Resilient Children of Parents Affected by a Dependency

Lessons learned concerning prevention and treatment for children of parents affected by dependency

The following paragraphs present a summary of resilience and compensation factors in children of alcohol- or drug-dependent parents; we also review resilience factors and compensatory factors in other areas for the sake of comparison. A few prevention programs specifically designed for children of dependent parents are mentioned. Finally, since targeted prevention programs are designed to reduce risk factors and promote resilience and protective factors, the principles and strategies of effective prevention programs are reviewed.

Specific Resilience Factors in Children of Alcohol- and Drug-dependent Parents

One might conclude that the best strategy for helping children of alcohol- or drug-dependent parents is to introduce or improve the resilience and protective factors discussed earlier, but this would be a premature and highly debatable approach. To begin with, the correlational nature³ of the designs employed in the studies from which presumed resilience, protection or compensatory factors have been derived scarcely lends itself to ascribing a causal status to these factors. This limitation stems from the inability of correlational studies, however sophisticated they might be, to control for all confounding variables or to predict all possible mediating or moderating variables. In addition to resilience variables, once again there may well be other differences between resilient and non-resilient children of alcohol- or drug-dependent parents. Even after reviewing all of the studies on resilience, it is still not possible to determine whether resilient children of alcohol- or drug-dependent parents have something more (resilience factors) or something less than their non-resilient peers (less exposure to risk factors or less genetic or neurophysiological vulnerability).

Studies show that the personal attributes most commonly linked to resilience seem to be an easy temperament, a low level of emotional reactivity, and a normal level of novelty seeking. In fact, these elements of resilience can as easily be defined through their absence in non-resilient children as through their presence in resilient children, since they constitute factors which are favourable for all children regardless of the dependency status of their parents. In other words, their presence constitutes a compensatory factor (rather than a resilience factor), whereas their absence (or the presence of their opposites) simply constitutes a risk factor. Furthermore, these apparent resilience elements (or, more accurately, compensatory elements) are highly hereditary in nature, as several quantitative genetic studies of large samples of twins have shown (Heath, Cloninger and Martin, 1994). Even aspects such as healthy self-esteem and good interpersonal skills seem to be genetically regulated to varying degrees (Kendler, Myers and Neale, 2000).

Additionally, these characteristics (an easy temperament, sociability, good problem-solving skills), which initially stem from an individual's genetic makeup, can give rise to positive social and familial experiences which, in turn, are apparently conducive to resilience. This is referred to by the authors as a genes-environment correlation (or r GE; Rutter, 2003). There are three types of r GE correlations: passive, active and evocative. The correlation at issue here is the evocative type: seemingly protective social and familial experiences and the personal attributes that give rise to them are, in fact, genetically controlled. However, this does not prevent social experiences from producing specific results which can accelerate adaptation in children deemed to be resilient (Rutter, Pickles, Murray and Eaves, 2001). In other words, personal attributes which have a strong likelihood of being genetically heritable, such as novelty seeking and emotional reactivity, can be substantially influenced by the educational practices and social norms mobilized in response to them. It is precisely because of the genetic nature of these attributes that it is appropriate to focus clinical and educational efforts towards vulnerable children as early as possible, thereby reducing the negative effects and promoting their compensatory counterparts, which are more conducive to successful adaptation.

Moreover, recent research in the field of molecular genetics has shown that unfavourable experiences generate harmful effects only when they are combined with a genetic vulnerability. This is what the authors refer to as gene X environment interactions (or GXE; Rutter, 2003). Two recent studies conducted by Caspi et al., illustrate such interactions. In the first study, Caspi et al., (2002), demonstrates that some children who had been abused or neglected by their parents do not develop problems in aggressiveness nor anti-social behaviour and, on the genetic level, these children showed a high level of MAOA gene activity. This is the gene which encodes an enzyme (monoamine oxydase A) which enables the metabolization of various neurotransmitters, such as norepinephrine, serotonin and dopamine. Conversely, adjustment problems in adolescence and adulthood have been shown to increase as the activity of this gene decreases. In the second study Caspi et al. (2003) report that child abuse and neglect are only associated with major depression and suicide attempts in adulthood when the gene responsible for transporting serotonin, 5-HTT, is found to be deficient (presenting a short allele). In the opposite genetic case, the same unfavourable experiences in childhood are not predictive of similar problems in adulthood. In both studies, the authors ensured that all of their subjects, both with and without genetic vulnerability, had been exposed to equivalent experiences of abuse and neglect in childhood.

One can readily understand the potential repercussions of these research studies into the resilience of children of alcohol- or drug-dependent parents. Given the genetic, psychophysiological and neuropsychological characteristics that distinguish well-adjusted children of alcohol- or drug-dependent parents from their maladjusted counterparts, one can assume that alcohol- or drug-dependent parents affects only or primarily the more genetically vulnerable children as previously cited, or affects them as a result of prenatal or perinatal factors associated with alcohol- or drug-dependent parents. As a corollary, it may be that compared to their non-resilient peers, resilient children of alcohol- or dug-dependent parents simply benefit from a genetic makeup which protects them from the environmental stress associated with parental alcoholism or drug-dependency. The hypothesis of an interaction between personal attributes and a stressful environment is not new. However, few studies have established a direct link between specific genes and well-documented socio-familial experiences - specifically longitudinal studies of more than 30 years - as Caspi et al. have done.

The studies of Caspi et al. also demonstrate the protective force of an adequate socio-familial environment for individuals who are genetically vulnerable. In fact, the aforementioned results show that an adequate socio-familial environment (one devoid of abuse or neglect) forestalls the development of anti-social or depressive tendencies even in individuals made vulnerable by weak MAOA activity or a 5-HTT gene deficiency. What is more, Suomi (2001) has discovered that rhesus monkeys who present a serotonin transporter gene (5-HTT) deficiency (which would normally bring about impulsive and inattentive behaviours like those observed in maladjusted children of alcohol- or drug-dependent parents) show no behavioural problems when they are raised by adoptive mothers who are nurturing and attentive. Some even become leaders among their peers. These findings corroborate the conclusions of many investigators whose work is cited here.

In short, one can assume that certain personal and socio-familial characteristics in children of alcohol- or drug-dependent parents will serve as resilience, protection or compensation factors, even if these characteristics are in part or entirely due to an r GE correlation or a GXE interaction. To summarize, the following list of resilience variables in children of alcohol- or drug-dependent parents was gathered from previous studies: an easy temperament, an absence of behavioural problems which could impede school learning (low level of hyperactivity, inattention, and impulsiveness), sociability, a non-dependent parent who maintains a measure of harmony within the family and exercises warm but firm supervision, adequate social support outside the family, self-confidence and a positive outlook towards the future.

³Longitudinal studies also employ a correlational design. However, unlike cross-sectional studies, these studies make it possible to establish the directionality of the relationship between the variables at play but preclude the identification of causal relationships. At most, they increase the degree of presumption of a potential causal relationship.

Generic Resilience Factors

After thirty years of research, numerous resilience or protective factors were identified in connection with a variety of risk factors other than parental alcoholism or drug dependency. These factors fall under the headings of individual attributes, family setting as well as social and community networks (Luthar, 2003; Rutter, 2000; Serbin and Karp, 2004). We will review these factors here, in order to: (a) demonstrate that the study of resilience and protective factors is not limited to children of alcohol- or drug-dependent parents; (b) ascertain the specificity or lack of specificity of resilience or protective factors attributed to children of alcohol- or drug-dependent parents; (c) demonstrate their usefulness in the general field of prevention (Vitaro and Caron, 2003); and lastly (d) establish the limits of these resilience factors.

The generic resilience factors which have been identified in a variety of fields over the past 30 years are summarized in tables 1 and 2. Table 1 provides a list of generic resilience factors developed by Master and Coastworth (1998), Werner (2000), and Luthar (2003), while Table 2 presents the generic strategies proposed by Rutter (in press).

The factors and experiences deemed to be conducive to resilience, listed in tables 1 and 2, can be summarized into four points according to Rutter (in press):

• Reduce the impact of the stress or risk situation.
• Avoid the chain reaction of negative events normally associated with the stress or risk situation.
• Promote a "positive chain reaction," which is to say opportunities and experiences for success and socialization.
• Develop effective strategies to resolve problems and focus on positive rather than negative aspects in the child's life.

These generic resilience, protection and compensatory factors are strikingly similar to the resilience, protection and compensatory factors identified with respect to children of alcohol- and drug-dependent parents (and, most likely, children of compulsive gamblers as well). Some authors have also proposed a model which promotes a number of fundamental protection or compensatory factors for all children subjected to stress of any kind (Masten, 2001; Masten and Reed, 2002; Serbin and Karp, 2004). These protection or compensatory factors are based on the most salient and readily-modifiable elements in tables 1 and 2. Four areas in particular are targeted: attachment with a significant and well-adjusted adult; a strong motivation to learn; an effective system of behavioural and emotional self-regulation; and responsive organizational and community structures. From an operational standpoint, meeting these objectives may require: (a) offering one-on-one or group training of a personal and social nature to the parents concerned; (b) involving and providing training to the partner of the affected parent, or to another family or community member, to promote bonding with the child and to ensure that the child receives special attention; (c) establish or locate community resources which can provide the child with positive experiences and the motivation to pursue such experiences; (d) supervise and encourage academic success, as well as success in other esteem-building pursuits of a personal or socio-familial nature. A number of early prevention and intervention programs - some of which are described below - reflect one or more of these strategies. A comprehensive survey of such programs and other reference materials can be found in the two volumes published by Vitaro and Gagnon (2000) with respect to prevention programs for youth. Obviously, the implementation of such strategies requires both leaders and promoters. Treatment centres for adults with an alcohol dependence, drug users and pathological gamblers may wish to assume this role, in cooperation with community-based health agencies such as the Centres locaux de services communautaires (CLSC) in Quebec, and schools.