Developmental need as set out in the framework

Things to look out for

What could be done to assist the situation

Health

Safety of, particularly young, children - not being left alone, not alone with a drunk adult, storage of drink containers, risk of fire from untended cigarettes. Risk of violence. Presence of other drinkers.

Ability of at least one parent/constant carer to provide a regular and adequate diet. Parents with alcohol related problems can be neglectful of their own diet and health needs and this is often passed onto children. Meal times as a routine family activity are regularly missed.

Ability of one parent/constant carer to ensure usual regular health checks take place and can care for a child when they are ill.

A Health Visitor could be employed to regularly check on the general health of young children of problem drinking parents.

Parenting capacity support could include advice on child nutrition and family meal planning.

The School Nurse could be contacted and asked to keep an eye on a particular child and ensure basic health needs are attended to.

Education

Attendance at school might become erratic due to child looking after a parent or younger siblings. They might exhibit tiredness and have difficulty meeting homework requirements.

A parent may not be interested in what is going on for the child at school. Opportunity for play and interaction with other children can be denied as the family withdraws from others.

Achievements are not recognised.

Teachers might be aware that the child’s behaviour has changed (either acting out or withdrawing) and the standard of concentration and quality of work might drop.

Although for some children school becomes a refuge from their home situation and they continue to excel, others risk falling behind which can compound the isolation they experience.

Parenting capacity support could encourage parents to take an interest in the children’s schooling and guide them on how to encourage their children. Some areas have ‘play together, learn together’ type programmes to help parents engage with their children’s learning.

The involvement of Sure Start/the local Children’s Centre might be an option for under 5s to ensure good play opportunities exist for the child. Play schemes and after school clubs might be an option for older children from these families to mix with others outside school and to get support and help with completing homework.

For school age children teachers could be asked to look out for factors that might suggest that the child is struggling. A mentoring programme within a school would be particularly useful. The child’s teacher could be informed of the family’s problems, which might be a useful monitoring role as well as offering particular encouragement and support and identifying situations for the child to excel and develop their skills. The school might be able to be more proactive in encouraging a child to take opportunities that become available – extra curricular activities or school outings.

Emotional and behavioural development

The nature and quality of early attachments - a problem drinking parent has problems being attached to anything other than alcohol, so the child is not able to learn by example in terms of self control and response to stress.

Children experience a loss of parental availability and often feel lonely and isolated. They are fearful that their parents might die or the family break up. They tend to see parental problems as in some way their fault and feel guilty. They become socially isolated as they attempt to ensure no one outside the family knows about their parents. Their home lives can be quite chaotic, their parents’ behaviour unpredictable, and parenting inconsistent. Children may witness increased family arguments and possibly violence. They often respond by developing problems of their own:-

• Anti-social behaviour, or conduct disorder - more aggressive behaviour (although some children will become quieter and more withdrawn), more delinquency, more temper tantrums, more truancy, more hyperactivity, and so forth.

• Emotional problems - include a wide range of psychosomatic problems, ranging from asthma to bed-wetting. They also include negative attitudes to their parents; negative attitudes to themselves, with high levels of self-blame and withdrawal, crying, and depression.
  

Children from families where parental alcohol misuse is a significant factor are more likely than other children to:-

• Start using alcohol and other drugs at a younger age
• Use alcohol in risky fashion
• Have problems with alcohol misuse
• Have a higher prevalence of psychiatric disorder

Research on the different effects on girls and boys is equivocal, although the effect on children is likely to be more obvious where the problem drinking parent is the mother.

Check for the presence of other role models – friends and other family members. Supporting the non drinking parent will help.

Research indicates that it is family conflict, disharmony and poor family relationships which are the significant factors and this can be reduced even when parents are apparently unwilling or unable to stop drinking. Working with parents on their parenting skills and management of family life could well have very positive effects and will reduce the likelihood of long term harm.

Significant problems in this area (and with others above and below) may well be best addressed by the provision of specific counselling and therapy. Ideally this should take the form of help tailored specifically to the needs and issues of, and for, children affected by problem drinking parents. However local services are few and far between although there are some examples of specific services to draw on. These include:-

Family Alcohol Service
Stars
Chrysalis
HAGA

Other services working directly with children may be able to help with input from an alcohol specialist. Information on all these services can be found in Further information

As it is unlikely that there are specific services in any one area we recommend:-

• Contacting the local alcohol services to see if there is any local information or support that might be of use
• Considering setting up a service – contact any of the above for more information
• Developing a support group for children affected by problem drinkers.

Identity

Depending on the severity of the situation, the child’s view of themselves and their abilities may be distorted due to messages given at home (are blamed or blame themselves, told or feel that they are just not good enough etc). The child may not want to belong to the family and certainly may sense that their family is not accepted by wider society due to taboos around alcohol.

Depending on the age of the child, it might be that involvement in a child carers group may bring them into contact with children will similar issues.

Specialist support for children affected by parental drinking would help address these areas.

Social presentation

Problem drinking parents might find it hard to keep up with day to day jobs such as washing and ironing. Their own lack of attention to cleanliness and personal hygiene can be compromised and this does not provide a helpful learning model for children.

Lack of attention can result in clothes not being replaced regularly as the child grows and there are often financial difficulties, which might also impact on the problem.

This is important for creating and maintaining relationships with peers. This subject can be dealt with in the context of supporting parenting capacity or via counselling made available directly to the child. Efforts need to be made to ensure a younger child is enabled to dress appropriately – this matter could be specifically raised with the stable adult figure. Older children made need help with the means to do this for themselves. The school nurse might be a helpful contact on these matters.

Family and social relationships

Fractured relationships are likely with extended family with parents falling out with other family members frequently. The family is likely to be more isolated than others and less able to draw on the support of family and neighbours and friends. Children tend to become more isolated as a consequence.

Inconsistent care and attention (sometimes no attention, sometimes over affectionate) can cause high levels of anxiety and insecurity in children.

The family often conspires to hide the problem drinking, denying the extent of it and the effect on children, and fearing the consequences of seeking external help. Children quickly pick up on the fact that this is not something they should talk about, within or outside the family group.

Parental behaviour or fear of it can lead to children avoiding contact with peers and becoming quite isolated as they cannot return invitations or simply feel too different from their peers to be able to form friendships.

Some children are able to separate their school/social life and family life completely. Whilst this helps the child cope and develop it also means parents have little sense of their child’s life outside the home – these children have to learn self-sufficiency early on.

When parental alcohol misuse does come to the attention of an outsider children are likely to feel:-

• Relief that someone has noticed mixed with
• A great deal of fear of losing their family as a consequence
• Fear of being blamed by their parents for the outside involvement and guilty about any consequences

The importance of a stable adult figure in regular contact with the family is stressed as a key factor in promoting resilience. Social workers could identify potential individuals and work with them to strengthen the role they might be able to carry out.

This could be addressed in parenting capacity support and training offered to parents.

Work on friendships with peers is important to prevent isolation. This could focus on ensuring that the child has opportunities to talk through their concerns (youth and child counselling facilities).

Environments such as schools and youth clubs should ensure that there is some openness about this type of problem on a general basis (posters, sessions on alcohol and drug education mentioning parental alcohol misuse, leaflets available etc)

Ensure that other barriers to social relationships are minimised (access to clean clothes and good hygiene etc); the encouragement of activity-based social opportunities; the introduction to services such as AlaTeen who can be contacted 020 7403 0888 (confidential advice covering the UK and the Republic of Ireland).

Self care skills

Children may develop a high degree of practical competencies required for increasing independence out of necessity. However their ability to look after themselves emotionally and psychologically could be much less developed given what they learn about social problem solving approaches from a parent who uses alcohol to solve most problems.

Alcohol and potential effect on parenting

Things to look out for (drawn from Cleaver, Unell & Aldgate, 1999)

Assessment Framework headings on Parenting Capacity to which the issue relates

Parenting skills

Apathy and listlessness, classic symptoms of depression may be mirrored in substance misusers and mean that parents may have difficulty organising their lives. This leads to inconsistent parenting, unpredictable responses to their children’s behaviour and ineffectiveness.

Neglect of physical needs – as said above the effects of alcohol misuse and link with depression can lead to a parent neglecting self and basic care of children.

All

Basic Care and Ensuring Safety

Parent’s perceptions

Reports of a parent losing consciousness or self reports of black out (not an unusual experience for people misusing alcohol, particularly binge drinkers), especially at times when no other adult is available to care for the children.

Alcohol misuse and alcohol problems can lead to a warped view of the world. Alcohol misuse leads to heighten anxiety, paranoia, and people can get fixated on an issue and distort matters, including their view of their children. For example blaming one for their distress or seeing a child as a saviour/main source of solace.

Alcohol misuse can lead to depression where parents might consider themselves inferior and less competent or see their children as having more behavioural problems than others. Parents are unlikely to be very objective.

Ensuring Safety – child’s ability to attend to themselves or know how to get help is key and clearly age related.

Emotional Warmth, Guidance and Boundaries, Stability.

Stimulation, Emotional Warmth

Alcohol misuse and the effects of heavy drinking can make parents irritable and angry with their children. Their stress tolerance can be radically reduced which adds to problems in dealing with a fractious infant or difficult teenager.

Withdrawal symptoms – particularly from binge drinking (chronic drinkers more likely to have a drink in the morning to stave this off) will increase the difficulty of responding appropriately to children.

Violent mood swings are a common feature of alcohol misuse – elation to argumentative with no warning. This can be frightening for children and the long term effect of unpredictable parenting can be significant in destabilising a child.

Being emotionally unavailable to the child. Although a concern for all children, this can be particularly concerning when the child is a young baby.

Low threshold for frustration than normal and frequent discharge of aggression/anger

Parents relying on harsh verbal responses in communication with their children

Insensitivity to children’s cues

Being more critical of their children

Violent relationships

Developmental need as set out in the Assessment Framework

Things to look out for

Key points

Family History and Functioning

a) Family Background

Whilst a family history will provide some indication of level of entrenchment of the drinker’s drinking problem it is by no means certain that a person from a background where alcohol misuse is common is less likely to be able to make significant changes to their lives. What is known however is that the impact of alcohol misuse is much greater for people from disadvantaged backgrounds and therefore also for their children. Whilst assessors should be very wary of overlooking heavy drinking and its impacts in a well-off family – the effects on children here will be masked to an extent - the effect of alcohol problems on a family from a more disadvantaged background is likely to be more immediate and acute, as well as long term in the sense of affecting the basic needs of a child as well as the emotional, developmental and behavioural ones.

b) Drinker’s childhood and background

Negative childhood experiences may lie behind alcohol problems (for example 75% of women with an alcohol problem will have been sexually abused). Alcohol misuse can be linked to unresolved loss.

c) Disharmony is the main cause of long term harm to children.

It is the effect of alcohol on family functioning which causes harm to children, not the drinking itself (see above).

Assess family functioning not just the drinking levels of parents – using the Assessment Framework will ensure this. Much research indicates that, in isolation, parental alcohol misuse presents little risk of significant harm to children. Most children of parents with problem alcohol use eventually ‘outgrow’ their troubled childhood and develop into balanced, productive adults and parents. The best indicator of adverse long-term effects is the co-existence of mental illness or family disharmony. When families remain cohesive and harmonious the children generally grow up relatively unharmed (Cleaver et al, 1999).

Children from lower socio-economic groups are likely to experience a higher degree of impact from parental drinking although this cannot be assumed.

Does the drinking parent need counselling and therapy and are they able to consider using it at this time?

Assess family functioning not the drinking problems of the parents.

Wider Family

As described above the child might be cut off from the wider family due the efforts made by parents to keep their problems secret or because other family members might be intolerant of their drinking and disapprove. Relationships between the drinker and their family and friends commonly break down. This can work against one of the most protective factors for children being in place – that of another family member closely involved with the child.

Conversely in some families where heavy drinking is the norm the child might be completed enmeshed in a drinking culture that goes through several generations. This can reinforce a negative experience children may have as being normal and to be expected.

Relationships with the extended family need to be nurtured to help ensure children have helpful role models and to provide for the protective effect of the close involvement of another adult.

Housing

Can exacerbate a drinking problem and the effects on children if space is at a premium.

Drinking problems can threaten tenancies.

Standards within the home may leave a lot to be desired again due to the fact that a drinking parent is not child or home focused. Cleanliness, hygiene and safety may be compromised.

Affects safety and basic care.

Can the child get out of the way if they need to?

Employment

Jobs might be lost. A person may not be fit to return to work. Children are likely to be aware of this.

People in lower paid jobs are usually less protected by employment legislation. In some professions drinking might be acceptable and therefore a drinking problem less noticeable.

Family social integration

Families can become isolated from friends due to trying to hide the problem, or be so integrated into a drinking subculture that children and their welfare are not paramount. The needs of the drinker dominate and children can be neglected. There may also be issues concerning other drinkers being in the house with young children and a potential risk of abuse.

Community resources

Services available to families are often underused by those with a drinking problem due to ‘keeping self to self’, in fear of having problems uncovered. Lack of motivation and interest can account for under use of resources that would benefit children – parks, libraries, etc.