Childhood Behavior Problems and Parental Drinking, Part 3

by National Institute of Health

(Page 4 of 4)

To facilitate data interpretation, the investigators modified the study design in several ways, as follows: They determined the subjects' family histories of alcohol problems, defined as having a father with alcohol problems, prior to the study and used this information as a criterion for subject selection. They quantified stress-induced drinking for each subject using a withinsubject design rather than the between-subject design employed in previous investigations. Thus, rather than comparing subjects who had interacted with a deviant child with subjects who had interacted with a normal child, the investigators had each subject participate in two laboratory sessions 1 week apart. In one session, the subject interacted with a deviant child and in the other session she interacted with a normal child. They measured the subjects' heart rate and blood pressure during their interactions with the children in order to obtain physiological information about subjects' stress levels. They administered numerous tests in order to identify dispositional characteristics, such as psychopathology, personality, coping, attributional style, alcohol expectancies, life events, family functioning, and drinking history, which might influence the subjects' response in addition to the family history of alcohol problems.

The results of the study confirmed the previous findings on the effects of child behavior on parental stress levels that were obtained from college students and parents of normal children. After interacting with the deviant children, the mothers of ADHD children showed greater physiological distress (significantly increased heart rate and blood pressure) than after interacting with the normal children. These mothers also showed greater subjective distress (increased negative affect; decreased positive affect; and increased self-ratings of unpleasantness, unsuccessfulness, and ineffectiveness). Furthermore, the mothers consumed approximately 20 percent more alcohol after interacting with the deviant children than after interacting with the normal children.

These findings clearly demonstrate that interactions with ADHD children engender large stress responses from their mothers in multiple domains. Furthermore, the mothers in this study as a group coped with this distress by drinking more alcohol. Contrary to the family history analysis in the previous study, however, the subject's paternal history of alcohol problems (selected in advance) did not affect alcohol consumption in this larger sample.

To further clarify the results of the study among mothers of ADHD children, the researchers also evaluated the mothers' dispositional characteristics before their interactions with the children to identify potential associations with their stress-induced drinking. The investigators correlated these measures with the amount of alcohol the mothers consumed after interacting with a deviant child (stress-induced drinking), controlling for the amount of alcohol consumed after the interaction with the normal child. These analyses identified numerous factors associated with higher levels of stress-induced drinking, including the following: Higher levels of routine drinking (a greater number of drinks per drinking occasion). More negative consequences of drinking. Higher levels of drinking problems. A denser family history of alcohol problems (alcoholic relatives in addition to the father). Maternal history of drinking problems. Higher self-ratings of using maladaptive coping strategies, feeling depressed, and experiencing more daily life stressors.

Although many mothers of ADHD children showed elevated drinking levels in response to interacting with a deviant child, a substantial number of mothers decreased their alcohol consumption after such interactions. This pattern of divergent responses is comparable to the one observed among mothers of ADHD children in the earlier study by Pelham and colleagues and points to the need for more fine-grained analysis.

The individual differences in coping with deviant child behavior noted in both studies suggest that alcohol consumption in mothers of ADHD children is a complex phenomenon. Clearly, some mothers resort to maladaptive coping mechanisms (drinking) in response to the stress of dealing with their child. Such a dysfunctional coping response often can be predicted by the mothers' general coping styles. Other mothers, however, cope in a problem-solving fashion by decreasing their alcohol consumption when anticipating another interaction with the deviant child, apparently believing that drinking would decrease their effectiveness in interacting with that child.

Whereas a paternal history of alcohol problems did not predict stress-induced drinking in the mothers of ADHD children, a maternal history of alcohol problems and the frequency of alcohol problems in other first-degree relatives did predict stress-induced drinking. These findings suggest that in addition to, or instead of, paternal alcohol problems, researchers should consider maternal drinking history and family density of drinking when assessing the influence of family history on female drinking behavior.

The study on the mothers of ADHD children, as well as all the other studies in this series, was conducted in an "artificial" laboratory setting. The fact that subjects' self-reported drinking levels (number of drinks per occasion) and self-reported alcohol problems correlated highly with stress-induced drinking measured in this setting confirms that this type of investigation can generate information that reflects real-life behavior.1 Thus, the laboratory findings provide strong support for the hypothesis that among mothers of ADHD children, routine drinking and drinking problems are at least in part a response to the daily stress of coping with their children.

Conclusions

A recent review of the relationship between AOD abuse and parenting concluded that huge gaps exist in understanding the association between parental alcohol abuse and parent-child relationships. For example, more information is needed regarding the effects of alcohol on parenting behaviors (overly punitive discipline) that are known to affect child development. Lang and colleagues recently demonstrated in a laboratory setting that alcohol negatively influences parenting behaviors (lax monitoring) that mediate the development of conduct problems in children. This finding confirms the parentto- child influence on the relationship between parental alcohol problems and externalizing behavior problems in children. Conversely, the studies described in this article strongly support the assumption that the deviant child behaviors that represent major chronic interpersonal stressors for parents of ADHD children are associated with increased parental alcohol consumption, thereby confirming a child- to-parent influence on the same relationship.

Childhood externalizing disorders affect approximately 7.5 to 10 percent of all children, with a considerably higher incidence among boys. The association between childhood behavior disorders and parental alcohol problems means that many adults with drinking problems are parents of children with behavior problems. Moreover, the study by Pelham and colleagues involving parents of normal children has demonstrated that parenting hassles may result in increased alcohol consumption even in normal families. Together, the results described in this article indicate that the stress associated with parenting and its influence on parental alcohol consumption should occupy a salient position among the variables that are examined in the study of stress and alcohol problems.

About the Author

NIH is the nation's medical research agency - making important medical discoveries that improve health and save lives. The National Institutes of Health (NIH), a part of the U.S. Department of Health and Human Services, is the primary Federal agency for conducting and supporting medical research.