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Resilient Children of Parents Affected by a Dependency

Resilience: a specific concept with its own methodological implications

Resilient Children of Drug-dependent Parents

Four studies were identified on the development of children of drug-dependent parents which draw a distinction between problem-free or resilient children and maladjusted children. Unlike the previously cited studies on paternal alcoholism, the studies dealing with children of drug-dependent parents primarily focus on maternal drug use.

According to our research, Kumpfer et al. (1986) are likely the first investigators to have identified a property of resilience in the cognitive and behavioural skills of children of drug-dependent parents. However, their studies did not include groups of children whose parents did not use drugs, which does not allow for the derivation of authentic resilience factors from their findings.

A recent study conducted by Luthar, D'Avanzo and Hites (2003) compared children of drug-dependent mothers with children of mothers suffering from emotional problems such as anxiety or depression, as well as with children of mothers suffering from two types of problems at the same time (comorbidity). As in any comparative study, a control group was established which was composed of mothers who had no addictions or emotional problems but they were matched with the other groups in terms of socio-economic status and the age and sex of their children. Resilient children were defined as children of drug-dependent mothers who did not manifest externalizing problems such as aggressiveness, hyperactivity, or opposition - close to 70% of subjects - nor internalizing problems such as anxiety or depression - slightly more than 50% of subjects - or children who manifested a level of personal or social competence which was above average for their age group - approximately 35% of subjects.

In order to identify the variables likely to have a protective or compensatory effect with respect to maternal drug dependency, the groups composed of children of dependent or comorbid mothers were combined into a single group (children of drug-dependent mothers). The group of children of mothers without problems and the group of children of mothers with a single emotional problem were also combined into a single group (children of non-drug-dependent mothers). This highly questionable procedure was adopted as a result of the authors' fear of having insufficient statistical power despite the fact that their sample comprised 227 participants. As a result of this, their analysis overlooks the interactions between presumed resilience variables and maternal drug dependency (group of drug-dependent mothers and group of non-drug-dependent mothers). This regrettable choice makes it impossible to circumscribe resilience variables since, as we know, it would have been necessary to introduce significant interaction terms between maternal drug use and the presumed resilience factors. The authors preferred to directly determine which variables are associated with behavioural problems or with social competence in both the children of drug-dependent mothers and the children of non-drug-dependent mothers. They then proceeded to interpret significant links in the case of children of drug-dependent mothers, and non-significant links in the case of children of non-drug-dependent mothers, as indicators of resilience factors.

With regards to the attributes of children, the results of this study show that gender, age, intellectual quotient and the degree of tolerance of deviant behaviours are partial predictors of externalizing and internalizing problems and of social competency, but only in children of drug-dependent mothers. While derived from two evaluation sources (children and parents), these links are nonetheless weak and non-systematic. From the standpoint of maternal attributes, a lower level of perceived stress and better disciplinary and communication skills are associated with fewer problems and more social competence among children of drug-dependent mothers, but the same associations were equally true for children of non-drug-dependent mothers. Finally, in terms of community-related variables, neither affiliation with deviant peers, nor exposure to neighbourhood violence emerged as predictors of adjustment problems or social competence in children of drug-dependent mothers when the other predictive variables were taken into account. In short, the interest of this study lies in the fact that several variables were considered simultaneously, as is required with any multivariate model. More debatable, however, are the types of analyses used and the cross-sectional nature of the research design. For example, parental stress is shown to be of an important variable in explaining a large portion of behavioural problems in children, supplanting other variables of a personal or socio-familial nature. However, parental stress is predictive of behavioural problems in both children of drug-dependent mothers and children of non-drug-dependent mothers, which confers upon it a compensatory status. Moreover, the cross-sectional nature of the research design forces one to conclude that such a variable could well stem from the adjustment problems of children rather than constitute the cause of these problems. Again, it is not possible with a cross-sectional design to establish the directionality of associative links, much less their causal nature.

In their study, Johnson, Glassman, Files, and Rosen (1989) examined the development of 36 children born of drug-dependent mothers who were, at the time, participating in a methadone maintenance program. The comparison group was composed of 18 children born of non-drug-dependent mothers. Using cluster analysis, the children were, at age 3, divided into three groups on the basis of their results on a battery of tests evaluating their physical, cognitive and socio-emotional development. The best adjusted children, based on all measurements combined, were those in group 1 which, proportionally speaking, comprised of as many children of drug-dependent mothers as it did of children of non-dependent mothers (9 and 4 respectively). At the opposite end, group 3 was comprised primarily of children of drug-dependent mothers (17 out of 20). It is in group 3 that developmental delays were most prevalent for all measures at the age of 36 months. In group 2, which was comprised of 10 children of drug-dependent mothers and 11 children of non-dependent mothers, the children achieved an intermediate performance level when their development was measured.

In their analysis of resilience, the authors compared the 17 maladjusted children of drug-dependent mothers from group 3 with the 9 resilient children of drug-dependent mothers in group 1. Greater maternal sensitivity, lower levels of domestic violence and abuse distinguished the resilient children of drug-dependent mothers from their non-resilient counterparts. No measure of a socio-economic or medical nature established a distinction between the same two groups. These results demonstrate the protective (and possibly compensatory) role played by the socio-familial environment in the first years of life of children of drug-dependent mothers. The small number of participants in this study and the brief period of development examined impedes any firm conclusions with respect to resilience factors, particularly since the greater maternal sensitivity observed in drug-dependent mothers of resilient children may in fact be the result of their children's more "easy-going" personality rather than be its cause.

The study conducted by Moe (2002) is not specifically directed at resilient children of drug-dependent parents. However, it does shed light on the socio-familial variables which are conducive to healthy adjustment in children of drug-dependent parents. Moe (2002) followed a cohort of 64 children (including 27 girls) born of drug-dependent parents but raised in adoptive or foster homes from birth to the age of 4.5 years, at which time they underwent a series of neurocognitive and psychomotor evaluations. The biological mothers of the children of drug-dependent parents had, in the course of their pregnancies, used psychoactive substances ranging from valium or cannabis to opiates and amphetamines. Some of the mothers had also consumed alcohol and smoked cigarettes. The control group was comprised of 52 children (including 22 girls) born of non-drug-dependent mothers. At the age of 4.5 years, the children of drug-dependent parents who were raised in non-drug-dependent families presented "normal" scores on the neurocognitive and psychomotor scales (average score within one standard deviation of the mean established with respect to a normative group). These results are encouraging for what they reveal about the compensatory effects of a normal socio-familial environment on the children of drug-dependent parents. However, the scores of children of drug-dependent parents (boys in particular) were, on average, significantly lower than those of children of non-drug-dependent parents on several neurocognitive and psychomotor scales, particularly from the standpoint of visual-motor development and perceptual skills. These results indicate the limits of the compensatory or protective effect of a favourable postnatal environment on children of drug-dependent mothers. It is important to note that approximately 20% of infants of drug-dependent parents had a lower-than-average birth size and weight or had been born prematurely, which was not the case with any of the infants of non-drug-dependent parents. What is more, at age one, these children already presented, on average, mental and psychomotor delays in comparison to the children of non-drug-dependent mothers. A comparison with children of drug-dependent parents raised by their biological parents would have made it possible to specify the degree of compensation or protection which a "normal" environment can provide children of drug-dependent mothers. Subdividing the children of drug-dependent parents and the children of non-drug-dependent parents into groups of "resilients" (showing an above-average level of adjustment) and "non-resilients" (below average) would have shed more light on the compensatory or protective role of adoptive or foster families.

Resilient Children of Compulsive Gamblers

No studies could be identified that specifically dealt with resilient children of parents who are compulsive gamblers, other than the study currently underway which we mentioned earlier (Vitaro et al., 2002). The results of this study may provide greater insight into resilience factors.

Summary Table

• Resilient children are children who successfully adapt despite their exposure to risk factors. In epidemiological terms, resilient children correspond to false positive cases.
  
  
• Resilience factors are frequently confused with compensatory factors. The former imply an interaction with risk factors while the latter involve additive effects.
  
  
• Resilience factors, like protective factors, correspond to moderating factors. The role of moderating factors is to attenuate (or to exacerbate) the relationship between risk factors and subsequent adjustment problems. Consequently, they also include vulnerability factors.
  
  
• The role of compensatory factors is to increase the well-being and adaptation of individuals, not by weakening risk factors but by developing opposite strengths. Obviously, knowledge of compensatory factors can be as useful in preventive interventions as knowledge of resilience factors.
  
  
• Appropriate analysis of resilience factors requires:
  
  
  • the assurance that children presumed to be resilient are exposed to thesame risk factors as their non-resilient counterparts;
    
    
  • the presence of comparison groups composed of children not exposed to the risk factors;
    
    
  • longitudinal follow-up of children presumed to be at risk in order to identify those who go on to develop adjustment problems at various points in life, as well as those who do not develop such problems;
    
    
  • an evaluation of various areas of functioning in children at risk and others who are not at risk;
    
    
  • the additional presence of children with parents who have a problem other than alcoholism or drug-dependency, in order to establish the specificity of resilience factors; however, the criterion is less important than the preceding one.
  
  
• The twelve-odd studies on resilient children of alcohol dependent parents deal primarily with boys of alcohol-dependent fathers. A few of these studies were conducted in Quebec.
  
  
• However, the half-dozen studies of resilient children of drug-dependent parents are directed at children of drug-dependent mothers.
  
  
• Few studies meet all of the criteria of methodological rigour listed here. Conse-quently, the conclusions derived from these studies are equivocal at times and far from definitive.
  
  
• There are no studies on resilient children of compulsive gamblers.