH 2mm m0 HH me< co .HmHoomHucm .Hophome muHHmaomHoe . AcoHumnumH mm pomocmep muoprou uoHEpm pcmv mHoounooanom paw meHuans m0 mnonumm 0908 mHmocwpr oHHuMH£0hmo mumpHOmHn 0>Huoomm< How onpmsom mfioHuoHpohm mnoom ucmsnmomm< unmasnumcH A.e.ucooo a mamm auto omH03 mm 0000 HHonu 0>H00Hom HHH3 mummmaH meHuann mo mumsumm owmuo>m 00:0 Houuom mm mcom HHosu 0>H00H0 HHH3 mucwmoH Howucoo m0 muosuoa mmwmno>m mm 0000 as HHonu 0>HO0H0m HHH3 modem (CH meunanz m0 muosuofi mcmHonzna HHosu mo pouuomou mm muHh0>om Houmouw mo mEpoouo whoa o>m£ HHH3 mucmm uaH meHuSan m0 whoauoa huHHm>om Hoummhw mo maoHnouo whoa uuoaouumHom HHH3 mucmm ncH meuuans m0 muonuoa mmocouommHo pouoomxm . mooHuomHo mcHHmoH pHHno Amnucofi qv umoEmnooEou m.ucmmcH unmmcH mo 00Huooouoa m.uo£umm ucmmcH m0 ooHuoooumm m.Ho£uoa mcoHu nmoHHmaoo HmoHHuoumbo maoHu (moHHoEoo HmoHHuoumbo msoom uaoammomm< H0H>mnom H0>Hwoumu wcHumm pom monom H009 30H>HoucH ucoEmH00509 zuouco>cH aOHDQoouom H00000oz 9H0000>0H cOHDQooumm Hmumcooz mcoHumoHHQEOU HmoHHumumbo pom Honcmz moomcwonm mo muoumHm unmasuumcH boommm m0 mCOHuooan poumoHoHuc< m mHm<9 AmHHoBm oNchooou ou oHnm GoupHHso mov mHohuaoo cmsu noumo whoa mome£3 H0\pam Home m0 HHofim oNHamooou coupHHso meuustn mHouucoo 00:0 mmoaHmmunwaozu paw .coHuoommm .mpHHm so H030H ouoom HHH3 mHoprou meHuann moaaaamm smau-ewae as CoupHHso an H0H>m£ob oocmHHo (Boo mmoH can .H0H>mnmn :oHuomuounH HmHoomouo mmoH .H0H>m£on ucmH>oo ouofi muoprou Houucoo 7.00:0 mHo>oH muH>Huom Hoann no 000 .muHHHbmuomHume ouofi .mocoumHmuoo mmoH umoMHcmB Haas mumfleeou meu-ewae muommaH Houuooo menu venomous 9H0930om mmoH we Haas summons emeu-ewae muosuoa Houucoo cmnu pHHno HHmnu nuH3 00>H0>0H mmoH 00m mooHumoH (038800 0.0HH50 0:0 00 0>Hm (common mmoH noon on HHH3 muammcH meHusts m0 muonuoa .moocouommHa pouoomxm Assess N\H-m0 Hoeooam mo mmemasocx m.eaaeo Amhmoh mv moowuomum wcHHmoH pHHso mGOHuomHoucH mHHEmm AmH009 NV ucoamnooaou 0.0HH50 udoESUmuum Amnuooa mHv mooHuomuo mcHHmou pHHso 03009 ucofimmomm< A.e.ucoov m mamcH 0:08 (GOHH30m 050 m0 00Hum>uombo 080m Soummm wchou coHuomuounH xHHEmm 30H>H000H uGoEmH0o609 ounpoooum aoHumouHm owcmuum muouso>cH 000800HH>GM 050 m0 00H00>Hombo 080m uCoEDuumcH 8 6 AmHHoEm oNHnwooou ou oHnm coupHHno mow mHouucoo 0050 noumo whoa momen3 H0\0cm Home «0 HHoBm oNHawooou CoHUHHno meHustn mmob Houu uaoo menu 0H0>0H zuH>Huom Hostn paw .muHHHomuomuume whoa .moaoumHmHoo mmoH 000MH008 HHH3 whoa meuusts Houomm 0>Hmmouwwm one 00 Hmann ouoom HHH3 090b meHuann tha pouoHHumou wathp mHohuaoo away Amuouoaouom 0:0 HmcoHum>Hmmnov mouoom Ho>0H muH>Huom noan: 0>m£ HHH3 muoHoonomon mehuann whoa Houucoo menu mouoom 90H>Huom umann m>me Haas mace smau-ewae mHouuaoo 00:0 H0H>m£0n 030 M0 @0500 00m HoH>0nob noxcbup hMHuoopH ob Hoonmo soupHHno meuuan: mooaoHWMMHQ wouoomxm Hozoon mo mwemHsoax m.emaeo Amuwok mv uaoamuooaou 0.0HH50 %w0H0 (Summofiommo pooanHso pHHno 0:0 mo H0>0H 90H>Huom pHHno ofiu mo H0>0H muH>Huom H0500Hm no mmemazoax m.eaaeo mHHUOh Ufimam mm m w< H.e.uooov m money mHHoEm mo ooHuHcmooom 30H>H000H ucoamuom809 umaaxomeo Hoa>memm cameo ucoammomm< huH>Huom uHmHMncooo onom meumm 90H>Huo< 080m mumuomummHmznmhnoz SHHm mmocoxcnun unmasuumnH 69 mHouucoo 00:0 H0H>m£0b 0:» mo 00:00 00m H0H>m£0o aoxcshp mmHuaopH ou Hoonoo doupHH£0 meuuans moocmumMMHn.0ouoomxm Honoon mo ompoH3ocx 0.00H0HH50 mHHOAOh ”:90th mm m m< A.0.uoouv m mqm<9 BHHm mmoaoxcoun unmaduumcH 7O gathered by any study known to us to date. While these instruments are.being used in an exploratory sense, we expect that the wives of alcoholics will have more obstet- rical and postnatal complications in general. Further discussion of this prediction will occur along with the discussion of the effects of stress on pregnancy. These instruments were selected because they were more thorough than previous questionnaires (cf. Mednick et al., 1971; Shereshefsky & Yarrow, 1973). They present clinical examples of each specific scoring category to enhance inter-physician scoring reliability, and scores on the Obstetrical Complications Scale have been found to be good predictors of continued risk for infants with neonatal difficulties (Field, Hallock, Ting, Dempsey, Dabiri, & Shusman, 1978). Additionally, the results are easily quantifiable and the Manual for Obstetrical Complications includes Apgar Scores (Apgar & James, 1962) at 1 and 5 minutes. First home visit. During the first week of the eighth month of pregnancy, a home visit will be made (see Table lA/B). While one parent is participating in a semi-structured interview with an undergraduate volunteer (HCP; Appendices J-l, 2, 3), the other parent will complete the Wakefield Self-assessment Depression Inventory (Snaith, Ahmed, Mehta, & Hamilton, 1971); the Gough Adjective Checklist (Gough, 1955; Appendix K); the Spanier Dyadic Adjustment Scale (Spanier, 1976); and the 71 History of Pregnancy (wives only; Appendix L). Both. parents will alternatively be interviewed and fill out questionnaires. At the conclusion of the visit, the undergraduate volunteer will complete a Q-Sort personality description (Block, 1961) for each parent. The Wakefield Self-assessment Depression Inventory is adapted from the Self-rating Depression Scale (Zung, 1965). It is briefer, more easily completed, is currently used more predominantly than other similar self-rating depression scales (cf. Lewis, Gottesman, & Gutstein, 1979), and is a valid measure of depression. Finally, the Wake- field attempts to clearly delineate feelings of depression from depressive illness per se. We expect no differences between the wives of alcoholics and controls on self- assessment of depression. A substantial literature has looked at wives of alcoholics (cf. Ablon, 1976; Jackson, 1962) and does not report excessive depressive symptoma- tology. Some evidence exists linking depression with alcoholism.in males (of. Barry, 1974a, b; Winokur & Clayton, 1968); however, Freed (1978) in his excellent review of alcoholism and mood noted that mixed results have been predominantly reported between self-rated depression and alcoholism.(also see Noel & Lisman, sub- mitted for publication, 1979). The Gough Adjective Checklist will also be utilized to compare alcoholics and their wives to the control subjects. The rationale for the use of the Gough as well 72 as specific predictions are elaborated in Pierson (1979). The Spanier Dyadic Adjustment Scale represents a signifi- cant improvement over earlier measures of marital adjust- ment. While some recent measures of marital and family systems offer excellent clinical applicability (Olson, Sprenkle, & Russell, 1979), the reliability (content and criterion) and validity of the scales makes them.more useful in the present context (Spanier, 1976). A sub— stantial literature indicates that conflict and tension hallmarks the alcoholic marriage (cf. Ablon, 1976; El-Guebary & Offord, 1977; Fox, 1962; Hanson & Estes, 1977; Jackson, 1962; Jacob, Favorini, Meisal, & Anderson, 1978; Levine, 1955; McCord & McCord, 1960, 1962; Wilson & Orford, 1978). It is interesting to note that recent studies on marital discord indicate that the effects are more long lasting in male than female children (Hethering- ton, 1979). Along with the marital dissatisfaction, some studies report poorer sexual adjustment between partners of an alcoholic marriage (Hanson & Estes, 1977; Jackson, 1962; Levine, 1955), although contradictory data on sexual adjustment does exist (Barry, 1974a). It is predicted that: 1. The control families will have higher scores than alcoholic families on the Spanier Dyadic Adjustment Scales, indicating greater marital adjustment and satisfaction. The History of Pregnancy was specifically designed for use in this study and represents a major improvement 73 over previous instruments that were designed to obtain these type data (cf. Leifer, 1977). In addition to a radically changed format from previous instruments which makes administration much simpler, this questionnaire combines both frequency and severity of symptoms. Since it is common for self-reported physical problems to differ from.the physician's account due to a multitude of social, situational, and psychological factors (cf. Lazarus, 1976; Mechanic, 1970), the two sources of data on the medical history of mother's pregnancy (the physician's and the mother's) will both be examined. Although the role of stress in female reproductive problems has received scant attention (see Reichlin, Abplanalp, Labrum, Schwartz, Sommer, & Taymor, 1979), some evidence links emotional adjustment (McDonald & Christakos, 1963; McDonald & Parham, 1964), anxiety (Davids & DeVault, 1962; Gorsuch & Key, 1974; Grimm, 1961; McDonald, 1968), and life stress (Gorsuch & Key, 1974) with obstetric complications. Wives of problem drinking males tend to be more anxious (Orford, 1976). They should also be beset by both the effects of a husband with drinking problems and marital conflict. None of the data which supports the aforementioned ideas have been obtained when wives of alcoholics were pregnant, and/or when husbands were presumably in earlier stages of the disorder. Insofar as differences occur, it is expected that mothers of high-risk infants will self—report more obstetrical complications of greater severity. 74 The semi-structured interview (Appendices J-l, 2, 3) are being utilized to explore attitudes and feelings that couples have toward the pregnancy, the baby, and one another. It examines the social support system for the family and how this system.has helped or hindered during the pregnancy. We are trying to understand if couples anticipate any changes will occur and what the baby means for the parents, i.e., the wantedness of the birth (David & Baldwin, 1979). This interview is included as a systematic attempt to gather other detailed information about the parents, their attitudes toward the baby, and how the pregnancy has affected each parent's feelings about themselves and their spouse. The interview schedule is similar for both parents. The father's consists of twenty-six questions. The schedule for the mother is identical to the father's, but has an additional eight questions concerned with various aspects of the pregnancy. Nearly all questions for both parents are followed by an optional probe designed to insure that the specific information desired is obtained. Thirty-five 7-point rating scales have been developed to score the data obtained from the interviews. Each point on the scales is specifically defined to facilitate scoring and make inter-rater reliability easier to obtain. Some of the scales are designed to be used with one specific question and its probes, while others which 75 obtain more general information are scored by examining responses to several interview questions. Four undergraduate volunteers will be trained to rate the interviews. Procedures that are elaborated in Bandura (1959) will be followed to insure that independent ratings are made and.an assessment of inter-rater reliability can be made (see also Jones, Reid, & Patterson, 1975). Briefly, the volunteers will be divided into pairs of one male and one female. Each pair will only rate either mother's interviews or father's interviews. Reliabilities of interview ratings can be estimated by using the Pearson product-moment correlations (r). Ratings will be made from the actual tape recordings. Second home visit. A second home visit will be made during the third week of the eighth month of the preg- nancy by the project's chief investigator (RAZ; see Table 1A/B). This visit will follow the same format as the initial home visit, in that one parent will be inter- viewed while the other parent completes the following questionnaires: the Antisocial Behavior Checklist (Appendix M); Buss-Durkee Hostility Interview (Buss & Durkee, 1957); and the Detailed Drinking History (adopted from Cahalan, Cisin, & Crossley, 1969; Schuckit, 1978; Appendix N). At the conclusion of the visit, a Q-sort personality description (Block, 1961) will be completed for each parent. 76 The interview will be based upon the semi-structured format of the Schedule for Affective Disorders and Schizo- phrenia (SADS; Spitzer & Endicott, 1977). The SADS was selected rather than the MMPI (Dahlstrom & Welsh, 1972) because the interview format offered excellent flexibility as well as high reliability and good validity. Also, while instruments like the MMPI yield an elaborate profile, the SADS interview will yield a psychiatric diagnosis in accordance with DSM-III (Note 1). The psychiatric diag- nosis is essential in establishing comparability of this study and its subject population with that of other investigators. Considerable evidence exists which links problem drinking in both adolescence (cf. Barry, 1976; Demone, 1972; Jessor, Graves, Hansen, & Jessor, 1968; Loper, Kammeier, & Hoffman, 1973; Robins, 1966; Zucker & Barron, 1973) and adulthood (Costello, Lawlis, Manders, & Celis- tino, 1978; DHEW, 1971; Schuckit, 1973; Williams, 1976; Wilson & Orford, 1978; Winokur et al., 1970) with anti- social behavior. Indeed Schuckit (1973) specifically attempts to clarify the distinction between alcoholism as a primary illness and alcohol problems as part of the psychiatric syndrome of sociopathy. On this basis, it is expected that all fathers of high-risk infants will receive a diagnosis of alcohol dependence on Axis I of DSM-III. Additionally, it is anticipated that: 77 2. Fathers of highrrisk.infants will receive a diagnosis of personality disorder, antisocial, on Axis II of DSM-III more often than fathers of control infants. All parents will be given the Antisocial Behavior Checklist developed for this project. To date, no questionnaire has been developed which deals with adult antisocial behavior, rather past efforts have been based upon interview data and loosely delineated typologies of antisocial activity (cf. Guze, Goodwin, & Crane, 1969). Specific items selected for use were culled from self- report checklists of antisocial behavior in adolescents (Barron, 1970; Kulik, Stein, & Sarbin, 1968; Zucker, 1966) and from clinical descriptions of antisocial personalities (Cleckley, 1976; DSM-III; W00druff, Goodwin, & Guze, 1974). Evidence exists that self-reports of antisocial behavior can provide valid data with both adolescent (Kulik et al., 1968) and adult populations (Widom, 1977). It is pre- dicted that: 3. Fathers of high-risk infants will score higher on the Antisocial Behavior Checklist than fathers of control infants or any female group. In addition to the antisocial tendencies typically manifested by male problem drinkers, some data indicate that these men are more aggressive than non-problem drinking males (Barry, 1974a, 1976; DHEW, 1971; Kulik et al., 1968; Williams, 1976; Wilson & Orford, 1978) and 78 that their aggression increases with excessive consumption of alcohol (Barry, 1974a; Orford, 1976). These data would tend to support the notion that alcohol is consumed by male problem drinkers for the increased feelings of power that inebriation evokes for them.(McClelland, 1972). While a consensus agree on the general aggressive- ness manifested by problem drinkers, specific behaviors and/or psychometric scores used to earmark the aggressive- ness vary from study to study. Indeed, some work does not even utilize the term aggression, but rather prefers the term hostility (cf. Orford, 1976; Noel & Lisman, submitted for publication). In general, however, the term aggression is predominantly used rather than hos- tility, since the latter term also implies both enduring negative feelings and a specific target (see Buss, 1961). In addition to the aggression and/or hostility formed among problem drinking males, the wives of alcoholics have been characterized as being more hostile, rather than aggressive (cf. Ablon, 1976; Fox, 1962; Jackson, 1962). Typically these women have been assessed when their husband's drinking problem was so severe it required treatment. The Buss-Durkee Hostility Inventory is a self- rating scale of hostility that provides a Total Hostility score as well as subscale scores measuring Irritability, Assault, Indirect Hostility, Resentment, and Verbal Hostility. It has been used to assess hostility in violent versus non-violent male alcohol abusers and has proven to 79 be a valid measure with this population (Benson, Adams, & Tinklenberg, 1978). It is predicted that: 4. Fathers of high—risk.infants will report more hostility on the Buss-Durkee than control fathers. 5. M0thers of high-risk infants will report more hostility on the Buss-Durkee than control mothers. A Detailed Drinking History questionnaire adopted from Cahalan et a1. (1969) and Schuckit (1978) will be given to both parents. This, rather than the SMAST, will serve as the determinative instrument to establish drinking history. This instrument has been extensively utilized and provides data on quantity, frequency, and variability of consumption of alcoholic beverages. Additionally, it provides information on consequences of alcohol consumption. Research on the addictions has typically lacked this type of concise information (Nathan & Lansky, 1978). By providing a clear picture of each subject's drinking patterns, in addition to a psychiatric diagnosis and extensive demographic data, this work will avoid a common methodological problem typical of clinical diagnosis, that is, the use of broad, ill-defined diagnostic categories (Garfield, 1978). Final inclusion into this project will be based upon the data obtained from both the SMAST and the Detailed Drinking History. Fathers of potential high-risk infants must meet the criteria of Goodwin et a1. (1973; Table 3) for alcoholic. Control family males and their wives must 80 not meet the Goodwin et a1. (1973) criteria for problem drinker or alcoholic, that is, they must be either heavy or moderate drinkers, or abstainers. Data will be obtained for mothers of potential high-risk infants, but these data will not effect inclusion into the study. If the father has met our diagnostic criterion for alcoholism.and the infant is a male, the family will be accepted into the project. At the conclusion of each year with the project, the family will be given payment of $100. The large payment subsequent to participation as well as regularly scheduled contacts will hopefully minimize or eliminate dropouts (see Wilson, 1978, for a discussion of this issue). Perinatal Contacts First 10 days of life. All infants will be assessed with the Neonatal Behavioral Assessment Scales (NBAS; Brazelton, 1973) on the third or fourth day after birth and again on the ninth or tenth day after birth (Als, Tronick, Lester, & Brazelton, 1977). This will permit a tentative analysis of the "recovery curves" for all of the babies, that is, an assessment of the physiological stress due to birth and the infant's capacity to reorganize. The NBAS will be utilized since it assesses much of the infant's repertoire of organizational and functional abilities (A13, 1978; Self & Horowitz, 1974); it is generally reliable (Sameroff, 1978b); and it has been utilized with numerous samples of infants. While alterna- tive assessment instruments of neonatal behavior are 81 available (of. Graham, 1956), including a modified NBAS that is completed by mothers (Field, Dempsey, Hollock, & Schuman, 1978), we feel that the standardized use of the NBAS with a certified examiner is necessary (see Sameroff, 1978b, for a discussion of the rationale for use of a certified examiner). Numerous methods of data analysis for the NBAS have been utilized such as item-by-item analysis (of. Brazelton, 1978), factor analysis (cf. Osofsky & O'Connell, 1977), and a priori scoring dimensions (cf. Adamson, Als, Tronick, & Brazelton, 1975). Each of these methods has advantages and disadvantages (see Sameroff, Krafchuk, & Bakow, 1978, for an excellent discussion of item group- ing). Since this work is a pilot study, a careful item- by-item analysis will be completed, although post hoc item-by-item data analysis has serious statistical limitations (Nunnally, 1978). The a priori scoring profile developed by Adamson et a1. (1975; A13 et al., 1977) will be utilized. Neonate's scores on the a priori clusters have been found to correlate with subsequent Bayley Score (Field at al., 1978; Sostek & Anders, 1977), Carey Temperament Score (Sostek & Anders, 1977) and were found to be good predictors of continued risk in neonates who had early medical difficulties (Field et al., 1978). The rationale for the development of these specific a priori clusters is based upon the extensive clinical experience of Brazelton and his colleagues, and will also 82 afford several statistical and design advantages (Brazelton, 1978). The profile will be utilized with a 5-point scale to increase variability (see Sameroff et al., 1978), rather than the 3-point scales. Finally, the over- all developmental status of the infant as measured by the NBAS will be examined. Some evidence exists which links conflict and tension in the marriage with poorer developmental status of the ne0nate subsequent to birth (Pederson, 1971). While a significant number of studies have been cited which indicate that wives of alcoholics are more anxious and their marriages are characteristically less harmonious, none of these data have been obtained while these women were pregnant. It is possible that wives of alcoholics are significantly less anxious when pregnant and the acrimony generally present in their marriage could dissipate considerably. Although there is no clear reason to expect differences between high-risk infants and controls, insofar as they occur it is expected that the overall developmental status of the newborn, as measured by the NBAS, will be lower for the high-risk infants. The NBAS is not being utilized strictly as a predictor of future behavior, as it is generally a disappointing predictor of future developmental events (Emde, 1978; Sameroff, 1978a). However, much of the work with the NBAS has been done with neonates who are not at high-risk for subsequent severe psychopathology such as alcoholism; some 83 exceptions exist (see Appendix of Sameroff, 1978a). Although we are not utilizing the NBAS strictly as a predictor, the work of Fish (1957, 1973) predicting subsequent schizophrenic outcomes based upon the infant's status at one menth, would suggest that the NBAS could be useful in predicting alcohol outcomes. Rutter (1972) reviews a substantial literature looking for continuities or discontinuities between child and adult psychiatric disorders and concludes that "psychopathy is the one disorder which has its roots most firmly set in childhood" (p. 17). The connections between psychopathy and problem drinking have been discussed and are well documented. Nevertheless, the NBAS is being primarily utilized as a small part of a complex methodological package which is designed to attempt to empirically assess and mark the dynamic system existing between the child and its parents which eventually leads to alcoholism. One month. Four weeks after the birth of the infant, an undergraduate volunteer will make a home visit (see Table 1A/B). The purpose of this visit is to empirically assess the mother-infant interaction during the feeding situation (Ainsworth & Bell, 1969; Appendix 0), and to have both parents complete the Neonatal Perception Inventory (NPI; Broussard & Hartner, 1971; Appendix P) and the Social Readjustment Rating Scales (adopted from Holmes & Rahe, 1967; Appendix Q) at the end of the obser- vation period. If the father is not present,copies will 84 be left for him along with a stamped, addressed envelope and instructions to fill out the questionnaires without consultation from family members. Phone contact will be utilized if there is any problem about understanding these materials. At the conclusion of the visit, a Q-sort personality description (Block, 1961) will be completed for the mother and father (if he was present). The feeding scales developed by Ainsworth and Bell (1969) will be utilized to empirically assess the quality of the feeding situation. These scales identify four salient dimensions of meternal behavior during the feeding situation and rate each dimension on a 9-point scale. While these scales have not received extensive use, all of the scales have significantly differentiated mothers of babies who were subsequently identified as securely attached from those identified later as anxiously attached, utilizing a random sample of "normal" mother- infant dyads (Ainsworth, 1979). According to Ainsworth (1979), maternal behavior in the feeding situation seems to remain remarkably stable from occasion to occasion. Additionally, Cohen and Beckwith (1979) report that care- giver behaviors generally remain consistent from one month to two years (also see Caldwell & Bradley, 1979). This visit and a second observation of the feeding situa- tion utilizing the scales four weeks later will be completed. 85 The undergraduate female volunteers have been trained to use the Ainsworth.and Bell feeding scales. They simultaneously but independently observed feedings of male infants in daycare and in private homes; afterwards their scores were compared. Some of the feedings observed were from the bottle; others were breast feedings. No significant differences were found between scaled scores obtained at daycare or in homes, or between caregivers who bottle fed their babies or those who breast fed their babies. Reliability data for the last ten practice sessions (Table 6) show that inter-rater reliability was excellent for total scores from scales I, II, and IV. Scale III was not included in the analysis since it will not be utilized by the project. It pertains to the infant's food preferences and would not be relevant at four weeks. Although inter-rater reliability for scale II was admittedly low (.55), the percent agreement within two was 100%. Problems with scale II arose because it was often difficult to ascertain when the baby was finished eating, as well as who had determined the end of the feeding. An infant might stop eating if something else interesting caught his attention 9; because he was full. Caregivers seemed to also have difficulty reading these signals as they typically would continue feeding. The obtained inter-rater reliability figures thus indicate that the dimensions of maternal behavior assessed by these observations can reliably be made (also see Jones et al., 1975). 86 000H00>p00n0 mo a Hmwo9 "an p0udo800 + N SHSDHB mwcHomu £0H3 mcoHum>u0mbo no 9 H0009 000900>H00b0 mo a 90009 "an 00umo800 4% H 8H50H3 mwcHumu :DHB 000H00>u00b0 m0 s H0009 00H000 ucHooum k 00H ow gm.H m¢.m Hm. A00H000 p0ch800v HHo 000a 0.9bmb ou mch00m m0 000H m0 ooHu ooa OOH ma.H w.q 5mm. -muscoueucsm m.sm>awmum0 .>H wch00m m0 000 000 000m mo OOH oo ¢.H w.0 mm. 000080 mo :oHumcHah0u0Q .HH 08£uznu 0.9n0b nuH3 mcoHua0>u0ucH 0.H0>Hw 00H om mm.H mo.o «ow. :0H00 mo coHuMNH80unockm .H +~ as «as as .e.m m m semamom unuH3 0808 unuHB 0008 noouwm N :00um0 N m0H00m wch00m nuho3mcH00H z m 00 000Hv 008_m m .......0 00000000 000 0000 000 m 8000 0000 00 0>00000000 0000800 000 000000 00 2 .000300000 “0000 00 000000000000 0000 000000800 000 0H0: 00 m .000000000 0H .0000000 00000 000 00000 00 000 m 0000w 00 0030000 00 w000000 .000000 00000 000 0000 0000000 8000 m 0HH00 2 008 m m.: .......m 0000000 0.2 00 00 w00000 0000 008 H 00000 0000000 0000 (08009 .0000000 000 0000 0 .0000000 00 0000000 m 0H .0000800 00 00000 000 0000 (000 000000 m .w00000 00 m 00 .0000 A0000000 0>000000000 o0 0>00000000 0000800 000 -000 0H08000x0 000H0 m0H0 00 m 030HH0 m .8000 00>00H z m 00 000Hv 008 m 0.0 .......0 008 H 000 h0H0 000 00\000 00000000000 00 m 00m0w00 “008 H 000 z 00 0xH00 “008 H 000 0H000H00 0000 “000000 00 000 000000 0 008 m m.m.z .......m 00000000 000 0000 000 00000000000 000 0000 00 0>00000000 00 000 000000 0000800 2 008 m m.z .......N 0.8000 0000 00 0>00000000 00 000 00000000000 00000000 000 0000 2 .000000 w000b 000000 0000 00 0 000000000 z_.%00000000 0H .m A.008 H 00.8000 m\m 0000 0000000000 000 m 000 z .000000V 0H00000> m.z .......H 0000000000 000 0000>m 0809 0000000 000000m 0000000 000000000 000000000 0w0000m_00 0008800. 9 mHm<9 107 mmmH .000003.8000 00H0 000 00 0000000 00 m 00 00000000 000.0000 000 m 8000 0000 00 0>00000000 0000800 000 000000 00 2 000300000 “0000 00 000000000000 0000 000 000000800 000 0H00 00 0 .000000000 00 .0000000 00000 000 00000 00 000 m 0000w 00 0030000 00 0000000 .000000 00000 000 0000 0000000 8000 m 0HH00 Z 008 m 0.2 .......w 0000000 0000 :08000 .00000000 0.2 00 00v 000000000 000000 000 000000800 00 000000 0 00 .0000800 00 00000 000 0000000 000000 0 00000000 .00000 0000003 000 00 000000 00 w00000 -000 000800000 00 m 00 .000000 00 000 0000000 0 m 00 000HV 008 m 0.0 .......0 0000000000 000 0000>m 0800 0000000 0000000 _ 0000000 0.0.00000 0 00000 108 on these five scales reflect an attempt to integrate aspects of the actual behavior as well as intensity, duration, and strength of behavior into a single score on that dimension. The third type of data analysis is to classify the infants on the basis of the overall patterning of their strange situation behavior as reflected in their fre- quency and scaled scores. Infants are categorized as securely attached (approximately 65% of past samples); anxiously attached and avoidant (approximately 20% of past samples) and anxiously attached and ambivalent (approximately 15% of past samples). The classification criterion are elaborated in Table 8. Two undergraduate volunteers will be trained to rate the SSP. Researchers who have employed the Ainsworth scoring system typically report inter-rater reliability of .85 or better (Ainsworth, 1979; Matas et al., 1978; Waters, 1978). Additionally, videotapes of 18 mmnth old infants are available (Waters, 1978) and will be utilized to insure criterion validity. While an extensive literature deals with familial characteristics where one parent is an alcoholic (cf. Ablon, 1976), none specifically discusses attachments between offspring and parents. In addition to this difficulty, there is a lack of data on prealcoholic males prior to the age of ten. Barry (1974b) discusses the personality of the alcoholic and concludes that the central conflict mnma .mumum3 Bosh Anowcnmuv swag ou muwuo uvoa .Anowumhmmmmv AcoHumummmm swan .Mcowuwummom noun Goumov -muav Hamaoammooo swam sou swam swam :uamflm>ana<: < xnwhuo wcwumwmmm mcflpwo>< wcacwmu wawxmom Houmanomma aoflumofimammmau oomucoo %uwawxohm uawmz zuwawxoum uomucoo Am a m mopOmHmm cowabom EOHMV «whouwuo GowumoHMflmmmHo mcowumoHMfimmmHo nowumfiuwm wmcmuum mo humEESm w m4m<fi 110 characteristic of the alcoholic male is ambivalent feelings between attachment and alienation. Blane (1974) states that these contradictory feelings probably have their origin in the earliest stages of development. Some evidence, both.c1inical and empirical, suggests that excessive use of alcohol relates highly to feelings of alienation (see Blane & Hewitt, 1977, for a review of this literature). Insofar as differences occur, we expect the high-risk infants to be less securely attached than con- trol infants. Twenty-four months. Two years after the infant's birth, a home visit will be made, by a qualified examiner who is trained to administer the Bayley Scales of Infant Development (Bayley, 1969) and also by an undergraduate volunteer (see Table lA/B). During the readministration of the Bayley Scales, both parents will recomplete the Social Readjustment Rating Scale (SRRS; Holmes & Rahe, 1967; Appendix Q), the Detailed Drinking History (adopted from Cahalan et al., 1969; Schuckit, 1978; Appendix N), and the mother will participate in a structured interview designed to assess the child's temperament again (Thomas et al., 1963). The rationale for selection of the Bayley Scales to assess the developmental status of the infant has already been discussed. Although scores obtained during the first 3 years on the Bayley Scales do not correlate with later intelligence test scores (Bayley, 1970), 111 this reassessment (see Table lA/B) of the child with the Bayley will again provide valid data on the child's current level of cognitive abilities. Scores obtained at 2 years can be compared to scores obtained when the child was tested at 4 mpnths. Although scores across this developmental epoch typically do not correlate, these data generally pertain to normal samples and results for high-risk children could possibly be vastly different (cf. Fish, 1959). The SRRS will also be regiven to both parents in an attempt to ascertain if parents of high-risk children have experienced more life stress than parents of controls during the previous 24 months. One exploratory question is whether parents of high-risk children score higher on the SRRS; if so, what effect might this have on the child? Some evidence suggests that high life stress can have a debilitating effect on the quality of the infant—mother attachment in poorer families (Stroufe, 1979). The undergraduate volunteer for this assessment will, as before, be trained to utilize the structured inter— view format developed by Thomas et al. (1963) for use with the New York Longitudinal Study (NYLS). If differences are found here, we anticipate that high-risk children will be described as manifesting less persistence and more distractability than control children. In addition, reviews of hyperactivity in preschool children (Laufer & Denhoff, 1957; Schleifer, Weiss, Cohen, Elmmn, 112 Cvejic, & Kruger, 1975; werry, 1968) discuss high activity level as a prominent feature of the syndrome during this developmental epoch. Given the potential link between alcoholism.and hyperactivity (see literature review), if differences in activity level occur we expect parents of high-risk toddlers to report higher activity levels in their sons than parents of control toddlers. The Detailed Drinking History is being readministered to both parents. A comparison of current responses with those made two years earlier will begin to provide vital longitudinal drinking information that will serve to chart the developmental course of problem drinking. While numerous researchers and clinicians attempt to deal with issues relevant to a diagnosis of alcoholism at a single point in time (see literature review), there is a paucity of work that attempts to deal with developmental aspects of problem drinking (see Zucker, 1979, for an exception). Thirty months. Two and one half years after the birth of the child, arrangements will be made with the family to have a: video recorder placed in the dining room of their home (see Table lA/B). The recorder will be in a small case along with a timing device that will be set to automatically activate the recorder ten (10) minutes prior to the typical onset of dinner. The recorder will remain on for forty (40) minutes each evening before automatically shutting off. These 113 recordings will be made for six (6) consecutive evenings. Since family members will not be required to operate the recorder, it is hoped that the reactive effects of having the recorder in the home can be minimized (Jacob, 1979). Three of the recorded dinner-time interactions will be randomly selected for analysis with the Family Inter- action Coding System (FICS; Patterson, Ray, Shaw, & Cobb, 1969) and the remaining three dinner-time inter- action tapes will be analyzed with the Structural Analysis of Social Behavior Model (SASB; Benjamin, 1974; McLemore & Benjamin, 1979). The SASB model represents an extensive elaboration of Leary's (1957) interpersonal circle. While the circumplex of social behavior variables that Leary constructed was based upon the two orthogonal axes of love-hate and dominance-submission, the SASB model has slightly modified these original orthogonal axes. Briefly, the SASB model is based upon a horizontal axis labeled affiliation and a vertical axis labeled interdependence; these axes are orthogonal in the SASB model. The model examines interpersonal behaviors by focusing on the behavior of the other (top surface, Table 9), the behavior of the self (middle surface Table 9) in response to the behavior of the other, and what happens when the behaviors of others (top surface) are turned inwards--represented by the introject of other to self (lower surface Table 9). On each of the three surfaces the horizontal axis is labeled affiliation and the vertical 114 as m>aw .uasnnm .wamaw >H HHH uaooo< kamaoo savcmaum maaumom mmaommou owumumom mfiocoua< haoaous< umououm ouwnoamon saecmaum maaumom >0mcm mxme HH ow com o woo sammsa Amv mHom Houucoo owmcmz HHH moCmSHmcH Hm3om saeamaum «Haumom huwamsxmm HopamH zflocous< zaocous< xomuum wawumHflSHan< saucmass maauwom mxo>nH HH on umnuo muoeam q<20mmmmmmHzH soa>mcom Hmaoom mo sumac was we coamsm> smamaasaam m mqm<fi QTIHO lNHHVd 115 maom nmwuoso Ea .fiamnfim so; an .Houucoo maom mmmhmao .m>og mama oumHfinwccm .ouduuoH maom ou Hmnuo mo aHV summouuaH mHom uommom OHEUWmm Ho .aowuom ohnusm .wcwahmump ou manwmmOQEH on panoz moamHHmEoo 50H53 Mom pamfiaoo 4% coflu ucouum panama Haow EwH>Humwmz mcflnz ouocwH momma wcmaaoo mama uumfim wcwaoumonne o>wu Ham» nwwmc Hmofimhnm oawsz BmH>Humwoz Susanne mocmwaaaoocoz mmmmH opost meH mama unmam mumwaflasm nosoe m>flooom o>Hu mush swam mmoco>fiuosuumoa xHMH mmcoammu oz umwm: Hmowmznm mumansfium m>ouamwmfln o>woomm m>mo4 mocmwaaaoocoz a. umaom vcmaaoo m>fluwmoa £0509 mwanoaH mumwawfism 1Iom¢ommou oz wafivcmum Hmo«m%£m o>HuHmom huw>auom mums swam 1 o>moq mo cowumaofi> cofluomuoucw Hmowmzzm unopcoamch mums muw>wuom hho Hmnuo>coz cowuomumocw o>ouaammwa um>au05humoa unopamnoch Amcwumc swung Hmnum>coz «mawua pcmEEoo pcmaaoo honoucmaon ufiahouv 0>Hu oodmwasoaH swamq chwumcaauouv wcwpcmum koaaua umwoc pfimaaoo xagaou mocmHHmfioQ o>wumwoc mo coHumHoH> camaaou pnmaaoo .aowucmuu< coflucmuu< vamaaou Gown vcmaaoo waacoummuah m>ouma< Hm>ouam< pcmeaoo ucouum pcmamo vamaaoo o>Humwoz m>wufimom Hmfloomoum uamw>mpcoz ucmw>mo knowoumo monozvmmaoo >Howmumo How>m£on pafino moahomoumo moconvmmaoo paw mownowoumo Hofl>m£mm pafizu mp wouqu mamuH mUHm OH MAm Story 2: Drunken man Man entering a bar; Man in bar drinking whiskey with a glass of beer in his other hand; Close shot of man drinking whiskey and stagger- ing away from.the bar; Man staggering out the barroom door and stagger- ing down the sidewalk. UOUUI> Story 3: Exhausted man Man entering a gymnasium; Man in a weight room lifting weights; Close shot of man putting weights down and walking listlessly out of the weight room; Man listlessly entering the locker room, collapsing onto a bench, and looking exhausted. c1 c3o1> Adopted from Jahoda & Cramond, 1972 126 An advanced child clinical graduate student will conduct the Recognition of Smells test and the Drunkeness Film test. Jahoda and Cramond (1972) reported that two examiners were used to give the aforementioned tasks. One was an experienced child psychologist, the other was "a part-time assistant experienced with children, but without psychological qualifications" (p. 3). Despite intensive training with appropriate procedures, the assistant was less adept at acquiring information from the children. That is, children tested by the assistant had more entries labeled "no reply" and also consistently made more "socially acceptable" responses. While cognitive testing is often considered easy or straightforward, this point of view can yield results that are biased (see Santostefano, 1978, p. 411). The use of advanced child clinical graduate students will hopefully ameliorate this problem. With the exception of the Jahoda and Cramond work, no systematic research has examined the development of children's attitudes and knowledge relating to alcohol with children under five years of age. Their data, obtained by testing a small additional sample of "nursery school children", showed that 66% of the four year olds who could correctly identify smells (a minimum of three recognized) could correctly identify the smell of beer and/or whiskey. No clinical or empirical research has been completed which scrutinizes the development of the young 127 child's knowledge and attitudes towards alcoholic beverages which one of the.child's parents is an alcoholic. The Smells Test with this sample will begin to fill this gap in our knowledge. Any expected differences between high-risk children and controls are highly speculative. We expect that of the group of children able to correctly identify smells (a minimum of three), the high-risk boys will be able to also correctly identify the smell of beer and/or whiskey more often than controls. This expectation is based upon the notion that alcoholic beverages will be present and more openly used in the high-risk homes. These children might be able to correctly identify the smell of beer and/or whiskey because these smells could be more familiar. Jahoda and Cramond tested a small sample (n = 14) of nursery school children (age 4) with the Drunkeness Film Task. Three of the children correctly recognized the man's drunken state after segment D; three more after segment CD; and six after segment BCD. Insofar as differences occur, we expect high-risk children will correctly identify the man's drunken state and its cause earlier in the testing sequence than controls. In response to the question, where have you seen men like that, we expect that high-risk boys will respond more often with "home". These expectations are based upon the notion that the high-risk children will have more live experiences with both excessive consumption of 128 alcohol and drunkeness. The limitations discussed in the preceding paragraph, vis a vis lack of data in this area, are relevant to our expectations on the Drunkeness Film Test. Fortyeeight'months. Four years after the birth of the child both parents and the child will participate in a session at Michigan State University in the psychology building (see Table lA/B). If necessary, subjects will be picked up at home and driven to the university. While the parents are alternating between participating in a semi-structured interview with the project's chief investigator (RAZ) and completing questionnaires, the child will first be assessed by a qualified examiner utilizing the Revised Yale Developmental Inventory (YDI) and will subsequently participate in a structured laboratory assessment of open-field activity. These procedures will require two to three hours to complete. At the conclusion of the visit, the project's chief investigator will complete a Q-sort personality descrip- tion (Block, 1961) for each parent. The parent's interview will be based upon the semi- structured format of the Schedule for Affective Disorders and Schizophrenia (SADS; Spitzer & Endicott, 1977). The SADS has already been utilized with both parents (see Table lA/B, eight mpnths pregnant), therefore the rationale for both the use of this procedure and the predicted results will not be discussed again. It is 129 predicted that: 7. Fathers of highrrisk toddlers will receive a diagnosis of personality disorder, antisocial, on Axis II of DSM-III more often than fathers of control infants. During the time one parent is participating in the interview, the other parent will complete the following questibnnaires: Social Readjustment Rating Scale (SRRS; Holmes & Rahe, 1967; Appendix Q); Werry-Weiss- Peters Home Activity Rating Scales (HARS; Werry, 1968); the Detailed Drinking History (Cahalan et al., 1969; Schuckit, 1978; Appendix N); and a modified version of the Worchester Scale of Social Attainment (Phillips, 1968). The SRRS will be given to both parents in an attempt to ascertain if parents of high-risk toddlers have experienced more life stress than parents of controls during the previous 24 months. One exploratory question is whether parents of high-risk toddlers score higher on the SRRS; if so, what effect might this have on the child? The HARS was originally designed for completion by mental health professionals during an interview of the parents of a child with suspected hyperactivity. Several researchers took items from the original interview and developed a self-administered questionnaire version (cf. Knights & Hinton, 1969) that parents can complete. Although the HARS is the mpst widely used parent rating scale of hyperactivity (see Sandoval, 1977), it is plagued 130 by reliability and validity problems that are typical of instruments developed to assess hyperactivity (see literature review). This project will attempt to minimize these problems by utilizing more than one rater when pos- sible, by using different metrics of behavior, by assessing behavior across a variety of settings, and by assessing behavior across the child's development. Items on the HARS evaluate the child's behavior across several settings with a wide variety of specific behaviors enumerated. The HARS has shown itself to be drug sensi- tive with hyperactive preschoolers (Knights & Hinton, 1969). The HARS has 31 items designed to assess the activity level of the child in 7 areas: meals, television, home work, play, sleep, behavior away from home, and school behavior. Since items in the areas of home work (5) and school behavior (4) are not appropriate with 4 year olds, they will be deleted. The 22 item shortened version of the HARS has been utilized by other researchers for use with younger children (cf. Routh, Schroeder, & O'Tuama, 1974). Scores on the 22 item.HARS can range from O to 44, higher numbers indicating higher activity ratings. In view of the possible links which which exist between hyperactivity in childhood and future alcohol problems (see literature review), if differences occur, it is expected that high-risk toddlers will be given higher mean activity scores than control toddlers. The Detailed Drinking History will be readministered to both parents. The rationale for use of this specific 131 metric and reasons for readministration of this instrument have already been discussed (see Table lA/B, third week of eighth month of pregnancy and twenty-four months). The modified version of the WOrchester Scale of Social Attainment (Phillips, 1968; Rudie & McGaughran, 1961) will be readministered to both parents. A comparison of current responses with those made three years earlier will begin to provide longitudinal information on changes in the general competence of both alcoholic and control families. Some longitudinal assessment of competence has been completed with schiZOphrenic populations (Lewine et al., 1978), but this type of work has not yet begun with alcoholic populations. While the parents are completing questionnaires and the SADS interview, the child will participate first in a developmental assessment with the Yale Developmental Inventory, and second in two 15-minute play sessions. The YDI will be given to the children prior to the play sessions for several reasons. Although items on the YDI are typically more compelling for children than items on other similar instruments, toys are generally more attractive to children at this age. When a child is allowed to first engage in free-play with toys, it is difficult to obtain cooperation on the YDI. Second, the children will probably be quite anxious when they arrive at a novel place and their parents leave them with a stranger. Providing the child cognitive structured 132 tasks will help them to adjust to the novel setting. Third, since the children will be most anxious when they initially arrive and separate from their parents, this would not be the optimal time to observe their free-play. Typically play is most easily distorted by anxiety and a sample of the child's play at this time might not be representativel. The YDI will be administered to the child by a qualified examiner. This inventory is a clinically oriented assessment tool that can be used with children aged 4 weeks through 6 years. The inventory examines the development of the child in five major areas: 1) gross motor, 2) fine motor, 3) adaptive, 4) language, and 5) personal-social. The result of the examination of the child with the YDI is a developmental age for the child in each of the five aforementioned areas and an overall developmental age of the child. The YDI is primarily the Gesell Institute of Child Development Inventory (Gesell & Amatruda, 1958) along with selected items from the Merrill-Palmer, Stanford-Binet, Bayley, and the Hetzer-Wolf Baby Scales from the Vienna Test. The YDI was originally developed as a more exten- sive and comprehensive developmental inventory, taking items from other scales to increase the scope and depth of the assessment capacity of the instrument. The Denver 1The author is indebted to Helen Benedict for the preceding discussion. 133 Developmental Screening Test (Frankenburg & Dodds, 1967) was developed primarily from items in the YDI, although the original rationale for item selection (i.e., ease of administration and lack of elaborate equipment) has made the Denver Developmental Screening Test a less than optimal measure of a child's development (see Garrity & Servos, 1978). Several other screening devices of child develop- ment are available, such as the A-M-L Scale (Brownbridge & VanVleet, 1969), the Teacher Rating Scale (Grossman & Levy, 1974), and the Minnesota Child Development Inventory (Ireton & Thwing, 1972), but again none offers the scope and depth of the YDI. Although administration of the YDI requires strick adherence to specific guidelines for each test item, the specific order of item presentation is left to the discretion of the examiner. This permits a flexible approach by the examiner so that the child's interest in the test can be optimized. This approach is in sharp contrast to other developmental inventories that require strict adherence to order of presentation as well as method of item presentation. The paucity of reliability and validity data on the YDI reflect this flexible approach; however, the flexibility generally permits a more complete assessment. Although the YDI is commonly used clinically and not as a research instrument, some empir- ical work has been done with the YDI (cf. Provence & Lipton, 1962). 134 The YDvaill be administered without the primary caregiver present. The YDI will permit exploration of any standard developmental marker differences that may exist between the high-risk toddlers and controls, not as a predictor of future functioning. The YDI is being utilized in an exploratory fashion. Subsequent to completion of the YDI, the child will participate in two consecutive lS-minute play sessions; activity level will be monitored via ankle and wrist - actometers strapped to the child's preferred ankle and wrist. The purpose of these sessions is to ascertain if high-risk preschoolers show higher levels of activity than control preschoolers. While numerous studies have been completed that utilize observational techniques to study activity levels in children (Cunningham & Barkley, 1979; Loney, in press; Sandoval, 1977), very few empirical studies of activity level in preschoolers have been done.» The majority of the studies of activity level in children have been concerned with hyperactivity. Since preschoolers are less often referred for this problem and typically display high activity levels (Schleifer et al., 1975), the dearth of studies is understandable. Many observational studies of hyperactive children utilizing a plethora of multidimensional rating scales have been completed. This work has primarily shown that hyperactive children and normal children demonstrate 135 similar levels of activity in unstructured or free-play situations. Behavioral differences in activity level only manifest themselves under conditions of external restraint, where activity is limited by task demand or requests to inhibit movement (Loney, in press; Sandoval, 1977). The few studies of activity level in preschoolers have similar findings. Scheifer et al. (1975) assessed activity level in preschoolers (average age 4) in free-play and in a structured nursery period. No differences were found between hyperactive and normal children on any of their measures of activity level during free-play; however, during structured nursery play hyperactive children dis- played higher activity levels on all of their measures. Routh et a1. (1974) assessed open—field activity level in normal children, examining the phenomenon from a developmental perspective, utilizing 140 children from 3 years to 9 years of age. The primary finding was that mean levels of open-field activity steadily decreased with age in both a free-play and a restricted play situation. These authors suggest that developmental view of activity level for both normal and pathological children is appropriate. The procedure that Routh and his colleagues (1974) have developed will be used in the present study. Briefly, children will be left alone in a large playroom that will be divided into four approximately equal segments. In each quadrant will be a table with a collection of 136 identical toys. Children will first be left in the room with free-play instructions and after 15~minutes they will be instructed to stay in one quadrant and play with one toy. Between the lS-minute segments the child will be taken for a walk while the room is straightened. During the sessions, tallies will be made of toy and quadrant changes. Routh et al. (1974) report inter- rater reliabilities (product-moment correlations) of .87 or higher. Raters will be two undergraduate volun- teers who will be trained by simultaneously, but indepen- dently observing male 4 year olds in a local daycare until inter-rater reliabilities of .9 for tally totals are obtained. Since the tally procedures are rather straight forward, no difficulties are anticipated. The possible connections between high activity level, hyperactivity, and future drinking problems has been discussed (see literature review). If any differences occur we expect high-risk preschoolers to have higher open-field activity than controls during the restricted play segment. Additionally, if differences occur on the actometers, we expect high-risk children to have higher actometer scores during the restricted play segment than controls. Sixty months. Within one month of the child's fifth birthday a home visit will be made by an advanced graduate student in child clinical psychology and an undergraduate volunteer (see Table lA/B). The purpose 137 of this visit is to have both parents complete the Child Behavior Checklist (CBCL; Achenbach, 1978b; Achenbach & Edelrock, 1979; Appendix T) and the mother participate in the Thomas et al. (1963) temperament inter- view. While the parents are completing these tasks, the graduate student will assess the child's attitudes and knowledge of alcoholic beverages. If the father is not present during this visit, one CBCL will be left for him to complete, along with instructions for him to complete the questionnaire on his own. The CBCL consists of 118 behavior problem items and 20 social competence items that have been adapted for their optimal use by parent report. The responses to the CBCL are scored for social competence and behavior problems utilizing the appropriate Child Behavior Profile. Separate editions of the Child Behavior Profile have been developed and standardized for each sex at ages 4-5, 6-11, and 12-16. Standardization and normative data for both age and sex of the child has repeatedly demonstrated that the same behavioral problems can vary in their empirical and clinical significance (Achenbach & Edel- brock, 1978; DeHorn, Lachar, & Gdowki, 1979). That is, nocturnal enuresis has vastly different implications/ consequences for a 4 year old boy than for a 16 year old female. The pattern of scores on the CBCL permits analysis of the child's behavior problems with respect to profile 138 types. These types are unique to each.age/sex group and are based upon score patterns per se, not elevations (Edelbrock & Achenbach, 1978). All behavior problems are dichotomized between the two general factors of internali- zing and externalizing. This dichotomy has proven to be highly robust with numerous instruments by different types of raters and in different situations (Achenbach, 1978b). The profiles that have been obtained with the CBCL are the result of factor analysis that has been systematically applied to completed checklists. The norms that have been obtained are clinical norms rather than norms for "normal" children. By utilizing a sample of clinic referred children to develop norms, maximal differentiation between profiles has been obtained (Edelbrock & Achenbach, 1978). Preliminary investigation of the stability and reliability of the CBCL has indicated that the instrument is satisfactory. Follow-up stability, across all sex/age groups for six months has been .7l-.73; for eighteen months it has been .59 (Edelbrock & Achenbach, 1978; Achenbach & Edelbrock, 1979). Follow-up stability has been even better when the continuity of profile types are assessed. For all age/sex groups six month profile type stability was .89; for eighteen months the profile pattern stability was .76 (Edelbrock & Achenbach, 1978). The test-retest reliability of the CBCL across all age/sex groups has been above .80 (Achenbach & Edelbrock, 1979). 139 Finally, parents have been given the CBCL independently and asked to complete the checklist. Interparent agree- ment for all boys has been .79 (Achenbach.& Edelbrock, 1979), although.these data were not obtained from families with an alcoholic parent. The juxtaposition of the high interparent agreement on this instrument and the high value generally given to parent reports of child behavior problems, i.e., "parents are typically the most important source of data on child behavior problems" (Achenbach & Edelbrock, 1978, p. 1289, 1290), indicates that the CBCL will provide a rich picture of any behavior problems the child may have. This extensive work is in striking contrast to many of the earlier instruments that have been employed in this area (see Barkley, 1977; Sandoval, 1977). Although numerous studies of children of alcoholics have been conducted (cf. Fox, 1962; Jacob et al., 1978; Haberman, 1966; Hindman, 1975; Wilson & Orford, 1978), this work suffers from several serious methodological short- comings. Blane and Hewitt (1977) cogently point out many of the methodological limitations in this literature and caution against reaching any conclusions. For example, extensive use of antecdotal data, sampling difficulties, lack of clear diagnostic criteria for alcoholism, no controls or controls that have not been screened to exclude alcoholics, and poor measures are but a few of the problems. In addition, no study specifies the age/sex of children of alcoholics along with a 140 specific catalog of problems of these offspring. In addition no attempt has been made to juxtapose these difficulties along with the duration and time of onset of theparent's alcohol related difficulties. Unfor- tunately then, from a developmental perspective little can be distilled from this earlier work. Despite these methodological shortcomings, impulsivity and hyperactivity (see literature review) are often cited as possible precursors that exist in the male child who subsequently becomes alcoholic. Insofar as differences exist, it is expected that parents of boys who are at high-risk will score higher on the aggressive scale of the CBCL. Items that make up the aggressive factor for 4 and 5 year old males include both_hyperactivity and impulsivity. The undergraduate volunteer will be trained to utilize the structured interview format developed by Thomas et a1. (1963) for use with the New York Longitudinal Study (NYLS). The rationale for use of the NYLS structured interview format, the method of rating the interviews, and the justification for expected differences in persistence, distractability, and activity level has already been discussed (see Table lA/B, four months and twenty-four months). If differences exist, we anticipate that high- risk children will be described at this age as manifesting less persistence, more distractability, and higher activity level than will control children. The assessment of the child's attitudes and knowledge of alcohol will be based upon the already reviewed work 141 (see.Table lA/B, forty-two months) of Jahoda and Cramond (1972). The asseSsment will require one hour and will occur simultaneously with the parental procedures just discussed. The following procedures will be utilized: Recognition of Smells Judgement of Photographs Perceived Likes and Dislikes Concept Task Drunkeness Film Following is a brief description of the experimental paradigms. The Recognition of Smells and Drunkeness Film.test have already been described (see Table lA/B, forty-two months). The Judgement of Photographs task is designed to ascertain what attitudes children have towards drinking behavior in male and female adults. Children will be shown photographs of adults engaged in various activities such as eating an apple, drinking beer, drinking from a shot glass, reading a book, etc. Specific methodological issues relevant to the design of this task are discussed in Jahoda and Cramond (1972) and necessary procedures will be carefully followed. Children will be seated at a table with a happy face, a neutral face, and a sad face clearly drawn on sheets of paper that are taped onto the table top. The examiner will explain to the child that they will be shown a series of photographs. Pictures they like are to be placed onto the happy face, pictures they dislike are to be placed onto the sad face, and so on. This type of sorting procedure has been employed with 142 even younger children (aged 4) as a reliable sociometric measure (Asher, Singleton, Tinsley, & Hymel, 1979), and should be easily understood by five year olds. The Perceived Likes and Dislikes task will employ the same scaling procedures utilized in the Judgement of Photographs. The children will be seated at a table with the various faces (happy, sad, neutral) taped onto the table top. They will be given a small male child doll and will be told to respond to the task as they think the little boy doll might really respond. Children will be read a list of 24 activities such as doing the cooking, repairing the car, drinking beer, drinking whiskey, going to school, etc. Children will be told that a list of activities is going to be read to them, They will be instructed to tell the examiner which ones the little boy doll would like to do, which ones he wouldn't like to do, and so on. Subsequent to completion of this trial, children will be given an adult female doll and the task will be repeated. The female doll will be referred to as a woman, someone like your mother. This will be followed by giving the child an adult male doll, a man, someone like your father, and a third replication of the task will be accomplished. Specific lists of activities and design issues are discussed in Jahoda and Cramend (1972). Procedures delineated by these workers will be carefully followed. 143 The Concept Task is designed to ascertain whether the child has developed the category "alcoholic beverages" as a logical class which includes various alcoholic drinks that the child has knowledge of. That is, while a child can identify various drinks individually, is the child aware of the concept of "alcoholic beverage" as an overarching category. Children as young as 3 are able to successfully place various objects into classes or categories which they can verbally identify (Santostefano, 1978). Although Jahoda and Cramond (1972) have developed an assessment procedure to test the child's knowledge of the concept "alcoholic beverage," it is felt that their design presents the child with an over-simplified task that limits the child's responses more than necessary. While the specific procedures have not been developed at this time, the assessment of the child's ability to accomplish the conceptual differentiation task will be a modification of the Object Sort Test II (Goldstein & Scheerer, 1941). We plan to alter the display of materials in the standardized test to include various beverages, both alcoholic and non-alcoholic. If the child does not spontaneously group beverages on the alcoholic/non- alcoholic dimension, specific inquiry will be developed to assess the child's ability to discriminate on that dimension. While the precise inquiry has not been pro- duced to date, inquiry procedures developed by Santostefano 144 (1978) for use with the Object Sort Test II will be used as a prototype for our specific inquiry. No clinical or empirical research has been completed which scrutinizes the development of the young child's knowledge and attitudes towards alcoholic beverages where one of the child's parents is an alcoholic. The aforementioned procedures will begin to explore this general area. Any expected differences we postulate between high-risk and control children are highly speculative, expecially on the Judgement of Photographs; Perceived Likes and Dislikes; and the Concept Task. We expect that of the group of children able to correctly identify smells (a minimum of three), the high-risk boys will be able to also correctly identify the smell of beer and/or whiskey more often than controls. We anticipate that high-risk boys will also do better on the Drunkeness Test. Postulated differences on the Judgement of Photographs and Perceived Likes and Dislikes will not be made as individual differences in families of alcoholics will significantly influence these data. As Jahoda and Cramond point out, results of the Concept Task are subject to the child's general cognitive development in the area of equivalence range (i.e. their ability to categorize and conceptualize information), in addition to their specific experiences with alcoholic beverages. Therefore no predictions will be made. At the conclusion of the visit, the undergraduate volunteer will complete a Q-sort 145 personality description (Block, 1961) for the mother and the father, if he was present. APPENDICES APPENDIX A AGENCY PARENT LETTER APPENDIX A AGENCY PARENT LETTER (Agency letterhead) Dear Mr. and Mrs. Dr. Robert Zucker and Dr. Hiram Fitzgerald of Michigan State University are conducting a long term scientific study concerning the relationship of the environment to child health and development as it occurs in the family. Although the major emphasis of their work is on the development of very young children (or early school age children for the 5-year-old sample) over a period of several years, information also is to be collected from other children in the family and from yourselves as parents in order to understand the context in which child health and development occurs. This letter is to inquire whether we may give your name to Drs. Zucker and Fitzgerald so that they or a member of their staff may contact you to discuss your participation in their study. Your family has been selected out of (agency name) records, along with a large number of other families from this and other Lansing area health facilities so as to provide a representative group of families from many different backgrounds. As is true of all work of this kind, once a potential family has been selected, it is especially important for the family to participate if the study is to be valid. I would like to add that in no way can any individual or family be identified once the information is collected. Strict confidence and anonymity are guaranteed by removing all names and identifying material from records that are kept. Should you agree to consider participating in this work, we will forward your name to the project staff. What will happen next is that they will contact you and arrange an interview to discuss study participation in greater detail. The interview would take place in your own home at a time convenient to you. Families will be compensated in a small way ($25.00) for taking part in the interview. If you are accepted in the project, $100 payment will be made to you at the conclusion of each year you participate in the study. The material to be collected then concerns behavioral, physiological, and pediatric information about children's development and parent-child relations. 146 147 APPENDIX A.(cont'd.) If you wish to consider participating in this work please sign the attached form so that we may inform the study workers so that they may call and schedule a visit. This Visit dOes not obligate you in any way should you decide not to participate. Also, although I hope you will decide otherwise, please indicate on the attached form if you do not wish to be contacted. Finally, if you have any questions about this letter, Ms. (person employed at agenc ) of our staff will try to answer them. She can be reac ed at (phone number) on (days of week) between (times). Sincerely, Appropriate agency member P.S. A stamped self-addressed envelope is provided for your convenience. 148 APPENDIX A (cont'd.) (agency letterhead) Please check one of the following: yes, we give the (agency name) permission to release our names to Drs. Zucker and Fitzgerald so that they may contact us to provide more detail about their experiment. no, we do not want our names released nor do we wish to participate in the project conducted by Drs. Zucker and Fitzgerald. Father's signature Father's name (please print) Mother's signature MOther's name (please print) Date: PLEASE RETURN THIS FORM IN THE SELF-ADDRESSED, STAMPED ENVELOPE. Thank you. APPENDIX B RESEARCH PARTICIPATION INFORMED CONSENT FORM APPENDIX B 'MICHIGAN STATE UNIVERSITY. Department of PsychoIOgy East Lansing, MI» 48824 RESEARCH PARTICIPATION INFORMED CONSENT FORM We have freely consented to take part in a long-term scientific study of human development being conducted by Dr. Robert A. Zucker and Dr. Hiram E. Fitzgerald (Professors of Psychology) and their staff. The study has been explained to us and we understand the explanation that has been given and what our participation will involve and what our child's participation will involve. We understand that we will receive additional explanations of specific studies during the five-year research project period. We understand that we are free to discontinue our partici- pation in the study at any time without penalty. We understand that the results of the study will be treated in strict confidence and that we and our child will remain anomyous. Within these restrictions, results of the study will be made available to us periodically throughout the course of the project and for a minimum of three years after the project has concluded. Also within the restrictions noted above, we understand that general results of the research will appear in professional journals and will be presented at scientific meetings. We understand that we will be paid $25 for participation in the initial screening interviews. We understand that once we are accepted into the study we will receive an annual honorarium of $100 for the partici- pation of our family in the project, to be paid at the end of the first year and yearly thereafter. We understand that our participation in the study does not guarantee any beneficial results to us or to the members of our family. Signed: Mother Date 149 150 APPENDIX B (cont'd.) Father Date Child (when appropriate) Date Witness """ Date APPENDIX C MEDICAL INFORMATION RELEASE FORM APPENDIX C MICHIGAN STATE UNIVERSITY, Department of Psychology East Lansing, MI 48824 MEDICAL INFORMATION RELEASE FORM Dear Dr. I have freely consented to take part in a long-term study of human development being conducted by Dr. Robert A. Zucker and Dr. Hiram E. Fitzgerald (Professors of Psychology at Michigan State University). I understand that the project requires access to medical records concerning obstetric, pediatric, and other medical information concerning myself and my child. I hereby authorize you to release this information to them. I understand that all information released will be held in strict professional confidence, and that I and my child will remain anonymous in the reporting of any findings from.the study. Thank you for your cooperation. Sincerely, Signature Date Parent's name (please print) Child's name (please print) Witness: signature 151 APPENDIX D SCHOOL ACHIEVEMENT AND PERFORMANCE RELEASE FORM APPENDIX D MICHIGAN STATE UNIVERSITY, Department of Psychology Fiat Lansing, MI 48824 SCHOOL ACHIEVEMENT AND PERFORMANCE RELEASE FORM Dear Our family has recently consented to take part in a long- term study of human development being conducted by Dr. Robert A. Zucker and Dr. Hiram E. Fitzgerald (Professors of PsychologY) at Michigan State University. We understand that their project requires access to school achievement and school performance records concerning our child. We hereby authorize release of this information to them. We understand that all information released to them will be held in strict professional confidence and that we or our child will remain anonymous in the reporting of any findings. We further understand that they will contact you personally to secure appropriate permissions and to inform you as to the purpose of their research. Sincerely, Mother's signature Mother's name (please print) Father's signature Fathér's name (please print) Child's fullfname (please print) Date: Witness: Date 152 APPENDIX E FOLLOW-UP INFORMATION FORM APPENDIX E MICHIGAN STATE UNIVERSITY, Department of Psychology East Lansing, MI 48824 FOLLOW-UP INFORMATION FORM The study you and your child are participating in is part of a larger project on human development and family relations. Our work is routinely reported in professional journals and scientific meetings and we like to have the parents of our research participants aware of the kind of work we are doing. Thus, if you would like to receive follow-up information on the results of the specific studies your child participates in, check the appropriate box below and provide a mailing address that will be good (to your knowledge) for the next twelve to twenty-four months. Please send periodic summaries of the findings of the studies in which I and/or my child were participants. Mailing address: (please print) Name Address City or Town State Zip Today's Date 153 APPENDIX F MODIFIED SMAST APPENDIX F ovfl.‘ VICElsa? TATE CHIVERSITY - Leoartment of Psychology East Lansing. MI. 48824 Following are some questions about your use of alcohol and other drugs. Please answer them by circling either YES or NO. 1. So you feel you are a normal drinker? (By normal we mean you drink less than or as much as most other peOple.) YES NO 2. Does your wife, husband, a parent or other near relative ever worry or complain about your drinking? YES NO 3. Do you ever feel guilty about your drinking? YES NO 4. Have you used marijuana (including also hash) more than 1000 times in your life? YES 3 5. Have you used marijuana (including also hash) more than 100 times in your life? YES NC 5. to friends or relatives think you are a normal drinker? YES NO Are you able to stop drinking when you want to” \‘f‘ 'V‘ Y2.) .v (I‘ Have you used stimulant drugs (like speed, benzedrine (hen: es,, dexedrine) more than 10 times in your ifs? YES 53 3. Have you ever attended a meeting of Alcoholics Anonymous? YEb NO 13. Have you used sedative (depressant) drugs (like downers. anytal, valuin, qualludes. reds) more than 13 tlnes in your life? YES NO 11. Has drinking ever created problems between you and your wife. husband, a parent. or other near relative? YES NC 154 12. 13. 11‘. 15. 16. 17. 18. 19. 155 APPENDIX F (cont'd.) Have you ever gotten into trouble at work because of drinking? YES NO Have you ever neglected your obligations. your family. or your work for two or nore days in a row because you were drinking? YB N0 Have you ever gone to anyone for help about your drinking? YES NO Have you used opiate drugs (like heroin. methadone. darvon) more than 10 tines in your life? YB NO Have you ever been in a hospital because of drinking? YE NO Have you ever been arrested for drunken driving. driving while intoxicated. or driving under the influence of alcoholic beverages? YES NO Have you ever used cocaine? YE NO Have you ever been arrested. even for a few hours. because of drunken behavior? YES NO APPENDIX C BACKGROUND INFORMATION QUESTIONNAIRE APPENDIX C MICHIGAN STATE UNIVERSITY - Department of Psychology East Lansing. MI 48824 FY Study P6 (DEMO) Background Information it We would like to ask you a few questions about yourself. The questions ask about your life during the time you were growing up. as well as now. Please answer all of the. as completely as possible. (PLEASE PRINT) 1. What is your full name? FIRST MIDDLE LAST '4 e What is your date of birth? MONTH DAY YEAR 3. Where did you live most of the time until you were 18? CITY OR TOWN (COUNTY) STAIE COUNTRY (IF, NON - U.S.} if rural 4. Until you were 18. about how many times did your family move? (CIRCLE UNE) l 2 3 4 5 6 7 or more 5a. Are both of your natural parents still living together? CIRCLE ONE) YES (If YES, go to question 6) N0 (if NO, go to question Sb) Sb. Your natural parents are no longer living together because: (CIRCLE UNL) 1. mother died 2. father died 3. both parents died 4. parents divorced or separated 5. parents never lived together 6. other (please explain) 6a. What adults did you live with most of the time from birth to 18? (CIRCLL use) 1 mother and father 2. mother. but no adult male 3. father. but no adult female 4. mother and step-father 5. father and step-mother 6. other (please explain) ob. Who was the main wage earner in your family during the time y0u were *Copyright, 1980 by Robert A. Zucker, Ph.D. and Robert B. N011. 156 157 APPENDIX C (cont ' (1.) growing up (check one) (a) your father (b) your mother .(c) someone else (their relationship to you) what was FOR YOUR FATHER 7a. 7b. What was the occupation of your father (or the adult male) who lived with you most of the time until you were 18? (Give job title; what kind at work he did: and what kind of business or industry it was) What was the highest grade of school he completed (CIRCLE THE HIGHEST GRADE COMPLETED) None 0 Elementary l 2 3 4 5 6 7 8 High School 9 10 ll 12 College I 2 3 4 Degree? ___ Graduate school 5 6 7 8+ Desrcc7___ FOR YOUR MOTHER 8a. 3b. 93. What was the occupation of your mother (or the adult female) who Ichd with you most of the time until you were 18? (Give job title; what kind of work she did; and what kind of business or industry it was) What was the highest grade of school she completed? (CIRCLE THE HIChLST GRADE COMPLETED) None 0 Elementary l 2 3 4 5 6 7 8 High school 9 10 ll 12 College 1 2 3 4 Degree: ‘, Graduate school 5 6 7 8+ Degree! Until you were 18. what religion was practiced in your home most of the time? (CIRCLE ONE) 1. Protestant 2. Roman Catholic 3. Jewish 4. None, no religion 5. Other (please explain) 9b. 9c. 10a. 10b. 10c. 11. 158 APPENDIX G (cont'd.) What denomination? (Please try to specify fully) Until you were 18, how often did you attend religious services? (CIRCLE ONE) 1. more than once a week 2. about once a week 3. 2 - 3 times a month 4. less than once a month 5. never What is yOur religious preference now? (CIRCLE ONE) Protestant Roman Catholic Jewish None, no religion . Other (please explain) M§UIQH I What denomination? (Please try to specify fully) About how often did you attend religious services in the lastgyear? (CIRCLE ONE) 1. more than once a week 2. about once a week 3. 2-3 times a month 4. less than once a month 5. never What was the highest grade of school you completed? CIRCLE THE HIGHEST GRADE COMPLETED) None 0 Elementary l 2 3 4 High school 9 10 ll 12 College I 2 3 4 Graduate school 5 6 7 8+ Degree! What is your present occupation? (Give job title; what kind of work you do; and what kind of business or industry it is) 159 APPENDIX C (cont'd.) 126. Approximately what is your present annual family income? (CIRCLE ONE) 1. under $4,000 2. $4,001 - $ 7.000 3. $ 7,001 - $10,000 4. $10,001 - $13,000 5. $13,001 - $16,000 6. $16,001 - $20,000 7. $20,001 ~ $30,000 8. over $30,000 13. How many times have you been married? (CIRCLE ONE) 1 2 3 4+ 14. List the children you have had from your present marriage or any previous marriages. Please list all children. starting with the oldest. and include birthdate, sex, and if the child lives with you now. NAME BIRTHDATE SEX LIVING WITH AND LIVING WITH (month a year) YOU NOW YOU NOW (check one) Please circle the names of the children you listed above who are from your present marriage. THANK YOU FOR FILLING OUT THIS QUESTIONNAIRE. APPENDIX H MSU Family Study Robert A. Zucker, Ph.D. and Hiram Fitzgerald, Ph.D. Principal Investigators MANUAL FOR OBSTETRICAL COMPLICATIONS* *Adopted from UCLA Infant Studies Project; Manual authored by Bruce Littman, M.D. & Arthur H. Parmelee, M.D. (also see p. 9). 160 161 APPENDIX H (cont'd.) The following manual and scoring form were deveIOped for use in assessing the occurrence of any complicating factors in the maternal medical history. The scoring form lists 41 eeperate items and is based on the Prechtl system of Optimal scoring, i.e.. each category is felt to be associated with increased risk of infant mortalityand therefore would likely have an effect on develOpment if the infant survived. Each item is scored after consulting the manual. At the conclu- sion of the scoring the optimal responses are summed. Since there will be occasional items where information is not available. the final percentage raw score is used, i.e., the number of optimal responses divided by the number of items completed. We have converted raw scores to a standard mean score of 100 and a standard deviation of 20. It must be remembered that higher scores are more Optimal ones. 'Reference performances by a group of premature infants are shown in the back of this booklet and allow for comparison to a representative population. 162 APPENDIX H (cont ' d. ) OCS SCORING SHEET Infant ' a Name Hospital Birth Date Sex M E.D.C. Date Form Completed Mother's Name Optimal II§!_ Response 1. Gestational Age >37 Weeks D 2. Birth Weight 2500 gms D 3. Marital Status Married D 4. Maternal Age 18 - 30 D 5. Previous Abortions 2 or less D 6. Previous Premature Births No D 7. Previous Stillbirths No D 8. Prolonged Unwanted Sterility NO D 9. Length of Time Since Last Pregnancy >12 mos. D 10. Parity 6 or less [:::1 ll. Pelvis No Disproportion D 12. Rh Antagonism or Other Blood [::] Group Incompatibility No 14. Infections or Other Acute Medical Problems During Pregnancy No 13. Bleeding During Pregnancy No D <37 weeks < 2500 gms Other Other 3 or more Yes Yes Yes < 12 mos 7 or more Dispronortion Yes Yes Yes C] DE] DDDDUDDDDDD 15. 16. 17. 18. 19. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. 31. 32. 33. 36. 351 36. 37. 163 APPENDIX H (cont'd.) Drugs Given to Mother During Pregnancy No Maternal Chronic Diseases No Chronic Drug Abuse No Blood Pressure During Pregnancy ‘140/90 Yes Yes < 10 Yes >12 hours Other Other <3 or >20 hrs. <10 or P 120 mine.- Yes Yes Other Other DDDEIDEJ DECIDE] UDDDDD (100 or >160 (per min.) Yes D Yes D Yes [3 Yes C] m [:J 38. 39. 60. 61. 164 APPENDIX H (cont'd.) Resuscitation Required Prenatal Care During First Half of Pregnancy Apgar Score - One minute Apgar Score - Five minutes CONVERSION TABLE 100 99 98 97 96 Total (Raw Score) Number of Items Recorded 2 Raw Score (a/b) Converted 2 Raw Score 166 166 133 131 131 122 121 115 112 112 106 103 98 98 98 93 92 89 87 87 81 80 78 76 76 73 71 66 71 7O 69 67 66 65 (65 63 63 60 57 S6 50 165 APPENDIX H (cont ' (1.) ITEM COMMENT l. Gestational Age Gestational age refers to post- menstrual age, i.e., age at birth in weeks from the beginning of mother's last menstrual period. ' Normal Response: >37 weeks 2. Birth Weight Normal Response: 72500 grams 3. Marital Status This pertains to the mother's status at the time of delivery and would involve legal and common law. Normal Response: Married 6. Maternal Age Normal Response: 18-30 Years 5. Previous Abortions Abortion is defined as pregnancy termination before gestational age of 20 weeks or birthweight less than 500 grams. Normal Response: None 6. Previous Premature Births Premarurity is a gestational age of less than 37 weeks. Normal Response: None 7. Previous Stillbirtha A stillbirth is an infant born dead who is greater than 20 weeks gesta- tional age and 500 brams birthweight. Normal Response: None 8. Prolonged Unwanted Sterility This item refers to those situations where a conception has been unsuc- cessful for more than 2 years. Normal Response: None 9. Length of Time Since Last This is the period from the end of Pregnancy the prior pregnancy to the birth of this infant. Normal Response: >12 months 10. 11. 12. 13. 16. 15. 16. 17. 166 APPENDIX H (cont ' d.) Parity Pelvis Rh or Other Blood Group Incompatibility Bleeding During Pregnancy Infections or Other Acute Medical Problems During Pregnancy Drugs Given to Mother During Pregnancy Maternal Chronic Diseases Chronic Drug Abuse This is delivery of a viable infant of more than 20 weeks gestational age and 500 grams birtbwsight. Normal Response: 6 or less This pertains to whether'cephalopelvic disproportion is felt to be present by the medical staff. Normal Response: None This item refers to only maternal- fetal incompatibilities of whatever type, i.e., Rh, ABO, etc. Normal Response: None Bleeding here may cover the spectrum of minimal spotting to hemorrhage and may occur at any time. Normal Response: None All medical problems of whatever severity are given affirmative res- ponses here as long as they are acute. Normal Response: None This refers to drugs used on an acute basis during pregnancy. It excludes vitamins, iron and those involved in drug abuse. Normal Response: None Usually covered here are those ill- nesses beginning prior to conception and continuing through the pregnancy such as diabetes, hypertension, etc. Drug abuse is excluded. Normal Response: None All drugs used illegally are referred to here. This may include approved medications used in an abusive fashion. e.g., amphetamines. Involved here are alcohol, LSD, marijuana, etc. Normal Response: None 18. 19. 20. 21. 22. 23. 25. 26. 27. 1(57 APPENDIX H (cont'd.) Blood Pressure During Pregnancy Albuminuria Ryperemesis Hemoglobin at End of Pregnancy Twins or Multiple Birth Membranes Ruptured Prior to Delivery Delivery Porceps Duration, First Stage Duration, Second Stage hypertension occurring even once is scored abnormally. Normal Response: (160/90 One'occurrence during pregnancy is . sufficient. Only those greater than 2+ are noted here. ' Normal Response: None Only excessive vomiting requiring hospitalization is scored affirma- tivsly. Normal Response: None This is the value found prior to delivery. Normal Response: 10 or greater Normal Response: None Membrane rupture may be spontaneous or artificial. Only length of time is pertinent. Normal Response: 12 hours or less Spontaneous delivery is a vaginal birth with no more than low forceps being used. Vacuum extraction, induction, C-section receive non- optimal responses. Normal Response: Spontaneous Normal Response: Low forceps (n ne or elecfive) First stage labor is that from onset of labor until complete cervical dilatation. Normal Response: 3-20 hours Second stage labor is that from com- plete cervical dilatation until birth of infant. Normal Response: 10-120 minutes 28. 29. 30. 31. 32. 33. 36. 35. 36. 37. 38. 168 APPENDIX H (cont ' d . ) Induced Labor Drugs During Labor and Delivery Amniotic Fluid Fe tal Presentation-Delivery Fetal Heart Rate During Labor (First 6 Second Stage) Nuchal or Knotted Coed Cord Prolapse Placental Infarction Placenta Previa or Abruptio Onset of Stable Independent Respiration within 6 Minutes Resuscitation Required Not to be used during first or second stage of labor. Normal Response: None Only oxygen and local perinsal anesthetics may recieve optimal res- ponses. All others including all anesthetics, analgesics, hypnotics do not. Normal Response: Nothing more than Oxygen or perineal anesthetic. Normal Response: Clear Normal Response: Vertex This may be detected by monitor or trans-abdominal auscultation at any time during labor. The occurrence of any acceleration or any decelera- tion for whatever length of time is scored non-Optimally. Normal Response: loo-160 Normal Response: None Normal Response: None Normal Response: None Normal Response: None Stable independent respiration is the maintenancy of pulmonary function with- out artificial assistance. Resuscitation here refers to the use of any artificial means to support respi- ration such as face mask with positive pressure or endotracheal intubetion. It excludes use of the bulb syringe or other means of oralpharyngeal suction- ing. Normal Response: None 169 APPENDIX H (cont ' d.) 39. Prenatal Care During First Normal Response: Yes Half of Pregnancy 60. Apgar Score - 1 Minute Normal Response: 7-10 41. Apgar Score - 5 Minute Normal Response: 7-10 Note: Manual reproduced from Littman. Bruce A Parmelee, Arthur H. Manual for Obstetrical Complications. UCLA Infant Studies Project, Dept. of Pediatrics and Mental Retardation Center. Univ. of Calif.. Los Angeles, October. 1976. APPENDIX I MANUAL FOR POSTNATAL COMPLICATIONS SCALE APPENDIX I MSU Family Study Robert A. Zucker, Ph.D. and Hiram Fitzgerald, Ph.D. Principal Investigators MANUAL FOR POSTNATAL COMPLICATIONS SCALE* *Adopted with permission from UCLA Infant Studies Project; Manual authored by Bruce Littman, M.D. & Arthur H. Parmelee, M.D. (also see p. 7). 170 171 APPENDIX I (cont ' d.) Recognizing the need for a clear and finite list of events to pro- vide an assessment of an infant's postnatal course, the following form was developed (called Postnatal Complication Scale or PCS). It purposely avoids any attempt to isolate single occurrences. Likewise it is restricted to ten items thereby, also avoiding an extensive list of possible factors. In so doing it relies on the occurrence of certain clusters of events often seen postnatally in newborn infants. The technique involved is that of optimal scoring initially employed by Prechtl. Items used are those that reflect increased risk of mortality for the infant and therefore with survival would presume to be significant factors in his later development. This system is a self weighting one. As a result the severity of the events will be reflected in how deviant the score is, i.e., how far from optimal are the sequence of factors arising postnatally. The form has been piloted and used on population of term and prema- ture infants. We have chosen to convert raw scores to another scale de- rived from work on pilot infants. In so doing the means were adjusted to 100 and the standard deviations to 20. Representative scores may be found at the back of this booklet. It must be stressed that higher scores represent more optimal courses, e.g., 160 vs. 104, etc. Scoring is accomplished by reference to the manual itself and then completing each of the individual items. The span of time covered by this form is from birth to one month of age regardless of time from con- ception. After the raw score is totaled it may then be converted to its corrected form and apprOpriate comparisons made by use of the tables available in the back. 172 APPENDIX I (cont 'd.) POSTNATAL COMPLICATION SCORING SHEET Infant 's Nome Hospital Birth Date EDC Date Form Completed ITEM 1. Respiratory Distress 2. Positive or SuSpected Infection 3. Ventilatory Assistance h. aninreetious Illness or Anomaly 5. Metabolic Disturbance 6. Convulsion 7. Hyperbilirubinemia or Exchange Transfusion 5. Temperature Disturbance 9. Feeding Within AS Hours 10. Mae 1? CCINERSION TABLE lmw Score Converted Score 10 .. 160 9 - 101: 8 - 8'! 7 - 81 6 - 77 5 - 72 h .. 67 3 - 55 2 - 55 1 -- SO 0 - - TOTAL No D Yes No D Yes No D Yes to D Yes No D Yes No D Yes 130 D Yes £3 DDDDDDDDDD No Yes D No NO DYes (Rev Score ) D Converted Score [II 3. 173 APPENDIX I (cont'd.) 1. Respiratory Distress Positive or suspected infection \entilatory Assistance COMMENT The occurrence of respiratory dis- tress in any form would elicit a positive response in this item. Distress is defined as at least one or more of the following: (I) grunting, (2) retractions, (3) respiratory rate greater then 60. or (4) nasal flaring. The dis- tress in any form must be present for more than an hour. Normal Response: No respiratory distress This refers to the occurrence of any infectious illness affecting any part of the body. The site may be as superficial as the skin or as widespread as sepsis. Simil- arly the degree may be from very mild to very serious. The term suspected refers to the point that the infection need not be proven by culture techniques but merely suspected by the physician. Thus treatment of suspected sepsis would be scored affirmatively. Normal Response: No infection This item is intended to define further complications of respir- atory distress. It entails the use of any of the following methods in the support of respiration: (l) intermittent positive pressure breathing, (2) continuous positive pressure breathing (3) continuous positive airway pressure, or (4) negative chest wall pressure. These methods may be administered by mask or endotracheal intubation. Normal Response: No ventilatory assistance 4. S. 174 APPENDIX I (cont'd.) Noninfectious Illness or Anomaly Metabolic Disturbance In an attempt to describe all other major illnesses or congenital ano- malies that might be brought to bear upon the infant, this item is scored affirmatively if that should occur. It specifically excludes any type of infection. Anomaly refers to any structural abnormality whether congenital or acquired. Minor skin anomalies are not included. Some examples are: (l) CNS-hemorrhage hydrocephalus, (2) GU-hypospadias, ambiguous genitalia, (3) GI—umbilical hernia, intestinal obstruction, (4) CV-PDA. other CHD, shock (BP less then 30), tachycardia (AP greater then lSO) bradycardia (AP less then 100). Normal ReSponse: No illnesses or anomalies. Metabolic disturbances are those pro- blems usually diagnosed by examina- tions of bodily fluids. Inborn errors of metabolism are also covered in this item. The most common disturbances with their physiologic limits are defined below: Hypoglycemia Prematures 20 mg% Terms 30 mg% Hypocalcemia Prematures 7 meq/l Terms 8 meq/l Hypomagnesemia All 1.27 meq/l Hypermagnesemia All 1.75 meq/l Acid-Base All pH 7.3 pH 7.45 Sodium All 130 meq/l 150 meq/l Potassium All 3.0 meq/l 3.5 meq/l Normal Response: No metabolic distur- bance. 6. S. 9. 175 APPENDIX I (cont'd.) Convulsion Hyperbilirubinemia or Exchange Transfusion Temperature Disturbance Feeding Within 48 Hours Here a convulsion is defined as any clonic, tonic, or repetitive acti- vity of a tremorous nature felt to be a seizure by the medical staff. Because of the frequent non-convulsive seizure-like activity so often seen by nursery personnel in order for a positive response to be scored the activity must be witnesses by a physician. Normal Response: No convulsion A bilirubin level greater than 14 mg% is defined as hyperbilirubinemia. Although exchange transfusion may be used for other purposes such as hemolytic disease of the newborn or other causes of hyperbilirubinemia. Normal Response: No hyperbilirubi- nemia or exchange transfusion. A disturbance is defined as any temperature outside the zone of 36- 37.5 degrees Centigrade. Because of the common occurrence of hypo- thermic temperatures in the delivery room after birth, a positive response refers only to those situations arising at least one hour postnatally. Normal Response: No temperature disturbance This item is intended to be an asses- ment of the infant's general state of health around the time of birth. If feedings are begun normally but then discontinued at a later date the item is still scored optimally. Normal Response: The beginning of feeding within 48 hours of birth 10. Surgery 176 APPENDIX I (cont ' d.) Surgery refers to (1) any procedure done under general anesthesia by a surgeon and would include all endo- scopic techniques, (2) any procedure requiring incision through the skin. However certain things are not to be included here and spinal taps, circumcisions, cutdowns, subdural taps, ventricular taps and other non-anesthetic radiologic studies are not to be given positive responses. Normal Response: No surgery 177 APPENDIX I (cont'd.) EXAMPLES 1. Jay S. 8.0. 7/1 EDC 7/7 PCS Completed 8/5 This term male was born uneventfully and placed in the regular nursery. Feedings were begun at 6 hours of age and though initially being dextrose and water they were advanced to formula at 12 hours. Other than a single temperature dip to 35.9 C at 18 hours of age there was no difficulties and he was discharged at 72 hours of age. PCS Score 9 (1 off for temperature disturbance) Converted Score 104 2. Cindy Y. 8.0. 6/5 EDC 7/22 PCS Completed 7/6 This premature infant was delivered without complication at 33 weeks gestational age. Shortly after birth she began having respiratory distress which ultimately per- sisted but resolved over the next 4 days. During that period she had repeated blood sampling which showed normal electrolytes but a recurring acidosis with pH's in the 7.25-7.29 range. As the distress resolved a temperature drop to 35 C alerted the attending physician and with sepsis suspected antibiotics were begun; cultures later proved negative. Feedings were begun at 96 hours of age and 10 days later she was sent home. PCS Score 5 (1 off for each of the following) a. Temperature b. Respiratory Distress c. Acidosis d. Feeding Delay e. Suspected.lnfection Converted Score 77 Tote: Manual reproduced with permission from Littman, :.ice 3 Farmelee, Arthur a. Manual for Postnatal Samplications Scale. JJLA Infant 321v. of Calif.. Los Angeles. Zopyrignt, 1974. APPENDIX J-l SEMI-STRUCTURED PREGNANCY INTERVIEW WITH HUSBAND APPENDIX J-l SEMI-STRUCTURED PREGNANCY INTERVIEW WITH HUSBAND* S# FY Study - Preg. Int. MICHIGAN STATE UNIVERSITY, Department of Psychology East Lansing, MI 68826 Pregnancy Interview Introduce yourself to the family and insure that they understand you are from the MSU family study. After you feel comfortable and have met the father and mother, give the mother the History of Pregnancy, ACL, Spanier, and Wakefield to fill out. Make certain she understands the instructions for all of them (you can go over each set of instructions for each instru- ment, if you feel it is necessary). You should interview the father first, while the mother is working on her questionnaires. Try to find separate rooms or different areas of the home for them to work. I. HUSBAND'S INTERVIEW 1. When a woman is pregnant things can go really well, or problems can arise. Some husbands enjoy the experience immensely, while others find the pregnancy very disturbing. Changes often occur that seem terrific, or changes occur that are really bothersome. a. What are your feelings about the pregnancy right now? Probe: Positive-negative feelings. b. How did you feel about your wife's pregnancy for the first few months of the pregnancy? Probe: Positive-negative feelings. c. Overall, how have you felt about the pregnancy; that is, what has been your predominant attitude towards your wife’s being pregnant? d. In what ways has your wife changed since she became pregnant? Probe: Specific examples of changed behavior or emotional responses and how he feels about each change. e. In what ways have the other children changed since your wife became pregnant? Probe: Specific examples of changed behavior or emotional responses, which kids, and how he feels about each change. f. How do you think you have changed since your wife became pregnant? Probe: Specific examples of changed behaviors or emotional responses, and how he feels about each change. *Copyright, 1980 by Robert A. Zucker, Ph.D. and Robert B. Noll. 178 179 APPENDIX J-l (cont'd.) 2. Some couples find that a pregnancy can cause some distrust between them and they feel more distant from each other, while others feel more trusting and that the pregnancy brings them closer together. a. Do you feel closer to your wife since she became pregnant or more distant? b. In what ways has this changed during the course of the pregnancy (i.e., ability to talk)? 3. Some men find that having their wife pregnant causes them to feel really good about themselves while others worry about such things as doctor bills or possible delivery complications and they feel down much of the time. a. How do you feel about yourself now, that is, your present feelings of well-being or self-esteem? Probe: Positive feelings and/or negative feelings. b. In what ways has this changed since your wife became pregnant? c. In what ways have your feelings about yourself changed during the course of the pregnancy? Probe: Specific examples of changed behavior or emotional responses and how he feels about each change. d. In what ways has your health changed since your wife became pregnant? Probe: Specific maladies, severity, and remedies used (i.e., doctor visit, over-the-counter drugs). 4. Another change that often occurs during a pregnancy is that men find that they feel differently towards their wife. Some enjoy their wives immensely when they are pregnant, while others find them intolerable. a. How do you feel about your wife now? b. How did you feel about your wife when you found out she was first pregnant? c. In what ways did your feelings towards your wife seem to change from before she was pregnant to afterwards? Probe: Specific examples of changed behavior or emotional responses and how he feels about each change. d. In what ways has the pregnancy changed your sex life? Probe: Quantity, quality, and changes in desire of husband or wife. 184 APPENDIX J-Z (cont ' d .) d. In what ways have your feelings towards the new baby changed during the pregnancy? Probe: Specific examples of changed feelings and how she feels about each one. e. When did you first notice activity from the new baby (in utero)? Probe: When, amount, etc. If appropriate, how do you feel about the movements? f. What type of plans have you made for delivery of the new baby? Probe: Special programs, anxiety about delivery, possible complications. g. What preparations have you already made for the arrival of the new baby? Probe: Details, specific examples of items bought, baby showers, etc. The last thing I would like to talk with you about is your friends and relatives. When a woman is pregnant additional support can be extremely useful and necessary to keep things running smoothly. On the other hand, meaningful relatives and friends can be a lot of trouble and just cause more headaches. Sometimes they just don't seem to be there when you need them, or they are there just when you don't need them. a. In what ways have friends been helpful to you? Probe: Who, amount of time, type support, i.e., behavior or emotional. b. In what ways have friends been a pain in the neck? Probe: Who, amount of time, type problems and emotional responses. c. In what ways have relatives been helpful to you? Probe: Who, amount of time, type support, i.e., behavior or emotional. d. In what ways have relatives been a pain in the neck? Probe: Who, amount of time, type problems, and emotional responses. If appropriate: Your responses have been very helpful for me and are appreciated. Is there anything else about the pregnancy or the new baby that you think I might be interested in? Thank you very much for your cooperation. ***** Collect the questionnaires from the father and insure that he understood what was required on each one and had no difficulties. 181 APPENDIX J-l (cont'd.) If appropriate: (Your responses have been very helpful for me and are appreciated.) Is there anything else about the pregnancy or the new baby that you can think of that we haven't already covered? Thank you very much for your cooperation. * t * t * Collect the questionnaires from the mother and give the father the ACL, Spanier, and Wakefield to fill out. Again, go over the instructions if you feel that it is necessary. Take the mother to another part of the house to conduct her interview while the father is filling out his forms. APPENDIX J-2 SEMI-STRUCTURED PREGNANCY INTERVIEW WITH WIFE APPENDIX J-3 SEMI-STRUCTURED INTERVIEW SCALES APPENDIX J-3 SEMI-STRUCTURED INTERVIEW SCALES H - Husband's interview W - Wife's interview Scale 1 (H): Father's present attitude towards the pregnancy. (Q. la, also Sa, b, c, d, e, f, g) Entirely positive. Pregnancy experienced as highly enjoyable, with no negative aspects. Generally positive. Pregnancy experienced as mostly enjoyable, with a few negative aspects. Moderately positive. Pregnancy experienced as enjoyable, with some negative aspects, but good outweighs the bad. Positive and negative aspects are about the same. Moderately negative. Pregnancy experienced unfavorably with some positive aspects, but bad outweighs the good. Generally negative. Pregnancy experienced unfavorably, with a few positive aspects. Entirely negative. Pregnancy experienced unfavorably, with no positive aspects. Scale 19 (W): Mother's present attitude towards the pregnancy. (Q. 7a, also 12 a, b, c, d, e, f) Same as Scale 1 185 186 APPENDIX J-3 (cont'd.) Scale 2 (H): Father's attitude towards the pregnancy for the first few months of the pregnancy. (Q. lb) 1. Entirely positive. (See Scale 1 for specific descriptions) 2. Generally positive. 3. Moderately positive. a. Positive and negative aspects are about the same. 5. Moderately negative. 6. Generally negative. 7. Entirely negative. Scale 20 (W): Mother's attitude towards the pregnancy for the first few months of the pregnancy. (Q. 7b) Same as Scale 2 187 APPENDIX J-3 (cont'd.) Scale 3 (H): Husband's perception of changes that his wife had made since becoming pregnant. Are the changes considered positive or negative? (Q. 1d) Positive changes only. Only recalls changes his wife has made that he liked. Mostly positive changes. Recalls many positive changes and few negative changes. More positive changes than negative changes. Same amount of positive and negative changes. No difference. More negative changes than positive changes. Mostly negative changes. Recalls many negative changes and few positive changes. Negative changes only. Only recalls changes that his wife has made that he disliked. Scale 21 (W): Wife's perception of changes that her husband has made since she became pregnant. Are the changes considered positive or negative? (Q- 7d) Same as Scale 3 188 APPENDIX J-3 (cont'd) Scale 4 (H): Husband's perception of changes that the children have made since his wife became pregnant. Are the changes considered positive or negative? (Q. 1e) 1. Positive changes only. (See Scale 3 for specific descriptions.) 2. Mostly positive changes. 3. More positive changes than negative changes. 4. Same amount of positive and negative changes. 5. More negative changes than positive changes. 6. Mostly negative changes. 7. Negative changes only. Scale 22 (W): Wife's perception of changes that the children have made since she became pregnant. Are the changes considered positive or negative? (Q. 7e) Same as Scale & 189 APPENDIX J-3 (cont'd) Scale 5 (H): Husband's perception of changes that he has made since his wife became pregnant. Are the changes considered positive or negative? (Q. lf) 1. Positive changes only. (See Scale 3 for specific descriptions.) 2. Mostly positive changes. 3. More positive changes than negative changes. ‘\ 0 Same amount of positive and negative changes. U! More negative changes than positive changes. 6. Mostly negative changes. 7. Negative changes only. Scale 23 (W): Wife's perception of changes that she has made since she became pregnant. Are the changes considered positive or negative? (Q. 7f) Same as Scale 5 190 APPENDIX J-3 (cont'd.) Scale 6 (H): The husband's feelings of closeness or distance to his wife Scale 24 since she became pregnant. (Q. 2a) Peels exceptionally close to his wife since she became pregnant. Feels closer to his wife since she became pregnant. No changes noted. Feels about the same. Feels more distant from his wife since she became pregnant. Feels exceptionally distant (alienated) from his wife since she became pregnant. (W): The wife's feelings of closeness or distance to her husband since she became pregnant. (Q. 9a) Feels exceptionally close to husband since she became pregnant. Peels closer to her husband since she became pregnant. No changes noted. Peels about the same. Peels more distant from her husband since she became pregnant. Feels exceptionally distant (alienated) from her husband since she became pregnant. 191 APPENDIX J-3 (cont'd.) Scale 7 (H): Changes in the husband's feelings of closeness or distance to his wife over the course of the pregnancy. (Q. 2b) Considerably closer. Reports numerous changes towards feeling closer. Marked changes. Moderately closer. Reports feeling closer, but only slightly. No changes no ted. Moderately more distant. Reports feeling more distant, but only slightly. Considerably more distant. Numerous changes. Reports feeling alienated and out of touch. Scale 25 (W): Changes in the wife's feelings of closeness or distance to her husband over the course of the pregnancy. (Q. 9b) Same as Scale 7 192 APPENDIX J-3 (cont'd.) Scale 8 (H): Husband's present level of self-esteem. 1. Scale 26 (Q. 3a) Extremely high. Expresses only positive feelings about himself. Seems very pleased with himself. Generally high. Expresses mostly positive things about himself, but has a few doubts. Moderately high. Seems content with himself, but has doubts. Average. Positive things about the same as doubts. Moderately low. Has more doubts about himself than positive things. Generally low. Seems discouraged with himself and down in the dumps. Extremely low. Excessive discouragement and self-doubt. Seems clinically depressed. (W): Wife's present level of self-esteem. (Q. 10a) Extremely high. Expresses only positive feelings about herself. Seems very pleased with herself. Generally high. Expressed mostly positive things about herself, but has a few doubts. Moderately high. Seems content with herself, but has doubts. Average. Positive things about the same as doubts. Moderately low. Has more doubts about herself than positive things. Generally low. Seems discouraged with herself and down in the dumps. Extremely low. Excessive discouragement and self-doubt. Seems clinically depressed. 193 APPENDIX J-3 (cont'd.) Scale 9 (H): Changes in the husband's self-esteem since his wife became Scale 27 pregnant. (Q. 3b) Vast improvement in his self-esteem since his wife became pregnant. Moderate improvement in his self-esteem since his wife became pregnant. Slightly higher self-esteem since his wife became pregnant. No change noted in selfoesteem since his wife became pregnant. Slightly lower self-esteem since his wife became pregnant. Moderate decline in self-esteem since his wife became pregnant. Extreme decline in self-esteem since his wife became pregnant. (W): Changes in the wife's self-esteem since she became pregnant. (Q. 10b) Vast improvement in her self-esteem since she became pregnant. Moderate improvement in her self-esteem since she became pregnant. Slightly higher self-esteem since she became pregnant. No change noted in self-esteem since she became pregnant. Slightly lower self-esteem since she became pregnant. Moderate decline in self-esteem since she became pregnant. Extreme decline in self-esteem since she became pregnant. 194 APPENDIX J-3 (cont'd.) Scale 10 (H): Changes in the husband's self-esteem during the course of the pregnancy. (Q. 3:) l. Self—esteem has increased greatly during the course of pregnancy. 2. Self-esteem has moderately increased during the course of the pregnancy. 3. Self-esteem has slightly increased during the course of the pregnancy. 4. No change noted in self-esteem during the course of the pregnancy. 5. Self-esteem has slightly decreased during the course of the pregnancy. 6. Self-esteem has moderately decreased during the course of pregnancy. 7. Self-esteem has decreased greatly during the course of the pregnancy. Scale 28 (W): Changes in the wife's self-esteem during the course of the pregnancy. (Q. 10c) Same as Scale 10 195 APPENDIX J-3 (cont'd.) Scale 11 (H): Changes in the husband's health since his wife became pregnant. (Q. 3d) Vast improvement in his overall physical health. Moderate improvement in his overall physical health. Slight improvement in his overall physical health. No changes noted. Overall health has remained about the same. Slight decline in his overall physical health. Reports repeated illness (i.e., colds, flu) during pregnancy, but not before. Moderate decline in his overall physical health. Reports frequent illness that has kept him from work during the pregnancy, but not before. Severe decline in his overall physical health. Reports required hospitalization or lengthy bedrest during pregnancy, but not before. Scale 12 1. Scale 29 196 APPENDIX J-3 (cont'd.) (H): The husband's present feelings toward his wife. (Q. be) Enjoys her immensely. Can't remember feeling better about her. No negative feelings noted. Generally feels favorably towards wife. Many more positive feelings discussed than negative feelings. Feels slightly favorably towards his wife. Acknowledges a few more positive feelings than negative feelings. Overall feelings towards wife neither favorable nor disfavorable. Positive and negative feelings seem the same. Balanced. Peels slightly dissatisfied with his wife. Acknowledges a few more negative feelings than positive feelings. Generally dissatisfied with his wife. Many more negative feelings discussed than positive feelings. Extremely dissatisfied with his wife. Openly hostile towards wife. Nothing positive discussed. (W): The wife's present feelings towards her husband. (Q. lla) Enjoys him immensely. Can't remember feeling better about him. No negative feelings noted. Generally feels favorably towards husband. Many more positive feelings discussed than negative feelings. Feels slightly favorably towards her husband. Acknowledges a few more positive feelings than negative feelings. ‘ Overall feelings towards husband neither favorable nor disfavorable. Positive and negative feelings seem the same. Balanced. Feels slightly dissatisfied with her husband. Acknowledges a few more negative feelings than positive feelings. Generally dissatisfied with her husband. Many more negative feelings discussed than positive feelings. Extremely dissatisfied with her husband. Openly hostile towards husband. Nothing positive discussed. 197 APPENDIX J-3 (cont'd.) Scale 13 (H): Husband's feelings toward wife when he first found out that Scale 30 she was pregnant. (Q. 4b) Absolutely delighted. Can never remember feeling better about her. (May also have wanted very much to have it happen.) Generally felt favorably towards his wife. Many more positive aspects recalled than negative aspects. Felt slightly favorably towards his wife. Slightly more positive aspects recalled than negative aspects. Positive and negative aspects about the same. Felt slightly dissatisfied towards his wife. Slightly more negative aspects recalled than positive aspects. Generally felt dissatisfied towards his wife. Many more negative aspects recalled than positive aspects. Extremely dissatisfied with his wife. Cannot recall any positive aspects. (W): Wife's feelings toward husband when she first found out that she was pregnant. (Q. llb) Absolutely delighted. Can never remember feeling better about him. (May also have wanted very much to have it happen.) Generally felt favorably towards her husband. Many more positive aspects recalled than negative aspects. Felt slightly favorably towards her husband. Slightly more positive aspects recalled than negative aspects. Positive and negative aspects about the same. Felt slightly dissatisfied towards her husband. Slightly more negative aspects recalled than positive aspects. Generally felt dissatisfied towards her husband. Many more negative aspects recalled than positive aspects. Extremely dissatisfied with her husband. Cannot recall any positive aspects. 198 APPENDIX J-3 (cont'd.) Scale 14 (H): Changes in the husband's feelings towards his wife from Scale 31 before she was pregnant to afterwards. (Q. 4c) Vastly more positive. Dramatic changes in his positive regard towards his wife. Moderately more positive. Significant increase in positive regard for his wife. Slightly more positive. Slight increase in positive regard for his wife. No changes reported. Slightly more negative. Slight decrease in positive regard for his wife. Moderately more negative. Significant decrease in positive regard for his wife. Vastly more negative. Marked decrease in positive regard for his wife. (W): Changes in the wife's feelings towards her husband from before she was pregnant to afterwards. (Q. llc) Vastly more positive. Dramatic changes in her positive regard towards her husband. Moderately more positive. Significant increase in positive regard for her husband. Slightly more positive. Slight increase in positive regard for her husband. No changes reported. Slightly more negative. Slight decrease in positive regard for her husband. Moderately more negative. Significant decrease in positive regard for her husband. Vastly more negative. Marked decrease in positive regard for her husband. Scale 15 Scale 32 ‘8 199 APPENDIX J-3 (cont'd.) (H): Changes in sex life attributed to the time of pregnancy by the husband. Significantly improved. Emphasis here on quality rather than quantity. Sex has become incredibly satisfying. Moderately improved. Sex life is much more satisfying since pregnancy. Slightly improved. Sex life has been better, but only slightly. No changes noted. Slightly worse. Sex life has been worse, but only slightly. Moderately worse. Sex life has become significantly worse since pregnancy. Both quality and quantity have been effected, especially quality. Significantly worse. Husband openly complains. Sex is infrequent and unsatisfying. (W): Changes in sex life attributed to the time of pregnancy by the wife. (Q. lld) Options l-6 - same as Scale 15 Significantly worse. Wife openly complains. Sex is infrequent and unsatisfying. 200 APPENDIX J-3 (cont'd.) Scale 16 (H): Husband's present feelings toward the new baby. 1. (Q. 58. d. f) Extremely excited about baby's anticipated arrival. Can hardly wait. (Probably planned, hoped for) Moderately excited about the new baby. Slightly excited about the new baby. Neither excited nor hostile. Slightly hostile towards the prospect of another baby, but still shows some positive affect. Moderately hostile towards the prospect of another baby. Little positive affect in this area. Extremely hostile towards the prospect of another baby. No positive affect in this area. (Probably unplanned/crummy accident) Scale 33 (W): Wife's present feelings toward the new baby. (Q. 123, d, f) Same as Scale 16 201 APPENDIX J-3 (cont'd.) Scale 17 (H): Changes in the husband's attitude towards the new baby during the pregnancy. (Qe 5b, C, d. e! f) Changes in attitude have been totally positive towards the new baby. No negative changes. Changes mostly positive towards having another baby, but some negative attitudes have developed. Changes slightly more positive than negative. Changes in attitude and feelings toward new baby are predominantly mixed, but slightly more positive changes than negative changes. Positive and negative changes about the same. Changes slightly more rejecting than accepting. Changes in attitude and feelings toward new baby are predominantly mixed, but slightly more negative changes than positive changes. Changes mostly negative towards having another baby, but some positive changes are acknowledged. Changes in attitude have been totally negative towards the new baby. No positive changes. Feels like it is a total mistake to have another baby. Scale 34 (W): Changes in the wife's attitude towards the new baby during the pregnancy. (Q. 12b, c, d, e, f) Same as Scale l7 202 APPENDIX J-3 (cont'd.) Scale 18 (H): Support available from friend(s). mo6mln Friend(s) extremely helpful. Always available when needed and willing to do what is needed. Can always be counted on. Priend(s) moderately helpful. Can usually be depended upon when needed, but sometimes not available or willing to help. Priend(s) slightly helpful. Can occasionally be depended upon when needed, but not very reliable. Overall more helpful than not. Priend(s) neither helpful nor unhelpful. You can take them or leave them and it wouldn't matter. Priend(s) slightly unhelpful. Can't usually be depended upon when needed, but occasionally helpful. Overall more unhelpful than helpful. Priend(s) moderately unhelpful. Can't usually be depended upon when needed, but sometimes are available or willing to help. Priend(s) extremely unhelpful. Never available when needed or willing to do what is needed. Never can be counted on. Scale 35 (W): Support available from friend(s). (Q. 13a, b) Same as Scale 18 203 APPENDIX J-3 (cont'd.) Scale 19 (H): Support available from relative(s). 1. (Q. 6c, d) Relative(s) extremely helpful. Always available when needed and willing to do what is needed. Can always be counted on. Relative(s) moderately helpful. Can usually be depended upon when needed, but sometimes not available or willing to help. Relative(s) slightly helpful. Can occasionally be depended upon when needed, but not very reliable. Overall more helpful than not. Relative(s) neither helpful nor unhelpful. You can take them or leave them and it wouldn't matter. Relative(s) slightly unhelpful. Can't usually be depended upon when needed, but occasionally helpful. Overall more unhelpful than helpful. Relative(s) moderately unhelpful. Can't usually be depended upon when needed, but sometimes are available or willing to help. Relative(s) extremely unhelpful. Never available when needed or willing to do what is needed. Never can be counted on. Scale 36 (W): Support available from relative(s). (Q. 13c, d) Same as Scale 19 APPENDIX K GOUGH ADJECTIVE CHECKLIST APPENDIX K GOUGH ADJECTIVE CHECKLIST NAME DATE us: a" run or IIRTM LAST PIIST ICDOLE . saw: on cuss IDE‘NTIFICATION!5 NSUMBQR --——1 PARKER ANSWER SHET THE ADJECTIVE CHECK LIST . g ..... 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I... 5a.; c .9»... sun- .“I.§:! 6...; 35 3.3.5 his ab: :32: b.3933 abut—3‘3 as. 3.32.!— “3.2.3:. car: a»! 45......“ .ai..hu .2; 2.5. JE-xozs: .2. 8522...; a»! mat-hug Nag.- g..§b .2211 act—.532. g I! A.w.ucoov z xHazmmm< I“- APPENDIX 0 FEEDING SCALES APPENDIX 0 S#’ ' ' FY Study - Feeding Scales MICHIGAN STATE UNIVERSITY, Department of Psychology East Lansing, MI9 48824 Rater: . . .. . ......... Date: ....... Time rating began: """" Time rating ended: C = Caregiver or Catetaker B = Baby or Infant Item #1: synchronization of'C's InterVentions with B's Rhythms: l 2 3 4 S 6 7 8 9 Very Arbitrary Some Ad- Flexible Excellent Arbitrary Timing justment Timing Adaptation Timing to B's of Timing timing Item #2: Determination of Amount of Food and End of Feeding: 1 2 3 4 5 6 7 8 9 Very Arbitrary C Terminates Flexible Excellent Arbitrary Termina- Feeding but Termination Adaptation Termi- tion Believes that in Regard nation B Does to Amount of Food Item #3: C's Handling of'B's Preferences for Kind of Food: l 2 3 4 S 6 7 8 9 Great Disregard Some Con- Considera- Excellent Disregard of B's sideration tion for Adaptation of B's -Prefer- for B's B's Pref- Prefer- ences Prefer- erences ences ences Item #4: C's Synchronization of Rate of Feeding to 3'3 Pace: 1 2 3 4 5 6 7 8 9 C Inter- C Tends to C Alternates C is Sen- C is Very feres with Determine Between sitive to Well Adapted B's Pacing the pacing Determining B's Pacing to 3'3 Pace Pacing and Letting B Determine it 214 APPENDIX P NEONATAL PERCEPTION INVENTORY APPENDIX P NEONATAL PERCEPTION INVENTORY AVERAGE BABY Although this is your first baby, you probably have some ideas of what most little babies are like. Please check the blank you think best describes the AVERAGE baby. Form A1 How much crying do you think the average baby does? a great deal a good bit moderate amount very little none How much trouble do you think the average baby has in feeding? a great deal a good bit moderate amount very little none How much spitting up or vomiting do you think the average baby does? a great deal a good bit moderate amount very little none How much difficulty do you think the average baby has in sleeping? a great deal a good bit moderate amount very little none How much difficulty does the average baby have with bowel movements? a great deal a good bit moderate amount very little none . How much trouble do you think the average baby has in settling down to a predictable pattern of eating and sleeping? a great deal a good bit moderate amount very little none AVERAGE BABY Although this is your first baby, you probably have some ideas of what most little babies are like. Please check the blank you think best describes the AVERAGE baby. How much crying do you think the average baby docs? a great deal a good bit moderate amount very little none How much trouble do you think the average baby has in feeding? a great deal a good bit moderate amount very little none How much spitting up or vomiting do you think the average baby does? a great deal a good bit moderate amount very little none How much difficulty do you think the average baby has in sleeping? a great deal a good bit moderate amount very little 333: How much difficulty does the average baby have with bowel movements? a great deal a good bit moderate amount very little none how much trouble do you think the average baby has in settling down to a predictable pattern of eating and sleeping? a great deal a good bit moderate amount very little none Form A2 215 216 APPENDIX P (cont'd.) lUUK uABY While it is not possible to know for certain what your baby will be like, you probably have some ideas of what your baby will be like. Please check the blank that you think best describes wnat your baby will be like. Form 81 How much crying do you think your baby will do? a great deal a good bit moderate amount very little none How much trouble do you think your baby will have feeding? a great deal a good bit moderate amount very little none How much Spitting up or vomiting do you think your baby will do? a great deal a good bit moderate amount very little none How much difficulty do you think your baby will have sleeping? a great deal a good bit moderate amount very little none How much difficulty do you expect your baby to have with bowel movements? a great deal a good bit moderate amount very little none How much trouble do you think that your baby will have settling down to a predictable pattern of eating and sleeping? a great deal a good bit moderate amount very little none YOUR BABY You have had a chance to live with your baby for about a month now. Please ch eck the blank you think best describes your baby. How much crying has your baby done? a great deal a good bit moderate amount very little none How much trouble has your baby had feeding? a great deal a good bit moderate amount very little none How much spitting up or vomiting has your baby done? * a great deal a good bit moderate amount very little none How much difficulty has your baby had in sleeping? a great deal a good bit moderate amount very little none How much difficulty has your baby had with bowel movements? a great deal a good bit moderate amount very little none How much trouble has your baby had in settling down to a predictable pattern of eating and sleeping? Porn 32 a great deal a good bit moderate amount very little none APPENDIX Q SOCIAL READJUSTMENT RATING SCALES 5# APPENDIX Q MICHIGAN STATE UNIVERSITY - Department of Psychology East Lansing, MI 48824 Please FY. Study L53 Life Events Questionnaire read the following list of common life events and check all items that have occurred to you during the past one (1) year. Mark the space to the left of each item if it applies. New Events Marriage Toubles with the boss Detention in jail or other institution Death of spouse uajor change in sleeping habits (a lot more or a lot less sleep, or change in part of day when asleep) Death of a close family member major change in eating habits (a lot more or a lot less food intake, or very different meal hours or surroundings) Foreclosure on a mortgage or loan Revision of personal habits (dress, manners, associations, etc.) heath of a close friend fiinor violations of the law (e.g. traffic tickets, jay walking, disturbing the peace, etc.) Outstanding personal achievement Pregnancy Hajor change in the health or behavior of a family member Sexual difficulties In-law troubles “ajor change in number of family get-togethers (e.g. a lot more or a lot less than usual) major change in financial state (e.g. a lot worse off or a lot better off than usual) Gaining a new family member (e.g. through birth, adoption, oldster moving in etc.) Change in residence Son or daughter leaving home (e.g. marriage, attending college, etc.) Marital separation from mate najor change in church activities (e.g. a lot more or a lot less than usual) marital reconciliation with mate Being fired from work Divorce 217 218 APPENDIX Q (cont'd.) hanging to a different line of work Major change in the number of arguments with spouse (e.g. either a lot more or a lot less than usual regarding childrearing, personal habits, etc. Major change in responsibilities at work (e.g. promotion, demotion, lateral transfer) Wife beginning or ceasing work outside the home Major change in working hours or conditions Major change in usual type and/or amount of recreation Taking on a mortgage greater than $10,000 (e.g. purchasing a home, business, etc.) Taking on a mortgage or loan less than $10,000 (e.g. purchasing a car, TV, freezer, etc.) Major personal injury or illness Hajor business readjustment (e.g. merger, reorganization, bankruptcy, etc. Major change in social activities (e.g. clubs. dancing, movies, visiting etc.) Major change in living conditions (e.g. building a new home, remodeling deterioration of home or neighborhood) Retirement from work Vacation Christmas Changing to a new school Beginning or ceasing formal schooling APPENDIX R FOUR SCALES FOR RATING CAREGIVER BEHAVIOR APPENDIX R S# ' FY Study - Four Scales MICHIGAN STATE UNIVERSITY, Department of Psychology East‘Lansing, MI 48824 Rater: ' ' Parent observed:(mother or father) Time rating began: ‘ " Time rating ended: Date: Scale #1: Sensitivity VS Insensitivity of the Babyjs Communications 1 2 3 4 5 6 7 8 9 Highly Insen- Inconsis- Sensitive Highly Insensi- sitive tently Sensitive tive Sensitive Scale #2: Acceptance VS Rejection: 1 2 3 4 5 6 7 8 9 Highly Substan- Ambivalent Accepting Highly Rejecting tially Accepting Rejecting Scale #3: Cooperation VS Interference: 1 2 3 4 5 6 7 8 9 Highly Interfer- Mildly Cooperative Conspicuously Interfer- ing Inter- Cooperative ing fering Scale #4: Accessibility VS Ignoring and Neglecting: l 2 3 4 5 6 7 8 9 Highly Often In- Inconsis- Usually Highly Inaccessi- accessible, tently Accessi- Accessible ble, Ig- Ignoring or Accessi- ble noring, or Neglecting ble Neglecting 219 APPENDIX S WORK QUESTIONNAIRE APPENDIX 3 WORK QUESTIONNAIRE S# PyStudy - Work Questionnaire MICHIGAN STATE UNIVERSITYI Department of Psychology East Lansing, MI 48824 work Questionnaire Following is a list of items about work and your attitude towards your job. Please read each of the items and circle the 22; answer that seems best to you. 1. Doing my job well gives me a good feeling. A. Strongly disagree 3. Disagree C. Slightly disagree D. Neither agree nor disagree 8. Slightly agree F. Agree G. Strongly agree 2. All in all, I am satisfied by my job. A. Strongly disagree ‘3. Disagree C. Slightly disagree D. Neither agree nor disagree E. Slightly agree F. Agree G. Strongly agree 3. I have too much at stake in my job to change jobs now. A. Strongly disagree 3. Disagree C. Slightly disagree D. Neither agree nor disagree 3. Slightly agree F. Agree G. Strongly agree 4. In general, I like working where I do. A. Strongly disagree 3. Disagree C. Slightly disagree D. Neither agree nor disagree E. Slightly agree F. Agree G. Strongly agree 220 221 APPENDIX 8 (cont'd.) when I disagree with my supervisor, I generally A. Refrain from argument; try not to get involved. 3. Play down the differences and emphasize common interests. C. Search for a position in the middle; try to find a compromise. D. Use the power of my position or knowledge to win acceptance of my point of view. 3. Bring the problem clearly into the open and carry it out until it is solved, even if feelings are hurt. I have to engmge in organizational politics if I am to perform my job. A. Strongly disagree 3. Disagree C. Slightly disagree 0. Neither agree nor disagree 2. Slightly agree P. Agree G. Strongly agree I am very much personally involved in my work. A. Strongly disagree 3. Disagree C. Slightly disagree D. Neither agree nor disagree 8. Slightly agree F. Agree 6. Strongly agree Do you feel you have suffered employment discrimination in the past five years? A. Yes D. No If you feel you have suffered employment discrimination, was it because of: A. Sex B. Race C. Ethnic origin or religion D. Age 8. Physical health handicaps (Specify ) P. Emotional handicap (Specify ) 10. ll. 12. 13. 14. 15. 222 APPENDIX 8 (cont'd.) what form did the discrimination take? (Circle as many as apply) A. Affirmative action guidelines led to my not being hired although I had sufficient qualifications. 3. My salary was lower than for other workers doing comparable work. C. I was expected to do more work, different work, or less prestigious work than other workers who had similar jobs. D. I could not get the job for which my skills qualified me. E. My salary was lower than for other workers doing comparable work. P. I was not accepted or invited to participate in informal social activities like lunch or a drink after work. C. I was not encouraged or allowed to participate in in-house train- ing programs. H. I did not have access to informal communication or sources of ' information relevant to my job. I. I was fired. If you discovered your employer was engaged in immoral or illegal business practice, how likely is it that you would report him to the proper authorities, even though it might mean losing your job? A. Not at all likely 3. Somewhat likely C. Quite likely D. Extremely likely If your boss were behaving illegally or immorally, how likely is it that you woudl confront himlher on the issue even though it might mean losing your job? .A. Not at all likely 3. Somewhat likely C. Quite likely D. Extremely likely Sometimes it is necessary for me to engage in behaviors which are considered immoral or illegal if I am to perform my job effectively. A. Strongly disagree 3. Disagree C. Slightly disagree D. Neither agree nor disagree E. Slightly agree P. Agree G. Strongly agree I live, eat, and breathe my job. A. Strongly disagree 3. Disagree C. Slightly disagree D. Neither agree nor disagree E. Slightly agree F. Agree G. Strongly agree How likely is it that you will actively look for a new job in the next year? A. Not at all likely 3. Somewhat likely C. Quite likely D. Extremely likely 16. 17. 18. 19. 20. 223 APPENDIX S (cont'd.) Does your partner work? A. 8. Yes No If your partner were offered a better job in another city, how likely is it that you would move even though you might initially be under— employed or unemployed? A. B. C. .D. Not at all likely Somewhat likely Quite likely Extremely likely Most of the people that I see socially outside of work are people that my partner met in connection with his/her job. 'A. OMNUG E Strongly disagree Disagree Slightly disagree Neither agree nor disagree Slightly agree Agree Strongly agree generally performs the following household tasks? Child care 1 2 3 4 5 6 Cooking 1 2 3 4 5 6 Cleaning up after meals 1 2 3 5 6 House-cleaning l 2 3 4 S 6 Driving children in activities I 2 3 6 S 6 Finances l 2 3 6 5 6 Grocery shopping I 2 3 4 5 6 Yard work 1 2 3 A 5- 6 All in all, whose career is given more weight when making decisions that affect both careers? coon» Nine Equal Weight Partner's Does not apply 224 APPENDIX 3 (cont'd ) 21. How much do you talk over job concerns with your partner? A. Not at all 3. A little C. Quite a bit D. A great deal 22. Host of the people that I see socially outside of work are people I've met in connection with my job. A. Strongly disagree B.’ Disagree .C. Slightly disagree D. Neither agree nor disagree E. Slightly agree F. Agree G. Strongly agree 23. How likely is it that you will change your occupation in the next five years? Not at all likely Somehwat likely Quite likely Extremely likely O0w> 24. People may relieve job-related stress in a number of ways. How likely are you to engage in the following behaviors as a result of work related tension? (Numbers in between 1 and 7 indicate intermediate degrees of likelihood.) 4. a; e. 6 65 p 46 *9 &§ 9! ”2- Q" a ('9 ( J I .I ’4 q; (4: r 9 £9 .b gfl- 0J- A. Have a drink of liquor, 2 3 4 5 6 7 beer, or wine after. 3. Have a drink of liquor, l 2 3 4 S 6 7 beer, or wine during the working day. C. Use drugs including 1 2 3 4 5 6 7 tranquilizers, amphe- tamines, and marijuana off the job. D. Use drugs including 1 2 3 4 5 6 7 tranquilizers, amphe- tamines, and marijuana during the working day. _E. Daydream F. Participate in counsel- ing or therapy N M 0" \J P‘H «a oaw e~b on 0‘ V 6. Exercise 1 2 3 4 S 6 7 H. Eat l 2 3 4 S 6 7 I. Buy something for your- 1 2 3 4 6 self J. Smoke 1 2 3 4 ~S 6 7 225 APPENDIX 8 (cont'd ) 25. On most days, time seems to drag on the job A. Strongly disagree 3. Disagree C. Slightly disagree D. Neither agree nor disagree E. Slightly agree P. Agree G. Strongly agree 26. Hard work makes you a better person. A. Strongly disagree 8. Disagree C. Slightly disagree D. Neither agree nor disagree E. Slightly agree F. Agree C. Strongly agree 27. What problems or difficulties do you run into concerning hours of work, your work schedule, or overtime? Circle all that apply. A. I have to start work too early and/or leave work too late. 3. My work schedule interferes with my family life. C. An excessive amount of overtime is required. D. I have difficulty completing my assigned work during office hours. E. All in all, my job requires excessive hours. 28. How often do you feel this way at work? (Numbers in between 1 and 7 indicate intermediate degree of frequency.) 4 1%., 6’ 904.1% #9: 0.9 5‘9 0094‘ 99": o, 4 9b “a IboD¢hb,°‘{p QQFIEQP A. I feel down-hearted l 2 3 4 5 ‘96 0 7 . and blue. 3. I get tired for no 1 2 3 4 5 6 7 reason C. I find myself restless and can't keep still 1 2 3 4 S 6 7 D. I find it easy to do the 1 things I used to do E. My mind is as clear as 1 2 3 4 S. 6 7 it used to be. P. I feel hopeful about 1 2 3 4 5 6 7 the future. G. I find it easy to make 1 2 3 4 5 6 7 decisions. H. I am more irritable than 1 2 3 4 S 6 7 usual. I. I feel that I am useful 1 2 3 4 5 6 7 N U &‘ U! 0‘ N 29. 30. 31. 32. 226 APPENDIX 5 (cont'd.) I get a feeling of personal satisfaction from doing my job well. A. B. C. D. E. P. G. Strongly disagree Disagree Slightly disagree Neither agree nor disagree Slightly agree Agree Strongly agree when you get home. how frequently do you think about the problems, errors, or frustrations that occurred during the day at work? A. B. C.. D. Very infrequently Infrequently Sometimes Frequently Very frequently I dread the thought of what might happen if I quit my job without having another one lined up. A. B. C. D. E. F. G. How Strongly disagree Disagree Slightly disagree Neither agree nor disagree Slightly agree Agree Strongly agree often would you say your home life interferes with your job? Almost never Seldom Sometimes Frequently Almost always 227 APPENDIX S (cont'd.) 33. How satisfied are you and how important to you is each of the following aspects of your job? Satisfaction I ortance ___.,_ L 0 ’9 2‘ '3- °o ‘3, a. w ‘34 w a“ “w ‘2 V .a I“ z. ‘5 o” 2”» w t 6.. €- 9 g. A 1‘. .4 a °A 4‘," A °A Q 3' Q'sg o. 9' 3 9‘ CO "9‘ Q o f’ f. ‘5 “" 9a 9 r g $ % $ ‘ ‘3 $ 6 ’ ‘3) C, p. n C, is a a A g o “3;?” “a" a“ ‘g; Q‘s” f“ 9:. V w r . “we, ‘5. “9‘ “o w. 3 "a. A.‘l'hswayyousrstreated 1234567 123456 by the people you work with. B. The respect you receive 1 2 3 4 5 6 7 l 2 3 4 S 6 from the people you work with. C. The friendlinessof the l 2 3 4 S 6 7 l 2 3 4 5 6 people you work with. D. The opportunity to develop 1 2 3 4 5 6 7 l 2 3 4 5 6 your skills and abilities. E. Thechsncsayouhaveto 1234567 123456 learn new things. 1'. Thechanceayouhsveto 1234567 123456 accomplish somthing worthwhile. G.Thechsncesyouhavetodo 1234567 123456 the things you do best. H.Thschancesyouhavetodo 1234567 123456 something that makes you feel good about yourself asa person. I. Theamountofinfomtion 1234567 123456 you get about how well you ‘ are doing your job. J The amount of pay you get. 1 2 3 4 5 6 7 l 2 3 4 5 6 K. The fringe benefits you 1 2 3 4 S 6 7 l 2 3 4 5 6 receive. L. The amount of job security 1 2 3 4 5 6 7 1 2 3 4 5 6 you have. H.1‘hepraiseyougetwhenyou 1234567 123456 do a good job. N. The physical surroundings l 2 3 4 5 6 7 l 2 3 4 5 6 of your job. 0. Yourchances for gettinga l 2 3 4 5 6 7 l 2 3 4 5 6 promtion. P. The chances you have to take 1 2 3 4 5 6 part in linking decisions. Q. The amount of freedom you 1 2 3 4 5 6 have on your job. \l \l R. The resources y0u have to 1 2 3 ’0 5 6 do your job. \I A r-a N u tr m o 34. 35. 36. 37. 38. 228 APPENDIX S (cont'd.) I often feel trapped in my present job. A. B. C. D. B. F. G. How A. B. C. .D. Now A. B. C. D. B. All A. B. C. D. E. F. G. Strongly disagree Disagree Slightly disagree Neither agree nor disagree Slightly agree Agree Strongly agree likely is it that you could find a job with another employer with about the same pay and benefits you now have? Not at all likely Somewhat likely Quite likely Extremely likely often would you say your job interferes with your home life? 'Almost never Seldom Sometimes Frequently Almost always in all, how satisfied are you with your life? Very dissatisfied Dissatisfied Slightly dissatisfied Neither satisfied nor dissatisfied Slightly satisfied Satisfied Very satisfied I feel bad when I do a poor job. A. B. C. D. E. F. G. Strongly disagree Disagree Slightly disagree Neither agree nor disagree .Slightly agree Agree Strongly agree 45. 46. a7. [.80 49. SO. 51. 229 APPENDIX S (cont ' d.) 11 How many years have you been in the work force? A. Less than one year 3. One to five years C. Six to 10 years D. Eleven to 15 years E. More than 15 years Approximately what is the percentage of women at your workplace? A. 0 percent .8. 25 percent C. 50 percent D. 75 percent E. 100 percent .What is your sex? A. Female B. Male What is the sex of your supervisor? A. Female 3. Male What is your age? A. Under 18 B. 18-24 C. 25-34 D. 35-44 E. 45-54 F. Over 55 Where do you stand politically on most issues? A. Very liberal 8. Somewhat liberal C. Moderate D. Somewhat convervstive E. Very conservative In what type of commity did you spend the largest portion of your life up to the time you were 16 years age? A. Large city (250,000 people or more) 3. Small city (less than 250,000 people) C. Suburb D Rural 52. 230 APPENDIX S (cont'd.) 12 In what type of community do you now live? A. B. C. D. Large city (250,000 people or more) Small city (less than 250,000 people) Small city (less than 250,000 people) Rural APPENDIX T CHILD BEHAVIOR CHECKLIST APPENDIX T Dossrtmsm or Health. Education,“ were. CHILD BEHAVIOR CHECKLIST - - For ages 4 — 18 CHILD'S ace CHILD'S SEX RACE PARENTS TYPE OF WORK {Please be specific-for example: auto mechanic, high school teacher, homemaker, laborer, lathe operator, shoe salesman. army D so, D Girl Isrrgeant, even if parent does not live with child.) n’fliée-s rms roan FILLED our av: ‘3‘“ rvre or woes: D Mother C] Father mower-rs C] Om“ (Specify): TYPE or worm; l. Please list the sports your child most likes Canard ta other children of the Comm to 0th" child!“ III the to take part in. For example: swimming, same age, about how mach tiles m III. MI roll «a filth do call baseball, skating, skate boarding, bike den belch- spsad is each? 000? riding, fishing, etc. [3 Non. Don't T“: Average Then Don't Below “or. Know Aura. Ayers. Known Average “W Ayers. a. C] D C] D E] III I] D b. E] C1 C1 D I] E] C] D c. D Cl E] El Cl C] C] {3 it. Please list your imam mom. new... new to other aim at the Compared to other children at the activities, and games, other mm m tame up, sheet haw mash time does same see, how well does lie/the do each For example: stamps, dolls, books, piano, WW m“ in M7 00'? crafts, singing, etc. I Do not include T.V.l 00“., I... More Km Than Average Then Don't Below A." Above D No". Ayers. A" Km Ayers. "' Average a. Cl [3 D C] C] Cl '2] CI b. Cl C] D [3 Cl 3 C] :I c. Cl Cl E] Cl C] :1 S E III. Pleaselittsnyoraanizatlons,cluba.tasrnt, Csusmedtastharcbidneelths or gaunt your child bdongs to. same age, hem active is halite is each? Don't Law More D N°"° km Active ‘W mm a. Cl E] Cl C] b. I] C] ' Cl C] c. Cl E] D II IV. Please list any iobs or chores your child has. Canned to other children al the For example: Paper route. babysitting, was up, how well does lie/the carry making bed, etc. them set? ' Don't Below Above D Non. Knows Ayers, A” Average ,, E] Cl C] C] b. Cl C] D C] c. C3 Cl Cl C) ADM 5‘2 TM. Achanosch, Ph.D . NIMH, Bethesda, Ma. zoom Rev. l-79 PAGE 1 231 232 APPENDIX T (cont'd.) V. 1.Abouthovvmanycloselriendsdoeeyourchildhave? UNone D1 r:120r3 Deormore 2. Abouthovvnlerlytimeaavreekdoeeyourcllllddomnitlldlern? C] lesstharll U lor2 [:1 3ormora VI. Comparedtootherchildrenolhis/heranhosvvrelldoesyourchild: M Abeetthesame lath a. Get along with his/her brothers & sisters? [3 [I] C] is. Get along with other children? C3 C3 C] c. Behave with his/her parents? [:1 C] D d. Play and work by himself/herself? U D C] VII. 1. Currentschool performance-for chiklrenagedfiandoldm. Q Does not go to school Failiag Islets averap Avery Above avarap a. Reading or English C C] D D b. Writing D C] D D c. Arithmetic or Math :1 [:1 Cl C] d. Spelling C] D C] D Other academic subjects: a. D D D C] (for example: history, science, foreign langaage, f. U C] U C] geogaphvl. g. i: D I: S 2. Is your child in a special claas? :1 No D Yes—what kind? 3. Haeyourchildevarrepeetedawade? C] No C] Yes-gradeandreason 4. Pleasedacriheanyacademicorodlerprohlemsyourdlildhaehadinuhool. D None ADM 31: PA Rev. l-79 0! 2 233 APPENDIX T (cont'd.) Vlll. Below is a list of items that describe children. For each item that describes your child now or within the past [2 months. please circle the 2 if the item is very true or often true of your child. Circle the I if the item is somewhat or sorrretr'mes true of your child. If the item is not true of your child, circle the 0. 0 1 2 1. Acts too young for his/her age 0 1 2 31. Fears he/she might think or do something 0 1 2 2. Allergy (describe): b“ 0 1 2 32. Feels he/she has to be perfect 0 1 2 33. Feels or complains that no one loves him/her 0 1 2 3. Argues a lot 0 1 2 34. Feels others are out to get him/her 0 1 2 4. Asthma 0 1 2 35. F eels worthless or inferibr 0 1 2 5. Behaves like opposite sex 0 1 2 36. Gets hurt a lot, accident-prone 0 1 2 6. Bowel movements outside toilet 0 1 2 37. Cats in many lights 0 1 2 7. Bragging, boasting o 1 2 38. Gets teased a lot 0 1 2 8. Can‘t concentrate, can‘t pay attention (or long 0 1 2 39. Hangs around with children who get in trouble 0 1 2 9. Can't get his/her mind off certain thoughts: obgessiong (describe): 0 1 2 40. Hears things that aren't there (describe): 0 1 2 1 . ' ' ' ' 0 Can t sit still, restless, or hyperactive 0 ‘ 2 41. .lmpulsive or acts without thinking 3 1 z 1; :2"r.;:.::::;:;.::::°°m . 1 2 .. .. ‘ mo 0 1 2 43. Lying or cheating g 1 g :3 gonfus'ed 0' seems to b. m a fog 0 1 2 44. Bites fingernails ' rues a at 0 1 2 46. Nervous, highstrung, or tense 0 1 2 15’ Cruel to animals 0 1 2 46. Nervous movements or twitching (describe): 0 1 2 16. Cruelty. bullying, or meanness to others 0 1 2 l7. Daydreams or gets lost in his/her thoughts 0 1 2 18. Deliberately harms sell or attempts suicide 0 1 z 47_ Nightmargg 0 1 2 19. Demands a lot of attention 0 1 2 48. Not liked by other children 0 1 2 20. Destroys his/her own things 0 1 2 49, Constipated. doesn't move bowels 0 1 2 21. Destroys. things belonging to his/her family or 0 1 2 50' Too “qu or anxious other children 0 1 2 51. Feels dizzy 0 1 2 22. Disobedient at home . ‘ 0 1 2 52. Feels too guilty 0 1 2 23. Disobedient at school 0 1 2 53. Overeating 0 1 2 24. Doesn't eat well . _ 0 1 2 54. Overtired 0 1 2 25. Doesn’t get along with other children 0 1 2 55 Overweight 0 1 2 26. Doesn‘t seem to feel guilty after misbehaving 56. Physical problems without known medical 0 1 2 27. Easily jealous cause: 0 1 2 28. Eats or drinks things that are not food 0 1 2 a, Aches or pain: (describe): 0 1 2 b. Headaches 0 1 2 c. Nausea, feels sick 0 1 2 d. Problems with eyes (describe): 0 1 2 29. Fears certain animals. situations, or places, 0 1 2 e flashes or other skin problems other than school (describe): . o 1 2 l. Stomachaches or cramps 0 1 2 g. Vomiting, throwing up 0 1 2 30. Fears going to school 0 1 2 h. Other (describe): ADM 512 PAGE 3 Please see ather side Rev. 1-79 234 APPENDIX T (cont'd.) 0 1 2 57 Physically attacks people 0 2 84. Strange behavior (desaibe): 0 1 2 58 Picks nose. skin, or other parts of body (describe): 0 2 85. Strange ideas (describe): 0 1 2 59 Plays with own sex parts in public 0 1 2 60 Plays with own sex parts too much 0 2 88. Stubborn, sullen, or irritable 0 1 2 61. Poor school work 0 2 87. Sudden changes in mood or feelings 0 1 2 62 Poorly coordinated or clumsy 0 2 88. Sulks a lot 0 1 2 63 Prefers playing with older children 0 2 89. Suspicious. 0 1 2 64 Prefers playing with younger children 0 2 90. Swearing or obscene language 0 1 2 65 Refuses to talk 0 2 91. Talks about killing self 0 1 2 66 Repeats certain acts over and over; 0 2 92. Talks or walks in sleep (describe): compulsions (describe): 0 2 93. Talks too much 0 1 2 67 Runs away from home 0 2 94. Teases a lot 0 1 2 68 Screams a lot 0 2 95, Temper tantrums or hot temper 0 1 2 69 Secretive, keeps things to self 0 2 96. Thinks about sex too much 0 1 2 7O Sees things that aren‘t there (describe): 0 2 97. Threatens peOple 0 2 98. Thumbrsucking 0 2 99. Too concerned with neatness or cleanliness 0 2 100. Trouble sleeping (describe): 0 1 2 71. Self-conscious or easily embarrassed 0 1 2 72. Sets fires 0 1 2 73 Sexual problems (describe): 0 2 101. Truancy, skips school 0 2 102. Underactlve, slow moving, or lacks energy a 2 103. Unhappy. sad, or depressed I) 2 104. Unusually loud 0 1 2 74 Showing off or clowning — 0 2 105. Uses alcohol or drugs (describe): 0 1 2 75. Shy or timid 0 1 2 76 Sleeps less than most children 0 2 106. Vandalism 0 1 2 77 Sleeps more than most children during day and/or night (describe): 0 2 107. Wets self during the day 0 2 108. Wets the bed 0 1 2 78 Smears or plays with bowel movements 0 2 109. Whining 0 2 110. Wishes to be of opposite sex 0 1 2 79 Speech problem (describe): .. 0 2 111. Withdrawn, doesn't get involved with others 0 2 1 12. Worrying 0 1 2 80 Stares blankly 113. Please write in any problems your child has 0 1 2 81 Steals at home "‘3‘ W0" ”0‘ ”“99 39°": 0 1 2 82 Steals outside the home 2 0 1 2 83 Stores up things he/she doesn't need (describe): 0 2 0 2 ‘0'“ 5‘2 PAGE 4 PLEASE BE SL'RE YOL' HA VE ANSWERED ALL ITEMS Rev 1-79 REFERENCES REFERENCES Ablon, J. Family structure and behavior in alcoholism: A review of the literature. In B. Kissin & H. Begleiter (Eds.), The biology of alcoholism (Vol. 4). New York: Plenum Press, 1976. Achenbach, T. M. Psychopathology of childhood. Journal of Consulting and Clinical Psychology, 1978a, §§, 759-776. , Achenbach, T. M. The child behavior profile: 1. Boys aged 6-11. Journal of Consulting and Clinical Psychology, I978b, fig, 478-488. Achenbach, T. M. & Edelbrock, C. 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