Resilient Children of Parents Affected by a Dependency

Implications in the areas of prevention and social policies

This section identifies some of the lessons learned from the studies on resilience concerning prevention and social policies. Since resilience, protection and compensatory factors seem to be the same for resilient children of alcohol- or drug-dependent parents and as for other categories of resilient children, an overview of promotion and prevention program principles and strategies found to have been effective with vulnerable children has been provided. This is followed by a description of a few prevention programs specific to children of dependent parents.

Effective Preventive Intervention Targets and Strategies

In relation to personal and social skills likely to promote resilience in children who have a parent in difficulty, Werner (1999) proposes the following objectives, which integrate or refine the suggestions formulated earlier:

• provide youth with prosocial models within their communities;
• mobilize adults who are likely to help youth develop their talents;
• involve youth in supervised community, cultural and athletic activities;
• foster an optimistic vision of the future and knowledge of cultural roots;
• promote humour as a means of dealing with difficulties of life;
• provide individualized support (tutors or mentors) in the various areas of development.

For their part, Rolf and Johnson (1999), attribute the following characteristics to effective prevention and promotion programs:

• they ensure that community agencies are involved in prevention efforts;
• they broaden or use community organizations in efforts to provide assistance to youth with adjustment problems;
• they coordinate prevention activities both within and outside the school setting;
• they establish structured programs designed to improve personal and social skills (see Vitario and Gagnon, 2000);
• they use the media as a means of building and promoting community support;
• they facilitate in connecting youth in difficulty with potential employers;
• they help to connect youth in difficulty with peer leaders in the community;
• they mobilize parents and other responsible adults;
• they seek to intervene, as early as possible, in situations involving children in difficulty;
• they provide consistent support to prevention program promoters through an ongoing process of strategy renewal designed to ensure maximum effectiveness, as well as theoretical coherence;
• they ensure that prevention principles and strategies reflect all relevant cultural paradigms.
  

Specific Prevention Experiences with Children of Alcohol- and Drug-dependent Parents

Few properly assessed prevention programs are directed specifically at children of alcohol- or drug-dependent parents. To our knowledge, there are no programs for children of compulsive gamblers.

Kumpfer and her partners (De Marsh and Kumpfer, 1986; Kumpfer and De Marsh, 1986; Kumpfer, Molgaard and Spoth, 1996) have developed a program which targets children and families in which one of the parents is alcohol- or drug-dependent. This program, known as the "Strengthening Families Program" or SFP, is designed exclusively for families with one child or more between the ages of 6 and 12 years. Although it targets families in which one of the parents has a drinking problem, the program's approach is not particularly unique, being based on existing programs aimed at various categories of vulnerable children (see Vitaro and Gagnon, 2000). In order to evaluate the SFP, Kumpfer et al., randomly distributed the families into three groups. The families in the first group took part in 14 sessions designed to improve parenting skills, based on the Patterson method (1975, 1976). Families in the second group also took part in the 14 sessions but their children took part in workshops intended to improve problem-solving skills, based on the technique developed by Shure and Spivack (1982). In addition to the activities performed by the first two groups, the families in the third group also took part in 14 sessions designed to improve their parenting skills, based on the Guerney method (1977). The analysis revealed that the families in the third group achieved the best results in terms of improving children's skills and reducing their behavioural problems; parenting skills were enhanced and family functioning and the home atmosphere improved. A reduction in tobacco and alcohol use in older children was also noted, while younger children seemed less drawn to these substances. Finally, the parents also reduced their use of these substances and had a better opinion of their parenting skills.

The SFP was evaluated from a socio-cultural standpoint with several vulnerable clienteles (see Kumpfer et al., 1996). A Quebec version of the program has been used with families which have a parent with an alcohol dependency in treatment (Beaudoin, 1996).

There are two other targeted programs for children and families in which there is an alcohol-dependent parent. The first of these, the Michigan State University Multiple Risk Outreach Program (Maguin, Zucker and Fitzgerald, 1994; Nye, Zucker and Fitzgerald, 1995), targets families with children between the ages of 3 and 6 years whose fathers have been convicted of impaired driving. Recognizing the elevated risk for children with alcohol-dependent fathers in developing behavioural problems which are, in turn, precursors of adolescent dependency, the goal of this program is to reduce behavioural problems in children by helping parents to develop the disciplinary skills needed to deal with problem behaviour and alternatively to generate an increase on appropriate behaviours. Part of the program deals with marital conflict and various other family problems. Incidentally, the program is solely intended for families in which both parents (including the alcohol-dependent father) live with the child. An evaluation of this program focuses on studying a group in which approximately half of the alcohol-dependent fathers also display anti-social personality traits. The short-term results indicate that the children in the experimental group show an increase in appropriate behaviours and a decrease in inappropriate behaviours, compared to children in a randomly-selected control group. What remains to be seen is whether these effects will favourably influence later adolescent tendencies (i.e., the distal outcome). The research plan seems reasonably rigorous and long-term follow-up of children and families is anticipated. Furthermore, the program has also incorporated suggestions made by a number of research groups, which were to focus prevention efforts on children exposed to well-known risk factors, such as parental alcoholism, deficient or erratic parenting practices, behavioural problems, and family conflict (Hawkins et al., 1992b; Zucker and Noll, 1987).

The last evaluated program which specifically targeted children of alcohol-dependent parents is that of Emshoff and his collaborators. Unlike the Zucker team, which targets preschool children, the Emshoff team focused on school-age children. Their strategy consists of gathering small groups of children of alcohol-dependent parents and helping them acquire a variety of personal and interpersonal skills (Ayers, Short, Gensheimer, Roosa and Sandler, 1988; Emshoff, 1989). The goal of the group sessions is also to provide vulnerable children with a social support network. The program does not seek to modify the family environment but, rather, to help children discover and develop the personal resources they need to deal with their problems. The available results were shown to be positive in the area of psychotropic drug use (Emshoff, 1989). However, the approach adopted in this program gives rise to a number of practical - if not ethical - problems. First, it is not easy to identify children of alcohol-dependent parents and there are no guarantees that the parents will agree to participate in the proposed prevention program. Secondly, identifying children at school can stigmatize them in the eyes of teachers and peers. Finally, gathering groups of maladjusted children may produce iatrogenic effects, as Dishion, McCord and Poulin (1999) have pointed out.

Obviously, there are many other programs designed to prevent early use or abuse of psychotropic drugs. Since such programs, be they universal or targeted, are not specifically directed at children of alcohol or drug-dependent parents, we have chosen not to review them here. However, a number of critical surveys of such programs are available (for example, Tobler et al., 2000, or Vitaro and Carbonneau, 2000).

On the other hand, there is one high-risk situation which warrants particular attention due to its harmful effects on children, as well as the fact that it is easily preventable based on a prevention approach. Namely, the use of tobacco, alcohol and other drugs during pregnancy by mothers and, in the case of tobacco, by their partners (given the well-documented effects of second-hand smoke). It is generally understood that alcohol and drug use during pregnancy can harm foetal development and cause untold problems later in life. Many research studies have demonstrated that smoking during pregnancy is equally harmful (see Dauphin and Gendreau, in press; Thapar et al., 2003). The situation is even more complex when tobacco, alcohol, and other drugs are used and abused concomitantly, which is not uncommon among young mothers who are coping with a variety of personal and socio-economic difficulties. Diminishing such practices among young mothers would have a major impact in terms of preventing adjustment problems in children.

Olds and coll. (1998) have created a program to assist single and poor young mothers during pregnancy and after the birth of their children. In comparison with a randomly-selected control group, the results of this program show that parental neglect and dependence on government benefits decreased among the young mothers in the experimental group. The results also show that the mothers in the experimental group reduced levels of smoking, and consumption of psychotropic substances. Finally, the results show that their children showed a higher level of social and academic adjustment in primary and secondary school. This program, which generated the "Jeunes Parents" program currently being offered in Quebec's CLSC, involves home visits by trained nurses who help young mothers overcome their personal problems and learn parenting skills which are consistent with healthy child development.

It is hoped that CLSC workers are also bringing their attention to bear on tobacco, alcohol and drug use by young mothers and that they will be able to accurately evaluate the efficacy of the "Jeunes Parents" program in its general application and particularly in the use of psychotropic drugs. It is equally desirable that the program will take advantage of the resilience elements which exist in the natural environment of the children rather than replace them. As pointed out by Werner and Smith (1993), resilient children of alcohol-dependent parents often prefer to receive support from a family member or from someone in the community rather than from health or social services professionals. The latter can nonetheless play an important role in coordinating and in helping to establish or nourish such supportive relationships.

Other strategies are designed to re-establish family harmony or improve parenting skills. Kumpfer and Alvarado (2003) have produced a highly insightful inventory of prevention programs for parents and families with a vulnerable child. Additionally, Serketick and Dumas (1996) have produced two meta-analyses which review a wide range of parenting programs, while Tobler and Kumpfer (2000) have generated a review of programs designed to improve family dynamics.

Some research results suggest that it is sometimes preferable to temporarily separate a child from an alcohol- or drug-dependent parent, or that a child learns to detach himself or herself from the affected parent, if not the entire family (McCord, 1988). It is in these situations that the involvement of social agencies becomes almost indispensable. Recently, a number of authors have proposed a generic prevention program which builds on current knowledge or resilience factors (Waaktaar, Christie, Borge and Torgersen, 2004). The latter propose strategies involving prosocial peer support and favour the development of satisfying social relationships outside the family. These authors also proposed group activities to stimulate children's cognitive development. Finally, they stress the importance of developing children's creativity and emphasize that children also need to connect positive experiences with their plans for the future. Unfortunately, only a few case studies were taken into consideration during the evaluation.

Summary table

• Individual genetic or psychophysiological vulnerability can moderate the effect of exposure to socio-familial risk factors such as parental addiction. It can also trigger a chain reaction of favourable or unfavourable events within the context of the socio-familial environment.
• In turn, the socio-familial environment can significantly moderate the relationship between genetic or psychophysiological vulnerability and individual adaptation. Analysis of gene-environment interactions and correlations constitutes the cornerstone of future research into resilience factors.
• The resilience and protective factors identified in children of alcohol- or drug-dependent parents are similar to those identified in children exposed to a variety of other risk factors. These factors, which can be termed generic resilience or protective factors, are presented in tables 1 and 2.
• Generic resilience factors suggest that a generic prevention approach may also be needed.
• Some prevention programs exist that are specifically directed at children of alcohol- or drug-dependent parents. On the whole, results are positive but a number of methodological shortcomings, particularly in the area of long-term follow-up, preclude any definitive conclusions. Moreover, the content and strategies of these prevention programs resemble those used with children exposed to various other risk factors. These programs essentially focus on two goals: the first is improving the children's personal skills; the second goal is improving parenting skills and family harmony. Given the progress which has taken place over the last ten years in the field of prevention, it should be possible to establish more complete and potentially more effective prevention programs for children of parents with a dependency.