Child abuse, autistic traits and alcohol consumption: a comment

The relation between autistic traits and alcohol use by adolescents has been discussed recently [1]. The following statements should be commented: “Attention Deficit Hyperactivity Disorder (ADHD) and its subclinical symptoms co-occur frequently with both autistic traits and clinical autism spectrum disorder (ASD)… in contrast to ASD traits alone, individuals with comorbid ADHD traits have been found to have an increased risk of alcohol abuse… Autistic traits have been associated with an enhanced risk of exposure to environmental stress, e.g. to bullying or child abuse… less exposure to substance using peers may protect adolescents from drinking alcohol” [1]. Autistic symptoms can develop through various mechanisms. Behaviors more or less compatible with ASD may develop after a head trauma in childhood [2–4]. In conditions of domestic violence, ADHD manifestations such as impulsivity and hyperactivity may be regularly punished. Excessively harsh discipline can produce maladjusted behavior. At the risk of punishments, a child may “dig in his heels and be negative” [5]. Apparently, some abnormal behaviors are adaptive, being consciously or unconsciously implemented to avoid trauma. Such behaviors can be partly compatible with ASD e. g. failure to initiate or respond to social interactions, poorly integrated communication, abnormalities of eye contact, deficits of developing and maintaining relationships. Deranged relationships with parents such as reduced sharing of emotions or interests (DSM-5) also result from child abuse in some cases. In an environment permitting impulsivity, hyperactivity and some annoying behavior, the child would preserve ADHD symptoms or develop in a more typical way. The cause-effect relationship may be bidirectional: autistic traits enhance the risk of child abuse and bullying while the violence would reinforce abnormal behaviors. In this connection, the heritability of ASD has a non-genetic mechanism in some cases: children of deviant parents are more exposed to the maltreatment, hence acquiring deviant features themselves.

In regard to the alcohol consumption by adolescents it should be pointed out that loitering with drinking companies is a way of escape from domestic violence. The attitude to alcohol of persons with autism and some other disorders depends on the attitude of the social environment to such persons. Undoubtedly, “avoidance of social situations is a common trait in people with ASD” [1]. However, this rule is more relevant for societies, where such avoidance is permitted. In conditions of collectivism and a pressure to be “normal” like everyone, an individual with communication derangements would have strong motives to contact with peers not to be an outsider. The alcohol consumption and, in particular, binge drinking is one of the ways to overcome communication barriers. Some persons with high-functioning autism deliberately drink alcohol to cope with anxiety, to maintain friendships and gain access to relationships [6,7].

Detection of child abuse often depends on the victim. Different tools are applied to prevent a disclosure: denial of facts, allegations of slander or sexual fantasies, intimidation, appeals to preserve honor of the family or nation [8]. More than 99 % of publications on child maltreatment have been based on research performed in developed countries [9], while elsewhere the child and elder abuse can persist without publicity. In the former Soviet Union, child abuse has been rarely discussed. Authorities not always reacted to known cases of domestic violence. A part of the society seems to be opposed to a public discussion of violence in families. There is no generally agreed attitude to the problem and no consequent policy, which is complicated by a shortage of adequately trained personnel and foreign professional literature. Violence towards children is sometimes discussed by the mass media as a norm. For example, the famous filmmaker Nikita Mikhalkov said on 28 May 2014 from the TV screen without any disapproval that his father Sergey Mikhalkov, the well-known writer, occasionally slapped him in the face (opleukha), which can cause additional cases of concussion in children. Celebrities are often emulated. Note that a man’s hand is weighty (Fig. 1). By the given momentum, the damage might be heavier in macrocephaly, which is associated with ASD [10]. Childhood autism, introduced into Russian classifications of mental disorders in the late 1980s but not immediately and uniformly accepted, has sometimes been classified as sluggish or early childhood schizophrenia, which led to stigma and overtreatment in some cases; details and references are in [11]. The treatment is beyond the scope of this article. Only the following topic, rarely discussed in the literature, should be tackled. Studies or work abroad is favorable for some adolescents and adults with autism and communication abnormalities because the abnormalities are less conspicuous as the person is not typical just because he or she comes from another country. In a foreign environment, individuals with certain disabilities may be devoid of stigma at least temporarily. Skills acquired abroad would help in future studies and work. We have limited positive experience with communication abnormalities, autistic traits and/or alcohol-related problems [12]. The latter may be alleviated in non-drinking cultural settings [13]. Programs facilitating education access including targeted exchange for studies abroad for adolescents with special needs should be developed.

There is evidence in favor of associations of childhood trauma with negative mental health, physical health and social outcomes, deficient communicative skills, substance abuse and, in particular, misuse of alcohol [14,15]. Some ASD cases are caused by intrinsic factors while others may be induced or reinforced by environmental factors such as physical abuse. ADHD, ASD and social anxiety disorder have partly overlapping symptoms. Differences in some cases are caused by external factors: in an environment permitting impulsivity and hyperactivity, the child would preserve ADHD symptoms or develop in a more typical way. In conditions of domestic violence, regularly punishing impulsivity and hyperactivity, the child might be “trained” towards abnormal behaviors aimed at avoidance of trauma [8]. From a broader perspective, it can be reasonably assumed that individuals with some disorders or neuroses (for example, obsessive-compulsive disorder) were on average more often beaten during their childhood than those with other conditions e. g. hysteria. A hysteric adolescent regularly punished for conniptions might discontinue them but start obsessive behaviors: nailbiting, nose-picking, bulimia, pica, alcohol abuse etc. This topic needs further studies and a review of literature.

Fig. 1. “Children are Victims of Adult Vices” — a group of bronze sculptures by Mihail Chemiakin (2001). The fragments: Violence propaganda (left) and Sadism (right).

References:

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