The effect of parental alcohol and drug abuse on children's future psychiatric disorders: modes of influence

There is irrefutable evidence for the fact that children of alcohol and substance abusing parents (ASAP) suffer a long range of mental health problems. Identifying potential adverse effects of ASAP on children's development is important for variety of rea sons, including legitimating societal restrictions on alcohol and substance use, and to inform preventive efforts. However, to what extent do these statistical associations convey actual causality? There are three possible interpretations of these results : (1) Causation, viz. ASAP is causing psychosocial problems in the child; (2) Reversed order of cause and effect, viz. the child's problems causes (increased) ASAP; and (3) Spurious effects, viz. a 3rd variable is causing both ASAP and child problems. We propose a theoretical model and a corresponding research design that allows for a comparison between these three explanations: (1) ASAP may lead to distortions in parent-child interactions that in turn may foster children with insecure/disorganized attach ment. Insecure attachment may increase the risk of future psychopathology as may deviant parent-child interactions, even when contextual factors and child characteristic are controlled. (2) Children's psychiatric disorders and problems, disruptive ones in particular, may increase parental stress and thereby increase alcohol and drug use in parents. (3). Potential 3rd variables need to be controlled, most notably children's temperament and language skills, prenatal alcohol and drug exposure, parental psych opathology. These competing hypotheses have not been previously contrasted with any conclusiveness. We intend to remedy this situation by carrying out a 2-wave study on 1000 4-year olds, their parents and their day-care personnel/teachers. After screeni ng for mental health problems (with oversampling of children with problems) parents are interviewed with a structured diagnostic interview. The parent and the child then meet at NTNU for observation and testing.