Maria M. Wong

Neuropsychological Executive Functioning in Children at Elevated Risk for Alcoholism: Findings in Early Adolescence

One component of individual risk for alcoholism may involve cognitive vulnerabilities prodromal to alcoholism onset. This prospective study of 198 boys followed between 3 and 14 years of age evaluated neurocognitive functioning across three groups who varied in familial risk for future alcoholism. Measures of intelligence, reward-response, and a battery of neuropsychological executive and cognitive inhibitory measures were used. Executive functioning weaknesses were greater in families with alcoholism but no antisocial comorbidity. IQ and reward-response weaknesses were associated with familial antisocial alcoholism. Executive function effects were clearest for response inhibition, response speed, and symbol-digit modalities. Results suggest that executive deficits are not part of the highest risk, antisocial pathway to alcoholism but that some executive function weaknesses may contribute to a secondary risk pathway.

Childhood sleep problems, early onset of substance use and behavioral problems in adolescence

BACKGROUND Very few prospective studies examine the relationship between childhood sleep problems and subsequent substance use. In this study, we examined how sleep problems at ages 3-8 predicted onset of alcohol, cigarette, and marijuana use in adolescence. We also investigated the relationships between childhood sleep problems and adolescent internalizing and externalizing problems. METHODS Study participants were 292 boys and 94 girls from a community sample of high risk families and controls in an ongoing longitudinal study. RESULTS Controlling for parental alcoholism, sleep problems at ages 3-8 predicted onset of alcohol, cigarette, and marijuana use among boys and onset of alcohol use among girls. Childhood sleep problems were related to maternal ratings of internalizing and externalizing problems during adolescence for both boys and girls. Adjusting for these problems did not weaken the effects of sleep problems on onset of substance use. CONCLUSIONS This is to our knowledge the first study that prospectively examines gender differences in the relationship between sleep problems and early onset of substance use. Childhood sleep problems predicted early onset of substance use for boys but not girls. If childhood sleep problems indeed increase the probability of substance use onset, greater attention by parents to sleep problems in children and adolescents would potentially have ameliorative long-term effects. Parents are encouraged to explore different ways to help their children sleep better, including obtaining information and suggestions from their primary care physicians.

Sleep problems, suicidal ideation, and self-harm behaviors in adolescence

OBJECTIVE Previous research has found an association between sleep problems and suicidal behavior. However, it is still unclear whether the association can be largely explained by depression. In this study, we prospectively examined relationships between sleep problems when participants were 12-14 years old and subsequent suicidal thoughts and self-harm behaviors--including suicide attempts--at ages 15-17 while controlling for depressive symptoms at baseline. METHODS Study participants were 280 boys and 112 girls from a community sample of high-risk alcoholic families and controls in an ongoing longitudinal study. RESULTS Controlling for gender, parental alcoholism and parental suicidal thoughts, and prior suicidal thoughts or self-harm behaviors when participants were 12-14 years old, having trouble sleeping at 12-14 significantly predicted suicidal thoughts and self-harm behaviors at ages 15-17. Depressive symptoms, nightmares, aggressive behavior, and substance-related problems at ages 12-14 were not significant predictors when other variables were in the model. CONCLUSIONS Having trouble sleeping was a strong predictor of subsequent suicidal thoughts and self-harm behaviors in adolescence. Sleep problems may be an early and important marker for suicidal behavior in adolescence. Parents and primary care physicians are encouraged to be vigilant and screen for sleep problems in young adolescents. Future research should determine if early intervention with sleep disturbances reduces the risk for suicidality in adolescents.

Really Underage Drinkers: Alcohol Use Among Elementary Students

Despite the current societal concern with underage drinking, little attention has been paid to alcohol use within the preadolescent population. This article presents the proceedings of a symposium held at the 2003 Research Society on Alcoholism meeting in Fort Lauderdale, Florida, that was organized and chaired by John E. Donovan. The intent of the symposium was to kick start research on alcohol use among elementary school children by reviewing what is known regarding drinking in childhood. Presentations included (1) The Epidemiology of Childrens Alcohol Use, by John E. Donovan; (2) The Validity of Childrens Self-Reports of Alcohol Use, by Sharon L. Leech; (3) Predicting Onset of Drinking From Behavior at Three Years of Age: Influence of Early Child Expectancies and Parental Alcohol Involvement Upon Early First Use, by Robert A. Zucker; and (4) Parent, Peer, and Child Risk Factors for Alcohol Use in Two Cohorts of Elementary School Children, by Carol J. Loveland-Cherry. Presentations indicated the need for better nationwide surveillance of childrens experience with alcohol; suggested that childrens reports of their use of alcohol tend to be reliable and valid; supported childrens alcohol use schemas and parental drinking and alcoholism at child age three as independent predictors of early onset drinking; and showed that onset of drinking before fourth or fifth grade, peer pressure, and parental norms and monitoring predict elementary student alcohol use and misuse.

Childhood Sleep Problems, Response Inhibition, and Alcohol and Drug Outcomes in Adolescence and Young Adulthood

BACKGROUND To our knowledge, no prospective studies examine the relationships among childhood sleep problems, adolescent executive functioning, and substance outcomes (i.e., substance use and substance-related problems). In this study, we examined whether childhood sleep problems predicted adolescent sleep problems and response inhibition. We also tested whether adolescent sleep problems and poor response inhibition mediated the relationship between childhood sleep problems and substance (alcohol and drug) outcomes in young adulthood. METHODS Study participants were 292 boys and 94 girls (M = 4.85, SD = 1.47) from a community sample of high-risk families and controls. RESULTS When compared to their counterparts, those with trouble sleeping in childhood were twice as likely to have the same problem in adolescence. Childhood overtiredness predicted poor response inhibition in adolescence. Persistent trouble sleeping from childhood to adolescence and response inhibition in adolescence mediated the relationship between childhood sleep problems and drug outcomes in young adulthood, whereas overtiredness in childhood directly predicted alcohol use outcomes and alcohol-related problems in young adulthood. CONCLUSIONS This is the first study showing a long-term relationship between childhood sleep measures and subsequent alcohol and drug outcomes. The developmental and clinical implications of these findings were discussed. Prevention and intervention programs may want to consider the role of sleep problems and response inhibition on substance use and abuse.

Childhood and adolescent resiliency, regulation, and executive functioning in relation to adolescent problems and competence in a high-risk sample

This study first examined the respective relations of resiliency and reactive control with executive functioning. It then examined the relationship of these different domains to the development of academic and social outcomes, and to the emergence of internalizing and externalizing problem behavior in adolescence. Resiliency and reactive control were assessed from preschool to adolescence in a high-risk sample of boys and girls (n = 498) and then linked to component operations of neuropsychological executive functioning (i.e., response inhibition, interference control, fluency, working memory/set-shifting, planning, and alertness), assessed in early and late adolescence. Consistent, linear relations were found between resiliency and executive functions (average r = .17). A curvilinear relationship was observed between reactive control and resiliency, such that resiliency was weaker when reactive control was either very high or very low. In multivariate, multilevel models, executive functions contributed to academic competence, whereas resiliency and interference control jointly predicted social competence. Low resiliency, low reactive control, and poor response inhibition uniquely and additively predicted internalizing problem behavior, whereas low reactive control and poor response inhibition uniquely predicted externalizing problem behavior. Results are discussed in relation to recent trait models of regulation and the scaffolded development of competence and problems in childhood and adolescence.

The prospective relationship between sleep problems and suicidal behavior in the National Longitudinal Study of Adolescent Health

OBJECTIVE Previous research has found a longitudinal relationship between sleep problems and suicidal behavior while controlling for depression and other important covariates in a high risk sample of adolescents and controls. In this paper, we replicated this longitudinal relationship in a national sample and examined whether the relationship was partially mediated by depression, alcohol-related problems and other drug use. METHODS Study participants were 6504 adolescents from the National Longitudinal Study of Adolescent Health (ADD HEALTH). RESULTS In bivariate analyses, sleep problems (i.e., having trouble falling asleep or staying asleep) at Wave 1 were associated with suicidal thoughts and suicide attempts at Waves 1, 2, and 3 (W1, 2 and 3). In multivariate analyses, controlling for depression, alcohol problems, illicit drug use, and important covariates such as gender, age, and chronic health problems, sleep problems at a previous wave predicted suicidal thoughts and suicide attempts at a subsequent wave. In mediation analyses, W2 depression significantly mediated the effect of W1 sleep problems on W3 suicide thoughts. Moreover, W2 suicidal thoughts also significantly mediated the effect of W1 sleep problems on W3 suicidal attempts. CONCLUSIONS Sleep problems appear to be a robust predictor of subsequent suicidal thoughts and attempts in adolescence and young adulthood. Having trouble falling sleeping or staying asleep had both direct and indirect effects (via depression and suicidal thoughts) on suicidal behavior. Future research could determine if early intervention with sleep disturbances reduces the risk for suicidality in adolescents and young adults.

Social competence in children of alcoholic parents over time.

In the current study, the authors tested the hypothesis that children of alcoholic parents (COAs) show deficits in social competence that begin in early childhood and escalate through middle adolescence. Teachers, parents, and children reported on the social competence of COAs and matched controls in a community sample assessed from ages 6 to 15. Hierarchical linear growth models revealed different patterns of change in social competence across development as a function of the reporter of various indicators of competence. Moreover, female COAs showed deficits in social competence in early childhood that receded in adolescence and that varied across subtypes of parent alcoholism. Implications of these findings for understanding the development of social competence in children, and at-risk children in particular, are discussed.

Prevention for Children of Alcoholics and Other High Risk Groups

Median age of onset of alcohol use nationally is age 14 and median age of first drunkenness is 17 (Johnston et al., 2003). Thus, it is not surprising that the greatest public concern about drinking among young people begins with a focus on adolescence. It does not necessarily follow that the problems of risk for children of alcoholics1 (COAs) and other children at high risk for the eventual development of alcohol use disorder (AUD) are the problems of adolescence. In fact, a now substantial body of evidence indicates that the drinking problems and other difficulties of adolescent and young adult COAs are predicted by much earlier markers. Thus the prevention question for this population becomes one of dealing with when the most appropriate time is to begin the intervention ( i.e., what age to target) as well as how best to dampen or eliminate risk. Similarly, what is known about the adult disorder can also be informative about what to prevent, and what some of the prevention issues may be, given that this is the parenting generation. This chapter applies a developmental lens to the problem of prevention of risk among these very high risk populations.

Alcohol expectancies in childhood: change with the onset of drinking and ability to predict adolescent drunkenness and binge drinking

AIMS We examined the relationship between alcohol expectancies in childhood and onset of drinking, binge drinking and drunkenness in adolescence and the influence of drinking onset on expectancy development. DESIGN A prospective, longitudinal study of children assessed for alcohol expectancies and drinking at four time-points between ages 6 and 17 years. SETTING Community study of families at high risk for alcoholism conducted in a four-county area in the Midwestern United States. PARTICIPANTS The study involved 614 children; 460 were children of alcoholics and 70% were male. MEASUREMENTS Expectancies about alcohol effects were measured using the Beverage Opinion Questionnaire and childs drinking by the Drinking and Drug History-Youth Form. FINDINGS Partial factor invariance was found for expectancy factors from ages 6 to 17 years. Survival analysis showed that social/relaxation expectancies in childhood predicted time to onset of binge drinking and first time drunk (Wald χ(2) , 1 d.f. = 3.8, P = 0.05 and 5.0, P < 0.05, respectively). The reciprocal effect was also present; when adolescents began drinking, there was an increase in social/relaxation expectancy and a concomitant increase in slope of the expectancy changes lasting throughout adolescence. CONCLUSIONS A reciprocal relationship exists between childhood alcohol expectancies and the development of alcohol involvement. Higher expectancies for positive effects predict earlier onset of problem drinking. Onset of use, in turn, predicts an increase in rate of development of positive expectancies.