Theodore Jacob

Maternal alcohol use disorder and offspring ADHD: Disentangling genetic and environmental effects using a children-of-twins design

BACKGROUND Children of alcoholics are significantly more likely to experience high-risk environmental exposures, including prenatal substance exposure, and are more likely to exhibit externalizing problems [e.g. attention deficit hyperactivity disorder (ADHD)]. While there is evidence that genetic influences and prenatal nicotine and/or alcohol exposure play separate roles in determining risk of ADHD, little has been done on determining the joint roles that genetic risk associated with maternal alcohol use disorder (AUD) and prenatal risk factors play in determining risk of ADHD. METHOD Using a children-of-twins design, diagnostic telephone interview data from high-risk families (female monozygotic and dizygotic twins concordant or discordant for AUD as parents) and control families targeted from a large Australian twin cohort were analyzed using logistic regression models. RESULTS Offspring of twins with a history of AUD, as well as offspring of non-AUD monozygotic twins whose co-twin had AUD, were significantly more likely to exhibit ADHD than offspring of controls. This pattern is consistent with a genetic explanation for the association between maternal AUD and increased offspring risk of ADHD. Adjustment for prenatal smoking, which remained significantly predictive, did not remove the significant genetic association between maternal AUD and offspring ADHD. CONCLUSIONS While maternal smoking during pregnancy probably contributes to the association between maternal AUD and offspring ADHD risk, the evidence for a significant genetic correlation suggests: (i) pleiotropic genetic effects, with some genes that influence risk of AUD also influencing vulnerability to ADHD; or (ii) ADHD is a direct risk-factor for AUD.

Family Interaction and Psychopathology

Throughout the past century, clinical researchers have been increasingly drawn to explorations of the family’s role in the etiology, course, treatment, and prevention of psychopathological disorders. In attempts to unravel and elucidate relationships involving family life and disordered behavior, various theoretical perspectives and research strategies have been exploited, each of which has been directed toward a somewhat different level, aspect, or concomitant of the family matrix. For the most part, however, investigators have emphasized either the characteristics of individual family members or the family group as a totality. Although interest in relational parameters has been strongly implied throughout much of this literature, programmatic studies of interaction per se have been undertaken only since the mid-1950s.

Alcohol, Alcoholism, and Family Violence

That excessive alcohol use may be related to family violence is by no means a new idea. William Hogarth’ s drawing of life in “Gin Alley” presents a striking visual image of the ills of alcohol: an intoxicated woman who neglectfully allows her small infant to fall from her arms. Temperance tracts in the 1830s and 1840s promulgated the view that alcohol, even in somewhat moderate doses, resulted in neglect of the basic needs of the family. Expenditures of family resources on alcohol rather than food and clothing and unusually cruel violence directed at children and spouse were repeatedly discussed. In 1832, for example, the Fifth Report of the American Temperance Society devoted several pages to instances where a father, while intoxicated, had murdered his wife or children: In the State of New York alone, in the course of a few weeks, not less than four men, under the influence of ardent spirits, murdered their wives, and with their own hands made their children orphans.... One of these men put to death not only his wife, but six of his children. (American Temperance Society Documents, 1972)

Marital interactions of depressed men and women

This article examined marital interactions in 50 couples with a depressed husband, 41 couples with a depressed wife, and 50 nondepressed control couples. As expected, couples with a depressed partner evidenced more disturbed marital interaction than control couples. Furthermore, couples with a depressed wife demonstrated less positive communication than couples with a depressed husband, notwithstanding the fact the depressed husbands exhibited greater depression severity than depressed wives. Findings are integrated with recent research on gender differences in affective expression.

The effects of maternal smoking during pregnancy on offspring outcomes

OBJECTIVE To evaluate the possible association between maternal smoking during pregnancy and offspring outcomes of birth weight, pre-term birth, remediation, low scholastic achievement, regular smoking, attention deficit hyperactivity disorder and conduct problems while controlling for similar behaviors in parents. METHODS Using telephone interviews, data were collected, in 2001 and 2004, as a part of two United States offspring-of-twins projects. Fathers, who were twins participating in the Vietnam Era Twin Registry, their female spouse and their offspring were interviewed - information on 1,342 unique pregnancies in mothers with a history of regular smoking was utilized for these analyses. The association between maternal smoking during pregnancy and birth weight, pre-term birth, remediation, low scholastic achievement, regular smoking, attention deficit hyperactivity disorder and conduct disorder while controlling for similar behaviors in parents, was examined using regression. RESULTS Maternal smoking during pregnancy was associated with decreased birth weight, low scholastic achievement, regular smoking and attention deficit hyperactivity disorder. However, the association between maternal smoking during pregnancy and offspring attention deficit hyperactivity disorder was explained by maternal attention deficit hyperactivity disorder. Maternal smoking during pregnancy was also associated with earlier age of offspring initiation of smoking and onset of regular smoking. CONCLUSIONS Maternal smoking during pregnancy may influence certain offspring outcomes via mechanisms that are independent from genetic risk attributable to comorbid conditions. Assisting expecting mothers with their smoking cessation efforts will likely provide widespread health benefits to both mother and offspring.

Family assessment : rationale, methods, and future directions

1. Family Research: Streams of Influence.- 2. Classifying Family Measurement Procedures.- 3. Detailed Review of Methods.- 4. Conclusions and Future Directions.- References.

The association between cannabis abuse and dependence and childhood physical and sexual abuse: evidence from an offspring of twins design

AIM This study examines the association between childhood physical abuse (CPA) and sexual abuse (CSA) and the development of cannabis abuse and dependence among adolescents and young adults while controlling for genetic and environmental risk factors. DESIGN To control for familial risk differences related to paternal drug dependence that might confound the relationship between CSA and CPA and cannabis abuse/dependence, we created four groups based on fathers and uncles substance use dependence (SUD) status reflecting different degrees of genetic and environmental risks to offspring: (i) high genetic, high environmental risk; (ii) high genetic, low environmental risk; (iii) medium genetic, low environmental risk; and (iv) low genetic, low environmental risk. PARTICIPANTS Adolescent and young adult offspring of monozygotic and dizygotic US military veteran twin fathers (n = 819). MEASUREMENTS Data on CPA and CSA, DSM-IV offspring cannabis abuse/dependence, other SUD and psychopathology and maternal and paternal SUD and psychopathology were collected via semi-structured telephone interview. FINDINGS Twenty-three per cent of the offspring sample met life-time criteria for cannabis abuse/dependence and 8.55% and 12.82% reported CSA and CPA, respectively. Offspring exposed to CSA, but not CPA, were at significantly greater risk of developing cannabis abuse/dependence compared to those who had not experienced CSA (hazard ratio = 2.16; 95% confidence interval = 1.48-3.16) after controlling for genetic and familial environmental risk and offspring gender, alcohol abuse and dependence and conduct disorder. CONCLUSIONS These results indicate that there are effects of CSA on development of cannabis abuse/dependence in addition to the genetic and familial environmental risk imparted by having a drug-dependent father.

Alcoholism and Family Interaction

This chapter reviews the family interaction literature concerned with families of alcoholics. The development of this area is traced from early reports that focused on individual family members to more recent approaches concerned with the family as an interacting unit. Theories that suggest that family processes reinforce patterns of abusive drinking are examined in light of existing empirical evidence. The interpretation of findings is limited by an insufficient number of studies, a lack of replication, and a lack of systematic programs of research. Recently, more rigorously controlled experiments have demonstrated that the interactions of families of alcoholics can be differentiated from those of nondistressed and other distressed families. Suggested future directions include exploration of family interactions with respect to female alcoholics and offspring outcome.

Genetic and environmental contributions to nicotine, alcohol and cannabis dependence in male twins.

AIMS To compute the common and specific genetic and environmental contributions to nicotine dependence (ND) alcohol dependence (AD) and cannabis dependence (CD). DESIGN Twin model. PARTICIPANTS Data from 1874 monozygotic and 1498 dizygotic twin pair members of the Vietnam Era Twin Registry were obtained via telephone administration of a structured psychiatric interview in 1992. MEASUREMENTS Data to derive life-time diagnoses of DSM-III-R ND, AD and CD were obtained via telephone administration of the Diagnostic Interview Schedule. FINDINGS The best-fitting model allowed for additive genetic contributions and unique environmental influences that were common to all three phenotypes. Risks for ND and AD were also due to genetic and unique environmental influences specific to each drug. A specific shared environmental factor contributed to CD. CONCLUSIONS These results suggest that the life-time co-occurrence of ND, AD and CD is due to common and specific genetic factors as well as unique environmental influences, and vulnerability for CD is also due to shared environmental factors that do not contribute to ND and AD. The majority of genetic variance is shared across drugs and the majority of unique environmental influences are drug-specific in these middle-aged men. Because differences between models allowing for specific genetic versus shared environment were small, we are most confident in concluding that there are specific familial contributions-either additive genetic or shared environment-to CD.

Accuracy of Mothers' Retrospective Reports of Smoking During Pregnancy: Comparison with Twin Sister Informant Ratings

Retrospective assessment of maternal smoking or substance use during pregnancy is sometimes unavoidable. The unusually close relationship of twin sister pairs permits comparison of self-report data versus co-twin informant data on substance use during pregnancy. Information about smoking during pregnancy has been gathered from a series of mothers from an Australian volunteer twin panel (576 women reporting on 995 pregnancies), supplemented in many cases by independent ratings of their smoking by twin sister informants (821 pregnancies). Estimates of the proportion of women who had never smoked regularly (56-58%), who had smoked but did not smoke during a particular pregnancy (16-21%), or who smoked throughout the pregnancy (16-18%), were in good agreement whether based on self-report or twin sister informant data. However, informants underreported cases who smoked during the first trimester but then quit (1-3% versus 7-9% by self-report). Women who smoked throughout pregnancy (by informant report) rarely denied a history of regular smoking (< 1%), although a small proportion of apparent false negative cases were identified where they either denied smoking during a pregnancy (9%) or denied smoking beyond the first trimester (10%). We conclude that retrospective smoking data can safely be used to identify potential associations of later child outcomes with maternal smoking during pregnancy.