Previous assessments of child psychopathology have shown that parents can be helpful in reporting symptoms of Attention Deficit Hyperactivity Disorder (ADHD) and Oppositional Defiant Disorder (ODD). A new study examines just how helpful parents are in assessing their children's alcohol and/or drug use and abuse. The answer? Not much.
Results are published in the October issue of Alcoholism: Clinical & Experimental Research.
"'Externalizing' disorders such as ADHD and ODD have behaviors associated with them that are obvious and affect others," explained Laura Jean Bierut, associate professor of psychiatry at Washington University School of Medicine. "For example, a child who cannot sit still or focus on his or her work at school and is disruptive in the classroom, or a child who argues with his or her parents or refuses to do the things that they ask. However, the symptoms associated with 'internalizing' disorders such as depression can be much more subtle and not as easily recognized. Things like feelings of worthlessness or loss of interest in favorite activities can be very troubling to a child, but they don't necessarily impact others and might go unnoticed unless the child chooses to talk about them." Bierut is also the corresponding author for the study.
In terms of psychiatric disorders in general, added Sherri Fisher, project coordinator of the St. Louis site of the Collaborative Study on the Genetics of Alcoholism (COGA) as well as co-author, this "disconnect" points out the importance of talking to both parents and children about the child's behavior and symptoms. "In terms of a child's substance use or substance-related problems, however, parents may be unaware of what's going on with their children, or simply repeat information that has already been reported by their child," she said.
To further test this hypothesis, researchers used data gathered as part of COGA, a multi-center family study that was initiated in 1989. For this analysis, 591 adolescent-parent pairs who participated in COGA between the years of 1991 and 1998 were interviewed: 12- to 17-year-olds were administered the child version of the Semi-Structured Assessment for the Genetics of Alcoholism (C-SSAGA), and one corresponding parent – usually the biological mother – was also interviewed about each adolescent using the parent version of C-SSAGA.
"The three most commonly used substances as reported by adolescents in our study were alcohol at 54 percent, tobacco at 44 percent, and marijuana at 23 percent," said Bierut. "We then compared the answers given by the teens and parents to see how often they agreed on this use."
The primary finding was that parents often failed to report that their children had used a substance when the children themselves reported that they had. "Specifically, if a child reported having used alcohol, the parent said their child had used alcohol only 50 percent of the time," said Bierut. "Similarly, when a child reported having used tobacco, the parent reported this only 55 percent of the time, and when a child reported having used marijuana, the parent report agreed only 47 percent of the time."
Parents were even more unaware of their child's use of other drugs, added Bierut. "When a child reported using any of the other drugs we asked about – for example, cocaine, speed, downers – the parent agreed that their child had used any of these drugs in only 28 percent of the cases."
Even among children who reported experiencing symptoms of alcohol or marijuana abuse or dependence, there were parents who did not know that their child had ever used these substances, added Fisher.
Both Bierut and Fisher noted that "age of the child" was one of the most influential factors in terms of parental awareness of adolescent substance use. "Specifically, there was higher agreement between the reports of parents and older adolescents," said Bierut. "Parental agreement was highest with 16- to 17-year-olds, and lowest with 12- to 13-year-olds. This is very troubling because research has shown that starting to use alcohol and drugs at a young age is a risk factor for developing substance abuse or dependence in the future."
"In general," said Fisher, "we found that parent reports added very little information to our knowledge about adolescent substance use beyond what adolescents themselves were reporting, particularly when compared to other types of psychiatric disorders like ADHD and ODD. Our conclusion is that parents do not provide valuable information about their children's use of alcohol and drugs because they simply don't know about it." She added that researchers may want to reconsider using time and resources to question parents at all when it comes to issues of adolescent substance use, abuse or dependence.
The take-home message, said Bierut, is two-part in nature: research clearly indicates that teens are using alcohol and drugs. "Parents who were surveyed, however, were largely unaware of this. Although as parents we might like to think that our children are not reflected in these percentages, it is important to realize that our kids do have access to substances and might very well be using them."
Alcoholism: Clinical & Experimental Research (ACER) is the official journal of the Research Society on Alcoholism and the International Society for Biomedical Research on Alcoholism. Co-authors of the ACER paper, "Teenagers Are Right - Parents Don't Know Much: An Analysis of Adolescent-Parent Agreement on Reports of Adolescent Substance Use, Abuse and Dependence," were: Kathleen K. Bucholz, Wendy Reich, Louis Fox, and Danielle M. Dick of the Washington University School of Medicine; Samuel Kuperman of the University of Iowa Hospitals; John Kramer of the University of Iowa College of Medicine; Victor Hesselbrock of the University of Connecticut Health Center; and John I. Nurnberger, Jr. and Howard J. Edenberg of the Indiana University School of Medicine. The study was funded by the National Institute on Alcohol Abuse and Alcoholism, and the National Institute on Drug Abuse.
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