I MSU y RETURNING MATERIALS: \_‘ Place in book drop to I 1 remove this checkout from L BRAR Es your record. FINES wil] be charged if book is returned after the date stamped below. \. I J QV/‘fl'fw ‘13 7', .3" .7??? £3: J!” 45-; Y . an" ‘ ‘1 :T r a .l 1 ... V 2"”.."..!!I‘.3!‘,il_l!z',1‘at0 , "f.“ u-o... ‘4 --..\......u- N“ .ugoooo-o.‘ ".'.’2t:n‘~ 1!. 311131.111: ~::.\\‘:.un “O“‘hunJJ Lu . ‘YOUNG MALE OFFSPRING 0F ALCOHOLIC FATHERS: EIXRLY DEVELOPMENTAL AND COGNITIVE DIFFERENCES FROM THE MSU VULNERABILITY STUDY By Robert B. N011 A DISSERTATION Submitted to Michigan State University in partiaT fulfiITment of the requirements for the degree of DOCTOR OF PHILOSOPHY Department of PsychoTogy 1983 © 1983 ROBERT BLUM NOLL All Rights Reserved ABSTRACT YOUNG MALE OFFSPRING OF ALCOHOLIC FATHERS: EARLY DEVELOPMENTAL AND COGNITIVE DIFFERENCES FROM THE MSU VULNERABILITY STUDY BY Robert Blum Noll Alcohol abuse has repeatedly been implicated in many behavioral and health related problems, yet little is known concerning etiology before age 12. The present study was designed to compare a sample of preschool boys statistically at risk for the development of alcohol related problems - in adulthood - to a sample of same-aged community control peers. The high risk boys in this study were the offspring of untreated but alcoholic fathers contacted by way of their arrest for drunk driving during the child's lifetime. Nine community control boys from families in the same census tract were also studied; matching was done on social prestige, sibship constellation, age of target child, and birth posi- tion of target child. Analysis of parental self-report data on alcohol problems indicated that while all of the fathers of high risk boys met formal diagnostic criteria as alcoholic, none of the fathers of community control boys were so diagnosed. Children were assessed with parental reports of children's activity level, mood, aggression, and Robert Blum Noll attention-span persistence. In addition children were assessed with direct observations of general developmental status and with three Piagetian like tasks to determine knowledge of alcoholic beverages. Significant differences were demonstrated on develop- mental assessment; control boys performed significantly better on indices of language, fine motor, personal/social, and adaptive development. 0n the tasks designed to assess knowledge of alcoholic beverages, high risk boys demon— strated quicker recognition of and greater knowledge about alcoholic beverages and its uses. However, no statistic- ally' significant differences were obtained on either of the parent report measures of temperament or of child behavioral symptomatology. The results of this study are discussed within the context of Zucker's multilevel heuristic model for the development of drinking behaviors. The differences in developmental status were hypothesized to be reflective of differences in socialization and maternal responsivity among these families; the implications of these findings for the subsequent development of psychopathology were also examined using social learning theory. The drinking cognitive data are discussed in the context of early learning within the family of origin. Etiological implications of these drink- ing related cognitive findings are examined within the framework of current prevention/education programs. ACKNOWLEDGEMENTS I would like to express special thanks to Dr. Robert A. Zucker whose patience and nurture has allowed me and this work to grow and flourish. I would also like to express thanks to the other members of my committee Drs. Lucy Ferguson, Nade Horn, and William Crano. Although she is not on this committee, Dr. Helen Benedict has played a significant role in the development of this research project and in my development as a clinical psychologist. A very special thanks also to William Bukowski whose statistical and computer wizardry made the data analyses very easy. -Finally I want to thank my family - Hope, Debbie, and David, for their love, support, and patience. This research was in part supported by a grant to Robert B. Noll from the National Council on Alcoholism, Michigan Inc. 11 TABLE OF CONTENTS LIST OF TABLES. LIST OF FIGURES CHAPTER I. INTRODUCTION . . . Problems of Definition . . Rationale for Cross- Sectional Design in Research with Statistically High- -Risk Children . . . . . Conceptual Models of the Etiology of Alcoholism . . . . The Jessor Model The Zucker Model 11. REVIEW OF THE LITERATURE Personality Theory as a Conceptual Basis Genetic Theory as a Conceptual Basis .Etiological Theories from the Perspective. of Longitudinal Data Etiological Theories from the Perspective. of Cross- Sectional Data. Summary. . Statement of the Problem and Predictive Framework. III. METHODS. . . Subjects . Rationale. . Alcoholic Families . . Community Control Families Procedure. . Initial Contacts and Screening Measures . Parent Measures. Child Measures . . Measurement of Temperament Measurement of Childhood Psychopathology. iii Page vi viii \l N--‘ ._.|...=J.._a (JON-d Assessment of Cognitions about Alcohol. . Smell Recognition Task Appropriate Beverage Task. Alcohol Concept Task . Measurement of General Developmental Status IV. RESULTS. Analysis Parent Measures. General. . . Diagnosis of Alcoholism. Drinking Problems. Drinking Patterns. Child Measures General. . . Direct Observations. Measure of General Developmental Status . . Assessment of Cognitions about Alcohol. Smell Recognition Task Appropriate Beverage Task. Alcohol Concept Task Parent Reports Measure of Temperament . . Measure of Childhood Psychopathol- Ogy V. DISCUSSION . . Adult Measures . Drinking Patterns and Problems Child Measures . . . . . . Direct Observations. . Measure of General Developmental Status . . Assessment of Cognitions About Alcohol. . . Can Preschool Children Iden- tify Alcoholic Beverages?. Do Preschool Children Possess Knowledge of Traditional Drinking Norms?. Do Preschool Children Report that They Currently Like Alcoholic Beverages and Do They Plan to Drink Them in The Future?. . . . . iv lOB NN—l—l-u-l lZl l3l l3l 136 I40 Page Parent Reports. . . . . . . . . . . . l43 Measure of Temperament. . . l43 Measure of Childhood Psychopathology . 151 Future Directions . . . . . l58 VI. SUMMARY . . . . . . . . . . . . . . . . . . . . l63 APPENDICES . . . . . . . . . . . . . . . . . . . . . . l67 I. Research Participation Informed Consent Form. . l67 II. Demographic Background Questionnaire. . . . . . l68 III. Health History - Husband. . . . . . . . . . . . l73 IV. Health History — Nife . . . . . . . . . . . . . l82 V. Drinking and Drug History . . . . . . . . . . . l9O VI. Recognition of Smells . . . . . . . . . . . . . 200 VII. Appropriate Beverage Task . . . . . . . . . . . 2l7 VIII. Alcohol Concept Task. . . . . . . . . . . . . . 244 IX. Raw Scores for Study Children on the Behavioral Style Questionnaire and Child Behavior Check- list. . . . . . . . . . . . . . . . . . . . . . 256 X. Revised Yale Developmental Inventory Examina- tion and Observation Form . . . . . . . . . . . 260 LIST OF REFERENCES . . . . . . . . . . . . . . . . . . 267 Table 10 11 12 13 LIST OF TABLES Research Diagnostic Criteria (RDC) for diagnosis of alcoholism. An organizational structure for classes of influence upon drinking behavior Formal predictions Anticipated directions of effect Child Behavior Checklist items indicative of high activity level, negative mood, or impul- sivity . . . . . . . . . . . . . . . . . . . Sociodemographic characteristics of alcoholic and community control families Contact schedule for collection of child related data (all contacts at respondent's home) Alcoholic diagnosis, drinking problem scores, and drinking pattern scores in alcoholic families and community control families. Correlations between performance on YDI indices and risk status. Children's_ability to verbally label substances using smell alone for the stimulus Children's responses to the question "Who uses this substance?. . . . . . . . . . Children's responses to the question "Do you like/dislike the substance?" . . . Appropriate Beverage Task: Comparison of bev- erage selections of high risk and control boys (risk status) for festive and non-festive occasions (type of occasion) involving pictures of adults and children (age effect). . . . . . vi Page 15 55 56 60 71 73 92 97 98 102 103 104 Table 14 15 16 17 18 Appropriate Beverage Task: Adult pictures only, comparison of high risk and controls (risk status) for festive and nonfestive occasions (type of occasion) involving pictures of adult males and adult females (sex effect). Children's ability to correctly name or identify photographs of alcoholic and non- alcoholic beverages Behavioral style questionnaire: Means and standard deviations for high risk boys and control boys. . . . . . . . Child Behavior Checklist: Means and standard deviations for high risk boys and control boys. SMAST data: Initial health history scores (single source) and best estimate scores (multiple data) vii Page 106 107 110 111 119 LIST OF FIGURES Figure 1 A heuristic model for changes in influencing structures affecting drinking behavior over developmental time. Scores on Yale Developmental Inventory Revised. Matched pair comparisons between high risk (HR) and control (C) children. . Children's ability to identify alcoholic beverages using smell. High risk vs. control viii Page 17 96 100 CHAPTER I INTRODUCTION High-risk research concerned with the etiology of the major behavioral disorders has become increasingly more prevalent during the past decade (cf. Garmezy, 1973, 1974; Hanson, Gottesman, & Meehl, 1977). While the majority of the work has focused upon schizophrenia, 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, 1974, 1978; O'Leary & Wilson, 1975). While schizo- phrenia occurs in somewhat less than 1 percent of the overall population (Kramer, 1978; Woodruff, Goodwin, & Guze, 1974), prevalence estimates of the number of severe problem drinkers and alcoholics are 4-6 percent, or 9.3-10 million persons (Alcoholism & Drug Addition Research Foundation, 1978; DHEW, 1971, 1978; Haglund & Schuckit, 1977). Primary or secondary problems with alcohol are associated with 50 percent 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). Approxi- mately five to six million Americans are considered to be alcoholic (Chafetz, 1967, p. 1014; Haglund & Schuckit, 1977). More than 50 percent of all fatal traffic accidents involve alcohol, as one of twelve Americans is too drunk to drive at any given moment on our nation's highways (Cummings, 1979). Clearly the scope of the problem is great; however, our knowledge of alcoholism, especially its earliest precursors, is limited. The earliest longitudinal 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 definition of the problem or trouble being studied (Baldwin, Cole, & Baldwin, 1982). Typically research on alcoholism and/or problems directly related to excessive consumption of alcohol has employed varied criteria and/or different labels for the same area of problems. Keller (1972) cogently analyzes the criteria necessary for a behavioral-operational definition of alcoholism 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) 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 (also see Schuckit, 1978). 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, quantity, and variability (Q-F-V index) of alcohol consumption, as well as the occurrence of a number of problems typically associated with excessive drinking. These problems 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 afore- mentioned classes. At a theoretical level, Keller is more concerned with chronicity of alcohol problems while Cahalan emphasizes current problems resulting from alcohol consumption; however, the specific operational criteria utilized by both for diagnosis are strikingly similar. Other researchers vary only slightly among themselves in their criterion of frequent intoxication or amount of heavy drinking, but 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 addic- tive symptoms. Other workers include consequences of alcohol abuse, symptoms of addictive drinking, social problems consequent to drunkenness, and interpersonal problems related to heavy drinking (Goodwin, Schulsinger, Hermansen, Guze, & Winokur, 1975; Reich, Robins, Woodruff, Taibleson, Rich, & Cunningham, 1975). A minimum of one positive response in three of four categories is generally required for a definite diagnosis of alcoholism. Finally, Feighner and his colleagues (see Table 1) in their paper on establishing specific research diagnostic criteria (RDC) for use in psychiatric research define an alcoholic as someone who has had symptoms in three of four general areas (Feighner, Robins, Guze, Woodruff, Winokur, & Munoz, 1972). The Feighner et a1. criteria 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 manifestations of excessive consumption of alcohol and accompanying problems. The criteria established by the committee for a diagnosis of alcoholism are far more elaborate than any of the Table 1 Research Diagnostic Criteria (RDC) for Diagnosis of Alcoholism Probable diagnosis - when symptoms occur in two of the following groups as a result of alcohol consumption Definite diagnosis - when symptoms occur in 3+ of the following groups as a result of alcohol consumption Group Group Group Group Any manifestations of alcohol withdrawal (ie. convulsions, tremulousness, delirium); history of medical complications (ie. cirrhosis, gastritis); alcoholic binges (48 hours+); or periods of amnesia (blackouts) Loss of control (ie. morning drinking, repeated attempts to control drinking by self limit setting Legal or work related difficulties (ie. traffic offenses, absenteeism) Social or interpersonal problems (ie. marital problems, feeling guilty about drinking, loss of friends) Adapted from Feighner et al., 1972. aforementioned diagnostic systems and are oriented towards clinical usage rather than research per se. This study will use the terms "problem drinker" and "alcoholic" interchangeably. While the term "problem drinker" is sometimes used to imply drinking difficulties, this is not our intended implica- tion. Along the lines of Zucker (1979), the less pejora- tive term of "problem drinking" will be used in this project to deal with situation specific drinking problems, and the term "problem drinker" will be used to imply greater individual stability over time of drinking related difficulties. It should also be noted that the term "problem drinker" or "alcohol abuser" is sometimes used to imply a decreased pattern of pathological alcohol use compared to the term "alcoholic" or "alcoholic dependent" (see DSM-III, 1980) irregardless of the social or behavioral consequences of drinking. The emphasis in this project is placed upon consequences of drinking behavior and our use of the term "problem drinker" does not mean decreased pathological alcohol use. 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 criterion can change results far more significantly than the choice of diagnostic labels. Specific sampling techniques and criteria for inclusion of subjects into our study will be extensively discussed in the Methods section. Rationale for Cross-Sectional 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 has insurmountable methodological flaws (cf. Livson & Peskin, 1980; Yarrow, Campbell, & Burton, 1970). We are therefore left with a serious gap in the data which consequently diminishes our knowledge of alcoholic etiology. The present study is a beginning at filling this critical gap. By selecting a small sample of young male children, identified as statistically at higher-risk for subsequent development of alcoholism on the basis of parental charac- teristics which are known to be associated with dispropor— tionately greater numbers of alcoholic offspring, it is hoped that an early but realistic goal can be achieved. We endeavor to differentiate these families from controls, and thus may identify specific childhood charac- teristics that could possibly precede later alcoholism. If differences are found they should begin to suggest hypotheses about the early etiological roots of alcoholism. The cross-sectional approach offers several advan- tages over traditional longitudinal research strategies. First, one can examine the inter-relationships among various classes of variables on the parent and the child, at various developmental points (Kagan, 1964). Just as the inter-relationships between depression (Weissman, Paykel, & Klerman, 1972), divorce (Hetherington, 1979), and other life events (see Bronfenbrenner, 1979) have been examined within the context of the family life cycle, the cross-sectional method would permit a study of the inter-relationships of paternal alcoholism, child rearing practices, and other classes of influence on the developing child who is statistically at risk. Evidence exists (cf. Nylander, 1960; Rydelius, 1981) that the relationship between parental alcoholism and the child depends upon numerous factors such as personality of both drinking and non-drinking parents, sex and age of the child, etc. (see Wilson and Orford, 1978, for a detailed discussion of potentially relevant variables). Second, the cross-sectional method can offer relief from data bias, by providing current information that is systematically and uniformly collected. Data are obtained before subjects suffer from the potential ravages of the disorder (cf. Mednick & McNeil, 1970). The data which are acquired on each subject are collected at one point in time, thus there are no repeated measurement effects as in longitudinal design. Third, a cross-sectional design would be less expensive and time consuming than a comparable longi- tudinal study. In addition, problems with attrition of subjects and locating subjects who are willing to participate over extended periods of time are not difficulties inherent to this approach. At the same time, certain pitfalls central to the cross-sectional method exist. First, changes in individual subjects across time cannot be traced. While a transactional model of development (Sameroff, 1975; Sameroff & Chandler, 1975) may form the theo- retical groundwork for conceptualization of the etiology of alcoholism, the cross-sectional method does not permit one to follow the growth of the developing child across time, while simultaneously assessing the effects of various classes of influence on the developing organism. 10 Second, cross-sectional designs are particularly vulnerable to problems caused by unrecognized sampling fluctuations. Since a new sample is utilized at each age, it is mandatory that the samples be comparable. Changes in a particular cohort from which a sample is drawn from uncontrolled cultural-historical effects can reduce the internal validity of cross-sectional comparisons. Mednick (1978) also discusses problems of the high-risk method with respect to sampling and the inevitable biased selec- tion of cases. He concludes that the only alternative would be to assemble an exceptionally large birth cohort and study them intensively for an extended period of time, although even this exhaustive project would require repli- cation (cf. Clarke-Stewart, VanderStoep, & Killian, 1979). Third, cross-sectional studies confound generational effects with the effects of aging. Achenbach (l978a,b) discusses problems associated with age, cohort and time of assessment, and notes inherent limitations of cross- sectional designs. The external validity of a cross- sectional design is threatened because differences or similarities among cohorts may not be generalizable to other points in time because of cultural-historical changes. The internal validity of the cross-sectional design is threatened by the possibility that differences between age groups may be caused by factors other than age, such as cultural-historical effects. The results that 11 Nesselroade and Baltes (1974) obtained utilizing a longi- tudinal-sequential design clearly demonstrated the limita- tions which Achenbach discusses. However the exploratory nature of the present study justifies the use of the cross-sectional design and still makes it an acceptable one. Conceptual Models of the Etiology of Alcoholism Much of the high-risk research on psychopathology has been completed without overarching theoretical models serving as a conceptual framework. When a specific orientation was utilized, it typically viewed psychiatric problems from a monist perspective. For example, problem drinking has been conceptualized as an attribute of personality (cf. Williams, 1976) or the result of non- specific biological or genetic variables (cf. Goodwin, 1976), Other workers have viewed problem drinking from the perspective of sociocultural variables (cf. Cahalan, 1970; Cutter & Fisher, 1980) 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 biopsychosocial model (Schwartz, 1982) which takes a more broad based perspec- tive. Sadava (1978) emphasizes the role of personality in the etiology of alcoholism, but gives careful consideration 12 to situational factors from a life span perspective. He argues that "attention must be directed toward patterns of interaction and reciprocal influence" (p. 209). Kissin (1977) 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 reasonably account for the acquisition of problem drinking behaviors (also see Freed, 1979; Jalali, Jalali, Crocetti, & Turner, 1981; Peele, 1979, 1980). 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, 1977) are specifically concerned with the acquisition of deviant behaviors and their development in youth. Problem drinking 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 13 divided into measurable component elements. For example, Jessor originally divided the personality system into three substructures: the personal belief structure, the personal control structure, and the perceived opportunity structure. Within the personal belief structure was the individual's general cognitive orientation. Specific variables which Jessor employed to measure this area were locus of control and alienation. While specific component elements within the model have changed as further work has been completed, the basic model structure has remained consistent. When the model is applied developmentally, Jessor emphasizes the reciprocal influence of major vari- ables 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 per- centage of variance which has been accounted for is 10-55 percent. While the 55 percent is clearly satisfactory, 10 percent is not adequate. Finally, the Jessor model is oriented towards general deviant behavior rather than the specific form it may take, such as excessive drinking. Greater specificity is clearly called for. The Zucker Model The Zucker (1976, 1979; Zucker & Noll, 1982) model of development of drinking behavior places emphasis upon 14 problem drinking within the general context of antisocial behavior. Originally Zucker postulated that problem drinking had its origins in disturbed or dysfunctional family relationships. Specifically, inadequate satiation of the child's dependency needs as well as disturbed emotional relationships 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 per- spective. Zucker postulates that four major classes of influence have an 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, parental personality influences, and other familial influences; Class III influences deal primarily with peer group socialization factors; and Class IV influences are intra-individual components such as personality, tempera- ment, and physiological factors that may influence predisposition towards excessive alcohol consumption (Table 2). These four classes of influence are examined longi- tudinally as the salience of each class of variables is postulated to change along with the development of the 15 .mgouume ummwumam o:_xcvcu1coc op mcmwmg moz mucouum» uwwmumnm mcwxcwgv ou mgmumc ma “muoz ApoummopoFm»;g\pogov>mgmav mmucmzommcou ucm Acmmmmgucv .umcwmucwms .vmswaouav Lom>mcwm acmxcwgo szucm>m pocoupm do mcowuum poupmopowa Loguo .uvponmuwe .pmuvmopoumsgmsaoguzma 1 pogoupu mg mcowu_cmou use movaumuum mcwxcwco 1 moucmspecw umumwuws appmumsmzuomm 1 Asmzuo ucm upumcmm ucwuapucwv mucwEmpm —m:opumucmmmgawgcoz 1 AucmEoLmnEmu .muwmgu .mcowum>_uosv mcauuagum mu_chomcma 1 Amwspu> .mmmmpmo .mmuauwuuo ch>Fo>cwv acauuacum w>wuwcmou 1 we we: mau=o=_c=_ _a=nc>,ecputucfi .1 mwvzuwuum mmuauwwum can mcgwuuma acmxcvgo 1 me can mccwuuma mcwxcwgo 1 ma moucoapmc_ co_um~wpmruom coma 1 mccmuuaa mcwcmwc upmsu 1 mmucmaPm2+ Pmcowuuogmucv mwucmapwcy pmcovuuocmucm 1 use xuwpmcomcma gown 1 zuwpmcomcoa acmgma 1 28a 8,. € 8.5 an m - 82 «8533 295 xgavcouom opas_a:~ coeummguogm mo xpvsmm van mgwma cmuwgo mo x—msmu can naogo xgmsvga . s 41 mmcwupom mcpxcwcv co moaxp1 acvxcvgu usonm mmapa> use pogoupo Co zuwpwnmpwm><1 ma lllllllllllllllIIIIIIIIIIOIIIIIIIIIIIllllllllltll t. mm>wumcgmqu gov>mzmn vcm mmucmapwcv mzpa> voongoagmwoz1 Ar... 3335.3? AL Lop>msoa new .mmucozpmcm m=o_o_pmg .mpwu*:zum1 mmucmapwcu xuvcassou xppsmm ma magnum upsocouwowuom1 «moz van pagaupauo+u0m cop>agmm m:_x:_co con: mucm=p$:_ mo mummmpu Low N w—aah «cauuacum Fucovuu~+cumgo c< .Nwm_ .ppoz a gmxu=~ ”mugsom1 .>H ._~H vcm .mH 16 organism. As can be seen in Figure l, Zucker has hypo- thesized 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 are cross-sectional and were obtained on samples of adolescents. Longitudinal data are 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 perspective is taken along with longitudinal methodology. Finally, the general classes of influence are exceptionally broad based. From the perspective of one overall model 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 individual, includes personality influ- ences as well as physiological. Some workers would argue that these classes of influence deserve separate cate- gories. 1 7 .Nmmp .Ppoz a meosN "Eon; coozoaazu >4mwu=,acu=~ { .Awgm; acm>wpmg uocv . .\ moucmafifi .83 . r- """ Auuzwummsoo<=mm uz~¥zfimo mmucmapmcfi »__sau \ mmucmapecH .3 25.5.8 \wcm pmcaupauovuom oz< mo~>o Low>msmm mcvxcvgo mcwuomwu< magauuzcum mcwucmapmca cp mmmcmgu gee Fave: ovumwusm: < .P agzapu 18 While the Zucker model clearly has limitations, its major advantage is the unique application of a developmental perspective to the etiology of problem drinking. While the perspective that various classes of influence may increase in significance across stages of the life span and at other times become less relevant is standard for developmental life span psychologists (see Baltes & Schaie, 1973), it is not commonly found in studies of psychopathology. This orientation is a major strength of the Zucker model and makes easily adaptable to a longitudinal study of children who are statistically at high-risk for subsequent develop- ment of alcoholism. The present study is a pilot, designed to gather data in an area that has not previously been systematically studied. It begins formal data collection early in the lifespan of the offspring, utilizing an eclectic, but conceptually guided approach. Through the use of direct observations, questionnaires, developmental assessments, and interviews, the groundwork will be laid for the eventual study of a larger group of high-risk subjects in a combined cross-sectional-1ongitudina1 design that could possibly have transcontextual validity (Weisz, 1978) for the development of alcoholism. The overall viewpoint of this work is that alcoholism develops as the result of transactions between numerous variables--biological, psychological, social, cultural. The developing organism is examined within a 19 larger ecological setting (Bronfenbrenner, 1977), attempting to understand the texture of the transactions between the high-risk child and his environment (Bell, 1979; Brazelton, 1978; Sameroff, 1975, 1978a,b). It is expected that effects may vary during different developmen- tal stages, dependent upon present salient issues for both the specific family and the child (Ainsworth, 1979; Field, 1977). 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 preven- tion rather than rehabilitation. Because this work is a pilot study and problem drinking is more prevalent in males (DHEW, 1971, 1974), this study focuses predominantly on the etiology of excessive drinking in men. All children included in this study will be male. CHAPTER II REVIEW OF THE LITERATURE Previous studies have attempted to reconstruct 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. While many of the major psychological (cf. Blum, 1966; Sadava, 1978; Williams, 1976) and/or biological (cf. 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 critical questions without encounter- ing the serious methodological flaws inherent to retro- spective research. Also, the majority of this work has either lacked a basic conceptual model or employs a monist model. By examining studies done utilizing the above methods and conscientiously avoiding "enlightened historical selectivity" (Nathan and Lansky, 1978; Pillemer & Light, 1980), an attempt will be made to select markers which might be indications that a child is high-risk for subsequent development of alcoholism. Four general types of research 20 21 will be reviewed: 1) studies which utilize personality theory as a conceptual basis, 2) studies which utilize genetic theory as a conceptual basis, 3) longitudinal studies, and 4) cross-sectional studies. Personality Theory as a Conceptual Basis This section will review and critique one representa- tive major study which attempts to describe the dynamic personality of the alcoholic. Other principal works in this area are referenced; however, they are not reviewed, since this would be overly redundant. In an extensive clinical study with adult 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 alcoholics suffer from a conflict between exaggerated dependency 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 require fulfill- ment and a masculine identity which prevents gratification of these needs. According to Blane, alcohol is the solution to the conflict over dependency wishes, since drinking is typically regarded as masculine activity, which provides feelings of comfort and warmth as well as permitting 22 dependent types of behavior to occur. We are left with the question of how alcoholic men develop the exacerbated dependency need which eventually culminates in the alcoholic experience. Blane (1968) attempts to understand the dynamic personality of the alcoholic, but offers little specific data for understanding 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 hypothetical causal agents in earlier life (e.g., White & 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 (cf. Blane, 1974). 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 23 hypothesis. Numerous other researchers have also examined the personality of the alcoholic in an attempt to uncover hypothesized underlying personality constructs or conflicts that are unique to the alcoholic population and the litera- ture supports the presence of depression, denial, and problems with impulse control (see Sadava, 1978; Williams, 1976). 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 (cf. McClelland, Davis, Kalin & Wanner, 1972). 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, 1974a; Freed, 1979; Williams, 1976). Genetic Theory as a Conceptual Basis Areas reviewed in this section include a brief review of genetic marker and metabolic studies as well as a subsequent exhaustive review of twin and adoption studies. Several groups of investigators have attempted to ascertain if any known genetic traits are found more often in alcoholics than controls. For example, extensive explorations of possible associations between alcoholism, cirrhosis, and color blindness (as a possible genetic 24 marker) have been done by Cruz-Coke and associates (cf. Cruz-Coke & Varela, 1966). These investigators have examined color vision defects in alcoholic patients and their non-alcoholic relatives. Their data indicate that male alcoholics have more color vision defects than male controls. In addition, similar color vision defects were found in male and female relatives of the male alcoholic. These researchers argue that the color vision defect found in the alcoholic males and their non—alcoholic relatives were clearly not the result of excessive alcohol consump- tion. Rather they argue that a genetic component associated to alcoholism and color vision defects is present (Varela, Rivera, Mardones & Cruz-Coke, 1969). Unfortunately data obtained in this area by other researchers have not repli- cated the above results when color vision testing was postponed until the alcoholic had been dry for 30 days (Failkow, Thuline, & Fenster, 1966; Smith & Brinton, 1971). A similar study of 11 serological markers of known genetic origin on alcoholic men who had been dry for 30 days also found no positive evidence for genetic association (Hill, Goodwin, Cadoret, Osterland, & Doner, 1975). Cruz-Coke argues that the failures to replicate are the result of insensitive color vision tests (Cruz-Coke & Mardones, 1972). A recent study examined the presence of color vision defects in a normal population being studied in the Tecumseh Community Health Study (Harburg, Gleiberman, & 25 Ozgoren, 1982). In this large sample, alcohol consumption ranged from abstinence to heavy use and a higher percentage of color blindness was found in moderate-heavy drinkers while no color blindness was found in any individual who was an abstainer. It is possible that the association between color blindness and drinking in the Harburg study was the result of recent heavy ingestion of alcohol since time of last drinking episode was not controlled. Metabolic studies focus on varying physiologic responses to alcohol ingestion. This type of approach attempts to explain why some individuals and even some ethnic groups seem to reSpond physiologically in vastly different ways to alcohol consumption. Why does alcohol ingestion cause adverse physiological symptoms (i.e. dizziness, nausea, etc.) in some and not in others? While the majority of this work has dealt with reactivity differences among different racial groups (Ewing, Rouse, & Pellizzari, 1974; Zeiner, Paredes, & Christensen, 1979), recent work by Schuckit and Rayses (1979) indicates that children of alcoholics meta- bolize alcohol differently from control children. Schuckit and Rayses cogently argue that their results indicate that children with family histories of alcoholism could be predisposed to alcoholism themselves. Goodwin (1979) reviews these data and hypothesizes that large numbers of individuals are protected from alcohol problems because of their adverse physiological reactions. Goodwin suggests 26 that minimally the alcoholic lacks an inherited intolerance of alcohol. The metabolic studies have begun to demonstrate that dif- ferential rates of alcohol problems among different ethno- cultural groups (Class I) could have physiological under- pinnings which presumably are genetically transmitted (Class IV). The study by Schuckit and Rayses examines Class IV factors which presumably cause higher familial rates of alcoholism. Goodwin's (1976, 1979) comprehensive review of adoption and family studies relevant to alcoholism gives us another perspective into the alcoholic problem. Alcoholism is viewed as a family disease, as no previous study of male alcoholics had less than 25-50 percent of the first degree male relatives also alcoholic (Fitzgerald & Mulford, 1981; Goodwin, Schulsinger, Hermansen, Guze, & Winokur, 1973; Goodwin, Schulsinger, Knop, Mednick, & Guze, 1977; Gregory, 1960; Jellinek, 1945; Schuckit & Haglund, 1977; Tarter, McBride, Buonpane, Schneider, 1977; Winokur, Reich, Remmer, & Pitts, 1970). 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 27 (biological fathers nonalcoholic). The groups were not different on a large number of dimensions (e.g., SES, edu- cational 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 fewer 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 problems for the drinker (also see Templer, Ruff, & Ayers, 1974). 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 and reared by nonrelatives" (Goodwin, 1976, p. 76). Goodwin's work has been sharply criticized by Tolor and Tamerin (1973). First, the assessment of psychopathology in the adoptive parents of both groups was based upon informa- tion provided by the adopted subjects 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 28 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 dramatically 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 percent) have some knowledge of their biologic parents (Eldred, Rosen- thal, Wender, Kety, Schulsinger, Welner, & Jacobsen, 1976). The precise effect of this contact on subsequent development of alcoholism has not been investigated. Last, no genetic evidence has been found among women, although alcoholism in females also runs in families. Clearly, the work of Goodwin requires replication. Further evidence for the heritability of alcohol prob- lems is advanced by a Swedish study (Kaij, 1960) that compared concordance rates for alcoholism between monozygotic and dyzy- gotic twins. The identical twins were concordant for alcohol problems in 54 percent of the cases, while fraternal twins were concordant in 28 percent of the cases. The twin study method was also utilized in a Finnish study (Partanen, Brunn, & Markkanen, 1966). The main findings of this research were 29 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 con- sequences 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) concluded on the basis of these data that "innate differences between individuals in their propen- sities 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. Goldfarb, 1970; Rosenthal, 1971), it does provide valuable information which can be viewed as a vital first step in the process of understanding the interplay between genetic and environmental factors (DeFries & Plomin, 1978; Fischbein, 1978). The final research reviewed which presents evidence for the heritability of alcohol problems utilizes the half- sibling method (Rosenthal, 1970). This work by Schuckit, Goodwin, and Winokur (1972a, b; Winokur, 1976) examined primary alcoholics (i.e. those with no other major psychi- atric disturbance) who had a half-sibling. A diagnosis of alcoholism was based upon excessive drinking that had 30 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= 69), all of their findings indicated that having an alco- holic biological parent was the most predictive factor of an alcoholic outcome in these offspring. Living with an alcoholic parent did not increase the incidence of alco- holism 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. Their data indicated that having an alcoholic biological parent had a greater influence on the incidence of alcoholism than environmental factors. Schuckit et a1. concluded "having a biological alcoholic parent was the strongest predictor of alcoholism in the half-siblings" (p. 126). Other inves- tigations of adopted and nonadopted sons of alcoholics report similar results (Goodwin, Schulsinger, Moller, Hermansen, Winokur, & Guze, 1974). The numerous studies reviewed in this section purport that alcoholism is a familial disease with a nonspecific genetic component. In addition to the published research reviewed, Goodwin (1979) cites two unpublished adoption studies (M. Bohmen, unpublished data, 1977; R. Cadoret & A. Gath, unpublished data, 1977), one unpublished twin 31 study (J.C. Loehlin, unpublished data, 1972), and one untranslated foreign twin study (Jonsson & Nilsson, 1968). Goodwin reviews these four studies and concludes that they present further evidence for a heredity factor in alcoholism. Utilizing a myriad of complex methods designed to estimate the proportions of variance specifically attributable to genetic factors or environmental factors, these researchers conclude that a genetic component plays a significant causal role in the etiology of alcoholism. Future work in this area should endeavor to identify the precise genetic mechanisms (Cruz-Coke, 1973) along with specifying the nature of their undoubtably complex inter- actions 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 socio- cultural (Class I), family of origin (Class II), and peer factors (Class III) are not generally integrated into this model, although the metabolic studies include some discus- sion of Class I factors. While considerable data clearly demonstrate that alco- holism can be a familial disease (Cotton, 1979), the data are not sufficient to specify whether this finding is the result of environment or biology. The studies of Goodwin and his colleagues begin to attempt to isolate the effects of heredity from environment. Goodwin (1982) suggests 32 that minimally what is inherited is a lack of intolerance, that is, many individuals are unable to drink because they possess a strong intolerance for alcohol. Neverthe- less the issue of mechanism is not yet at all understood. The high familial incidence of alcoholism can also be viewed from a social learning perspective, ie. the effect of a significant adult role model on the male offspring's future expectations about his own behavior. Etiological Theories from the Perspective of Longitudinal Data Several studies have looked at problem drinking with the specific intent of identification of its precursors. This work follows the course of an individual's development across time. As members of the subject pool subsequently have problems associated with drinking, the data that already exists can be carefully examined to see what commonalities exist between different afflicted individuals. In addition, the available data on subjects who do not have subsequent difficulties can also be examined to ascertain what commonalities exist within this group of "invulnerable" individuals (El-Guebaly & Offord, 1980; Garmezy, 1981). 33 This design (follow-through methodology) avoids the pitfalls already mentioned with retrospective analysis or extrapo— lation vis-a-vis deductive logic to assumed earlier events, although the longitudinal method does have several basic limitations (see Achenbach, 1978a). Four representative longitudinal studies are reviewed in this section (see Zucker & Noll, submitted for publication, for a review of all longitudinal studies completed). 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 personality correlates. The age of first contact with subjects was ten and the last published follow-up report was at 33. The criterion for diagnosis of problem drinker was based on 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 negative attitude towards life. Also they were impulsive 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 proposed model we employ, these results focus on intra-individual (Class IV) effects. 34 Jones' work produced 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 11 (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) concluded that the men with drinking problems developed an intense independence- dependence conflict, as a result of earlier familial experi- ences. The conflict is resolved through the use of alcohol. 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 of influence within our purported model. Her conclusions fit easily into the theoretical framework of the Zucker model as she postulates that interactions between Class 11 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. 35 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, 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 sub- jects were ten or a bitolder, and was maintained for over 20 years. All subjects were males and alcoholism was diagnosed on the basis of AA membership and/or public records from hospitals, welfare agencies, and courts. These operational criteria result in selection of a sample of individuals who are probably not representative of all problem drinking (Sadava, 1978). According to the McCords the primary source of alcoholism 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 confusion of the child. These data are intra-individual factors (Class IV). The aggres- sion and antisocial behavior commonly manifested by the prealcoholic male (also see Kulik, Stein, & Sarbin, 1968; Williams, 1970; Zucker & 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 & McCord, 1962). While the heightened dependency needs remain as the primary contributing factor, the male 36 alcoholic also suffers from role confusion. The combina- tion of these two specific elements culminates in alcohol- ism, 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 IV 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 inconsistent care. The vascillations between good care and neglect cause the child to always want more. Additionally, because of the antagonistic maternal attitude towards society, the child never feels completely safe with his 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 vari- ables which are also 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 37 ultimately identified with by the child. These boys are not trained by example or by appropriate discipline to accept the responsibilities of an appropriate male role; they fluctuate between roles and never feel certain of their male identity (see Lamb, 1979, for an excellent dis- cussion 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 factors combine to cause the exaggerated dependency needs, the masculine role confusion, and the resulting conflict. While these variables often seem to contribute to many types of psychopathology, the McCords argue that this very specific combination of complex elements results in alcohol related deviance. Later work by Joan McCord (1979) on child-rearing antecedents of adult criminal behavior suggests that child rearing variables which are most relevant to future criminal behavior are quite different from those which lead to alcoholism. The model that the McCords suggest is associated with the following pattern. The family background of the future alcoholic (from early adolescence 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 intensified dependency conflicts over means of satisfying these needs. 38 This specific constellation of elements leaves the male vulnerable to alcoholism rather than other types of psycho- pathology. 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 inter- actions between them are hypothesized to cause a specific personality type to develop which is highly susceptible to future drinking problems. A recent longitudinal study was completed by Rydelius (1981). He followed up on a sample of male and female children of alcoholics and their controls who had been originally evaluated by Nylander (1960). Children in the original study were between four and 12 years and follow-up occurred twenty years after the initial contact. All of the follow-up data was collected by using the numerous public registers maintained by Swedish authorities and no personal contact took place. Rydelius found that, compared to male controls, male probands demonstrated poorer social adjustment, poorer general health, and more visits to psychiatric polyclinics as a result of abuse of alcohol or other drugs. Female probands demonstrated more health related difficulties, but did not differ from female controls on overall adult social adjustment. While this 39 work presents very interesting findings it is not yet a longitudinal study of alcoholism as the age at follow-up is still generally too young for severe manifestations of chronic alcohol abuse to be present. In addition these data were collected on a sample that was predominantly lower class and difficulties these children experienced were exacerbated by the multiple effects of social misery and severe paternal alcoholism. The final study to be reviewed in this section was recently completed by Valliant & Milofsky (1982). They reported results from a follow up study of early adolescent boys (14 i 2 years) who had served as a non-delinquent inner city control group for a study of delinquent youths. These boys were reinterviewed at ages 25, 31, and 47 years in an attempt to examine the contribution of five variables to subsequent development of alcoholism over the 33 years of the study. The variables examined were: 1) ethnic back- ground, 2) alcoholic heredity, 3) antisocial behavior prior to alcoholism, 4) boyhood emotional adjustment, and 5) family stability/instability. Alcoholism was diagnosed on the basis of self-report interview information at ages 31 and 47 years utilizing diagnostic criteria of DSM-III, the Cahalan scale (Cahalan, 1970) and the Problem Drinking Scale (Vaillant, 1980). While these scales view alcoholism from different perspectives (ie. medical, sociological) the results of the study were minimally effected by these 40 various diagnostic criteria, that is, the specific criteria used to diagnose alcoholism had a negligible effect on the results. According to Valliant and Miloksky, the best premorbid predictors of alcoholism were alcoholism in parents and ancestors; cultural background; and school behavior problems. The child's socioeconomic status during develop- ment, childhood emotional problems, quality of maternal affection, child's 1.0., and number of mentally ill rela- tives were not related to subsequent development of alcoholism. While these data suggest that having alcoholic relatives increases the child's risk, they do not allow any partitioning of variance between hypothesized genetic effects and/or effects as a result of living with an alcoholic parent. This study examines sociocultural and community influences (Class I) as well as family of origin (Class II) and intraindividual (Class IV) effects. The author's conclude that when a life span prospective approach is utilized, their data indicate that the most important contributions to explaining the etiology of alcoholism comes from consideration of cultural background (Class I) and alcoholism in one's parents and ancestors (Class IV). The findings of this study are not conclusive as several serious methodological and conceptual issues are present. First, much of the parent and child data was collected 41 retrospectively. Problems with this technique have already been discussed. Second, the authors attempt to separate the contribution of school behavior problems from childhood emotional problems to adult alcoholism outcomes and argue that these two classes of variables contribute independently. Many children who experience school behavior problems also have emotional problems (cf. Loney, 1978) and while recent investigations have begun to attempt to tease apart any independent contributions of these childhood symptoms to eventual adult symtomotology (Loney, Kramer, & Milich, 1980) considerable work remains. The problem of differentiation of specific symptoms in childhood is especially critical in the Valliant study since data was collected retrospectively and interrater reliability for the presence of childhood emotional problems was very low - .56. Finally, while Valliant argues that culture and alcoholic parents make the most significant contributions of variance in his regres- sion equation, these variables were the first entered into the equation and together account for only 11.1 percent of the variance. Etiological Theories from the Perspective of Cross-Sectional Data Areas reviewed in this section include a critical review of literature on children of alcoholics; a brief review of cross-sectional studies of problem drinking in 42 adolescence; and a review of a wide variety of studies which attempt to link hyperactivity in children to problem drinking in adults. The hyperactivity studies which are reviewed employ a broad spectrum of methodological approaches in addition to cross-sectional procedures. All of these studies are reviewed here to facilitate under- standing. The majority of the cross-sectional data on younger children who are statistically at risk for becoming alco- holic adults is discussed under the general rubric of children of alcoholic parents (Black, 1979; Blane & Hewitt, 1977; El-Guebaly & Offord, 1977; Fox, 1962, 1963; Haberman, 1966; Herjanic, Herjanic, Penick, Tomelleri, & Armbruster, 1977; Hindman, 1975; Jackson, 1962; Jacob, Favorini, Meisei, & Anderson, 1978; Moos & Billings, 1982; Nylander, 1960; Stevens, 1967; Wilson & Orford, 1978; Whitfield, 1980). This literature generally focuses upon either the numerous problems which children of alcoholic parents typically encounter when living with an alcoholic parent or any emotional/behavioral problems which are manifested by these children; presumably the child's problems are the result of the detrimental effect of parental alcoholism on children. Interestingly, except for the Herjanic study the literature which discusses young children from these families does not focus on the child's overall stature in juxtaposition to the child's high-risk status for 43 subsequent problems with alcohol. Behavioral/emotional problems which these children manifest are simply not commented upon from the perspective of earliest precursors of adult alcoholism. Zucker and N011 (1982) speculate that the ravages of adult alcoholism are so severe that atten- tion of clinicians and researchers has remained riveted on the problem drinking along With its direct consequences on children, rather than viewing the children of alcoholics with a more critical eye. The perspective suggested is that a child's development is the result of numerous transactions between parents and child; each makes their own unique contribution. Thus the problems so typically found in children of alcoholics are seen as the result of contributions from both parents and child. The recent study of Moos and Billings (1982) begins to adopt such a per- spective by looking at children of alcoholics still having difficulties and comparing these children to offspring of recovered alcoholics as well as normal controls. 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 both the age and sex of 44 children of alcoholics along with a specific catalog of problems of these offspring and only one study (Herjanic et al., 1977) differentiates age of children and problems manifested. Finally, only one attempt has been made to juxtapose the difficulties of the child with the duration and time of onset of the parent's alcohol related diffi- culties (Moos & Billings, 1982). Unfortunately then, from a developmental perspective little can be distilled from this earlier work. Substantial cross-sectional evidence exists which links male adolescent problem drinking with concurrent antisocial behavior and impulsive activity (Costello, Parsons-Manders, & Schneider, 1978; Demone, 1972; Jessor et al., 1968; Jessor 8 Jessor, 1973; Schuckit & Chiles, 1978; Williams, 1970; Zucker & Barron, 1973; Zucker & Devoe, 1975). Further longitudinal data on adolescent behaviors has demonstrated that antisocial and impulsive activity can precede future alcohol abuse (Jessor, Collins, & Jessor, 1972; Robins, 1966). Since antisocial behavior and impulsivity frequently occur along with alcohol abuse, often even preceding the alcohol abuse (Loeber, 1982), perhaps a pattern exists which may be utilized by mental health professionals to intervene prior to the actual alcohol abuse. Along these lines, some researchers argue that the prealcoholic male manifests the hyperactive child syndrome during early and middle childhood (Bell & Cohen, 1981; 45 Cantwell, 1972, 1978; El-Guebaly 8 Offord, 1977; Goodwin et al., 1975; Mendelson, Johnson, 8 Stewart, 1971; Morrison 8 Stewart, 1971, 1973; Tarter et al., 1977). Although hyperkinesis lacks a standard- ized diagnostic definition (Lambert, Windmiller, Sandoval, 8 Moore, 1976; Loney, 1980; Rosenthal 8 Allen, 1978), which varies dependent upon the source of data (Langhorne, Loney, Paternite, 8 Bechtoldt, 1976; DeFilippis, 1980), the type of measurement employed (Barkley, 1977; Sandoval, 1977), and the item pool utilized (Lahey, Stemp- niak, Robinson, 8 Tyroler, 1979; Loney, Langhorne, 8 Paternite, 1978), nearly all authorities agree that impul- sivity is a primary symptom of the hyperactive child syndrome (Cantwell, 1978; Goodwin et al., 1975; Lambert et al., 1976; Rosenthal 8 Allen, 1978; Sandoval, 1978; Shaffer 8 Greenhill, 1979; Werry, 1968a, b). Some research- ers have speculated that perhaps the impulsivity found in hyperactive boys underpins first hyperkinesis in early/ middle childhood, second antisocial behavior in adolescence, and third problem drinking in adulthood (cf. Hale, Hessel- brock, 8 Hesselbrock, 1982; Tarter et al., 1977). This notion is especially intriguing since some argue that hyperactivity has a genetic etiology with an organic basis (Cadoret, 1976; Humphries, Kinsbourne, 8 Swanson, 1978; Rose, 1978), although others argue against this organic and/or genetic hypothesis (Dubey, 1976; Grinspoon 8 Singer, 46 1973; Langsdorf, Anderson, Waechter, Madrigal, 8 Juarez, 1979; Shaffer 8 Greenhill, 1979; Waechter, Anderson, Juarez, Langsdorf, 8 Madrigal, 1979). The aforementioned problems with the hyperkinesis literature must be kept in mind when links between childhood hyperactivity and adult alcoholism are discussed. Despite the limitations, a substantial amount of work has been done which utilizes follow-up methodology to trace the adult outcome of childhood hyperactivity. In general, the pattern which emerges across numerous different studies suggests that hyperactive children are at risk for subsequent alcohol abuse and/or antisocial behavior; they also tend to remain impulsive, irregardless of treatment during childhood (Blouin, Bornstein, 8 Trites, 1978; Cantwell, 1972, 1978; Goodwin et al., 1975; Hechtman, Weiss, Wener, 8 Benn, 1976; Mendelson et al., 1971; Menkes, Rowe, 8 Menkes, 1967; Schaffer 8 Greenhill, 1978; Tarter et al., 1977; Weiss, Hechtman, Perlman, H0pkins, 8 Wener, 1979; Weiss, Minde, Werry, Douglas, 8 Nemeth, 1971). Recent work in this area has utilized longitudinal methodol- ogy (follow-through) along with multivariate statistics (Loney, Kramer, 8 Milich, in press). This work attempts to ascertain which specific symptoms of the hyperactive child syndrome are related to subsequent outcomes. The developmental pathway suggested by the Loney et al. data is that aggression in childhood rather than over activity is 47 the precursor of antisocial behavior and over activity in adolescence. Aggressive behavior is often reported in hyperactive children as one common symptom in the syndrome; however, much of the literature on childhood hyperactivity does not differentiate hyperactive behavior from aggressive behavior in these children (see Shaffer, McNamara, 8 Pincus, 1974, for a discussion of this problem). m The work discussed thus far provides some leads into the possible etiology of alcoholism. It is particularly weak in areas that concern behavioral manifestations in the child and his environment occurring prior to age 10 that are the precursors of alcoholism. The earliest longitu- dinal studies that deal with the ontogeny of alcoholism have not begun until late childhood, and most begin in late adolescence. The cross-sectional studies which provide data on younger children at statistical risk have primarily focused upon children of alcoholic parents as victims. When this literature is re-examined from the perspective of seeking earliest precursors of alcoholism, a host of serious methodological problems arise (see literature review). A second limitation with the work cited is that generally 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 48 influence (ie. Vaillant 8 Milofsky, 1982) as well as the potential effects of peers. While some of the work that has been reviewed seems to indicate that the first "sensi- tive period" in the etiology of alcoholism in males might not occur until the child reaches his second or third birthday (ie, attachment theory as it relates to dependency), clearly strong evidence has been cited that indicates some generational continuity in the use of alcohol in males does exist (also see Cotton, 1979; Seixas, 1977; Whitlock, 1975). On this basis the precursors for subsequent alco- holism could be present from birth onwards, or at least shortly thereafter. All previous attempts at conceptuali- zation of the earliest stages of development of the prealcoholic male have been done without actual observations and systematic data collection. Statement of the Problem and Predictive Framework The present project is a pilot study aimed at beginning to fill the critical gap which exists in our understanding of the development of alcoholic disorders. The research program will begin very early in the life of the child for several reasons: (1) Considerable evidence has been reviewed which suggests that both males and females with a biological alcoholic parent have a substantially increased risk of 49 subsequently becoming alcoholic (also see Coombs 8 Dickson, 1981). While the data indicate that alcoholism is often a familial disorder, insufficient data exists to firmly iden- tify specific etiological mechanisms. It is possible that high-risk children, from birth onwards, manifest subtle harbingers of future problems (see Schwarz, 1979). (2) McCord and McCord (1960, 1962) found that male alcoholics exhibited more overt seeking of comfort, care, and direct guidance than nondeviate controls. These beha- viors were categorized by the McCords as dependency beha- viors. 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 ever; dependency behaviors than controls during adolescence (also see Blane 8 Chafetz, 1971; Jones, 1968). Zucker (1968), using the Gough Femininity Scale, found that heavy drinking adoles- cent males scored higher on tests of overt masculinity, but found no differences on tests of covert masculinity. 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 passivity (Wolowitz, 1964; Wolowitz 8 Barker, 1968). Finally, alcoholics have been found to be perceptually more field dependent than controls (Witkin, Karp, 8 Goodenough, 1959). These findings 50 generally support the notion that male problem drinkers tend to have problems with developing means for satisfying dependency needs and they resolve this difficulty by establishing a facade of independence. The origin of the conflict over satisfying dependency needs could possibly lie in earliest infant attachments (Blane, 1974). Heavy drinking cultures have more oral themes in their folk tales (McClelland, Davis, Wanner, 8 Kalin, 1966) and male ado- lescents who have drinking problems have more oral themes in their fantasies than nonproblem drinkers (Zucker 8 Fillmore, 1968). In addition to the oral and dependency themes, psychodynamic conceptualizations of drug dependence emphasizes the narcissistic nature of the problem (Greenspan, 1977; Wurmser, 1977) and/or the unresolved conflicts between attachment and alienation (Barry, 1974b). Drug abuse, including alcohol, is viewed by many clinicians and re- searchers as a long standing problem in personality malad- justment (Apfeldorf, 1978; Huba, Wingard, 8 Bentler, 1979). "An impulsive, uninhibited, violent quality characterizes the normal infant, the intoxicated person and the chronic alcoholic" (Barry, 1974a, p. 92). (3) The dramatic rise in the number of studies on the infant and preschooler during the past ten years (cf. Sameroff, 1978b) 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 51 sophisticated methods (cf. Brazelton, 1973; Thomas, Chess, Birch, Hertzig, 8 Korn, 1963) for assessing young children. These methods can be applied systematically and reliably to study children who are at higher-risk for subsequent drinking problems. (4) An offshoot of improved research methods has been increasingly fine-grained analyses of early life 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, 8 Caron, 1978). Transient neonatal symptoms (ie., restlessness, rigidity, apathy) have recently been found to correlate with loneli- ness 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 hyperkinetic children does strongly suggest that a subtle deviation in prenatal development can lead to both minor physical anomalies and behavioral devi- ance" (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 8 Moss, 1978), although Walraven (1974) reported that methods 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. 52 (5) Sarnoff Mednick and his colleagues (Mednick, Mura, Schulsinger, 8 Mednick, 1971) 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, psychiatric status of the mother, type abnormali- ty 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 under- taken. The present pilot work attempts to move into new areas to advance our understanding of the alcoholic problem. The aim is to conduct a preliminary cross-sectional study which makes contact early in the child's life (under 6 years). The primary concern is to acquire valid and reliable data on each child using a wide variety of techniques such as formal and informal observations; mothers' and fathers' questionnaires; and experimental paradigms. We are care- fully attempting to acquire data on each child from a number of perspectives especially direct observations, since much of the data on children of alcoholics has been obtained via mother's reports or indirect methods (Jacob et al., 1978; Moos 8 Billings, 1982). It is hoped that if high-risk markers exist, they will eventually 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 53 conducted using larger cohorts longitudinally. The major weakness of this design is that if no signi- ficant differences are found, the results would be extremely difficult to interpret since this initial pilot study will be conducted with nine alcoholic and nine control families (see Minium, 1970, for a discussion of this problem). The low group N biases the study in the direction of committing Type II error. The optimal solution to this problem is to increase the sample size. This work is currently being planned. The methods and theoretical framework described in this dissertation are one segment of a larger cross—sectional study-~the Michigan State University Risk Study (Zucker, 1980; Zucker, Baxter, Noll, Theado, 8 Neil, l982)--which is being conducted by Professor Robert Zucker and a number of his students. The scope of this paper is purposefully limited as it dovetails into the work which is being completed by others on the project staff. Thus each par- ticipant in the project is focusing their research on a relevant tapic which is also of interest to them. This will facilitate the project's goal of utilizing a broad-based approach with limited resources. Following the model which Zucker proposes, the present study will assess factors within Class IV, intra-individual influences in children from ages 28-6. The remaining three spheres of influence are assessed using generic measures 54 which are collected on all families, or by specific metrics developed by other project members for their individual studies. This will permit us to establish the beginnings of a map of presumed etiological factors, within each of the four spheres of influence which have been suggested by the research on older populations. Since this study focuses upon young children who are statistically at risk and no empirical data is available which is directly relevant, expected results are based entirely upon long range use of hypothetic—deductive think- ing. Extrapolations must be made from retrospective, genetic, longitudinal, and cross-sectional data on alco- holics and preproblem drinkers. Whenever a clear body of directly pertinent data exists, a formal prediction of expected results will be made. Formal predictions are listed in Table 3, as well as being included in the text of the Methods section. If no directly relevant data is avail- able or if previous findings are methodologically unsound, a statement of expected findings will be made. Expected findings are listed in Table 4, as well as being included in the text of the Methods section; they are more specula- tive than formal predictions. Much of the data to be collected within the intra- individual sphere of influence focuses on generic topics of purported relevance to the etiology of alcoholism. As noted earlier (Zucker, 1980), variables which are being studied 55 =mmmcw>mn umposou_m= pawocou an» we mmmcmcmzm ages on?“ 1mcpmcoEmn was» mxon Pocucoo cusp :muwo mcos uwFosoopmcoc1QWFo; 1ouFm we mwmmn esp co mmmmcm>mn 8;“ 820m F_Pz axon eat; 58?: mpocucou cusp cmpwo mcos mmmmcm>mn uw_o;oupm “umpmm Frwz macs ewe; gow511=ace_w;u cage mu_:cm Low :muwo mcos mmmmcm>ma ow_o;oo_m pompwm FFTZ mxon FP< maon Focucou can» canto mcos Ppmsm an mwmmgw>wn uwpocoupm zcwpcauw P__3 axon xmec new: Amkmp .eCOEacu w auogaq sect ua_eweosv xmme pamucou Fogoofi< AwNmF .amoccma soc; umwmwuosv xmmp mammcm>om mauvggocaa< Amemp .ecosmcu a seesaw sate eawcweosv xmae mFFmEm we cowgwcmoumm =mmmcm>mn umFosoupm= xcommumu Fmmeo— 6:9 do mmvmpzocx m.:mccpwgu mcowmmuuo do mmaau mzowcm> :o cwcupwcu co mupzcm x3 cowpassmcou Loe mumwcaocagm mcm mmmmcm>mn was: we mmuszocx m.=mcnpw;u PFmEm mcwm: mmmmcm>mn umpozoupm scepcmew op apwpwam m.=mce_w;u mcowpowumca “amascpmcH mzuod pcmsmmmmm< mcowanumca Passed m mpnmh 56 mpocucou cusp m>wuauuu ccu Logos mcwm co cmzop acoum pr3 uses smwc1smw: sumo co copuue m>wm 1mmcmm< 1 apw>wmpcaew so .voos m>vuummc .Fm>mp xpw>muuu sows yo m>wpuuwccw mew“? mcos mmcoccm Fsz macs smws1sacs so m.u=mcus mxos Focucou cusp woos m>wpumuc mcoE ccu .mucuumwmcma cuam1cowucmpuu Luzop .mpm>mp zpw>wuuu cwsmws mcw>us mu mucmsuc cums» xs easwsumuu ms _sz axon saws1smcz xsoucm>cH Fuucme 1aoFm>mo mpu> cmmw>mm mucwpmwmsmq cuqm 1cowpcmuuu ccu xpw>wmpcasH zuw>wmpcasw mim .suuscwso< .sumuv ccu .cowmmmsmmu .coos PF 3 u suasu sop>usau u_,su ._m>a_ xuwswuuu m.u_csu Awump .xmcuu cooE ccu w uww>mouz mommv msmuc mucmumwmcwa .cuam1cowucmuuu 1cowpmmco mrxum Low>usmm .~m>mp xpw>muuu m.cpwsu mucmcmcewo cmpumaxm acmsacpmcH pcmsmmmmm< pause” so meowpumswo casuawacucc e mpnuh 57 have been selected on the basis of three major criteria: 1) Variables which appear to be etiologically relevant based upon data obtained with older high— risk populations (cf. Jones, 1968; McCord 8 McCord, 1960). 2) Variables which attempt to assess major classes of influence hypothesized to be theoretically relevant (cf. Sadava, 1978; Zucker, 1979; Zucker 8 Noll, 1982) to the development of drinking problems. 3) Variables which add to our general knowledge of child development in the context of the family (cf. Kagan, 1979). Within the above context this research examines the following areas: 1. Each child's general development and cognitive capacities is assessed. This assessment is relevant to criteria 2 and 3 above. Impulsivity and hyperactivity are often cited as possible precursors that exist in the male child who subsequently becomes an alcoholic (see literature review). Insofar as the high-risk child tends to be more impulsive, has a shorter attention-span, and is less reflec— tive in his approach to problem solving, performance on tasks which require attention and persistence will be less optimal (cf. Humphries, Swanson, Kinsbourne, 8 Yiu, 1979). Thus, if differences exist between high-risk and control boys, we anticipate that fine motor and adaptive scores will 58 be lower in the high-risk children (see Table 4). Assess- ment items in these areas favor an approach which is more reflective and persistent. Also, clumsiness of fine move- ments has been found in hyperactive children (cf. Menkes et al., 1967) and this could decrease performance on fine motor items. Since the ability levels in the children have not been controlled, this could potentially serve to mediate differences. For example, a high-risk boy may possess exceptionally high adaptive ability and perform only slightly above age level because he responded impulsively, or gave up relatively quickly. Despite this methodological problem, we anticipate that differences will emerge. II. A second set of measures assesses the child's temperament, again evaluating attention-span_persistence, but also focusing on activity level and mood. This assess- ment is relevant to criteria 1 and 2 above. The majority of studies on alcoholics and adolescent heavy drinkers agree that these men are characterized by negative mood and impulsivity (see literature review). Preproblem drinking males could tend towards impulsivity and negative mood from very early periods of development onwards, or this aspect of temperament might manifest itself only later (Zucker, 1979). Collection of temperament data cross- sectionally could provide new and important information. Insofar as differences emerge between the high-risk and control boys, we expect that the high-risk boys will be 59 described by their parents as being higher on activity level, lower on attention-span persistence and having more negative mood than the descriptions of control boys by their parents (see Table 4). III. Another area of focus is childhoodppsycho- (pathology. This assessment is relevant to criteria 1 and 2 above. We are again especially interested in items endorsed by parents which indicate high activity levels, negative moods, or impulsivity in their child. These characteristics have been cited as possible precursors that exist in pre- problem drinking male children. Since none of the data which have been reviewed is directly relevant to specific items which might be endorsed by the parents of a preproblem drinking male child at age 28-6 years, no formal prediction of results will be made. However, insofar as differences exist, we expect parents of high-risk males to more fre- quently endorse items on the aggressive factorof the CBCL profile for males age 4-5 (see Table 5). IV. The last set of measures assesses the child's knowledge of alcoholic beverages and their effects (see Aitken, 1979). This assessment is relevant to criteria 2 and 3 above. We are especially interested in exploring whether the high-risk boys perform differently from control boys with respect to knowledge, attitudes, and expectations about alcohol (cf. Christiansen, Goldman, 8 Inn, 1982). Only three studies have explored the development of 60 Table 5 Child Behavior Checklist Items Indicative of High Activity Level. Negative Mood, or Impulsivity. 10. 19. 22. 35. 37. 41. 74. 86. 87. 95. 109. Argues a lot Can't concentrate, can't pay attention for long Can't sit still, restless or hyperactive Demands a lot of attention Disobedient at home Feels worthless or inferior Gets in many fights Impulsive or acts without thinking Showing off or clowning Stubborn, sullen, or irritable Sudden changes in mood or feelings Temper tantrums or hot temper Whining 61 children's (under ten) attitudes and knowledge of alcoholic beverages (Jahoda 8 Cramond, 1972; Penrose, 1978; Spiegler, in press). Perhaps the major reason for the paucity of system- atic investigations in this area is the implicit belief that young children have no real knowledge of alcoholic beverages and their effects. Along with this belief has been the accompanying fear that exposure of young innocent children to knowledge of alcohol by researchers could cause harmful effects. Although our everyday experiences with young children and even infants in our own homes, as well as some empirical data (Jahoda 8 Cramond, 1972; Penrose, 1978; Spiegler, in press), clearly demonstrates that young children know about alcoholic beverages, the myth of children's innocence in this area seems to live on. Insofar as differences exist between the high-risk and control boys, we predict the high-risk boys will possess greater knowledge of alcohol and its effects than control boys (Table 3). This prediction of expected differences is based upon a social learning framework and Zucker's heuristic model. Zucker's model postulates that a young child will be affected more heavily by familial influences (Class II) than social and community influences (Class I). Social learning theory has demonstrated that an important person modeling live behaviors will have a greater impact than less significant individual modeling behaviors either live or pictorially (Bandura, 1969). CHAPTER II METHOD Subjects Rationale Due to the higher rates of alcoholism among men (see literature review), all children included in this study are male. High-risk male children were selected on the basis of paternal alcoholism. According to Goodwin (1976), no study which has examined the first degree male rela- tives of alcoholic men (fathers and brothers) has found less than 25 percent of these men alcoholic also. Thus alcoholism is 4-6 times more prevalent in these families than the general population (also see Cotton, 1979; Winokur, 1976). While a wide variety of additional sociological, cultural, and psychological factors have been implicated by investi- gators as being associated with the etiology of alcoholism, and conceivably could be used in selecting a high-risk group, we believe on the basis of the available data that the acquisition of families with problem drinking fathers renders the male child at sufficiently higher-risk for future alcohol abuse to warrant this research, utilizing this criterion only. 62 63 Alcoholic Families The goal of our subject recruitment efforts was to locate a sample of men who had recently had sufficient drinking related problems to warrant a diagnosis of defin- ite or probable alcoholic. The focus of this search was placed upon identification of men with intact families and young male children who had experienced drinking related problems during the life of their child. The initial search process focused upon three potential sources of subjects: 1) industry; 2) the medical community; and 3) the Michigan Alcohol Highway Safety Program. Contacts with industry were limited to the Lansing area General Motors Plants since they already had an alcohol program established within the Oldsmobile and Fisher Body Plants. Because of non-resolved issues of confidentiality and a lack of cooperation from individuals in charge of this program, we were unable to use this potential source of subjects. The greatest problem in this area was the lack of cooperation and the implicit attitude we experi- enced of why should we help, what's in it for us? If cooperation could be obtained from large industry, this could be an excellent source of subjects. Our search into the local medical community focused upon two potential subject pools: 1) inpatient alcoholism treatment centers and 2) physicians in the Greater Lansing area who specialized in the treatment of alcoholics. The 64 St. Lawrence Alcoholism Treatment Unit was open to our ideas and supportive, but the majority of the population they treated were older men with no young children. They did see a few younger men in this facility but the sample was very small. A larger treatment facility of this type would probably yield a sample of alcoholic men with pre- school children. Our contacts with physicians who specialized in the treatment of alcoholics met with some enthusiasm, but the group of men they treated was generally older with pathOphysiological problems as a result of chronic long term alcohol abuse. Contacts with the Michigan Alcohol Highway Safety Program brought us into contact with a large population of problem drinkers as well as the Alcoholics Anonymous (AA) hierarchy of the community. This large population of individuals arrested for drunk driving (DWI) had people of all ages and appeared to be an excellent source of subjects. Problems arose as a result of the generally uncooperative stance taken by project staff who were typi- cally AA members and did not agree with aspects of the research we were conducting. Our anticipation of an unsympathetic view of our study had caused us to avoid official contact with AA as resource and the experience we had with officials at the Michigan Alcohol Highway Safety Program confirmed our expectations about the generally closed nature of the AA community to researchers. 65 The recruitment process failed to locate subjects through industry, the medical community, or the legal system. However, the legal system looked promising as men of all ages were getting arrested for DWI. Contact was initiated with the presiding judge of the East Lansing District Court who was enthusiastic about our project and permitted us to begin working with the probation officers who had contact with nearly all of the people arrested for DWI. The probation officers were also enthusiastic about our project and assisted project staff with an exhaustive search of court records to compile a list of all men who were married and arrested for drunk driving from January, 1978, to December, 1982. Subsequent to our successful work with the East Lansing District Court, we began a similar process with the Lansing District Court. The work with the Lansing District Court focused upon development of a list of men who were recently arrested for DWI and were married with a young male child between the ages of 2% and 6-0 years. The high-risk families were contacted via these two district courts in the Greater Lansing metrOpolitan area. From the East Lansing court all males who were married and had been arrested for impaired driving or driving under the influence of liquor from January, 1978, to the present were asked by probation officers on the court staff for permission to release records, names, and phone numbers to the research 66 project staff. The study was described as focusing on child development and family health. During this initial screening of records, the court staff attempted to contact 164 men. Phone contact was established with 129 of these men, as 35 had either moved away from the local area or had no current phone listing. Of the 129 men who were contacted 116 (90%) gave permission to court staff to release their name to the MSU study. The Lansing District Court also provided subjects for this project. All contacts attempted by this court staff were successful in that potential respondants agreed to allow contact with the researchers, but within the present sample, only one respondant had a male child in the appropriate age range. This man also was included. Subsequent to obtaining permission these records were screened by the research staff to ascertain whether criteria for inclusion are met. The criteria were: 1) Blood alcohol concentration (BAL) when arrested at least .15% (150 mg/100 ml; to reach this level a 150 1b. man would have to consume approximately 8 drinks in the past 1-2 hours on an "empty stomach" or 10 drinks in the past 1-2 hours on a "full stomach"1 (AAA, 1982). 2) Having a biological male child between ages 2% and 6-0 years at the time of data collection. 1In Michigan, a blood alcohol concentration of 0.08% (80 mg/ 100 ml) to .10% (100 mg/100 ml) is considered impaired driving and blood alcohol concentration of greater than .10% is considered driving under the influence. 67 3) At time of initial study involvement, marriage is intact (ie. biological mother and father living together). When a name on the court list met our criteria,project staff contacted the family either by phone or letter. Although it was sometimes difficult to make initial contact, all eligible families were eventually contacted. During the initial phone or mail contact families were told we were conducting a research project on child development and family health. Families were told they would be paid, and were asked when an appropriate time might be for our staff to explain the project in greater detail to them. The initial contact was not an active recruiting effort; rather it was to establish contact with the family prior to asking them to participate in person. All alcoholic families who were contacted in this fashion agreed to participate. Nine alcoholic families were qualified and then recruited from this list. The majority of the names on our lists were disqualified because they were older men whose children no longer met project age limits (no families were disqualified for low BAL). It should be noted that our method for selection of families on the basis of paternal legal problems which are a direct result of excessive drinking was designed to insure that fathers meet time frame diagnostic criteria for a research diagnosis of definite or probable alcohol 68 abuse which have been used by other researchers. For this purpose, more complete information on parental drinking and its consequences were obtained on both alcoholic and control parents later during the course of data collection. Community Control Families This study utilized one control group, a "community” control group. A matched community control family was located for each alcoholic family that was part of the study. The family was to control for the effects of social prestige; age and birth position of the target child; and sibling constellation. By selecting families that lived well within the same census tract we hoped that control families would be very similar in sociocultural back- ground. Subsequent to the successful recruitment of an alcoholic family the person who contacted the alcoholic family began a door to door canvassing of the homes at least one block or more away from where the alcoholic family lived, but still in the same census tract. The purpose of this search was to locate comparable families with young children, specifically, to find a number of families who had a male child whose chronological age was matched to the age of the target child in the alcoholic family. Families were not actively recruited at this point, rather they were told that a research project on child development and family 69 health was taking place in their neighborhood. They were asked for their name, phone number, and the ages/sex of children living at home and were told they might be contacted in the future by the MSU Family Study staff. They were also informed they were under no obligation but if they did par- ticipate they would be paid for their time. In this fashion an extended list of potential community control families was developed. Ranging in an ever increasing recruitment circle, the list included all intact families in the neighborhood with a male child within 1 one year (but no younger than 2% years) of the target child in the alcoholic family. The list was extended until a perfect match on all relevant criteria (see below) was obtained, or until five potential families were found with appropriate aged sons. In the latter case the recruiter, in consultation with the project director, selected the family from the list of five that most closely fit our criteria. From our list of families, first priority was given to matching on the basis of age of target child. Second priority was given to the type of home, avoiding obvious economic discrepancies, and third priority was to match the age/sex distribution of the sibship (Lahey, Hammer, Crumine, 8 Forehand, 1980; Lewis 8 Kreitzberg, 1979; Weller 8 Bell, 1965) as well as its overall size (El-Guebaly, Offord, Sullivan, 8 Lynch, 1978). (See Jacob, 1975; Seifer, Sameroff, 8 Jones, 1981, for a discussion of the rationale for matching). Over 90 percent of the families 70 contacted during neighborhood canvasses gave their names and phone numbers. Every family that was selected from our lists consented to participate. Table 6 gives the demographic characteristics of the alcoholic and control families. There were no differences between the alcoholic and control families on any of the variables we attempted to match. In addition the age of the alcoholic and control parents did not significantly differ, nor did the current religious backgrounds of the families. "NA" in Table 6 indicates that a clear lack of differences was present so no statistic was computed. Procedure Initial Contacts and Screening Subsequent to the initial phone contacts with families1 who met research criteria, an appointment was made with each family to explain the details of the project (see Table 7) and to actively recruit them into "a project focusing on child development and family health". All recruitment was done in the home of potential subjects at the family's convenience (often weekends or evenings) by core research staff. During the initial face-to-face contact families were assured that all of the information they gave us was 1If a family agreed to participate in this project, and then or at a later point the parents voiced concerns about family problems in general, appropriate referrals were made. 71 Table 6 Sociodemographic Characteristics of Alcoholic and Community Control Families Alcoholic Community F- families control value.l (n=9) families (n=9) Age in Years - father's 7 31.78 28.89 1.59 S.D. 3.90 5.17 - mother's 7 30.22 28.11 <1.00 S.D. 4.16 4.70 Religion % Protestant -fathers 44% 33% NA -mothers 44% 44% NA % Catholic -fathers 33% 44% NA -mothers 44% 33% NA % no religion -fathers 22% 22% NA -mothers 11% 22% NA Family Social Prestigez’3 7 29.72 27.03 <1.00 S.D. 9.89 16.04 Number of Children Currently Living At Home 7 3.22 2.78 <1.00 S.D. 2.11 1.72 72 Table 6 (cont'd.) Age of Children Living at Home (Years) 7 6.50 4.61 3.03 S.D. ' 4.68 2.80 Age of Target Child (Years) 7 4.11 4.07 <1.00 S D 1 17 1 28 Birth Position of Target Child % Tst 22% 33% NA % 2nd 56% 45% NA % 3rd 22% 22% NA 1Based on univariate F - tests; all p's nonsignificant. 2Duncan TSE12 Socioeconomic Index, Stevens 8 Featherman (1980). These scores are based upon father's occupation except in one alcoholic family. This man had not worked for over 2 years as he was attempting to claim a work related physical disability. His wife's occupation was utilized, score 21.2. 3Two alcoholic fathers had been chronically unemployed. Phone contact with the Michigan Employment Security Commission established that "laborer" jobs at the minimum wage are available in the Lansing area and that the job classification "laborer" is not currently on the surplus labor list. Both of these men had been working previously as semi-skilled laborers. 73 Table 7 Contact Schedule for Collection of Child Related Data (All Contacts at Respondent's Home). I. Initial contact for recruiting and screening (1% hr) A. Consent forms and questionnaires (Project staff) 1. Research Participation Informed Consent form - H 8 W* (Appendix I) 2. Demographic Background Questionnaire - H 8 W (Appendix II) 3. Health Questionnaires - H 8 W (Appendix III 8 IV) a. includes SMAST b. early developmental history of target child 11. Developmental assessment; questionnaires for parents (2 hr) A. Questionnaires about parents - Drinking and Drug History - H 8 W (Appendix V) - Project staff B. Developmental assessment + questionnaires about the child (RBN + Project staff) 1. Revised Yale Developmental Inventory (YDI) 2. Temperament questionnaire (Behavioral Style Questionnaire) - H 8 W 3. Child Behavior Checklist - H 8 W 74 Table 7 (cont'd.) III. Knowledge of alcoholic beverages (1 hr) A. Assessment of child's attitudes and knowledge of alcoholic beverages (RBN) 1. Recognition of Smells (Appendix VI) 2. Appropriate Beverage Task (Appendix VII) 3. Alcohol Concept Task (Appendix VIII) IV. Final contact session A. Debriefing family and feedback from family (Project staff) *H = Husband, W = Wife 75 confidential. Twelve of the 18 families (six alcoholic and six control) contacted were randomly requested to participate in a more elaborate project that included home visits and video taping (see Baxter, 1981). All families who were offered this lengthier schedule consented to participate. Families were paid $150 for participation in the extended project and $75 for participation in the regular project and all families contacted agreed to participate. When agreement was obtained parents signed consent forms (Appendix I) and were asked to complete a demographic information form (Appendix II) and a health history (Appendix III 8 IV). They were informed that they could end their voluntary participation whenever they wanted, but that payment would occur after the final data collection. Sub- sequent to this first session, the health histories of all men were examined since we had placed the short-form of the Michigan Alcoholism Screening Test (SMAST; Seltzer, 1971, 1975) within the health history questionnaire. The SMAST was used as the initial alcoholism screening inventory to insure that the ostensibly alcoholic families had men who in fact met appropriate alcoholic diagnostic criteria, and that they were having problems as a result of their drinking and con- trol families did not have fathers who met these criteria. The father in one family that was initially recruited as a control scored very high on the SMAST and reported a recent DWI. This family was reassigned to the alcoholic group on the basis of these data. Mother's scores on the SMAST were not utilized 76 as criteria for either inclusion or exclusion from the pro- ject. Since self-reports of alcoholic's drinking behaviors generally coincide with the reports of collateral informants (Adams, Grant, Carlin, 8 Reed, 1981; Cotton, 1979; Guze, Tuason, Steward, 8 Picken, 1963; Maisto, Sobell, 8 Sobell, 1979; Polich, 1982), we had reason to expect the information from the SMAST would be valid. Even so,subjects' scores on the SMAST were only used to initially screen families. The definitive information on current patterns of alcohol consumption and problems associated with drinking were collected later in the data collection process (N.B. In point of fact, this screening was entirely successful; in no instance was a family admitted into the study as alco— holic, where later information disconfirmed that, although as we have noted, the obverse situation occurred in one instance.). In general our goal was to collect all of the data for this project in the blind. Unfortunately this was possible in only 4 of the 9 pairs of families as I participated in recruitment of the remaining families. Possible differences as a result of blind vs. non blind data collection will be dealt with later in the discussion. Measures Each family that participated in the project completed numerous questionnaires, interviews,and direct observation sessions (see Zucker, 1980). It is beyond the scope of this 77 paper to discuss the methodology of the overall project. Measures included in this study in addition to sociodemo- graphic characteristics of families are six sets of variables about the status of the target child and two variables about parent's drinking. Each parent completed four self-adminis- tered questionnaires, while each child was individually evaluated on two occasions (see Table 7). Parent measures. Each parent was given two questionnaires about current (last six months) drinking patterns and problems they may have had related to consumption of alcoholic beverages. During initial screening each parent completed the SMAST and on a second testing each parent completed a Drinking and Drug History (DDH). The DDH was developed to provide detailed information on current consumption patterns of alcoholic beverages as well as problems resulting from drinking; it also provided detailed information on current and past consumption of other drugs (ie. marijuana, amphetamines, LSD, cocaine, etc.) as well as problems resulting from abuse of these drugs. Although detailed analysis of the polydrug use has not been completed, cursory examination of these data indicate that one of the alcoholic fathers has had problems as a result of excessive use of drugs other than alcohol in addi- tion to problems resulting from alcohol consumption. Items were taken from a variety of sources (Cahalan, Cisin, 8 Crossley, 1969; Johnston, Bachman, 8 O'Malley, 1979; Schuckit, 1978; Appendix V). The consumption data from this question- naire permits cataloging of drinking patterns into 78 quantity-frequency-variability (Q-F-V) indexes (Cahalan et al., 1969). The Q-F-V reflects the amount of alcoholic beverages consumed on each drinking occasion and the frequency of drink- ing occasions as well as the variability between drinking occasions. The Q-F-V index number is then placed into one of five drinking categories: 1) Heavy drinker, 2) Moderate drinker, 3) Light drinker, 4) Infrequent drinker, and 5) Abstainer. The DDH also has multiple questions (22 items) on problems and con- sequences of drinking. Ten of the items are the same or similar to SMAST items and twelve of the items reference dif- ferent alcohol related problems. Items from the SMAST and DDH were carefully selected to insure that sufficient information was available on each subject so that a diagnosis of definite or probable alcoholism could be made using the Research Diagnostic Criteria (Feighner et al., 1972). Child measures. Six sets of variables were assessed on each target child using a variety of different instruments and informants as well as direct assessments of the child. The variables assessed in each child were 1) impulsivity, 2) atten- tion-span persistence, 3) mood, 4) activity level, 5) knowledge of alcoholic beverages, and 6) overall developmental status. (A) Measurement of Temperament (especially activity level, mood, and attention-span persistence) Both parents of children who participated completed the Behavior Style Questionnaire (BSQ; McDevitt 8 Carey, 1978). Thus for each child two measures of temperament were obtained. This approach permitted us to begin to ascertain if interrater 79 reliability between parents for the temperament dimensions conceptualized exists. Within Zucker's heuristic model, this assessment was designed to measure intra-individual factors (Class IV). The BSQ is a lOO-item questionnaire designed to obtain parental ratings on temperament for children ages 3-7. The BSQ is based directly upon the New York Longitudinal Study conceptualization of temperament and was developed in an attempt to provide a reliabile and practical instrument to assess NYLS temperament dimensions. Initially, 135 potential items were screened by eight judges familiar with the NYLS concept of temperament. Items were retained only if five of eight judges agreed which of the nine temperament dimensions that an item measured. An initial questionnaire containing 112 items was pre-tested on 53 school-aged children. Items were retained if they were highly correlated (2.30) with their assigned temperament dimension. An lOB-item version of the BSQ was given to 369 parents of three to seven year old children. Items were retained as in the pre-test and this resulted in a final lOO-item questionnaire. The BSQ was returned by 350 of 369 parents and 55 of these parents were asked to retake the questionnaire four weeks later. The total score test-retest reliability was .89. The alpha coefficients (Cronbach, 1951) for the nine factors ranged from .47 to .80, with threshold (.47) and rhythmicity (.48) the only factors below .60. Thus the internal consistency for seven of nine temperament factors was above .60 for the overall sample (N = 350). The relationship between BSQ scores and early 80 school adjustment was investigated by Carey and associates (Carey, Fox, 8 McDevitt, 1977). They found that temperament was "a significant factor in school adjustment and that it can be measured by a clinical instrument appropriate for pediatric use" (p. 621). Carey et a1. argue that their data provide some support for the external validity of the BSQ measure of tem- perament (also see Billman 8 McDevitt, 1980; Carey, McDevitt, 8 Baker, 1979; Field 8 Greenberg, 1982). Finally, Carey and McDevitt (1978) examined stability of temperament clusters in children from infancy (4 to 6 months) to early childhood (3 to 7 years) utilizing an infant temperament questionnaire and the BSQ. They found that a disproportionate number of children sampled showed continuity of temperament across time. Diffi- cult infants who also had either high activity levels or very negative mood were most likely to remain classified as difficult in childhood (also see McDevitt 8 Carey, 1981). An excellent review of the psychometric adequacy of the BSQ along with 25 other instruments developed to measure tempera- ment can be found in Hubert, Wachs, Peters-Martin, 8 Grandour (1982). (B) Measurement of Childhood Psychopathology (especially activity level, mood, aggression, impulsivity) Both parents completed the Child Behavior Checklist (CBCL; Achenbach, 1978c; Achenbach 8 Edelbrock, 1979; 1981). The CBCL consists of 118 behavior problem items and 20 social competence items that have been adapted for optimal use by parent report. The responses to the CBCL are scored 81 for social competence and behavior problems utilizing the appropriate Child Behavior Profile. Separate editions of the Child Behavior Profile have been developed and stan- dardized for each sex at ages 4-5, 6-11, and 12-16. The profile developed for males, ages 4-5 was utilized for all children in this study including those under age four and over five years 11 months. 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 8 Edelbrock, 1978c; DeHorn, Lachar, 8 Gdowki, 1979). For example, noctural enuresis has vastly different implications/consequences for a four year old male than for a 16 year old female. The CBCL provides data on any problem behaviors which the parent's perceive the child manifesting. The pattern of scores on the CBCL permits analysis of the child's behavior problems with respect to profile types. These types are unique to each age/sex group and are based upon score patterns per se, not elevations (Edelbrock 8 Achenbach, 1978). All behavior problems are dichotomized between the two general factors of internalizing and exter- nalizing. This dichotomy has proven to be highly robust with numerous instruments by different types of raters and in different situations (Achenbach, 1978c; Edelbrock 8 Achenbach, 1980). The profiles that have been obtained with the CBCL are the result of factor analysis that has been 82 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 8 Achenbach, 1978). Preliminary investigation of the stability and relia- bility of the CBCL has indicated that the instrument is satisfactory for both referred and nonreferred children. Follow-up stability, across all sex/age groups for six months has been .7l-.73; for eighteen months it has been .59 (Edel- brock 8 Achenbach, 1978; Achenbach 8 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 8 Achenbach, 1978). The test-retest reliability of the CBCL across all age/sex groups is above .80 (Achenbach 8 Edelbrock, 1979, 1981). Finally, parents have been given the CBCL independent- ly and asked to complete the checklist. Interparent agreement for all boys has been .79 (Achenbach 8 Edelbrock, 1979). Clearly the reliability and stability of the CBCL is satis- factory, although these data were not exclusively 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 83 behavior problems, i.e., "parents are typically the most important source of data on child behavior problems" (Achenbach 8 Edelbrock, 1978c,p. 1289, 1290), indicates that the CBCL will provide a rich picture of any behavior problems the child may have. We were especially interested in items endorsed by parents which indicate high activity levels, negative moods, or impulsivity in their child (see literature review). The majority of these items (11 of 13) are on the aggressive factortrf the CBCL profile for males age 4-5 and are consid- ered by Achenbach to be externalizing items. (C) Assessment of Cognitions about Alcohol Recent work by Hood and Bloom (1979) strongly suggests that preschool children possess greater cognitive conceptual competence than classic Piagetian theory predicts (also see Brainerd, 1979; Gelman, 1979; Gelman, Bullock, 8 Mech, 1980; Nelson, 1972; Sugarman, 1981). Therefore all children were assessed on the child's knowledge and attitudes towards alcoholic beverages. This assessment was designed to ascer- tain whether male children of alcoholic fathers have a special awareness of alcohol and its effects at an early age as a result of presumed familial influences. The experi- mental paradigm being used was designed to assess whether differences exist. Each child was tested in one session that lasted approximately thirty to forty-five minutes. The testing was 84 done by the same experienced examiner who assessed the child with the YDI. To avoid sensitizing the parents to our interest in alcoholic beverages, this assessment was done in our research van in front of the child's home. While cognitive testing appears straightforward, it is very diffi- cult to conduct properly, and biased results can easily occur (see Jahoda 8 Cramond, 1972; Santostefano, 1978, p. 411). We attempted to create an optimal setting to assess the child by using an individual familiar to the child who is experienced in child assessment in a safe place free from distractions. Children were assessed on their ability 1) to recognize and verbally label the smell of alcoholic beverages, 2) to correctly identify the appro- priate beverage for adults and children on various festive or everyday occasions, and 3) to correctly group various beverages into the class "alcoholic" or "non-alcoholic". C-l: Smell recognition task The recognition of smells task was developed by Jahoda and Cramond (1972) to assess the degree of familiarity that Scotish children ages six to 10 years had with one aspect of alcoholic beverages - the smell. The original procedures developed by Jahoda and Cramond have been modified slightly to increase task appropriateness for the younger American children assessed in this project. Children were asked to close their eyes and smell the contents of nine jars with various substances in them one at a time. Subsequent to the 85 first trial children who did not correctly name three sub- stances plus one alcoholic beverage were shown photographs of the jars' contents and the task was repeated. In addition to assessment of children's ability to provide verbal labels for substances they smelled, children were asked a series of standardized questions after each correct response to deter- mine whether they liked/disliked the substance and had knowledge of its appr0priate uses. (See Appendix VI for a complete description of this task.) C-2: Appropriate beverage identification The appropriate beverage task is a "projective-like“ technique developed by Penrose (1978). This task was designed to find out if a child is aware of which beverages are appropriate for children or adults on various occasions. Children were shown an array of photographs of different types of beverages and then were shown drawings of adults and children in different situations. For each drawing depicting women and men, boys and girls, the child was asked what the person(s) in the drawing would like to drink. At the conclusion of the task children were asked to provide verbal labels for all of the photographed beverages they had not already named. (See Appendix VII for a complete descrip- tion of this task.) C-3: Alcohol concept task The final procedure assessed children's knowledge of the logical category "alcoholic beverage". The procedures 86 which were developed are based upon the work of Jahoda and Cramond (1972) and Santostefano (1978). Although children may be capable of naming an individual alcoholic drink, this ability does not imply that the child understands that each alcoholic drink falls into the larger, more general over- arching category of "alcoholic beverages“. The essential portion of this task examined whether each child could sort a group of eight beverage containers into smaller groups Of beverages that belong together. The desired outcome for this object sorting task was for the child to sort the beverage containers into two groups - alcoholic and non-alcoholic beverages. If the child did not sort the beverage containers on this basis, then the examiner did it for the child. The child was then asked the basis for the object sort (alcoholic vs. non-alcoholic) and a series of standardized questions regarding their knowledge of alcoholic beverages. (See Appendix VII for a complete description of this task.) 0. Measurement of General Developmental Status (espec- ially impulsivity, attention-span persistence) All children who participated in the project were assessed with the Revised Yale Developmental Inventory (YDI). This inventory was administered to the child by a qualified examiner (RBN) who knew the purpose of the study. The YDI is difficult to administer properly, so undergraduate volun- teers were not utilized. 87 The YDI was utilized to obtain extensive normative general developmental data on the children. These data provided a broad-based graphic of the child's general developmental status; they also permitted another assessment of the child's tempo as it impaired or enhanced his perfor- mance on the developmental assessment. Finally, the data could be compared to similar data that had been obtained in other major longitudinal studies (i.e., Study of Human Development, Fels Research Institute; Berkeley Growth Study, Institute of Human Development, University of California). The YDI is a clinically oriented assessment tool that can be used with children aged four weeks through six years. The inventory examines the child's development in five major areas: 1) gross motor, 2) fine motor, 3) adaptive, 4) lan- guage,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 quotient for the child. The YDI is primarily the Gesell Institute of Child Development Inventory (Gesell 8 Amatruda , 1958), along with selected supplementary items from the Merrill-Palmer, Stanford-Binet, Bayley, and the Hetzer-Wolf Baby Scales from the Vienna Test. The instrument was originally developed to be an extensive and comprehensive developmental inventory, taking items from other scales to increase the scope and depth of the assessment (Benedict, Note 1). It was chosen 88 over other potential early childhood developmental screening measures because of its scope and depth. Although administration of the YDI requires strict 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 and enjoyment can be optimized. This approach is in sharp contrast to other preschool assessment measures that require strict adherence to order of presentation as well as method of item presen- tation (ie. Stanford-Binet). The paucity of reliability and validity data on the YDI reflect this flexible approach; however, the flexibility generally permits a more comprehen- sive assessment. The YDI is typically used clinically, not as a research instrument; however, the YDI has been used in several studies. This work has used the YDI to assess: 1) effects of infantile institutionalization on the child's subsequent general development (Provence 8 Lipton, 1962), 2) effects of day care (Provence, Naylor 8 Patterson, 1977), 3) effects of an extensive intervention project with high-risk infants (Provence, 1980), and 4) assessment of cognitive and language development in a longitudinal study of 47,XXX females studied from birth to 6-14 years (Pennington, Puck, 8 Robinson, 1980). The YDI has also served as a frame of reference for 89 the development of other preschool assessment instruments. Ritter (1977) reports a concurrent validity coefficient of r = .86 between the personal /social scale of the YDI and the Preschool Attainment Record (Doll, 1966), and Krasner and Silverstein (1976) report a concurrent validity coeffic- ient between the YDI personal/social scale and the Vineland Social Maturity Scale (0011, 1953) of r = .97. Finally, a correlation between the Denver Developmental Screening Test (Frankenburg, Dodds, Fandal, Kazuk, 8 Cohrs, 1975) and the YDI of .97 was reported by Frankenberg and Dodds (1967). The YDI was administered to all children in the home during the morning. This minimized the stress for the child and should facilitate performance (Passman 8 Laut- mann, 1982). In addition, testing at home with both parents present enhanced the ecological validity of this assess- ment of the child's emerging competencies. The YDI permitted exploration of any standard developmental marker differences that existed between high-risk and control children; it was not utilized as a predictor of future intellectual function- ing, since longitudinal studies of mental abilities have clearly shown that early performance (under six years) has relatively little predictive validity for future cognitive abilities (Bayley, 1970). CHAPTER IV RESULTS Analyses The two groups were compared on the six sets of variables relevant to the target boys and the two sets of variables about parents' drinking, all previously described. Since the target children were recruited on a matched pair basis, these six indices were analyzed using a matched pair analysis of variance (BMD-PZV). Analyses of covariance (BMD-PZV) controlling for chrono- logical age, were conducted on the measures reported by parents and the developmental data to determine whether differences were significant when this factor was taken into account. Results obtained using analyses of variance and covariance were strikingly similar. The two parental self report indices were compared using one way analyses of variance (SPSS). Parent Measures General Each parent completed a SMAST and a DDH. These two self-report questionnaires provided data on current drinking patterns and problems experienced as a result of 90 91 drinking. All of these results are given in Table 8. Diagnosis of Alcoholism Based upon Research Diagnostic Criteria (Feighner et al., 1972; Table 1) for diagnosis of alcoholism, all of the alcoholic fathers were diagnosed as either definite or probable alcoholic, while none of the control fathers were diagnosed as alcoholic. Two of the wives of alcoholics were also diagnosed as being definite alcoholics; thus in two of the alcoholic families both parents were alcoholics. One of the control wives was diagnosed as a probable alcoholic. These diagnoses are based upon self-reported problems or consequences of drinking during the life of the target child, ie. approximately over the past four years. Alcoholism related signs reported before this period were not included in arriving at these tabulations. DrinkingAProblems The alcoholic fathers reported significantly more drinking related problems on the SMAST and on the measure of total number of drinking related problems from the DDH. Differences between wives of alcoholics and control wives were not significant for SMAST scores or total number of problems. The scores of control fathers were quite similar to the scores obtained by both groups of wives and all of these scores are indicative of nonproblem drinking. 92 Table 8 Alcoholic Diagnosis, Drinking Problem Scores, and Drinking Pattern Scores in Alcoholic Families And Community Control Families Alcoholic Community x2 Value] Families Control (N=9) Families (N=9) % with diagnosis of alcoholic during life of target child - fathers % probable 22% 0% <1.00 % probable + definite 100% 0% 37.98*** - mothers % probable 0% 11% <1.00 % probable + definite 22% 11% oo mu mmu FuumeFOcossu .<>ouwuquc< mcwm mmosm Fuucmaco—m>mo Fuuwmopococsu a: «M\\ \ - li a: om.u¢ 1\\\1 us a: u \\\\ _ . m \ J mu m: 3.2 ll. _ 83.18 u_.as so as . _ uu.me :mmu 1: 5.8 A u 8 .W a . i. m a . u a a a .. u U _ gm. . 0 U .1! . I m s _mwum em .s co.um _ 4.mm smum . , ..um ou.um . 1s~m .cmcu_csu suv _osusou use Amzv smug saw: cmmZumm mcomwsuceou svum cmsuuuz .cmmw>mm1xsoucm>cH Puucwanpw>mo mpu> co museum .N mszmwu 97 Table 9 Correlations1 Between Performance on YDI Indices and Risk Status Developmental age .76** Gross Motor .31 Fine Motor .82** Adaptability .76** Language .70** Personal/social .70** **p<.01 1 Note: Correlations were obtained with chronological age as a covariate using EWFTOR statistical procedures (Cohen 8 Cohen, 1975). 98 Table 10 Children's Ability to Verbally Label Substances Using Smell Alone for the Stimulus High risk Control F Value1 (N=9) (N=9) Smell Alone2 7 4.22 2.78 2.38 S.D. 1.79 2.17 Smell and Photographs R 4.38 4.13 <1.00 S.D. 1.18 1.25 1Based on univariate F-tests, all p's nonsignificant. 2Note: The children smelled nine different substances: Coffee, play doh, popcorn, beer, whiskey. wine, apple juice, tobacco, and perfume. 99 of these differences are significant. Data on alcoholic beverages alone show that while control and high risk boys did equally well in their overall ability to correctly label alcoholic beverages, the high risk boys did signifi- cantly better than control boys during the first trial (Task 1) of the assessment (ie. without any picture present; Figure 3). These findings are based upon giving children positive credit on alcoholic beverage identification even when they mislabeled the specific beverage (ie. called whiskey"beer”). Both groups of children made nearly equal numbers of errors (17 total; nine errors by controls and eight by high risk boys) and children rarely labeled any of the alcoholic beverages anything exceptits correct name or another alcoholic beverage. For individual subjects, six high risk boys (67%) succeeded at labeling alcoholic beverages correctly on Task 1, while only two control boys (22%) were successful (x2 = 3.83, p<.10, with Yates con- tinuity correction). When the substances were presented to the children along with photographs (Task 2) the control boys improved significantly. For individual subjects, eight high risk and seven control boys could correctly label at least one of the alcoholic beverages on either Task 1 or 2. Across both tasks for all trials of alcoholic beverages high risk boys correctly labeled alcoholic substances 44 percent of the time, control boys 31 percent of the time. It should % of children making 100 Figure 3 Children's Ability to Identify Alcoholic Beverages Using Smell]. High Risk vs. Controlsz. 100% 100%11 ‘ -——— ~100% 90 | 88% 41. 90 . * . C>/ No p1ctures i W1th pigtures 1,. 80 .. 75% 1 7 T 80 a. o 1» 7 » L'- / re : §' 50 F I Egg, 4 6O : g’ 3 1 z e 2 'U E 50 44 | HR 6 50 f; t; 1: 2— ‘5 3.5 8 4O - HR 1 f2: -w 40 ,3 o ,. U 30 25% | Z * 30 o\° 20 / I 7 -- 20 :j?, ,fii’ ac; -§>< 10 v- ? i g 10 ///,; j 7: Task 1 Task 2 1Children first attempted the smelling task (Task 1) without pictures. If a child could not correctly identify 1 alco- holic beverage plus 3 other smells, they attempted it again with photographs of the substances placed before them (Task 2). If a child succeeded with Task 1, the task ended. 2N=8 pairs. The youngest pair of children ages 32 and 31 months did not comprehend the task. *X2=4.25, p<.05. (x2 computed with Yates continuity correction). 101 be noted that within this sample chronological age and the ability to correctly label substances by smell alone were significantly correlated (r=.59, p<.005); of the three boys who were never able to correctly label any of the alcoholic beverages on either Task 1 or 2, all were under 33 months. Children were asked questions about the substances they had correctly identified from smell. The children not only could identify the substances, but could provide socially normative information about the substance. In response to "who uses these things?", Table 11 shows the children stated that adults more typically used both alcoholic beverages and adult substances, while children reported the generic substances (e.g. pop corn) were used by both adults and/or children. When asked "do you like (particular substance)?, they showed a clear preference for the generic substances, but generally reported they did not like the alcoholic beverages or the adult substances (Table 12). There were no differences between the high risk and control boys on either of the above two questions. B-2: Appropriate beverages task. In general both the high risk and the control boys selected alcoholic beverages significantly more often for pictures of adults (age effect) than they did for pictures of children (Table 13). Alcoholic beverages were selected for pictures of children 5 percent of the time and for pictures of adults 27 percent of the time. This analysis 102 Table 11 Childrens' Responses to the Question "Who Uses This Substance?"1 Who uses substance? Type Of Substance Adults Adults and/or only children Alcoholic beverages 84% 16% (Beer, wine, whiskey) x =4.47* Adult substances 68% 32% (goffee, tobacco, perfume) x =l.32 Generic substances 0% 100% (Blay doh, popcorn, apple juice x =18.01** 1Only children who successfully identified a substance by smell were asked this question about that substance. *p<.05, **p<.01. (x2 computed with Yates Continuity correction). 103 Table 12 Childrens' Responses to the Question "Do You Like/Dislike the Substance?"1 Type substance Like Dislike Alcoholic beverages 33% 67% ggeer, wine, whiskey) =l.03 Adult substances 32% 68% ( offee, tobacco, perfume) X5=1.48 Generic substances 100% 0% (play doh, popcorn, apple juice) x =16.02* 1Only children who successfully identified a substance by smell were asked this question about that substance. *p<.01. (X2 computed with Yates continuity correction). 104 Table 13 Appropriate Beverage Task: Comparison of Beverage Selections of High Risk and Control Boys (Risk Status) for Festive and Non-festive Occasions (Type of Occasion) Involving Pictures of Adults and Children (Age Effect).1 Source SS df MS F Total 2.019 56 A. Risk status .100 l .100 3.71* B. Type occasion .025 l .026 .63 C. Age effect 1.648 1 1.648 48.86** A x B .022 1 .022 1.06 A x C .011 l .011 .51 B x C» .030 l .030 1.41 A x B x C .003 l .003 .26 Error .180 49 .004 —_—_ *p<.10, **p<.OO3. 1Note: These data were analyzed using a matched pair analysis of variance design (N=8 pairs). One pair was not available for this analysis because the youngest matched pair of children (ages 31 and 32 months) did not understand the task and it was not administered. 105 also shows a risk status effect; high risk boys tended to select alcoholic beverages more often than control boys, but this difference only reached the 10 percent level of confidence. A second analysis of these data examined responses to pictures of adults alone (Table 14). Both groups of child- ren selected alcoholic beverages more often for pictures of men than women. Alcoholic beverages were selected as appropriate beverages 51 percent of the time for adult men and 22 percent of the time for adult women. Both risk status groups were similar on this task. There also were no differences on either of these analyses as a result of the type of occasion (festive/non-festive). Subsequent to completing the Appropriate Beverage Task children were asked to name or identify the photographs of the beverages. This provided an additional assessment of the Childrens' knowledge of alcoholic beverages vis Eivis their ability to recognize photographs of alcoholic beverages. Table 15 shows that while children were generally better at identifying the non-alcoholic beverages, beer was correctly identified as often as milk or soda. The risk groups did not differ on this task. B-3: Alcohol Concept Task Very few of the children were able to determine an appropriate verbal label for any of the groups of objects that they had been presented. Even fewer understood the 106 Table 14 Appropriate Beverage Task: Adult Pictures Only: Comparison of High Risk and Controls (Risk Status) for Festive and Non-festive Occasions (Type of Occasion) Involving Pictures of Adult Males and Females (Sex Effect)1. Source SS df MS F Total 2.136 56 A. Risk status .192 1 .192 2.18 B. Type occasion .000 l .000 .00 C. Sex effect 1.147 1 1.147 29.88** A x B .004 l .004 .06 A x C .074 1 .074 .29 B x C .038 l .038 1.03 A x B x C .010 1 .010 .11 Error .671 49 .014 **p<.001. 1Note: These data were analyzed using a matched pair analysis of variance design (N=8 pairs). One pair was not available for this analysis because the youngest matched pair of children (ages 31 and 32 months) did not understand the task and it was not administered. 107 Table 15 Children's Ability to Correctly Name or Identify Photographs of Alcoholic and Non-Alcoholic Beverages1 Alcoholic % of children Non-alcoholic % of children beverages who correctly beverages who correctly named or iden- named or iden- tified photograph tified photograph Beer 100% Coffee 94% Wine 59% Lemonade 88% Whiskey 41% Milk 100% Sherry 12% Orange Juice 94% Gin/Godka 47% Soda 100% 1These data are based upon N=l7. One high-risk child aged 32 months did not participate in this task. 108 concept of sorting objects into groups that belonged together. Regardless of their ability to sort objects or supply verbal labels to groups of objects, all of the children were asked if they had ever tasted any alcoholic beverages, who gave the beverage to them, and whether they planned to drink alcoholic beverages when they were adults. Many of the children reported trying alcoholic beverages (67%) and nearly all of these children reported that their fathers had given it to them (80%). Nearly all of the children reported they planned to drink as adults (89%), while all (100%) of the children reported they planned to use tools as adults. There were no differences between the risk groups. Parent Reports (A) Measurement of Temperament No differences were found in any of the data obtained with the Behavioral Style Questionnaire (BSQ). These data were analyzed using a matched pair design with chronological age as a covariate to test the three hypo- theses concerning mood, activity level, and attention-span persistence. A second analyses of these data using the same design, compared responses of parents on all of the nine temperament dimensions assessed by the BSQ, and again found no differences between parents in alcoholic or control families. A final analysis to determine whether high risk parents disagreed more than control parents on 109 their child's temperament also revealed no significant differences (see Table 16 for the means and standard devi- ations used in these analyses.) (B) Measure of Childhood Psychopathology No differences were found in any of the data obtained with the Child Behavior Checklist (CBCL). These data were analyzed using a matched pair design with chrono- logical age as a covariate. The first analysis compared scores of high risk to control boys on the 11 critical items (Table 7) selected from the CBCL as being indicative of high activity levels, negative mood, or impulsivity. A second analysis compared the groups on all of the CBCL factor scores. The final analysis of these data examined differences in reporting between alcoholic and control parents to determine if alcoholic parents disagreed more or less in their perceptions of their sons' than control parents. There were no significant differences in any of the above analyses (see Table 17 for the means and standard deviations used for these analyses). Ta Behavioral Style Ques Deviations for Hig 110 ble 16 tionnaire: Means and Standard h Risk Boys and Control Boys Hi Famil gh Risk Control ies (N=9) Families (N=9) F-Vaiud Fathers Mothers Fathers Mothers Activity level 7 3.70 S.D. .49 Mood 7 2.82 S.D. .51 Attention-span Persistence _ X 2.98 S.D. .67 —— 1Based upon balanced des 8 Frankmann, 1981) high 3.73 3.55 3.53 1.14 .51 .38 .56 3.38 2.93 3.01 <1.00 .80 .42 .56 3.13 3.02 2.70 <1.00 .63 .76 .77 igns analysis of variance (Coyle risk vs. control parents. 111 Table 17 Child Behavior Checklist: Means and Standard Deviations for High Risk Boys and Control Boys High Risk Control Fam111'es (N=9) Fami1les (N=9) F-Va1ue] Fathers Mothers Fathers Mothers Aggression XI .1.) O on \1 .n—I O m w 00 .89 11.44 <1.00 S.D. 4.30 8.65 5.11 4.36 Critical items XI \1 .78 7.20 5.89 7.56 <1.00 S.D. 3.77 4.58 3.37 3.32 Total problems 7 22.22 25.11 24.44 29.22 eou< ucwsmcmaswh mo mcowmcmewo m m A o m a m N F mpcoqmc cmgpmw . m m A o m a m N F museum; cmsoos . conga: _ ep_;u sate ;m_: mcwmccovpmmzo mpxum chow>mcmm .< umwpxomzu Low>mgmm v—wcu ucm mcwmzcowummzo m_zpm chow>mcmm mcu co cmcupwzu auspm com mmcoum 3mm xH xHozmaa< 257 o Focpcou nmgupme wsu m4 conga: ucoumm we» ucm upwzu xmwc gov: P .eene== 4.444; ago 44 League emcee ago meme; Am.mv Am.wv A~.Av Ao.ov Am.mv A4.4v AN.mV A4.NV A_._v eta 424aa vacuoae wee oo.m om.m om.m oo.m om.m mm.~ m4.m om.m mm.m Nw.m 04.4 om.~ mm.~ om.4 om.N oo.m om.~ .m.m Am.m ok.m o~.m mm.m mm.4 N4.N om.m No.m mm.m 4m.m O4.m ow._ 44.~ mm.4 om._ om.4 m~.m Ne.m we.m o_.4 om.m mm.N N4.4 ~4._ 4o.4 Am.m 4N.m 44.m om.m oe.~ om.m mN.4 Am.m O4.m mm.~ Fo.m 4m.~ oc.m om.N No.~ mm.m N4.N me.~ 44.m mm.m 4o.~ om.m O4.m 40.~ mm.~ oo.m oo.m F4.m 4G.N 4o.m om.m om.4 mm.m 44.4 mm.~ AN.m we.~ N4.m m4.4 om.4 O4.N mo.m mN.4 om._ mo.m NN.N m~.m m_.4 om.~ om._ m~.N mo.4 A..m 4o.~ Am._ A~.N 4m.m om.m om.m mm.N o_.4 me.~ om.m 44.m o_.4 4o.m om.4 ce.m om.m mN.4 om.~ om.~ 44.4 mN.4 N~.~ om.. om.m mm.m No.m me.m 40.4 __.m m~.m mm.m om.~ ON.N N4.N mm.4 mm._ om.m 44.~ wo.m 4m.m om.m oo.~ N4.~ om.4 mm.~ mm.m 44.N m4.m 40.4 om.4 om.~ m4.m mN.m me.~ om.~ 44.m 4m.m m4.4 o4.m oe.N ~4.m wo.m AP.N w_.m 4_.N 4m.4 .emmc;4 .oeatomwo .omwmema coo: .mcmp=H oaae< eo_3\aa< sneeze 4n4>woo4 mucoamc Logan; 1 mucoamc canoes . r-NMVLDSDNQO Fde-mtotxoocn conga: 4 e_weu nocpcou Aumscmocouv mcwmccowpmmao waum cho4>mcmm 258 4 4 04 N o N m N m m o 4 ON 4 o 4 m o 4 N N 4 4 o o N o 4 o 4 m 4 4 o o o 4 o 4 o o N m4 4 4 m N4 o m m 4 o o o o N m o 4 4 o 0 N4 o o N N N 4 m o 0 N4 o o m 4 4 N N o4 4 m o o m m o N 4 ucoqmc Legumw . m o w o o 4 o4 4 m m m o NN N o 4 m N 4 N N N o m o m m 4 N 4 o o o o o N 4 4 o o 44 4 4N m m 4 mN N 4 m 4 o m 4 N m 4 o 4 4 4 o 4 o o o o o o m 4 4 04 4 o N N o m N 44 o 04 o m m m 4 .mm 4 mecca .5443 cmsuo .cc44mo .mmwcmm< .N4zum xmm .44254 .mmmcamo o4pmsom oom 444> 44> 4> > >4 444 44 4 4cmnsac mucoqmc c44zu Nmmcoum zmm copumm cmsuoe u xm4c :44: 444440444 to4>agmm 44440 .4 259 .umxomgo msmp4 4o mazm mcm mmeoumN .4635:: m 4:0 4ocpcou nmguums msp m4 topaz: ccoomm 6:4 4:4 444su xm44 :44; 4 .44. 4:4 m4 44424: 44444 4:4 44443 44.44 44.44 4.44 44.44 4m.m4 4m.44 4N.m4 44.N4 44.44 eta mc4aa umeuoae 4:44 4 4 N o 4 4 m o m m o4 N m N o 4 o 4 4 w o o 04 o o m 4 o 4 4 4 N o o o o o 4 o o o 4 44 o 4 m m o o m 44 4 44 N o m 44 4 o 4 o o m 4 o N 4 o 4 m N o m o o o 4 4 o N N4 o 04 4 4 m N o 4 4 mucoamc cm5444 . m 4 o o o m m4 4 m m m o 04 4 o m m 4 N w 44 N 44 4 o 4 4 4 N 4 m 4 ON 4 o 4 m 4 m o 4 4 N4 o 4 4 m o o m m o m o o 4 N o N 4 4 o m4 N o m m o N m m4 o m N o 4 4 N o N m N m4 4 4 o m m .N4 4 mnocm .5443 tmcuo .cc44mo .mmm4444 .N4gum xmm .44554 .mmmcamo u4umeom uom 444> 44> 4> > >4 444 44 4 4cmnE:c mucoamc 444:0 cwguoe . 4ocpcou 44444444044 444446444 to4>aeam 444:4 APPENDIX X Revised Yale Developmental Inventory Examination and Observation Form 260 YALE CHILD STUDY CENTER CHILD DEVELOPMENT UNIT CSC # Name of Child Examiner Date(s) of Exam. EXAMINATION AND OBSERVATIONS 1. PERSONS ACCOMPANYING CHILD 2. GENERAL STATUS OF CHILD (relation to feeding, sleep, illness, injections, evidences of unusual apprehensiveness) 3. PHYSICAL DESCRIPTION (including handicaps) 4. ADJUSTMENT TO EXAMINATION (include initial adjustment; response to transitions, stress and/or fatigue; need for adaptation from examiner) 5. EYES AND VISION (movements, visual acuity, pupils, etc.) 6. HEARING (response to voice, other sounds -- designate) 261 7. OTHER PHYSICAL FINDINGS (when indicated -- reflexes, measurements, P.E., etc.) 8. MOTOR BEHAVIOR Gross Motor (quantitative, + co-ordination, gait, agility, modulation, etc.) Fine Motor (quantitative, + precision of grasp, manipulative skill, eye-hand co-ordination, tremor, etc.) Activity Characterization and Tonus (output, tempo, fluctuations) Abnormal or Unusual Motility Patterns (whirling, rocking, head nodding, tics, posturing, flicking, "hot cube" behavior, seizures, etc.) 9. Dominant Hand Foot Eye 262 10. ADAPTIVE BEHAVIOR Quantitative Reaction to Tasks (degree of interest, specific preferences; style of approach to different kinds of tasks, "appropriate" use of materials, possible situational reasons for failure on specific tasks) ll. LANGUAGE Quantitative (production and comprehension) 263 Disturbance of Quality (dysarthria, echolalia, stuttering, infantile speech, neologisms, etc.) Non-Verbal Communication of Requests (type and effectiveness) 12. PERSONAL - SOCIAL Quantitative Relationship to Examiner Interaction with Parent or Others in Room (e.g., does child turn to parent for assistance, protection, to share pleasure, with aggressivity, etc.?) 264 Auto-erotic and Auto-aggressive Behavior (describe type and context) l3. FEELING STATES AND EMOTIONS (how and when are states of comfort-discomfort, anxiety, anger, sadness, negativism, pleasure, excitement, etc., expressed. Describe the behavior from which feelings are inferred.) 14. COPING MECHANISMS (any behavior which appears to be a voluntary effort to cope with discomfort or other stress) 265 15. ESTIMATE OF VALIDITY OF TEST 16. EXAMINER'S IMPRESSION OF PARENTS 17. IMPRESSION AND FORMULATION REGARDING CHILD'S PROBLEM 18. 19. 266 RECOMMENDATIONS SALIENT FEATURES OF FINAL CONFERENCE WITH PARENTS LIST OF REFERENCES LIST OF REFERENCES Abel, E. Behavioral teratology of alcohol. Psychological Bulletin, l98l, 29, 564-581. Achenbach, T.M. Psychopathology of childhood. Journal of Consulting and Clinical Psychology, 1978a, E6, 759- 776. Achenbach, T. Research in developmental psychology: Concepts, strategies, methods. NY: FreeTPress, l978(b). Achenbach, T. The child behavior profile: 1. Boys aged 6-ll. Journal of Consulting and Clinical Psychology, l978c, 5g, 478-488. Achenbach, T. & Edelbrock, C. The classification of child psychopathology: A review and analysis of empirical efforts. Psychological Bulletin, 1978, §§, l275-l301. Achenbach, T. & Edelbrock, C. 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Psychopathology from a longitu- dinal perspective: Developmental aspects of alcoholism and drinking problems. Submitted to Child Development for publication. 533.198.9121”. ' 33819 MN Assam": , \ nxcwtcnw STATE UNIV. LIBRARIES iliiiiililliiliililllliilliiiliiliilillilil 312931.4702083