Some Genetic Aspects of Alcoholism and Criminality A
Population
Michael
Bohman,
of
Adoptees
MD
\s=b\ The state criminal records and official registers of alcoholics were used in a study of 2,000 adoptees and their biological and adoptive parents. The frequency of registration for the adoptees were approximately the same as for the population in general, but for the biological parents it was two to three times greater. Very few adoptive parents appeared in the records. It is conceivable that to a large extent adoption neutralized the "social heritage" from the biological parents. There was, however, a significant correlation in the records between alcoholism in biological parents and in their adopted-out sons. On the other hand, the criminal records showed no such correlation between biological parents and their children. These results support the hypothesis that there is a genetic explanation for the development of alcoholism, but not for the manifestation of
criminality. (Arch Gen Psychiatry 35:269-276, 1978) is an established idea that social maladjustment is more common in some families than in others; the term "social heritage" has been coined to cover this phenome¬ non. In one study of severely maladjusted boys, Jonsson1 found that some of the parents exhibited social maladjust¬ ment in various forms—a high incidence of criminality, alcoholism, and disorders of a nervous or somatic type. It even proved possible to trace the social maladjustment back to the boys' grandparents. Jonsson viewed his popula¬ tion mainly in terms of social psychology, interpreting the progressive maladjustment in these families as a process of social rejection over a period of several generations. While not excluding the possiblity that genetic and constitutional
It
publication June 23, 1977. Department of Child and Youth Psychiatry, University of Ume\l=a%0\(Sweden). Reprint requests to Department of Child and Youth Psychiatry, University of Ume\l=a%0,\901 87 Ume\l=a%0,\Sweden (Dr Bohman). Accepted
From the
for
factors could have some influence, he seems to consider that the situation is best explained within the framework of social psychology. The therapeutic approach he subse¬ quently presented for "breaking the social heritage" was a result of this viewpoint. It has been claimed in various studies that genetic factors do play a part in the development of social and mental insufficiency,- but it is extremely difficult to distinguish satisfactorily between hereditary and environ¬ mental factors—children usually receive their upbringing as well as their genes from their biological parents. One way of achieving such a distinction, however, is to study subjects who were separated from their biological parents at an early age and have been brought up by foster or adoptive parents not related to them. In this way, one can largely eliminate the influence of the biological envi¬ ronment. One such series of studies has been carried out using a Danish adoption population, the aim of which was to distinguish between hereditary and environmental factors in the manifestation of various states of mental or social insufficiency, eg, schizophrenia,1 psychopathy,4 crim¬ inality,5 and alcohol abuse.6 Adoption is a social and legal measure that definitely breaks at least one precondition for "social heritage." In my earlier studies,7"' of children who were separated from their biological parents at an early age and had no contact with them while they grew up in adoptive homes, no relationship could be found between their symptomatology and the social adjustment of their biological parents, as seen through the public records concerning misuse of alcohol, criminality, or both. As both social and mental problems were common among the biological parents of these children (eg, alcohol abuse and criminality were markedly overrepresented), it was concluded that adoption had on these counts neutralized
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Table
1—Registered Alcohol Among Biological Parents and
Abuse and Criminality Their Adopted Children
Biological
Biological
Adopted
Adopted
Fathers
Mothers
Men
Women
(N
=
Alcohol abuse
1,902) (N 34 29
Criminality
=
2,261)
4.6 6.4
(N
=
1,125) (N
16.1 12.8
=
1,199)
2.4 2.9
Table 2.—Correlation Between Registered Alcohol Abuse and Criminality
Biolog-
ical Fathers
(N Alcohol abuse alone
Criminality Both Total
alone
=
Biolog¬ ical Mothers
880) (N
=
Male
Female
Adoptees Adoptees 221) (N = 247) (N = 47)
37.2
34.8
42.1
26.5 36.3 100.0
52.9 12.3
26.3 31.6
100.0
100.0
46.8 40.4 12.8 100.0
heritage. This conclusion was supported by findings among children who had been registered for adoption but who ultimately grew up in their biological environments: the incidence of psychosocial disturbances, compared with that of the adopted chil¬ dren,81" was relatively high. These studies obviously do not in themselves provide sufficient grounds for rejecting the hypothesis that social maladjustment is associated with genetic factors. My most recent study"' was carried out when the children were only 15 years old, and genetic factors may manifest themselves later in life. The existence of genetic determinants of, for example, alcoholism and "sociopathy" has been convinc¬ ingly demonstrated in several earlier studies on a clinical population,11 twins,12·13 and adoptees.4-614 In order to examine these problems more closely, with special reference to Swedish conditions, a study has been started on a new sample of adoptees who were separated in infancy from their biological parents and brought up by nonrelated adoptive parents. The purpose of this study has been to analyze both the relative influence of environmental and genetic factors in the children's social
the manifestation of various social and mental states of insufficiency, and the factors on which social and mental adjustment depend. In order to make this possible, we are currently collecting data from various official registers covering many aspects of the living conditions of the adoptees and their relatives. To date, we have collected data about alcohol abuse and criminality among the adop¬ tees and both their biological and adoptive parents that permit us to present some preliminary findings. Thus, the special aim of the section presented in this article is to investigate by way of "the adoption method" whether or not there is any support for the hypotheses that alcoholism and criminality have genetic determinants.
SUBJECTS The population for the study comprised 2,324 persons born in Stockholm during the period 1930 to 1949 who were adopted at an early age by nonrelatives. Information about these persons was obtained from a list of illegitimate children for whom a child welfare officer had been appointed. In practice, this list includes all such children from that period who were adopted. It should be noted, however, that the population does not include adopted children who were born in wedlock. The population was selected to some extent in that it was confined to those children who were placed in an adoptive home at an early age, the upper limit being 3 years. Most of the children, however, were in fact separated from their biological environment in the first few months of life. Before being placed in an adoptive home, a large number of them stayed in a foster home or in an infants' home. The child's date of birth and age at placement were obtained from the register, as were the ages, occupations, and places of residence of both the biological and the adoptive parents. Pater¬ nity had not been established for 334 of the children. For all the biological parents and the children they left for adoption, a search was made for entries in the register of offenses kept by the Excise Board (registrations of alcohol abuse) and in the Criminal Register. The Excise Board's register contains information about fines imposed for intemperance, records of supervision by temperance boards (elected representatives and civil servants responsible for maintaining sobriety at the commu¬ nity level and thus also for the treatment and supervision of alcoholics), and time spent in institutions for alcoholics. In this context, the incurrence of a criminal sentence of more than 60 "day-fines" (a fine assessed on the basis of the defendant's daily income) constitutes criminality. Other public records were also consulted (eg, the records kept by the Health Insurance Office, the register of conscripts), but these results will be reported else¬ where.
RESULTS
The prevalence of alcohol abuse and criminality up to 1972 is summarized in Table 1 for the groups of biological fathers and mothers and for their sons and daughters who were put out for adoption. Compared to other Swedish groups investigated or official statistics for the population in general, the biological parents were greatly overrepresented in both registers. For example, according to a census of men15 born in 1917 and followed up through 1964, the prevalence risk of being registered for alcohol abuse was 14.4% as compared to 34% in my population. In an investigation in the 1950s of a randomly selected sample of Stockholm schoolboys born between 1939 and 1946, Jons¬ son1 found that 18% of the fathers appeared in the Excise Board register and 10% in the Criminal Register. For women, the prevalence risk in the general population is reported to be below 1% in both registers, whereas in my population it was 4.6% and 6.4% for alcohol abuse and criminality, respectively.1 The biological mothers in our sample are thus markedly overrepresented in both the alcohol abuse and criminal registers. It is clear from these figures alone that the biological parents are a selected group with a high frequency of social insufficiency. A closer study of the degree and nature of the alcohol abuse and criminality registered showed, moreover, that they were often interrelated and were also frequently present on a massive scale in the form of
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Table 3—Recorded Alcohol Abuse and
Criminality
for Male
Adoptees
and for Their
Biological
% of
Biological Mothers Registered Male Adoptees Registered lor
Alcohol Abuse
Alcohol abuse alone Criminality alone
22.5
Both_
16.9 43.9
(N
=
89)
Criminality (N = 169) 7.6 8.9 3.6 20.1
4.5
Total
Table 4.—Recorded Alcohol Abuse and Criminality for Female Adoptees and for Their Biological Parents
Biological
%of Parents Registered for
_A_\ r—
Adoptees Registered for
Female
Alcohol abuse alone
Criminality Both Total
Alcohol Abuse
(N
=
197)
2.0
Criminality (N = 192)
=
1,796)
1.6 1.0 4.7
0.5 3.6
or institutional for alcoholism. Table 2 shows, for instance, that 36.3% of the biological fathers who featured in the registers appeared in both. The corresponding figure for the mothers is, however, no more than 12.3%. The incidence of the adoptees in the two registers is also given in Table 1. The frequencies for the male adoptees are what one might expect in an age-related group: 16.1% for alcohol abuse and 12.8% for criminality. A proper compar¬ ison is difficult because of the lack of adequate control data, but a recently published follow-up study of the abovementioned sample of "normal" Stockholm boys1 may provide a comparison. Further studies16 of these boys through the official registers were carried out in 1973, eighteen years after the first investigation, when their age ranged from 26 to 34 years, which corresponds fairly well to the average age of the adoptees in my present sample (23 to 43 years). The prevalence of registered alcohol abuse in this sample was 19%, and that of criminality 15%. Thus, the
repeated offenses, long prison sentences,
care
two
investigations correspond fairly closely
Neither
(N
=
Alcohol Abuse
723)
(N
=
42)
14.3
6.6 5.0 7.0
14.3
18.6
33.4
these
%of Mothers
4.8
men
and that to
some
Registered tor
Criminality (N 48)
Neither
(N
=
1,029)
10.4 6.3
8.8 5.7
6.3 23.0
6.7 21.2
extent at least their crimi¬
nality was secondary to this abuse. Only 2.3% of the adoptive parents appeared in the register for alcohol abuse. Criminal records are lacking at present, but the incidence is probably very low, as it was in my earlier findings in another sample.7
Neither
(N
alone_VO_2 _1.3 0.5 3.5
Biological
for
Parents
as
regards
notation in both registers. The female adoptees, however, have incidences of 2.4% and 2.9% for alcohol abuse and criminality, respectively, which is more than one would expect in a random sample of women in this age group.1 The correlation between alcohol abuse and criminality for those adoptees who appeared in these registers (247 men, 46 women) is shown in Table 2. Male adoptees had a rather high association in this respect (31.6%), as did their biological fathers (36.3%). This link between alcohol and criminality has been found in other studies concerning problem populations. In this study by Jonsson,1 for instance, the association was even more frequent (56%) among fathers of boys with severe social and mental disturbances. Jonsson supposed that alcohol abuse was an important factor in the problems of
ANALYSIS WITH THE ADOPTION METHOD In a preliminary analysis, we compared adoptees whose biological parents appeared in the registers of alcohol abuse and /or criminality with adoptees whose parents had no such records. We excluded subjects with a parent who appeared in both registers, in order to keep these two factors as separate and uncontaminated as possible. The findings are summarized in tables 3 and 4. 1. Male adoptees whose biological fathers were regis¬ tered for alcohol abuse only (and do not have a criminal record) were themselves significantly overrepresented in this register as compared with adoptees whose fathers had no registration (39.4% and 13%, respectively, < .01). Registration for criminality in combination with alcohol abuse was also more common among adoptees with a father registered for alcohol abuse (16.9% vs 7.0%, > .05 [NS]). 2. Male adoptees whose biological mothers were regis¬
tered for alcohol abuse alone were likewise overrepre¬ sented in this register (28.6% and 15.5%, respectively, < .01). Here, too, criminality in combination with alcohol abuse was more common among the adopted sons of registered mothers (14.3% vs 6.7%). 3. Male adoptees whose fathers had a criminal record alone were not overrepresented in the criminal register as compared with male adoptees with fathers who had no record (12.5% and 12.0%, respectively). Nor was there any difference between the two groups of adoptees concerning alcohol abuse. 4. Male adoptees whose mothers had criminal records only were not overrepresented as compared with those whose mothers had no record. (12.6% and 12.4%, respective¬ ly). Here, too, the incidence of alcohol abuse was almost the same in both groups of adoptees. 5. Female adoptees whose biological fathers or mothers were registered for alcohol abuse or for criminality appeared about as frequently in each register as those whose fathers or mothers were not registered. However, so few of the female adoptees were registered for either alcohol abuse or criminality that no conclusions could be drawn from these data. These results suggest that genetic factors have a bearing
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the manifestation of alcohol abuse among »vomen as well as men. In the case of (registered) criminal behavior, on the other hand, there are no indications of such a genetic link. If anything, criminality seems to be genetically related to alcohol abuse. Support for these conclusions seems to be forthcoming from various parts of the analysis. If selective factors, such as a poorer placement for children with socially maladjusted parents, had been present and had affected the development of the adoptive children, one would expect them to have an equal influence on children with biological parents with different types of social maladjustment. In other words, there should have been a link for criminality between parents and children as there was a link for alcohol abuse. That this is not the case may indicate that selective factors connected with placement did not play a major part in the development of criminality or alcohol abuse among the adoptees; at the same time, the absence of a link between the biological parents and their children for criminality may indicate that, in this respect at least, the adoption prevented a social maladjustment among the adoptees. on
CONTROL STUDY
The
preliminary analysis accordingly suggests
that genetic factors may play a part in the manifestation of alcoholism among the subjects and their biological parents in this sample. There are, however, many factors that may have influenced the results, eg, the age of the children at placement, the selective placement of certain children with a poorer background, poor somatic status. Awareness of the biological parents' social failure, alcoholism, and crimi¬ nality may also have influenced the placement of and expectations concerning the child. A child with a particu¬ larly "poor" background may be the victim of a selffulfilling prognosis. While it is of course impossible to check all these factors retrospectively, an attempt has been made by selecting certain subjects whose biological parents had the most long-lasting and frequent records of alcohol abuse or criminality from the primary sample and matching them with controls who were placed under more or less equivalent conditions but whose biological parents do not feature in the registers. In this way, a control study ex post facto has been undertaken to throw further light on two questions: (1) Is there any support for the hypothesis that "sociopathy" and alcoholism may be transmitted genetically? (2) Is the passing on of serious social malad¬ justment from the biological parents to the child prevented
by adoption?
METHOD From the
2,324 adoptees, we selected 380 probands whose most frequent or serious registrations for either
primary sample. Most of these men had been sentenced to long terms in prison; many had been subjected to forensic psychiatric examination and had as a result been admitted to mental institutions. These fathers could well be regarded as having "sociopathic" personalities. When I selected subjects in terms of the severity of alcohol abuse and criminality among their biological fathers, it was inevitable that most fathers appeared in both registers. in the
A selection
was
also made of 42
and 50
women
whose
few of them had been in institutions for alcoholics. On the other an entry for a women is presumably a considerably stronger indicator of social insufficiency than it is in the case of men. It is a known fact that Swedish men run a comparatively greater risk of being apprehended for drunkenness and thus of featuring in the register. This risk is normally very slight for women, and when they are registered it is undoubtedly more frequently a sign of substantial psychosocial problems underlying the alcohol abuse. The same applies to registered criminality a
hand,
among
women.
Finally,
48 men and 50 women were selected whose biological mothers had entries in the criminal register. Here, too, the number of registrations among the mothers was relatively few, and no more than 48 adopted men fulfilled the selection criteria. This selection procedure thus produced eight groups based on the sex of the probands and the type of social incompetence (alcohol abuse or criminality) in the biological father or mother.
Controls and
Matching
Procedure
A control from the primary series was selected for each proband in the eight groups. The controls, whose parents had not been registered for either alcohol abuse or criminality, were matched with the subjects in terms of sex, age, age at placement, occupa¬ tional category of the adoptive parents, and the ages of the biological and the adoptive parents when the child was born. There was no difficulty in obtaining a good match between subjects and controls in respect of sex, age, ages of the biological and adoptive mothers at the birth of the child, and the occupational category of the adoptive father. The breakdown of the adoptive fathers by occupational category is shown in Table 5. The categories are based on the occupational register of the National Swedish Board of Health and Welfare: group I roughly corresponds to "profes¬ sional occupations," group II to "intermediate occupations," group III to "skilled," group IV to "semiskilled," and group V to "unskilled workers." As can be seen, there was a good match between probands and controls. Certain difficulties were encoun¬ tered, however, when matching the age at placement, owing to the
Table 5.—Occupational Classification of Adoptive Fathers of Probands and Fathers of Controls, by Sex No. of
parents had the
alcohol abuse or criminality. These probands included 50 men and 50 women whose biological fathers were registered for repeated alcohol abuse. Most of these fathers had spent time in institutions for alcoholics and had been committed for several offences under the Temperance Act. In view of such histories of alcohol abuse, it seems reasonable to regard these fathers as alcoholics in a medical and social sense. Similarly, 50 men and 50 women were selected whose biological fathers were among those with the most serious criminal records
men
biological mothers were registered for alcohol abuse. As compara¬ tively few of the mothers appeared in this register, it was not possible to select subjects whose mothers had the same frequency of registration as the fathers mentioned earlier. In fact, no more than 42 men had mothers registered for alcohol abuse. Generally, these mothers had only occasional entries in the register, and only
Male
Occupational
Probands
Adoptive Fathers
Subjects Controls
Female Probands
Subjects Controls
Group_(N 190) (N 190) (N 200) (N 200) I_19_18_13_15 II_42_37_50_47 =
=
=
=
III_71_76_74_80 IV_14_16_15_15
V
44
43
48
43
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Biological
parents
with abuse of alcohol
,c?
F
Subjects,
=
M
A
9
/\
with criminal record
F
cf
/\
cT9 50 50
cT9 42 50
cf Ç 50 50
50
50
42
50
50
cf 9
cf
î
J î
9
M
/\ e? ? 50
Adoptees Controls,
=
\/cf \/9
FM Biological
composition of the primary sample. Both the male and female probands among the subjects were placed, on the average, three months later than the controls, which cannot be regarded as entirely satisfactory for the present analysis. The significance of this discrepancy in the age at placement will be considered in more detail in the discussion of the results. The probands and controls are presented schematically in Fig 1. ANALYSIS AND RESULTS study confirms the results found in the preliminary analysis of the larger, unmatched sample. A correlation was found for alcohol abuse between the biolog¬ ical parents and their sons, but as in the preliminary analysis, there was no definite relationship between the male subjects and their parents with respect to criminality. The results are summarized in Tables 6 and 7.
The control
Adopted Fathers
Registered
Men
for Severe Alcohol Abuse
Persistent
Criminality.—Twenty percent of male probands whose fathers were registered for severe alcohol abuse featured in the same register, as compared with 6% of the controls.
iî
FM
parents with no criminal record
for control
study.
Fourteen percent of the probands and 12% of the controls registered for criminality. Criminality alone among the adoptees occurred in 4% of both groups. However, the difference between the groups is not significant according to a conventional 2 test. Among the probands whose fathers had serious criminal records, only four (8%) were themselves registered for criminality, the comparative figure for the controls also being four (8%). At the same time, nine (18%) of the probands but only two (4%) of the controls appeared in the alcohol register. It is reasonable to see this as a reflection of the previous finding that the biological fathers with a serious criminal record also tended to misuse alcohol. This appears to provide further confirmation of the hypothesis that alcohol abuse has a genetic background, at least in this population, while criminal behavior does not. were
Mothers or
50
\/cf \/9
with no abuse of alcohol Fig 1 .—Model
50
Registered
for Alcohol Abuse
or
Criminality.—Of
the adopted men whose biological mothers had been regis¬ tered for alcohol abuse, 33.4% appeared in this register compared with 19% of the controls. Furthermore, 21.5% of these probands were registered for criminality alone or for
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Table 6.—Alcohol Abuse and
Biological Alcohol Abuse (P)
Male Adoptees Registered for Alcohol abuse alone Criminality alone Both Total
(N
=
50)
50)_(N
8 12 22
Adoptees Registered for
=
(C) 50)_(N = 50)
16
12
24
12
Table 7.—Alcohol Abuse and
Female
and Matched Controls
Biological Neither
Criminality (P)
(C) =
(P)
%of Fathers Registered for
Neither
(N
Male Probands
Criminality Among
Criminality Among
% With Either Biological Parent Registered For Alcohol Abuse
(N =100)
(N=42)
=
100)
(P)
Registered for
(C) (N = 42)
Criminality (P) (N = 48)
9.5
10.4
9.5 19.0
6.3 8.3 25.0
Neither
16.7 4.8 16.7 38.2
Female Probands
C % With Biological Parents not Registered
(N
Alcohol Abuse (P)
%of Mothers
(C)
and Matched Controls % With Either Biological Parent Registered for Criminality
(N
=
100)
Neither
(N
(C) = 48) 2.1 4.2 2.1 8.4
(C) C % With Biological Parents not Registered
(N
m
100)
0
Alcohol abuse alone Criminality alone
Both_ Total
this in addition to alcohol abuse, compared with only 9.5% of the controls. These results are of particular interest in that most of the probands' mothers had only a single entry in the alcohol register. The difference does not, however, reach statistical
significance.
A similar comparison of alcohol abuse and criminality is in the table for those probands and controls whose mothers had or did not have a criminal record. In this group it is again alcohol abuse that distinguishes the probands from their controls-18.7% of the former feature in the alcohol register but only 4.2% of the controls. On the other hand, criminality alone, or in combination with alcohol abuse, is equally frequent in both groups. When the entries in both registers are combined, the difference between probands and controls is significant at the 5% level. These results are of interest in the light of findings published recently by Crowe14 from a group of adopted individuals whose mothers had a criminal record. Crowe's findings supported the hypothesis that heredity con¬ tributes to the development of an "antisocial" personality, but they also indicated that an unfavorable childhood environment contributed as well; no correlation was found, on the other hand, between antisocial behavior among the mothers and alcohol abuse among their sons.
presented
Adopted Women Registered for Alcohol
Abuse and/or the whose women parents were Criminality.—When adopted registered for alcohol abuse were compared with their controls, no significant differences were found, nor were there any clear tendencies in support of a genetic hypothe¬ sis. As mentioned above, however, registrations were infrequent among the women, and one can hardly draw any definite conclusions from this section of the popula¬ tion. The combined results for the adopted women with a registered father or mother are presented in Table 7.
Biological
Parents
It can be seen from Table 7 that registered alcohol abuse found in 3% of the probands and 3% of the controls. Although alcohol abuse was clearly documented among the biological fathers of the probands (repeated offenses under the Temperance Act and, in most cases, one or several periods in institutions for alcoholics), their adopted daughters had much the same frequency of registered abuse as the controls. As also mentioned above, although the female probands have low frequencies in general in the registers for alcohol abuse and criminality, these inci¬ dences are definitely higher than one would expect to find in a comparable representative group of women. A criminal record for their biological parents was reflected in somewhat increased frequency of alcohol abuse among adopted women compared to controls: three probands but none of the controls featured in the register of alcohol abuse. Three probands and two controls featured in the criminal register. The numbers, however, one too small to permit definite conclusions to be drawn. was
COMMENT
questions in this particular section of the study the possibility of a genetic disposition for alco¬ holism or criminality. The results suggest that there is a genetic determinant for alcoholism but not for criminality (defined as repeated offenses with long prison sentences). If a genetic disposition did exist for criminality, it seemed The
concern
to be related to that of alcoholism.
Compared with the fathers, relatively few of the biolog¬ ical mothers had been registered for alcohol abuse or criminality, and most of those who did appear in the registers had only one or a few offenses against their names. Consequently, one cannot assess personalities of the mothers from the register data alone. Under these circumstances, however, it is noteworthy that the relatively few records of cases of alcohol abuse or criminality among the biological mothers were signifi-
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cantly reflected particularly in the alcohol abuse among the sons they allowed to be adopted. In the case of the mothers, a record in either register may be an indication of a personality disturbance with a genetic-constitutional
basis. As noted already, the probands with antisocial or alco¬ holic parents were placed in an adoptive home two to three months later, on average, than the controls. In this respect, therefore, the match between probands and controls was not entirely satisfactory. One must therefore consider to what extent the results have been influenced by the later placement of the probands. It is conceivable that later placement is associated with selective factors that contributed independently to poorer social adjustment later in life and hence to an increased risk of appearing in the registers. Such factors could be negative expectations, diseases or handicaps in infancy, as well as adverse condi¬ tions in general before the placement in an adoptive home. Furthermore, late placement may be a negative experience in itself, due to the change of mother figure at a sensitive age. It is therefore necessary to investigate whether a later age at placement is linked with a higher frequency of registration among both probands and controls and, if so, whether probands and controls differ in this respect. For this purpose, the number of registrations among adopted individuals who were placed before they were 1 year old has been compared with the number for those placed after their first birthday. This analysis was confined to male adoptees because it would have been meaningless for the women as so few of them appeared in the registers. For the controls, a review of the population, group by group, yielded no support for the assumption that late placement increased the risk of an entry in either of the registers. On the contrary, registrations were found for 13% of those who were placed before their first birthday and for 8% of those who were placed at a later age. It therefore seems that the time lapse before placement did not affect the risk of being registered for either crimi¬ nality or alcohol abuse. Among the probands, on the other hand, there was a higher proportion of registrations for the males who were placed after their first birthday—33% compared with 24% for those who were placed earlier than 1 year. This difference came chiefly from registered alcohol abuse (29% vs 20%). These differences are, however, not statistically
significant. This analysis accordingly indicates that late placement may have increased the risk for the child of being regis¬ tered for alcohol abuse—but not for criminality—and then only if the adoptees had biological parents who also had records. Even if negative conditions at the start of their lives were more frequent among the children who were placed late, this does not seem to have affected the risk of criminality. One cannot rule out the possibility of some increase in the risk of being registered for alcohol abuse, but this applies only to those adoptees whose biological parents were also registered for such abuse. It is conceiv¬ able that this has to do with a combination of genetic and
environmental factors. An overall assessment of the importance of the child's age at placement suggests that this does not upset the
basis for
conclusions concerning the part played by in the manifestation of alcohol abuse but that there is reason to presume that this may be influenced by environmental conditions during the first years of life. our
genetic factors
The
Prophylactic
Effects of
Adoption
One of the aims of the control study was to investigate the extent to which the transmission of a severe social maladjustment from the biological parents to their child is prevented by adoption. One way of illustrating this is to combine different groups of adoptees whose biological parents have various severe social insufficiencies. Such a pooling is presented in Fig 2, in which all adopted men with biological parents with social insufficiencies are compared with matched controls, ie, those without such a background. It can be seen that 26.9% of the men with a negative familial background appeared in some register, compared with 12.7% of the controls (P < .05). As we have already seen, it is clearly alcohol abuse that is transmitted most frequently. A record of such abuse was accordingly found for 21.1% of the probands compared with only 7.9% of the controls. The corresponding figures for registered crimi¬ nality are 14.2% and 8.9%, respectively. Criminality without alcohol abuse is equally frequent in both groups (4.7%). It seems reasonable to conclude that an antisocial nature in the form of repeated criminality among the parents was prevented to a large extent in the sons by their adoption, whereas adoption was not so influential when the parent was an alcoholic. On the other hand, the prevalence of registrations for alcohol abuse among the probands was about the same magnitude as that
25 20 + 15
-
10
—
5
12.6
--
PROBANDS =
190
CONTROLS =
190
Fig 2.—Alcohol abuse (A) and criminality (C) among probands and controls.
male
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found in the age-related sample cited above (19%). These conclusions must be confined to the sons, as the material does not permit any definite conclusions to be drawn for the daughters. One of the purposes of the study was to determine how adoption as a social measure influenced the living condi¬ tions of a group of individuals who were socially at risk at birth. The section presented here can hardly provide a conclusive answer to this question. It is confined to a couple of variables that may be regarded as indicators of social incompetence, namely registered alcohol abuse and regis¬ tered criminality. It should be realized that the presence or absence, of such records is a very uncertain measure of an individual's social sufficiency. Pending closer studies of other variables that may give a more detailed picture of the adopted individuals' living conditions, one should therefore draw only limited conclusions about the consequences of adoption for the 2,000 and more individuals in this popula¬ tion. What, then, do the results so far tell us about the prophylactic power of adoption? It is clear that the biolog¬ ical parents were greatly overrepresented in both regis¬ ters, whereas the adopted individuals, or at least the men, had much the same frequency of incidences as an agerelated population. It is highly probable that an unadopted group with the same biological background would have had a-considerably higher frequency of entries in the registers. Others studies have shown that children who grow up under extremely adverse conditions are very prone to exhibit social disturbances as adults.1 -17 This seems to warrant the assumption that adoption, in the present population, greatly reduced the risk of social incompetence among the adopted individuals. A more definite conclusion will have to await a study of a suitable control population, ie, biological full- or half-siblings who were not left for
adoption.
CONCLUSIONS
Summing up, the comparative analysis of probands and matched controls supports the hypothesis that there is a genetic predisposition to misuse alcohol. These results are in line with those obtained in other studies cited in the introduction611·1213 and that of Goodwin et al,1819 who studied the adopted and nonadopted sons and daughters of alcoholics. On the other hand, no such genetic predisposi¬ tion could be shown for criminality. The frequency for this was admittedly higher among the adopted men whose parents had a criminal record, but at the same time it showed a strong correlation with alcohol abuse. Instead of supporting the assumption that a predisposition for crimi¬ nality may be genetically governed, it seems more likely that it may be a consequence of alcohol abuse, as was pointed out in Jonsson's study.1 In this respect, these results do not confirm earlier adoption studies, for exam¬ ple, that of Hutchings and Mednick,5 who found a clear association for registered criminality between biological
fathers and their adopted sons. The lack of such an association in the present results could be due to national differences between the two adoption populations, but at present we cannot draw any conclusions. The results reported here must be regarded as prelimi¬ nary. Strictly genetic questions would seem to call for more detailed studies of unadopted siblings and of foster siblings so that these could be compared, for example, as regards alcohol abuse and criminality. Such studies should yield a more definite assessment of the relative importance of heredity and environment for the development of social maladjustment or alcohol abuse. By studying the adoptees' unadopted full- or half-siblings as well as adoptive siblings of the adoptees, it should be possible to obtain some measure of the ability of adoption to prevent the manifestation of social maladjustment. This work was supported in part by grant B76-27X-03789-05 from the Swedish Medical Research Council.
References 1. Jonsson G: Delinquent boys. Acta Psychiatr Scand, 2. Robins LN: Deviant Children Grown Up: A
suppl 195, 1967.
Sociological and Psychiatric Study of Sociopathic Personality. Baltimore, Williams & Wilkins Co, 1966. 3. Kety SS, Rosenthal D, Wender PH, et al: The types and prevalence of mental illness in the biological and adoptive families of adopted schizophrenics, in Rosenthal D, Kety SS (eds): The Transmission of Schizophrenia. London, Pergamon Press, 1968, pp 345-362. 4. Schulsinger F: Psychopathy, heredity and environment. Int J Ment
Health 1:190-206, 1972. 5. Hutchings B, Mednick S: Registered criminality in the adoptive and biological parents of registered male criminal adoptees, in Fieve RR, Brill H, Rosenthal D (eds): Genetic Research in Psychiatry. Baltimore, Johns Hopkins University Press, 1975. 6. Goodwin DW, Schulsinger LF, Hermansen L, et al: Alcohol problems in adoptees raised apart from alcoholic biological parents. Arch Gen Psychiatry 28:238-243, 1973. 7. Bohman M: Adopted Children and Their Families: A Follow-up Study of Adopted Children, Their Background, Environment and Adjustment. Stockholm, Proprius, 1970. 8. Bohman M: A comparative study of adopted children, foster children and children in their biological environment born after undesired pregnancies. Acta Paediatr Scand, Suppl 221, 1971. 9. Bohman M: A study of adopted children, their background, environment and adjustment. Acta Paediatr Scand 61:90-97, 1972. 10. Bohman M: Fifth Hilda Lewis Lecture: "Unwanted" children\p=m-\a prognostic study: Child adoption. J Assoc Br Adoption Agencies 2:13-25, 1973. 11. \l=A%o\markC: A study in alcoholism: Clinical, social-psychiatric and genetic investigations. Acta Psychiatr Neurol Scand, suppl 70, 1951. 12. Kaij L: Studies on the etiology and sequels of abuse of alcohol. Lund, Sweden, Department of Psychiatry, University of Lund, 1960. 13. Partanen J, Bruun K, Markkanen T: Inheritance of Drinking Behavior. New Brunswick, NJ, Rutgers University Center of Alcohol Studies, 1966. 14. Crowe RR: An adoption study of antisocial personality. Arch Gen Psychiatry 31:785-791, 1974. 15. Cure or Fines, government publication 56. Stockholm, 1968. 16. Anderson M: Hur g\l=a%o\rdet for 50-talets Stockholmspojkar? Monographs edited by Stockholm Municipality, No. 38, Stockholm, 1976. 17. Otterstr\l=o"\mE: Delinquency and children from bad homes. Acta Paediatr Scand 33(suppl 5): 1946. 18. Goodwin DW, Schulsinger LF, M\l=o"\llerN, et al: Drinking problems in adopted and nonadopted sons of alcoholics. Arch Gen Psychiatry 31:164-169, 1974. 19. Goodwin DW, Schulsinger LF, Knop J, et al: Alcoholism and depression in adopted-out daughters of alcoholics. Arch Gen Psychiatry 34:751-755, 1977.
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Population
Michael
Bohman,
of
Adoptees
MD
\s=b\ The state criminal records and official registers of alcoholics were used in a study of 2,000 adoptees and their biological and adoptive parents. The frequency of registration for the adoptees were approximately the same as for the population in general, but for the biological parents it was two to three times greater. Very few adoptive parents appeared in the records. It is conceivable that to a large extent adoption neutralized the "social heritage" from the biological parents. There was, however, a significant correlation in the records between alcoholism in biological parents and in their adopted-out sons. On the other hand, the criminal records showed no such correlation between biological parents and their children. These results support the hypothesis that there is a genetic explanation for the development of alcoholism, but not for the manifestation of
criminality. (Arch Gen Psychiatry 35:269-276, 1978) is an established idea that social maladjustment is more common in some families than in others; the term "social heritage" has been coined to cover this phenome¬ non. In one study of severely maladjusted boys, Jonsson1 found that some of the parents exhibited social maladjust¬ ment in various forms—a high incidence of criminality, alcoholism, and disorders of a nervous or somatic type. It even proved possible to trace the social maladjustment back to the boys' grandparents. Jonsson viewed his popula¬ tion mainly in terms of social psychology, interpreting the progressive maladjustment in these families as a process of social rejection over a period of several generations. While not excluding the possiblity that genetic and constitutional
It
publication June 23, 1977. Department of Child and Youth Psychiatry, University of Ume\l=a%0\(Sweden). Reprint requests to Department of Child and Youth Psychiatry, University of Ume\l=a%0,\901 87 Ume\l=a%0,\Sweden (Dr Bohman). Accepted
From the
for
factors could have some influence, he seems to consider that the situation is best explained within the framework of social psychology. The therapeutic approach he subse¬ quently presented for "breaking the social heritage" was a result of this viewpoint. It has been claimed in various studies that genetic factors do play a part in the development of social and mental insufficiency,- but it is extremely difficult to distinguish satisfactorily between hereditary and environ¬ mental factors—children usually receive their upbringing as well as their genes from their biological parents. One way of achieving such a distinction, however, is to study subjects who were separated from their biological parents at an early age and have been brought up by foster or adoptive parents not related to them. In this way, one can largely eliminate the influence of the biological envi¬ ronment. One such series of studies has been carried out using a Danish adoption population, the aim of which was to distinguish between hereditary and environmental factors in the manifestation of various states of mental or social insufficiency, eg, schizophrenia,1 psychopathy,4 crim¬ inality,5 and alcohol abuse.6 Adoption is a social and legal measure that definitely breaks at least one precondition for "social heritage." In my earlier studies,7"' of children who were separated from their biological parents at an early age and had no contact with them while they grew up in adoptive homes, no relationship could be found between their symptomatology and the social adjustment of their biological parents, as seen through the public records concerning misuse of alcohol, criminality, or both. As both social and mental problems were common among the biological parents of these children (eg, alcohol abuse and criminality were markedly overrepresented), it was concluded that adoption had on these counts neutralized
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Table
1—Registered Alcohol Among Biological Parents and
Abuse and Criminality Their Adopted Children
Biological
Biological
Adopted
Adopted
Fathers
Mothers
Men
Women
(N
=
Alcohol abuse
1,902) (N 34 29
Criminality
=
2,261)
4.6 6.4
(N
=
1,125) (N
16.1 12.8
=
1,199)
2.4 2.9
Table 2.—Correlation Between Registered Alcohol Abuse and Criminality
Biolog-
ical Fathers
(N Alcohol abuse alone
Criminality Both Total
alone
=
Biolog¬ ical Mothers
880) (N
=
Male
Female
Adoptees Adoptees 221) (N = 247) (N = 47)
37.2
34.8
42.1
26.5 36.3 100.0
52.9 12.3
26.3 31.6
100.0
100.0
46.8 40.4 12.8 100.0
heritage. This conclusion was supported by findings among children who had been registered for adoption but who ultimately grew up in their biological environments: the incidence of psychosocial disturbances, compared with that of the adopted chil¬ dren,81" was relatively high. These studies obviously do not in themselves provide sufficient grounds for rejecting the hypothesis that social maladjustment is associated with genetic factors. My most recent study"' was carried out when the children were only 15 years old, and genetic factors may manifest themselves later in life. The existence of genetic determinants of, for example, alcoholism and "sociopathy" has been convinc¬ ingly demonstrated in several earlier studies on a clinical population,11 twins,12·13 and adoptees.4-614 In order to examine these problems more closely, with special reference to Swedish conditions, a study has been started on a new sample of adoptees who were separated in infancy from their biological parents and brought up by nonrelated adoptive parents. The purpose of this study has been to analyze both the relative influence of environmental and genetic factors in the children's social
the manifestation of various social and mental states of insufficiency, and the factors on which social and mental adjustment depend. In order to make this possible, we are currently collecting data from various official registers covering many aspects of the living conditions of the adoptees and their relatives. To date, we have collected data about alcohol abuse and criminality among the adop¬ tees and both their biological and adoptive parents that permit us to present some preliminary findings. Thus, the special aim of the section presented in this article is to investigate by way of "the adoption method" whether or not there is any support for the hypotheses that alcoholism and criminality have genetic determinants.
SUBJECTS The population for the study comprised 2,324 persons born in Stockholm during the period 1930 to 1949 who were adopted at an early age by nonrelatives. Information about these persons was obtained from a list of illegitimate children for whom a child welfare officer had been appointed. In practice, this list includes all such children from that period who were adopted. It should be noted, however, that the population does not include adopted children who were born in wedlock. The population was selected to some extent in that it was confined to those children who were placed in an adoptive home at an early age, the upper limit being 3 years. Most of the children, however, were in fact separated from their biological environment in the first few months of life. Before being placed in an adoptive home, a large number of them stayed in a foster home or in an infants' home. The child's date of birth and age at placement were obtained from the register, as were the ages, occupations, and places of residence of both the biological and the adoptive parents. Pater¬ nity had not been established for 334 of the children. For all the biological parents and the children they left for adoption, a search was made for entries in the register of offenses kept by the Excise Board (registrations of alcohol abuse) and in the Criminal Register. The Excise Board's register contains information about fines imposed for intemperance, records of supervision by temperance boards (elected representatives and civil servants responsible for maintaining sobriety at the commu¬ nity level and thus also for the treatment and supervision of alcoholics), and time spent in institutions for alcoholics. In this context, the incurrence of a criminal sentence of more than 60 "day-fines" (a fine assessed on the basis of the defendant's daily income) constitutes criminality. Other public records were also consulted (eg, the records kept by the Health Insurance Office, the register of conscripts), but these results will be reported else¬ where.
RESULTS
The prevalence of alcohol abuse and criminality up to 1972 is summarized in Table 1 for the groups of biological fathers and mothers and for their sons and daughters who were put out for adoption. Compared to other Swedish groups investigated or official statistics for the population in general, the biological parents were greatly overrepresented in both registers. For example, according to a census of men15 born in 1917 and followed up through 1964, the prevalence risk of being registered for alcohol abuse was 14.4% as compared to 34% in my population. In an investigation in the 1950s of a randomly selected sample of Stockholm schoolboys born between 1939 and 1946, Jons¬ son1 found that 18% of the fathers appeared in the Excise Board register and 10% in the Criminal Register. For women, the prevalence risk in the general population is reported to be below 1% in both registers, whereas in my population it was 4.6% and 6.4% for alcohol abuse and criminality, respectively.1 The biological mothers in our sample are thus markedly overrepresented in both the alcohol abuse and criminal registers. It is clear from these figures alone that the biological parents are a selected group with a high frequency of social insufficiency. A closer study of the degree and nature of the alcohol abuse and criminality registered showed, moreover, that they were often interrelated and were also frequently present on a massive scale in the form of
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Table 3—Recorded Alcohol Abuse and
Criminality
for Male
Adoptees
and for Their
Biological
% of
Biological Mothers Registered Male Adoptees Registered lor
Alcohol Abuse
Alcohol abuse alone Criminality alone
22.5
Both_
16.9 43.9
(N
=
89)
Criminality (N = 169) 7.6 8.9 3.6 20.1
4.5
Total
Table 4.—Recorded Alcohol Abuse and Criminality for Female Adoptees and for Their Biological Parents
Biological
%of Parents Registered for
_A_\ r—
Adoptees Registered for
Female
Alcohol abuse alone
Criminality Both Total
Alcohol Abuse
(N
=
197)
2.0
Criminality (N = 192)
=
1,796)
1.6 1.0 4.7
0.5 3.6
or institutional for alcoholism. Table 2 shows, for instance, that 36.3% of the biological fathers who featured in the registers appeared in both. The corresponding figure for the mothers is, however, no more than 12.3%. The incidence of the adoptees in the two registers is also given in Table 1. The frequencies for the male adoptees are what one might expect in an age-related group: 16.1% for alcohol abuse and 12.8% for criminality. A proper compar¬ ison is difficult because of the lack of adequate control data, but a recently published follow-up study of the abovementioned sample of "normal" Stockholm boys1 may provide a comparison. Further studies16 of these boys through the official registers were carried out in 1973, eighteen years after the first investigation, when their age ranged from 26 to 34 years, which corresponds fairly well to the average age of the adoptees in my present sample (23 to 43 years). The prevalence of registered alcohol abuse in this sample was 19%, and that of criminality 15%. Thus, the
repeated offenses, long prison sentences,
care
two
investigations correspond fairly closely
Neither
(N
=
Alcohol Abuse
723)
(N
=
42)
14.3
6.6 5.0 7.0
14.3
18.6
33.4
these
%of Mothers
4.8
men
and that to
some
Registered tor
Criminality (N 48)
Neither
(N
=
1,029)
10.4 6.3
8.8 5.7
6.3 23.0
6.7 21.2
extent at least their crimi¬
nality was secondary to this abuse. Only 2.3% of the adoptive parents appeared in the register for alcohol abuse. Criminal records are lacking at present, but the incidence is probably very low, as it was in my earlier findings in another sample.7
Neither
(N
alone_VO_2 _1.3 0.5 3.5
Biological
for
Parents
as
regards
notation in both registers. The female adoptees, however, have incidences of 2.4% and 2.9% for alcohol abuse and criminality, respectively, which is more than one would expect in a random sample of women in this age group.1 The correlation between alcohol abuse and criminality for those adoptees who appeared in these registers (247 men, 46 women) is shown in Table 2. Male adoptees had a rather high association in this respect (31.6%), as did their biological fathers (36.3%). This link between alcohol and criminality has been found in other studies concerning problem populations. In this study by Jonsson,1 for instance, the association was even more frequent (56%) among fathers of boys with severe social and mental disturbances. Jonsson supposed that alcohol abuse was an important factor in the problems of
ANALYSIS WITH THE ADOPTION METHOD In a preliminary analysis, we compared adoptees whose biological parents appeared in the registers of alcohol abuse and /or criminality with adoptees whose parents had no such records. We excluded subjects with a parent who appeared in both registers, in order to keep these two factors as separate and uncontaminated as possible. The findings are summarized in tables 3 and 4. 1. Male adoptees whose biological fathers were regis¬ tered for alcohol abuse only (and do not have a criminal record) were themselves significantly overrepresented in this register as compared with adoptees whose fathers had no registration (39.4% and 13%, respectively, < .01). Registration for criminality in combination with alcohol abuse was also more common among adoptees with a father registered for alcohol abuse (16.9% vs 7.0%, > .05 [NS]). 2. Male adoptees whose biological mothers were regis¬
tered for alcohol abuse alone were likewise overrepre¬ sented in this register (28.6% and 15.5%, respectively, < .01). Here, too, criminality in combination with alcohol abuse was more common among the adopted sons of registered mothers (14.3% vs 6.7%). 3. Male adoptees whose fathers had a criminal record alone were not overrepresented in the criminal register as compared with male adoptees with fathers who had no record (12.5% and 12.0%, respectively). Nor was there any difference between the two groups of adoptees concerning alcohol abuse. 4. Male adoptees whose mothers had criminal records only were not overrepresented as compared with those whose mothers had no record. (12.6% and 12.4%, respective¬ ly). Here, too, the incidence of alcohol abuse was almost the same in both groups of adoptees. 5. Female adoptees whose biological fathers or mothers were registered for alcohol abuse or for criminality appeared about as frequently in each register as those whose fathers or mothers were not registered. However, so few of the female adoptees were registered for either alcohol abuse or criminality that no conclusions could be drawn from these data. These results suggest that genetic factors have a bearing
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the manifestation of alcohol abuse among »vomen as well as men. In the case of (registered) criminal behavior, on the other hand, there are no indications of such a genetic link. If anything, criminality seems to be genetically related to alcohol abuse. Support for these conclusions seems to be forthcoming from various parts of the analysis. If selective factors, such as a poorer placement for children with socially maladjusted parents, had been present and had affected the development of the adoptive children, one would expect them to have an equal influence on children with biological parents with different types of social maladjustment. In other words, there should have been a link for criminality between parents and children as there was a link for alcohol abuse. That this is not the case may indicate that selective factors connected with placement did not play a major part in the development of criminality or alcohol abuse among the adoptees; at the same time, the absence of a link between the biological parents and their children for criminality may indicate that, in this respect at least, the adoption prevented a social maladjustment among the adoptees. on
CONTROL STUDY
The
preliminary analysis accordingly suggests
that genetic factors may play a part in the manifestation of alcoholism among the subjects and their biological parents in this sample. There are, however, many factors that may have influenced the results, eg, the age of the children at placement, the selective placement of certain children with a poorer background, poor somatic status. Awareness of the biological parents' social failure, alcoholism, and crimi¬ nality may also have influenced the placement of and expectations concerning the child. A child with a particu¬ larly "poor" background may be the victim of a selffulfilling prognosis. While it is of course impossible to check all these factors retrospectively, an attempt has been made by selecting certain subjects whose biological parents had the most long-lasting and frequent records of alcohol abuse or criminality from the primary sample and matching them with controls who were placed under more or less equivalent conditions but whose biological parents do not feature in the registers. In this way, a control study ex post facto has been undertaken to throw further light on two questions: (1) Is there any support for the hypothesis that "sociopathy" and alcoholism may be transmitted genetically? (2) Is the passing on of serious social malad¬ justment from the biological parents to the child prevented
by adoption?
METHOD From the
2,324 adoptees, we selected 380 probands whose most frequent or serious registrations for either
primary sample. Most of these men had been sentenced to long terms in prison; many had been subjected to forensic psychiatric examination and had as a result been admitted to mental institutions. These fathers could well be regarded as having "sociopathic" personalities. When I selected subjects in terms of the severity of alcohol abuse and criminality among their biological fathers, it was inevitable that most fathers appeared in both registers. in the
A selection
was
also made of 42
and 50
women
whose
few of them had been in institutions for alcoholics. On the other an entry for a women is presumably a considerably stronger indicator of social insufficiency than it is in the case of men. It is a known fact that Swedish men run a comparatively greater risk of being apprehended for drunkenness and thus of featuring in the register. This risk is normally very slight for women, and when they are registered it is undoubtedly more frequently a sign of substantial psychosocial problems underlying the alcohol abuse. The same applies to registered criminality a
hand,
among
women.
Finally,
48 men and 50 women were selected whose biological mothers had entries in the criminal register. Here, too, the number of registrations among the mothers was relatively few, and no more than 48 adopted men fulfilled the selection criteria. This selection procedure thus produced eight groups based on the sex of the probands and the type of social incompetence (alcohol abuse or criminality) in the biological father or mother.
Controls and
Matching
Procedure
A control from the primary series was selected for each proband in the eight groups. The controls, whose parents had not been registered for either alcohol abuse or criminality, were matched with the subjects in terms of sex, age, age at placement, occupa¬ tional category of the adoptive parents, and the ages of the biological and the adoptive parents when the child was born. There was no difficulty in obtaining a good match between subjects and controls in respect of sex, age, ages of the biological and adoptive mothers at the birth of the child, and the occupational category of the adoptive father. The breakdown of the adoptive fathers by occupational category is shown in Table 5. The categories are based on the occupational register of the National Swedish Board of Health and Welfare: group I roughly corresponds to "profes¬ sional occupations," group II to "intermediate occupations," group III to "skilled," group IV to "semiskilled," and group V to "unskilled workers." As can be seen, there was a good match between probands and controls. Certain difficulties were encoun¬ tered, however, when matching the age at placement, owing to the
Table 5.—Occupational Classification of Adoptive Fathers of Probands and Fathers of Controls, by Sex No. of
parents had the
alcohol abuse or criminality. These probands included 50 men and 50 women whose biological fathers were registered for repeated alcohol abuse. Most of these fathers had spent time in institutions for alcoholics and had been committed for several offences under the Temperance Act. In view of such histories of alcohol abuse, it seems reasonable to regard these fathers as alcoholics in a medical and social sense. Similarly, 50 men and 50 women were selected whose biological fathers were among those with the most serious criminal records
men
biological mothers were registered for alcohol abuse. As compara¬ tively few of the mothers appeared in this register, it was not possible to select subjects whose mothers had the same frequency of registration as the fathers mentioned earlier. In fact, no more than 42 men had mothers registered for alcohol abuse. Generally, these mothers had only occasional entries in the register, and only
Male
Occupational
Probands
Adoptive Fathers
Subjects Controls
Female Probands
Subjects Controls
Group_(N 190) (N 190) (N 200) (N 200) I_19_18_13_15 II_42_37_50_47 =
=
=
=
III_71_76_74_80 IV_14_16_15_15
V
44
43
48
43
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Biological
parents
with abuse of alcohol
,c?
F
Subjects,
=
M
A
9
/\
with criminal record
F
cf
/\
cT9 50 50
cT9 42 50
cf Ç 50 50
50
50
42
50
50
cf 9
cf
î
J î
9
M
/\ e? ? 50
Adoptees Controls,
=
\/cf \/9
FM Biological
composition of the primary sample. Both the male and female probands among the subjects were placed, on the average, three months later than the controls, which cannot be regarded as entirely satisfactory for the present analysis. The significance of this discrepancy in the age at placement will be considered in more detail in the discussion of the results. The probands and controls are presented schematically in Fig 1. ANALYSIS AND RESULTS study confirms the results found in the preliminary analysis of the larger, unmatched sample. A correlation was found for alcohol abuse between the biolog¬ ical parents and their sons, but as in the preliminary analysis, there was no definite relationship between the male subjects and their parents with respect to criminality. The results are summarized in Tables 6 and 7.
The control
Adopted Fathers
Registered
Men
for Severe Alcohol Abuse
Persistent
Criminality.—Twenty percent of male probands whose fathers were registered for severe alcohol abuse featured in the same register, as compared with 6% of the controls.
iî
FM
parents with no criminal record
for control
study.
Fourteen percent of the probands and 12% of the controls registered for criminality. Criminality alone among the adoptees occurred in 4% of both groups. However, the difference between the groups is not significant according to a conventional 2 test. Among the probands whose fathers had serious criminal records, only four (8%) were themselves registered for criminality, the comparative figure for the controls also being four (8%). At the same time, nine (18%) of the probands but only two (4%) of the controls appeared in the alcohol register. It is reasonable to see this as a reflection of the previous finding that the biological fathers with a serious criminal record also tended to misuse alcohol. This appears to provide further confirmation of the hypothesis that alcohol abuse has a genetic background, at least in this population, while criminal behavior does not. were
Mothers or
50
\/cf \/9
with no abuse of alcohol Fig 1 .—Model
50
Registered
for Alcohol Abuse
or
Criminality.—Of
the adopted men whose biological mothers had been regis¬ tered for alcohol abuse, 33.4% appeared in this register compared with 19% of the controls. Furthermore, 21.5% of these probands were registered for criminality alone or for
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Table 6.—Alcohol Abuse and
Biological Alcohol Abuse (P)
Male Adoptees Registered for Alcohol abuse alone Criminality alone Both Total
(N
=
50)
50)_(N
8 12 22
Adoptees Registered for
=
(C) 50)_(N = 50)
16
12
24
12
Table 7.—Alcohol Abuse and
Female
and Matched Controls
Biological Neither
Criminality (P)
(C) =
(P)
%of Fathers Registered for
Neither
(N
Male Probands
Criminality Among
Criminality Among
% With Either Biological Parent Registered For Alcohol Abuse
(N =100)
(N=42)
=
100)
(P)
Registered for
(C) (N = 42)
Criminality (P) (N = 48)
9.5
10.4
9.5 19.0
6.3 8.3 25.0
Neither
16.7 4.8 16.7 38.2
Female Probands
C % With Biological Parents not Registered
(N
Alcohol Abuse (P)
%of Mothers
(C)
and Matched Controls % With Either Biological Parent Registered for Criminality
(N
=
100)
Neither
(N
(C) = 48) 2.1 4.2 2.1 8.4
(C) C % With Biological Parents not Registered
(N
m
100)
0
Alcohol abuse alone Criminality alone
Both_ Total
this in addition to alcohol abuse, compared with only 9.5% of the controls. These results are of particular interest in that most of the probands' mothers had only a single entry in the alcohol register. The difference does not, however, reach statistical
significance.
A similar comparison of alcohol abuse and criminality is in the table for those probands and controls whose mothers had or did not have a criminal record. In this group it is again alcohol abuse that distinguishes the probands from their controls-18.7% of the former feature in the alcohol register but only 4.2% of the controls. On the other hand, criminality alone, or in combination with alcohol abuse, is equally frequent in both groups. When the entries in both registers are combined, the difference between probands and controls is significant at the 5% level. These results are of interest in the light of findings published recently by Crowe14 from a group of adopted individuals whose mothers had a criminal record. Crowe's findings supported the hypothesis that heredity con¬ tributes to the development of an "antisocial" personality, but they also indicated that an unfavorable childhood environment contributed as well; no correlation was found, on the other hand, between antisocial behavior among the mothers and alcohol abuse among their sons.
presented
Adopted Women Registered for Alcohol
Abuse and/or the whose women parents were Criminality.—When adopted registered for alcohol abuse were compared with their controls, no significant differences were found, nor were there any clear tendencies in support of a genetic hypothe¬ sis. As mentioned above, however, registrations were infrequent among the women, and one can hardly draw any definite conclusions from this section of the popula¬ tion. The combined results for the adopted women with a registered father or mother are presented in Table 7.
Biological
Parents
It can be seen from Table 7 that registered alcohol abuse found in 3% of the probands and 3% of the controls. Although alcohol abuse was clearly documented among the biological fathers of the probands (repeated offenses under the Temperance Act and, in most cases, one or several periods in institutions for alcoholics), their adopted daughters had much the same frequency of registered abuse as the controls. As also mentioned above, although the female probands have low frequencies in general in the registers for alcohol abuse and criminality, these inci¬ dences are definitely higher than one would expect to find in a comparable representative group of women. A criminal record for their biological parents was reflected in somewhat increased frequency of alcohol abuse among adopted women compared to controls: three probands but none of the controls featured in the register of alcohol abuse. Three probands and two controls featured in the criminal register. The numbers, however, one too small to permit definite conclusions to be drawn. was
COMMENT
questions in this particular section of the study the possibility of a genetic disposition for alco¬ holism or criminality. The results suggest that there is a genetic determinant for alcoholism but not for criminality (defined as repeated offenses with long prison sentences). If a genetic disposition did exist for criminality, it seemed The
concern
to be related to that of alcoholism.
Compared with the fathers, relatively few of the biolog¬ ical mothers had been registered for alcohol abuse or criminality, and most of those who did appear in the registers had only one or a few offenses against their names. Consequently, one cannot assess personalities of the mothers from the register data alone. Under these circumstances, however, it is noteworthy that the relatively few records of cases of alcohol abuse or criminality among the biological mothers were signifi-
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cantly reflected particularly in the alcohol abuse among the sons they allowed to be adopted. In the case of the mothers, a record in either register may be an indication of a personality disturbance with a genetic-constitutional
basis. As noted already, the probands with antisocial or alco¬ holic parents were placed in an adoptive home two to three months later, on average, than the controls. In this respect, therefore, the match between probands and controls was not entirely satisfactory. One must therefore consider to what extent the results have been influenced by the later placement of the probands. It is conceivable that later placement is associated with selective factors that contributed independently to poorer social adjustment later in life and hence to an increased risk of appearing in the registers. Such factors could be negative expectations, diseases or handicaps in infancy, as well as adverse condi¬ tions in general before the placement in an adoptive home. Furthermore, late placement may be a negative experience in itself, due to the change of mother figure at a sensitive age. It is therefore necessary to investigate whether a later age at placement is linked with a higher frequency of registration among both probands and controls and, if so, whether probands and controls differ in this respect. For this purpose, the number of registrations among adopted individuals who were placed before they were 1 year old has been compared with the number for those placed after their first birthday. This analysis was confined to male adoptees because it would have been meaningless for the women as so few of them appeared in the registers. For the controls, a review of the population, group by group, yielded no support for the assumption that late placement increased the risk of an entry in either of the registers. On the contrary, registrations were found for 13% of those who were placed before their first birthday and for 8% of those who were placed at a later age. It therefore seems that the time lapse before placement did not affect the risk of being registered for either crimi¬ nality or alcohol abuse. Among the probands, on the other hand, there was a higher proportion of registrations for the males who were placed after their first birthday—33% compared with 24% for those who were placed earlier than 1 year. This difference came chiefly from registered alcohol abuse (29% vs 20%). These differences are, however, not statistically
significant. This analysis accordingly indicates that late placement may have increased the risk for the child of being regis¬ tered for alcohol abuse—but not for criminality—and then only if the adoptees had biological parents who also had records. Even if negative conditions at the start of their lives were more frequent among the children who were placed late, this does not seem to have affected the risk of criminality. One cannot rule out the possibility of some increase in the risk of being registered for alcohol abuse, but this applies only to those adoptees whose biological parents were also registered for such abuse. It is conceiv¬ able that this has to do with a combination of genetic and
environmental factors. An overall assessment of the importance of the child's age at placement suggests that this does not upset the
basis for
conclusions concerning the part played by in the manifestation of alcohol abuse but that there is reason to presume that this may be influenced by environmental conditions during the first years of life. our
genetic factors
The
Prophylactic
Effects of
Adoption
One of the aims of the control study was to investigate the extent to which the transmission of a severe social maladjustment from the biological parents to their child is prevented by adoption. One way of illustrating this is to combine different groups of adoptees whose biological parents have various severe social insufficiencies. Such a pooling is presented in Fig 2, in which all adopted men with biological parents with social insufficiencies are compared with matched controls, ie, those without such a background. It can be seen that 26.9% of the men with a negative familial background appeared in some register, compared with 12.7% of the controls (P < .05). As we have already seen, it is clearly alcohol abuse that is transmitted most frequently. A record of such abuse was accordingly found for 21.1% of the probands compared with only 7.9% of the controls. The corresponding figures for registered crimi¬ nality are 14.2% and 8.9%, respectively. Criminality without alcohol abuse is equally frequent in both groups (4.7%). It seems reasonable to conclude that an antisocial nature in the form of repeated criminality among the parents was prevented to a large extent in the sons by their adoption, whereas adoption was not so influential when the parent was an alcoholic. On the other hand, the prevalence of registrations for alcohol abuse among the probands was about the same magnitude as that
25 20 + 15
-
10
—
5
12.6
--
PROBANDS =
190
CONTROLS =
190
Fig 2.—Alcohol abuse (A) and criminality (C) among probands and controls.
male
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found in the age-related sample cited above (19%). These conclusions must be confined to the sons, as the material does not permit any definite conclusions to be drawn for the daughters. One of the purposes of the study was to determine how adoption as a social measure influenced the living condi¬ tions of a group of individuals who were socially at risk at birth. The section presented here can hardly provide a conclusive answer to this question. It is confined to a couple of variables that may be regarded as indicators of social incompetence, namely registered alcohol abuse and regis¬ tered criminality. It should be realized that the presence or absence, of such records is a very uncertain measure of an individual's social sufficiency. Pending closer studies of other variables that may give a more detailed picture of the adopted individuals' living conditions, one should therefore draw only limited conclusions about the consequences of adoption for the 2,000 and more individuals in this popula¬ tion. What, then, do the results so far tell us about the prophylactic power of adoption? It is clear that the biolog¬ ical parents were greatly overrepresented in both regis¬ ters, whereas the adopted individuals, or at least the men, had much the same frequency of incidences as an agerelated population. It is highly probable that an unadopted group with the same biological background would have had a-considerably higher frequency of entries in the registers. Others studies have shown that children who grow up under extremely adverse conditions are very prone to exhibit social disturbances as adults.1 -17 This seems to warrant the assumption that adoption, in the present population, greatly reduced the risk of social incompetence among the adopted individuals. A more definite conclusion will have to await a study of a suitable control population, ie, biological full- or half-siblings who were not left for
adoption.
CONCLUSIONS
Summing up, the comparative analysis of probands and matched controls supports the hypothesis that there is a genetic predisposition to misuse alcohol. These results are in line with those obtained in other studies cited in the introduction611·1213 and that of Goodwin et al,1819 who studied the adopted and nonadopted sons and daughters of alcoholics. On the other hand, no such genetic predisposi¬ tion could be shown for criminality. The frequency for this was admittedly higher among the adopted men whose parents had a criminal record, but at the same time it showed a strong correlation with alcohol abuse. Instead of supporting the assumption that a predisposition for crimi¬ nality may be genetically governed, it seems more likely that it may be a consequence of alcohol abuse, as was pointed out in Jonsson's study.1 In this respect, these results do not confirm earlier adoption studies, for exam¬ ple, that of Hutchings and Mednick,5 who found a clear association for registered criminality between biological
fathers and their adopted sons. The lack of such an association in the present results could be due to national differences between the two adoption populations, but at present we cannot draw any conclusions. The results reported here must be regarded as prelimi¬ nary. Strictly genetic questions would seem to call for more detailed studies of unadopted siblings and of foster siblings so that these could be compared, for example, as regards alcohol abuse and criminality. Such studies should yield a more definite assessment of the relative importance of heredity and environment for the development of social maladjustment or alcohol abuse. By studying the adoptees' unadopted full- or half-siblings as well as adoptive siblings of the adoptees, it should be possible to obtain some measure of the ability of adoption to prevent the manifestation of social maladjustment. This work was supported in part by grant B76-27X-03789-05 from the Swedish Medical Research Council.
References 1. Jonsson G: Delinquent boys. Acta Psychiatr Scand, 2. Robins LN: Deviant Children Grown Up: A
suppl 195, 1967.
Sociological and Psychiatric Study of Sociopathic Personality. Baltimore, Williams & Wilkins Co, 1966. 3. Kety SS, Rosenthal D, Wender PH, et al: The types and prevalence of mental illness in the biological and adoptive families of adopted schizophrenics, in Rosenthal D, Kety SS (eds): The Transmission of Schizophrenia. London, Pergamon Press, 1968, pp 345-362. 4. Schulsinger F: Psychopathy, heredity and environment. Int J Ment
Health 1:190-206, 1972. 5. Hutchings B, Mednick S: Registered criminality in the adoptive and biological parents of registered male criminal adoptees, in Fieve RR, Brill H, Rosenthal D (eds): Genetic Research in Psychiatry. Baltimore, Johns Hopkins University Press, 1975. 6. Goodwin DW, Schulsinger LF, Hermansen L, et al: Alcohol problems in adoptees raised apart from alcoholic biological parents. Arch Gen Psychiatry 28:238-243, 1973. 7. Bohman M: Adopted Children and Their Families: A Follow-up Study of Adopted Children, Their Background, Environment and Adjustment. Stockholm, Proprius, 1970. 8. Bohman M: A comparative study of adopted children, foster children and children in their biological environment born after undesired pregnancies. Acta Paediatr Scand, Suppl 221, 1971. 9. Bohman M: A study of adopted children, their background, environment and adjustment. Acta Paediatr Scand 61:90-97, 1972. 10. Bohman M: Fifth Hilda Lewis Lecture: "Unwanted" children\p=m-\a prognostic study: Child adoption. J Assoc Br Adoption Agencies 2:13-25, 1973. 11. \l=A%o\markC: A study in alcoholism: Clinical, social-psychiatric and genetic investigations. Acta Psychiatr Neurol Scand, suppl 70, 1951. 12. Kaij L: Studies on the etiology and sequels of abuse of alcohol. Lund, Sweden, Department of Psychiatry, University of Lund, 1960. 13. Partanen J, Bruun K, Markkanen T: Inheritance of Drinking Behavior. New Brunswick, NJ, Rutgers University Center of Alcohol Studies, 1966. 14. Crowe RR: An adoption study of antisocial personality. Arch Gen Psychiatry 31:785-791, 1974. 15. Cure or Fines, government publication 56. Stockholm, 1968. 16. Anderson M: Hur g\l=a%o\rdet for 50-talets Stockholmspojkar? Monographs edited by Stockholm Municipality, No. 38, Stockholm, 1976. 17. Otterstr\l=o"\mE: Delinquency and children from bad homes. Acta Paediatr Scand 33(suppl 5): 1946. 18. Goodwin DW, Schulsinger LF, M\l=o"\llerN, et al: Drinking problems in adopted and nonadopted sons of alcoholics. Arch Gen Psychiatry 31:164-169, 1974. 19. Goodwin DW, Schulsinger LF, Knop J, et al: Alcoholism and depression in adopted-out daughters of alcoholics. Arch Gen Psychiatry 34:751-755, 1977.
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