1 23

Journal of Child and Family Studies ISSN 1062-1024 J Child Fam StudDOI 10.1007/s10826-015-0280-x

Youth Emotional Reactivity, InterparentalConflict, Parent Hostility, and WorryingAmong Children with Substance-AbusingParents

Michelle L. Kelley, Tyler D. White,Robert J. Milletich, Brittany F. Hollis,Brianna N. Haislip, Erin K. Heidt, CassieA. Patterson, et al.

1 23

Your article is protected by copyright and all

rights are held exclusively by Springer Science

+Business Media New York. This e-offprint is

for personal use only and shall not be self-

archived in electronic repositories. If you wish

to self-archive your article, please use the

accepted manuscript version for posting on

your own website. You may further deposit

the accepted manuscript version in any

repository, provided it is only made publicly

available 12 months after official publication

or later and provided acknowledgement is

given to the original source of publication

and a link is inserted to the published article

on Springer's website. The link must be

accompanied by the following text: "The final

publication is available at link.springer.com”.

ORIGINAL PAPER

Youth Emotional Reactivity, Interparental Conflict, ParentHostility, and Worrying Among Children with Substance-AbusingParents

Michelle L. Kelley1 • Tyler D. White1 • Robert J. Milletich1 • Brittany F. Hollis1 •

Brianna N. Haislip1 • Erin K. Heidt1 • Cassie A. Patterson1 • James M. Henson1

� Springer Science+Business Media New York 2015

Abstract The present study examined whether emotional

reactivity mediated the association between interparental

violence, parental hostility, and children’s worrying among

90 youth living with substance-abusing parents. Children

completed measures of security and anxiety. Mothers and

fathers’ completed measures of violence perpetrated

toward their partners and general hostility. Results of a

Bayesian mediation model revealed indirect effects such

that after controlling for other variables in the model,

fathers’ hostility was associated with greater emotional

reactivity, which in turn was associated with children’s

reports of worrying. The indirect effects of mothers’ hos-

tility, parents’ interparental violence, and child age on

children’s reports of worrying via children’s emotional

reactivity were not statistically significant. Results suggest

that fathers’ hostility is associated with children’s reports

of worrying among children residing with a substance-

abusing parent via associations with children’s emotional

reactivity to parental conflict.

Keywords Interparental violence � Parent hostility �Children’s anxiety � Children of substance-abusing parents

Introduction

Children of substance abusers (COSAs) are at greater risk

for internalizing symptoms such as anxiety (Billick et al.

1999; Eiden et al. 2009; Hussong et al. 2008; Wilens et al.

2002). Both interparental violence (e.g., Bergman et al.

2014) and to a lesser extent, chronic exposure to parental

hostility (e.g., Berman et al. 2000), are associated with

children’s tendencies to worry. Emotional reactivity, which

involves habitual elevation of arousal and dysregulation of

children’s emotions (Davies and Cummings 1994) in

response to interparental conflict and parent hostility are

likely to contribute to children’s anxiety; however, these

processes have received little attention among youth living

with substance-abusing parents.

The larger developmental literature has demonstrated

ties between interparental violence and children’s inter-

nalizing difficulties (e.g., Evans et al. 2008; Ingram and

Luxton 2005). For instance, Kitzmann et al. (2003) found a

significant association between exposure to interparental

violence and children’s somatic complaints. In a meta-an-

alytic study, Buehler et al. (1997) found an average effect

size (d-value) of 0.35 for parents’ use of an overt parental

conflict style (which included physical violence and verbal

aggression) and youth internalizing and externalizing

problems.

Not only do COSAs experience high levels of anxiety

(e.g., Hussong et al. 2008), but parental substance abuse

may impede recovery from anxiety as adults. For instance,

in a longitudinal study of young adults with some form of

anxiety disorder, parental anxiety disorder did not predict

participants’ relapse from anxiety disorders; however,

those with a history of parental substance use were twice as

likely go from asymptomatic to symptomatic panic disor-

der or social phobia over the course of the study (Pagano

et al. 2007).

One reason parental substance abuse is highly tied to

children’s internalizing symptoms (e.g., Eiden et al. 2009;

Hussong et al. 2008) may be that interparental violence is

common among parents with substance use disorders (see

& Michelle L. Kelley

mkelley@odu.edu

1 Department of Psychology, Old Dominion University,

Norfolk, VA 23529-0267, USA

123

J Child Fam Stud

DOI 10.1007/s10826-015-0280-x

Author's personal copy

Kelley et al. 2010 for a review; Stover and Kiselica 2014).

In fact, approximately 50–65 % of adults entering sub-

stance abuse treatment report past-year partner violence

(e.g., Burnette et al. 2008; Chermack et al. 2001; Chermack

et al. 2010; Kaufmann et al. 2014; see Murphy and Ting

2010, for a review). Moreover, the association between

intimate partner violence and substance abuse has been

demonstrated for alcohol (Foran and O’Leary 2008; Moore

et al. 2011; Shorey et al. 2014), cocaine (Norlander and

Eckhardt 2005), opioids (El-Bassel et al. 2007; Subodh

et al. 2014), and alcohol and cocaine or marijuana (Crane

et al. 2014; Kraanen et al. 2014).

Relative to interparental violence and youth anxiety,

previous studies have paid less attention to psychopathic

traits such as general hostility among parents that may also

contribute to the development of internalizing symptoms.

Patterson et al. (2000) contend that hostile interactions in

families undermine effective responses to children. Like-

wise, Denham et al. (2000) described parent hostility as a

form of chronic distress that may diminish parents’ ability

to respond effectively to children’s behavior and needs. In

a subset of children in the Denham et al. sample who had

elevated externalizing behavior scores, mothers’ supportive

behavior and less anger, and fathers’ reports of lack of

hostility and anger, discriminated between youth whose

behavior problems diminished or increased 5 years later. In

a sample of fathers who had been arrested for domestic

violence, there was a tendency for men’s interpersonal

hostility to be associated with their reports of their chil-

dren’s overall emotional and behavioral functioning (Fe-

bres et al. 2014). In a community sample, emotional

dysregulation and self-blame mediated the association

between interparental hostility measured when children

were in sixth grade and youth internalizing problems

2 years later (Buehler et al. 2007). Correspondingly, parent

hostility was one of the best predictors of youth who

recovered from phobic and anxiety disorders after receiv-

ing exposure-based cognitive and behavioral treatment as

compared to children who did not (Berman et al. 2000).

Research examining associations between parent hos-

tility and anxiety among COSAs is rare. Hostility is asso-

ciated with drug and alcohol use (Calhoun et al. 2001;

Hamdan-Mansour et al. 2009; Hampson et al. 2010; Stover

and Kiselica 2014). Furthermore, both cocaine (e.g., Parrott

et al. 2003; Roozen et al. 2011) and alcohol (e.g., Eckhardt

2007; Giancola et al. 2002) administration studies have

documented increases in negativity and hostility. More-

over, adult children of alcoholics (ACOAs) are more likely

than non-ACOAs to report their parents as hostile,

uncontrolled, and rejecting (MacPherson et al. 2001). It is

possible that the overt hostile style of interparental conflict

described by Ahrons (1981) and Camara and Resnick

(1988) depicts many substance-abusing couples and may

impact children’s internalizing symptoms (Buehler et al.

2007; Denham et al. 2000). Extrapolating from the larger

literature with children of non-substance-abusing parents,

general hostility may be essential to understanding why

some COSAs develop internalizing symptoms such as

worrying.

A prominent theory, the emotional security hypothesis

(EST; Cummings and Davies 2010; Davies and Cummings

1994), holds that children develop a sense of security from

their developmental contexts. When their emotional secu-

rity is threatened by family processes, particularly hostile,

threatening interparental behavior, children may be affec-

ted in many ways. Constant threats from interparental

conflict may deplete children’s coping resources and result

in disrupted physiological responses (Cummings et al.

2006; Davies et al. 2006). Over time, children exposed to

interparental violence decrease their ability to regulate

feelings of fear, worry, and increase vulnerability to

internalizing problems (Bergman et al. 2014). In contrast,

children who are better able to maintain emotional regu-

lation in the midst of family violence and other hostile and

threatening behaviors should be less likely to experience

symptoms of emotional anxiety (Cummings and Davies

2010). Considerable research, primarily with community

samples, has found emotional insecurity accounts for the

relationship between interparental conflict and children’s

(Davies and Forman 2002) and adolescents’ (Bergman

et al. 2014) internalizing symptoms.

Although relatively few studies have examined inter-

parental violence, parent characteristics, and emotional

regulation in COSAs, Ballard and Cummings (1990) found

children of problem drinking parents (COAs) were more

likely to become involved in marital conflicts than non-

COAs. Keller et al. (2007) found when mothers were the

identified problem drinker children were more likely to

intervene in response to escalating interparental conflict

that was about child caretaking. In contrast, exposure to

paternal problem drinking was related to child mediation

and avoidance when parents were arguing about the child,

and no response to escalated conflict. Some (Fergusson and

Horwood 1998), but not all research (El-Sheikh et al. 2008)

with community samples has found children’s emotional

security may be more threatened in instances of male-to-

female aggression. It is possible that the degree to which

youth report emotional reactivity during parent conflict

may vary by whether violence is male-to-female or female-

to-male and mothers’ versus fathers’ hostility.

In the present study, we tested whether mothers’ and

fathers’ reports of the perpetration of interparental violence

and psychopathological symptoms of hostility were indi-

rectly associated with their children’s reports of worrying.

We hypothesized that fathers’ and mothers’ interparental

violence perpetration and hostility would be associated

J Child Fam Stud

123

Author's personal copy

with youth reports of worrying via increases in emotional

reactivity during parental conflicts.

Method

Participants

Participants were 90 triads (90 fathers, 90 mothers, and 90

children) in which one or both parents met drug, alcohol, or

both drug and alcohol disorder criteria for alcohol or drug

abuse (4th ed., text rev.; DSM-IV-TR; American Psychi-

atric Association 2000). Families were recruited from

advertisements to take part in a larger study in which eli-

gible couples could receive substance abuse treatment.

Data are reported here on the pretreatment assessment.

Families did not differ on background variables reported in

Table 1 as a function of type of substance abuse (i.e., drug

use only, drug and alcohol abuse, or alcohol abuse) or

whether one or both parents met substance abuse criteria.

Families were excluded if (a) the child had cognitive,

physical, or psychological limitations that would preclude

their ability to understand the questions, (b) partners did

not reside together, (c) the child did not reside with parents

full-time (or in a few instances the child resided with the

parent part-time but on a regular basis such as alternating

weeks and the study parent maintained joint custody of the

child), or (d) any family member was not fluent in English.

In the case of families with more than one child in the age

range, to prevent selection bias, the child with the closest

birthday to the initial screening was invited to participate.

Parents gave approval for themselves and their children to

participate. Children gave assent. Family members were

compensated $90.00 ($30.00 each).

The mean age for fathers was 39.84 years (SD = 7.84);

the mean age for mothers was 38.22 years (SD = 7.42).

The majority of parents were White. The mean age for

children was 11.08 years (SD = 3.81; range 6–18 years);

Table 1 Demographics for

sampleVariable Mother Father

Count (%) Mean SD Count (%) Mean SD

Age in years – 38.22 7.42 – 39.84 7.84

Ethnicity

African-American 15 (16.67) – – 21 (23.33) – –

American Indian or Alaskan Native 2 (2.22) – – 4 (4.44) – –

Asian 1 (1.11) – – 0 (0.00) – –

Caucasian 55 (61.11) – – 52 (57.78) – –

Hispanic or Latino 3 (3.33) – – 7 (7.78) – –

Multicultural/other 14 (15.56) – – 6 (6.67) – –

Married

Yes 48 (53.33) – – 48 (53.33) – –

No 42 (46.67) – – 42 (46.67) – –

Years cohabitating – 9.13 7.05 – 9.13 7.05

Years of education – 13.53 2.38 – 12.70 2.41

Income (past 6 months)

\$20,000 61 (67.78) – – 48 (53.33) – –

$20,000–\$40,000 17 (18.89) – – 19 (21.11) – –

$40,000–\$60,000 7 (7.78) – – 11 (12.22) – –

[$60,000 3 (3.33) – – 12 (13.33) – –

Missing 2 (2.22) – – 0 (0.00) – –

SUD diagnosis

None 47 (52.22) – – 7 (7.78) – –

Alcohol only 10 (11.11) – – 19 (21.11) – –

Drug only 10 (11.11) – – 15 (16.67) – –

Alcohol and drug 23 (25.56) – – 49 (54.44) – –

Child age in years – 11.08 3.81 – 11.08 3.81

Child sex

Male 44 (48.89) – – 44 (48.89) – –

Female 46 (51.11) – – 46 (51.11) – –

J Child Fam Stud

123

Author's personal copy

46 children were girls. See Table 1 for additional

sociodemographic information.

Procedure

After a brief initial phone screening to determine if the

family met general study criteria and determine whether

both partners and children were interested, a convenient

time was set to meet for the assessment. At this meeting,

the study was described in detail and partners were indi-

vidually consented and gave permission for their children

to participate. Parents were individually and separately

administered the SCID (First et al. 2010) by a licensed

mental health counselor or psychologist with 5–15 years of

clinical substance abuse research experience. Each parent

then independently and separately completed the self-re-

port instruments. In several instances, after the initial

phone screening, the SCID was administered by a trained

research assistant. The counselor or clinical psychologist

reviewed the SCID prior to determining substance use

diagnosis. Children give assent and then were administered

questionnaires privately from their parents. Care was given

to ensure that children adequately understood the ques-

tions. This included asking children to restate the instruc-

tions, encouraging questions, and having children complete

sample items. The study was conducted in accordance with

the code of ethics of the American Psychological Associ-

ation and human subjects approval was granted by the

participating research university prior to participation.

Measures

Security in the Interparental System (SIS; Davies et al.

2002)

Children were administered the 9-item Emotional Reac-

tivity subscale from the SIS. The SIS assesses children’s

strategies for preserving emotional security in the context

of parent conflict. Specifically, after a brief preface chil-

dren answer each question reflecting how they felt during

the past year [e.g., ‘‘When my parents argue, I feel (sad,

scared, angry, unsafe); After my parents argue, (it ruins my

whole day, I can’t seem to calm myself down, I can’t seem

to shake off my bad feelings); ‘‘When my parents have an

argument, I try to hide what (I’m feeling, I can’t stop

thinking about their problems)]. Response choices were (1)

not at all true of me, (2) a little true of me, (3) somewhat

true of me, and (4) very true of me. Test-retest reliability

over a 6 months period for the SIS was 0.87 among sixth,

seventh, and eighth graders, and validity has been shown in

relation to children’s responses to conflict across different

informants, conflict stimuli, and more than one occasion

(Davies et al. 2002). For the present study, alpha was 0.89.

Revised Children’s Manifest Anxiety Scale (RCMAS;

Reynolds and Richmond 1978)

The RCMAS is a 37 item scale designed to assess the level

and nature of children’s anxiety. Scores for four subscale

scores can be derived (i.e., worry/oversensitivity, physio-

logical anxiety, concerns/concentration, and a lie scale).

For the present study we examined scores from the Worry

(e.g., ‘‘I worry a lot of the time’’ ‘‘My feelings get hurt

easily’’; 11 items) dimension. Children respond to each

item ‘yes’ or ‘no’. Affirmative responses are given 1 point;

negative scores are given 0 points. Because scores are

derived from affirmative responses, high scores reflect

greater worrying. In a community sample of children ages

8 to 16, Schudlich and Cummings (2007) found internal

consistency of the RCMAS of 0.90. Internal consistency

for the Worry scale was 0.83 in the present study.

Symptom Checklist-90-Revised (SCL-90-R; Derogatis

1994)

Mothers and fathers completed the SCL-90, a 90-item

questionnaire that assesses symptom dimensions. For the

purpose of the present study, six items that assess hostility

(e.g., ‘‘Temper outbursts that you could not control’’,

‘‘Having urges to beat, injure or harm someone’’,

‘‘Shouting or throwing things’’). Items are scored on a

5-point scale from (0) not at all, to (4) extremely. Schmitz

et al. (2000) found reliable change and clinical significance

of the SCL-90 in normative and clinical samples, with an

overall SCL-90 alpha of and 0.78 for the hostility subscale.

In a study of treatment outcomes of children exposed to

interparental violence, Lieberman et al. (2005) reported

subscale alphas for the SCL-90 between 0.77 and 0.90.

Internal consistency for the hostility dimension of the SCL-

90-R was 0.80 and 0.81 for mothers and fathers,

respectively.

Conflict Tactics Scale-2 (CTS2; Straus et al. 1996)

To assess interparental violence, both parents completed

the Physical Assault and Injury subscales of the CTS2. The

CTS2 assesses the frequency with which each partner

perpetrated and were victims of various physical violence

(e.g., hit, slapped, slammed against a wall), in the past year.

Response choices were 0 (never), 1 (once), 2 (twice), 3 (3–

5 times), 4 (6–10 times), 5 (11–20 times), 6 (more than 20

times), or 7 (not in the past year, but it did happen before).

Responses of 7 (not in the past year, but it did happen

before) were recoded as 0. For the present study, item

responses were summed to obtain total scores for fathers’

reports of father-to-mother perpetration of violence and

mothers’ reports of mother-to-father perpetration of

J Child Fam Stud

123

Author's personal copy

violence. The CTS2 has been used in over 600 studies of

family violence (Straus 2007). Internal consistency was

0.90 for mothers and 0.89 for fathers.

Data Analyses

The hypothesized mediation model was tested with Baye-

sian methods using a Gibbs sampler algorithm in Mplus

7.2. A Bayesian approach was used, as opposed to boot-

strapping, to test for the significance of indirect effects

given that Bayesian inferences in small samples are exact

(Yuan and MacKinnon 2009) and Bayesian methods tend

to have lower Type I error rates than bootstrapping

(Koopman et al. 2014). Diffuse priors were specified for

regression coefficients and variances with three indepen-

dent chains using 20,000 iterations (see Asparouhov and

Muthen 2010 for technical details). The first 10,000 itera-

tions were treated as a burn-in phase, which are iterations

not used to represent the posterior distribution.

Model fit was evaluated using a 95 % confidence

interval for the model Chi square (v2), which is a statistic

that represents the difference in v2 values for the real and

replicated data. Good model fit is indicated by a negative

lower limit and a large posterior predictive p value (As-

parouhov and Muthen 2010). Model convergence was

assessed using potential scale reduction (PSR) statistics and

trace plots. PSR statistics compare the parameter variation

within each chain to the parameter variation between

chains to determine if the chains converge to the same

values. The PSR criterion essentially requires the between-

chain variation to be small relative to the total of between-

and within-chain variation (Asparouhov and Muthen

2010). Typically, convergence is satisfied is the PSR is

close enough to 1 for each parameter. Trace plots are used

to visually inspect if a Markov Chain Monte Carlo algo-

rithm (i.e., Gibbs sampler for this data) converges to the

target posterior density and mixes well throughout the

support of the target posterior density. A trace plot that

shows no upward or downward trend in the parameter

draws across each chain provides evidence for convergence

to the target posterior distribution (Yuan and MacKinnon

2009). Similarly, trace plots that show the parameter draws

varied around the support of the target posterior density

provide evidence that the chains mixed well (Gelman et al.

1995).

Autocorrelation plots were used to examine the degree

of correlatedness of parameter values across iterations for

different lags. Small autocorrelations (i.e., \0.1) indicate

approximately independent draws from the posterior dis-

tribution, which is a desired result (Asparouhov and

Muthen 2010). Missing data were imputed internally under

the hypothesized model. Due to the small sample size, the

median was used as a point estimate. Significance testing

for direct and indirect effects was done using 95 % highest

posterior density (HPD) intervals.

Results

As shown in Table 2, the typical child answered affirma-

tively to 4.30 (SD = 3.16) of 9 symptoms of worrying. On

average, children reported the emotional reactivity items

were ‘‘a little true of me’’. Fathers and mothers typically

endorsed at least some level of four or five psychopathologic

symptoms of hostility such as temper outbursts and shout-

ing or throwing things, M(fathers) = 4.09, SD = 4.40;

M(mothers) = 5.24, SD = 4.28. On average, fathers’

reported two acts of male-to-female violence in the previous

year, M(fathers = 1.89; SD = 3.23); mothers’ reported four

instances of female-to-male violence in the previous year,

M(mothers = 3.96, SD = 5.56). Table 2 also presents cor-

relations and means and SD between study variables.

Results of the mediation model demonstrated that the

model provided a good fit to the data, 95 % CI for the

model v2 (-21.468, 28.826) (p = 0.418). Examination of

autocorrelation plots revealed that all autocorrelations were

\0.1, which indicates approximately independent draws

from the posterior distributions. All PSR statistics were

\1.022, trace plots for each parameter showed stability in

parameter values across each chain, and the chains

appeared to mix well across values of the parameter spaces,

all of which provide evidence for model convergence

(Gelman et al. 1995).

Indirect effect analyses revealed that after controlling

for parental IPV perpetration, mother’s hostility, and

child’s age, father’s hostility was associated with higher

levels of children’s emotional reactivity, which in turn was

associated with higher levels of children’s worrying

symptoms, B = 0.120, 95 % HPD interval (0.019, 0.230)

(see Table 3). On the contrary, while controlling for other

variables, the indirect effects of the exogenous variables

mother’s hostility, mother-to-father physical IPV perpe-

tration, father-to-mother physical IPV perpetration on

children’s worrying symptoms via children’s emotional

reactivity were not statistically significant. These null

effects are due to the lack of direct effects between the

exogenous variables and children’s emotional reactivity

(i.e., the mediating variable). Figure 1 presents the fitted

hypothesized mediation model.

Discussion

Despite calls for research on drug-abusing fathers (e.g.,

McMahon et al. 2005), relatively few such studies have

appeared. Furthermore, studies of children’s anxiety focus

J Child Fam Stud

123

Author's personal copy

on mothers’ influences (Kim et al. 2009). Moreover, par-

ents underestimate their children’s worry and anxiety

(Lagattuta et al. 2012) and children’s ratings of the inter-

nalizing symptoms have been shown to be reliable

(Michael and Merrell 1998). Therefore, children rated their

own symptoms of anxiety and emotional reactivity. Our

focus is particularly appropriate given that studies consis-

tently find higher rates of internalizing problems among

COSAs (e.g., Hussong et al. 2008). In addition, COSAs are

likely to be exposed to family influences that have been

associated with anxiety among children in community

samples (e.g., Bergman et al. 2014; Davies and Forman

2002; Harold et al. 2012).

Controlling for mothers’ hostility and both parents’

reports of interparental violence, fathers’ accounts of hos-

tility were associated with COSAs’ reports of worrying.

This finding supports research demonstrating that chil-

dren’s ability to regulate their emotions may serve to

mediate the effects of parental hostility on children’s

anxiety in community (Bergman et al. 2014; Davies et al.

2002; Koss et al. 2013) and clinical (e.g., Graham-Ber-

mann 1996) samples. Berman et al. (2000) found parent

hostility was one of the best predictors of youth who

recovered from phobic and anxiety disorders after receiv-

ing exposure-based cognitive and behavioral treatment as

compared to children who did not. Related to the Berman

et al. findings, we found parent hostility in substance-

abusing fathers was associated with their children’s reports

greater emotional reactivity during parent conflicts and

contributed to youth reports of worrying. Thus, among

children residing with substance-abusing parents, fathers’

reports of hostility may be expected to be associated with

children’s emotional reactivity, which in turn may con-

tribute to children’s reports of worrying.

The stronger impact of paternal hostility on youth

reports of worrying via emotional reactivity during inter-

parental conflict may reflect that nearly all fathers met

criteria for drug or drug and alcohol use. Taft et al. (2010)

found drug use was associated with hostility and antisocial

behavior in men. Furthermore, even among substance-

abusing adults who are not typically hostile, during periods

of withdrawal, parents may exhibit irritability, anger, and

hostility (Hanson 2009). In addition, it is possible that

fathers may stimulate more fear than mothers due to their

Table 2 Descriptive statistics

among study variablesVariable 1 2 3 4 5 6 7

1. Child: worry symptoms (0.827)

2. Child: emotional reactivity 0.568 (0.855)

3. Child: age in years 0.083 -0.139 –

4. Father: hostility 0.094 0.301 -0.107 (0.820)

5. Mother: hostility 0.063 0.198 -0.031 0.193 (0.794)

6. Father: IPV perpetration -0.116 -0.088 0.055 0.211 0.201 (0.881)

7. Mother: IPV perpetration -0.175 -0.065 -0.059 0.138 0.397 0.342 (0.904)

Mean 4.301 18.425 11.083 4.098 5.243 1.893 3.976

SD 3.160 7.305 2.784 4.402 4.288 3.237 5.563

Skewness 0.634 0.698 0.162 1.546 0.720 1.902 1.905

Kurtosis -0.527 -0.678 -1.091 2.276 -0.418 3.255 3.766

Missing data % 11.111 8.889 0.000 18.889 20.000 13.333 6.667

Cronbach’s alphas are presented along the diagonal in parentheses. Correlations are presented below the

diagonal. Bold correlations indicate statistical significance at a = 0.05 (the frequentist perspective). Aside

from Cronbach’s alphas, statistics were estimated using full-information maximum likelihood

Table 3 Bayesian estimates of

indirect effectsIndirect effect B 95 % HPD interval

LL UL

Father: H ? child: ER ? child: W 0.120 0.019 0.230

Father: IPV ? child: ER ? child: W -0.074 -0.230 0.061

Mother: H ? child: ER ? child: W 0.092 -0.013 0.218

Mother: IPV ? child: ER ? child: W -0.049 -0.143 0.044

The median was used as a point estimate

HPD highest posterior density, H hostility, ER emotional reactivity, W worry symptoms of anxiety, IPV

intimate partner violence perpetration

J Child Fam Stud

123

Author's personal copy

comparable physical strength and size and the pitch and

inflection of their voice (Horn and Sylvester 2002).

Because nearly all fathers had substance use disorder,

children may have had more opportunities to see situations

in which the fathers’ hostility played out in the family

context (e.g., during periods of high use), thus, contributing

to greater emotional reactivity and symptoms of worry.

In contrast to our predictions, controlling for other

variables in the model, mothers’ hostility did not contribute

to children’s emotional reactivity. Furthermore, while the

association between mothers’ hostility and children’s

anxiety was in the expected direction, this association was

not significant. It should also be noted that less than half of

mothers had substance use disorder. Relative to fathers,

mothers generally have larger caregiving roles in their

children’s lives (Jacobs and Kelley 2006). Even substance-

abusing women living with another adult are typically their

children’s primary caregivers (Stewart et al. 2007). Thus,

mothers’ hostility may have less association with

children’s emotional reactivity and worrying because

children may have more opportunity to develop emotional

security with their mothers who typically provide much of

their care. The lack of an association between hostility in

mothers and children’s emotional reactivity during parental

conflict may reflect that maternal hostility may elicit less

fear or concern among children. In addition, some have

also argued that drug and alcohol use may have different

etiology for women versus men. For instance, men with

drug and alcohol use disorder are more likely to have

antisocial personality disorders, whereas women’s drug

and alcohol use may stem from relationship dissatisfaction,

anxiety and depression (e.g., Grella et al. 2009). Gender

differences in caretaking, as well as possible differences in

the etiology maternal and paternal drug use, and that nearly

all fathers met criteria for substance abuse, may account for

the finding that fathers’ hostility contributed to children’s

symptoms of worrying via greater emotional reactivity

during interparental conflict.

Father: Hostility

Mother: Hostility

Child: Emotional Reactivity

Child:Worry

Symptoms

-0.068 [-0.197, 0.067]

0.255[0.166, 0.346]

Father: IPV

perpetration

Mother: IPV

perpetration

Child:Age

-0.022 [-0.230, 0.180]

-0.034[-0.192, 0.116]0.009

[-0.160, 0.176]

0.130 [-0.035, 0.293]

-0.198 [-0.559, 0.149]

-0.298[-0.843, 0.252]

0.373 [-0.039, 0.816]

0.482 [0.116, 0.870]

-0.200 [-0.616, 0.223]

R 2 = .211[.064, .378]

R 2 = .406[.239, .575]

Fig. 1 Fitted mediation model. Numbers are unstandardized median

parameter estimates; 95 % highest posterior density intervals are

presented in brackets below point estimates. Bold indicates statistical

significance at a = 0.05. Covariances among exogenous variables are

omitted for clarity

J Child Fam Stud

123

Author's personal copy

Of note, mothers and fathers’ reports of hostility were

not correlated. The lack of correlation between mothers’

and fathers’ hostility is in contrast to what might be

expected based on spillover theory (Erel and Burman

1995). According to this theory, one parent’s hostility

should ‘spillover’ and influence the other partner and for

that matter, other aspects of the family environment.

After controlling for other variables in the model, par-

ents’ reports of the perpetration of violence toward their

partners was not associated with either children’s emo-

tional reactivity to interparental conflict or children’s

reports of worrying. There are a number of possible reasons

for this finding. First, approximately half of couples

reported no interpartner violence. Among those who

reported interparental violence, most couples reported

common couple violence (i.e., pushing or shoving one’s

partner, grabbing one’s partner, slapping one’s partner) as

opposed to patriarchal terrorism (i.e., violence that is typ-

ically male-to-female and involves more control typically

by the male partners and greater potential for or actual

injury such as beating up one’s partner (Johnson 1995). It is

possible that common couple violence may elicit less

emotional arousal among COSAs. Furthermore, mothers’

mean violence perpetration scores were nearly twice that of

fathers. This finding was not unexpected as Caetano et al.

(2001) found non-substance-abusing women perpetrated

twice as many acts of violence than their alcohol-abusing

male partners. It is also important to note that parents’

reported on interparental violence which may not reflect

what children actually saw or heard.

Clinical Implications

While providing services to children who live with sub-

stance-abusing parents may be ideal, parents in need of

substance abuse treatment are reluctant to allow their

children to receive any type of family or individual mental

health treatment (Kelley et al. 2014). At present, parenting

components are rarely part of adult treatment for drug and

alcohol addiction. While it may be a slow process until the

mental health professional is able to broach some of the

deeper family problems, assessing for paternal hostility and

directly approaching the impact that paternal hostility may

have on the emotional reactivity and anxiety symptoms of

children in their homes is of clear importance.

In other instances, COSAs may come to the attention of

teachers and school counselors who suggest the child

receive mental health services or the child’s behavior may

be the catalyst that brings the family into treatment. In

these situations, it may be possible to gain the trust of the

family by first working with the child. After gaining the

trust of the parents, it may be possible to examine the

impact that family functioning, and particularly fathers’

hostility, may play in their children’s anxiety.

Study Limitations

Although the present findings add to our understanding of

anxiety among COSAs, several limitations need to be

considered when interpreting these results. The sample was

comprised of triads in which married or cohabitating two-

parent families were living with their children. Although

this family dynamic may be the most common way that

children are exposed to parental substance use disorder,

results may not generalize to single-parent families or

COSAs who live with extended family members. Also,

families agreed to take part in the preassessment, and

importantly, as part of the larger study, they agreed to come

to couples therapy. This may not reflect couples who are

not interested in substance abuse treatment.

In addition, parents were recruited to the study that met

substance use disorder criteria for any number of drugs or

alcohol use combinations. The sample size prohibited fine-

grained analysis of different forms of alcohol or drug use as

related to parents’ or children’s adjustment. Ideally, future

research should examine how addiction to various sub-

stances may be differentially associated with children’s

internalizing symptoms. Additionally, all data were col-

lected contemporaneously using correlational analyses.

Thus, causal inferences cannot be inferred. Also, we did

not examine whether children had experienced abuse or

neglect, both may be related to children’s emotional

adjustment. Furthermore, we did not examine protective

factors that may be able to facilitate adaptive functioning in

the face of risk (Martinez-Torteya et al. 2009).

References

Ahrons, C. R. (1981). The continuing coparental relationship between

divorced spouses. American Journal of Orthopsychiatry, 51, 415.

American Psychiatric Association. (2000). Diagnostic and statistical

manual of mental disorders: DSM-IV-TR. Washington, DC:

Author.

Asparouhov, T., & Muthen, B. (2010). Bayesian analysis using

Mplus: Technical implementation. Los Angeles: Muthen &

Muthen.

Ballard, M., & Cummings, E. M. (1990). Response to adults’ angry

behavior in children of alcoholic and nonalcoholic parents. The

Journal of Genetic Psychology, 151, 195–209.

Bergman, K. N., Cummings, E. M., & Davies, P. T. (2014).

Interparental aggression and adolescent adjustment: The role of

emotional insecurity and adrenocortical activity. Journal of

Family Violence, 29, 763–771.

Berman, S. L., Weems, C. F., Silverman, W. K., & Kurtines, W. M.

(2000). Predictors of outcome in exposure-based cognitive and

behavioral treatments for phobic and anxiety disorders in

children. Behavior Therapy, 31, 713–731.

J Child Fam Stud

123

Author's personal copy

Billick, S., Gotzis, A., & Burgert, W. (1999). Screening for

psychosocial dysfunction in the children of psychiatric patients.

Psychiatric Annals, 29, 8–13.

Buehler, C., Anthony, C., Krishnakumar, A., Stone, G., Gerard, J., &

Pemberton, S. (1997). Interparental conflict and youth problem

behaviors: A meta-analysis. Journal of Child and Family

Studies, 6, 233–247.

Buehler, C., Lange, G., & Franck, K. L. (2007). Adolescents’

cognitive and emotional responses to marital hostility. Child

Development, 78, 775–789.

Burnette, M. L., Lucas, E., Ilgen, M., Frayne, S. M., Mayo, J., &

Weitlauf, J. C. (2008). Prevalence and health correlates of

prostitution among patients entering treatment for substance use

disorders. Archives of General Psychiatry, 65, 337–344.

Caetano, R., Schafer, J., & Cunradi, C. B. (2001). Alcohol-related

intimate partner violence among white, black, and Hispanic

couples in the United States. Alcohol Research and Health, 25,

58–65.

Calhoun, P. S., Bosworth, H. B., Siegler, I. C., & Bastian, L. A.

(2001). The relationship between hostility and behavioral risk

factors for poor health in women veterans. Preventive Medicine,

33, 552–557.

Camara, K. A., & Resnick, G. (1988). Interparental conflict and

cooperation: Factors moderating children’s post-divorce adjust-

ment. In E. M. Hetherington & J. D. Arasteh (Eds.), Impact of

divorce, single parenting, and stepparenting on children (pp.

169–195). Hillsdale, NJ: Lawrence Erlbaum Associates.

Chermack, S. T., Grogan-Kaylor, A., Perron, B. E., Murray, R. L., De

Chavez, P., & Walton, M. A. (2010). Violence among men and

women in substance use disorder treatment: A multi-level event-

based analysis. Drug and Alcohol Dependence, 112, 194–200.

Chermack, S. T., Walton, M. A., Fuller, B. E., & Blow, F. C. (2001).

Correlates of expressed and received violence across relationship

types among men and women substance abusers. Psychology of

Addictive Behaviors, 15, 140.

Crane, C. A., Oberleitner, L. M. S., Devine, S., & Easton, C. J.

(2014). Substance use disorders and intimate partner violence

perpetration among male and female offenders. Psychology of

Violence, 4, 322–333.

Cummings, E. M., & Davies, P. T. (2010). Marital conflict and

children: An emotional security perspective. The Guilford series

on social and emotional development. New York: Guilford

Press.

Cummings, E. M., Schermerhorn, A. C., Davies, P. T., Goeke-Morey,

M. C., & Cummings, J. S. (2006). Interparental discord and child

adjustment: Prospective investigations of emotional security as

an explanatory mechanism. Child Development, 77, 132–152.

Davies, P. T., & Cummings, E. M. (1994). Marital conflict and child

adjustment: An emotional security hypothesis. Psychological

Bulletin, 116, 387–411.

Davies, P. T., & Forman, E. M. (2002). Children’s patterns of

preserving emotional security in the interparental subsystem.

Child Development, 73, 1880–1903.

Davies, P. T., Forman, E. M., Rasi, J. A., & Stevens, K. I. (2002).

Assessing children’s emotional security in the interparental

relationship: The Security in the Interparental Subsystem Scales.

Child Development, 73, 544–562.

Davies, P. T., Winter, M. A., & Cicchetti, D. (2006). The implications

of emotional security theory for understanding and treating

childhood psychopathology. Development and Psychopathology,

18, 707–735.

Denham, S. A., Workman, E., Cole, P. M., Weissbrod, C., Kendziora,

K. T., & Zahn-Waxler, C. (2000). Prediction of externalizing

behavior problems from early to middle childhood: The role of

parental socialization and emotion expression. Development and

Psychopathology, 12, 23–45.

Derogatis, L. R. (1994). SCL-90-R: Symptom Checklist-90-R. Min-

nesota: NCS Pearson.

Eckhardt, C. I. (2007). Effects of alcohol intoxication on anger

experience and expression among partner assaultive men.

Journal of Consulting and Clinical Psychology, 75, 61–71.

Eiden, R. D., Molnar, D. S., Colder, C., Edwards, E. P., & Leonard,

K. E. (2009). A conceptual model predicting internalizing

problems in middle childhood among children of alcoholic and

nonalcoholic fathers: The role of marital aggression. Journal of

Studies on Alcohol and Drugs, 70, 741.

El-Bassel, N., Gilbert, L., Wu, E., Chang, M., & Fontdevila, J. (2007).

Perpetration of intimate partner violence among men in

methadone treatment programs in New York City. American

Journal of Public Health, 97, 1230–1232.

El-Sheikh, M., Cummings, E. M., Kouros, C. D., Elmore-Staton, L.,

& Buckhalt, J. (2008). Marital psychological and physical

aggression and children’s mental and physical health: Direct,

mediated, and moderated effects. Journal of Consulting and

Clinical Psychology, 76, 138.

Erel, O., & Burman, B. (1995). Interrelatedness of marital relations

and parent–child relations: A meta-analytic review. Psycholog-

ical Bulletin, 118, 108.

Evans, S. E., Davies, C., & DiLillo, D. (2008). Exposure to domestic

violence: A meta-analysis of child and adolescent outcomes.

Aggression and Violent Behavior, 13, 131–140.

Febres, J., Shorey, R. C., Zucosky, H. C., Brasfield, H., Vitulano, M.,

Elmquist, J., et al. (2014). The relationship between male-

perpetrated interparental aggression, paternal characteristics, and

child psychosocial functioning. Journal of Child and Family

Studies, 23, 907–916.

Fergusson, D. M., & Horwood, L. J. (1998). Early conduct problems

and later life opportunities. Journal of Child Psychology and

Psychiatry, 39, 1097–1108.

First, M. B., Spitzer, R. L., Gibbon, M., & Williams, J. B. W. (2010).

Structured clinical interview for DSM-IV-TR Axis I disorders,

research version, non-patient edition (SCID-I/NP). New York:

Biometrics Research, New York State Psychiatric Institute.

Foran, H. M., & O’Leary, K. D. (2008). Alcohol and intimate partner

violence: A meta-analytic review. Clinical Psychology Review,

28, 1222–1234.

Gelman, A., Carlin, J. B., Stern, H. S., & Rubin, D. B. (1995).

Bayesian data analysis. London: Chapman and Hall.

Giancola, P. R., Helton, E. L., Osbourne, A. B., Terry, M. K., Fuss, A.

M., & Westerfield, J. A. (2002). The effects of alcohol and

provocation on aggressive behavior in men and women. Journal

of Studies on Alcohol, 63, 64–73.

Graham-Bermann, S. A. (1996). Family worries: Assessment of

interpersonal anxiety in children from violent and nonviolent

families. Journal of Clinical Child Psychology, 25, 280–287.

Grella, C. E., Karno, M. P., Warda, U. S., Niv, N., & Moore, A. A.

(2009). Gender and comorbidity among individuals with opioid

use disorders in the NESARC study. Addictive Behaviors, 34,

498–504.

Hamdan-Mansour, A. M., Halabi, J. O., & Dawani, H. A. (2009).

Depression, hostility, and substance use among university

students in Jordan. Mental Health and Substance Use: Dual

Diagnosis, 2, 52–63.

Hampson, S. E., Tildesley, E., Andrews, J. A., Luyckx, K., &

Mroczek, D. K. (2010). The relation of change in hostility and

sociability during childhood to substance use in mid adoles-

cence. Journal of Research in Personality, 44, 103–114.

Hanson, D. (2009). Marijuana withdrawal: A survey of symptoms. In

A. Browne-Miller (Ed.), The Praeger international collection on

addictions, Vol 2: Psychobiological profiles. Praeger perspec-

tives: Abnormal psychology (pp. 111–124). Santa Barbara, CA:

Praeger.

J Child Fam Stud

123

Author's personal copy

Harold, G. T., Elam, K. K., Lewis, G., Rick, R., Thapar, A., & Reiss,

D. (2012). Interparental conflict, parent psychopathology, hostile

parenting, and child antisocial behavior: Examining the role of

maternal versus paternal influences using a novel genetically

sensitive research design. Development and Psychopathology,

24, 1283–1295.

Horn, W., & Sylvester, T. (2002). Father facts. Gaithersburg, MD:

National Fatherhood Initiative.

Hussong, A. M., Flora, D. B., Curran, P. J., Chassin, L. A., & Zucker,

R. A. (2008). Defining risk heterogeneity for internalizing

symptoms among children of alcoholic parents. Development

and Psychopathology, 20, 165–193.

Ingram, R. E., & Luxton, D. D. (2005). Vulnerability-stress models.

In Development of psychopathology: A vulnerability-stress

perspective (pp. 32–46). Thousand Oaks, CA: Sage.

Jacobs, J. N., & Kelley, M. L. (2006). Predictors of paternal

involvement in childcare in dual-earner families with young

children. Fathering, 4, 23–47.

Johnson, M. P. (1995). Patriarchal terrorism and common couples

violence: Two forms of violence against women in U.S. families.

Journal of Marriage and the Family, 57, 283–294.

Kaufmann, V. G., O’Farrell, T. J., Murphy, C. M., Murphy, M. M., &

Muchowski, P. (2014). Alcohol consumption and partner

violence among women entering substance use disorder treat-

ment. Psychology of Addictive Behaviors, 28, 313.

Keller, P. S., Cummings, E. M., Davies, P. T., & Lubke, G. (2007).

Children’s behavioural reactions to marital conflict as a function

of parents’ conflict behaviours and alcohol problems. European

Journal of Developmental Psychology, 4, 157–177.

Kelley, M. L., D’Lima, G. M., Henson, J. M., & Cotton, C. (2014).

Substance-abusing mothers and fathers’ willingness to allow

their children to receive mental health treatment. Journal of

Substance Abuse Treatment, 47, 106–111.

Kelley, M. L., Klostermann, K., Doane, A., Mignone, T., Lam, W.

K. K., & Padilla, M. A. (2010). The case for examining and

treating the combined effects of parental drug use and inter-

parental violence on children in their homes. Aggression and

Violent Behavior, 15, 76–82.

Kim, H. K., Capaldi, D. M., Pears, K. C., Kerr, D. C. R., & Owen, L.

D. (2009). Intergenerational transmission of internalising and

externalising behaviours across three generations: Gender-

specific pathways. Criminal Behaviour and Mental Health, 19,

125–141.

Kitzmann, K. M., Gaylord, N. K., Holt, A. R., & Kenny, E. D. (2003).

Child witnesses to domestic violence: A meta-analytic review.

Journal of Consulting and Clinical Psychology, 71, 339.

Koopman, J., Howe, M., Hollenbech, J. R., & Sin, H. (2014). Small

sample mediation testing: Misplaced confidence in bootstrapped

confidence intervals. Applied Psychology, 1, 1–9.

Koss, K. J., George, M. R., Davies, P. T., Cicchetti, D., Cummings, E.

M., & Sturge-Apple, M. L. (2013). Patterns of children’s

adrenocortical reactivity to interparental conflict and associa-

tions with child adjustment: A growth mixture modeling

approach. Developmental Psychology, 49, 317.

Kraanen, F. L., Vedel, E., Scholing, A., & Emmelkamp, P. M. (2014).

Prediction of intimate partner violence by type of substance use

disorder. Journal of Substance Abuse Treatment, 46, 532–539.

Lagattuta, K. H., Sayfan, L., & Bamford, C. (2012). Do you know

how I feel? Parents underestimate worry and overestimate

optimism compared to child self-report. Journal of Experimental

Child Psychology, 113, 211–232.

Lieberman, A. F., Van Horn, P., & Ippen, C. G. (2005). Toward

evidence-based treatment: Child-parent psychotherapy with

preschoolers exposed to marital violence. Journal of the

American Academy of Child and Adolescent Psychiatry, 44,

1241–1248.

MacPherson, P. S., Stewart, S. H., & McWilliams, L. A. (2001).

Parental problem drinking and anxiety disorder symptoms in

adult offspring: Examining the mediating role of anxiety

sensitivity components. Addictive Behaviors, 26, 917–934.

Martinez-Torteya, C., Anne Bogat, G., Von Eye, A., & Levendosky,

A. A. (2009). Resilience among children exposed to domestic

violence: The role of risk and protective factors. Child Devel-

opment, 80, 562–577.

McMahon, T. J., Winkel, J. D., Luthar, S. S., & Rounsaville, B. J.

(2005). Looking for poppa: Parenting status of men versus

women seeking drug abuse treatment. The American Journal of

Drug and Alcohol Abuse, 31, 79–91.

Michael, K. D., & Merrell, K. W. (1998). Reliability of children’s

self-reported internalizing symptoms over short to medium-

length time intervals. Journal of the American Academy of Child

and Adolescent Psychology, 37, 194–201.

Moore, T. M., Elkins, S. R., McNulty, J. K., Kivisto, A. J., & Handsel, V.

A. (2011). Alcohol use and intimate partner violence perpetration

among college students: Assessing the temporal association using

electronic diary technology. Psychology of Violence, 1, 315–328.

Murphy, C. M., & Ting, L. A. (2010). Interventions for perpetrators of

intimate partner violence: A review of efficacy research and

recent trends. Partner Abuse, 1, 26–44.

Norlander, B., & Eckhardt, C. (2005). Anger, hostility, and male

perpetrators of intimate partner violence: A meta-analytic

review. Clinical Psychology Review, 25, 119–152.

Pagano, M. E., Rende, R., Rodriguez, B. F., Hargraves, E. L.,

Moskowitz, A. T., & Keller, M. B. (2007). Impact of parental

history of substance use disorders on the clinical course of

anxiety disorders. Substance Abuse Treatment, Prevention, and

Policy, 2(13). doi:10.1186/1747-597X-2-13.

Parrott, D. J., Drobes, D. J., Saladin, M. E., Coffey, S. F., & Dansky,

B. S. (2003). Perpetration of partner violence: Effects of cocaine

and alcohol dependence and post-traumatic stress disorder.

Addictive Behaviors, 28, 1587–1602.

Patterson, G., Dishion, T., & Yoerger, K. (2000). Adolescent growth

in new forms of problem behavior: Macro and micro-peer

dynamics. Prevention Science, 1, 3–13.

Reynolds, C. R., & Richmond, B. O. (1978). What I think and feel: A

revised measure of children’s manifest anxiety. Journal of

Abnormal Child Psychology, 6, 271–280.

Roozen, H. G., van der Kroft, P., van Marle, H. J., & Franken, I. H.

(2011). The impact of craving and impulsivity on aggression in

detoxified cocaine-dependent patients. Journal of Substance

Abuse Treatment, 40, 414–418.

Schmitz, N., Hartkamp, N., & Franke, G. H. (2000). Assessing

clinically significant change: Application to the SCL-90-R.

Psychological Reports, 86, 263–274.

Schudlich, T. D. D. R., & Cummings, E. M. (2007). Parental

dysphoria and children’s adjustment: Marital conflict styles,

children’s emotional security, and parenting as mediators of risk.

Journal of Abnormal Child Psychology, 35, 627–639.

Shorey, R. C., Stuart, G. L., McNulty, J. K., & Moore, T. M. (2014).

Acute alcohol use temporally increases the odds of male

perpetrated dating violence: A 90-day diary analysis. Addictive

Behaviors, 39, 365–368.

Stewart, D., Gossop, M., & Trakada, K. (2007). Drug dependent

parents: Childcare responsibility, involvement with treatment

services, and treatment outcomes. Addictive Behaviors, 32,

1657–1668.

Stover, C. S., & Kiselica, A. (2014). Hostility and substance use in

relation to intimate partner violence and parenting among

fathers. Aggressive Behavior, 41, 205–213.

Straus, M. A. (2007). Conflict Tactics Scales. In N. A. Jackson (Ed.),

Encyclopedia of domestic violence (p. 195). New York:

Routledge.

J Child Fam Stud

123

Author's personal copy

Straus, M. A., Hamby, S. L., Boney-McCoy, S., & Sugarman, D. B.

(1996). The revised conflict tactics scales (CTS2) development

and preliminary psychometric data. Journal of Family Issues, 17,

283–316.

Subodh, N. B., Grover, M., Grewal, M., Grewal, S., Basu, D., &

Mattoo, S. K. (2014). Interpersonal violence against wives by

substance dependent men. Drug and Alcohol Dependence, 138,

124–129.

Taft, C. T., O’Farrell, T. J., Doron-LaMarca, S., Panuzio, J., Suvak,

M. K., & Murphy, C. M. (2010). Longitudinal risk factors for

intimate partner violence among men in treatment for alcohol

use disorders. Journal of Consulting and Clinical Psychology,

78, 924–935.

Wilens, T. E., Biederman, J., & Bredin, E. (2002). A family study of

the high-risk children of opioid- and alcohol-dependent parents.

The American Journal of Addictions, 11, 41–51.

Yuan, Y., & MacKinnon, D. (2009). Bayesian mediation analysis.

Psychological Methods, 14, 301–322.

J Child Fam Stud

123

Author's personal copy