Clarifying the effects of parental substance abuse, child sexual abuse, and parental caregiving on adult adjustment.

Parental alcoholism, childhood sexual abuse, and other forms of child maltreatment are generally viewed as contributing to adult adjustment problems. The long-term effects of these various factors, however, are actually not well understood. The present study found that the largest amount of variance in college students' psychological distress was explained by parental emotional abuse and neglect, with child sexual abuse, parental substance abuse, and other factors explaining additional but smaller amounts of variance in distress. This suggests that comprehensive conceptualizations of family influences on development will result in a more complete understanding of long-term adjustment outcomes than merely focusing on particular childhood risk factors. Parental alcoholism and childhood sexual abuse (CSA) have received a tremendous amount of research, clinical, and policy attention in the past two decades, and there have been significant advances in knowledge regarding the effects of each of these factors (for reviews, see Briere, Berliner, Bulkley, Jenny, & Reid, 1996; Brown & Schmid, 1999). Large numbers of adult children of alcoholics NOT THE PUBLISHED VERSION; this is the author’s final, peer-reviewed manuscript. The published version may be accessed by following the link in the citation at the bottom of the page. Professional Psychology: Research and Practice, Vol. 31, No. 1 (February 2000): pg. 64-69. DOI. This article is © American Psychological Association and permission has been granted for this version to appear in e-Publications@Marquette. American Psychological Association does not grant permission for this article to be further copied/distributed or hosted elsewhere without the express permission from American Psychological Association. 2 (ACOAs) and CSA survivors have also benefited from mental health services and support groups (for reviews, see Baer, Marlatt, & McMahon, 1993; Wolfe, McMahon, & Peters, 1997). Despite these developments, there is still a great deal about the consequences of parental alcoholism, CSA, and other forms of child maltreatment that remains unclear. In particular, there are limited data to help explain why particular ACOAs and child abuse victims suffer from a variety of adjustment problems, whereas some others apparently do not. A better understanding of the diverse outcomes associated with these risk factors would be very helpful for informing clinical assessment, treatment planning, prevention efforts, and theory development. Though Freud actually wrote little about the effects of different approaches to parenting (Symonds, 1949), a major legacy of the psychoanalytic approach (e.g., Horney, 1933; Levy, 1931) has been a focus on the effects of parental acceptance (and its obverse, rejection or emotional abuse) and parental responsiveness (and its obverse, emotional neglect). Parental approaches to behavioral control also figured prominently in several early models of child socialization (e.g., Baldwin, 1949). Since that time, other aspects of parenting have also received extensive examination. Kempe, Silverman, Steele, Droegemueller, and Silver (1962) were the first researchers to bring widespread professional attention to the problem of child physical abuse. CSA and parental alcoholism also began receiving widespread attention somewhat later (cf. Armstrong, 1978; Black, 1981). The long-term consequences of each of these factors are not yet well understood, however, despite significant empirical investigation. In particular, the effects of the more recently investigated variables (physical and sexual abuse and parental alcoholism) relative to other aspects of parental caregiving are not clear. For example, many studies have found that parental alcoholism is correlated with a variety of psychological symptoms in ACOAs, including depression, anxiety, substance abuse, relationship problems, and antisocial behavior (Sher, 1997; Steinhausen, 1995). It is also clear, however, that many ACOAs function well and do not show signs of serious maladjustment. NOT THE PUBLISHED VERSION; this is the author’s final, peer-reviewed manuscript. The published version may be accessed by following the link in the citation at the bottom of the page. Professional Psychology: Research and Practice, Vol. 31, No. 1 (February 2000): pg. 64-69. DOI. This article is © American Psychological Association and permission has been granted for this version to appear in e-Publications@Marquette. American Psychological Association does not grant permission for this article to be further copied/distributed or hosted elsewhere without the express permission from American Psychological Association. 3 A variety of theories have been proposed to explain these findings (e.g., Collins, Leonard, & Searles, 1990), but the specific effects of parental substance abuse on children's development, independent of other aspects of family functioning, have received relatively little empirical attention. Most of the studies that have examined this question have found that parental alcoholism does not explain additional variance in maladjustment after the effects of general family dysfunction are partialled out (e.g., Harrington & Metzler, 1997; Werner & Broida, 1991). Other studies, however, have found the opposite result (e.g., Buelow, 1995; Rubio-Stipec, Bird, Canino, Bravo, & Alegria, 1991). Researchers have found that a history of CSA is also associated with a variety of negative psychosocial consequences (Kendall-Tackett, Williams, & Finkelhor, 1993). Posttraumatic stress disorder and low self-esteem are relatively common outcomes associated with this form of abuse, though a wide range of symptomatic and pathological behavior has been associated with CSA. Studies have also found, however, that up to 40% of sexually abused children are seemingly not symptomatic at all (Berliner & Elliott, 1996). As with parental substance abuse, other aspects of family dysfunction may account for the adverse outcomes associated with CSA. The research on these questions also provides inconsistent findings. For example, Nash, Hulsey, Sexton, Harralson, and Lambert (1993) found that no additional variance in level of adjustment was explained by a history of CSA after the effects of general family dysfunction had been partialled out, whereas the findings of Harter, Alexander, and Neimeyer (1988) supported the opposite conclusion. The inconsistent research findings regarding the previously mentioned questions present a significant difficulty for practitioners because of the high prevalence of childhood risk factors such as CSA, parental alcoholism, and other types of family dysfunction in the clinical population. Explanations for adult maladjustment and treatment planning in these cases often must rely on clinical experience and theoretical approaches to psychotherapy without the clear support of empirical evidence. Theory and clinical experience obviously are valuable tools for mental health practice, but empirical support for our assessments and treatments is also steadily increasing NOT THE PUBLISHED VERSION; this is the author’s final, peer-reviewed manuscript. The published version may be accessed by following the link in the citation at the bottom of the page. Professional Psychology: Research and Practice, Vol. 31, No. 1 (February 2000): pg. 64-69. DOI. This article is © American Psychological Association and permission has been granted for this version to appear in e-Publications@Marquette. American Psychological Association does not grant permission for this article to be further copied/distributed or hosted elsewhere without the express permission from American Psychological Association. 4 in importance. Therefore, finding answers to these questions is a matter of some import. Some of the inconsistent findings in this research are likely to have resulted from the manner in which the risk factors were defined. With regard to the consequences of CSA, for example, most studies have combined intrafamilial and extrafamilial abuse when participants were divided into treatment and control groups. It appears, however, that intrafamilial sexual abuse has greater negative effects than extrafamilial abuse (Briere & Elliott, 1993; Finkelhor & Baron, 1986). Much of the research has also combined unwanted sexual contact with willing sexual contact as well as unwanted and willing noncontact sexual experiences (e.g., exhibitionism). Definitions of CSA are unclear and controversial, but certainly unwanted and forced sexual contact are abusive. There is less agreement regarding the abusiveness of some willing noncontact sexual experiences, particularly with nonrelatives. No clear boundaries between these categories of sexual experience may exist, but there are important distinctions between them nonetheless. Much of the research regarding the consequences of CSA has lumped together diverse categories of sexual experience, and the associations found between CSA and adjustment outcomes have been weakened as a result (see Rind, Tromovitch, & Bauserman, 1998). Most of the studies that have examined the independent effects of CSA and parental substance abuse beyond the effects of general family dysfunction have also used global measures of family functioning such as the Family Adaptability and Cohesion Evaluation Scale (Olson, Russell, & Sprenkle, 1983; see Harter et al., 1988) or the average score from the Family Environment Scale (Moos & Moos, 1986; see Briere & Elliott, 1993). Global measures of family functioning are obviously useful for some purposes, but it can be difficult to infer what specific aspects of parental caregiving and family functioning are assessed by these measures. For example, parental substance abuse and CSA are presumably dysfunctional for families, and it is unclear which aspects of this dysfunction may be partialled out by global measures of family functioning before the independent effects of CSA or parental substance abuse are