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When adolescents disagree with others about their symptoms: differences in attachment organization as an explanation of discrepancies between adolescent, parent, and peer reports of behavior problems.

This study examined whether attachment theory could be used to shed light on the often high degree of discordance between self- and observer ratings of behavioral functioning and symptomatology. Interview-based assessments of attachment organization, using the Adult Attachment Interview, were examined as predictors of the lack of agreement between self- and other reports of behavioral and emotional problems among 176 moderately at-risk adolescents. Lack of agreement was measured in terms of concordance of adolescent and parent or close friend report on equivalent measures of behavioral and emotional adjustment. Insecure-dismissing attachment was linked to less agreement in absolute terms between self- and mother reports of externalizing symptoms, and between adolescent and close friend reports of behavioral conduct. Insecure-preoccupied attachment was associated with higher levels of adolescent reporting of internalizing and externalizing symptoms relative to parent reports of adolescent symptomatology. The findings suggest that attachment organization may be one factor that accounts for individual differences in the degree of discordance between self- and other reports of symptoms in adolescence.

Adolescent↗

Adolescent substance-use assessment: methodological issues in the use of the ADAD (Adolescent Drug Abuse Diagnosis).

During the past twenty years, various instruments have been developed for the assessment of substance use in adolescents, mainly in the United States. However, few of them have been adapted to, and validated in, French-speaking populations. Consequently, although increasing alcohol and drug use among teenagers has become a major concern, the various health and social programs developed in response to this specific problem have received little attention with regard to follow-up and outcome assessment. A standardized multidimensional assessment instrument adapted for adolescents is needed to assess the individual needs of adolescents and assign them to the most appropriate treatment setting, to provide a single measurement within and across health and social systems, and to conduct treatment outcome evaluations. Moreover, having an available instrument makes it possible to develop longitudinal and trans-cultural research studies. For this reason, a French version of the Adolescent Drug Abuse Diagnosis (ADAD) was developed and validated at the University Child and Adolescent Psychiatric Clinic in Lausanne, Switzerland. This paper aims to discuss the methodological issues that we faced when using the ADAD instrument in a 4-year longitudinal study including adolescent substance users. Methodological aspects relating to the content and format of the instrument, the assessment administration and the statistical analyses are discussed.

Adolescent↗

Dissociation among Swedish adolescents and the connection to trauma: an evaluation of the Swedish version of Adolescent Dissociative Experience Scale.

The purpose of this study was to investigate the psychometric properties of the Swedish version of Adolescent Dissociative Experience Scale (A-DES), dissociative symptoms among Swedish adolescents, and dissociative symptoms connected to trauma and sexual and physical abuse. A normative group of 400 adolescents aged 12 to 19 years and a clinical group of 20 adolescents with known experienced trauma were given A-DES. A test-retest procedure was conducted with 90 subjects from the normative group. The results showed good reliability, internal consistency and test-retest. Factor analysis in the normative sample (N = 400) resulted in a one factor solution. Correlation between A-DES and other measures of dissociation was high (r = .86). Significant differences for the total sum of A-DES were found in the normative group between adolescents with and without self-reported trauma and between the normative group and the clinical group with known experienced trauma. The Swedish version of A-DES was shown to be a screening instrument with satisfactory psychometric qualities and the capability of capturing dissociative symptoms in adolescents with self-reported trauma as well as clinical cases with identified trauma.

Adolescent↗

Adolescent health concerns: a comparison of adolescent and health care provider perceptions.

The purpose of this study was to ascertain adolescent perceptions of health concerns and to contrast the health care provider perceptions of adolescent concerns. The student sample consisted of 179 students from the 9th, 10th, and 11th grade in a 2,000-student suburban high school. The health care provider sample consisted of 74 physicians, nurse practitioners, and school nurses. The largest number of students reported concerns about AIDS, schoolwork, making friends, sex, discrimination, and dental problems. Additionally, menstruation, violence, rape, abuse, pregnancy, sadness, and obesity were of concern to a greater number of female than male students. Homosexuality, sex, auto accidents, and low weight were of concern to a greater number of male than female students. The findings of this study support the following conclusions: (a) Adolescents have more diverse health concerns with greater magnitude than expected by health care providers; (b) health care providers underestimate adolescent psychological and social health concerns; (c) female adolescents were more concerned about their health and more concerned about gender-specific and violent issues than males; (d) women's health care providers are unaware of female adolescent concern about violent acts against women.

Adolescent↗

Differences in health behaviors and parenting knowledge between pregnant adolescents and parenting adolescents.

To better understand the differences between pregnant adolescents and parenting adolescents, we examined substance use, contraceptive behavior, and parenting knowledge among 91 first-time pregnant and parenting adolescents enrolled in an adolescent parenting case management program. After one year of program participation, pre- and post-test comparisons indicated improvements in contraception use and parenting knowledge, and increases in reported use of cigarettes, alcohol and other drugs among both groups. Adolescents who entered the program while pregnant experienced greater benefit than adolescents who entered the program already parenting. We discuss several implications for practitioners at both the programmatic and direct practice level who work with young women during pregnancy and as they transition to early parenthood.

Adolescent↗

[Adolescence and adolescents: new meaning based on the social determination of the health-disease process].

This study, of historical and dialectic referential, was written from the perspective of the redefinition of adolescence, and how it fits into health intervention. Recognizing the transdisciplinary character of this task, the objective of this work is to contribute to the nursing of the adolescent, learning by analyzing work is to contribute to the nursing of the adolescent, learning by analyzing works produced within Brazilian academic nursing studies. The empirical material consisted of 22 Masters dissertations with themes related to adolescence, from the decade 1984-1994. Investigated were the content of conceptual categories such as human being, society, adolescence/adolescent, health-illness process, nursing/nursing care and hte proposals of intervention driven towards this population. Observed was a narrow consonance between the content of these categories and the scientific referential of positivism which oriented 21 of the dissertations analyzed. There was a predominant concept of adolescence as a universal phenomenon and the adolescence was defined in opposition both to the adult, with emphasis on the medical biological paradigm for the interpretation of its health-illness process. Identified was the persistence of nightingale knowledge elements orienting the nursing intervention proposals which in turn emphasized education. The historical reconstruction of the concepts as well as their correspondence to practice permitted the formulation of new significance to the conceptual categories.

Adolescent↗

Relational factors of vulnerability and protection for adolescent pregnancy: a cross-sectional comparative study of Portuguese pregnant and nonpregnant adolescents of low socioeconomic status.

This study explores multiple relational contexts that promote vulnerability and protection against early pregnancy in a potential risk group of Portuguese adolescents. A comparative analysis was made between two groups of female adolescents of low socioeconomic status: pregnant adolescents (n=57) and adolescents without a history of pregnancy (n=81). Results suggest that several variables belonging to different contexts-family and school and peer relations--are important in the characterization of the two groups. Lower levels of mother's overprotection and father's emotional support, presence of early pregnancy in adolescent's mother, lower level of emotional proximity to peer relations, and higher number of school failures are significantly associated with adolescent pregnancy.

Adolescent↗

Parent-adolescent intimacy: impact on adolescent functioning.

This paper examines the influence of parent-adolescent intimacy on adolescent functioning. Intimacy for both adolescent males and females was assessed in relation to their mothers and fathers. Adolescent development was measured using two scales: self-esteem and problem behavior. No significant differences were found between males and females on the measures of self-esteem, problem behavior, and intimacy. However, mothers were found to share greater degrees of intimacy than did fathers for both male and female adolescents. A regression analysis revealed that father intimacy was a better predictor of positive adolescent functioning than was mother intimacy.

Adolescent↗

Communicating with adolescents from culturally varied backgrounds: a model based on Mexican-American adolescents in south Texas.

Health care delivery to Mexican-American adolescents requires knowledge of the general health needs of adolescents, as well as culturally determined beliefs about health and illness. Specific concepts about the cause and treatment of a variety of symptoms may cause some Mexican-American families to seek help from parallel systems of health care (i.e., the curandera and the physician). By understanding the family's beliefs about the problem, the physician can incorporate both systems to enhance a positive outcome. The physician needs to be aware of the extent to which the family both suffers with the ill adolescent patient and contributes to the acquisition of the patient's health. Differences in the extent of acculturation between adolescents and their parents may intensify the common parent-adolescent conflicts seen as a developmental phenomenon. As with any adolescent patient, a thorough history will help to assess the problem and will provide clues as to the best methods for intervention.

Acculturation↗

Patterns of parenting during adolescence: perceptions of adolescents and parents.

The purposes of this study were (1) to explore differences in maternal and paternal parenting style and parental involvement, (2) to examine the differences between parents' and adolescents' perceptions of parenting style and parental involvement, and (3) to explore the changes in parenting style and parental involvement between the adolescents' ninth and twelfth grade years. Subjects were 244 ninth graders recruited from several school districts in the Southeast and Midwest. Thirty-one subjects participated in a small longitudinal study three years later when they were in the twelfth grade. Measures of maternal and parental demandingness, responsiveness, values toward achievement, involvement in schoolwork, and involvement in school functions, designed for this program of research, were obtained from both adolescents and their parents. Results showed that both adolescents and parents perceived mothers to be more involved in parenting than were fathers during both ninth and twelfth grades. Mothers and fathers were not found to be different regarding their values toward achievement. Additionally, both mothers and fathers perceived themselves to be higher on all aspects of parenting than their adolescents perceived them to be during both ninth and twelfth grades. In the longitudinal study, both adolescents and parents perceived levels of parenting to drop between ninth and twelfth grades, except values toward achievement which did not change. Implications for interpretation of existing research and for considerations of future research are discussed.

Achievement↗

Psychometric properties of the DUKE Health Profile-adolescent version (DHP-A): a generic instrument for adolescents.

PURPOSE: Quality of life in general population of adolescents has been scarcely documented. The study was aimed at evaluating the psychometric properties of the DUKE Health Profile-Adolescent version (DHP-A), an adaptation from the adult version. MATERIAL AND METHOD: Feasibility and construct validity were assessed in a sample of 618 adolescents from school settings. Test-retest reliability was assessed in another sample of 100 adolescents at 2 weeks interval. Construct validity was assessed in groups by gender, age and existence of a health problem. RESULTS: The DHP-A, a short instrument of HRQOL, easy to administer, proved its ability to discriminate between boys and girls, with or without a health problem, for all of health and dysfunction dimensions (p < 0.05). Its reliability is also acceptable for three health dimensions and anxiety, depression (ICC = 0.68-0.72), moderate for social, perceived health, self-esteem and pain (ICC = 0.43-0.59), and debatable for disability (ICC = 0.22) (single item). CONCLUSION: The initial testing of the adolescent version (DHP-A) indicates that the psychometric properties are acceptable and will provide a useful tool for the assessment of health status in adolescents. Three single-item dimensions (perceived health, pain and disability) should be interpreted with caution.

Adolescent↗

The development of the Comprehensive Addiction Severity Index for Adolescents (CASI-A). An interview for assessing multiple problems of adolescents.

The Comprehensive Addiction Severity Index for Adolescents (CASI-A) is a 45 to 90-minute comprehensive, semi-structured clinical interview for evaluating adolescents who present for treatment at various provider agencies. CASI-A modules and their individual items were selected and revised based on theory, clinical wisdom, and adolescent experiences obtained during pilot interviews and focus groups. The CASI-A assesses known risk factors, concomitant symptomatology, and consequences of adolescent alcohol/drug use within seven primary areas of functioning: education status, alcohol/drug use, family relationships, peer relationships, legal status, psychiatric distress, and use of free time. The CASI-A is not a diagnostic or screening instrument, but rather a clinical assessment tool that obtains clinically pertinent information designed to guide treatment planning and to evaluate treatment outcome. The CASI-A's design makes it suitable for administration in a variety of settings, for repeat administration at posttreatment follow-up evaluations, and for assessment of virtually all adolescents in treatment regardless of their admission problem. Overall, the CASI-A has encouraging but preliminary evidence of validity and internal consistency. Information collected soon after admission during administration of the CASI-A by nonclinical interviewers corresponded quite well with that obtained over the course of the adolescent's treatment stay by the entire treatment team. Revisions to the instrument are being made in those areas where correspondence between information on the CASI-A and that extracted from clinical records dropped below 75%, or in those early subscales, where alpha coefficients dropped below .6. As a result of the encouraging results reported in this paper, we are beginning additional psychometric testing, refining the proposed scoring system, and developing a computerized data entry, scoring, and report system.

Adolescent↗

Health related quality of life of adolescents in Vietnam: cross-cultural adaptation and validation of the Adolescent Duke Health Profile.

Quality of life (QOL) of adolescents has been scarcely documented in a general population sample. The study was aimed at translating and adapting the Adolescent Duke Health Profile to Vietnamese, validating the questionnaire, determining reference value, and identifying determinants of poor QOL. Following a cross-cultural methodology, the Adolescent Duke Health Profile (ADHP) had content adapted to Vietnamese by alteration of 2 out of 17 items. Test-retest validity was checked in 408 adolescents. Construct validity and internal consistency were assessed in a 1408 probability sample of adolescents in Vietnam, and determinants were analysed by multiple linear regression. The ADHP showed satisfactory internal consistency (Cronbach's alpha=0.87-0.92) and satisfactory construct validity in relation with drug abuse or not, or with parent situation living in couple or alone. Test-retest reliability was acceptable (ICC=0.7-0.8) and major determinants were age, sex, education, chronic disease, alcohol and drug use. This works provide a validated, simple health related QOL scale suited to adolescent population with reference values. Taking into account determinants identified will help program prevention and intervention health policy and to evaluate the effect of these actions.

Adolescent↗

Psychological distress among HIV(+) adolescents in the REACH study: effects of life stress, social support, and coping. The Adolescent Medicine HIV/AIDS Research Network.

PURPOSE: To investigate the effects of life events, social support, and coping on anxiety and depression among human immunodeficiency virus (HIV)-infected adolescents. It was hypothesized that higher levels of stressful events would be associated with higher levels of anxiety and depression, but that this association would be moderated by satisfaction with social support and by adaptive coping. METHODS: HIV-infected adolescents from 16 locations in 13 U.S. cities (N = 230, median age 16.09 years, standard deviation 1.2, range 13-19; 77% females) were recruited into the Reaching for Excellence in Adolescent Care and Health (REACH) project. REACH is the first large-scale disease progression study of HIV(+) adolescents infected through sexual behavior or injection drug use. The adolescent assessment was conducted by audio-computer assisted self-interview. Least squares regressions were used to test hypotheses. RESULTS: Life events with high impact were associated with higher levels of depression and anxiety. Frequently reported events included: being prescribed medications (74%), family financial problems (61%), and parental alcohol abuse (20%). Contrary to expectations, the buffering hypotheses of social support and adaptive coping were not supported. Satisfaction with social support and adaptive coping methods were both associated directly with lower levels of depression, but no association was detected between these two measures and anxiety. CONCLUSIONS: Although life event distress was directly associated with psychological distress, neither social support nor adaptive coping seemed to moderate this association. However, both satisfaction with support and adaptive coping were associated directly with depression in HIV-infected adolescents.

Adaptation, Psychological↗

The patient health questionnaire for adolescents: validation of an instrument for the assessment of mental disorders among adolescent primary care patients.

PURPOSE: To investigate the validity of the Patient Health Questionnaire for Adolescents (PHQ-A), a self-administered instrument that assesses anxiety, eating, mood, and substance use disorders among adolescent primary care patients. METHODS: A total of 403 adolescents from California, New Jersey, New York, and Ohio completed the PHQ-A and the Medical Outcomes Study Short-Form General Health Survey (SF-20) during or shortly after a visit to a primary care clinic or a school nurse's office. A few days later, clinical psychologists who were blind to the results of the PHQ-A administered a semi-structured clinical interview to assess the same psychiatric disorders and to conduct a global assessment of functioning (GAF) among 403 patients. Diagnostic agreement coefficients were computed and analyses of covariance were conducted. RESULTS: Findings support the diagnostic validity of the PHQ-A. The PHQ-A and the clinical interview produced similar estimates of the prevalence rates of anxiety, eating, mood, and substance use disorders. The PHQ-A demonstrated satisfactory sensitivity, specificity, diagnostic agreement, and overall diagnostic accuracy, compared with the clinical interview. Adolescents with PHQ-A diagnoses experienced significantly poorer mental and overall functioning, more physical pain, and poorer overall health compared with those without psychiatric disorders. These differences remained significant after patients' age, gender, ethnicity, and site were controlled statistically. CONCLUSION: The PHQ-A may be used to assist primary care practitioners in identifying psychiatric disorders among their adolescent patients. The PHQ-A is the first such tool to be tested for use in adolescents and offers an acceptable and efficient tool for early detection and recognition of mental disorders in this high-risk group.

Adolescent↗

Changes in food habits in healthy Swedish adolescents during the transition from adolescence to adulthood.

OBJECTIVE: To investigate the change in food habits in Swedish adolescents between 15 and 21 y of age with reference to age, sex, region and socioeconomic background. DESIGN: A longitudinal study from 1993 to 1999. SETTING: Two different regions in Sweden, the university city of Uppsala and the industrial town of Trollhättan. SUBJECTS: On three different occasions, 1993, 1995 and 1999, 208 adolescents, 96 males and 112 females, were studied. METHODS: A food frequency questionnaire containing 29 different food groups was used. The questionnaire also contained questions about food habits and amounts of some food items and socioeconomic conditions of the participants and their families. RESULTS: At 17 and 21 y of age, the adolescents consumed significantly more often pasta, vegetables, coffee and tea compared to age 15, while the frequency consumption of fat spread, milk, bread, potatoes, carrots and buns and biscuits decreased. The changes between 15 and 17 were smaller than between age 17 and 21. At age 21, the males decreased their intake of fruit, while the females decreased their intake of meat. No-meat consumers among females increased from 2 to 13%. Higher educational level of the mothers of the adolescents was associated with more frequent consumption of vegetables and pasta between ages 17 and 21. Milk consumption decreased significantly in both sexes. Breakfast habits did not change: 90% had breakfast five times/week or more. CONCLUSIONS: Food habits change significantly during adolescence along with lifestyle changes. Therefore, health promotion during adolescence ought to be more supported by the society.

Adolescent↗

Family socialization and adolescent personality and their association with adolescent use of marijuana.

This study examines family socialization practices and adolescent personality/attitudinal characteristics, their interrelation, and association with adolescent use of marijuana. Two hundred and eighty-four adolescents and their mothers served as Ss. As hypothesized, parental socialization factors and adolescent personality/attitudinal attributes each had an independent effect on adolescent use of marijuana and each comprised its own set of sufficient conditions for adolescent marijuana use.

Adolescent↗

Distinguishing female borderline adolescents from normal and other disturbed female adolescents.

PSYCHOANALYTIC theory would suggest that differentiating the borderline adolescent from his or her normal peers should be a difficult task. In many respects the developmental crises of adolescence dovetail with critical conflicts of Borderline Personality Disorder--e.g., identity formation and separation-individuation. Extensive semi-structured interviews (Gunderson's Diagnostic Interview for Borderlines) of normal, borderline and other disturbed adolescents provide a data base for examining the hallmarks of borderline pathology in adolescence. This paper focuses on the qualitative differences in patterns of impulsivity, affective lability, dissociative experience, and interpersonal relationships that distinguish borderline teenagers from other seriously disturbed and normal adolescents. The paper also outlines modifications in the Gunderson interview for an adolescent population.

Acting Out↗