Original Article

Behavioral Problems and Temperamental Characteristics

among Children in Alcoholic Families
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Ottilingam Somasundaram Ravindran, K. Hima1, S. Natarajan, R. Sathianathan

Departments of Psychiatry and 1Clinical Psychology, Sri Ramachandra Medical College and Research Institute, Chennai, Tamil Nadu, India
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ABSTRACT
Background: Children of alcoholics (COAs) are at high risk for behavioral problems and temperamental difficulties. Aim: The aim of
this study was to compare the behavioral problems and temperamental characteristics in children of persons with and without alcoholism.
Materials and Methods: Using a case–control design, 60 children (30 in the study group and 30 controls) were evaluated for their behavioral
problems, aggression, and temperamental characteristics. Tools used were: Child Behavior Checklist, Aggression Questionnaire, and the
Malhotra’s Temperament Schedule. Results: The COAs were found to be more aggressive, manifesting more behavioral problems and
temperamental difficulties than the controls. Conclusion: Children in families with an alcohol‑dependent father are at increased risk for
problem behaviors with a difficult temperament.

Keywords: Children, parental problem drinking, temperament

Introduction been associated with the development of problem behaviors

among COA parents[14] and with later substance use.[15,16] Thus,
Alcoholism tends to run in families. It is well established
COA parents are at increased risk of behavioral regulation
that children of alcoholics (COAs) are at both biological difficulties that may prevent the expected normal decline in
and environmental risk for a myriad of social, emotional, aggressive behavior.
and behavioral problems.[1,2] These children are at risk for
externalizing[3,4] and internalizing problems.[5] A number of Studies conducted in the past have reported that certain
environmental mechanisms may underlie this risk, including temperament deviations in childhood may increase the risk
exposure to impaired parenting, family conflict, and high for alcoholism in adulthood.[l7] Temperament is defined as
levels of life stress.[6] Parental substance use may interfere early‑appearing and relatively stable differences in emotional
with parents’ abilities to remain warm during parent–child reactivity and regulation. [18] It has been suggested that
interactions.[7] Less nurturing parenting may disrupt children’s temperament and parental alcoholism may interact to predict
sense of security and increase the risk for later depression.[8] subsequent behavioral problems. Temperamental factors,
specifically high activity, high emotionality, low capacity for
Families of alcoholics are found to be a vulnerable place self‑soothing, low attention span‑persistence, and low sociability
for children to become aggressive. The association between are associated with a high risk for alcoholism and may be a
alcohol and problem behaviors may have its roots in early reflection of the child’s genetic liability to later addiction.[19] As
self‑regulation difficulties. It has been hypothesized that COA early as infancy, apparent markers of temperament including
parents are at greater risk for temperamental difficulties[9] high novelty seeking and low harm avoidance, appear to
manifested as negative affect,[10‑12] high activity level, and
attention problems [12,13] which can adversely affect the Address for correspondence: Dr. Ottilingam Somasundaram Ravindran,
development of such self‑regulatory capabilities. As such, No. 30 (New No. 17), 23rd Cross Street, Besant Nagar, Chennai ‑ 600 090,
Tamil Nadu, India.
the capacity for internalization of rules and behavioral control E‑mail: [email protected]
in these children may be impaired leading to later conduct
problems. Indeed, high activity level and negative affect have
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How to cite this article: Ravindran OS, Hima K, Natarajan S,

DOI: Sathianathan R. Behavioral problems and temperamental characteristics
10.4103/jmhhb.jmhhb_2_18 among children in alcoholic families. J Mental Health Hum Behav
2018;23:52-6.

52 © 2018 Journal of Mental Health and Human Behaviour | Published by Wolters Kluwer ‑ Medknow
 Ravindran, et al.: Psychological effects of a person’s alcohol use on children in the family

predict adolescent onset of drinking.[20,21] Several previous scored above the cutoff on the GHQ‑12 were excluded from the
works have established relations between low temperamental study. The mother was interviewed by the second author using a
reactive control and low resiliency in childhood and disruptive sociodemographic data sheet (developed for the study), the Child
behaviors and substance abuse in adolescence.[22] Other work Behavior Checklist (CBCL),[26] Aggression Questionnaire,[27]
links novelty seeking, high physical activity, low behavioral and the Malhotra’s Temperament Schedule (MTS).[28]
control, and negative emotionality with alcoholism.[20‑24] Thus,
the risk for adolescent substance misuse may be identified in
Study instruments
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GHQ was used for measuring the psychological well‑being.

early childhood through temperamental traits.
Each item was assessed on a 4‑point Likert scale (less than usual,
With this background, this study was conducted to compare the no more than usual, rather more than usual, and much more
levels of externalizing and internalizing behaviors, aggression than usual). Minimum score is 12 and the possible maximum score
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and temperamental difficulties in children with or without a is 48. Cronbach’s alpha coefficients ranged from 0.82 to 0.93.
parental history of alcoholism.
CBCL for ages 6–18 is a widely used measure of children’s
behavioral/emotional problems, with well‑established
Materials and Methods psychometrics. Mothers reported whether a given behavior
Participants described his/her child’s behavior within the previous 6 months
Study sampling was purposive. The study group comprised of using a Likert rating of 0 = “not true,” 1 = “somewhat or
30 school‑going children (17 males and 13 females, age range sometimes true,” or 2 = “very true or often true” for each
9–14 years) whose biological fathers attending the De‑addiction item. Scores from internalizing and externalizing scales of the
Clinic, Department of Psychiatry, Sri Ramachandra Medical CBCL were analyzed. The construct of “internalizing” consists
College and Research Institute, Chennai, met the ICD‑10 criteria of items from anxious/depressed, withdrawn/depressed,
for Alcoholism. Thirty age‑ and gender‑matched children from and somatic complaints subscales, with rule‑breaking and
the schools were taken with no parental psychiatric illness aggressive behavior subscales comprising the “externalizing”
(ruled out through detailed psychiatric history and examination) construct. Higher scores indicate more behavior problems.
and mother scoring <4 on the General Health Questionnaire
Aggression questionnaire was used to assess the trait aggression
(GHQ‑12), to prevent any influence of maternal psychiatric
in children. It consists of 34 items. Each item was answered on
disorder on the study outcome. In this study, the independent
a 5‑point Likert scale ranging from 1 (not at all like me) to 5
variable is the presence of alcohol dependence in the father.
(completely like me). The questionnaire measures five constructs
However, the dependent variables assessed are also expected to
related to aggression: physical aggression, verbal aggression,
be influenced by other confounding factors and other independent
anger, hostility, and indirect aggression. Scores can range
factors unrelated to alcohol dependence in the father. Hence, these
from 34 to 170, with higher scores indicating more aggressive
confounding factors were addressed by adopting a case–control
behaviors. The internal consistency ranges from 0.55 to 0.94.
design, so that the children in the two groups differed only
with respect to the alcoholic status of the father, all other Child temperament was assessed using MTS. This scale
psycho‑socio‑demographic variables were matched between measures nine temperamental variables identified by Thomas
the subjects of the two groups automatically because of the and Chess.[29] There are 45 items in the schedule covering
study design; meaning the subjects in either group were similar nine dimensions. The nine variables have been reduced to
regarding all other independent (possible confounding) variables. five factors using the factor analysis. Factor I (Sociability)
comprised of approach/withdrawal, adaptability, and threshold
The inclusion criteria for the study group were: father
of responsiveness. Factor II (Emotionality) constitutes mood
diagnosed with alcoholism; having no other known psychiatric
and persistence. Factor III (Energy) includes activity and
illness; aged between 9 and 14 years; with mother having
intensity. Factor IV (Attentivity) measures distractibility.
GHQ scores <4 and living with the index parent for at least
Factor V (Rhythmicity) is retained as an independent factor.
the preceding year.
Each item is rated on a 5‑point scale. Scores of 1–5 represent
The exclusion criteria were: children with major medical, the extremes of intensity and frequency of occurrence of that
neurological, or psychiatric illness; children with intellectual behavior rated on negative and positive directions. Mean
disability (IQ<70), or a diagnosis of autism or Asperger’s scores for each of the variables are computed by dividing the
disorder. The written informed consent for participation was total scores by 5. The MTS is reported to have high test‑retest
obtained from all the parents of the children who participated reliability (0.83–0.94) as well as high validity.
in this study and the children provided written assent. The
study period was January–March 2017.
Statistical analysis
All the data obtained were analyzed after using SPSS (SPSS for
Procedure Windows, version 20, SPSS Inc., Chicago), using the Student’s
All the assessments were done by the second author. First, t‑test. A comparison of all the parameters ‑ behavior problems,
the mother was screened using the GHQ‑12 item version[25] aggression, and temperamental difficulties was made between
for psychopathology in both groups. Children whose mothers the study group and the control group.

Journal of Mental Health and Human Behaviour ¦ Volume 23 ¦ Issue 1 ¦ January-June 2018 53
 Ravindran, et al.: Psychological effects of a person’s alcohol use on children in the family

Results Table 1: Sociodemographic profile of the sample (n=30)

The sociodemographic profile of the study and control groups Variables COA, n (%) CON, n (%)
is shown in Table 1. The age of the children in the sample Gender
ranged from 9 to 14 years. Of 60 children included in the study, Male 17 (56.67) 17 (56.67)
there were more males (56.67%) than females in both study Female 13 (43.33) 13 (43.33)
and control groups. Around 56.67% (17/30) of the alcoholics Education
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had been drinking nearly for more than 15 years. Up to 5th 5 (16.67) 5 (16.67)
The scores on the CBCL were analyzed based on the two 6th to 8th 8 (26.67) 8 (26.67)
9th to 10th 17 (56.67) 17 (56.67)
subscales – Internalizing Scale and Externalizing Scale.
Income per month (INR)
Table 2 shows the scores obtained by the two groups on
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5000‑15,000 26 (86.67) 20 (66.67)

the two scales of CBCL. As can be seen from the table, the
16,000‑20,000 3 (10.00) 8 (26.67)
COA‑dependent parents obtained statistically significant high
>20,000 1 (3.33) 2 (6.67)
scores on the externalizing scale and a marginal high score on Duration of parental alcohol use (year)
the internalizing scale. 5‑10 8 (26.67) ‑
Table 3 presents the data obtained from the Aggression 10‑15 5 (16.67) ‑
Questionnaire. As can be seen from the table, the children of 15‑20 17 (56.67) ‑
alcohol‑dependent parents obtained statistically significant high COA: Children of alcoholics, CON: Children of nonalcoholics,
INR: Indian rupee
scores on the Aggression Questionnaire. They were found to be
more aggressive, impulsive, hostile, and bullying than the controls.
Table 4 contains the scores obtained on the MTS. There is a Table 2: Comparison of behavior problems between the
statistically significant difference between the two groups on the two groups (n=30)
MTS, with children of alcohol‑dependent parents manifesting CBCL Mean±SD Comparison
temperamental difficulties. They differed significantly from COA CON
the controls in being less rhythmic, less adaptable, more Internalizing scale
withdrawn, more distractible, with a lower threshold of Anxious/depressed 59.10±12.87 53.90±4.59 P=0.042; t=2.08
responsiveness and displayed negative emotionality. Withdrawn/depressed 65.07±10.64 60.70±5.45 P=0.050; t=2.00
Somatic complaints 62.87±6.91 57.90±3.73 P=0.001; t=3.46
Discussion Externalizing scale
Aggressive behavior 66.87±11.28 58.60±9.10 P=0.003; t=3.12
The prevalence of alcoholism in India is reported to be 21.4%,
Rule breaking behavior 68.63±13.09 58.83±11.08 P=0.003; t=3.13
and there is an increasing alcohol consumption among the COA: Children of alcoholics, CON: Children of nonalcoholics,
youth.[30] COAs are at substantially increased risk for becoming SD: Standard deviation, CBCL: Child behavior checklist
alcoholics themselves, and this elevated risk appears to be a
function of both genetic and environmental factors.[31] Studies
conducted in India have reported both externalizing[32,33] and Table 3: Comparison of aggression between the two
internalizing behaviors[34,35] among the children of parents with groups (n=30)
alcoholism. The current study examined whether COAs were Factor Mean±SD Comparison
at greater risk for externalizing and internalizing problems. COA CON
In this study, we found that there was a statistically significant Aggression 77.53±47.49 48.57±31.38 P=0.007; t=2.79
difference between the COAs and the non‑COAs on the COA: Children of alcoholics, CON: Children of nonalcoholics,
externalizing and internalizing subscales of CBCL. The SD: Standard deviation
findings of the present study and those of previous research[36]
show higher levels of externalizing and internalizing problems
among COAs in contrast to children of controls. Genetic factors Table 4: Comparison of temperament between the two
play a crucial role in the etiology of alcoholism. In an earlier groups (n=30)
study, King et al.[37] observed strong relations between parent Temperament Mean±SD Comparison
alcoholism and higher levels of child behavioral disinhibition
COA CON
within biological but not adoptive families, implicating a
Sociability 26.57±5.54 34.17±5.67 P=0.000; t=5.24
genetically transmitted vulnerability to externalizing spectrum
Energy 30.90±6.05 33.33±3.92 P=0.070; t=1.84
disorders among children of parents with alcoholism. In terms Emotionality 35.40±3.12 32.27±4.17 P=0.002; t=3.29
of externalizing problems, the current findings indicate that Distractibility 23.50±1.65 21.67±2.86 P=0.004; t=3.03
having a parent with substance use predicted externalizing Rhythmicity 12.33±4.72 16.47±4.99 P=0.002; t=3.29
behavior. Moreover, parents with alcoholism may not provide COA: Children of alcoholics, CON: Children of nonalcoholics,
consistent support to their children which may contribute to SD: Standard deviation

54 Journal of Mental Health and Human Behaviour ¦ Volume 23 ¦ Issue 1 ¦ January-June 2018
 Ravindran, et al.: Psychological effects of a person’s alcohol use on children in the family

elevated rates of children’s externalizing problems. Similar groundwork for later maladaptive developmental patterns
findings have been reported by Bountress and Chassin[38] and even addiction.[9,17,49] Moreover, there is some evidence
in a study involving children of parents with substance use to suggest that temperamental difficulties might mediate
disorders. Less consistent parenting may allow children the relationship between parental alcoholism and childhood
to associate with deviant peers who maintain children’s problems. Blackson et al.[50] evaluated this hypothesis among
externalizing behaviors. These findings have been replicated 10–12‑year‑old boys and reported that a “difficult affective
in other studies, such as those by Dishion and Owen.[39] temperament” mediated the relationship between paternal
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alcoholism and child maladjustment. These results suggest

In predicting internalizing problems, the results of this study
that a child with a genetic predisposition for substance abuse,
demonstrate that the offspring of alcoholics are at statistically
raised in an alcoholic environment, may be at a heightened
elevated risk for internalizing behavior. Differences in
risk for the development of behavior problems.
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internalizing symptomatology were observed between the

COAs and the non‑COAs. The present study is not without limitations. First, the study
population is “children of fathers with alcoholism seeking
Alcoholic families have been characterized as being high
treatment” and so, the findings cannot be generalized to the
in marital conflict, antisocial behavior, and depression,
broader population of “COAs.” Second, this study utilized
all of which have been shown to have a deleterious effect
maternal reports of child behavior problems which could be
on parent‑child relations and may in turn influence the
considered a study liability. Further, it has been found that
development of child behavior problems.[40,41] In secure
parent report on childhood behavior predicts later valid means
relationships, children can regulate their negative emotions
of assessment. Prevention programs aimed at improving the
through guidance and nurturance from the caregivers. Whereas
quality of the relationship with the nonalcoholic parent may
children of inconsistent parents (such as COAs) may learn
be effective at protecting the child against socio‑emotional
to under‑regulate or over‑regulate their emotions, possibly
maladaptation resulting from one’s father’s alcoholism.
leading to later internalizing and externalizing behavior
Interventions for this population may be particularly crucial as
problems reports Sroufe.[42]
deficits in behavioral regulation, reflective of a genetic liability
Results of the current study indicated that COAs have obtained are often present in COAs. Such dysregulation may negatively
high scores on the aggression questionnaire in contrast to impact the children’s ease in developing secure parent‑child
children with non‑alcoholic parents. There are several variables attachments. By using these techniques with COAs, child
that may influence the development of aggression, both in resilience can be maximized.
isolation and in interaction with one another. Patterson[43]
Future studies including samples of mothers with and without
observed that a spiralling chain of exchanges between parent
alcoholic partners may be able to better answer the question
and child with increasing levels of negative affect leads to a
of the role of maternal alcohol problems in the development
coercive cycle that promotes the development of children’s
of behavior problems.
aggressive behavior. Negative affect, a dimension of parenting
has been consistently associated with the development of Financial support and sponsorship
externalizing behavior problems.[44,45] The literature on COA Nil.
parents suggests that one pathway to maladjustment among
these children is through the associations between lack of Conflicts of interest
adequate early behavioral control with externalizing behavior There are no conflicts of interest.
problems leading to conduct disorder and delinquency,[19,46] a
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56 Journal of Mental Health and Human Behaviour ¦ Volume 23 ¦ Issue 1 ¦ January-June 2018