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Defining risk heterogeneity for internalizing symptoms among children of alcoholic parents

  • Andrea M. Hussong (a1), David B. Flora (a2), Patrick J. Curran (a1), Laurie A. Chassin (a3) and Robert A. Zucker (a4)...


Adopting a developmental epidemiology perspective, the current study examines sources of risk heterogeneity for internalizing symptomatology among children of alcoholic parents (COAs). Parent-based factors, including comorbid diagnoses and the number of alcoholic parents in the family, as well as child-based factors, namely child gender, formed the indicators of heterogeneity. Following a novel approach to cross-study methods, we present a three-stage analysis involving measurement development using item response theory, examination of study effects on latent trajectories over time using latent curve modeling, and prediction of these latent trajectories testing our theoretically derived hypotheses in two longitudinal investigations across both mother- and self-reported symptomatology. Specifically, we replicated previous findings that parent alcoholism has a unique effect on child internalizing symptoms, above and beyond those of both parent depression and antisocial personality disorder. However, we also found important subgroup differences, explaining heterogeneity within COAs' risk profile in terms of the number of alcoholic parents in the family, comorbid diagnoses for the alcoholic parent and, for self-reported symptoms, child gender. Such factors serve to refine the definition of risk among COAs, suggesting a more severely impaired target group for preventive interventions, identifying the significance of familial alcoholism in individual differences underlying internalizing symptoms over time, and further specifying the distal risk matrix for an internalizing pathway to alcohol involvement.


Corresponding author

Address correspondence and reprint requests to: Andrea Hussong, CB#3270 Davie Hall, University of North Carolina, Chapel Hill, Chapel Hill, NC 27599-3270; E-mail:


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This work was supported by Grants R01 DA15398 (to A.M.H.), R37 AA 07065 (to R.A.Z.), R01 AA16213 (to L.A.C.), and R01 DA13148 (to P.J.C.). We thank the Centre for Addictions Research in British Columbia at the University of Victoria and the Reynolds Competitive Study Leave program for their support, and we acknowledge the contributions of Michael Edwards, R. J. Wirth, and Daniel Serrano.



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Achenbach, T., & Edelbrock, C. (1981). The classification of child psychopathology: A review and analysis of empirical efforts. Psychological Bulletn, 85, 12751301.
Andreasen, N. C., Endicott, J., Spitzer, R. L., & Winokur, G. (1977). The family history method using diagnostic criteria. Reliability and validity. Archives of General Psychiatry, 34, 12291235.
Angold, A., & Costello, E. (2001). The epidemiology of disorders of conduct: Nosological issues and comorbidity. In Maughan, B. & Hill, J. (Eds.), Conduct disorders in childhood and adolescence (pp. 126168). New York: Cambridge University Press.
Angold, A., Erkanli, A., Loeber, R., Costello, E.J., Van Kammen, W., & Stouthamer-Loeber, M. (1996). Disappearing depression in a population sample of boys. Journal of Emotional and Behavioral Disorders, 4, 95104.
Arbuckle, J. (1996). Full information estimation in the presence of incomplete data. In Marcoulides, G. & Schumacker, R. (Eds.), Advanced structural equation modeling: Issues and techniques (pp. 243277). Mahwah, NJ: Erlbaum.
Babor, T. F. (1996). The classification of alcoholics: Typology theories from the 19th century to the present. Alcohol Health and Research World, 20, 617.
Benjamini, Y., & Hochberg, Y. (1995). Controlling the false discovery rate: A practical and powerful approach to multiple testing. Journal of the Royal Statistical Society, Series B, 57, 289300.
Berlin, J. A., Santanna, J., Schmid, C. H., Szczech, L. A., & Feldman, H. I. (2002). Individual patient- versus group-level data meta-regressions for the investigation of treatment effect modifiers: Ecological bias rears its ugly head. Statistics in Medicine, 21, 371387.
Biesanz, J. C., Deeb-Sossa, N., Aubrecht, A. M., Bollen, K. A., & Curran, P. J. (2004). The role of coding time in estimating and interpreting growth curve models. Psychological Methods, 9, 3052.
Bingham, C. R., Fitzgerald, W. W., Fitzgerald, H. E., & Zucker, R. A. (1996). Prenatal history, parental alcoholism, and the development of preschool aged sons of alcoholics (Abstract). Alcoholism: Clinical and Experimental Research, 20, 469.
Bollen, K. A., & Curran, P. J. (2006). Latent curve models: A structural equation approach. New York: Wiley.
Boye-Beaman, J., Leonard, K. E., & Senchak, M. (1991). Assortative mating, relationship development, and intimacy among offspring of alcoholics. Family Dynamics of Addiction Quarterly, 1, 2033.
Boyle, M. H., & Pickles, A. (1997). Maternal depressive symptoms and ratings of emotional disorder symptoms in children and adolescents. Journal of Child Psychology and Psychiatry, 38, 981992.
Cairns, R. B., & Cairns, B. D. (1994). Lifelines and risks: Pathways of youth in our time: New York: Cambridge University Press.
Carrig, M., Wirth, R. J., & Curran, P. J. (2004). A SAS macro for estimating and visualizing individual growth curves. Structural Equation Modeling: An Interdisciplinary Journal, 11, 132149.
Caspi, A., Moffitt, T. E., Newman, D. L., & Silva, P. A. (1996). Behavioral observations at age 3 years predict adult psychiatric disorders: Longitudinal evidence from a birth cohort. Archives of General Psychiatry, 53, 10331039.
Chassin, L., Barrera, Jr. M., Bech, K., & Kossak-Fuller, J. (1992). Recruiting a community sample of adolescent children of alcoholics: A comparison of three subject sources. Journal of Studies on Alcohol, 53, 316319.
Chassin, L., Pillow, D. R., Curran, P. J., & Molina, B. S. (1993). Relation of parental alcoholism to early adolescent substance use: A test of three mediating mechanisms. Journal of Abnormal Psychology, 102, 319.
Chassin, L., Pitts, S. C., DeLucia, C., & Todd, M. (1999). A longitudinal study of children of alcoholics: Predicting young adult substance use disorders, anxiety, and depression. Journal of Abnormal Psychology, 108, 106119.
Chassin, L., Rogosch, F., & Barrera, M. (1991). Substance use and symptomatology among adolescent children of alcoholics. Journal of Abnormal Psychology, 100, 449463.
Cohen, J., Cohen, P., West, S. J., & Aiken, L. S. (2003). Applied multiple regression/correlation analysis for the behavioral sciences. Mahwah, NJ: Erlbaum.
Compas, B. E., Oppedisano, G., Connor, J. K., Gerhardt, C. A., Hinden, B. R., & Achenbach, T. M. (1997). Gender differences in depressive symptoms in adolescence: Comparison of national samples of clinically referred and nonreferred youths. Journal of Consulting & Clinical Psychology, 65, 617626.
Costello, E. J., & Angold, A. (2006). Development and epidemiology. In Cicchetti, D. & Cohen, D. J. (Eds.), Developmental psychopathology: Vol. 1. Theory and method (2nd ed., pp. 4175). Hoboken, NJ: Wiley.
Costello, E., Mustillo, S., Erkanli, A., Keeler, G., & Angold, A. (2003). Prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry, 60, 837844.
Curran, P. J., & Chassin, L. (1996). A longitudinal study of parenting as a protective factor for children of alcoholics. Journal of Studies on Alcohol, 57, 305313.
Curran, P. J., Edwards, M. C., Wirth, R. J., Hussong, A. M., & Chassin, L. (2007). The incorporation of categorical measurement models in the analysis of individual growth. In Little, T., Bovaird, J., & Card, N. (Eds.), Modeling in ecological and contextual effects in longitudinal studies of human development (pp. 89120). Mahwah, NJ: Erlbaum.
Davis, B., Sheeber, L., & Hops, H. (2002). Coercive family processes and adolescent depression. In Patterson, G. R. & Reid, J. B. (Eds.), Antisocial behavior in children and adolescents: A developmental analysis and model for intervention (pp. 173192). Washington, DC: American Psychological Association.
DuRocher, T. D., & Cummings, E. M. (2006). Parental dysphoria and children's internalizing symptoms: Marital conflict styles as mediators of risk. Child Development, 74, 16631681.
Edwards, E. P., Leonard, K. E., & Eiden, R. D. (2001). Temperament and behavioral problems among infants in alcoholic families. Infant Mental Health Journal, 22, 374392.
Embretson, S. E., & Reise, S. P. (2000). Item response theory for psychologists. Mahwah, NJ: Erlbaum.
Feighner, J. P., Robins, E., Guze, S. B., Woodruff, R. A., Winokur, G., & Munoz, R. (1972). Diagnostic criteria for use in psychiatric research. Archives of General Psychiatry, 26, 5763.
Fitzgerald, H. E., Sullivan, L. A., Ham, H. P., Zucker, R. A., Bruckel, S., Schneider, A. M., et al. (1993). Predictors of behavior problems in three-year-old sons of alcoholics: Early evidence for the onset of risk. Child Development, 64, 110123.
Fitzgerald, H. E., Zucker, R. A., & Yang, H. Y. (1995). Developmental systems theory and alcoholism: Analyzing patterns of variation in high-risk families. Psychology of Addictive Behaviors, 9, 822.
Ge, X., Lorenz, F. L., Conger, R. D., Elder, G. H., & Simons, R. L. (1994). Trajectories of stressful life events and depressive symptoms during adolescence. Developmental Psychology, 30, 467483.
Graber, J. (2004). Internalizing problems during adolescence. In Lerner, R. M. & Steinberg, L. (Eds.), Handbook of adolescent psychology (pp. 587626). Hoboken, NJ: Wiley.
Grant, B. F., Dawson, D. A., Stinson, F. S., Chou, S., Dufour, M. C., & Pickering, R. P. (2004). The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991–1992 and 2001–2002. Drug and Alcohol Dependence, 74, 223234.
Hussong, A. M., & Chassin, L. (2004). Stress and coping among children of alcoholic parents through the young adult transition. Development and Psychopathology, 16, 9851006.
Hussong, A. M., Zucker, R. A., Wong, M. M., Fitzgerald, H. E., & Puttler, L. I. (2005). Social competence in children of alcoholic parents over time. Developmental Psychology, 41, 747759.
Jacob, T., & Leonard, K. (1986). Psychosocial functioning in children of alcoholic fathers, depressed fathers and control fathers. Journal of Studies on Alcohol, 47, 373380.
Jansen, R. E., Fitzgerald, H. E., Ham, H. P., & Zucker, R. A. (1995). Pathways into risk: Temperament and behavior problems in three- to five- year old sons of alcoholics. Alcoholism: Clinical and Experimental Research, 25, 835843.
Kaslow, N. J., Deering, C. G., & Racusin, G. R. (1994). Depressed children and their families. Clinical Psychology Review, 14, 3959.
Kellam, S. G., Ensminger, M. E., & Simon, M. B. (1980). Mental health in first grade and teenage drug, alcohol and cigarette use. Drug and Alcohol Dependence, 5, 273304.
Kendler, K. S., Neale, M. C., Heath, A. C., Kessler, R. C., & Eaves, L. J. (1994). A twin-family study of alcoholism in women. American Journal of Psychiatry, 15, 707715.
Kendler, K. S., Prescott, C. A., Myers, J., & Neale, M. C. (2003). The structure of genetic and environmental risk factors for common psychiatric and substance use disorders in men and women. Archives of General Psychiatry, 60, 929937.
Khoo, S. T., West, S. G., Wu, W., & Kwok, O. M. (2006). Longitudinal methods. In Eid, M. & Diener, E. (Eds.), Handbook of multimethod measurement in psychology. (pp. 301317). Washington, DC: American Psychological Association.
Kim, H. K., Capaldi, D. M., & Stoolmiller, M. (2003). Depressive symptoms across adolescence and young adulthood in men: Predictions from parental and contextual risk factors. Development and Psychopathology, 15, 469495.
Kosten, T. A., Anton, S. F., & Rounsaville, B. J. (1992). Ascertaining psychiatric diagnoses with the family history method in a substance-abuse population. Journal of Psychiatric Research, 26, 135147.
Loukas, A., Piejak, L. A., Bingham, C. R., Fitzgerald, H. E., & Zucker, R. A. (2001). Parental distress as a mediator of problem behaviors in sons of alcohol-involved families. Family Relations, 50, 293301.
Loukas, A., Zucker, R. A., Fitzgerald, H. E., & Krull, J. L. (2003). Developmental trajectories of disruptive behavior problems among sons of alcoholics: Effects of parent psychopathology, family conflict, and child undercontrol. Journal of Abnormal Psychology, 112, 119131.
Maes, H. H. M., Neale, M. C., Kendler, K. S., Hewitt, J. K., Silberg, J. L., Foley, D. L., et al. (1998). Assortative mating for major psychiatric diagnoses in two population-based samples. Psychological Medicine, 28, 13891401.
Mayfield, D., McLeod, G., & Hall, P. (1974). The CAGE questionnaire: validation of a new alcoholism screening instrument. American Journal of Psychiatry, 131, 11211123.
McArdle, J. J. (1988). Dynamic but structural equation modeling of repeated measures data. In Cattell, R. B. & Nesselroade, J. R. (Eds.), Handbook of multivariate experimental psychology (2nd ed., pp. 561614). New York: Plenum Press.
McArdle, J. J., & Horn, J. L. (2002). The benefits and limitations of mega-analysis with illustrations for the WAIS. Paper presented at the International Meeting of CODATA, Montreal.
Mehta, P. D., & West, S. G. (2000). Putting the individual back into individual growth curves. Psychological Methods, 5, 2343.
Merikangas, K. R., Leckman, J. F., Prusoff, B. A., Pauls, D. L., & Weissman, M. M. (1985). Familial transmission of depression and alcoholism. Archives of General Psychiatry, 42, 367372.
Muthén, L. K., & Muthén, B. O. (2004). Mplus user's guide. New York: Author.
Muthén, B. O., & Satorra, A. (1995). Complex sample data in structural equation modeling. In Marsden, P. (Ed.), Sociological methodology (pp. 267316). Washington, DC: American Sociological Association.
Noll, R. B., Zucker, R. A., Fitzgerald, H. E., & Curtis, W. J. (1992). Cognitive and motoric functioning of sons of alcoholic fathers and controls: The early childhood years. Developmental Psychology, 28, 665675.
Preisig, M., Fenton, B. T., Stevens, D. E., & Merikangas, K. R. (2001). Familial relationship between mood disorders and alcoholism. Comprehensive Psychiatry, 42, 8795.
Puttler, L. I., Zucker, R. A., Fitzgerald, H. E., & Bingham, C. (1998). Behavioral outcomes among children of alcoholics during the early and middle childhood years: Familial subtype variations. Alcoholism: Clinical and Experimental Research, 22, 19621972.
Robins, L. N., Helzer, J. E., Croughan, J., & Ratcliff, K. S. (1980). The NIMH Diagnostic Interview Schedule: Its history, characteristics and validity. St. Louis, MO: Washington University School of Medicine.
Selzer, M. L., Vinokur, A., & van Rooijan, L. (1975). A self-administered short Michigan Alcoholism Screening Test (SMAST). Journal of Studies on Alcohol, 36, 117126.
Sher, K. J. (1993). Children of alcoholics: A critical appraisal of theory and research. Psychology of Addictive Behaviors, 7, 201202.
Sokol, R. J., & Claren, S. K. (1989). Guidelines for use of terminology describing the impact of prenatal alcohol on the offspring. Alcoholism: Clinical and Experimental Research, 13, 597598.
Thissen, D. (1991). MULTILOG user's guide: Multiple, categorical item analysis and test scoring using item response theory [Computer Software]. Chicago: Scientific Software.
Thissen, D. (2001). IRTLRDIF v. 2.01b: Software for the computation of the statistics involved in item response theory likelihood-ratio tests for differential item functioning [Software]. Chapel Hill, NC: L.L. Thurstone Psychometric Laboratory.
Thissen, D., & Orlando, M. (2001). Item response theory for items scored in two categories. In Wainer, H. & Thissen, D. (Eds.), Test scoring (pp. 73140). Mahwah, NJ: Erlbaum.
Thissen, D., Steinberg, L., & Wainer, H. (1993). Detection of differential item functioning using the parameters of item response models. In Wainer, H. & Holland, P. (Eds.), Differential item functioning (pp. 67113). Hillsdale, NJ: Erlbaum.
Tubman, J. G. (1993). Family risk-factors, parental alcohol-use, and problem behaviors among school-age-children. Family Relations, 42, 8186.
Twenge, J. M., & Nolen-Hoeksema, S. (2002). Age, gender, race, SES, and birth cohort differences on the Children's Depression Inventory: A meta-analysis. Journal of Abnormal Psychology, 111, 578588.
Werner, E. E. (1986). Resilient offspring of alcoholics: A longitudinal study from birth to age 18. Journal of Studies on Alcohol, 47, 3440.
Wichstrom, L. (1999). The emergence of gender difference in depressed mood during adolescence: The role of intensified gender socialization. Developmental Psychology, 35, 232245.
Wingersky, M. S., & Lord, F. M. (1984). An investigation of methods for reducing sampling error in certain IRT procedures. Applied Psychological Measurement, 8, 347364.
Wong, M., Zucker, R., Puttler, L., & Fitzgerald, H. (1999). Heterogeneity of risk aggregation for alcohol problems between early and middle childhood: Nesting structure variations. Development and Psychopathology, 11, 727744.
Zimmerman, M., Coryell, W., Pfohl, B., & Stangl, D. (1988). The reliability of the family history method for psychiatric diagnoses. Archives of General Psychiatry, 45, 320322.
Zucker, R. A. (2006). Alcohol use and alcohol use disorders: A developmental–biopsychosocial systems formulation covering the life course. In Cicchetti, D. & Cohen, D. J. (Eds.), Developmental psychopathology: Vol. 3. Risk, disorder and adaptation (2nd ed., pp. 620656). Hoboken, NJ: Wiley.
Zucker, R. A., Chermack, S. T., & Curran, G. M. (2000). Alcoholism: A lifespan of etiology and course. In Sameroff, A., Lewis, M., & Miller, S. (Eds.), Handbook of developmental psychopathology (2nd ed., pp. 569587). New York: Plenum Press.
Zucker, R. A., Ellis, D. A., Bingham, C. R., & Fitzgerald, H. E. (1996). The development of alcoholic subtypes: Risk variation among alcoholic families during the early childhood years. Alcohol Health and Research World, 20, 4655.
Zucker, R. A., Ellis, D. A., Fitzgerald, H. E., Bingham, C. R., & Sanford, K. (1996). Other evidence for at least two alcoholisms, II: Life course variation in antisociality and heterogeneity of alcoholic outcome. Development and Psychopathology, 8, 831838.
Zucker, R. A., Fitzgerald, H., & Noll, R. B. (1990). Drinking and drug history (rev. ed., version 4). Unpublished manuscript.
Zucker, R. A., Fitzgerald, H. E., Refior, S. K., Puttler, L. I., Pallas, D. M., & Ellis, D. A. (2000). The clinical and social ecology of childhood for children of alcoholics: Description of a study and implications for a differentiated social policy. In Fitzgerald, H. E., Lester, B. M., & Zuckerman, B. S. (Eds.), Children of addiction: Research, health and policy issues (pp. 174222). New York: Garland Press.


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