Identifying patterns of early risk for mental health and academic problems in adolescence: a longitudinal study of urban youth.
ABSTRACT This investigation examined profiles of individual, academic, and social risks in elementary school, and their association with mental health and academic difficulties in adolescence. Latent profile analyses of data from 574 urban youth revealed three risk classes. Children with the "well-adjusted" class had assets in the academic and social domains, low aggressive behavior, and low depressive symptoms in elementary school, and low rates of academic and mental health problems in adolescence. Children in the "behavior-academic-peer risk" class, characterized by high aggressive behavior, low academic achievement, and low peer acceptance, had conduct problems, academic difficulties, and increased mental health service use in adolescence. Children with the "academic-peer risk" class also had academic and peer problems but they were less aggressive and had higher depressive symptoms than the "behavior-academic-peer risk" class in the first grade; the "academic-peer risk" class had depression, conduct problems, academic difficulties, and increased mental health service use during adolescence. No differences were found between the risk classes with respect to adolescent outcomes.
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ABSTRACT: Sex differences in rates of internalizing disorders have been attributed in part to heightened sensitivity to stress in females. While the sex difference in disorder rates becomes most pronounced in adolescence, developmental research suggests that stress reactivity in girls may be related to elevated internalizing symptoms even in childhood. We therefore examined whether child sex moderated associations between symptoms of psychopathology and cortisol reactivity to a standardized stress task in 409 three-year-old community-dwelling children. Anxious symptoms were associated with elevated cortisol reactivity, but only in girls. Externalizing symptoms were unrelated to baseline cortisol or cortisol reactivity, and no evidence for moderation by child sex was found. Results suggest that cortisol reactivity to stress in early childhood has a sex-specific association with girls' internalizing symptoms.Psychoneuroendocrinology 06/2013; · 5.59 Impact Factor
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ABSTRACT: Although past research has provided important information about the relationship between language use and mental health in the period of adolescence, the role of intervening variables in this association has been seriously neglected. The aim of the present study was to illuminate the association between language use (operationalized by "the gap between experience and language--GAP") and mental health (e.g., adjustment and depression, with the mediator role of emotion regulation). Three-hundred-and-seventy-four adolescents (220 female, 154 male; 16.08 mean age) participated in the study. The results provided support for the mediator role of emotion regulation in the relationship between GAP and mental health. Moreover, it was shown that the relationship between emotion regulation and depression was mediated by adjustment.The Journal of Psychology Interdisciplinary and Applied 05/2013; 147(3):293-309. · 0.86 Impact Factor
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ABSTRACT: Internet addiction after launching smartphone is becoming serious. Therefore this paper has attempted to sketch out the diverse addiction treatment and then check the feasibility of exercise rehabilitation. The reason to addict the internet or smartphone is personalized individual characters related personal psychological and emotional factors and social environmental factors around them. We have shown that 2 discernible approaches due to 2 different addiction causes: that is behavioral treatment and complementary treatment. In the behavioral treatment, cognitive behavioral approach (CBT) is representative methods for changing additive thoughts and behaviors. Motivational interviewing (MI) is also the brief approach for persons not ready to change their behavior. Mindfulness behavioral cognitive treatment (MBCT) also the adapted treatment based on CBT. There are different types following the emphatic point, mindfulness-based relapse prevention (MBRP) or mindfulness oriented recovery enhancement (MORE). It is apparent that therapeutic recreation, music therapy using drumming activity, and art therapy are useful complementary treatment. Exercise rehabilitation contained the systematic procedures and comprehensive activities compared to previous addiction treatments by contents and techniques. Exercise rehabilitation can treat both physical symptoms at first and mental problems in the next step. So more evidence-based exercise rehabilitation researches need to do, but it is highly probable that exercise rehab can apply for smartphone addiction.Journal of exercise rehabilitation. 01/2013; 9(6):500-505.
CHILDHOOD RISK 1
Identifying Patterns of Early Risk for Mental Health and Academic Problems in Adolescence:
A Longitudinal Study of Urban Youth
Running Head: CHILDHOOD RISK PATTERNS FOR MENTAL HEALTH AND ACADEMIC
PROBLEMS IN ADOLESCENTS
Carmen R. Valdez1
Sharon F. Lambert2
Nicholas S. Ialongo3
We thank the Baltimore City Public Schools for their continuing collaborative efforts and
the parents, children, teachers, principals, and school psychologists and social workers who
participated. We also express our appreciation to Hanno Petras and Scott Hubbard, who made
significant contributions to the data analysis and editing of the manuscript.
This research was supported by National Institutes of Mental Health Grants RO1
MH42968 (Sheppard Kellam, Principal Investigator) and T-32 MH18834 (Nicholas Ialongo,
Principal Investigator) and Centers for Disease Control and Prevention Grant R49/CCR318627–
Correspondence concerning this article should be addressed to Carmen R. Valdez,
Department of Counseling Psychology, University of Wisconsin-Madison, Madison, WI 53706.
Phone: 608-263-4493; Fax: 608-265-3347. Email: email@example.com.
1 Department of Counseling Psychology, University of Wisconsin-Madison, Madison, WI
2 Department of Psychology, George Washington University, Washington, DC
3 Department of Mental Health, Johns Hopkins University, Baltimore, MD
CHILDHOOD RISK 2
This investigation examined profiles of individual, academic, and social risks in elementary
school, and their association with mental health and academic difficulties in adolescence. Latent
profile analyses of data from 574 urban youth revealed three risk classes. Children with the
“well-adjusted” class had assets in the academic and social domains, low aggressive behavior,
and low depressive symptoms in elementary school, and low rates of academic and mental health
problems in adolescence. Children in the “behavior-academic-peer risk” class, characterized by
high aggressive behavior, low academic achievement, and low peer acceptance, had conduct
problems, academic difficulties, and increased mental health service use in adolescence. Children
with the “academic-peer risk” class also had academic and peer problems but they were less
aggressive and had higher depressive symptoms than the “behavior-academic-peer risk” class in
the first grade; the “academic-peer risk” class had depression, conduct problems, academic
difficulties, and increased mental health service use during adolescence. No differences were
found between the risk classes with respect to adolescent outcomes.
Key words: childhood risk, adolescent adjustment, person-centered approach
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Identifying Patterns of Early Risk for Mental Health and Academic Problems in Adolescence:
A Longitudinal Study of Urban Youth
Life Course Social Fields and Developmental Cascades models suggest that children
entering formal schooling experience rapid changes in their activities, social roles, and capacities
based on new tasks and demands set forth by teachers and peers [1, 2, 3]. Children’s successful
navigation of demands is largely determined by their skills and performance in a variety of areas
(e.g., academics, athletics) [2, 4, 5]. Also of importance in this regard is children’s appraisal of
how their performance fares relative to teachers’ standards and to their classmates’ own
performance [2, 4]. This appraisal influences children’s sense of confidence and competence ,
which in turn may shape children’s later attitudes and adjustment in school [1, 6].
Emerging risks may be emotional, behavioral, academic, and interpersonal, and are likely
to be interrelated . Guided by both developmental models and recently developed person-
centered analytical approaches, the present study examines risks salient during the elementary
school years and identifies how these risks co-occur. The study then examines whether these
early risk patterns are differentially associated with adolescent mental health and educational
outcomes. Having an enhanced understanding of patterns of risk factors in elementary school for
subsequent problems will direct to potential targets for early preventive interventions .
Risks in Elementary School
Risk factors salient in the early elementary school years include aggressive behavior,
depressive symptoms, peer difficulties, and academic problems . Separately, these problems
have been documented to have a significant impact on child adaptation and subsequent
adolescent adjustment . For example, studies using community samples have estimated the
prevalence of aggression in children to range from 0.9% to 20%, with estimates being much
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higher (up to 90%) in clinical samples . Physical aggression is more common in elementary
school boys than girls, for whom onset takes place approaching adolescence . Rates of
aggressive behavior in elementary school are alarming not only because of the increased number
of aggressive acts during this time but because aggression has a different purpose for the
elementary school child than the preschool child (e.g., hostility and retaliation vs. frustration for
not getting needs met). Unabated and in the presence of other risk factors (e.g., individual,
family, neighborhood), aggressive behavior in elementary school is associated with a life course
trajectory of conduct problems and delinquency [9, 10].
While clinically diagnosable depression is comparatively rare in childhood, with an
estimated 1-year prevalence ranging from less than 1% to up to 3% , studies show that
children can and do experience depression at early ages (i.e., elementary school) . Ialongo and
colleagues  measured depressive symptoms in the first grade and found that children were
reliable and valid reporters of their mood. Further, they found that first-graders’ report of
depressive symptoms was associated with educational and mental health outcomes in fourth,
sixth, and eighth grades . Other studies show that 10-15 % of children have depressive
symptoms, which can be just as functionally impairing as clinically diagnosed depression 
and increase risk of depression in middle childhood and adolescence [1, 3]. Thus, depressive
symptoms alone can have deleterious effects on children’s functioning over time, and its
association with suicide and loss of productivity in adolescence and adulthood are concerning
not only to the individual but society as a whole [3, 11].
Research shows that the establishment of social friendships is a hallmark of the transition
to elementary school [1, 2]. Children rely on peers for coordinated play, conversation, and
coping with peer rejection or bullying . The availability of these supportive functions
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depends greatly on children’s social acceptance [1, 2]. Whether children are accepted by peers is
of utmost importance in their identity development [4, 13]. Thus, low peer acceptance in
childhood predicts isolation and social avoidance, deviant peer affiliation, conduct problems,
depression, and poor school functioning in adolescence [12, 13]. Further, low peer acceptance
relates to higher mental health utilization in adolescence .
Finally, children’s successful accomplishment of early academic tasks may provide a
sense of mastery and self-esteem that in turn forms the foundation for successful academic
functioning during adolescence . Conversely, children with low academic achievement in
one or more areas (e.g., reading, math) may experience feelings of low self-concept and low
sense of control that jeopardizes their competence in and orientation to academics . Thus,
children with an early history of low academic achievement are particularly vulnerable to grade
retention, school failure and attrition, disruptive behavior, and depression in adolescence [7, 15].
In addition to these personal costs, there are societal costs related to the associated use of special
education services, school dropout, and subsequent under- or unemployment .
Co-occurrence of Early Risks
Although the individual aforementioned risk factors in elementary school each predict
adolescent functioning, studying the interrelatedness of these risk factors can help determine
which types of children are at greater risk for a variety of outcomes in adolescence. Determining
various types of risk groups further allows researchers and practitioners to design early
prevention programs to better suit the complex and different presentations of children .
Aggressive behavior, low social acceptance, depressive symptoms, and low academic
achievement do not typically occur in isolation. Children with aggressive behavior tend to
engage in bullying, both as perpetrators and victims [9, 17] because they have fewer friendships
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and are less accepted by peers [17, 18]. Likewise, aggressive behavior relates to concurrent and
later low peer acceptance given its impact on peers and others around the child . Because
aggressive behavior results in frequent negative feedback from peers, aggressive children are less
likely to like school and more likely to exhibit depressive symptoms during elementary school
. Although depressive symptoms are more variable in children than aggressive behavior,
children who experience both aggressive behavior and depressive symptoms in childhood are at
an increased risk for depression and conduct problems in adolescence, compared to children with
aggressive behavior problems alone . Moreover, aggressive behavior tends to be associated
with poor academic achievement, with rates of co-occurrence ranging from 10% - 50% [see 5].
To further elaborate on the co-occurrence among risk factors, children with depressive
symptoms may experience diminished self-worth, lowered academic competence, and negative
peer relationships . Theoretical models of the cognitive foundations of depression elucidate a
strong relationship between depressive symptoms and school-related variables [11, 19]. For
example, the learned helplessness model states that repeated perceptions of uncontrollable events
can challenge children’s belief that they can shape events around them . Thus, perceived lack
of control resulting from depressive symptoms is associated with deficits in (a) motivation to
initiate or sustain a task, (b) cognitive planning and execution to control events, and (c)
emotional regulation leading to hopelessness, sadness, and lowered self-esteem . Not
surprisingly, depressive symptoms are strongly linked with lowered academic achievement.
Similarly, depressive symptoms and academic achievement have been linked to peer
relationships in that children who have a high sense of efficacy and competence are more likely
to have higher academic performance and to be viewed by peers as more desirable friends [3,
20]. Reciprocally, socially desirable children receive more positive feedback about their
CHILDHOOD RISK 7
competence in academics and other areas, in turn experiencing greater confidence and self-
The co-occurrence of aggressive behavior, low peer acceptance, depressive symptoms,
and low academic achievement is also greater for children who are exposed to negative life
events (e.g., family problems, community violence) . Salient to this study, is the relationship
between patterns of risk and outcomes for urban minority youth, who may have the greatest
behavioral and community risks and lowered access to mental health services [7, 18].
Significance of Mental Health and Educational Adjustment in Adolescence
The literature reviewed is commensurate with Life Course/Social Field and
Developmental Cascades models, in that early school failures may set the stage for subsequent
failures and, thus, increased and more challenging demands from teachers and peers. A chronic
history of failure or developmental cascades may result in sustained emotional, behavioral,
academic, and social distress and the risk of negative outcomes in adolescence [1, 3, 10].
In adolescence, depression is associated with future depressive episodes, anxiety,
substance abuse, suicidal behaviors, and interpersonal difficulties  particularly among urban
adolescents . Problems with conduct are also common in urban settings and have been linked
to subsequent juvenile offending, substance use, depression, school drop-out, and early sexual
activity and parenthood . Emotional and conduct problems in adolescence are often
accompanied by decreases in academic achievement [3, 10]. Lower academic achievement has
been found to decrease self-esteem and competence, and increase delinquent behaviors .
Moreover, academic difficulties in urban adolescents are associated with school-dropout and
limited employment opportunities .
CHILDHOOD RISK 8
Adolescents who experience emotional, behavioral, and academic difficulties may likely
be in need of mental health services. Despite this need, few adolescents receive services for
internalizing problems . Bradshaw and colleagues  found that children with internalizing
symptoms were not only less likely to be referred by teachers to mental health services, but were
referred for these symptoms at a later age than children with externalizing symptoms. This
referral difference may partially be explained by teachers’ (a) difficulty detecting depressive
symptoms, and (b) decreased experience of classroom disruption from these children relative to
children with aggressive behavior . Although children with externalizing problems are more
likely to be referred for mental health services, far fewer female and minority adolescents receive
services for externalizing problems than male or non-minority adolescents .
Although mental health service use per se is not a precise indicator of adolescent
emotional, behavioral, and educational adjustment, the type of mental health setting may reflect
the severity of the difficulties experienced. Adolescents with moderately impaired behaviors
generally receive mental health services at school . Referral to inpatient and outpatient
mental health services, on the other hand, may indicate very impaired behavior and referral is
often initiated by parents who are burdened by and unable to address the child’s emotional and
behavioral needs . As mental health services utilization in adolescence has been associated
with elementary school functioning , and use of these services has the potential to curb the
negative trends that may continue into adulthood, it is critical to study mental health service use
as an adjustment outcome of early patterns of elementary school risk.
A Person-Centered Approach to Childhood Risk
Our conceptual framework is based on the Life Course Social Fields model which posits
that failure to meet early task demands, and the consequent academic, social, and behavioral
CHILDHOOD RISK 9
difficulties that may emerge, can limit children’s ability to successfully navigate future
developmental challenges [1, 2]. The Developmental Cascades model  further proposes that
difficulties in early domains of functioning (e.g., academics, peer relationships) tend to co-occur,
are interrelated, and together may undermine adaptive functioning.
Our study uses a person-centered approach to advance these theoretical models by
examining how difficulties in domains of functioning in the first grade come together to predict
adolescent outcomes. To better understand a person-centered approach, it is important to
distinguish it from traditional, variable-centered approaches. A variable-centered approach, like
SEM and regression analyses, focuses on relations among variables and aims to predict
outcomes, relate independent and dependent variables, or assess intervention effects . In
contrast, a person-centered approach distinguishes classes of individuals based on characteristics
that are similar within a class and that are different from individuals in other classes .
Person-centered approaches like latent profile analysis (LPA) and cluster analysis may
reveal a group of children with overall positive functioning across emotional, behavioral, and
academic domains, and groups of children with varying combinations of negative functioning
across the same domains. Within person-centered approaches, LPA has advantages over cluster
analysis in that LPA is model-based (allowing more flexibility in model specification), and uses
fit statistics to determine the number of underlying classes [24, 26]. In addition, outcomes can be
included in an LPA model to examine predictive validity of the classes . Moreover, LPA has
a conceptual and empirical advantage over cumulative risk models . In cumulative risk
models, isolated risk experiences or single stressors often have negligible effects on adjustment
while exposure to multiple stressors better predicts adjustment in adolescence [7, 28].
Cumulative stress models focus on the number of stressors experienced but do not inform about
CHILDHOOD RISK 10
whether patterns of stressors experienced have differential effects on later adjustment, or what
patterns of risk that distinguish well-adapted from poorly-adapted children and that are
associated with different outcomes in adolescence. LPA has the potential to advance existing
research by grouping children not only based on the number of risks but also based on
qualitatively distinct risks  from emotional, behavioral, academic, and peer risk domains.
Thus, a person-centered approach like LPA is an ideal method for studying the complexity of
children’s interrelated risks, and their consequences in adolescence.
For the present study, children were grouped into qualitatively distinct patterns based on
domains of functioning that are salient in the first grade: aggressive behavior, depressive
symptoms, low peer acceptance, and low academic achievement. We evaluated the utility of
these risk patterns in predicting later adolescent depression, conduct problems, academic
achievement, and use of school-based and outpatient and inpatient mental health services. We
hypothesized that children with different risk patterns in the first grade would experience
different levels of depression and conduct problems, academic failure, and mental health services
use during adolescence. However, given the limited attention to patterns in samples like ours, we
relied on our person-centered methods to determine the number and composition of risk profiles.
This study was based on a large community sample of primarily African American youth.
Although urban youth are exposed to multiple stressors, there is expected variation in exposure
to risks. Thus, multiple problem groups were expected in this sample.
Data were drawn from a community sample of youth living in an urban metropolitan
area. Children were representative of first graders across nine elementary schools and were
CHILDHOOD RISK 11
assessed in the fall of first grade as part of an evaluation of two randomized school-based
preventive interventions whose immediate targets were early learning and behavior . The first
intervention consisted of curricular enhancement and improved behavior management in the
classroom; the second intervention consisted of parent and teacher training in parent-school
collaboration. Written parental consent and youth assent were obtained for 97% of eligible
children prior to data collection. Thirty-three percent of the sample participated in the classroom
intervention, 33% in the family intervention, and 33% in the control condition. First grade
assessments were conducted prior to the intervention. As shown in Table 1, the majority of youth
who completed the first grade assessments were African American (86.3%), half were male
(53.4%), and ages ranged from 5.3 to 7.7 (M = 6.2, SD = .34). Sixty-eight percent of the sample
received free or reduced lunches. Study procedures were conducted with full IRB approval.
Approximately 85% of the original sample (N = 574) participated in the adolescent
follow-up assessments in grades 6 through 9 and comprise the sample of interest for this study.
Reasons for non-participation included parental refusal (n=42), failure to respond (n=30),
inability to locate (n=30), and death of child (n=3). For the variables of interest, no differences
were found between participants and nonparticipants in grades 6-9 based on intervention status,
gender, race, or lunch status in the first grade (ps > .05).
Child functioning was measured in grade 1. Children reported their depressive symptoms,
and their academic achievement was based on standardized achievement test scores. Children’s
aggressive behavior and social acceptance were reported by peers. In grades 6 through 9,
symptoms leading to diagnoses of Major Depressive Disorder (MDD) and Conduct Disorder
(CD) were reported by adolescents and their parents, academic difficulties were reported by
CHILDHOOD RISK 12
teachers, and inpatient/outpatient treatment and school counseling were separately reported by
parents and teachers, respectively. Adolescents, parents, and teachers completed these measures
annually between grades 6 and 9. MDD, CD, academic difficulties, and counseling were
recorded if reported at any time during the 6th through 9th grades.
Child functioning: Grade 1. Depressive symptoms were assessed using the Baltimore
How I Feel-Young Child Version, Child Report (BHIF-YC-C) , a 30-item self-report scale
of depressive and anxious symptoms as defined in the Diagnostic and Statistical Manual of
Mental Disorders, Third Edition, Revised (DSM-III-R) . The BHIF-YC-C was designed to
be administered on a classroom-wide basis and to require no reading skills on the part of the
children. Children reported the frequency of depressive and anxious symptoms over the last two
weeks on a three-point scale (0 = Never, 1 = Sometimes, 2 =Almost Always). The 11-item BHIF
Depression subscale (e.g., “felt sad”, “no use in really trying”) was used in the current research.
The internal consistency of this subscale was .70 in the fall of 1st grade, consistent with studies of
first-grade children using the Children’s Depression Inventory over a two-week period . In
terms of concurrent validity, previous studies have shown that for each standard deviation
increase in BHIF-YC-C Depression subscale scores in 1st grade, there was a threefold increase in
the likelihood of the child’s parent reporting that the child was in need of mental health services
for “feeling sad, worried or upset” and a fivefold increase in the likelihood of the child’s teacher
reporting that the child was in need of an evaluation for special education services. In addition,
BHIF-YC-C administered in elementary school was associated with lifetime suicide attempt
(Odds ratio [OR] = 2.38, Confidence Interval [CI] = 1.30, 4.25) and episodes of Major
Depressive Disorder at age 19-20 (OR = 1.84, CI = 1.16, 2.92).
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Aggressive behavior was measured using the Peer Assessment Inventory (PAI), a
modified version of the Revised-Pupil Evaluation Inventory (R-PEI) . The PAI assesses the
child's adaptation to the demands of the classroom peer group. A question is read aloud to the
class and children are instructed to circle the pictures of all children in their classroom described
by the question. Peers make unlimited nominations of their classmates for each one of the four
items assessing aggressive behavior (“which children: ‘are bullies?,’ ‘start fights?,’ ‘are picked
on?,’ ‘get in trouble?’”). A summary score was created from the mean of these items. Coefficient
alpha for the aggressive behavior subscale in fall of grade 1 was .88. In terms of concurrent
validity, the aggressive behavior items were each significantly correlated with teacher-rated
conduct problems and oppositional defiant behavior in first grade.
Peer acceptance also was assessed using items from the PAI . Peers make unlimited
nominations of their classmates for each of the following 3 questions: “which children: ‘do you
like best?,’ ‘have lots of friends?,’ ‘are your best friends?’” A summary score was created from
the mean of these items. The coefficient alpha for this subset in fall of first grade was .85. In
terms of concurrent validity, in a previous study these items were each correlated in the expected
direction with teacher-rated likeability/rejection in first grade.
Academic achievement was assessed with the Comprehensive Test of Basic Skills 4
(CTBS) , which is one of the most frequently used standardized achievement tests
in the United States. The CTBS was individually administered to children to measure
their academic achievement through verbal and quantitative subtests. Results from the CTBS
are reported as Normal Curve Equivalent scores which have a mean of 50 and a
standard deviation of 21.06. The mean of the CTBS reading and math scores was computed to
create a composite academic achievement variable. The CTBS was standardized with a
CHILDHOOD RISK 14
nationally representative sample of 323,000 children and adolescents and has a coefficient alpha
of 0.89 (KR-20 = .90) .
Adolescent outcomes: 6th through 9th grades. Major Depressive Disorder and Conduct
Disorder were assessed using the Diagnostic Interview Schedule for Children-IV (DISC-IV)
, a structured clinical interview designed to be administered by lay interviewers, that yields
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) diagnoses
. Although complete results of the psychometric studies of the DISC-IV have yet to be
published, data on an earlier version, DISC 2.1, suggest adequate test-retest reliability of
combined parent and child reports (.70 for Major Depressive Disorder, .71 for Conduct
Disorder). In terms of validity, DISC-IV diagnoses are associated with elevated scores on the
SCL-90-R Global Severity Index , and there appears to be adequate correspondence (52%-60%
agreement) between DISC diagnoses by lay interviewers and clinician diagnoses .
The DISC-IV's Major Depressive Disorder (MDD) and Conduct Disorder (CD) modules
were administered to adolescents and parents in each of the 6th through 9th grades. A computer
algorithm developed by Shaffer et al.  was used to determine whether respondents met
criteria for MDD and CD. A diagnosis of MDD or CD was recorded based on either the
adolescent or parent report, given that multiple informants are likely to contribute complimentary
observations about different aspects of the condition . While youth may be better reporters of
feelings and thoughts, adults may be better reporters of irritability and other behavioral
manifestations of depression. A binary variable was created to indicate whether or not the
adolescent met criteria for MDD and CD at any time during the 6th through 9th grades.
Mental health service utilization was assessed using the Service Assessment for Children
and Adolescents-Parent Report (SACA-P) , a structured interview designed to accompany
CHILDHOOD RISK 15
the DISC-IV . In each of grades 6-9, parents indicated whether their adolescent had received
inpatient or outpatient treatment during the past year. A binary variable was created to indicate
whether or not the adolescent had received inpatient or outpatient treatment at any time during
grades 6 through 9. School counseling was assessed using a school version of the SACA-P. Each
academic year, the school psychologist and/or social worker reported the nature, quantity, and
types of counseling provided at school. A binary variable was created to indicate whether or not
adolescents participated in counseling at school at any time in the 6th through 9th grades.
Academic performance was assessed by the adolescents’ English and Math teachers’
report of their grades on a 5-point scale (1 = excellent, 2 = good, 3 = fair, 4 = barely passing, 5 =
failing). Teachers reported grades in each of 6th through 9th grades, and these reports were
combined to give an overall average for each academic year. An average grade point average
over the 6th through 9th grades was calculated. An initial inspection of the data revealed highly
skewed distributions for academic performance. Thus, this variable was dichotomized to indicate
whether the adolescent’s average grade point average was indicative of (a) low academic
performance based on barely passing or failing grades (letter-grade equivalents of C, D, or F), or
(b) high academic performance based on fair to excellent grades (letter-grade equivalents of A or
B). The cut-point was selected to specifically examine adolescents who were struggling
academically versus those who were not. This dichotomization has been used in prior research
 and found to have significant relations with early risk factors.
Latent Profile Analysis (LPA) is a statistical technique that derives information about
categorical latent variables based on the observed values of continuous manifest variables or
indicators . Because LPA assumes that the indicators are explained by unobserved