B M Stilwell

Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, United States

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Publications (20)56.41 Total impact

  • Barbara M. Stilwell
    12/2007: pages 123-135;
  • Matthew R Galvin, Jerry Fletcher, Barbara M Stilwell
    Journal of the American Academy of Child & Adolescent Psychiatry 07/2006; 45(6):745-8. · 6.97 Impact Factor
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    ABSTRACT: An I.U. Conscience Project and HELP Collaboration. The presentation describes models for teaching ethics and caring attitudes to undergraduate medical students in both formal and informal medical education curriculum. Competency based curriculum is discussed. Indiana University Conscience Project 1982, Health-professional Ethics Leadership Program (HELP) 1997, Teaching Caring Attitudes (TCA) 1998
    01/2005;
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    M. Gaffney, M. Galvin, B. Stilwell
    01/2002;
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    ABSTRACT: To compare moral development and psychopathological interference with conscience functioning (PI) among adolescents exposed to different degrees of earthquake-related trauma and to investigate the relationship of moral development and PI to exposure to trauma, severity of posttraumatic stress disorder (PTSD) symptoms, postearthquake adversities, and extent of loss of nuclear family members. Adolescents (N = 193) from 2 cities at different distances from the epicenter were evaluated. The Stilwell Structured Conscience Interview was used to assess moral development and PI. Structured self-report instruments were used to obtain ratings of severity of earthquake-related trauma, posttraumatic stress symptoms, and postearthquake adversities. Adolescents in the city near the epicenter manifested advanced moral development as compared with their counterparts in the less affected city. Concomitantly, they endorsed responses indicating PI. Levels of PI were significantly correlated with severity of PTSD symptoms. In the aftermath of a catastrophic natural disaster, children assume greater responsibilities and confront a multitude of morally challenging interpersonal situations which may result in an advancement of their moral development. Yet, at the same time, PTSD symptoms and negative schematizations of self and others may give rise to disturbances in conscience functioning. The findings suggest that therapeutic consideration should be given to assisting children in integrating the horror of their traumatic experiences and the harshness of posttrauma adversities into an adaptive schema of good and evil in themselves and the world.
    Journal of the American Academy of Child & Adolescent Psychiatry 05/1999; 38(4):376-84. · 6.97 Impact Factor
  • B M Stilwell, M R Galvin, S M Kopta, R J Padgett
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    ABSTRACT: To define discrete developmental levels of understanding of the ways in which normal children and adolescents link autonomy and will to moral obligation and to study the correlation between this progression and previously identified stages of conscience conceptualization. One hundred thirty-two normal volunteers between the ages of 5 and 17 years were individually interviewed using the moral volition section of the semistructured Stilwell Conscience Interview. Analysis of the interviews resulted in five levels of understanding of moral self-evaluation and volitionally chosen behavior. Analyses of variance and covariance showed that the five levels of moral volition had significant correlation with five conceptualization stages, with stage criteria showing a stronger correlation than age. Self-identified tasks of oughtness were hierarchically defined beginning with those defining a morality of restraint followed by moralities of mastery/sufficiency, virtuous striving, idealization, and individual responsibility. Perception of increased independence of self in interaction with conscience was noteworthy at stages 4 and 5. Moral volition is the domain of conscience functioning that defines understanding of moral self-evaluation and volitionally chosen actions; five levels of understanding can be demonstrated in normal children between the ages of 5 and 17 years.
    Journal of the American Academy of Child & Adolescent Psychiatry 03/1998; 37(2):202-10. · 6.97 Impact Factor
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    ABSTRACT: To define discrete developmental levels of understanding regarding the ways in which normal children and adolescents link remembered and current attachment experiences to their moral belief system and to study the correlation between this progression and previously identified stages of conscience conceptualization. Using the moralization of attachment section from the semistructured Stilwell Conscience Interview, 132 normal volunteers between the ages of 5 and 17 years were individually interviewed. Analysis of the interviews resulted in five levels of understanding. By analyses of variance and covariance, the five attachment levels showed significant correlation with the five conceptualization stages. Conceptualization stage showed a stronger correlation than age. In normal development, moralization of attachment is a domain of conscience functioning which follows a five-level hierarchical developmental progression; first, the child's sense of security and empathic responsiveness become paired with a sense of moral obligation; caretaker rules are then incorporated; an understanding of how empathy modifies strict rule-following develops; idols and ideals are chosen that reflect earlier learning in attachment relationships; finally, a visualization of the self as moral standard-bearer or teacher unfolds.
    Journal of the American Academy of Child & Adolescent Psychiatry 09/1997; 36(8):1140-7. · 6.97 Impact Factor
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    ABSTRACT: Identify associations among early maltreatment, sufficiencies, and psychopathological interferences in the domains of conscience functioning and low serum dopamine beta hydroxylase activity. Nineteen emotionally disturbed boys screened for maltreatment experiences were compared according to age at onset of maltreatment, enzyme activity, and their conscience functioning in the domain of moral valuation. They were also compared in conscience functions to 19 age and sex matched normal counterparts. Subjects who endured maltreatment prior to 36 months had developmental delays and interferences with functioning in more conscience domains than those who were either spared such experiences or who endured maltreatment later in life. Subjects with low enzyme activity had significantly more interference with authority and peer valuation than subjects with high enzyme activity. Greater interference with valuation was associated with lower enzyme activity and more frequent abuse prior to 36 months. Psychosocial sequelae of early maltreatment have been identified in the domains of conscience. An association has been established between pathological interference in the domain of moral valuation and a putative neurobiologic sequelae of early maltreatment. Implications for future research in the psychobiology of maltreatment are discussed.
    Child Abuse & Neglect 02/1997; 21(1):83-92. · 2.47 Impact Factor
  • B M Stilwell, M Galvin, S M Kopta, R J Padgett
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    ABSTRACT: To assess development of moral valuation in normal children and adolescents, that is, how moral rules for living are derived and justified, and to examine the relationship of this progression with previously identified stages of conceptualization of conscience. Using three semistructured questions from the Stilwell Conscience Interview, 132 normal volunteers between the ages of 5 and 17 years were assessed. All moral valuation responses were examined within three aspects of social reference: authority-derived, self-derived, and peer-derived. Each aspect was scaled for complexity into six anchored levels. The levels of all three aspects correlated positively with conceptualization stages as well as with each other. When the covariate, age, was taken into consideration, peer-derived valuation was significantly correlated with both age and stage. Moral valuation is a domain of conscience functioning in which moral rules and their justifications are socially referenced in relationship to authority, self, and peers. Anchored levels of these three aspects of moral valuation provide developmental guidelines for mental status examinations in patients between 5 and 17 years of age as well as providing criteria for future comparative studies in various diagnostic categories of psychopathology.
    Journal of the American Academy of Child & Adolescent Psychiatry 03/1996; 35(2):230-9. · 6.97 Impact Factor
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    ABSTRACT: Fifty boys, hospitalized on a school-age and an adolescent unit in an intermediate length psychiatric hospital, were studied while off psychoactive medication to determine how serum dopamine beta hydroxylase (DBH) activity varies with different childhood maltreatment experiences. Childhood maltreatment was categorized according to onset (before 36 months old, between 36-72 months old and over 72 months old). Childhood maltreatment groups were compared with a group of psychiatrically hospitalized boys who had neither been abused nor neglected. Boys who were younger than 72 months at age of onset of maltreatment had significantly lower DBH activity than those who had experienced maltreatment later in childhood and those who had not been subjected to abuse or neglect. This difference appeared attributable to the DBH activity of school age (but not adolescent) boys who had been abused/neglected before 72 months. Boys with a principal diagnosis of conduct disorder solitary aggressive type had lower DBH activity than boys without this diagnosis regardless of whether or not they had been maltreated. Low serum DBH may be a biological sequela of maltreatment early in life that correlates with the development of conduct disorder solitary aggressive type in boys.
    Child Abuse & Neglect 08/1995; 19(7):821-32. · 2.47 Impact Factor
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    ABSTRACT: Fifty boys, hospitalized on a school-age and an adolescent unit in an intermediate length psychiatric hospital, were studied while off psychoactive medication to determine how serum dopamine beta hydroxylase (DBH) activity varies with different childhood maltreatment experiences. Childhood maltreatment was categorized according to onset (before 36 months old, between 36–72 months old and over 72 months old). Childhood maltreatment groups were compared with a group of psychiatrically hospitalized boys who had neither been abused nor neglected. Boys who were younger than 72 months at age of onset of maltreatment had significantly lower DBH activity than those who had experienced maltreatment later in childhood and those who had not been subjected to abuse or neglect. This difference appeared attributable to the DBH activity of school age (but not adolescent) boys who had been abused/neglected before 72 months. Boys with a principal diagnosis of conduct disorder solitary aggressive type had lower DBH activity than boys without this diagnosis regardless of whether or not they had been maltreated. Low serum DBH may be a biological sequela of maltreatment early in life that correlates with the development of conduct disorder solitary aggressive type in boys.RésuméCinquante garçons enaˆge scolaire, hospitalise´s dans une unite´d'adolescents d'un hoˆpital psychiatriquea`se´jour de dure´e interme´diaire onte´te´e´tudie´s. En l'absence de toute me´dication psycho-active les variations de l'activite´se´rique en dopamine beta hydroxylase (DBH) onte´te´e´tudie´es en fonction des diffe´rentes expe´riences de maltraitance infantile. Les maltraitances infantiles onte´te´classe´es en fonction de leur de´but (avant 36 mois), entre 36 et 72 mois et apre`s 72 mois de vie. Les groupes d'enfants maltraite´s onte´te´compare´s avec un groupe de garçons, hospitalise´s pour des raisons psychiatriques, mais qui n'avaient jamaise´te´abuse´s ou ne´glige´s. Les garçons qui avaient moins de 72 mois lors du de´but des mauvais traitements avaient une activite´DBH significativment plus basse que ceux maltraite´s plus tard dans l'enfance et que ceux n'ayant jamaise´te´sujeta`de l'abus ou de la ne´gligence. Cette diffe´rence est apparue attribuablea`l'activite´DBH des garçons enaˆge scolaire abuse´s avant 72 mois et nona`ceux adolescents. Les garçons dont le diagnostic principal de desordre de comportemente´tait de type agressif et solitaire avaient une activite´DBH plus basse que les garçons ne pre´sentant pas ce diagnostique et cela qu'il aiente´te´maltraite´s ou non. Un taux se´rique bas en DBH peuteˆtre une se´quelle biologique de mauvais traitements pre´coces qui est corre´le´s avec le de´veloppement d'un de´sordre de comportement agressif et solitaire chez les garçons.ResumenCincuenta nin˜os de sexo masculino, hospitalizados en una unidad para nin˜os de edad escolar y adolescentes en un hospital psiquia´trico de ingreso de media estancia, fueron estudiados mientras no estaban tomando medicacio´n psicoactiva, para determinar co´mo variaba la actividad de la Dopamina Beta Hidroxilasa (DBH) en suero en funcio´n de diferentes experiencias de maltrato en la infancia. El maltrato en la infancia se categorizo´de acuerdo al momento de su inicio (antes de los 36 meses de edad, entre los 36–72 meses, y despue´s de cumplidos los 72 meses). Se compararon los grupos de maltrato en la infancia con un grupo de nin˜os hospitalizados en dicho centro psiquia´trico que no habi´an sido objeto ni de malos tratos ni de abandono. Los nin˜os que teni´an menos de 72 meses de edad en el momento en el que comenzo´el maltrato, teni´an una actividad de la DBH mucho menor que aquellos que habian comenzado a sufrir el maltrato mas tarde y que aque´llos que no habi´an sido objeto ni de malos tratos ni de abandono. Esta diferencia pareci´a atribuible a la actividad de la DBH en nin˜os de edad escolar (pero no adolescentes) que habi´an sido objeto de malos tratos/abandono antes de los 72 meses. Los nin˜os con un diagno´stico principal de trastorno de conducta de tipo solitario-agresivo teni´an una menor actividad de la DBH que los nin˜os sin ese diagno´stico, independientemente de si habi´an sido o no maltratados. El bajo DBH en suero puede ser una sexuela biolo´gica de una experiencia de maltrato ene´pocas tempranas de la vida, que correlaciona en nin˜os de sexo masculino con el desarrollo de un trastorno de conducta de tipo solitario-agresivo.
    Child Abuse & Neglect. 07/1995;
  • B M Stilwell, M Galvin, S M Kopta, J A Norton
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    ABSTRACT: The purpose of this study was to assess the progression in development of moral-emotional responsiveness in children and adolescents and to examine the relationship of this progression with previously identified stages of conceptualization of conscience. Using three semistructured questions from the Stilwell Conscience Interview, 132 normal volunteers between the ages of 5 and 17 years were assessed regarding comprehension of their emotional responses to moral stimuli. Rational analysis of the responses identified six items; each item was scaled for complexity into five stages. Factor analysis of the six items revealed two factors: moral-emotional responsiveness 1 contained items relating to external anxiety, internal anxiety, and mood; more-emotional responsiveness 2 contained items relating to the restoration of psychophysiological equilibrium through the processes of reparation and healing. Differences between conceptualization stages, with the moral-emotional responsiveness factors serving as dependent variables, were accounted for by stage differences in age and the positive correlations between the moral-emotional responsiveness factors and age. Moral-emotional responsiveness is a two-factor domain of the conscience. The findings provide additional developmental guidelines for assessing conscience development and functioning both in clinical practice and in research.
    Journal of the American Academy of Child & Adolescent Psychiatry 02/1994; 33(1):130-9. · 6.97 Impact Factor
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    ABSTRACT: Twenty-one psychiatrically hospitalized boys were studied while off psychoactive medication to determine if conduct disorder, solitary type, and abuse or neglect experiences correlated with low levels of dopamine-beta-hydroxylase (DBH) activity. Preliminary results supported earlier findings that undersocialized types of conduct disorder in boys were correlated with low DBH activity. Possible or definite neglect or abuse before 36 months of age was correlated with low DBH activity. Abuse or neglect was not correlated with low DBH activity when time of occurrence was not specified. Low serum DBH may be a biological sequela of seriously disrupted attachment.
    Psychiatry Research 11/1991; 39(1):1-11. · 2.68 Impact Factor
  • B M Stilwell, M Galvin, S M Kopta
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    ABSTRACT: In order to determine how normal children and adolescents conceptualize their conscience, the Stilwell Conscience Interview was given to 125 normal subjects between the ages of 5 and 17. Responses to questions 1, 2 and 11 (including the drawing of conscience) were empirically analyzed, resulting in a five-stage developmental model. The responses were then randomly presented to two blinded raters to assign them to one of the five stages. Highly acceptable interrater reliability was found, Kappa = 0.90. The relationship of age to stage demonstrated a highly significant positive correlation, indicating that the conceptualization of conscience in normal development follows an invariant, hierarchical pattern of organization. A commentary regarding each stage is presented. The value of this conceptualization model as a comparative standard of normality in the clinical assessment of youngsters suffering from psychopathology is discussed relative to assessment, psychotherapy, and future research.
    Journal of the American Academy of Child & Adolescent Psychiatry 02/1991; 30(1):16-21. · 6.97 Impact Factor
  • B M Stilwell, M Galvin
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    ABSTRACT: Forty-eight nonpsychiatrically disturbed 11–12-year-olds were asked to describe their conscience, to draw a picture of it, and to describe their internal and external responses to personal transgressions and acts of moral goodness. Three stages of conceptualization emerged, represented by both verbal description and pictorial presentation. The reporting of emotional responses of physiological discomfort, persistent thoughts, and depressive symptoms showed statistically significant variation at the three stages. There were also significant sex differences.Journal of the American Academy of Child Psychiatry, 24, 5:630–636, 1985.
    Journal of the American Academy of Child Psychiatry 10/1985; 24(5):630-6.
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    Matthew R. Galvin, Barbara Stilwell
  • Matthew R Galvin, Margaret M Gaffney, Barbara M Stilwell
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    ABSTRACT: Objective: This is the first in a series of articles to characterize and critically consider recently employed forms of conscience sensitive psychiatric treatment of children and adolescents. Method: Modules were designed based upon domains of conscience functioning identified in empirical research and applied to recognized benchmarks for interventions in the treatment of psychopathology. Each module was designed to be sufficiently complete such that full participation from persons entering the cycle of modules at any point would not be compromised. One of the authors paired with interested, experienced therapists in existing programs to conduct and refine interventions in a group psycho-educational therapy format. Results: Over one hundred and fifty hours of conscience sensitive psycho-educational group therapy were conducted in therapeutic loci within a well-established, community-based continuum of care. The therapeutic loci ranged from a child and adolescent psychiatry outpatient clinic to a closed youth residential setting and included adolescent psychiatric intensive outpatient and partial hospitalization programs. Number of participants in any module varied from one in the outpatient locus to fifteen in the intensive outpatient locus. Age of participants varied from school age to late adolescent. Formal intellectual testing was not uniformly available for participants. Most however appeared to be average intellectually. Each participant had, at minimum, an initial assessment by a mental health clinician yielding a DSM IV multiaxial psychiatric diagnosis. No restrictions were placed upon participants in terms of principal or secondary diagnoses or severity of impairment although all had sufficiently severe impairment to be deemed in need of the aforementioned current and standard psychiatric or psychosocial interventions. Length of time for each of the seven modules was permitted to vary according to the stability of the participant population. Individual modules conducted in the adolescent psychiatric intensive outpatient program were limited to one hour each, whereas some modules conducted in the residential and youth day school settings extended over several sessions held once weekly. Seven modules were eventually developed and refined to comprise a full course of conscience sensitive psycho-educational group therapy. Conclusions: Each of the seven modules in its current stage of development and refinement is characterized in terms of praxis, but also considered critically in terms of treatment philosophy. Conscience sensitive group psycho-educational therapy can be conducted in child adolescent psychiatric therapeutic loci ranging from outpatient to closed residential programs. Constraining variables were encountered in the adolescent intensive outpatient program when census became large, and turnover rapid, in consequence of which the full cycle of seven modules conducted at a frequency of one per week could not be completed by many participants. This could be remedied by conducting sessions more frequently, perhaps two to three times per week, and offering a sufficient number of groups to ensure that the number of participants in each group does not exceed eight. In the outpatient setting, there were fewer referrals than had been hoped, perhaps because of limitations upon reimbursement for the total number and/or kind of therapeutic interventions, a condition which, in the local mental health community, favors individual psychotherapy over group psychotherapy. However, the possibility cannot be excluded that there have been referral biases or parental preferences in favor of groups with a more readily recognizable focus such as anger management or social skills over a novel, less familiar approach. Conscience Works: Theory, Research and Clinical Applications, 2005, 1(1): 1-23. Key Words: conscience sensitive, child and adolescent psychiatry, benchmarks for intervention, psycho-educational, group format.
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    M Gaffney, M Galvin, B Stilwell
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    ABSTRACT: An I.U. Conscience Project and HELP Collaboration. The article describes models for teaching ethics and caring attitudes to undergraduate medical students in both formal and informal medical education curriculum. Competency based curriculum is discussed.
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    ABSTRACT: OBJECTIVES : 1) to highlight studies in the last eight years in which functional magnetic resonance imaging or other neuroimaging techniques have been employed in identifying brain activities as putative correlates of various TASKS proposed to represent essential MORAL PSYCHOLOGICAL FUNCTIONS and 2) to consider how NEUROIMAGING STUDIES of CONSCIENCE FUNCTIONAL TASKS might be conducted which provide more depth and meaning in future moral psychobiological investigation. METHOD: Brief descriptions of the principles and caveats of interpreting findings from NEUROIMAGING are provided. A GLOSSARY OF TERMS derived from cognitive sciences including neuropsychology and developmental psychology is presented. These terms, it is suggested, are necessary but not sufficient in understanding the DOMAINS OF CONSCIENCE. Existing NEUROIMAGING STUDIES of putative MORAL PSYCHOLOGICAL FUNCTIONAL TASKS that (at least nominally) address aspects of each CONSCIENCE DOMAIN are reviewed. These STUDIES are organized according to the following subtitles (with the CONSCIENCE DOMAIN of concern identified parenthetically): MORAL COGNITION: MORAL JUDGMENT AND VALENCE (CONSCIENCE DOMAIN: VALUATION), EMPATHY (CONSCIENCE DOMAIN: MORALIZED ATTACHMENT), MORAL EMOTIONS (CONSCIENCE DOMAIN: MORAL EMOTIONAL RESPONSIVENESS), and SELF CONTROL (CONSCIENCE DOMAIN: MORAL VOLITION). No existing NEUROIMAGING STUDIES clearly correspond to the anchor domain, CONCEPTUALIZATION OF CONSCIENCE. The CONSCIENCE DOMAINS are briefly characterized with reference to the empirical research supporting each. CONCLUSIONS: In the last several years, a number of intriguing findings have emerged from NEURO-IMAGING STUDIES relevant to putative MORAL PSYCHOLOGICAL FUNCTIONAL TASKS. However, in addition to caveats attaching to any attribution of activity to neurological structures and their connections based upon signals captured via NEURO-IMAGING, serious concerns also arise regarding the validity of the TASKS currently employed in these studies as truly representative of CONSCIENCE FUNCTIONS. Instruments designed to inquire into relevant CONSCIENCE DOMAINS are put forward. Complementary TASKS more sensitive to each CONSCIENCE DOMAIN are imagined and offered for consideration as ways to provide more depth and meaning to future NEUROIMAGING STUDIES OF CONSCIENCE. Conscience Works Theory, Research and Clinical Applications 3(1): 1-36, 2009.