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The effectiveness of a group treatment program for children of addicted parents Mason, Marcelle S. 1990

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THE EFFECTIVENESS OF A GROUP TREATMENT PROGRAM FOR CHILDREN OF ADDICTED PARENTS By MARCELLE S. MASON B.S.W., The University of British Columbia, 1987 A THESIS SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE OF MASTER OF SOCIAL WORK in THE FACULTY OF GRADUATE STUDIES SCHOOL OF SOCIAL WORK We accept this thesis as conforming to the required standard THE UNIVERSITY OF BRITISH COLUMBIA June, 1990 Marcelle Mason, 1990 In presenting this thesis in partial fulfilment of the requirements for an advanced degree at the University of British Columbia, I agree that the Library shall make it freely available for reference and study. I further agree that permission for extensive copying of this thesis for scholarly purposes may be granted by the head of my department or by his or her representatives. It is understood that copying or publication of this thesis for financial gain shall not be allowed without my written permission. Department of The University of British Columbia Vancouver, Canada DE-6 (2/88) Abstract T i t l e d "Children of Addicted Parents", the purpose of this study was to evaluate the effectiveness of a psycho-educational group i n t e r -vention for latency age c h i l d r e n of a l c o h o l i c s . The treatment group consisted of eleven c h i l d r e n between the ages of eight and twelve, who have l i v e d or who are l i v i n g with an a l c o h o l i c parent or step-parent. Referrals were obtained from elementary school guidance counsellors, Family Service Agencies, Alcohol and Drug Programs and the M i n i s t r y of S o c i a l Services and Housing. The c h i l d r e n and three therapists met one hour a week for nine weeks. The group's dual objectives include educating the c h i l d r e n about alcoholism/drug addiction and i t s e f f e c t on the family as well as enhancing the c h i l d r e n s ' inherent strengths by teaching s t r a t e g i e s to increase self-esteem, problem solving and other coping s k i l l s . The program's objectives were c a r r i e d out through b r i e f lectures, discussion, f i l m , a r t and therapeutic games. The treatment model has been evaluated using a quasi-experimental design. There was a s i g n i f i -cant change i n the i n t e n s i t y of behaviour problems with a trend for a decrease i n the number of problems, as well as a decrease i n depression. In addition there was a tendency for an increase i n self-esteem. I l l TABLE OF CONTENTS Abstract Acknowledgements vi" Dedication v"' VI" Preface Introduction 1 CHAPTER I: BACKGROUND INFORMATION 4 D e f i n i t i o n of the Problem 4 Ch a r a c t e r i s t i c s Of COAs 9 Psychological Abuse 14 Psychological Disorders 19 Impact of Psychosocial Development 24 Development of Intervention Approachs 28 Group Treatment Effectiveness 32 CHAPTER II: METHODS 39 Procedure 40 Subjects 41 Table 1 42 Design 43 Session Content 45 Measures 46 1. Children of Alc o h o l i c s Screening Test 47 2. Self Appraisal Inventory 47 3. Kovacs Childhood Depression Inventory 48 4. Children's Manifest Anxiety Scale 49 5. Eyberg C h i l d Behaviour Inventory 50 Observations 50 CHAPTER I I I : RESULTS 51 Children of Alc o h o l i c s Screen Test 51 Table 2 52 Eyberg C h i l d Behaviour Inventory 53 Table 3 54 Childhood Depression Inventory 55 Table 4 56 Sel f - A p p r a i s a l Inventory 57 Table 5 58 Table 6 59 Indi v i d u a l Evaluations 60 Table 7 61 Case 2 62 Table 8 63 Case 3 64 Table 9 65 Case 4 66 Table 10 67 IV TABLE OF CONTENTS (Continued Case 5 68 Table 11 69 Case 6 70 Table 12 71 Case 7 72 Case 8 72 Table 13 73 Table 14 74 Case 9 75 Table 15 76 CHAPTER IV: DISCUSSION 77 C l i n i c a l Implications 80 Limitations of the Research 83 Recommendations f or Further Research 84 REFERENCES 85 APPENDIX A 91 Consent Form 92 Demographic Questionnaire 96 APPENDIX B: Measures of Self-Concept 100 Self Appraisal Inventory Grades K-3 101 Grades 4-6 103 Grades 7-12 107 APPENDIX C 110 Children of Alcoholics Screening Test 111 APPENDIX D 114 Kovac's C h i l d Depression Inventory 115 Feelings Questionnaire 116 What I Think, and Feel Questionnaire 121 LIST OF TABLES Table 1 DEMOGRAPHIC DATA 42 Table 2 CHILDREN OF ALCOHOLICS SCREENING TEST 5 2 Table 3 MEAN SCORES OF ALL PARTICIPANTS 54 Table 4 MEAN SCORES OF ALL PARTICIPANTS ON CHILDHOOD DEPRESSION INVENTORY 56 Table 5 MEAN SCORES OF ALL PARTICIPANTS ON SELF-ESTEEM MEASURE 58 Table 6 MEAN SCORES OF ALL PARTICIPANTS ON CHILDHOOD ANXIETY 59 Table 7 MEAN SCORES ON ALL MEASURES FOR CASE #1 61 Table 8 MEAN SCORES ON ALL MEASURES FOR CASE #2 6 3 Table 9 MEAN SCORES ON ALL MEASURES FOR CASE #3 65 Table 10 MEAN SCORES ON ALL MEASURES FOR CASE #4 67 Table 11 MEAN SCORES ON ALL MEASURES FOR CASE #5 69 Table 1 2 MEAN SCORES ON ALL MEASURES FOR CASE #6 71 Table 13 MEAN SCORES ON ALL MEASURES FOR CASE #7 7 3 Table 14 MEAN SCORES ON ALL MEASURES FOR CASE #8 74 Table 15 MEAN SCORES ON ALL MEASURES FOR CASE #9 76 VI ACKNOWLEDGEMENTS Many people have contributed to the development of this p r o j e c t . In p a r t i c u l a r I would l i k e to thank my dear f r i e n d and colleague S t e l l a Charlambidis who was instrumental i n developing the o r i g i n a l c h i l d r e n s ' program i n 1987. In addition, I would l i k e to express my appreciation to Janice B e l l , who co-led the group with me, f o r her s k i l l s , encouragment and sense of humour. I would also l i k e to thank Myrna D r i o l , of Family Services, North Burnaby Alcohol and Drug Programs. Her support was c e n t r a l to the success of the proj e c t . Special thanks to Professor Madeline L o v e l l for her ongoing guidance, encouragement and unending b e l i e f i n my a b i l i t i e s . As well I would l i k e to thank Kloh-Ann Amacher and Catherine McCannell. To my parents, my sincere gratitude f o r without th e i r support, both f i n a n c i a l and emotional, my education might not have been poss i b l e . F i n a l l y , my deepest thanks to my son Jesse and my daughter L a i l a . Their honesty, free s p i r i t s and magical way of viewing the world enabled me to have the courage to see the pain of the children I worked with and maintain the hope that change i s possible. DEDICATION To the c h i l d r e n and th e i r parents, who through the intimate ac of sharing t h e i r pain I have learned so much and i n the process part of myself has been transformed. PREFACE LEAVE TAKING I never thought i t would be paradise I walked a rugged pathway from the s t a r t No ugliness was hidden from my eyes Nor was l i f e ' s pain a stranger to my heart And yet, the earth sprung from beneath my feet And summer winds were gentle to my hair I breathed upon the dusk and found it.sweet 1 INTRODUCTION Children of a l c o h o l i c s have been i d e n t i f i e d as a vulnerable population, victims of numerous emotional and behavioural problems and at a greater r i s k of developing alcoholism l a t e r i n l i f e (Jesse, 1989). Latency age c h i l d r e n i n p a r t i c u l a r have been targeted as having d i f f i c u l t i e s i n adjustment. Problems which a r i s e , due to a parent's chemical dependency, create obstacles f o r these c h i l d r e n as they begin to venture outside t h e i r family and become part of s o c i a l groupings (Jesse, 1989). Parental alcoholism creates onging d i f f i -c u l t i e s for c h i l d r e n making passing through l i f e ' s developmental stages more problematic. Consequently adolescence may be the culmination of severe c o n f l i c t that seems to have been brewing since middle-childhood (Jesse, 1989). Research reports that as many as 50% of c h i l d r e n of a l c o h o l i c s become a l c o h o l i c themselves, i n d i c a t i n g the e s c a l a t i n g nature of these c h i l d r e n s ' d i f f i c u l t i e s (Jesse, 1989). Most of the l i t e r a t u r e reports on the research regarding the impact of parental alcoholism on the developing c h i l d . Researchers agree that alcoholism within the family appears to shape patterns of i n t e r a c t i o n a l behaviour, molding i t s members i n subtle and not so subtle ways. Children become enmeshed i n t h e i r family's dynamics, unable to separate themselves from t h e i r chaotic, unpredictable family system. This d i s t o r t e d family system may lead to problematic parent-child i n t e r a c t i o n s , which may be d i r e c t l y r e l a t e d to continuing the cycle of addiction (01Gorman & Diaz, 1986). 2 Although there i s a vast amount of l i t e r a t u r e confirming the deleterious a f f e c t of parental alcoholism on the developing c h i l d not much i s being offered i n terms of treatment for latency age c h i l d r e n of a l c o h o l i c s . In addition research supporting the importance of early intervention has been accumulating since the mid 1970's, but s t i l l a tremendous gap remains to be f i l l e d with respect to providing e f f e c t i v e treatment programs for these c h i l d r e n . As well e m p i r i c a l l y based documentation regarding treatment effectiveness i s v i r t u a l l y nonexistent. This project evaluated the effectiveness of a group treatment program for c h i l d r e n of addicted parents. Based on the previous research on the impact of parental alcoholism, which i d e n t i f i e d a number of areas of impairment of functioning f o r the c h i l d , s p e c i f i c areas were targeted i n order to improve the c h i l d ' s functioning. These areas were: self-esteem enhancement, teaching coping s k i l l s and educating the c h i l d about addiction and i t s a f f e c t on the family, thereby reducing anxiety and depression. According to p r i o r research findings u t i l i z i n g a group in t e r v e n t i o n model with this population, (Sunshine & Brown, 1982; Robinson, 1983; P i l a t & Jones, 1985) i t was expected that the group intervention (independent variable) would have a p o s i t i v e e f f e c t on the c h i l d ' s self-esteem and behaviour and decrease the c h i l d ' s l e v e l of depression and anxiety (independent v a r i a b l e s ) . In order to 3 increase the v a l i d i t y of the f i n d i n g s obtained through p r i o r d e s c r i p t i v e s t u d i e s , the treatment i n t e r v e n t i o n was evaluated using a quasi-experimental one-group p r e t e s t - p o s t e s t design, u t i l i z i n g s e l f - r e p o r t measures f o r c h i l d r e n and a c h i l d b e h a v i o u r a l c h e c k l i s t completed by parents. Outcome measures i n c l u d e : s e l f a p p r a i s a l , childhood depression and c h i l d behaviour i n v e n t o r i e s , as w e l l as an an x i e t y s c a l e . The f i n d i n g s obtained from t h i s study w i l l provide the foundation f o r a more comprehensive study and program implemen-t a t i o n f o r c h i l d r e n of addicted parents. 4 CHAPTER 1 BACKGROUND LITERATURE DEFINITION OF THE PROBLEM The mental health r i s k s of ch i l d r e n l i v i n g with parental alco-holism has been well documented for over t h i r t y years. Beginning with one of the f i r s t Canadian studies implemented by Margaret Cork and expanded on by numerous researchers i t has been determined that c h i l d r e n of a l c o h o l i c s (COAs) are at a high r i s k for both hereditary and psychological problems which w i l l continue throughout t h e i r l i v e s . While some of these children's problems w i l l be exhibited during childhood, for others problems may not become apparent u n t i l adulthood (Arneson, T r i p p l e t t , Schweer & Snider, 1983). Neverthe-les s f o r the majority of these c h i l d r e n long term e f f e c t s of physio-l o g i c a l and psychological damage leads to a profound disruption of family l i v i n g and a s i g n i f i c a n t decrease i n t h e i r own p r o d u c t i v i t y and sense of well being (Arneson et a l , 1983). Children raised i n families that have a l c o h o l i c members are at a greater r i s k f o r becoming a l c o h o l i c (Robinson, 1989; Bennett, Wolin, Reiss & Teitelbaum, 1987), compulsive eaters, gamblers, spenders, sex and drug addicts (Robinson, 1989). In addition, COAs are at high r i s k for marrying people who become a l c o h o l i c (Naiditch, 1986). I t has been suggested that t h i s process of mate s e l e c t i o n often sets the stage for a l i f e that revolves around alcoholism (Richards, 1979). Alcoholism then becomes a powerful organizer of family l i f e , a l t e r i n g d a i l y routines and shaping patterns of i n t e r a c t i o n a l 5 behaviour (Steinglass, 1981; Bennett, e t a l . , 1987). While not a l l COAs grow up to become a l c o h o l i c , research indicates that they are also l i k e l y to have more physical, mental and emotional problems than c h i l d r e n from abstaining f a m i l i e s (Woodside, 1988). The d i f f i c u l t i e s associated with parental alcoholism are then passed down through the generations (Woodside, 1988). Children of addicted parents often receive l i t t l e a t tention and care. In these families attentioned i s focused on the addiction and parents lack the time and energy required f o r c h i l d care. Addicted parents are often unable to meet the physical and psychological needs of t h e i r c h i l d r e n with any semblence of consistency (Black & Mayer, 1980; Jesse, 1989). The greater the degree of alcoholism the more severe the phys i c a l abuse or neglect (Woodside, 1983). As well sexual abuse i s a common occurrence. Alcohol abuse i s generally found among 50% to 80% of homes reporting p h y s i c a l and/or sexual abuse (Black, 1987). Black & Mayer (1980) conducted a study, which was designed to investigate the adequacy of c h i l d care i n f a m i l i e s with an alcohol or opiate addicted parent. They report that, from t h e i r sample of 200, 42% p h y s i c a l l y or sexually absued t h e i r c h i l d r e n . In addition, these parents were l i k e l y to have been abused themselves during childhood. In severely disrupted f a m i l i e s c h i l d r e n may not be fed, p h y s i c a l l y cared for and/or medical a t t e n t i o n may be neglected, even i n serious s i t u a t i o n s (Black & Mayer, 1980). 6 The l i t e r a t u r e reports a number of variables which influence how a c h i l d experiences his/her parent's drinking. These include: the age of the c h i l d at onset of parental alcoholism, r e l a t i o n s h i p with a l c o h o l i c parent; independent of the drinking behaviour, the c h i l d ' s resources outside of the family, a v a i l a b i l i t y of the non-alcoholic parent (Brown & Sunshine, 1982; Ackerman, 1986; Morehouse, 1979), se v e r i t y of alcoholism, duration, degree of marital c o n f l i c t , sex of a l c o h o l i c parent, presence of violence, (Ackerman, 1986; Morehouse, 1979; west & Prinz, 1987), and socioeconomic status (West & Prinz, 1987). Such factors determine the s e v e r i t y of the impact f o r the c h i l d . The age of the c h i l d when parental alcoholism began i s s i g n i f i c a n t i n terms of the impact on the c h i l d . If the c h i l d i s exposed to a chemically dependent parent at an early age they often have more severe s o c i a l and emotional problems l a t e r i n l i f e (Spence & Schmidt, 1989; Richards, Morehouse, Seixas & Kern, 1981). In addition, the impact of maternal alcoholism i s viewed as more detrimental to a c h i l d than paternal alcoholism for a number of reasons. T r a d i t i o n a l l y the mother i s seen as the primary caretaker of her ch i l d r e n . If her functioning i s impaired then i t i s much more l i k e l y that the c h i l d ' s basic needs w i l l not be met (Spence & Schmidt, 1989). When mom i s the a l c h o l i c the household i s usually more chaotic and the c h i l d r e n s u f f e r more, e s p e c i a l l y i f the father escapes the s i t u a t i o n by overworking (Richards et a l . , 1981). 7 Maternal alcoholism creates s i g n i f i c a n t d i f f i c u l t i e s for her daugh-ter, as she i s pushed i n t o a surrogate housekeeper and companion r o l e , g i v i n g r i s e to the problems associated with pseudo-adulthood (Richards et a l . , 1981). As well, female a l c o h o l i c s are more l i k e l y to abuse t h e i r c h i l d r e n as compared to male a l c o h o l i c s (Black & Mayer, 1980). The s i t u a t i o n i s also compounded by a d d i t i o n a l stressors such as single parenthood and poverty. Also s o c i e t a l implications are more severe f o r female a l c o h o l i c s . For a woman al c o h o l i c her femininity as well as her mothering c a p a b i l i t i e s are questioned. Sex of the a l c o h o l i c i s also i n d i c a t i v e of differences i n terms of resources available and socioeconomic status. The l i t e r a t u r e reports that only 1 out of 10 men w i l l stay with an a l c o h o l i c wife while 9 out of 10 women w i l l stay with a a l c o h o l i c husband (Ackerman, 1986). Consequently female a l c o h o l i c s are more l i k e l y to be single parents with low incomes. Lower f i n a n c i a l status and poor l i v i n g conditions compound the problems and are associated with c h i l d abuse and neglect (Black & Mayer, 1980). F i n a n c i a l and s o c i a l supports appear to be p a r t i c u l a r l y important i n preventing c h i l d maltreatment i n families with an alcohol or opiate addicted parent (Black & Mayer, 1980). If support systems are weak i e . r e l a t i v e s l i v e out of town and/or the nonaddicted spouse i s c h r o n i c a l l y i l l or has alcohol or drug problems, then the c h i l d i s viewed as i n a more vulnerable p o s i t i o n . Support, both emotional and informational, was 8 also found to be related to adjustment within a l c o h o l i c f a m i l i e s . Resources may a s s i s t i n counteracting the r i s k s associated with l i v i n g i n a disordered family ( C l a i r & Genest, 1986). Parental violence within the a l c o h o l i c family system exascer-bates an already strained s i t u a t i o n . COAs c o n s i s t e n t l y report greater frequency of family violence than children from abstaining f a m i l i e s (Black, Buck & W i l d e r - P a d i l l a , 1986). One of the strongest predictors of violence between parent and c h i l d i n Black & Mayer's study was violence between parents. Black (1987) also reports that 95% of her sample (n=409) described greater frequency of both parents being v i o l e n t i n general, and 56% stated that t h e i r parents were v i o l e n t when drinking. Poor marital r e l a t i o n s h i p s were reported more frequently within the a l c o h o l i c home as well (Wilson & Orford, 1978). The m a r i t a l r e l a t i o n s h i p i s characterized by c r i t i c a l , h o s t i l e and disapproving communication (Edwards, Harvey & Whitehead, 1973). Families of these c h i l d r e n tend to be characterized by family disruptions, i n c o n s i s t e n t d i s c i p l i n e and lack of supervision ( M i t c h e l l , Hong & Corman, 1979). COAs report considerably more disruption i n t h e i r family environments, and they see t h e i r family as l e s s cohesive, less organized and more c o n f l i c t - r i d d e n ( C l a i r & Genest, 1986). In addition, C l a i r & Genest report that these f a m i l i e s are less oriented toward i n t e l l e c t u a l or c u l t u r a l p ursuits. These children 9 l i v e i n an atmosphere of psychological and physical s t r e s s . Consequently they are constantly anxiety ridden (Obuchowska, 1974). There i s consensus among researchers that latency age c h i l d r e n of addicted parents comprise a p a r t i c u l a r l y vulnerable group. The e f f e c t of parental alcoholism i s seen as most d i s r u p t i v e to the pre-pubescent c h i l d ( M i l l e r & Jang, 1979; Brown S Sunshine, 1982; Richards, Morehouse, Seixas & Kern, 1981). This c h i l d has not witnessed a model for normal family l i f e as compared to the adolescent who has already developed his/her coping patterns before the onset of parental alcoholism ( M i l l e r & Jang, 1979). There are four areas that the l i t e r a t u r e points to i n terms of the impact of parental alcoholism on the c h i l d : c h a r a c t e r i s t i c s common to these c h i l d r e n , impact of psychological abuse, underlying psychological disorders and how these factors impact the c h i l d ' s psychosocial development. CHARACTERISTICS OF COAs Various researchers have i d e n t i f i e d a number of c h a r a c t e r i s t i c s common to c h i l d r e n l i v i n g i n an environment disrupted by a l c o h o l i c behaviour. Children f e e l responsible d i r e c t l y or i n d i r e c t l y for t h e i r parents' drinking (Morehouse, 1979; La Pantois, 1986; Richards et a l . , 1981; Spence & Schmidt, 1989) and conclude that something i s wrong with them (Arneson et a l . , 1983). Parents who are consuming large amounts of alcohol and/or drugs become s e l f absorbed and are 10 more concerned with their r e l a t i o n s h i p with alcohol/drugs than with t h e i r family (Jesse, 1989). Consequently they equate t h e i r parents' drinking/drugging with not being loved (Morehouse, 1979; P i l a t & Jones, 1985; Ackerman, 1986). Due to the lack of attention and a f f e c t i o n , these children f e e l rejected and hurt (Spence & Schmidt, 1989; Woodside, 1983). In time the c h i l d r e n learn that e i t h e r no one i s concerned about how they f e e l or that they w i l l be punished for expressing f e e l i n g s . As a r e s u l t these c h i l d r e n learn to deny or displace feelings (Arneson et a l . , 1983). COAs react to the i r s i t u a t i o n with a flood of emotions. The most common emotional reaction i s anger, with underlying f e e l i n g s of hurt and sadness (Robinson, 1989). The c h i l d f e e l s angry with the nonaddicted parent f o r not improving the family's s i t u a t i o n (Morehouse, 1979), for allowing the loss of some of the carefree aspects of childhood and for not protecting them from the violence and/or verbal abuse (Spence & Schmidt, 1989). Anger i s also d i r e c t e d towards the addicted parent f o r the never ending broken promises (Hecht, 1973). COAs are t e r r i f i e d of t h e i r home s i t u a t i o n (Richardson, 1989). The chaos and u n p r e d i c t a b i l i t y of t h e i r home l i f e often creates fear and apprehension for these c h i l d r e n (Robinson, 1989). The c h i l d excessively worries about the addicted parent's well-being (Morehouse, 1979; Black, 1981; Wegescheider-Cruise, 1985). In extreme cases c h i l d r e n w i l l want to stay home 11 from school i n order to take care of t h e i r parent (Seixas & Youcha, 1985; Cermak, 1986). G u i l t i s a prevalent emotion for many c h i l d r e n . They f e e l g u i l t y and responsible for t h e i r parent's drinking and they believe they can get them to stop (Robinson, 1989). In s i t u a t i o n s where the drinking parent i s more affectionate and permissive while i n t o x i c a -ted, the c h i l d wants the parent to drink, but then f e e l s g u i l t y (Jesse, 1989; Morehouse, 1979). Confusion i s a frequent companion for c h i l d r e n l i v i n g within the alcohol/drug addicted family system. Inconsistency, u n p r e d i c t a b i l i t y and mood swings which are the hallmarks of alcoholism, complicate parental i n t e r a c t i o n s and create constant confusion for the c h i l d (Robinson, 1989). Black-outs are e s p e c i a l l y confusing for these c h i l d r e n as they make r e a l i t y t e s t i n g d i f f i c u l t (Morehouse, 1979; Richards et a l . , 1981; Jesse, 1989). C o n f l i c t and confusion i s created for the c h i l d because behaviour during the black-out event i s subsequently denied by one or both parents. The c h i l d ' s sense of embarrassment and shame concerning h i s family's s i t u a t i o n prevents him from bringing friends home, consequently l i m i t i n g his/her a b i l i t y to form peer r e l a t i o n s h i p s and increasing his/her sense of i s o l a t i o n (Brown & Sunshine, 1982; Morehouse, 1979; Fossum & Mason, 1986; Wilson & Orford, 1978; Robinson, 1989). 1 2 The COA experiences g r i e f on many l e v e l s . He/she w i l l mourn the loss of a "normal" family, l o s t childhood and the loss of a parent to alcohol/drug addiction (Robinson, 1989). Black (1987) contends that t h i s loss can be so traumatizing that i t has been compared to the loss of a loved one. These unresolved emotions when carried throughout childhood and adulthood i n t e r f e r e with f u l l y functioning r e l a t i o n s h i p s with friends, spouses and loved ones (Robinson, 1989). Children i n chemically dependent families learn behaviours that allow them to function within t h e i r family context but which are s e l f - d e s t r u c t i v e i n the outside world (Black, 1981; Wegescheider, 1981). The r o l e s they adopt hide t h e i r p a i n f u l emotions. Black (1979) believes that the majority of COAs escape detection because they adopt one or more of three basic r o l e s which help them manage t h e i r l i v e s . The f i r s t born or only c h i l d may take on the role of the responsible one. These c h i l d r e n receive p o s i t i v e reinforcement f o r the r e s p o n s i b i l i t i e s they assume which are age-inappropriate. For example, i n an a l c o h o l i c family i t i s not unusual f o r a c h i l d of 8 or 9 to be responsible for such tasks as taking care of younger s i b l i n g s , doing laundry and other household chores. These c h i l d r e n delevop strong leadership s k i l l s and usually have p o s i t i v e s e l f -concepts, although l a t e r i n l i f e they u s u a l l y f e e l deprived of t h e i r childhoods. In addition, they t r y to manage and control others with often disastrous r e s u l t s . Children who assume the placator r o l e develop unusual s e n s i t i v i t y to the hurts of others and have a need 1 3 to ease t h e i r pain. This i s often accomplished at t h e i r own expense. Their l i s t e n i n g s k i l l s and comforting nature i s sought by others, while t h e i r own emotional needs are generally neglected. In contrast, c h i l d r e n who take on the r o l e of the adjuster tend to go with the flow and put t h e i r l i v e s into someone elses hands. Being manipulated by others follows the adjustor i n t o adulthood. Wegescheider (1981), on the other hand, believes c h i l d r e n assume four d i f f e r e n t roles i n response to t h e i r family dynamics. The family hero, s i m i l a r to the responsible one, i s a c h i l d who tends to become p e r f e c t i o n i s t , always demanding more of themselves and others. They are usually unable to relax and l e t others care f o r them. The scapegoat ro l e , often assumed by the second c h i l d i s viewed as the o u t l e t for parental anger. She/he i s groomed to act out the family's dysfunction. Children who act out are r e a d i l y i d e n t i f i a b l e and are often labeled problem c h i l d r e n or delinquents. The c h i l d r e n who assume the l o s t c h i l d role are the most d i f f i c u l t to i d e n t i f y . Like the adjuster she/he hopes to go through l i f e unnoticed. In order to avoid attention and c o n f l i c t , they constantly adapt. The mascot r o l e i s usually reserved for the youngest c h i l d . They are seen as a r e l i e f from anxiety by t h e i r family. Members of the family t r y to s h i e l d the mascot from t h e i r troubles and i n return the mascot learns to entertain, charm and manipulate others. 14 Jesse (1989) questions the u t i l i t y of role assignment of the c h i l d ' s observable behaviour. She contends that the process of c h i l d recovery i s neither enhanced nor strengthened by seeing the c h i l d as a r o l e . She believes that these la b e l s "merely obscure the l o s t c h i l d - s e l f which i s screaming for f u l l expression" (p. 186). PSYCHOLOGICAL ABUSE The re s u l t a n t behaviour of a parent's chemical dependency i s i n and of i t s e l f p sychologically disruptive to the developing c h i l d (Jesse, 1989). I t creates a form of psychological maltreatment, which promotes unhealthy patterns of c h i l d and family r e l a t i o n s (Spence & Schmidt, 1989). The l i t e r a t u r e delineates those parental i n t e r a c t i o n s which r e s u l t i n the psychological abuse of the c h i l d r e n . C h i l d - r e a r i n g i s d i f f i c u l t f o r an a l c o h o l i c parent (Udaykamuri, Mohan, Sharr i f , Sekar & Chamundi, 1984; M i l l e r & Jang, 1979; Jesse, 1989). Parents who are dependent on alcohol/drugs become l o s t i n t h e i r s e l f absorption (Jesse, 1989). In the chemically dependent family system, the addicted parent(s)' alcohol l e v e l appears to set the tone for parent c h i l d i n t e r a c t i o n s . The a l c o h o l i c ' s behaviour i s determined by how much she/he has had to drink and how hung over she/he i s . Sudden i r r a t i o n a l punishment, or over-reactions followed by over-indulgent behaviour bewilders these c h i l d r e n (Woodside, 1983). Woodside (1983) postulates that these c h i l d r e n compensate by 15 experiencing the parent as two d i s c r e e t p e r s o n a l i t i e s , one good, one bad. Negative f e e l i n g s about the bad parent are often externalized as anger directed at others. Parents studied at the Washington Center for Addiction described addiction as d i r e c t l y and i n d i r e c t l y i n t e r f e r i n g with the time, energy and emotional responsiveness required f o r adequate c h i l d - r e a r i n g (Black & Mayer, 1980; Jesse, 1989). Love consistency and p r e d i c t a b i l i t y are important parenting tasks. The very nature of alcohol/drug addiction i n h i b i t s one's a b i l i t y to carry out these tasks. The parenting s t y l e of a chemically dependent person i s charac-t e r i z e d by chaos and u n p r e d i c t a b i l i t y which presents extreme incon-s i s t e n c i e s to the c h i l d (Morehouse, 1983; Jesse, 1989; N a i d i t i c h , 1987; Wegescheider-Cruse, 1985). Black (1981), Wegescheider (1981) and Woiltz (1983) have suggested that the c h i l d ' s development and i d e n t i t y are s t i f l e d by parental i n c o n s i s t e n c i e s , double bind messages, hidden f e e l i n g s , incomplete information, shame, uncertain-ty and mistrust. The c o n f l i c t - r i d d e n a l c o h o l i c family causes an i n c r e d i b l e amount of psychological stress and s t r a i n on i t s members. Parents cannot protect t h e i r c h i l d r e n from the marital c o n f l i c t which accompanies alcoholism. Through her work with latency age c h i l d r e n of addicted parents Jesse (1989) found that the c h i l d i s used to buffer the emotional turmoil of the s t r e s s f u l marital r e l a t i o n s h i p . Two of the most potent r o l e s that a c h i l d can take i n order to buffer the emotional turmoil of the marital r e l a t i o n s h i p s 16 are those of the scapegoat and the responsible one. In the case of the scapegoat, the c h i l d rebels and/or acts-out thus drawing atten-t i o n away from the marital c o n f l i c t onto himself. The responsible one, by becoming the confidante and support system for one of the parents, balances what i s missing i n the marital r e l a t i o n s h i p . The addition of each c h i l d to the family increases the stress on the parental r e l a t i o n s h i p and may escalate the addictive behaviour. When parents are preoccupied with t h e i r own f r u s t r a t i o n s , emotional upsets and defensiveness, they have d i f f i c u l t y focusing on their c h i l d ' s needs. Consequently the c h i l d s u f f e r s interference i n s e l f development. Through the lack of attention, d i r e c t i o n and p o s i t i v e modelling by t h e i r parents these c h i l d r e n may lack the development of a coherent p o s i t i v e self-concept. Emotional a v a i l a b i l i t y , although d i f f i c u l t to define, must be present for a c h i l d to f e e l loved and secure. Alcohol/drug addiction i n t e r f e r e s with a person's a b i l i t y to be t r u l y empathic, g i v i n g or t r u l y s e l f denying, which i s c r u c i a l to emotional a v a i l a b i l i t y (Jesse, 1989). There i s a pervasive lack of empathy which characterizes parent-child i n t e r a c t i o n s within the a l c o h o l i c home. The f a i l u r e to be empathic with one's chi l d r e n a f f e c t s the c h i l d ' s a b i l i t y to maintain self-cohesion — the a b i l i t y to maintain i n t e g r a t i o n and balance within. This i n a b i l i t y to integrate and balance d a i l y l i f e experiences may lead to a c h i l d acting-out agressively or conversely becoming withdrawn and passive. The 17 parents' i n a b i l i t y to be empathically attuned to others and his/her c h i l d r e n i s due to the chaotic or unstable s e l f of both parents (Jesse, 1989). If the parents' cannot balance and integrate t h e i r own d a i l y l i f e experiences and must use alcohol as a s t a b i l i z e r , how can they model healthy i n t e g r a t i o n for t h e i r children? Jesse (1989) proposes that the parents own lack of self-cohesion i n t e r f e r e s with t h e i r a b i l i t y to acknowledge each other or t h e i r c h i l d r e n as separate autonomous beings. A disordered s e l f i s analagous to alcoholism. The nonaddicted parent's co-dependency i s f a r more subtle and more r e s i s t a n t to change, consequently his/her lack of self-cohesion i s often less obvious. As long as t h i s parent operates within a controlled external context, the sense of s e l f w i l l appear i n t a c t . Any loss of structure threatens the inner s e l f thus making control a major issue. This need for control d i s t o r t s the parent-child r e l a t i o n s h i p . The purpose of c o n t r o l i s always aimed at maintaining the sense of s e l f . Jesse continues to postulate that what underlies the need for c o n t r o l i s fear. The major fear i n the alcoholic/addicted family system i s the fear of loss of s e l f . Fear of loss of s e l f (absorption of another person) may e x i s t because the true self-concept has never been established (Tuna, 1988). Inconsistent, confusing responses from parents can lead to an incomplete sense of s e l f , consequently the adult with an a l c o h o l i c family background may have no i d e n t i t y which i s strong enough to withstand intimate association with another person (Tuna, 18 1988) . This r e s u l t s i n a r i g i d set of mechanisms for s e l f p r o t e c t i o n . Some of these mechanisms are d e n i a l , repression and d i s s a s s o c i a t i o n , a l l of which i n t e r f e r e with the parents' a b i l i t y to be empathic, and lead to t h e i r i n a b i l i t y to i n t e r p r e t the c h i l d ' s cues. The development of a healthy s e l f begins with what may be c a l l e d the "caretaking surround" (Jesse, 1989). In order f o r the c h i l d to develop healthy i n t e r n a l coping s k i l l s , the caretakers ( i n most instances the parents) must provide optimal responsiveness to the c h i l d ' s basic needs (Jesse, 1989). The caretaker's approval of the c h i l d contributes to the c h i l d ' s inner experiences of being valued, worthwhile and loved (Jesse, 1989). A c h i l d i s unable to resolve these f e e l i n g s on h i s own. Consequently she/he tends to d i s p l a y unrest or a g i t a t i o n , i n d i c a t i n g a lack of inner soothing (Jesse, 1989) . The capacity f o r inner coping of a c h i l d of an a l c o h o l i c i s u s u a l l y grossly disturbed (Jesse, 1989). As well the c h i l d ' s a b i l i t y to experience his/her f e e l i n g s are also impaired, for t h i s process can only happen i f there i s someone who f u l l y supports, accepts and understands him/her ( M i l l e r , 1981). The lack of an i n t e r n a l i z e d soothing voice culminates i n t h e i r lack of s e n s i t i v i t y to t h e i r own inner cues, often leading them to follow the patterns set out by t h e i r addictive parents (Jesse, 1989). 19 PSYCHOLOGICAL DISORDERS The heightened psychological r i s k f o r a l l c h i l d r e n with a l c o h o l -i c parents has been investigated by a number of researchers. A few studies u t i l i z i n g objective measures have been conducted i n order to determine the s p e c i f i c connections between parental alcoholism and psychological disorders. The r e s u l t s from these studies i n d i c a t e that COAs have lower self-esteem and a more external locus of con t r o l implying that t h e i r perceptions of rewards and l i f e reinforcements are under control of others (Woodside, 1984). COAs believe that external forces govern t h e i r destiny, r e s u l t i n g i n an e x t e r n a l i z a t i o n of t h e i r r e s p o n s i b i l i t i e s (Robinson, 1989). Fine (1976) compared COAs with c h i l d r e n whose parents had p s y c h i a t r i c disorders and found that COAs were more emotionally detached, dependent and s o c i a l l y aggressive. They were les s able to concentrate, more prone to emotional upset, f e a r f u l , anxious and more preoccupied. Research indicates that male c h i l d r e n of an a l c o h o l i c parent were more l i k e l y to ex h i b i t acting out behaviour than female c h i l d r e n (Anderson & Quest, 1983). Children whose fathers were a l c o h o l i c s tended to show greater frequency of conduct disorders whereas c h i l d r e n with an a l c o h o l i c mother tended to show more emotional problems (Steinhausen, Godel & Nestler, 1984). Children of a l c o h o l i c fathers have been reported to show p o s i t i v e emotional functioning when they have experienced a p o s i t i v e r e l a t i o n s h i p with 20 t h e i r mothers (Obuchowska, 1974). If t h i s p o s i t i v e maternal contact i s absent the c h i l d r e n are negative, resigned or aggressive (Jesse, 1989). In Richard's (1979) work with c h i l d r e n of a l c o h o l i c mothers he observed a high degree of impairment i n r e a l i t y t e s t i n g . These c h i l d r e n witness not only blackouts, but constant denial of drinking behaviour, often reinforced by t h e i r nonaddicted father. Richard's (1979) found that prolonged exposure to such a confusing s i t u a t i o n u s u a l l y r e s u l t s i n an intense dependency upon the mother. Since the c h i l d can not t r u s t what he or she sees, the mother i s needed more, not l e s s , as the c h i l d grows. One of the most comprehensive studies of COAs was completed by Nylander (1960). Nylander compared 229 c h i l d r e n of a l c o h o l i c fathers i n Stockholm with 163 c h i l d r e n of nonalcoholic parents. He found that COAs exhibited somatic complaints such as nausea, vomiting and headache. As well they had problems with t i c s , encopresis, aggression and u n s o c i a b i l i t y . These chi l d r e n also showed mental i n s u f f i c i e n c i e s , mainly anxiety, nuerosis and depression. These o v e r a l l patterns of symptoms are consistent with the findings of another large scale study completed by Haberman (1966). In t h i s study COAs were rated by t h e i r mothers for c h i l d -hood symptoms of emotional problems. These ratings were compared to those of mothers of ch i l d r e n from nonalcoholic homes. The COAs had a higher frequency of s t u t t e r i n g or stammering, unreasonable fears, staying alone and r a r e l y playing with other children, frequent 21 temper tantrums, con s i s t i n g f i g h t i n g with other c h i l d r e n , bed wetting a f t e r age 6, frequent trouble i n school because of bad conduct or truancy and often i n trouble i n the neighbourhood. Miketic (1972) studied 364 COAs between 1968 and 1971 and found s i m i l a r r e s u l t s . His sample comprised of c h i l d r e n from families i n which 91% of the fathers were a l c o h o l i c . In 4% of the f a m i l i e s , the mothers were a l c o h o l i c and 5% of both parents were a l c o h o l i c . The c h i l d r e n displayed neurotic disturbances manifested i n bedwetting, fear of the dark, n a i l b i t i n g and s t u t t e r i n g . Underage delinquency was also a consistent f i n d i n g . COAs are under a tremendous amount of s t r e s s . The n a t u r a l l y calm i n t e r n a l state of latency age does not seem to apply to c h i l d r e n from chemically dependent f a m i l i e s (Jesse, 1989). Inner coping problems i n these c h i l d r e n indicated that t h e i r inner experience i s not a peaceful one (Jesse, 1989). Rather, d i s r u p t i o n i n s e l f development, such as low self-esteem and delayed verbal s k i l l s , which have been occuring throughout childhood renders these latency age c h i l d r e n p a r t i c u l a r l y vulnerable to the e f f e c t of stress (Jesse, 1989). In Ackerman's (1986) view these c h i l d r e n use d e n i a l , regression, withdrawal and impulsive acting-out i n order to cope with the s t r e s s . He defines d e n i a l as being f u n c t i o n a l . I t i s u t i l i z e d by the c h i l d to a l l e v i a t e his/her emotional pain or to give him/her a break from thinking about the s i t u a t i o n . When the c h i l d regresses i t i s an attempt to return to an e a r l i e r more secure 22 st a t e . Withdrawal can provide r e l i e f from his/her s t r e s s f u l circum-stances by removing the c h i l d emotionally or p h y s i c a l l y from the s i t u a t i o n . Impulsive acting-out may be a way for chil d r e n under stress to draw attention to themselves instead of focusing on the r e a l issues. Jesse (1989) i d e n t i f i e s seven defense mechanisms which COAs u t i l i z e i n order to protect t h e i r " f r a g i l e t entative s e l f " . Impulsive behaviour i s used to r e l i e v e the inner tension created by the c h i l d ' s s i t u a t i o n . Disassociation allows the c h i l d to s p l i t o f f strong fee l i n g s and memories of these feelings from consciousness. The defense mechanism disavowal i s defined as the repression of the emotional component of a p a i n f u l experience. The p a i n f u l r e a l i t y i s understood but the associated fee l i n g s are blocked. Thus, p a i n f u l ideas or fe e l i n g s whose origins are within the s e l f , are projected outwardly and are experienced as though they o r i g i n a t e i n the other. When the c h i l d has encountered early trauma, i n having h i s / her e a r l y achievements met by c r i t i c i s m and discounting from the parent, he/she experiences depersonalization. Jesse contends as adults they then have t h e i r accomplishments clouded by a sense of un r e a l i t y . Hypochandriasis and somatization are also c h a r a c t e r i s t i c defenses used by COAs for s e l f preservation. I t i s the expression through physical symtoms of d i f f i c u l t f e e l i n g states. Anxiety and depression are common reactions to both parental drinking and to the ongoing family c o n f l i c t (Robinson, 1989; Moos & B i l l i n g s , 1982). Fear and anxiety r e s u l t from a lack of s t a b i l i t y 23 i n the home and the consequent lack of inner security i n the c h i l d (Brown s Sunshine, 1982). Children within the age range of 6-12 years scored higher on the anxiety scales than c h i l d r e n from abstaining f a m i l i e s (Anderson & Quest, 1983). COAs are more l i k e l y to become depressed than c h i l d r e n from nonalcoholic homes. They are more l i k e l y to describe t h e i r childhood as unhappy and unstable, as compared to chil d r e n from nonaddicted families (Callan & Jackson, 1986). The diagnosis of both major depressive disorder and alcohol disorder are strongly related to unfair d i s c i p l i n e or inconsistent d i s c i p l i n e (Holmes & Robins, 1988), common occurrances i n the a l c o h o l i c home. "Depression can r e s u l t from the depriving nature of the home environment, from the c h i l d ' s low self-esteem and/or from the i n t r o j e c t i o n of harsh devalued parental objects" (p. 69) (Brown & Sunshine, 1982). Their depression, i f not treated, may be c a r r i e d i n t o adulthood, becoming a l i f e long legacy (Black, 1981). I t i s apparent that by the time the COA reaches middle childhood he/she may demonstrate impairment i n emotional development manifes-t i n g i n a va r i e t y of mental and physical symptoms. The ongoing stress and s t r a i n of l i v i n g i n t h i s chaotic environment takes i t s t o l l on these c h i l d r e n . If there i s a p o s i t i v e r e l a t i o n s h i p with the nonaddicted parent, as suggested by Obushowska (1974), the c h i l d may be less adversely affected. 24 IMPACT ON PSYCHOSOCIAL DEVELOPMENT The experience of l i v i n g i n an a l c o h o l i c home generates a d a i l y environment of fear, abandonment and tension (Cermak, 1986; Wilson, 1985; Booze & A l l e n , 1974). Many c l i n i c a l reports i n d i c a t e that the o f f s p r i n g of a l c o h o l i c s appear to be at an increased r i s k for psy-chosocial problems (El-Guebley & Orford, 1977; Jacobs & Leornard, 1986; Chaftez, Blane & H i l l , 1971). The l i t e r a t u r e concurs that the impact and s e v e r i t y of poor parenting due to alcoholism a f f e c t s the c h i l d ' s self-concept and l a t e r adult behaviour i n a number of areas. Peer r e l a t i o n s h i p s , academic achievement and the a b i l i t y to parent t h e i r own c h i l d r e n are adversely effected. The self-esteem of c h i l d r e n who grow up i n an a l c o h o l i c family i s often severely damaged (Robinson, 1989). S o c i a l science research reports that o v e r a l l COAs score lower on v i r t u a l l y a l l the s e l f -image measures (Robinson, 1989). Self-esteem i s a family a f f a i r . The c h i l d ' s f i r s t experiences i n h i s family leads him to makes decisions on how loveable and l i k e a b l e she/he i s (Naiditch, 1987). Factors such as the nonalcoholic parent who i s preoccupied and never seems to have enough time; the a l c o h o l i c parent who predictably changes or who promises and never d e l i v e r s ; the c h i l d ' s g u i l t and self-blame for causing the drinking; the betrayal and h o s t i l i t y that accompanies parental alcoholism; the embarrassment i n front of friends and the s o c i a l stigma attached to alcoholism - a l l culminate i n poor self-worth (Robinson, 1989). When chil d r e n have been 25 blamed, humiliated and shamed by the dynamics of the a l c o h o l i c family, they become enmeshed i n those dynamics. Children then have a d i f f i c u l t time separating themselves from t h e i r family s i t u a t i o n . Consequently they i n t e r n a l i z e humiliation and shame and begin to f e e l unworthy. Shame then becomes part of t h e i r self-concept (Robinson, 1989; Fossum & Mason, 1986). Family patterns of r e l a t i n g set the stage for the kinds of r e l a t i o n s h i p s c h i l d r e n w i l l have with others outside the home. In the chemically addicted family p o s i t i v e r o l e models are generally missing. Furthermore, s i l b i n g r e l a t i o n s h i p s are often c o n f l i c t -ridden (Robinson, 1989). This less than i d e a l home environment a f f e c t s the developing c h i l d ' s a b i l i t y to r e l a t e to others i n mutually enhancing ways (Morehouse & Richards, 1982). For many of these c h i l d r e n the "need for co n t r o l " leads to d i f f i c u l t y i n maintaining meaningful r e l a t i o n s h i p s (Black, 1981). During the middle childhood years when s o c i a l i z a t i o n and peer r e l a t i o n s h i p s are p a r t i c u l a r l y important these c h i l d r e n are often prevented from making normal friendships. They may withdraw inward or may turn t h e i r f r u s t r a t i o n and anger outward i n aggressive a n t i - s o c i a l behaviour (Jesse, 1989). Consequently, they tend to have fewer peer r e l a t i o n s h i p s and a greater tendency to have adjustment problems as adolescents (Spence & Schmidt, 1989; Robinson, 1989). 26 In the a l c o h o l i c home, with i t s skewed communications and confused r o l e s , the c h i l d has to make sense of what i s often an i r r a t i o n a l s i t u a t i o n (Hecht, 1977). Trapped i n t h i s d i s t o r t e d family system i t i s d i f f i c u l t f o r these c h i l d r e n to master l i f e ' s developmental tasks. They have trouble developing t r u s t i n verbal communication due to the parents' broken promises and unpredictable behaviour (Hecht, 1977; Richards et a l . , 1981). They become cue-oriented, that i s , dependent on environmental feedback to determine how they should act (Hecht, 1977; Jesse, 1989). D i s t r u s t of parents i s often generalized to other adults, authority figures and peers (Robinson, 1989). The r e a l tragedy occurs when as adults them-selves, they f i n d i t d i f f i c u l t to form intimate r e l a t i o n s h i p s , which are nec e s s a r i l y based on t r u s t (Subby, 1987; Richards et a l . , 1981; Robinson, 1989). I t i s apparent from the l i t e r a t u r e that the chemically addicted family environment i s often plagued with tense, b i t t e r i nteractions that cause anxiety and stress for a l l family members. The c h i l d ' s anxiety may be so high that i t i n t e r f e r e s with his/her a b i l i t y to process and store information, thus creating d i f f i c u l t i e s i n short and long-term memory storage (Jesse, 1989). Their academic success i s hindered by d i f f i c u l t i e s created i n behaviour and r e l a t i o n s h i p s . Some behavioural d i f f i c u l t i e s are lack of concentration (Spence & Schmidt, 1989; Brown & Sunshine, 1982), low attention span (Robinson, 1989) and fidgety, r e s t l e s s behaviour (Jesse, 1989; Brown 27 & Sunshine, 1982). Learned helplessness (Brown & Sunshine, 1982), fear of teachers, fear of f a i l u r e and fear that other students w i l l d i s l i k e them (Brown & Sunshine, 1982; Robinson, 1989), increase these children's already heightened anxiety and stress l e v e l thus making academic success d i f f i c u l t (Robinson, 1989). Robinson (1989) points to several a d d i t i o n a l factors that increase our understanding of why these c h i l d r e n do poorly i n school. Parents are consumed by t h e i r problems and are unable to be a support to t h e i r c h i l d r e n . If the c h i l d does do well i n school i t i s generally without parental assistance. It i s d i f f i c u l t for ch i l d r e n to study or keep t h e i r mind on homework i n a home where chaos i s the norm. The u n p r e d i c t a b i l i t y and inconsistency of a l c o h o l i c households have a d i r e c t bearing on poor academic performance. Constant upheaval at home makes completing homework assignments impossible. Coping with the e f f e c t s of alcoholism on the family often drains 90% of a c h i l d ' s energy, leaving the c h i l d with very l i t t l e l e f t for school. A l c o h o l i c parents model poor mastery of adult s k i l l s i n c l u d i n g parenting. O'Gorman & Diaz (1986) i n the i r work with parents who were raised by alch o l i c / d r u g addicted parents found that the dys-functional parent-child i n t e r a c t i o n s are d i r e c t l y related to continuing the cycle of addiction. They contend that alcoholism anesthetizes emotions and prevents the a l c o h o l i c from being able to 28 i d e n t i f y h i s emotions, thus making i t d i f f i c u l t for him/her to handle his/her c h i l d ' s emotions. Such parents often react negative-l y or respond i n ways which attempt to stop the c h i l d ' s emotional expression i n order to lower the parent's own anxiety. As a r e s u l t the c h i l d r e n learn to hide t h e i r feelings to avoid displeasing t h e i r parents. This repeats the cycle of d e n i a l that most a l c o h o l i c s went through as c h i l d r e n . I t breeds resentment, erodes self-esteem and sets the stage for the next generation of a l c o h o l i c s . DEVELOPMENT OF INTERVENTION APPROACHS Despite the l i t e r a t u r e confirming the impact of parent alcohol-ism, u n t i l r e c ently l i t t l e e f f o r t has been devoted to creating su i t a b l e treatment alte r n a t i v e s for these c h i l d r e n . In the past i t was seen as s u f f i c i e n t to work with only the parents, with sobriety of the parent being viewed as the only so l u t i o n needed to solve the c h i l d ' s problems. C l i n i c a l evidence supporting the importance of e a r l y interven-t i o n gradually began to accumulate i n the mid 1970s. Researchers and t h e o r i s t s generally agree that e a r l y education and intervention i s needed i n order to e f f e c t long-term behavioural changes i n COAs (El-Guebaly & Orford, 1977; Richards, 1979; Homonoff & Stephen, 1979; Morehouse, 1983; Brown & Sunshine, 1982; Typpo & Hastings, 1984; Spence & Schmidt, 1989; P i l a t & Jones, 1985; La Pantois, 1987; Jesse, 1989). The bulk of the l i t e r a t u r e are descriptions of group 29 treatment interventions using c l i n i c a l observations to determine treatment success. Although to date there i s l i t t l e documentation regarding empirical evidence as to the method that would be most b e n e f i c i a l f o r t h i s population, beginning work i n t h i s area would now suggest that group treatment at an e a r l y age maybe an e f f e c t i v e way to intervene (Typpo & Hastings, 1984; P i l a t & Jones, 1985; Brown S Sunshine, 1982). One of the primary tasks of treatment i s to help the c h i l d deal with the f r i g h t e n i n g and shameful secret of alcoholism by t a l k i n g about i t (Brown & Sunshine, 1982; La Pantois, 1987; P i l a t & Jones, 1985; Morehouse, 1983). This process i s immediately r e l i e v i n g f o r the c h i l d . Sharing secrets reduces shame, i s o l a t i o n and g u i l t and allows the exchange of ideas for coping with common problems (Cable, Noel & Swanson, 1985; La Pantois, 1987). Theory suggests that as the c h i l d gains a greater understanding of alcohol, alcoholism and the recovery process, p a i n f u l feelings of g u i l t and r e s p o n s i b i l i t y w i l l decrease reducing the c h i l d ' s anxiety and depression (Brown & Sunshine, 1982; Robinson, 1989). There are a number of reasons as to why group treatment might be an e f f e c t i v e way to intervene with these c h i l d r e n . COAs often have d e f i c i t s i n the area of s o c i a l development and lack successful experiences i n r e l a t i n g to peers. Thus a group treatment model would seem to provide those s k i l l s necessary for s o c i a l i n t e r a c t i o n . However there seems to be some controversy i n terms of the effectiveness of i n d i v i d u a l treatment versus group treatment. 30 Werner (1986) states that "intervention for c h i l d r e n of a l c o h o l i c s may be conceived as an attempt to restore balance, e i t h e r by decreasing t h e i r exposure to the r i s k of parental alcoholism and associated problems or by increasing the number of protective f a c t o r s , i . e . competencies, sources of support that c h i l d r e n can draw upon i n themselves and t h e i r care-giving environment" (p. 39). P r a c t i t i o n e r s generally agree on the common goals of a treatment group. A psycho-educational group should focus on assessing the c h i l d r e n s 1 needs and s i t u a t i o n (Cable et a l . , 1985; Morehouse, 1983; Jesse, 1989); providing support and education regarding alcohol, a l cohol abuse and alcoholism (Cable et a l . , 1985; Brown & Sunshine, 1982; Typpo & Hastings, 1984; Robinson, 1989); teaching coping st r a t e g i e s and problem solving (Homonoff & Stephen, 1979; Typpo & Hastings, 1984; Brown & Sunshine, 1982; Naiditch, 1986; Spence & Schmidt, 1989); enhancing self-esteem and modeling the i d e n t i f i c a -t i o n and expression of fee l i n g s (Cable et a l . , 1985; Morehouse, 1983; P i l a t & Jones, 1985; La Pantois, 1987; Typpo & Hastings, 1984). These objectives are c a r r i e d out through b r i e f l e c t u r e s , discussions, r o l e plays, f i l m and art a c t i v i t i e s . Jesse (1989) has integrated previous work and taken i t a step further i n her development of the "Parent as Co-Therapist C h i l d Recovery Model (PACT)". She believes that group treatment can be used i n addition to i n d i v i d u a l c h i l d centered therapy. She states that a group treatment model w i l l not s i g n i f i c a n t l y a l t e r a c h i l d ' s 31 developmental d e f i c i t s . She believes group treatment i s not the most b e n e f i c i a l treatment model for a number of reasons. Children have d i f f i c u l t y forming a cohesive sense of s e l f , thus making group cohesion very d i f f i c u l t . In addition these children's problems i n verbal s k i l l s and d i f f i c u l t i e s with inner coping i n t e r f e r e with the therapeutic e f f e c t of group treatment. The PACT c h i l d recovery model i s based on the assumption that the most therapeutic agent for the c h i l d w i l l be the parents and that the family i s most conducive to supporting l a s t i n g change. She views the c h i l d ' s treatment and parents' treatment as simultaneous. While developing the empathic p o t e n t i a l of the parent, she i s c o n t i n u a l l y f a c i l i t a t i n g the development of a more adequate and responsive care-taking environment for the c h i l d . Jesse (1989) states that intrapsychic change comes about slowly. The c h i l d ' s sense of s e l f which was derived from the chaotic period of drinking i s extremely r e s i s t e n t to change. This i s due to the i n t e r n a l i z a t i o n process that takes place unquestioned by the c h i l d . This i s p a r t i c u l a r l y evident for the c h i l d who i s born i n t o the a l c o h o l i c family system, the dynamics of which become part of his i d e n t i t y formation. Consequently she sees one year as a minimum for successful treatment. In her model i n d i v i d u a l c h i l d centered therapy focuses on f a c i l i t a t i n g cohesion of the c h i l d ' s inner world and encouragement of the f u l l expression of the c h i l d ' s inner s e l f . 32 Soothing interactions with the therapist promotes ego strengthening and increases the c h i l d ' s a b i l i t y to use the t h e r a p i s t as a source of calm and strength. Jesse's (1989) major intervention with the parent during t h i s time i s based on a suportive/observational model. Supporting the parents through early phase recovery work, the therapist acts as a r o l e model of empathic responsiveness. This process comprises the f i r s t 10-15 minutes of a c h i l d ' s session. Later i n a session with the parents, the therapists speaks about her obsrevations and gives feedback regarding misconceptions about t h e i r c h i l d and parenting. Jesse (1989) belives that the r e a l healing for the c h i l d comes from healing the troubled parent-child r e l a t i o n s h i p . The c h i l d ' s healing i s going to require slow, steady, ongoing recovery with l o t s of love. Although Jesse recognizes that engaging the parents as ..co-therapist i s not always possible, she believes the parent i s the best person to provide that care and healing. GROUP TREATMENT EFFECTIVENESS Documentation regarding the effectiveness of ch i l d r e n of addicted parents groups are few i n number. Five studies were found i n the l i t e r a t u r e and of those f i v e only one was e m p i r i c a l l y based, u t i l i z i n g an experimental design i n v o l v i n g 81 c h i l d r e n (Roosa, Gensheimer, Ayers & S h e l l , 1989). In the remaining four studies, 33 research design methods were not mentioned, sample sizes were small and c l i n i c a l observations were used to assess treatment success (Homonoff & Stephen, 1979; La Pantois, 1986; P i l a t & Jones, 1985; Robinson, 1983). In two of the studies, parent-child questionnaires were administered to measure improvement i n the c h i l d ' s functioning (Homonoff & Stephen, 1979; Robinson, 1983). Recruitment procedures, sample s i z e s , s e l e c t i o n c r i t e r i a , group s i z e and duration of the group intervention varied among the studies. Of those studies that mentioned recruitment, procedures consisted of s e l f - r e f e r r a l (Homonoff & Stephen, 1979; La Pantois, 1986; Robinson, 1983); s e l f - s e l e c t i o n ; active recruitment within the elementary school system (Roosa et a l . , 1989); and encouragement of c l i e n t s from alcohol and drug treatment programs to e n r o l l t h e i r c h i l d r e n (Brown S Sunshine, 1982; P i l a t & Jones, 1985). Of those studies that reported sample s i z e , numbers ranged from 25 (La Pantois, 1986) to 81 i n the Roosa et a l . (1989) study. C r i t e r i a f o r entry into a p a r t i c u l a r program d i f f e r e d as well. In the Roosa et a l . (1989) study, c h i l d r e n i n the 4th, 5th and 6th grades were shown a f i l m c a l l e d "Kids Like Us" which depicted 10 and 12 year old COAs experiencing a number of c r i s e s , p e r c i p i t a t e d by t h e i r parent's alcoholism. The f i l m portrays an a l c o h o l i c family r e a l i s t i c a l l y from the c h i l d ' s perspective. Children who were interested i n dicussing the f i l m and a related program being offered 34 i n the school were i n v i t e d to a second meeting scheduled for l a t e r that day. Children who attended the second meeting were given parental permission s l i p s . Those c h i l d r e n who received parental permission were then randomly assigned to an intervention or co n t r o l group. Those assigned to the intervention group met i n groups of 8 to 10 f o r one hour a week for eight weeks. Each session was led by a graduate student and teacher or s o c i a l worker from the host school. Brown S Sunshine's (1982) study was heterogeneous with regard to age, sex and socioeconomic c l a s s . The c h i l d ' s parents were required to have a diagnosis of alcoholism and be i n treatment. The group met during the school year for an hour each week and the ch i l d r e n remained members for an average of two years. The group size was lim i t e d to eight c h i l d r e n . The remaining studies did not mention sampling c r i t e r i a . La Pantois (1986) conducted an open-ended group with c h i l d r e n of alc o h o l and cocaine-addicted parents. The chi l d r e n were from lower middle cl a s s f a m i l i e s . Most of t h e i r parents were i n treatment. Although there were a t o t a l of 25 c h i l d r e n who registered i n the program, only 8 c o n s i s t e n t l y attended the group each week. The ch i l d r e n met once a week for 1 1/2 house i n an outpatient drug and alcohol c l i n i c . P i l a t & Jones (1985) developed a treatment program f or COAs through a large family alcoholism treatment center. Parents that 35 were involved with the center were encouraged to bring t h e i r c h i l d r e n aged 5 to 19 years to the children's group. Their three phase program met for a t o t a l of twenty weeks. Before the f i r s t phase c h i l d r e n attend a serie s of educational lectures with the en t i r e program population twice a week for four weeks. The purpose of Phase I i s to begin to educate the ch i l d r e n about alcoholism and i t s a f f e c t on the family. During t h i s phase the ch i l d r e n are encouraged to be open and honest with t h e i r f e e l i n g s . The c h i l d r e n were divided into age appropriate groupings and met for 1 1/2 hours a week for four weeks. Phase II i s based on a support group model. The structure i s s i m i l a r to Phase I. Children attend Phase II f o r 1 1/2 hours once a week for twelve weeks. Important issues that are deal t with i n t h i s phase include: coping mechanisms, self-esteem and mastery, generational boundaries and s e l f - i d e n t i t y . Phase I II involves regular attendance at Alateen or pre-Alateen meetings i n the community. These meetings allow ongoing support and provide a s o l i d program f o r recovery from family alcoholism. Description of the sample was not mentioned i n t h i s study or the Robinson (1983) study. The Robinson study required c h i l d r e n to maintain a minimum acti v e membership of s i x months. The c h i l d r e n met once a week for 2 to 5 hours for a ten week module. The intervention i n a l l these studies was a group treatment model that educated the ch i l d r e n about the addictive process and how i t a f f e c t s family members. Goals of treatment were overcoming 36 f e e l i n g s of i s o l a t i o n , shame or g u i l t related to parent's addic-t i o n s . As well the c h i l d r e n were taught s k i l l development regarding problem solving and coping; how to i d e n t i f y and express emotions; self-esteem enhancement and how to seek support from outside resources. Two of the studies (Brown & Sunshine, 1982; Homonoff & Stephen, 1979) attempted to repair the family r e l a t i o n s h i p s that had been damaged by alcoholism, although they did not describe how t h i s was done. The objectives of the group were implemented by a range of i n t e r v e n t i o n techniques including play therapy, art a c t i v i t i e s , structured homework, ro l e playing and f i l m s . Roosa et a l . (1989) used video taped modelling, d i d a c t i c presentations and behavioural rehearsal as teaching aides. Reports regarding implimentation d i f f i c u l t i e s were minimal. Homonoff & Stephen (1979) reported d i f f i c u l t i e s i n recruitment, noting that word of mouth by s a t i s f i e d c l i e n t s proved to be the most successful method. In La Pantois (1986) study one of the c r i t e r i a f o r determining therapeutic success was the development of group cohesion. This might imply that group cohesion was d i f f i c u l t . Outcome measures were u t i l i z e d i n only one study (Roosa et a l . , 1989). The measures used were designed to serve three objectives: to i d e n t i f y c h i l d r e n who have an alcohol abusing parent, to evaluate the impact of the mediator variables manipulated by the intervention 37 (self-esteem, coping and t h e i r impact on mental health outcomes regarding depression and school adjustment), and to c o l l e c t informa-t i o n on the intervention process for the purpose of guiding c u r r i c u -lum r e v i s i o n and future program implementation. Outcome measures were: Harter's (1985) Self-Perception P r o f i l e for Children (SPPC), which was used to assess global self-concept and s e l f evaluation i n s p e c i f i c domains (cognitive competence, s o c i a l competence and global self-worth); W i l l ' s (1985) Coping Strategies Inventory (modified version); Kovac's (1985) Children's Depression Inventory (CDI) and the AML Behaviour Rating Scale (1973). Process measures were used to evaluate p a r t i c i p a n t s ' p a r t i c i p a t i o n and s a t i s f a c t i o n with the program. At post-test a l l c h i l d r e n were given a 16 item question-naire requesting t h e i r opinions on various aspects of the program. In addition, group leaders completed a b r i e f evaluation form a f t e r each session. Evaluation was done i n terms of completing goals, l e v e l of group p a r t i c i p a t i o n and l e v e l of tension i n the group. Researchers found that the intervention group c h i l d r e n showed a s i g n i f i c a n t increase i n the use of p o s i t i v e coping s t r a t e g i e s , while the c o n t r o l group showed no change. There was a trend (p<.06) f o r an improvement i n support-seeking behaviour and s i g n i f i c a n t changes i n the use of both problem-focused and emotion-focused coping. In ad d i t i o n to the s e l f reported changes i n coping scores, there was a trend (p<.06) f o r teacher reports of children's moodiness to be more p o s i t i v e . There was a trend (p<.07) for group p a r t i c i p a n t s to experience a drop i n depression. However, there was no improvement 38 on the self-concept measures. Due to the small sample size the researchers state that the r e s u l t s should be treated with caution. Although no formal evaluations have been done i n terms of the following programs, c l i n i c a l observations of c h i l d r e n of addicted parents who p a r t i c i p a t e i n a psycho-educational group report s i m i l a r r e s u l t s . P i l a t & Jones (1985) i n t h e i r three phase program noted that a f t e r the intervention the c h i l d r e n had a greater understanding of alcohol and i t s a f f e c t on the family, as well as improved communications with family members. Other studies have reported an increase i n coping strategies within the system, improved problem so l v i n g ( P i l a t & Jones, 1985; Homonoff & Stephen, 1979), le s s intense f e e l i n g s of anger, fear and confusion, with an increase i n a b i l i t y to d i s c l o s e these f e e l i n g s to others (La Pantois, 1987; P i l a t & Jones, 1985) and more ass e r t i v e , s e l f - c o n f i d e n t behaviour ( P i l a t & Jones, 1985; Homonoff & Stephen, 1979; Robinson, 1983). Common l i m i t a t i o n s to the current research l i e s i n two major areas: an empirical base i s lacking and sample sizes are limited and poorly described. Given that the l i t e r a t u r e delineates a number of variables that influence the l e v e l of impairment for these c h i l d r e n future research would b e n e f i t from f u l l d e s criptions of the sample. Such data w i l l aid i n the assessment of intervention methods for c h i l d r e n who have varying l e v e l s of dysfunction. 39 CHAPTER II METHODS Between January and A p r i l 1990, eleven c h i l d r e n from eight f a m i l i e s attended Family Services, North Burnaby Alcohol and Drug Programs' Children of Addicted Parents Group. The ch i l d r e n ranged i n age from eight to twelve and were l i v i n g or had l i v e d with an alcohol or drug addicted parent/step-parent. Referrals were made by guidance counsellors, family service agencies, addiction programs and c h i l d protection agencies. Two ch i l d r e n did not complete the program. A 12 year o l d g i r l f e l t that the program was too immature for her. Furthermore, her mother was not committed to bringing her to the sessions every week. The other c h i l d , a 9 year o l d g i r l who was extremely withdrawn, attended three sessions and then continued treatment with a therapist on an i n d i v i d u a l b a s i s . C r i t e r i a f o r i n c l u s i o n i n the study were: the c h i l d must be of latency age, l i v i n g or have l i v e d with an alcohol/drug addicted parent/step-parent, have informed parental consent, and agreement to p a r t i c i p a t e i n pre- and post-testing. P a r t i c i p a t i o n i n the study was e n t i r e l y voluntary. Children were not forced to attend. If the c h i l d was reluctant about his/her enrollment i n the group we contracted with the c h i l d to attend three sessions. At that time he/she could decide whether or not to continue. No Alcohol or Drug Services or Family Services were contingent upon willingness to p a r t i c i p a t e i n the research. 40 PROCEDURE Information l e t t e r s were sent to a v a r i e t y of s o c i a l service agencies i . e . Family Services, Alcohol and Drug Programs (ADP), Women's Resource Centers, M i n i s t r y of So c i a l Services and Housing (MSSH) and T r a n s i t i o n Houses, requesting r e f e r r a l s . In addition a presentation was given by the writer to l o c a l elementary school guidance counsellors. Advertisements were taken out i n the l o c a l newspaper advising the public of a children's group geared towards addressing the needs of COAs. The p o t e n t i a l p a r t i c i p a n t s were refe r r e d by the following sources: three from MSSH, four from ADP, three were referred by elementary school guidance counsellors and one was s e l f - r e f e r r e d . The parents and/or guardians of the ref e r r e d c l i e n t s met with the writer at her o f f i c e at ADP. At th i s time the program's objec-t i v e s , goals and philosophy were explained. Background information regarding family h i s t o r y with respect to substance abuse, as well as information concerning s p e c i f i c problems that the c h i l d may be experiencing was discussed. If sexual abuse was i d e n t i f i e d as an issue, back up support was e n l i s t e d . 41 SUBJECTS Insert Table 1 about here The mean age for the four boys and seven g i r l s was 9.8 years. The average age of the c h i l d at onset of parent alcoholism was 2.6 years. Six of the chil d r e n were from single parent families and over h a l f the sample were l i v i n g with maternal alcoholism. Four of the c h i l d r e n were from homes where violence was an issue. One of the mothers of two boys i n the group suffered from mental i l l n e s s and was refusing treatment. Seven of the addicted parents were i n ea r l y recovery from alcohol/drug addiction and three were s t i l l a c t i v e l y abusing. Five of the chil d r e n were involved with MSSH concerning abuse and/or neglect issues. Seven of the children's mothers had completed high school, one was a high school graduate and two of the moms had u n i v e r s i t y degrees. Six of the children's fathers had completed high school, two graduated and the information on the remaining fathers was unavailable. Five of the mothers were at home with th e i r c h i l d r e n on a f u l l - t i m e basis. Two worked out-side the home as u n s k i l l e d workers, one as a s k i l l e d worker and one women was employed i n a professional p o s i t i o n . Six of the fathers were employed as u n s k i l l e d workers, two were s k i l l e d workers, two were i n professional positions and the information on the remaining men was unavailable. More than h a l f the sample (6) reported f a m i l i a l substance abuse. Two of the ch i l d r e n aged 11 and 12 42 Table 1 DEMOGRAPHIC DATA VARIABLE CATEGORY RAW # PERCENT SEX Addicted Parent M a r i t a l Status Mental I l l n e s s Present Education Level (Mom) Education Level (Dad) Occupa t i on (Mom) Occupation (Dad) C h i l d Experimenting w/Alcohol/Drugs Length of Sobriety F a m i l i a l Alcoholism Co-Dependent In Treatment Addicted Parent In Treatment Male 04 Female 07 Mom 06 Dad 05 Married 05 Sep/Divorced 06 Yes 04 No 07 Some High School 07 High School Grad 01 Technical School 01 University Degree 02 Some High School 06 High School Grad 02 Unknown 0 3 Caretaker of Children 05 Unskilled Worker 02 S k i l l e d Worker 01 Student 02 Professional 01 Unskilled Worker 04 S k i l l e d Worker 02 Professional 02 Unknown 03 Yes 02 No 09 Less Than 30 Days 02 Less Than 6 Months 02 More Than 1 Year 04 Active 03 Yes 06 No 05 Yes 02 No 04 Not Available 05 Yes 08 No 03 36.4 63.6 54.5 45.5 45.5 54.5 36.4 63.6 63.6 9.1 9.1 1 8.2 54.5 1 8.2 27.3 45.5 18. 2 9.1 18. 2 9.1 36.4 18.2 18.2 27.3 18.2 81.8 18.2 18.2 36.4 27.3 54.5 45.5 18.2 36.4 45.5 72.7 27.3 43 ( s i b l i n g s ) reported experimenting with alcohol and drugs. In terms of treatment, eight of the addicted parents were i n attendence at various Alcohol and Drug Programs and/or A.A. With respect to the nonaddicted parents two were i n treatment, four were not and for the remaining f i v e t h i s was not applicable or the information was un-a v a i l a b l e . Most of the c h i l d r e n attended the sessions on a regular b a s i s . DESIGN A one group pretest-posttest quasi-experimental design was u t l i z e d . P a r t i c i p a n t s were interviewed approximately 1 1/2 weeks p r i o r to the group. The writer met with the c h i l d and parent/ guardian to explain to the c h i l d the group and research process, e s t a b l i s h a r e l a t i o n s h i p with the c h i l d and explain and administer the measures. Measures were completed i n d i v i d u a l l y i n the writer's o f f i c e at ADP, 1 1/2 weeks p r i o r to the group (Time 1) and 10 to 12 weeks l a t e r (Time 2). The questions were read aloud and the c h i l d was asked to respond as best he/she could. The c h i l d was assured that there was no r i g h t or wrong answers and that t h i s was not a t e s t . If the c h i l d was unsure of how to respond he/she was asked to reply with the f i r s t answer that came to mind. During this time the parent/guardian was i n the waiting room signing consent forms and completing a demographic questionnaire which also described f a m i l i a l substance abuse, c h i l d ' s behavioural problems and current m a r i t a l s i t u a t i o n s . 44 The intervention was conducted over a nine week period. The group met weekly, every Tuesday from 3:30 pm to 4:30 pm. The group was led by three therapists: myself, a MSW student with experience i n family violence and the ADP program d i r e c t o r with experience i n addictions and sexual abuse. A l l leaders were knowledgeable about the addictive process and i t s a f f e c t on the c h i l d and family. Each session addresses issues relevent to c h i l d r e n of addicted parents. The major issues are those dealing with c o n t r o l , mistrust, avoidance of emotions, i n a b i l i t y to define boundaries and over-r e s p o n s i b i l i t y . During every session each c h i l d was treated with acceptance, consistency and understanding. Rather than s t r i c t l y adhering to program scheduling leaders respected each c h i l d and t h e i r family's i n d i v i d u a l i t y with t h e i r own timing of understanding and i n t e g r a t i n g the program content. The leaders focused on the c h i l d ' s strengths as well as helped f a c i l i t a t e healing the parent-c h i l d r e l a t i o n s h i p . The intervention targets three major goals; 1. To educate the c h i l d r e n regarding alcoholism/drug addiction, substance abuse use and i t s impact on the family. 2. To enhance the c h i l d ' s inherent strengths by teaching problem sol v i n g , coping strategies and increasing networking s k i l l s with community resources. 3. To increase the c h i l d ' s self-esteem. 45 SESSION CONTENT Session 1 - The group content, objectives and purpose were i n t r o -duced to the chil d r e n . The concept of c o n f i d e n t i a l i t y was discussed at length. The ch i l d r e n and group leaders spoke about the rules of the group. Children introduced themselves to each other through a group exercise. Session 2 - The concept of committment was discussed and the l i n k s of the committment chain were made by each c h i l d (art a c t i v i t y ) . The check-in r i t u a l was introduced. During t h i s r i t u a l each c h i l d b r i e f l y describes who his/her week went or brings up and problem or issue he/she may want to discuss. This r i t u a l s t a r t s every group meeting. The alcohol/drug education component was introduced, through a f i l m and b r i e f l e c t u r e . Session 3 - This session focused on problem-solving s k i l l s . Children were encouraged to discuss problems they were facing, and problem-solve with the help of the other c h i l d r e n . Generating a l t e r n a t i v e s and making a plan helps reduce the c h i l d ' s sense of powerlessness. The c h i l d r e n also viewed a f i l m t i t l e d "Facing Your Fears", which was the basis of a discussion that followed. Session 4 - Id e n t i f y i n g and expressing emotions were the topics of th i s session. A f i l m on body language was shown. The c h i l d r e n were encouraged to talk about what t h e i r body language was tr y i n g to say. 46 Session 5 - Trapped feelings and defenses were discussed. Each c h i l d drew h i s body and coloured areas where his/her f e e l i n g s were trapped. Session 6 - Through family sculpting, the c h i l d ' s perception of his family was explained to the group. Each c h i l d had a turn at t h i s exercise and discussion was encouraged. Session 7 - The chi l d r e n were taught the technique of "brain-storming" as a means to develop a resource l i s t . This i s a l i s t of names and agencies i n the community that the c h i l d can c a l l i f he/ she needs help. Session 8 - The c h i l d r e n were taught progressive r e l a x a t i o n and cre a t i v e v i s u a l i z a t i o n techniques. Session 9 - Part of this session focused on exploring the childrens' f e e l i n g s regarding the completion of the group and saying good-bye to the group members. The remainder of th i s session was spent playing games and having a party. MEASURES To standardize t e s t administration the interview schedule was read to a l l p a r t i c i p a n t s . The measures were chosen f o r t h e i r relevance, ease of administration and a v a i l a b i l i t y . 47 1. Children of Al c o h o l i c s Screening Test (CAST) (Jones, 1983). Children were asked to complete the CAST, which i s a 30-item inventory designed to i d e n t i f y COAs, as well as determine the c h i l d ' s perception and concerns regarding his/her family s i t u a t i o n . Research has shown that the CAST can withstand s c i e n t i f i c s crutiny and w i l l y i e l d impressive r e l i a b i l i t y and v a l i d i t y ( P i l a t & Jones, 1985). A r e l i a b i l i t y c o - e f f i c i e n t of .98 i s reported f o r t h i s i n -strument using a Spearman-Brown s p l i t - h a l f procedure (Jones, 1982). V a l i d i t y was determined by chi-square analysis and i t showed that a l l 30 items s i g n i f i c a n t l y discriminated COAs from control group c h i l d r e n . 2. Self Appraisal Inventory ( F r i t h & Narakawa, 1972). This s e l f - r e p o r t inventory i s used as an i n d i c a t o r of s e l f -concept. I t was developed to evaluate programs designed to improve the learner's self-esteem and i t s use i s encouraged within an educational s e t t i n g . The t e s t consists of items r e l a t i n g to the ch i l d ' s subjective f e e l i n g s about peers, family, school and general self-concept (a comprehensive estimate) (Harrison, 1984). As well i t of f e r s a global score which i s a composite of a l l subscales. The instrument i s divided into three l e v e l s : grades k-3 with 36 items, 4-6 with 77 48 items and a high school l e v e l with 66 items. A high score i s i n d i c a t i v e of e f f e c t i v e adjustment ( F r i t h & Narakawa, 1972). Using t h i s system t e s t - r e t e s t r e l i a b i l i t y for the measures has shown to be .73 for the primary l e v e l , .88 f o r the intermediate l e v e l and .87 fo r the high school l e v e l . ( F r i t h & Narakawa, 1972). 3. Kovacs Childhood Depression Inventory (CDI) (Kovacs, 1985). This s e l f rated depression inventory was designed to quantify the s e v e r i t y of the depressive syndrome (Kovacs, 1985). I t has been used to assess treatment outcome, t e s t research hypotheses, as well as to s e l e c t research subjects (Kovacs, 1985). The CDI i s a 27 item s e l f report symptom oriented scale that was designed for school-aged c h i l d r e n and adolescents. Its r e a d a b i l i t y i s at the f i r s t grade l e v e l (Kazdin & P e t t i , 1982). The instrument assesses a f f e c t i v e , cognitive and behavioural symptoms of childhood depression (e.g. sleep disorders, sadness) (Roosa et a l . , 1989). Each item consists of three possible responses keyed from 0-3 i n the d i r e c t i o n of increasing s e v e r i t y . The t o t a l score can range from 0-54. Reported i n t e r n a l consistency r e l i a b i l i t i e s have ranged from .70 to .94 (Kovacs, 1985; Saylor, Finch, Bennett & S p i r i t o , 1984). V a l i d i t y studies i n d i c a t e that the CDI can d i s t i n g u i s h c h i l d r e n with general emotional d i s t r e s s from normal school c h i l d r e n (Saylor et a l . , 1984). However differences between CDI scores of 49 depressed (by symptom check l i s t , DSM III) and non-depressed c h i l d r e n were not s i g n i f i c a n t l y d i f f e r e n t (Saylor et a l . , 1984). The authors' data suggests that the CDI measures a multidimensional construct that overlaps with other childhood anxiety. As well they report that although the CDI may be the best researched instrument a v a i l a b l e to measure depression from the c h i l d ' s point of view, more work i s needed before i t can be interpreted with confidence i n c l i n i c a l research s e t t i n g s . 4. Children's Manifest Anxiety Scale (Reynolds & Richmond, 1979). This instrument was u t i l i z e d to measure changes i n anxiety l e v e l s of the p a r t i c i p a n t s . The scale consists of 28 anxiety items and nine l i e items. The reading l e v e l i s s u i t a b l e f or primary grade c h i l d r e n . The scale has shown to be a r e l i a b l e measure of anxiety i n c h i l d r e n by Reynolds & Richmond (1979). R e l i a b i l i t y estimates have ranged from .83 to .88 (Reynolds & Richmond, 1979). As well there i s considerable support for the construct v a l i d i t y of t h i s scale as a measure of childhood anxiety (Reynolds, 1980; Reynolds & Richmond, 1979). I t i s seen as a valuable t o o l i n determining anxiety l e v e l s when used i n a pre-post design. 50 5. Eyberg C h i l d Behaviour Inventory (Eyberg, 1980). This scale was designed to measure parental perception of behaviour problems i n t h e i r c h i l d r e n . The measure i s appropriate fo r c h i l d r e n between the ages of 2 and 16. Total problem scores and problem i n t e n s i t y scores are computed. Test-retest r e l i a b i l i t y (.86) f o r the i n t e n s i t y score and (.88) f o r the problem score was found (Robinson, Eyberg & Ross, 1980). The mean s p l i t - h a l f r e l i a -b i l i t y for i n t e n s i t y i s .95 and the mean s p l i t - h a l f r e l i a b i l i t y for the problem score i s .94 (Robinson e t a l . , 1980). Item analysis showed that each of the minimum standards for item r e l i a b i l i t y were met. The external v a l i d i t y of t h i s instrument was reported i n previous research (Eyberg & Ross, 1978). 6. Observations At the end of each session the leaders discussed each c h i l d ' s progress. Information was gathered on each c h i l d with regards to phy s i c a l appearance, behavioural and emotional changes, p a r t i c i p a -t i o n l e v e l and in t e r a c t i o n s with other c h i l d r e n and leaders. Additional information was gathered on an informal basis from parents, s o c i a l workers and guidance counsellors, i f appropriate. These observations were important i n order to improve the r e l i a b i l -i t y and v a l i d i t y of these conclusions. 51 CHAPTER III RESULTS The findings w i l l be presented i n two sections. The f i r s t s e c tion w i l l be comprised of the outcome measures; Children of Alc o h o l i c s Screening Test, Eyberg Childhood Behaviour Inventory and The F r i t h and Narawaka Self-Appraisal Inventory. The second section presents i n d i v i d u a l evaluations. CHILDREN OF ALCOHOLICS SCREEN TEST Insert Table 2 about here This t o o l was u t i l i z e d for i d e n t i f i c a t i o n purposes only. Nine c h i l d r e n yeilded scores which are i n d i c a t i v e of c h i l d r e n of a l c o h o l i c s . Two of the children's scores ind i c a t e c h i l d r e n of problem drinkers (see Table 2). Table 2 CHILDREN OF ALCOHOLICS SCREENING TEST CASE SCORE 1 19 2 1 1 3 17 4 1 7 5 04 6 04 7 19 8 17 9 15 1 0 16 1 1 10 A score of: 0 to 1 indicates c h i l d r e n from non-alcoholic homes 2 to 5 indicates c h i l d r e n of problem drinkers 6 or more i n d i c a t i v e of c h i l d r e n of a l c o h o l i c s 53 Eyberg C h i l d Behaviour Inventory Insert Table 3 about here Results of the i n t e n s i t y of problem scale indicates a s i g n i f i -cant d i f f e r e n c e between time 1 and time 2. Intensity r e f e r s to the frequency of occurrence of the behaviour (see Table 3). Paired t-tests found that parents' perception of i n t e n s i t y of c h i l d behaviour problems decreased between time 1 (x=138, SD-37.0) and time 2 (x=119, SD-11.6, p<.05). In terms of number of problems, neither paired t-te s t s or Wilcoxon Matched-Pairs Ranked-Sign tests revealed s i g n i f i c a n t changes between time 1 and time 2. However, an examina-t i o n of mean scores does reveal a tendency for a decrease i n number of problems between time 1 (x=18.2, SD=7.0) and time 2 (x=14.0, SD=7.1 ). 54 Table 3 MEAN SCORES OF ALL PARTICIPANTS ON CHILD BEHAVIOUR SCALE Time 1 Time 2 Variable N=9 X SD x SD Intensity 1 38 37.0 119* 11.6 # of Problems 18.2 7.0 14.0 7.1 *p<.05 55 Childhood Depression Inventory Insert Table 4 about here Paired t-te s t s and Wilcoxon Matched-Pairs Ranked-Sign tests did not reveal any s i g n i f i c a n t change between time 1 and time 2 (see Table 4). However, the change i n t o t a l mean scores does show a decrease i n depression. Time 1 mean scores y i e l d 13.7 (x=13.7, SD-5.7) and time 2 y i e l d s 10.4 (x=10.4, SD=5.0) i n d i c a t i n g movement i n the anticipated d i r e c t i o n . 56 Table 4 MEAN SCORES OF ALL PARTICIPANTS ON CHILDHOOD DEPRESSION INVENTORY Time 1 Time 2 Variable N=9 X SD x SD Depression 1 3.7 5.7 1 0.4 5.0 *p<.05 57 Se l f - A p p r a i s a l Inventory Insert Table 5 about here Neither paired t - t e s t s , nor Wilcoxon Matched-Pairs Ranked-Sign tests y i e l d any s i g n i f i c a n t change between time 1 and time 2 (see Table 5). The change i n t o t a l mean scores reveals that there i s a trend f o r an increase i n a f f e c t i v e adjustment between time 1 (x=60.2, SD=16.8) and time 2 (x=63.4, SD=5.9). When looking at the subscales family r e l a t i o n s , again there i s a tendency f o r improve-ment. Time 1 mean scores y i e l d 61.1 (x=61.1, SD=14.1 ) and time 2 yielded a score of 68.5 (x=68.5, SD=13). The general subscale yielded scores of time 1 (x=60.3, SD=28.6) and time 2 (x=72.4, SD=15.2) also i n d i c a t i n g movement i n the an t i c i p a t e d d i r e c t i o n . Mean scores i n the subscales peer r e l a t i o n s and school, as well as i n the anxiety measure yielded lower scores i n time 2 (see Table 6). Individual evaluations which w i l l be presented i n the next se c t i o n may explain these r e s u l t s by describing each c h i l d ' s family s i t u a t i o n and his/her progress i n the group. Insert Table 6 about here 58 Table 5 MEAN SCORES OF ALL PARTICIPANTS ON SELF-ESTEEM MEASURE Time 1 Time 2 Variable N=9 X SD x SD Total 60.7 16.8 63.4 5. 9 General 60.3 28.8 72.4 15. 2 Family Relations 61.0 1 4.1 68.5 1 3. 0 Peer Relations 64.0 17.8 63.8 14. 2 School 51.4 27.7 46.6 21. 3 *p<.05 59 Table 6 MEAN SCORES OF ALL PARTICIPANTS ON CHILDHOOD ANXIETY Time 1 Time 2 Variable N=9 . X SD X SD Anxiety 16.4 5.7 1 6.7 6.2 L i e 2.2 2. 3 2.1 2.3 *p<.05 6 0 INDIVIDUAL EVALUATIONS In the descriptions that follow names and ages have been a l t e r e d i n order to maintain c o n f i d e n t i a l i t y . Insert Table 7 about here Case 1 Beverly i s an eleven year old g i r l who l i v e s with her a l c o h o l i c mother and two older s i b l i n g s . Her mother recently separated from a p h y s i c a l l y abusive r e l a t i o n s h i p . However, during the duration of t h i s r e l a t i o n s h i p , Beverly and her s i b l i n g s were witnesses to violence on a regular b a s i s . Also due to c e r t a i n age-inappropriate behaviours exhibited by the chi l d r e n , sexual abuse was suspected. Although Beverly's attendence was consistent she i n i t i a l l y d i d not p a r t i c i p a t e i n any of the group a c t i v i t i e s . Midway through the pro-gram she was able to begin to d i s c l o s e her f e e l i n g s , p a r t i c i p a t i n g i n a c t i v i t i e s and a c t u a l l y take a leadership role (when her s i b l i n g was absent) i n the group. I t was noticeable that by the end of the group Beverly was now wearing almost no make-up and looking more l i k e an eleven year o l d . She shows improvement on most of the measures except for perception of s e l f i n r e l a t i o n to school. Beverly had s i g n i f i c a n t school d i f f i c u l t i e s during the time of the group that might account for the lower scale (see Table 7). 61 Table 7 MEAN SCORES ON ALL MEASURES FOR CASE #1 Scale Before After Change Self-Esteem Total 48 61 +1 3 Peer Relations 74 84 +1 0 Family Relations 42 57 +05 School 53 84 -05 General 53 84 +31 Depression 17 15 -02 Anxiety 17 10 -07 Lie 0 01 +01 Intensity of Problem 1 05 93 -1 2 Number of Problems 28 12 -16 *p<.05 62 Case 2 Insert Table 8 about here Abby, a year older than Beverly, presents s i m i l a r to her s i s t e r i n terms of appearance and age-inappropriate behaviour. Abby spoke frequently about her dates with her 17 year old boyfriend. She took on a powerful p o s i t i o n i n her family, the caretaker r o l e . Abby's progress i n the group was s i m i l a r to her s i s t e r with respect to p a r t i c i p a t i o n i n group a c t i v i t i e s and to the changes i n her p h y s i c a l appearance. As well Abby recognized that her parental role i n her family was a heavy burden for her to bear and i t appeared that she was making an e f f o r t to r e l i n q u i s h t h i s p o s i t i o n . Abby's mom was also making progress i n her treatment. Consequently she was becoming more e f f e c t i v e i n her parenting. Although this change appeared to create anxiety for Abby, i t might also account for the higher score i n the family r e l a t i o n s subscales, a decrease i n depression and number of behaviour problems as well (see Table 8). 63 Table 8 MEAN SCORES ON ALL MEASURES FOR CASE #2 Scale Before After Change Self-Esteem Total 58 66 +08 Peer Relations 44 62 + 1 8 Family Relations 44 81 +37 School 29 25 -04 General 50 81 +31 Depression 12 10 -02 Anxiety 09 10 +01 Lie 01 01 0 Intensity of Problem 84 84 0 Number of Problems 14 06 -08 *p<.05 64 Case 3 Insert Table 9 about here Matthew i s a nine and a half year old boy whose s i b l i n g i s i n the group as w e l l . There i s a parental h i s t o r y of mental health problems and alcohol abuse. His parents have been separated many times due to h i s mom's r e f u s a l to take her medication or remain i n treatment. Matthew presents as a severely p h y s i c a l l y and emotional-l y neglected c h i l d i n need of prote c t i o n . Matthew's p a r t i c i p a t i o n i n the group enabled him to d i s c l o s e the p a i n f u l feelings he had trapped i n s i d e him. Although h i s t e s t r e s u l t s reveal a decline i n adjustment, c l i n i c a l observations ind i c a t e he no longer i s i n denial regarding h i s family s i t u a t i o n and i t appears that he i s not repressing his pain. His poor scoring on the measures might be i n d i c a t i v e of an attempt by the c h i l d to deal with h i s p a i n f u l emotions (see Table 9). 65 Table 9 MEAN SCORES ON ALL MEASURES FOR CASE #3 Scale Before After Change Self-Esteem Total 61 58 -03 Peer Relations 67 55 -1 2 Family Relations 56 55 -01 School 44 55 +1 1 General 78 66 -1 2 Depression 15 18 -0 3 Anxiety 25 25 0 Lie 01 0 -01 Intensity of Problem 157 1 63 +06 Number of Problems 22 23 +01 *p<.05 66 Case 4 Insert Table 10 about here Carlton, Matthew's brother, suffers from learning problems. Although t h e i r family s i t u a t i o n i s s i m i l a r , t h e i r t e s t scores are very d i f f e r e n t . Carlton was experiencing problems i n school, r e l a t e d to h i s learning problems and h i s d i s r u p t i v e acting-out behaviour. Consequently the school i d e n t i f i e d him as having d i f f i -c u l t y and enrolled him i n extra group and i n d i v i d u a l counselling. The divergent t e s t scores might be accounted for by Carlton's attendence i n a d d i t i o n a l therapeutic groups. Although Carlton improved on a l l measures, his anxiety l e v e l i s s t i l l high (see Table 10). 67 Table 10 MEAN SCORES ON ALL MEASURES FOR CASE #4 Scale Before After Change Self-Esteem Total 28 58 +30 Peer Relations 33 33 0 Family Relations 56 88 +77 School 11 22 +1 1 General 11 88 +77 Depression 20 06 -1 4 Anxiety 23 20 -03 Lie 04 03 -01 Intensity of Problem 1 72 1 50 -22 Number of Problems 26 19 -07 *p<.05 68 Case 5 Insert Table 11 about here Susie i s a nine year old g i r l l i v i n g with her mother. Susie's parents are separated due to her father's alcoholism and violence. Susie v i s i t s her dad frequently and r e g u l a r l y . Susie disclosed i n the group that she does not enjoy these v i s i t s because her dad i s e i t h e r sleeping or y e l l i n g at her. Susie presented as a "happy go lucky" l i t t l e g i r l and i n i t i a l l y scored r e l a t i v e l y high on a l l the subscales of the self-esteem measure. However, during her p a r t i c i -pation i n the group, she was able to v e r a b l i z e her f e e l i n g s of anger towards both her mother and father. Her lower scales i n terms of perception of s e l f i n r e l a t i o n to peers, family and school as well as the increase i n the number of behavioural problems was seen as consistent with her p a r t i c u l a r s i t u a t i o n (see Table 11). Susie's mom reported that although Susie seemed angry a good deal of the time and was harder to handle, she f e l t t h i s was p o s i t i v e i n the sense that her daughter was f i n a l l y able to a r t i c u l a t e her repressed f e e l i n g s . This may account for the decrease i n depression. 69 Table 11 MEAN SCORES ON ALL MEASURES FOR CASE #5 Scale Before After Change Self-Esteem Total 69 66 -03 Peer Relations 74 64 -1 0 Family Relations 84 64 -20 School 80 60 -20 General 42 68 +26 Depression 1 2 09 -03 Anxiety 16 26 +1 0 Lie 07 04 -03 Intensity of Problem 1 21 107 -14 Number of Problems 08 10 +02 *p<.05 70 Case 6 Insert Table 12 about here Charles i s a nine year old boy l i v i n g with his younger s i b l i n g s and a l c o h o l i c parent. His parent's are separated and Charles has l i b e r a l access to the noncostodial parent. Charle's p a r t i c i p a t i o n i n the group a c t i v i t i e s was i n h i b i t e d by the constant f i g h t i n g with h i s s i b l i n g , who was also i n the group. Although Charles' parent reported that h i s behaviour improved at home, his scores were s l i g h t l y lower on the peer, school and general subscales of s e l f -esteem. There was a larger decrease i n terms of perception of s e l f i n r e l a t i o n to family (see Table 12). This change might be a t t r i b u t e d to Charles' c o s t o d i a l parent being absent from the family f o r several weeks. Charles was unable to discuss t h i s s i t u a t i o n , although i t was clear from h i s acting-out behaviour that he was d i s t r e s s e d about the absence. This might account for the increase i n depression and anxiety (see Table 12). 71 Table 12 MEAN SCORES ON ALL MEASURES FOR CASE #6 Scale Before After Change Self-Esteem Total 75 67 -08 Peer Relations 74 65 -10 Family Relations 75 53 -22 School 89 70 -1 9 General 63 84 +21 Depression 09 14 +05 Anxiety 11 1 2 +01 Lie 0 0 0 Intensity of Problem 175 142 -54 Number of Problems 21 20 -01 *p<.05 72 Case 7 Insert Table 13 about here Bryan i s Charles' ten year old brother. Bryan did not do very well i n the group. The group leaders spent most of t h e i r time managing Bryan's aggressive behaviour. His p a r t i c i p a t i o n i n every a c t i v i t y was i n h i b i t e d by t h i s acting-out behaviour. The leaders believed that Bryan would benefit from i n d i v i d u a l counselling and the appropriate r e f e r r a l was made. Case 8 Insert Table 14 about here Charlotte i s an eleven year o l d g i r l who l i v e d away from her family at the time she entered the group. At mid-point she returned to her parent who i s recovering from drug addiction. Charlotte improved i n a l l areas except i n terms of her perception of s e l f i n r e l a t i o n to family (see Table 14). This may well be re l a t e d to her change i n her l i v i n g s i t u a t i o n . Her decrease i n depression i s viewed as a p o s i t i v e i n d i c a t o r . 73 Table 13 MEAN SCORES ON ALL MEASURES FOR CASE #7 Scale Before After Change Self-Esteem Total 88 61 -22 Peer Relations 89 67 -22 Family Relations 56 67 +1 1 School 89 33 -56 General 99 77 -22 Depression 14 10 -04 Anxiety 16 16 0 Lie 01 0 -01 Intensity of Problem 1 73 1 58 -15 Number of Problems 21 22 +01 *p<.05 74 Table 14 MEAN SCORES ON ALL MEASURES FOR CASE #8 Scale Before After Change Self-Esteem Total 51 58 +07 Peer Relations 53 57 +04 Family Relations 74 68 -06 School 40 65 +25 General 37 42 +05 Depression 22 11 -1 1 Anxiety 21 20 -01 Lie 02 03 +01 Intensity of Problem 93 67 -26 Number of Problems 10 04 -06 *p<.05 75 Case 9 Insert Table 15 about here A l i c e i s a nine year old g i r l who l i v e s with her mom and dad. A l i c e ' s a l c o h o l i c parent refuses treatment and i s s t i l l a c t i v e l y d rinking. I n i t i a l l y A l i c e was very withdrawn and would not p a r t i c i -pate i n any of the a c t i v i t i e s or discussions. She would stay a f t e r each session was over and complete the exercise with me i n p r i v a t e . A l i c e would l i k e to spend time with one of the leaders on her own and speak about her fears and her family s i t u a t i o n . Towards the f i f t h session A l i c e started to p a r t i c i p a t e i n the group exercises. She did p a r t i c u l a r l y well i n the family sculpting exercise. This enabled A l i c e to see what ro l e she played i n her family and how she could keep herself safe when her parent was drunk. Although A l i c e improved minimally i n terms of the subscales peer and school r e l a t i o n s , her guidance counsellor reported a noticeable change i n her. She appeared happy and was able to concentrate on her work. Her mother as well reported an improvement i n the frequency of behavioural problems. Although there was a s l i g h t increase i n anxiety there was an increase i n her perception of s e l f i n r e l a t i o n to her family, and a decrease i n depression (see Table 15). 76 Table 15 MEAN SCORES ON ALL MEASURES FOR CASE #9 Scale Before Af t e r Change Self-Esteem Total 74 76 -02 Peer Relations 79 78 +01 Family Relations 63 84 +21 School 70 70 0 General 84 73 -11 Depression 03 01 -02 Anxiety 10 1 2 +02 Lie 04 07 +03 Intensity of Problem 162 11 4 -48 Number of Problems 10 10 0 *p<.05 77 CHAPTER IV DISCUSSION Data from the interviews have given strong suport for the study's hypothesis, that the group intervention would have a p o s i -t i v e e f f e c t on the c h i l d ' s s e l f esteem and behaviour and decrease the c h i l d ' s l e v e l of depression and anxiety. One measure was s t a t i s t i c a l l y s i g n i f i c a n t , and with one exception r e s u l t s on the no n s i g n i f i c a n t r e s u l t s were i n the expected d i r e c t i o n . Findings regarding the subjects are consistent with those reported i n the l i t e r a t u r e . These c h i l d r e n tend to f e e l g u i l t y and responsible for the parental drinking. The household revolves around the a l c o h o l i c parent, leaving the ch i l d r e n f e e l i n g angry and unloved. Their lack of self-cohesion, which may manifest i t s e l f i n acting-out aggressive behaviour or a l t e r n a t i v e l y passive withdrawn behaviour, often made group cohesion d i f f i c u l t . Low self-esteem, depression and anxiety were found again i n t h i s study. Due to t h e i r anxiety c h i l d r e n were often unable to concentrate and were r e s t l e s s and fidgety, which i n h i b i t e d t h e i r a b i l i t y to p a r t i c i p a t e i n group a c t i v i t i e s . In t h i s p a r t i c u l a r sample more than h a l f the c h i l d r e n had a l c o h o l i c mothers. As well parental alcoholism began when the c h i l d r e n were young. Again i n accordance with the l i t e r a t u r e these c h i l d r e n were more l i k e l y to be abused and neglected, often with 78 basic needs not being met. This was true for a number of the p a r t i -cipants i n t h i s study. Two of the c h i l d r e n reported p h y s i c a l abuse and observations by leaders and r e f e r r a l sources indicated that a number of the c h i l d r e n were p h y s i c a l l y and emotionally neglected. In addition early childhood age at onset of parental alcoholism i s associated with more problematic functioning for the c h i l d . The average age of the c h i l d when parental alcoholism began was 2.6 years. These c h i l d r e n have not witnessed a r o l e model for "normal" family functioning, nor have they developed nondestructive coping s t r a t e g i e s . Also some of the c h a r a c t e r i s t i c s of alcoholism such as chaos, inconsistency and u n p r e d i c t a b i l i t y become entrenched i n the c h i l d ' s i d e n t i t y and continue to d i r e c t h i s or her behaviour. Ove r a l l r e s u l t s suggest that attendance at the children's group i s associated with changes i n how p a r t i c i p a n t s see themselves. As the c h i l d r e n gained a better understanding of the process of a d d i c t i o n and i t s impact on the family they were able to r e l i n g u i s h f e e l i n g s of r e s p o n s i b i l i t y and g u i l t . Through t h i s education and the various therapeutic games the c h i l d r e n were able to view t h e i r s i t u a t i o n as out of t h e i r c o n t r o l and r e a l i z e d that they could only be responsible for themselves. Thus, they were more able to d i s -engage from t h e i r family's dynamics. The group provided a safe and consistent environment for these c h i l d r e n to begin to form t r u s t i n g r e l a t i o n s h i p s . The leaders 79 modelled consistent emotional responsiveness, as well as open and honest communication. They encouraged t h i s type of i n t e r a c t i o n among the ch i l d r e n enabling p o s i t i v e experiences related to s o c i a l s i t u a t i o n s . The secret that surrounds alcoholism was shared and the c h i l d r e n began to f e e l supported, thus reducing t h e i r a l i e n a t i o n and i s o l a t i o n . This process and t h e i r increase i n self-esteem may account for the decrease i n depression for the c h i l d r e n . Most of the parents i n this sample were i n treatment for co-dependency and/or alcoholism. Although t h i s may have confounded the r e s u l t s , i t appeared to have a p o s i t i v e impact i n terms of the parents' perception of c h i l d behaviour. The parents were f e e l i n g better about themselves, consequently they were able to view th e i r c h i l d i n a more p o s i t i v e l i g h t . The s i g n i f i c a n t change i n frequency of behavioural problems and a tendency for a decrease i n the number of problems might indi c a t e that both parent and c h i l d were working i n co-operation. As well, the group provided a place where the c h i l d could a l l e v i a t e some of his/her pain, and use the t h e r a p i s t as a source of calm which helped f a c i l i t a t e self-cohesion. This might have helped reduce the c h i l d ' s acting-out behaviour, thus making parent-child interactions more p o s i t i v e . When the occurrence of multiple stressors i s taken into account, these a d d i t i o n a l factors may explain why some of the c h i l d r e n did not do as well as compared to others i n the group. For example the 80 l i t e r a t u r e reports that the impact on the c h i l d of parental alcohol-ism i s more severe when violence, mental i l l n e s s , poverty, e t c . are present, which compounds the already problematic s i t u a t i o n for the c h i l d . These family s i t u a t i o n s were present f o r a number of the c h i l d r e n . An a d d i t i o n a l factor that might account for lower re s u l t s i n time 2 was the children's r i g i d defense mechanisms. At the begin-ning of the group the c h i l d ' s denial regarding the family s i t u a t i o n , repression of uncomfortable f e e l i n g s , or people pleasing manner were operating without the c h i l d ' s awareness. The lower r e s u l t s i n time 2 might be explained by the occurrance of the i n t e r v e n t i o n . I t was designed to help the c h i l d i d e n t i f y when and why she/he was using a p a r t i c u l a r defense mechanism and to a s s i s t the c h i l d i n making a conscious choice as to whether or not to use i t . Having triggered those defense mechanisms i t s conceivable that the c h i l d became more aware of his/her s i t u a t i o n and pain. Thus i n i t i a l l y the interven-t i o n could have exacerbated the c h i l d ' s s i t u a t i o n due to the impact on the c h i l d ' s denial system. CLINICAL IMPLICATIONS The chi l d r e n s ' group appears to be e f f e c t i v e i n preparing the p a r t i c i p a n t s for self-change as described above. Given that change comes about slowly, a continuation of the group would be most b e n e f i c i a l to these c h i l d r e n . Attendance i n the childrens' group 81 appears to be associated with improvements i n perceptions of frequency of behavioural problems, as well as nons i g n i f i c a n t trends towards improved self-esteem, decrease i n depression and number of behavioural problems. However, anxiety l e v e l s increased. The general nature of the group process as well as the content appears to have increased the c h i l d ' s anxiety l e v e l . Although stress reduction exercises were taught, i t was apparent that the chil d r e n were unable to implement these techniques on t h e i r own on any regular b a s i s . Factors that might contribute to th i s problem are the c h i l d ' s lack of s e l f -cohesion, which made exercises that produced uncomfortable f e e l i n g s impossible to complete. As well, a nine week program did not seem to be enough time to r e l i e v e these c h i l d r e n of t h e i r anxiety. For some of these children, t h e i r family s i t u a t i o n was such that they were going home to a place that was a c t u a l l y d e t e r i o r a t i n g instead of improving. This study's findings i s consistent with Jesse's (1989) work which suggests that the c h i l d ' s lack of self-cohesion creates d i f f i -c u l t i e s i n group cohesion. She states that group treatment w i l l not s i g n i f i c a n t l y a l t e r a c h i l d ' s developmental d e f i c i t s . The leaders noticed that at times the ch i l d r e n were unable to s i t s t i l l , i n -capable of coping with t h e i r inner turmoil, which led to a constant struggle for the leader's attention. Jesse (1989) contends that 82 group treatment which focuses on education about substance abuse, reducing f e e l i n g s of a l i e n t a t i o n and improving peer functioning, may be used along with i n d i v i d u a l treatment. Although i t was not f e a s i b l e during t h i s study to incorporate i n d i v i d u a l work with these c h i l d r e n , i n future ADP could provide i n d i v i d u a l work before group treatment begins. The i n d i v i d u a l sessions would give the leader the time necessary to assess the severity of the trauma for the c h i l d , as well as determine where the c h i l d i s developmentally. Individual sessions would help the c h i l d t r u s t the t h e r a p i s t and use him/her as a source of comfort. The c h i l d would get the i n d i v i d u a l attention he/she so desparately needs, which could help reduce his/her p a i n f u l f e e l i n g s . He/she could then i n t e r n a l i z e the therapist's soothing voice and begin to develop his/her own. This process w i l l begin to prepare him/her for the group process which i n e v i t a b l y produces anxiety. This does not imply that change w i l l come e a s i l y or q u i c k l y f o r these chi l d r e n , given the scope of the problems these ch i l d r e n and t h e i r f a m i l i e s face. The group process d i d produce p o s i t i v e changes f o r these children, but the stressors i n t h e i r l i v e s s t i l l remain. For example, parents who are engaged i n e a r l y recovery have a long road ahead of them. In two of the cases the addicted parent was s t i l l a c t i v e l y drinking. The c h i l d r e n and t h e i r parents would be n e f i t from more than one l e v e l of treatment available to them. 83 Although this group seems to be a viable one, to date a c h i l d r e n s 1 group i s not part of ADP programming. ADP r a r e l y considers the c h i l d ' s recovery as important. Individual work for c h i l d r e n i n t h i s f i e l d i s v i r t u a l l y non-existent. A nine week program can plant the seeds for recovery for these c h i l d r e n . It provides the c h i l d r e n with another view of l i f e removed from t h e i r chaotic, inconsistent and unpredictable environment. However, b r i e f intervention w i l l not be s u f f i c i e n t to a s s i s t these c h i l d r e n . Unless the c h i l d ' s recovery i s considered as important as the addicted parents' recovery, the cycle of addiction w i l l continue. LIMITATIONS OF THE RESEARCH There are a number of l i m i t a t i o n s to t h i s study. F i r s t , the v a l i d i t y of the data i s effected by the small sample s i z e . Consequently, caution must be exercised when i n t e r p r e t i n g trends and drawing conclusions. Secondly, there were extraneous variables that might confound the r e s u l t s . For example, the high incidence of maternal alcoholism, the presence of mental i l l n e s s and violence and the childrens' p a r t i c i p a t i o n i n other therapeutic groups, may have threatened the v a l i d i t y of the data. Measurement issues may also confound the r e s u l t s . The measures did not account for a range of defense mechanisms that are common 84 among ch i l d r e n of addicted parents. The c h i l d ' s denial and people pleasing manner may have biased the childrens' responses. As well i t was not fe a s i b l e i n th i s study to take into account the ch i l d ' s developmental l e v e l . Consequently, some of the c h i l d r e n experienced some d i s t r e s s related to t h e i r not understanding c e r t a i n questions or words used i n the interview schedule. Measuring the c h i l d ' s developmental l e v e l might enhance the v a l i d i t y of the findings. RECOMMENDATIONS FOR FURTHER RESEARCH A c o n t r o l l e d study with a larger sample would be required i n order to f u l l y t e s t the success of the intervention. As well the u t i l i t y of d i f f e r e n t intervention modes could be e f f e c t i v e l y examined using multiple group comparison. 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B r i t i s h Journal of Addictions, 83, 785-792. 91 APPENDIX A 92 Children of Addicted Parent's Group School of S o c i a l Work University of B r i t i s h Columbia CONSENT FORM Researcher: Marvelle Mason M.S.W. Student School of S o c i a l Work University of B r i t i s h Columbia Dear Parent/Guardian I would l i k e to i n v i t e your c h i l d to p a r t i c i p a t e i n a project to study the effectiveness of a children's group whose goal i s to help c h i l d r e n learn to cope with the problems of l i v i n g i n a home with alcoholism or other drug addictions. This research w i l l help us understand the impact of parental alcholism on chi l d r e n as well as help us develop future programs for these c h i l d r e n . I would l i k e to explain more about t h i s program that your c h i l d w i l l be involved i n , should you agree to his/her p a r t i c i p a t i o n . Program Through role play, fil m s , discussions and structured a c t i v i t i e s , the chi l d r e n w i l l learn about alcoholism and i t s e f f e c t s on the family. As well they w i l l learn how not to get caught up i n the cycle of alcohol/drug dependence and co-dependence. The group w i l l focus on stress management, problem solving, assertiveness t r a i n i n g ; including discussion of t h e i r personal r i g h t s , how to take care of themselves i n an emergency s i t u a t i o n and b r i e f l y on how to say no to inappropriate touching. This group w i l l run for 12 weeks, every Tuesday from 3:30 to 4:30. Evaluation Process Before the group begins you w i l l be asked to attend with your c h i l d an interveiw with myself or a co-worker. At t h i s time we w i l l discuss the children's group i n more d e t a i l and get to know your c h i l d . You w i l l be asked to f i l l out an information sheet regarding your family's alcohol/drug problem. Separately your c h i l d w i l l be given a serie s of tests that w i l help us understand how he i s coping with his/her s i t u a t i o n , how much control he/she feels he has over his/her l i f e and how good he f e e l s about him/herself. This appoint-ment w i l l take approximately 1 1/2 hours. In addition, while your c h i l d i s p a r t i c i p a t i n g i n the group as well as a f t e r i t s completion your c h i l d w i l l again be tested with the same series of t e s t s . Testing a f t e r the group's completion w i l l require approximately 1 hour. 93 • • • 2 While we hope that the group experience w i l l be i n t e r e s t i n g and enjoyable f o r your c h i l d , we also know that uncomfortable f e e l i n g s may ari s e during p a r t i c u l a r sessions. If th i s should happen we w i l l help your c h i l d deal with h i s fe e l i n g s by being supportive and nur-turing as well as using stress management techniques. In addition, we r e a l i z e that some c h i l d r e n become anxious during t e s t s . If t h i s happens we w i l l help your c h i l d deal with his discomfort, again with stress management techniques, and i f necessary make arrangements to administer the tests at another time. Should you decide to allow your c h i l d to p a r t i c i p a t e i n th i s study, we w i l l require written consent. C o n f i d e n t i a l i t y w i l l be maintained by having i n d i v i d u a l responses coded so that you c h i l d ' s forms w i l l not be matched with his/her name. The forms w i l l be destroyed no l a t e r than August 1990. At any point during your c h i l d ' s involve-ment i n t h i s program you w i l l b able to contact me with any ques-tions or concerns. As well you may withdraw your c h i l d from the study without prejudice. Withdrawing your c h i l d from t h i s study w i l l i n no way e f f e c t his/her treatment with Alcohol and Drug Programs or Family Services, now or i n the future. I believe that the information we learn from t h i s study w i l l help make future programs for chi l d r e n more h e l p f u l . Please l e t me know i f you have any questions about t h i s p r o j e c t now or i n the future. DATE WITNESS SIGNATURE PARENTAL/GUARDIAN CONSENT I Hereby consent to my c h i l d / r e n attending the Children of Addicted Parent's Group Study at Family Services North Burnaby Alcohol and Drug Programs. I have had an explanation of the content of the group and the evaluation process and f u l l y understand that my child/ren's involvement and my consent to t h e i r involvement i s completely voluntary. Should I disagree with the manner i n which the group i s conducted, I know that I can withdraw my c h i l d / r e n at any time; otherwise I commit myself to t h e i r attend-ance at a l l sessions of the group. I understand that I have a r i g h t to a f u l l explanation of the workings of the group as i t a f f e c t s my c h i l d / r e n . I understand that t h i s consent i n no way obligates me to further i n -volvement with Alcohol and Drug Programs or Family Services. I also understand that as per l e g a l and e t h i c a l requirements we w i l l r e -spond to current physical, sexual or extreme emotional abuse. Where possible or appropriate the parent w i l l be given the opportunity to contact t h e i r l o c a l Ministry of Soc i a l Services and Housing. F a i l i n g t h i s we w i l l be obligated to contact the above agency. This would be discussed p r i o r to such contact being made, i f appropriate. 94 . . .3 PARENT/GUARDIAN NAME SIGNATURE ADDRESS TELEPHONE CHILD'S NAME BIRTHDATE CHILD'S NAME BIRTHDATE CHILD'S NAME BIRTHDATE ******************************************** 95 University of B r i t i s h Columbia School of S o c i a l Work To Whom It May Concern: Re: Children of Addicted Parent's Group (8-12 years old) I am currently a graduate student attending the UBC School of S o c i a l Work. My thesis i s concerned with the e f f e c t s of parental a l c o h o l -ism on children who are between the ages of 8-12 years old, and the effectiveness of an educational/therapeutic group intervention. I am conducting this group through Family Services, North Burnaby Alcohol and Drug Program and welcome r e f e r r a l s from inter e s t e d parent's and agencies. This group w i l l run for 12 weeks, every Tuesday from 3:30 to 4:30. The goal of the group i s to teach c h i l d r e n how to cope with the problems of l i v i n g i n a home with alcoholism or other drug addic-tio n s . This group w i l l focus on stress management, assertiveness, self-esteem enhancement and an understanding of addicted f a m i l i e s . Through r o l e plays, f i l m s , discussion and structured a c t i v i t i e s , c h i l d r e n w i l l learn how to i d e n t i f y and express feelings and how to prevent themselves from getting caught up i n the cycle of a l c o h o l / drug dependence and co-dependence. In order to determine the effectiveness of the group, each c h i l d w i l l be given a series of tests before, during and a f t e r the group's completion. These tests w i l l measure self-esteem, stress, h e l p l e s s -ness and the c h i l d ' s perception of his/her environment. An assess-ment interview w i l l be set up with each parent and c h i l d , at which time information about the group w i l l be given i n d e t a i l and with parental permission the tests w i l l administered by me or my co-worker Myrna D r i o l . Parent's have the r i g h t to withdraw t h e i r c h i l d from the study at any point, without jeopardizing present or future treatment with Family Services or Alcohol and Drug Programs. Interested parents should contact North Burnaby Alcohol and Drug Programs at For further information please f e e l free to contact me at t h i s c l i n i c . Thank you, Marcelle Mason, BSW, RSW CHILDREN OF ADDICTED PARENT'S GROUP DEMOGRAPHIC QUESTIONNAIRE 97 TO THE PARENT(S): Please complete the following information on your c h i l d . Child's F u l l Name Birthdate Please l i s t a l l member's of the c h i l d ' s immediate family and provide the information indicated: Name Age Relation How Person Gets to C h i l d Along With Ch i l d Which parent i s alcoholic? Mother ( ) Father ( ) Both ( ) If applicable — Length of sobriety of the a l c o h o l i c parent(s) Mother Father Age of c h i l d when parental alcoholism developed . If the a l c o h o l i c parent i s not the c h i l d ' s natural ( b i o l o g i c a l ) parent at what age did the c h i l d come to l i v e with the step-parent? If the c h i l d has not always l i v e d i n the same home, please l i s t a l l the moves. Area Age Moved Away Length of Stay Are parent's currently l i v i n g together: Together ( ) Separated ( ) If separated please b r i e f l y explain: For example due to alcohol/drug abuse? Vi o l e n t behaviour? Length of separation? 98 . .2 Education l e v e l of mother Education l e v e l of father Mother's occupation Father's occupation Describe b r i e f l y family h i s t o r y of alcoholism. Mother's Father's If you or your partner are s t i l l a c t i v e l y using alcohol or drugs, please describe b r i e f l y the nature of your involvement/partner's involvement. 9 9 • • • 3 Have you had any reports from the school regarding poor academic performance or behavioural problems i n the classroom concerning your chi l d ? Yes ( ) No ( ) If yes, when? If yes, please explain i n d e t a i l . B r i e f l y describe what you consider your c h i l d ' s major problems now. Name of person completing form Relationship to c h i l d Date: APPENDIX B Measures of Self-Concept Grades K-3 4-6 7-1 2 1 01 SELF-APPRAISAL INVENTORY Grades K - 3 Subject # NAME: SEX: GRADE: YES NO 1 . Are you easy to like? 2. Do you often get i n trouble at home? 3. Can you give a good talk i n front of your class? 4. Do you wish you were younger? 5. Are you an important person i n your family? 6. Do you often f e e l you are doing badly i n school? 7. Do you l i k e being j u s t what you are? 8. Do you have enough friends? 9. Does your family want too much of you? 10. Do you wish you were someone else? 11. Can you wait your turn easily? 1 2. Do your friends usually do what you say? 13. Is i t easy for your to do good i n school? 1 4. Do you often break your promises? 15. Do most chi l d r e n have fewer friends than you? 16. Are you smart? 17. Are most chi l d r e n better l i k e d than you? 18. Are you one of the l a s t to be chosen for games? 19. Are the things you do at school easy for you? 20. Do you know a lot? 21. Can you get good grades i f you want to? > 1 2 2. Do you forget most of what you learn? 2 3. Do you f e e l lonely very often? 24. If you have something to say do you usually say i t ? 25. Do you get upset e a s i l y at home? 26. Do you often f e e l ashamed of yourself? 27. Do you l i k e the teacher to ask you questions i n f ront of the other children? 28. Do the other c h i l d r e n i n class think you are a good worker? 29. Are you hard to be friends with? 30. Do you f i n d i t hard to talk i n your class? 31. Are most chi l d r e n able t o • f i n i s h t h e i r school work more quickly than you? 32. Do members of your family pick on you? 33. Are you any trouble to your family? 34. Is your family proud of you? 35. Can you talk to your family when you have a problem? 36. Do your parents l i k e you even i f you've done something bad? 103 SELF-APPRAISAL INVENTORY Grades 4 - 6 Subject # NAME: SEX: GRADE: YES NO 1 . Other c h i l d r e n are interested i n me? 2. Schoolwork i s f a i r l y easy for me. 3. I am s a t i s f i e d to be j u s t what I am. 4. I should get along better with other c h i l d r e n than I do. 5. I often get into trouble at home. 6. My teachers usually l i k e me. 7. I am a cheerful person. 8. Other c h i l d r e n are often mean to me. 9. I do my share of work at home. 10. I often f e e l upsent i n school. 11. I'm not very smart. 12. No one pays much attention to me at home. 1 3. I can get good grades i f I want to. 14. I can be trusted. 15. I am popular with kids my own age. 16. My family i s ' n t very proud of me. 17. I for g e t most of what I learn. 18. I am easy to l i k e . 19. G i r l s seem to l i k e me. 20. My family i s glad when I do things with them. I 21. I often volunteer to do things i n c l a s s . 22. I'm not a very happy person. 23. I am lonely very often. 24. The members of my family don't usually l i k e my ideas. 25. I am a good student. 26. I can't seem to do things r i g h t . 27. Older kids l i k e me. 28. I behave badly at home. 29. I often get discouraged i n school. 30. I wish I were younger. 31. I am f r i e n d l y toward other people. 32. I u s u a l l y get along with my family as well as I should. 33. My teacher makes me f e e l I'm not good enough. 34. I l i k e being the way I am. 35. Most people are much better l i k e d than I am. 36. I cause trouble to my family. 37. I am slow f i n i s h i n g my school work. 38. I am often unhappy. 39. Boys seem to l i k e me. 40. I l i v e up to what i s expected of me. 41. I can give a good report i n front of the clas 42. I am not as nice looking as most people. 43. I have many fr i e n d s . 44. My parents don't seem interested i n the things I do 45. I am proud of my school work. 46. If I have something to say, I u s u a l l y say i t . 47. I am among the l a s t to be chosen for teams. 48. I f e e l that my family usually doesn't t r u s t me. 49. I am a good reader. 50. I can usually figure out d i f f i c u l t things. 51. I t i s hard for me to make f r i e n d s . 52. My family would help me i n any kind of trouble. 53. I am not doing as well i n school as I would l i k e . 54. I have a l o t of s e l f - c o n t r o l . 55. Friends usually follow my ideas. 56. My family understands me. 57. I f i n d i t hard to talk i n front of the c l a s s . 58. I often f e e l ashamed of myself. 59. I wish I had more close f r i e n d s . 60. My family often expects too much of me. 61. I am good i n my school work. 62. I am a good person. 63. Others f i n d me hard to be f r i e n d l y with. 64. I get upset e a s i l y at home. 65. I don't l i k e to be c a l l e d on i n c l a s s . 66. I wish I were someone e l s e . 67. Other ch i l d r e n think I'm fun to be with. 106 . . .4 YES NO 68. I am an important person i n my family. 69. My classmates think I am a poor student. 70. I often f e e l uneasy. 71. Other c h i l d r e n often don't l i k e to be with me. 72. My family and I have a l o t of fun together. 73. I would l i k e to drop out of school. 74. Not too many people r e a l l y t r u s t me. 75. My family usually considers my f e e l i n g s . 76. I can do hard homework assignments. 77. I can't be depended on. 107 SELF-APPRAISAL INVENTORY Grades 7 - 1 2 Subject # NAME: SEX: GRADE: YES NO 1. School work i s f a i r l y easy f o r me. 2. I am s a t i s f i e d to be j u s t what I am. 3. I ought to get along better with other people. 4. My family thinks I don't act as I should. 5. People often pick on me. 6. I don't usually do my share of work at home. 7. I sometimes f e e l upset when I'm at school. 8. I often l e t other people have t h e i r way. 9. I have as many friends as most people. 10. Usually no one pays much attention to me at home. 11. Getting good grades i s pretty important to me. 12. I can be trusted as much as anyone. 13. I am we l l l i k e d by kids my own age. 14. There are time when I would l i k e to leave home. 15. I for g e t most of what I learn. 16. My family i s surprised i f I do things with them. 17. I am often not a happy person. 18. I am not lonely very often. 19. My family respects my ideas. 20. I am not a very good student. 21. I often do things that I'm sorry for l a t e r . 2 2. Other kids seem to l i k e me. 23. I sometimes behave badly at home. 24. I often get discouraged i n school. 25. I often wish I were younger. 26. I am usu a l l y f r i e n d l y toward other people. 27. I don't usually t r e a t my family as well as I should. 28. My teacher makes me f e e l I'm not good enough. 29. I always l i k e being the way I am. 30. I am j u s t as well l i k e d as most people. 31. I cause trouble to my family. 32. I am slow f i n i s h i n g my school work. 3 . 1 often am not as happy as I would l i k e to be. 34. I am not as nice looking as most people. 35. I don't have many f r i e n d s . 36. I f e e l free to argue with my family. 37. Even i f I have something to say, I often don't say i t . 38. Sometimes I am among the l a s t to be chosen f o r team. 39. I f e e l that my family always trusts me. 40. I am a good reader. 41. I t i s hard for me to make fr i e n d s . 42. My family would help help me i n any kind of trouble. 4 3. I am not doing as well i n school as I would l i k e . 44. I f i n d i t hard to talk i n front of the c l a s s . 45. I sometimes f e e l ashamed of myself. 46. I wish I had more close f r i e n d s . 47. My family often expects too much of me. 48. I'm note very good i n my school work. 49. I'm not as good a person as I would l i k e to be. 50. Sometimes I am hard to make friends with. 51. I wish I were someone else . 52. People don't usually have much fun when they are with me. 53. I am an important person to my family. 54. People think I am a good student. 55. I am not very sure of myself. 56. Often I don't l i k e to be with other kids. 57. My family and I have l o t s of fun together. 58. There are times when I f e e l l i k e dropping out of school. 59. I can always take care of myself. 60. Many times I would l i k e to be with kids younger than me. 61. My family usually doesn't consider my f e e l i n g s . 62. I can't be depended on. 110 APPENDIX C 111 Children of A l c o h o l i c s Screening Test 1 1 2 C # A « S • T • Please check ( ) the answer below that best describes your f e e l i n g s , behaviour and experiences re l a t e d to a parent's alcohol use. Take your time. Answer a l l 30 questions be checking e i t h e r yes or no. YES NO QUESTIONS 1. Have you ever thought that your parent's had a drinking problem? 2. Have you ever l o s t sleep because of your parent's drinking? 3. Did you ever encourage one of your parent's to q u i t drinking? 4. Did you ever f e e l alone, scared, nervous, angry or f r u s t r a t e d because a parent was not able to stop drinking? 5. Did you ever argue or f i g h t with a parent when he or she was drinking? 6. Did you ever threaten to run away from home because of a parent's drinking. 7. Has a parent y e l l e d at or h i t you or other family members when drinking? 8. Have you ever heard your parent's f i g h t when one of them was drunk? 9. Did you ever protect another family member from a parent who was drinking? 10. Did you ever f e e l l i k e hiding or emptying a parent's bottle of liquor? 11. Do many of your thoughts revolve around a problem drinking parent or d i f f i c u l t i e s that a r i s e because of his/her drinking? 12. Did you ever wish that a parent would stop drinking? 13. Did you ever f e e l responsible f o r and g u i l t y about a parent's drinking? 14. Did you ever fear that your parent's would get divorced due to alcohol misuse? 1 1 3 YES NO 15. 16. 17. 18. 19. 20. 21. 22. 23. 24. 25. 26. 27. 28. 29. 30. QUESTIONS Have you ever withdrawn from and avoided out-side a c t i v i t i e s and friends because of embarr-assment and shame over a parent's drinking? Did you ever f e e l caught i n the middle of an arguement or f i g h t between a problem drinking parent and your other parent? Did you ever f e e l that you made a parent drink alcohol. Have you ever f e l t that a problem drinking parent d i d not r e a l l y love you? Did you ever resent a parent's drinking? Have you ever worried about a parent's health because of h i s or her drinking? Have you ever been blamed for a parent's drinking? Did you ever think your father was an alcoholic? Did you ever wish that your home could be more l i k e the homes of your friends who d i d not have a parent with a drinking problem? Did a parent ever make promises to you that he/she d i d not keep because of drinking? Did you ever think your mother was an alcoholic? Did you ever wish that you could talk to someone who would understand and help the alcohol-related problems i n your family? Did you ever f i g h t with your brothers and s i s t e r s about a parent's drinking? Did you ever stay away from home to avoid the drinking parent or your other parent's reaction to the drinking? Have you ever f e l t s i c k , c r i e d or had a knot i n your stomach a f t e r worrying about a parent's drinking? Did you ever take over any chores and duties at home that were usually done by a parent before he/she developed a drinking problem? 114 APPENDIX D KOVAC'S CHILD DEPRESSION INVENTORY 116 FEELINGS QUESTIONNAIRE KIDS SOMETIMES HAVE DIFFERENT FEELINGS AND IDEAS. THIS FORM LISTS THE FEELINGS AND IDEAS IN GROUPS. FROM EACH GROUP, PICK ONE SENTENCE THAT DESCRIBES YOU BEST FOR THE PAST TWO WEEKS. AFTER YOU PICK A SENTENCE FROM THE FIRST GROUP, GO ON TO THE NEXT GROUP. THERE IS NO RIGHT ANSWER OR WRONG ANSWER. JUST PICK THE SENTENCE THAT BEST DESCRIBES THE WAY YOU HAVE BEEN RECENTLY. PUT A MARK LIKE THIS NEXT TO YOUR ANSWER. PUT THE MARK IN THE BOX NEXT TO THE SENTENCE THAT YOU PICK. HERE IS AN EXAMPLE OF HOW THIS FORM WORKS. TRY IT. PUT A MARK NEXT TO THE SENTENCE THAT DESCRIBES YOU BEST. EXAMPLE: I READ BOOKS ALL THE TIME. I READ BOOKS ONCE IN A WHILE. I NEVER READ BOOKS. 117 REMEMBER, PICK OUT THE SENTENCES THAT DESCRIBE YOUR FEELINGS AND IDEAS IN THE PAST TWO WEEKS. 1 . 2. 3. 4. 5. 6. 7. I AM SAD ONCE IN A WHILE. I AM SAD MANY TIMES. I AM SAD ALL THE TIME. NOTHING WILL EVER WORK OUT FOR ME. I AM NOT SURE IF THINGS WILL WORK OUT FOR ME. THINGS WILL WORK OUT FOR ME O.K. I DO MOST THINGS O.K. I DO MANY THINGS WRONG. I DO EVERYTHING WRONG. I HAVE FUN IN MANY THINGS. I HAVE FUN IN SOME THINGS. NOTHING IS FUN AT ALL. I AM BAD ALL THE TIME. I AM BAD MANY TIMES. I AM BAD ONCE IN A WHILE. I THINK ABOUT BAD THINGS HAPPENING TO ME ONCE IN A WHILE. I WORRY THAT BAD THINGS WILL HAPPEN TO ME. I AM SURE THAT TERRIBLE THINGS WILL HAPPEN TO ME. I HATE MYSELF. I DO NOT LIKE MYSELF. I LIKE MYSELF. 118 ALL BAD THINGS ARE MY FAULT. MANY BAD THINGS ARE MY FAULT. BAD THINGS ARE NOT USUALLY MY FAULT. I DO NOT THINK ABOUT KILLING MYSELF. I THINK ABOUT KILLING MYSELF BUT I WOULD NOT DO IT. I WANT TO KILL MYSELF. I FEEL LIKE CRYING EVERY DAY. I FEEL LIKE CRYING MANY DAYS. I FEEL LIKE CRYING ONCE IN A WHILE. THINGS BOTHER ME ALL THE TIME. THINGS BOTHER ME MANY TIMES. THINGS BOTHER ME ONCE IN A WHILE. I LIKE BEING WITH PEOPLE. I DO NOT LIKE BEING WITH PEOPLE MANY TIMES. I DO NOT WANT TO BE WITH PEOPLE AT ALL. I CANNOT MAKE UP MY MIND ABOUT THINGS. IT IS HARD TO MAKE UP MY MIND ABOUT MANY THINGS. I MAKE UP MY MIND ABOUT THINGS EASILY. I LOOK O.K. THERE ARE SOME BAD THINGS ABOUT MY LOOKS. I LOOK UGLY. I HAVE TO PUSH MYSELF ALL THE TIME TO DO MY SCHOOLWORK I HAVE TO PUSH MYSELF MANY TIMES TO DO MY SCHOOLWORK DOING SCHOOLWORK IS NOT A BIG PROBLEM. I HAVE TROUBLE SLEEPING EVERY NIGHT. I HAVE TROUBLE SLEEPING MANY NIGHTS. I SLEEP PRETTY WELL. I AM TIRED ONCE IN A WHILE. I AM TIRED MANY DAYS. I AM TIRED ALL THE TIME. MOST DAYS I DO NOT FEEL LIKE EATING. MANY DAYS I DO NOT FEEL LIKE EATING. I EAT PRETTY WELL. I DO NOT WORRY ABOUT ACHES AND PAINS. I WORRY ABOUT ACHES AND PAINS MANY TIMES. I WORRY ABOUT ACHES AND PAINS ALL THE TIME. I DO NOT FEEL ALONE. I FEEL ALONE MANY TIMES. I FEEL ALONE ALL THE TIME. I NEVER HAVE FUN AT SCHOOL. I HAVE FUN AT SCHOOL ONLY ONCE IN A WHILE. I HAVE FUN AT SCHOOL MANY TIMES. I HAVE PLENTY OF FRIENDS. I HAVE SOME FRIENDS BUT I WISH I HAD MORE. I DO NOT HAVE ANY FRIENDS. MY SCHOOLWORK IS ALRIGHT MY SCHOOLWORK IS NOT AS GOOD AS BEFORE. I DO VERY BADLY IN SUBJECTS I USED TO BE GOOD 1 20 I CAN NEVER BE AS GOOD AS OTHER KIDS. I CAN BE AS GOOD AS OTHER KIDS IF I WANT TO. I AM JUST AS GOOD AS OTHER KIDS. NOBODY REALLY LOVES ME. I AM NOT SURE IF ANYBODY LOVES ME. I AM SURE THAT SOMEBODY LOVES ME. I USUALLY DO WHAT I AM TOLD. I DO NOT DO WHAT I AM TOLD MOST TIMES. I NEVER DO WHAT I AM TOLD. I GET ALONG WITH PEOPLE. I GET INTO FIGHTS MANY TIMES. I GET INTO FIGHTS ALL THE TIME. The End THANK YOU FOR FILLING OUT THIS FORM 1 21 What I Think and Feel Questionnaire. 1. I have trouble making up my mind. Y N 2. I get nervous when things do not go the r i g h t way for me Y N 3. Others seem to do things easier than I can. Y N 4. I l i k e everyone I know. Y N 5. Often I have trouble getting my breath. Y N 6. I worry a l o t of the time. Y N 7. I am a f r a i d of a l o t of things. Y N 8. I am always kind. Y N 9. I get mad e a s i l y . Y N 10. I worry about whay my parents w i l l say to me. Y N 11. I f e e l that others do not l i k e the way I do things. Y N 12. I always have good manners. Y N 13. I t i s hard for me to get to sleep at night. Y N 14. I worry about what other people think of me. Y N 15. I f e e l alone even when there are people with me. Y N 16. I am always good. Y N 17. Often I f e e l sick to my stomach. Y N 18. My feeli n g s get hurt e a s i l y . Y N 19. My hands f e e l sweaty. Y N 20. I am always nice to everyone. Y N 21. I am t i r e d a l o t . Y N 22. I worry about what i s going to happen. Y N 23. Other c h i l d r e n are happier than I. Y N 1 22 2 * • • 24. I t e l l the truth every single time. Y N 25. I have bad dreams. Y N 26. My fe e l i n g s get hurt e a l i t y when I am fussed at. Y N 27. I f e e l someone w i l l t e l l me to do things the wrong way. Y N 28. I never get angry. Y N 29. I wake up scared some of the time. Y N 30. I worry when I go to bed at night. Y N 31. I t i s hard f o r me to keep my mind on my schoolwork. Y N 32. I never say things I shouldn't. Y N 33. I wiggle i n my seat a l o t . Y N 34. I am nervous. Y N 35. A l o t of people are against me. Y N 36. I never l i e . Y N 37. I often worry about something bad happenig to me. Y N 

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