In this study, we examined the internal consistency of informant discrepancies in reports of youth behavior and emotional problems and their unique relations with youth, caregiver, and family characteristics. In a heterogeneous multisite clinic sample of 420 youths (ages 11-17 years), high internal consistency estimates were observed across measures of informant discrepancies. Further, latent profile analyses identified systematic patterns of discrepancies, characterized by their magnitude and direction (i.e., which informant reported greater youth problems). In addition, informant discrepancies systematically and uniquely related to informants' own perspectives of youth mood problems, and these relations remained significant after taking into account multiple informants' reports of informant characteristics widely known to relate to informant discrepancies. These findings call into question the prevailing view of informant discrepancies as indicative of unreliability and/or bias on the part of informants' reports of youths' behavior.
Reduced P3 amplitude to targets is an information-processing deficit associated with adult antisocial behavior and may reflect dysfunction of the temporal-parietal junction. This study aims to examine whether this deficit precedes criminal offending. From a birth cohort of 1,795 children, 73 individuals who become criminal offenders at age 23 and 123 noncriminal individuals were assessed on P3 amplitude. The two groups did not differ on gender, ethnicity, and social adversity. P3 amplitude was measured over the temporal-parietal junction during a visual continuous performance task at age 11, together with antisocial behavior. Criminal convictions were assessed at age 23. Reduced P3 amplitude at age 11 was associated with increased antisocial behavior at age 11. Criminal offenders showed significantly reduced P3 amplitudes to target stimuli compared to controls. Findings remained significant after controlling for antisocial behavior and hyperactivity at age 11 and alcoholism at age 23. P3 deficits at age 11 are associated with adult crime at age 23, suggesting that reduced P3 may be an early neurobiological marker for cognitive and affective processes subserved by the temporal-parietal junction that place a child at risk for adult crime.
Parenting is related to children's adjustment, but little research has examined the role of parenting in children's responses to disasters. This study describes parenting responses specific to the 9/11 terrorist attacks and examines pre-9/11 parenting, child temperament, and 9/11-specific parenting as predictors of children's posttraumatic stress (PTS) symptoms among children geographically distant from the attack locations. A community sample of children and parents (n = 137, ages 9-13 years) participating in an ongoing study were interviewed 1 month following 9/11. Parents reported engaging in a number of parenting responses following 9/11. Pre-9/11 acceptance and 9/11-specific, self-focused parental responses predicted PTS symptoms. Pre-9/11 parenting and temperament interacted to predict PTS symptoms, suggesting that parenting and temperament are important prospective predictors of children's responses to indirect exposure to disasters.
In the aftermath of disasters, understanding relationships between disaster-related life disruption and children's functioning is key to informing future postdisaster intervention efforts. The present study examined attack-related life disruptions and psychopathology in a representative sample (N = 8,236) of New York City public schoolchildren (Grades 4-12) surveyed 6 months after September 11, 2001. One in 5 youth reported a family member lost their job because of the attacks, and 1 in 3 reported their parents restricted their postattack travel. These forms of disruption were, in turn, associated with elevated rates of probable posttraumatic stress disorder and other anxiety disorders (and major depressive disorder in the case of restricted travel). Results indicate that adverse disaster-related experiences extend beyond traumatic exposure and include the prolonged ripple of postdisaster life disruption and economic hardship. Future postdisaster efforts must, in addition to ensuring the availability of mental health services for proximally exposed youth, maintain a focus on youth burdened by disaster-related life disruption.
This study is an exploration of the measurement and correlates of childhood traumatic grief (CTG). Eighty-three children of uniformed service personnel who died during the World Trade Center attack on September 11, 2001, were assessed using measures of demographic characteristics, trauma exposure (physical proximity, emotional proximity, and secondary adversities), use of coping strategies, psychiatric symptoms (posttraumatic stress disorder [PTSD], general anxiety, depression), self-esteem, and traumatic grief. An exploratory factor analysis of the Extended Grief Inventory (EGI; Layne, Savjak, Saltzman, & Pynoos, 2001) indicated distinct constructs of normal versus traumatic grief. CTG factor scores were correlated with secondary adversities from the traumatic event, symptoms of PTSD, anxiety, depression, and coping responses, underscoring the theoretical and clinical utility of the content of the measure. Study limitations and future research recommendations are discussed.
This article describes the successful application of family-based treatment (FBT) for a 17-year-old identical twin presenting with a 4-month history of clinically significant symptoms of anorexia nervosa (AN). FBT is a manualized treatment that has been studied in randomized controlled trials for adolescents with AN. This case study illustrates the administration of this evidence-based intervention in a clinical setting, highlighting how the best available research was used to make clinical decisions at each stage of treatment delivery.
This 18-month prospective study investigated factors that contributed to changes in eating disorder symptoms among adolescents living in the People's Republic of China. Five hundred forty-one Chinese middle school and high school students (182 boys, 359 girls) completed measures of eating disorder symptoms; body dissatisfaction; appearance ideal endorsements; negative affect; and appearance-based social pressure, teasing, and comparison. For girls, baseline levels of negative affect, preference for a thin appearance ideal, and fatness concern made unique contributions to reported eating disturbances at the 18-month follow-up. For boys, baseline body mass index and fatness concerns were the only significant univariate predictors of changes in eating pathology.
We compared the prevalence and correlates of adolescent suicidal ideation and attempts in two nationally representative probability samples of adolescents interviewed in 1995 (National Survey of Adolescents; N = 4,023) and 2005 (National Survey of Adolescents-Replication; N = 3,614). Participants in both samples completed a telephone survey that assessed major depressive episode (MDE), post-traumatic stress disorder, suicidal ideation and attempts, violence exposure, and substance use. Results demonstrated that the lifetime prevalence of suicidal ideation among adolescents was lower in 2005 than 1995, whereas the prevalence of suicide attempts remained stable. MDE was the strongest predictor of suicidality in both samples. In addition, several demographic, substance use, and violence exposure variables were significantly associated with increased risk of suicidal ideation and attempts in both samples, with female gender, nonexperimental drug use, and direct violence exposure being consistent risk factors in both samples.
Framed by a previously established conceptual model of youths' posttraumatic stress (PTS) responses following a disaster, the current longitudinal study examined the relation of predisaster child characteristics (age, gender, depressive symptoms, ruminative coping), predisaster environmental characteristics (negative life events and supportive and negative friendship interactions), and level of disaster exposure to youths' PTS symptoms in the wake of a natural disaster. Prior to the 2010 Nashville, Tennessee, flood, 239 predominantly Caucasian youth from four elementary and middle schools (ages = 10-15, 56% girls) completed measures of depressive symptoms, rumination, negative life events, and social support in the form of both supportive and negative friendship interactions. Approximately 10 days after returning to school, 125 completed measures of disaster exposure and postflood PTS symptoms. Bivariate correlations revealed that disaster-related PTS symptoms were unrelated to age, gender, or predisaster supportive friendship interactions and significantly positively related to level of disaster exposure and predisaster levels of negative life events, depressive symptoms, rumination, and negative friendship interactions. After controlling for level of disaster exposure and other predisaster child and environmental characteristics, depressive symptoms and negative friendship interactions predicted postdisaster PTS symptoms. The effect of child's flood-related experiences on PTS symptoms was not moderated by any of the preexisting child characteristics or environmental indicators. Faced with limited resources after a natural disaster, school counselors and other health professionals should focus special attention on youths who experienced high levels of disaster-related losses and whose predisaster emotional and interpersonal lives were problematic.
Parent-teacher cross-informant agreement, although usually modest, may provide important clinical information. Using data for 27,962 children from 21 societies, we asked the following: (a) Do parents report more problems than teachers, and does this vary by society, age, gender, or type of problem? (b) Does parent-teacher agreement vary across different problem scales or across societies? (c) How well do parents and teachers in different societies agree on problem item ratings? (d) How much do parent-teacher dyads in different societies vary in within-dyad agreement on problem items? (e) How well do parents and teachers in 21 societies agree on whether the child's problem level exceeds a deviance threshold? We used five methods to test agreement for Child Behavior Checklist (CBCL) and Teacher's Report Form (TRF) ratings. CBCL scores were higher than TRF scores on most scales, but the informant differences varied in magnitude across the societies studied. Cross-informant correlations for problem scale scores varied moderately across societies studied and were significantly higher for Externalizing than Internalizing problems. Parents and teachers tended to rate the same items as low, medium, or high, but within-dyad item agreement varied widely in every society studied. In all societies studied, both parental noncorroboration of teacher-reported deviance and teacher noncorroboration of parent-reported deviance were common. Our findings underscore the importance of obtaining information from parents and teachers when evaluating and treating children, highlight the need to use multiple methods of quantifying cross-informant agreement, and provide comprehensive baselines for patterns of parent-teacher agreement across 21 societies.
Examined the relation between children's self-reported anger and sadness regulation and the presence of internalizing and externalizing symptoms. Participants were 121 boys and 106 girls in the fourth and fifth grades who completed the Children's Depression Inventory (CDI), State-Trait Anxiety Inventory for Children (STAIC), Emotion Expression Scale for Children (EESC), and Children's Emotion Management Scales (CSMS, CAMS) and rated each other on aggressive behavior. Results of multiple regression analyses indicated that the inability to identify emotional states, the inhibition of anger, the dysregulation of anger and sadness, and the constructive coping with anger predicted internalizing symptoms. The dysregulated expression of sadness and constructive coping with anger were inversely related to externalizing symptoms.
There is evidence that females display higher levels of depressive symptoms and disordered eating than males from adolescence onward. This study examined whether different risk factors and their interaction with sex (moderator effect) prospectively predicted depressive symptoms and disordered eating in adolescents. A total of 415 female adolescents and 413 male adolescents were evaluated at 2 different times: In the first evaluation (T1) the mean age of the participants was 12.8 years, and in the second evaluation (T2) it was 14.9 years. Differences between sexes were observed in relation to depressive symptoms at T2 and in disordered eating at T1 and T2. Body dissatisfaction was a significant predictor of both depressive symptoms and disordered eating. In addition, moderation tests indicated that the interaction between self-esteem and sex and the interaction between body mass index and sex significantly predicted depressive symptoms and disordered eating, respectively.
Problematic family dynamics are common among youth with attention-deficit hyperactivity disorder (ADHD). Multiple mechanisms, including diathesis-stress (vulnerability) and differential susceptibility Gene × Environment interaction effects (G × E), have been proposed to account for this association. G × E effects for ADHD were examined via interactions between a genetic marker hypothesized to influence sensitivity to the environment (the promoter polymorphism of the serotonin transporter gene −5HTTLPR) and family conflict and cohesion in predicting ADHD symptoms. There were 498 youth ages 6–17 years (251 ADHD, 213 non-ADHD) and their parents who completed a multistage, multi-informant assessment (including parent and youth reports on the Family Environment Scale), and saliva sample collection for genotyping. Linear regression analyses examined interactions between 5HTTLPR genotype and the Family Environment Scale scales of conflict and cohesion reported by parent and child. Criteria laid out by Roisman et al. (201247.
Roisman, G. I., Newman, D. A., Fraley, R. C., Haltigan, J. D., Groh, A. M. & Haydon, K. C. (2012). Distinguishing differential susceptibility from diathesis–stress: Recommendations for evaluating interaction effects. Development and Psychopathology, 24, 389–409. doi:10.1017/s0954579412000065View all references) were applied to evaluate diathesis stress versus differential susceptibility G × E mechanisms. Results demonstrated interactions between 5HTTLPR genotype and both conflict and cohesion in predicting inattention but not hyperactivity-impulsivity. Both interactions were highly consistent with differential susceptibility models of G × E effects. 5HTTLPR genotype appeared to moderate the relationship between family conflict/cohesion and inattentive symptoms. Interactions highlight the role of 5HTTLPR genotype as a potential marker of environmental sensitivity and provide support for differential susceptibility models of G × E effects for ADHD.
We propose that stronger than usual correlations between abilities indicate which cognitive processes are impaired in autism. Study 1 compared partial correlations (controlling age) between intelligence and social cognition in children with autism (n = 18), mental retardation (MR; n = 34), or no psychological disorder (n = 37). Correlations were stronger in the autism group. Study 2 compared correlations between measures of perceptual organization and verbal comprehension, receptive and expressive language, fine and gross motor coordination, and theory of mind, emotion recognition, and emotion understanding abilities in children with autism (n = 30) or MR (n = 24) and in a large representative sample of children (n = 449). Results indicate that autism is marked by stronger correlations between all ability domains, and MR is marked by stronger correlations between motor coordination tasks and other ability measures.
Examined the relation between childhood anxiety and threat-perception abnormalities using vignettes in which external (i.e., exposure to potential threat cues) and internal (i.e., experience of anxiety responses) information were systematically varied. Nonclinical children (N = 156) aged 8 to 13 years completed anxiety questionnaires and were then exposed to 3 types of stories: ambiguous stories, ambiguous + anxiety-response stories, and nonthreatening stories. From children's responses to these stories, a number of threat-perception indexes were derived. Results showed that both external and internal information inflated children's perception of threat. Further, high levels of anxiety were accompanied by enhanced threat perception in response to external threat cues. Finally, little evidence was found that high levels of anxiety, and in particular of anxiety sensitivity, were associated with a greater tendency to use internal information (i.e., emotional reasoning). Potential avenues for future studies on anxiety-related threat-perception distortions are briefly discussed.
This study explored the interactive effect of substance abuse and depression on social competence among 106 adolescent inpatients (57% female, 86% Caucasian). Substance abuse and depression were conceptualized using dimensional ratings of illness severity based on adolescent interviews, whereas social competence was conceptualized using parent ratings of adolescent behavior. Cross-sectional analyses revealed that substance abuse and depression had a negative interactive effect on adolescent social competence: Higher severity levels of both dimensions were associated with lower levels of competence than accounted for by the additive effects of the two dimensions. These findings persisted when controlling for gender, race, and other common dimensions of psychopathology. Significant impairment in social competence occurred at subdiagnostic levels of substance abuse when depression severity was high, highlighting the value of assessing outcomes across the full range of severity.
A brief version of the Child Abuse Potential Inventory (CAP) was developed using a development sample of N = 1,470, and cross-validated using an additional sample of N = 713. Items were selected to maximize (a) CAP variance accounted for; (b) prediction of future child protective services reports; (c) item invariance across gender, age, and ethnicity; (d) factor stability; and (e) readability and acceptability. On cross-validation, scores from the resulting 24-item risk scale demonstrated an internal consistency estimate of .89, a stable 7-factor structure, and substantial correlations with the CAP Abuse Risk score (r = .96). The CAP risk cutoff was predicted with 93% sensitivity and 93% specificity (area under the receiver operating characteristics curve = .98), and the Brief Child Abuse Potential Inventory (BCAP) and CAP demonstrated similar patterns of external correlates. The BCAP may be useful as a time-efficient screener for abuse risk.
Prior research has established the independent associations of depressive symptoms and childhood trauma to overgeneral memory (OGM); the present study addresses the potentially interactive effects between these two risk factors on OGM. In addition, the current study comprehensively evaluates whether executive functions (EF) mediate the relation between depressive symptoms and/or abuse to OGM in a child and adolescent sample. OGM was assessed among an inpatient-psychiatric sample of 49 youth (ages 7-17) with, and without, child abuse histories and depressive symptomatology. EF was assessed with standardized neuropsychological measures of verbal fluency, inhibition, and cognitive flexibility. There was a significant interaction of depressive symptoms and abuse in predicting OGM; the effect of depression on OGM was less pronounced among youth with abuse histories, who had elevated OGM at both low and high depressive symptoms relative to those with no abuse and low depressive symptoms. Among the EF measures, only category fluency was associated with OGM. An additive, rather than mediational, model was supported, whereby category fluency accounted for a significant proportion of variance in OGM above child abuse and depressive symptoms. The meaning of these findings for models of OGM and clinical practice are emphasized.
This study investigated two theoretical risk models predicting child maltreatment potential: (a) Belsky's (1993) developmental-ecological model and (b) the cumulative risk model in a sample of 610 caregivers (49% African American, 46% European American; 53% single) with a child between 3 and 6 years old. Results extend the literature by using a widely accepted and valid risk instrument rather than occurrence rates (e.g., reports to child protective services, observations). Results indicated Belsky's developmental-ecological model, in which risk markers were organized into three separate conceptual domains, provided a poor fit to the data. In contrast, the cumulative risk model, which included the accumulation of risk markers, was significant in predicting child abuse potential.
Potential pathways from childhood sexual abuse (CSA) to negative self-schemas to subsequent dissociative symptoms and low global self-esteem were examined in a prospective longitudinal study of 160 ethnically diverse youth with confirmed CSA histories. Participants were interviewed at the time of abuse discovery, when they were 8 to 15 years of age, and again 1 and 6 years later. Abuse-specific indicators of stigmatization, in particular the combination of shame and self-blame more than general self-blame attributions for everyday events, explained which youth with CSA histories experienced more dissociative symptoms and clinically significant levels of dissociation. Abuse-specific stigmatization was found to operate as a prospective mechanism for subsequent dissociative symptoms but not self-esteem.
Abused children may be at risk for problems with aggression. In a sample of 397 seriously emotionally disturbed children, reactive aggression was associated with documented history of physical abuse but not sexual abuse. Girls were equally likely to be classified as reactively aggressive regardless of physical abuse history, but boys with physical abuse histories were 50% more likely to be classified as reactively aggressive than boys with no physical abuse history. Proactive aggression was unrelated to physical or sexual abuse history. The association of physical abuse and reactive aggression warrants further scientific study and attention in clinical assessment and treatment with seriously emotionally disturbed children.
This study examined the relations among early and recent experiences with abuse, depression, and adolescents' autobiographical memory in a longitudinal study of family violence. Participants' (N = 134) exposure to violence was documented when they were 6 to 12 years old and again when they were 12 to 18 years old. The second assessment included measures of depression and autobiographical memory for childhood experiences. Memory problems were more consistently related to current circumstances than childhood abuse history. For instance, depressive symptoms were associated with increased rates of "overgeneral" childhood memories. Recent exposure to family violence predicted more overgeneral memories, shorter memories, and lower rates of negative memories. The patterns suggest that adolescents currently stressed by depression or family violence might strategically avoid the details of past experiences to regulate affect.
This review synthesized findings from 17 studies since 1998 regarding evaluation of outpatient treatments for adolescent substance abuse. These studies represented systematic design advances in adolescent clinical trial science. The research examined 46 different intervention conditions with a total sample of 2,307 adolescents. The sample included 7 individual cognitive behavior therapy (CBT) replications (n = 367), 13 group CBT replications (n = 771), 17 family therapy replications (n = 850) and 9 minimal treatment control conditions (n = 319). The total sample was composed of approximately 75% males, and the ethnic/racial distribution was approximately 45% White, 25% Hispanic, 25% African American, and 5% other groups. Meta-analysis was used to evaluate within-group effect sizes as well as differences between active treatment conditions and the minimal treatment control conditions. Methodological rigor of studies was classified using Nathan and Gorman (2002108.
Nathan , P. E. , & Gorman , J. M. ( 2002 ). Efficacy, effectiveness, and the clinical utility of psychotherapy research. In
P. E. Nathan &
J. M. Gorman (Eds.), A guide to treatments that work ( , 2nd ed. , pp. 642 – 654 ). New York : Oxford University Press . View all references) criteria, and treatments were classified using criteria for well-established and probably efficacious interventions based on Chambless et al. (199625.
Chambless , D. L. ( 1996 ). In defense of dissemination of empirically supported psychological interventions . Clinical Psychology: Science and Practice , 3 , 230 – 235 . View all references). Three treatment approaches, multidimensional family therapy, functional family therapy, and group CBT emerged as well-established models for substance abuse treatment. However, a number of other models are probably efficacious, and none of the treatment approaches appeared to be clearly superior to any others in terms of treatment effectiveness for adolescent substance abuse.
The development and evaluation of effective strategies for transporting evidence-based practices to community-based clinicians has become a research and policy priority. Using multisystemic therapy programs as a platform, an experimental design examined the capacity of an Intensive Quality Assurance (IQA) system to promote therapist implementation of contingency management (CM) for adolescent marijuana abuse. Participants included 30 therapists assigned to Workshop Only (WSO) versus IQA training conditions, and 70 marijuana-abusing youths and their caregivers who were treated by these clinicians. Analyses showed that IQA was more effective than WSO at increasing practitioner implementation of CM cognitive-behavioral techniques in the short-term based on youth and caregiver reports, and these increases were sustained based on youth reports. On the other hand, IQA did not increase therapist use of CM monitoring techniques relative to WSO, likely because of an unanticipated ceiling effect. Both sets of findings contribute to the emerging literature on the transport of evidence-based practice to real-world clinical settings.
This study examined the temporal concordance between the onset of childhood anxiety disorders and the points of onset and ending of child sexual abuse (CSA). Sexually abused children (N = 158) were assessed with structured diagnostic interviews. Onset ages for lifetime prevalence anxiety disorders were combined and sequenced with the onset and ending of sexual abuse. Hazard rates were calculated. Departures from the overall linear hazard trajectory for onsets were modeled using piecewise growth curve analyses. Increases from the overall trajectory were found around the point of sexual abuse onset for most childhood anxiety disorders. Decreases were found around the ending of sexual abuse. The risk for developing new anxiety disorders after the onset of sexual abuse showed a positive dose-effect relation with abuse severity. The findings add support to the idea that CSA can have a direct link to childhood anxiety disorders, apart from confounded vulnerability factors, postabuse events, or stable family background factors. The findings are contrasted with those from cross-sectional partial correlation studies that have suggested that there is little direct connection between sexual abuse and mental health outcomes.
This intergenerational study investigates histories of both attachment relationships and abusive experiences and domains of current functioning that distinguish families of sexually abused children from families of nonabused children. The participants included (a) 199 nonoffending African American mothers of whom approximately half had children with documented sexual abuse histories and half had children with no documented abuse histories and (b) 106 maternal grandmothers of these children; approximately half had sexually abused grandchildren and half had grandchildren with no documented abuse. The children were 4 to 12 years old. Histories of abuse and attachment experiences and current functioning of the grandmother and mother were evaluated. Logistic regression analyses revealed that sexual abuse in a child was best predicted by 3 factors: maternal problems in adult functioning, a currently negative relationship between the grandmother and mother, and a disrupted pattern of caregiving during the mother's childhood. The findings underscore that troubled intergenerational attachment relationships in families can significantly heighten the risk of a child being sexually abused.
Childhood sexual abuse (CSA) has been associated with HIV/AIDS risk behavior; however, much of this work is retrospective and focuses on women. The current study used semi-parametric mixture modeling with youth (n = 844; 48.8% boys) from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN) to examine the link between trajectories of CSA (2 to 12 years old) and HIV/AIDS risk behavior at age 14 (i.e., sexual intercourse & alcohol use). Trajectory analyses revealed a link between a history of CSA and the development of risky behavior. In addition, trajectories for physical and emotional abuse, but not neglect or witnessed violence, contributed to risky behavior over and above the role of CSA. Child gender did not moderate the findings. Findings highlight the significance of CSA histories, as well as the broader context of maltreatment, for better understanding the development of risk behaviors in both girls and boys.
Although experiencing childhood sexual abuse (CSA) puts youth at risk for involvement in relationship violence, research is limited on the potential pathways from CSA to subsequent dating aggression. The current study examined prospective pathways from externalizing behavior problems and stigmatization (abuse-specific shame and self-blame attributions) to anger and dating aggression. One hundred sixty youth (73% female, 69% ethnic/racial minorities) with confirmed CSA histories were interviewed at the time of abuse discovery (T1, when they were 8-15 years of age), and again 1 and 6 years later (T2 and T3). Externalizing behavior and abuse-specific stigmatization were assessed at T1 and T2. Anger and dating aggression were assessed at T3. The structural equation model findings supported the proposed relations from stigmatization following the abuse to subsequent dating aggression through anger. Only externalizing behavior at T1 was related to later dating aggression, and externalizing was not related to subsequent anger. This longitudinal research suggests that clinical interventions for victims of CSA be sensitive to the different pathways by which youth come to experience destructive conflict behavior in their romantic relationships.
This study tested associations in path models among positive and negative parenting and children's rule-breaking behavior, aggressive and oppositional behavior, and attention problems for families with a drug-dependent parent. A structural model tested relations between parenting and children's externalizing problems for 251 families with 399 children between the ages of 6 and 18, controlling for nonindependence of ratings at the family level. The model also tested potential moderators, including child age, gender, and ethnicity (White vs. other), and caregiver gender (families with a female substance-abusing caregiver vs. families with a male substance-abusing caregiver). Results indicated that caregiver ratings of monitoring predicted rule-breaking behavior and use of inconsistent discipline predicted ratings of all 3 externalizing syndromes, after controlling parenting and externalizing problems for the effects of the moderators and after controlling significant relations among types of parenting and types of externalizing problems.
The purpose of this study is to distill the "effective practice elements" from randomised controlled interventions (RCTs) to prevent the recurrence of abusive and neglectful parenting and the associated health and developmental impairment of children. The resulting elements would be used then to develop a step-by-step modular-systemic approach to intervention that is suitable to the needs of a variety of frontline practitioners in social care, health, and education. A series of 22 randomised RCTs were analysed using the distillation and matching approach to establish the presence of effective practice elements. The focus was physical and sexual abuse, victims and children, and young people as perpetrators; neglect including failure to thrive, emotional abuse (exposure to violence and mental health issues). The studies were analysed for effective practice elements, across different approaches matched to interventions focused on parenting, on children and young people, and on family/professional relationships. The proportion of practice elements utilised in each form of maltreatment was defined. The distillation process resulted in a total of 47 practice elements present across all forms of maltreatment studied. An experienced group of practitioners from statutory and voluntary agencies ordered and integrated the most frequently utilised emerging elements into a series of step-by-step modules, which could fit the complex needs of families when maltreatment had occurred. The resulting manual, Hope for Children and Families, provides a "menu" of evidence-based, step-by-step modular interventions targeting the profile of abusive and neglectful parenting and associated impairments of children. To be effective for frontline practitioners, the manual will need to be delivered in a user-friendly format, training developed, and supervision and support provided.
This longitudinal study examined the predictive associations between cumulative multidomain risk factors and cognitive (IQ), academic (reading fluency), and social adaptive outcomes at 8 to 9 years among 190 children with or without familial risk for dyslexia. Other risk factors included parental and neurocognitive risks assessed when the children were 1 to 6 years of age. Risks accumulated more among children with familial risk for dyslexia than among children without familial risk. A higher number of risks was associated with poorer performance in all outcome measures as postulated by the cumulative risk model. However, when the effects of individual risk variables were controlled for at the outset, the cumulative risk indices did not have incremental effects beyond those of individual risks. This suggests that the detrimental effect of several risks was due to the content-specific effect of individual risks. Children with familial risk were not differentially affected by the number of risks.
This study evaluated the effectiveness of a military-style residential treatment program for adolescents with academic and conduct problems. Two hundred twelve referred adolescents were separated into 3 groups for analyses: (a) adolescents who completed the 22-week program, (b) adolescents who prematurely withdrew, and (c) wait-list controls. Adolescents' socioemotional and behavioral functioning were measured at baseline and 6 months after treatment. Results showed statistically and clinically significant reductions in externalizing symptoms and increases in adaptive behavior associated with treatment. Treatment was also associated with increased likelihood of high school completion or employment and decreased likelihood of alcohol or drug problems and arrest. The relation between treatment participation and outcomes was moderated by adolescents' living environments after treatment, but it was not moderated by age of symptom onset. The benefits of treatment may be partially attributable to the voluntary nature of the intervention.
Despite an abundance of evidence linking maltreatment and violence-related trauma exposure to externalizing problems in youth, there is surprisingly little evidence to support a direct link between disaster exposure and youth aggressive behavior. This study tested the theory that there is primarily an indirect association between disaster exposure and aggression via posttraumatic stress disorder (PTSD) symptoms. The current study also examined the association between aggression and academic achievement. A sample of 191 4th- to 8th-grade minority youth who experienced Hurricane Katrina were assessed for aggressive behavior using the Peer Conflict Scale (PCS), disaster exposure, PTSD symptoms, and academic achievement. Structural equation modeling of the set of associations was consistent with the theory suggesting that there is an indirect link between disaster exposure and aggression through PTSD symptoms. Aggression was negatively associated with academic achievement, and modeling indicated that the set of associations was age and gender invariant. Findings advance the theoretical understanding of the linkage between aggression and disaster exposure. Findings also support the utility of the PCS in disaster research and the link between PCS scores and academic achievement.
The primary purpose of the study was to examine the moderating effects of academic achievement on relations between aggressive behavior and social and psychological adjustment in Chinese children. A sample of children (N = 1,171; 591 boys, 580 girls; initial M age = 9 years) in China participated in the study. Two waves of longitudinal data were collected in Grades 3 and 4 from multiple sources including peer nominations, teacher ratings, self-reports, and school records. The results indicated that the main effects of aggression on adjustment were more evident than those of adjustment on aggression. Moreover, aggression was negatively associated with later leadership status and positively associated with later peer victimization, mainly for high-achieving children. The results suggested that consistent with the resource-potentiating model, academic achievement served to enhance the positive development of children with low aggression. On the other hand, although the findings indicated fewer main effects of adjustment on aggression, loneliness, depression, and perceived social incompetence positively predicted later aggression for low-achieving, but not high-achieving, children, which suggested that consistent with the stress-buffering model, academic achievement protected children with psychological difficulties from developing aggressive behavior. The results indicate that academic achievement is involved in behavioral and socioemotional development in different manners in Chinese children. Researchers should consider an integrative approach based on children's behavioral, psychological, and academic functions in designing prevention and intervention programs.
This study examined whether response to behavior modification with and without methylphenidate differed for children with attention-deficit/hyperactivity disorder (ADHD) and conduct problems (CP) depending on the presence of callous/unemotional (CU) traits. Participants were 37 children ages 7 to 12, including 19 with ADHD/CP-only and 18 with ADHD/CP-CU, referred to a university-based summer treatment program. Results showed that ADHD/CP-CU children had worse behavior in the behavior-therapy-only (BT-only) condition, especially on measures of CP, noncompliance, and rule violations, but these differences largely disappeared when medication was added to BT. Children with ADHD/CP-CU were also less likely to be normalized by treatment than were children with ADHD/CP-only. These findings, though tentative, suggest that children with ADHD/CP-CU may not show a sufficient positive response to BT alone and that the combination of medication and BT may be especially important for them.
Adolescent delinquency and academic underachievement are both linked with child and adolescent behavior problems. However, little is known about behavioral pathways leading to these adverse outcomes. Children's aggression, opposition, status violations, and property violations scores were collected at ages 5, 10, and 18. Delinquency and academic functioning was rated at age 18. Age 18 status violations were linked to delinquency, and property violations to academic underachievement. Engagement in status and property violations was predicted by childhood opposition. Findings suggest that (a) disaggregated forms of externalizing behavior are needed to understand behavioral pathways to adverse outcomes and (b) prevention of adolescent delinquency and academic underachievement should target childhood opposition.
This study investigated an integrative model of the effects of peer victimization (PV) and peer rejection (PR) on youth adjustment using data from 508 middle-school students. In the proposed model, PV and PR each contribute independently to problems in emotional, behavioral, and academic adjustment. The adverse consequences of PV and PR are each mediated by their more proximal contributions to lower self-esteem in the form of negative self-evaluations for peer relations and global self-derogation, respectively. Results of structural equation modeling (SEM) analyses provided support for the overall model, including significant indirect linkages of PV and perceived PR with adjustment problems via their intermediary negative associations with lower levels of self-esteem. Additional analyses revealed that indirect linkages of victimization and perceived rejection with emotional problems via self-esteem were evident only for girls. Implications of these findings are discussed.
The United States continues to have the highest incidence of adolescent births among industrialized nations. This study used transactional and life span theories of development to examine whether caregiving patterns assessed over the first 24 months postpartum predicted children's behavior and academic achievement at 7 years. Participants included 120 primiparous, urban, low-income, African American adolescent mothers who participated in a randomized controlled trial of home intervention. Group-based trajectories were used to examine the pattern of caregiving involvement over time. Two distinct, consistent trajectories of caregiving involvement were found: maternal and shared. Maternal caregiving involvement over the first 24 months postpartum predicted positive child behavior and academic achievement at 7 years. In keeping with both transactional and life span theories, findings suggest that adoption of the parent role may lead to positive long-term outcomes for children of adolescent mothers.
The current study examined predictors of academic achievement, measured by standardized test scores, and performance, measured by school grades, in adolescents (Mn age = 16.8) who met diagnostic criteria for Attention-Deficit/Hyperactivity Disorder (ADHD)-Combined type in early childhood (Mn age = 8.5; N = 579). Several mediation models were also tested to determine whether ADHD medication use, receipt of special education services, classroom performance, homework completion, or homework management mediated the relationship between symptoms of ADHD and academic outcomes. Childhood predictors of adolescent achievement differed from those for performance. Classroom performance and homework management mediated the relationship between symptoms of inattention and academic outcomes.
Whereas much is known about the deficits in social behaviors and social competence in youth with social anxiety disorder (SAD), less is known about those characteristics among youth with generalized anxiety disorder (GAD). This study aimed to better elucidate the social repertoire and peer acceptance of youth with SAD and youth with GAD, relative to normal control (NC) youth. The sample consisted of 58 primarily Caucasian children, ages 6 to 13 years: 20 SAD (12 female), 18 GAD (12 female), and 20 NC (9 female). Diagnoses were based on Anxiety Disorders Interview Schedule for DSM-IV: Children and Parent Versions interviews. A multimodal assessment strategy included parent and child reports, observer ratings of social performance, computer-based analysis of vocal qualities of speech, and peer ratings of likeability and friendship potential. Whereas self- and parental report did not differentiate the two diagnostic groups, differences on observable behaviors were apparent. Children with SAD exhibited anxious speech patterns, extended speech latencies, a paucity of speech, few spontaneous vocalizations, and ineffective social responses; they were perceived by peers as less likeable and socially desirable. Children with GAD had typical speech patterns and were well liked by their peers but displayed fewer spontaneous comments and questions than NC children. Parent and child reports are less sensitive to what could be important differences in social skill between youth with SAD and GAD. Direct observations, computer-based measures of speech quality, and peer ratings identify specific group differences, suggesting the need for a comprehensive evaluation to inform treatment planning.
The purpose of this study was to conduct a multiagent-multimethod analysis of the validity of a brief measure of deviant peer affiliations and social acceptance (PASA) in young adolescents. Peer relationships are critical to child and adolescent social and emotional development, but currently available measures are tedious and time consuming. The PASA consists of a youth, parent, and teacher report that can be collected longitudinally to study development and intervention effectiveness. This longitudinal study included 998 middle school students and their families. We collected the PASA and peer sociometrics data in Grade 7 and a multiagent-multimethod construct of deviant peer clustering in Grade 8. Confirmatory factor analyses of the multiagent-multimethod data revealed that the constructs of deviant peer affiliations and social acceptance and rejection were distinguishable as unique but correlated constructs within the PASA. Convergent, discriminant, concurrent, and predictive validity of the PASA was satisfactory, although the acceptance and rejection constructs were highly correlated and showed similar patterns of concurrent validity. Factor invariance was established for mother reports and for father reports. Results suggest that the PASA is a valid and reliable measure of peer affiliation and of social acceptance among peers during the middle school years and provides a comprehensive yet brief assessment of peer affiliations and social acceptance.
Despite the importance of the family in the treatment of pediatric obsessive-compulsive disorder (OCD), relatively little empirical attention has been directed to family accommodation of symptoms. This study examined the relations among family accommodation, OCD symptom severity, functional impairment, and internalizing and externalizing behavior problems in a sample of 57 clinic-referred youth 7 to 17 years old (M = 12.99 +/- 2.54) with OCD. Family accommodation was a frequent event across families. Family accommodation was positively related to symptom severity, parent-rated functional impairment (but not child-rated impairment), and externalizing and internalizing behavior problems. Family accommodation mediated the relation between symptom severity and parent-rated functional impairment.
This study examined, in 102 mother-daughter dyads, whether (a) girls' social skills and loneliness are related to girls' social anxiety, after adjusting for girls' depressive symptoms, and (b) mothers' social functioning (social anxiety, social skills, and loneliness) is related to girls' social anxiety, after accounting for girls' social functioning (social skills and loneliness) and mothers' and girls' depressive symptoms. After accounting for girls' depression, girls' loneliness (and not social skills) was related to girls' self-reported social anxiety and girls' social skills (and not loneliness) were related to mothers' reports of girls' social anxiety. Mothers' social functioning accounted for significant variance in girls' social anxiety, beyond that accounted for by girls' social functioning and mothers' and girls' depression. Mothers' loneliness and fear of negative evaluation showed significant relations to girls' social anxiety when variance attributable to other variables was partialed out, whereas mothers' social skills and social avoidance and distress did not. Directions for future research on social anxiety are highlighted.
This study investigated the accuracy of depressed youths' appraisals of naturally occurring life events. Participants (49% girls; M age = 12.44 years) with clinical diagnoses of depression (n = 24), subsyndromal symptoms of depression (n = 29), and no symptoms of psychopathology (n = 36) completed semi-structured interviews of life stress. As predicted, depressed youth experienced more independent and self-generated interpersonal stress than did nonsymptomatic youth. Consistent with a cognitive bias, clinically depressed youth overestimated the stressfulness of events and overestimated their contribution to events relative to nonsymptomatic youth. Youth with subsyndromal symptoms demonstrated similar, although typically less severe, impairment than those with clinical depression. Results contribute to cognitive-interpersonal models of depression by illustrating the need to consider both realistic interpersonal difficulties and biased appraisals of experiences.
Anxiety disorders are common among children but can be difficult to diagnose. An actuarial approach to the diagnosis of anxiety may improve the efficiency and accuracy of the process. The objectives of this study were to determine the clinical utility of the Achenbach Child Behavior Checklist (CBCL) and Youth Self Report (YSR), two widely used assessment tools, for diagnosing anxiety disorders in youth and to aid clinicians in incorporating scale scores into an actuarial approach to diagnosis through a clinical vignette. Demographically diverse youth, 5 to 18 years of age, were drawn from two samples; one (N = 1,084) was recruited from a research center, and the second (N = 651) was recruited from an urban community mental health center. Consensus diagnoses integrated information from semistructured interview, family history, treatment history, and clinical judgment. The CBCL and YSR internalizing problems T scores discriminated cases with any anxiety disorder or with generalized anxiety disorder from all other diagnoses in both samples (ps < .0005); the two scales had equivalent discriminative validity (ps > .05 for tests of difference). No other scales, nor any combination of scales, significantly improved on the performance of the Internalizing scale. In the highest risk group, Internalizing scores greater than 69 (CBCL) or greater than 63 (YSR) resulted in a Diagnostic Likelihood Ratio of 1.5; low scores reduced the likelihood of anxiety disorders by a factor of 4. Combined with other risk factor information in an actuarial approach to assessment and diagnosis, the CBCL and YSR Internalizing scales provide valuable information about whether a youth is likely suffering from an anxiety disorder.
Behavioral parent training (BPT) includes a variety of evidence-based treatments with diverse techniques to alter parent behavior. Parent-Child Interaction Therapy is an innovative BPT with its use of in vivo feedback (i.e., "coaching") during parent-child interactions. An experimental design was used to assess whether coaching without elaborate didactic improves parenting. Sixty mothers with children 2 to 7 years old were recruited from the community and randomly assigned to a coaching or no coaching group. After a baseline assessment, all dyads participated in two play interactions 1 week apart during which parents in the coaching group were provided with in vivo feedback. Coached parents displayed significant improvements in skills, and coaching predicted skill gains beyond the influence of baseline ability. Findings suggest that providing parents with feedback through in vivo coaching is an important mechanism of change.
Self-medication models of smoking posit that the emotional benefits of smoking reinforce and maintain cigarette use, yet research demonstrates both positive and adverse affective consequences of smoking. The current study examined longitudinal changes in adolescent mood variability and overall negative mood at various stages of smoking behavior to inform understanding of the etiology of adolescent smoking. Participants included 461 adolescents (M age = 15.67 years, SD = 0.61; 55% girls, 56.8% White) drawn from a longitudinal study of adolescent smoking. Youth provided data on smoking behavior at baseline and a 15-month follow-up wave. Ecological momentary assessments were used to measure overall levels of negative mood as well as within-person mood fluctuations (i.e., negative mood variability) at each wave. Findings revealed that smoking-mood relations vary across different stages of smoking behavior. Youth who rapidly escalated in their smoking during the study experienced improved mood regulation (for girls) and improved overall mood (for boys) as smoking increased. However, mood improvements were not observed among youth with sustained heavy use and symptoms of dependence. The current data argue for a model of smoking that accounts for changes in risk and maintenance factors at different points along the developmental trajectory of smoking, involving elements of both self-medication and dependence.
Much remains to be learned about typical and individual growth trajectories across treatment for adolescent panic disorder with and without agoraphobia and about critical treatment points associated with key changes. The present study examined the rate and shape of change across an 8-day intensive cognitive behavioral therapy for adolescent panic disorder with and without agoraphobia (N = 56). Participants ranged in age from 12 to 17 (M = 15.14, SD = 1.70; 58.9% female, 78.6% Caucasian). Multilevel modeling evaluated within-treatment linear and nonlinear changes across three treatment outcomes: panic severity, fear, and avoidance. Overall panic severity showed linear change, decreasing throughout treatment. In contrast, fear and avoidance ratings both showed cubic change, peaking slightly at the first session of treatment, starting to decrease at the second session of treatment, and with large gains continuing then plateauing at the fourth session. Findings are considered with regard to the extent to which they may elucidate critical treatment components and sessions for adolescents with panic disorder with and without agoraphobia.
This study examined the stability of adolescent physical and psychological dating aggression across both time and partners in a sample of 664 high school students using both nonparametric and growth curve (GC) modeling techniques. Nonparametric and GC modeling tests demonstrated moderate levels of stability of all forms of aggression. Nonparametric tests also revealed higher rates of stability among those with relationship continuity. Although GC analyses indicated that significant increases in psychological aggression perpetration were associated with relationship continuity, staying with the same partner did not place adolescents at heightened risk for physical perpetration or physical or psychological victimization. Being female was associated with significant decreases in psychological victimization and perpetration across time. Findings demonstrate the importance of early prevention of dating aggression and the need to consider gender and relationship variables.