Psychosocial adjustment of adult children of alcoholics: a review of the recent empirical literature.

This review examines controlled studies of the psychosocial adjustment of adult children of alcoholics (ACOAs) published since 1988. ACOAs appear at increased risk for a variety of negative outcomes, including substance abuse, antisocial or under-controlled behaviors, depressive symptoms, anxiety disorders, low self-esteem, difficulties in family relationships, and generalized distress and maladjustment. However, none of these outcomes are uniformly observed in ACOAs and none are specific to ACOAs. Comorbid parental pathology, childhood abuse, family dysfunction, and other childhood stressors may contribute to or produce similar outcomes. There is little empirical support for "ACOA syndromes" described in the clinical literature.

Parental alcoholism, child abuse, and adult adjustment.

Parallel findings in the adult children of alcoholics (ACOA) and child abuse literatures are integrated and extended by assessing long-term adjustment and childhood histories of parental alcoholism and sexual, physical, and emotional abuse in college students (N = 333). Abuse histories were most strongly related to adult symptom distress and social maladjustment. Parental alcoholism had no independent effects when controlling for abuse history. Parental alcoholism interacted with abuse history in relation to social adjustment, exacerbating the effects of emotional abuse. This study adds to a growing literature calling for more complex models of ACOA development that can account for the diversity of this population.

Traumatic brain injury: influence of blood alcohol level on post-acute cognitive function.

Alcohol intoxication frequently contributes to the occurrence of traumatic brain injury. Few studies, however, have examined whether acute pre-injury alcohol intoxication or premorbid history of alcohol abuse exacerbate cognitive impairments that commonly result from traumatic brain injury. This study examined the influence of blood alcohol level at time of hospital admission on cognitive functioning during the post-acute stage of recovery from traumatic brain injury. After controlling for pre-injury history of alcohol abuse, hospital admission blood alcohol level was predictive of poorer delayed verbal memory, greater decrement in verbal memory over time, and poorer visuospatial functioning. Moreover, there were non-significant trends for higher blood alcohol levels to predict poorer performance on measures of immediate verbal memory and perseveration.

Expanded scoring criteria for the design fluency test: reliability and validity in neuropsychological and college samples.

In spite of sensitivity to right frontal lobe dysfunction, the Design Fluency Test (DFT) has been limited by one global score with little psychometric data. This study developed an expanded scoring system with standardized instructions for multiple dimensions of design performance and provided reliability and validity data in a college (n = 64) and diverse neuropsychological sample (n = 165). The scoring system allowed reliable scoring of number of novel designs, complexity of designs, variations in designs, and concrete, frankly perseverative, and scribbled responses. Performances for a college sample were relatively stable at 1-month retest, but showed practice effects for number of novel designs and complexity. Two principal components showed modest, expected relationships to other neuropsychological measures in the clinical sample. Clinical subjects with a history of closed-head injury or dementing disorder showed impaired DFT performances, with complexity the most sensitive indicator of impairment.