The early emergence and stability of emotional and behavioral problems among COAs underscores the utility of a developmental perspective in explaining when and how some of these youth will come to evidence SUDs. Growing evidence suggests that the roots of this process are evident for some individuals as early as birth. This is most evident among those infants who experienced prenatal exposure to alcohol, tobacco or other drugs and the subsequent challenges associated with Fetal Alcohol Effects/Syndrome (Kodituwakku, Kalberg, & May, 2001; Streissguth et al., 2004; Testa, Quigley, & Eiden, 2003).3 However, research shows an early pattern of risk behavior in young children of alcoholic parents who avoided prenatal exposure to substances for their children. For example, analyses of two community samples showed that COAs without prenatal exposure began to evidence elevated internalizing symptoms and externalizing symptoms as early as age 2, with risk for symptomatology remaining high and stable into adulthood (Hussong et al., 2007; Hussong et al., 2008). To date, the few prevention programs that have been empirically evaluated target COAs between middle childhood and adulthood (see Price & Emshoff, 1997), after these emotional and behavioral problems have had years to stabilize.
