disorder and depression. It appears likely that it is the accumulation of both genetic and psychosocial risk factors that increases the risk for alcohol abuse and dependence. Six risk factors are strongly associated with the onset of alcohol problems: (1) having a parent or other close biological relative with alcohol abuse or dependence; (2) having a biological marker that is highly associated with later onset of alcohol dependence, including decreased sensitivity to alcohol; (3) demonstrating antisocial behaviors or a combination of aggressiveness and shyness during childhood; (4) having low adaptability; (5) being exposed to group norms that foster alcohol use and abuse; and (6) having easy access to alcohol. Control of availability obviously continues to be a powerful prevention tool.

Five risk factors are likely to be associated with the onset of depression: (1) having a parent or other close biological relative with a mood disorder; (2) having a severe stressor such as a loss, divorce, marital separation, unemployment, job dissatisfaction, a physical disorder such as a chronic medical condition, a traumatic experience, or, in children, a learning disorder; (3) having low self-esteem, a sense of low self-efficacy, and a sense of helplessness and hopelessness; (4) being female; and (5) living in poverty. Approaches that have targeted either the prevention of clinical depression in high-risk adults or the prevention of depressive symptoms for those at high risk because of a major loss have all shown some promise. Definitive evidence of the prevention of the initial episode of major depressive disorder is not available at this time, but this area is one of the most promising for continued preventive intervention research.

Conduct disorder has the earliest average age of onset of the five illustrative disorders. Much remains to be learned about its risk and protective factors, but it is clear that the accumulation of risk factors as the child develops is more important than any specific risk factor. The lack of twin and adoption studies in conduct disorder is a major research gap. Such studies have provided tantalizing clues toward understanding the roles of genetic and environmental influences for the other illustrative disorders.

It has become evident that even though some risk factors, primarily genetic ones, may be specific to a particular disorder, others are common to many disorders. For a child, such factors as low birthweight, low IQ, and even gender can lead to a state of vulnerability in which other risk factors may have more effect (McGauhey, Starfield, Alexander, and Ensminger, 1991; Rutter, 1979). Factors that can contribute to resilience include positive temperament, above-average intelligence, and social competence (Rutter, 1985; Rutter, Tizard, and Whitmore,

The National Academies | 500 Fifth St. N.W. | Washington, D.C. 20001
Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement