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PubMed1989

Adolescent personality development: three phases, three courses and varying turmoil. Findings from the Toronto Adolescent Longitudinal Study.

The Toronto Adolescent Longitudinal Study was launched in 1977 to examine personality development in a non-clinical sample of children from ages ten through 19 over an eight year period. Following a description of their conceptualized model of personality and of the nature of the study, the authors summarize their findings which suggest new perspectives in three areas of adolescent personality development: 1) the subphases of adolescence, 2) the routes of passage through which adolescents proceed, and 3) adolescent turmoil.

Adolescent↗
PubMed2006

Auditory change detection in schizophrenia: sources of activity, related neuropsychological function and symptoms in patients with a first episode in adolescence, and patients 14 years after an adolescent illness-onset.

BACKGROUND: The event-related brain response mismatch negativity (MMN) registers changes in auditory stimulation with temporal lobe sources reflecting short-term echoic memory and frontal sources a deviance-induced switch in processing. Impairment, controversially present at the onset of schizophrenia, develops rapidly and can remain independent of clinical improvement. We examined the characteristics of the scalp-recorded MMN and related these to tests of short-term memory and set-shifting. We assessed whether the equivalent dipole sources are affected already at illness-onset in adolescence and how these features differ after a 14-year course following an adolescent onset. The strength, latency, orientation and location of frontal and temporal lobe sources of MMN activity early and late in the course of adolescent-onset schizophrenia are analysed and illustrated. METHODS: MMN, a measure of auditory change-detection, was elicited by short deviant tones in a 3-tone oddball-presentation and recorded from 32 scalp electrodes. Four dipole sources were placed following hypothesis-led calculations using brain electrical source analysis on brain atlas and MR-images. A short neuropsychological test battery was administered. We compared 28 adolescent patients with a first episode of schizophrenia and 18 patients 14 years after diagnosis in adolescence with two age-matched control groups from the community (n = 22 and 18, respectively). RESULTS: MMN peaked earlier in the younger than the older subjects. The amplitude was reduced in patients, especially the younger group, and was here associated with negative symptoms and slow set-shifting. In first-episode patients the temporal lobe sources were more ventral than in controls, while the left cingular and right inferior-mid frontal sources were more caudal. In the older patients the left temporal locus remained ventral (developmental stasis), the right temporal locus extended more antero-laterally (illness progression), and the right frontal source moved antero-laterally (normalised). CONCLUSION: From the start of the illness there were differences in the dipole-model between healthy and patient groups. Separate characteristics of the sources of the activity differences showed an improvement, stasis or deterioration with illness-duration. The precise nature of the changes in the sources of MMN activity and their relationship to selective information processing and storage depend on the specific psychopathology and heterogeneous course of the illness.

Acoustic Stimulation↗
PubMed2003

Family instability and young adolescent maladjustment: the mediating effects of parenting quality and adolescent appraisals of family security.

Examined relations among family instability and adolescent's psychological functioning using family models of children's emotional security in a sample of 220 young adolescents and their primary caregivers. Primary caregiver reports of family instability were associated with multiple informant measures of adolescent internalizing and externalizing symptoms. Findings from structural equation models supported the hypothesis that family instability increases adolescent risk for psychological problems by directly undermining their insecure appraisals of the family. Results also supported a pathway whereby family instability predicted parenting difficulties and parenting difficulties, in turn, indirectly predicted adolescents' internalizing and externalizing symptoms through its association with lower levels of perceived insecurity in the family. Results are discussed in relation to how they advance process-oriented conceptualizations of family instability.

Adaptation, Psychological↗
PubMed2000

Sexual behavior change among human immunodeficiency virus-infected adolescents with hemophilia. Adolescent Hemophilia Behavioral Intervention Evaluation Project Study Group.

PURPOSE: To determine the factors associated with the adoption or maintenance of consistent safer sexual behaviors among human immunodeficiency virus-positive adolescents and young adults with hemophilia. METHODS: One hundred eleven adolescents at 10 hemophilia care sites participated in an intervention program designed to increase safer sexual behaviors (abstinence, condom use, or nonpenetrative behavior). The theory-based intervention spanned 1 year. Adolescents attended individual sessions, small group activities, and an intensive group retreat. RESULTS: Patients who maintained or improved safer sexual behaviors were compared with those who relapsed or did not improve. Logistic regression analyses found that improvement and maintenance of safer sexual behavior were significantly associated with perceived peer support for outercourse (odds ratio [OR]: 5.47; confidence interval [CI]: 1.4-20.8), perceived peer support for abstinence (OR: 5.08; CI: 1.2-20.1), and decreased general emotional distress (OR: 4.65; CI: 1.04-20.6). Perceived health status and previous sexual behavior were unrelated to change in safer sexual behavior. CONCLUSIONS: These longitudinal data indicate that improvement and maintenance of safer sexual behavior among adolescents during an intervention is strongly associated with perceptions of peer support for safer sex and lesser degrees of emotional distress. Programs for human immunodeficiency virus-infected adolescents may require developmentally appropriate social and psychological approaches to impact peer norms and emotional well-being.

Adolescent↗
PubMed1999

Ethnic similarities and differences in the association of emotional autonomy and adolescent outcomes: comparing Euro-American and Asian-American adolescents.

This study has conducted an ethnic comparison on the strength of the association between Individuation, a subscale from the Emotional Autonomy construct presented originally by Steinberg and Silverberg in 1986, and adolescent outcomes in terms of self-esteem and susceptibility to negative peer pressure. Consistent with what was expected, the association between Individuation and lowered self-esteem was more salient among 287 Asian-American adolescent boys than among 1,353 Euro-American adolescent boys. Contrary to what was hypothesized, the association between Individuation and susceptibility to negative peer pressure was more pronounced among 1,573 Euro-American adolescent girls than among 292 Asian-American adolescent girls.

Adolescent↗
PubMed2003

Marital and severe parent-to-adolescent physical aggression in clinic-referred families: mother and adolescent reports on co-occurrence and links to child behavior problems.

This study examined the interplay of marital and severe parental physical aggression, and their links to child behavior problems, in 232 families of clinic-referred adolescents. Combined reports from mothers and adolescents indicated that two thirds of adolescents exposed to marital aggression in the past year had also experienced parental aggression. Mothers and fathers who used and/or were victims of marital aggression were both more likely to direct aggression toward their adolescent. Mother and youth reports of marital aggression were tied to each party's report of greater externalizing problems and to youth reports of greater internalizing problems. Severe parental aggression uniquely predicted maternal reports of both behavior problems, after controlling for marital aggression; the reverse was not true. Also, adolescents exposed to both types of family aggression did not display greater maladjustment than those subjected to only one type of family aggression.

Adolescent↗
PubMed1991

[Significance of parent-child relations for development of moral reasoning in adolescence: a study of psychiatrically disordered adolescents].

In accordance with structural-developmental theory in the tradition of Piaget and Kohlberg, moderate amounts of conflict between adolescents and their parents should influence the sociomoral development of the adolescents in an optimal way. The same hypothesis is compatible with a social-constructivistic approach (Youniss, Keller, Haan, Miller), which emphasizes the role of communicative processes in the development and validation of moral rules. The results of our empirical study with 43 severely mentally disturbed adolescents aged 14 to 19 years indirectly confirm this hypothesis. Adolescents with moderate amounts of family conflict reached a higher stage in moral reasoning than those with either very severe problems or only minor problems with their parents. In an additional analysis we investigated the relation between the severity of the conflicts and the emotional attachment of the adolescent to his or her parents. Our data indicate that moderate problems in the interaction between child and parents are associated with a family atmosphere that seems to facilitate the development of an integrated personality and identity. A balanced coexistence of separateness and connectedness offers the young person the best chance to develop and clearly communicate his or her own point of view and to solve interpersonal problems by reaching a consensus that takes into account the needs and interests of the other family members.

Adolescent↗
PubMed1986

The evaluation and treatment of adolescent overdoses in an adolescent medical service.

Aspects of the mental health care provided in an adolescent medical setting are examined. Over a six-month period, 38 patients were admitted to an inpatient adolescent medical unit because of drug ingestion. Following evaluation by the adolescent medical team, psychiatric consultations were requested in 47 percent of the cases. Most patients were referred for follow-up "counseling" in an adolescent clinic. In comparing the "consult" and "non-consult" groups, data are given on the demographics, diagnoses, reasons for the consultation request, lengths of hospital admission, follow-up dispositions, and compliances. Illustrations are given of the counseling process in the adolescent clinic. Patients in both groups had substantial psychosocial problems. Many patients received conduct-disorder diagnoses with varying degrees of subjective distress. It was generally the degree of depression, as assessed by the pediatrician, that determined whether a psychiatric consultation was requested. The acceptance of follow-up recommendations was approximately 50 to 60 percent in both groups.

Accidents↗
PubMed1978

A comparison of self-esteem, dogmatism and fantasy in psychiatric inpatient adolescents and their parents with non-hospitalized adolescents and their parents.

Forty in-patient adolescents and 40 non-hospitalized adolescents, comparable in age, sex, education, birth position and socioeconomic level, and their parents were administered the Rokeach Dogmatism Scale, Barksdale Self-Esteem Evaluation Scale, the Singer and Antrobus Imaginal Process Inventory, and the Elms Empathic Fantasy Scale. Distinct differences were found between the in-patient adolescent and his/her parents in aspects of fantasy, empathy, dogmatism, and self-esteem, while the non-hospitalized adolescents were very similar in fantasy with both parents. In addition, both parents of the nonhospitalized adolescents had greater levels of self-esteem with less dogmatism evident in the fathers. The results are discussed in terms of the identification process and modeling, the socialization process with its suppression or reduction of taboo drive manifestations and fantasy as a means of achieving unattainable drives.

Adolescent↗
PubMed1980

Dynamic exercise response in hypertensive adolescent on clonidine therapy: clonidine therapy in adolescent hypertension.

The cardiovascular response to dynamic exercise is compared in 16 normotensive control adolescents (C), 15 untreated hypertensive (H) adolescents, and 14 hypertensive adolescents on clonidine therapy (HRx) for blood pressure control. All subjects exercised to exhaustion (heart rate (HR) = 200) on a treadmill by Bruce protocol. Blood pressure and HR were monitored during exercise and recovery. Systolic pressure was greater in H and HRx and than C at baseline, exercise, and recovery (P less than 0.01) as was the product of systolic blood pressure times heart rate (SBP X HR). Diastolic blood pressure (DBP) was greater in H and HRx at base line but decreased in all subjects (C, H, and HRx) during vigorous exercise. Our results indicate that H and HRx adolescents have higher SBP and HR at rest and exercise consistent with a hyperkinetic circulatory state; DBP response to exercise is normal in H adolescents; and, clonidine in HRx lowered baseline HR and blood pressure but did not alter a normal exercise response.

Adolescent↗
PubMed1998

Pathways to mental health care among South African adolescents: analysis of referrals to an adolescent psychiatric unit.

Assessment forms of 670 adolescents referred over four years to an adolescent psychiatric unit were analyzed to establish how they entered mental health care. The first part of the study examined referral sources; the second established the appropriateness of referral. Adolescents were referred via a number of pathways, of which school sources, psychiatric services, and social agencies were prominent. Interestingly, 60.7% of the referrals were from persons not trained in mental health care. No significant difference in appropriateness of referral was found between trained and nontrained sources. Thus, the unique referral base of adolescents in need of mental health care must be recognized. Although the majority in this study were not mental health care workers, the findings show that their referrals were clinically appropriate. This suggests that by improving the mental health skills of this sector, the provision of psychiatric care to adolescents could be enhanced.

Adolescent↗
PubMed1997

Parent-adolescent interactions and psychosocial risk in adolescents: an analysis of communication, support and gender.

The main purpose of this study was to verify the correlation between family functioning and the presence of psychosocial risk in adolescents. The sample of 279 intact families with a late adolescent and their parents complete self-report instruments in order to evaluate support and communication in parent-adolescent relationships. An index of risk was constructed with the MAUT technique. Data analysis was conducted on individual and relational dyadic levels. It was found that: (a) a supportive relationship and adequate communication between parents and adolescents are correlated to the absence or presence of psychosocial risk; and (b) the father in this phase of life is a reliable source of information regarding his relationship with his children and their psychosocial adjustment.

Adolescent↗
PubMed2026

Co-Use of Some Substances Associated With Higher Doses in Adolescents: Findings From the Adolescent Brain Cognitive Development Study.

PURPOSE: Adolescence is a critical developmental period marked by heightened vulnerability to initiating substance use, with long-term implications for health and behavior. Nicotine, alcohol, and cannabis are the most commonly used substances among adolescents. Their use often co-occurs but few studies have described or quantified the patterns and doses of substance co-use in this vulnerable population. METHODS: We used data from six waves of the Adolescent Brain Cognitive Development study. Substance use was measured through a web-based timeline followback interview, and outcomes are operationalized into substance use quantity (in standard units), single use, and co-use (use of two substances on the same day) of alcohol, cannabis, and nicotine. Group differences of average dose in standard units between single use and co-use for each substance class were analyzed using linear mixed-effects modeling in years 4-6. RESULTS: The average dose of nicotine was significantly higher when co-used with alcohol (4.32; 95% confidence interval [CI]: 2.55-6.09; p < .001) or when co-used with cannabis (4.41; 95% CI: 2.76-6.05; p < .001) in year 6; nicotine trends were similar in years four and five. In year 6, the average dose of alcohol was higher when co-used with cannabis (1.87; 95% CI: 0.37-3.36; p = .004) or co-used with nicotine (1.64; 95% CI: 0.06-3.22; p = .03) compared to single use of alcohol. The average dose of cannabis was not significantly different when used singularly or co-used with either alcohol or nicotine in our study years. DISCUSSION: During adolescence, the co-use of substances (namely alcohol and nicotine) may lead to higher average doses compared to single-substance use.

Humans↗
PubMed2003

Recruitment and retention of adolescent participants in HIV research: findings from the REACH (Reaching for Excellence in Adolescent Care and Health) Project.

PURPOSE: To evaluate the importance of 13 items in the recruitment and retention of HIV-positive and HIV-negative adolescent participants in a longitudinal study (REACH study). METHODS: A confidential, self-administered, visual analog, cross-sectional survey was offered to active participants (November 1999-August 2000) with 438 subjects (86%) participating. Sixty-six percent of the cohort were HIV-positive and 34% were HIV-negative with a mean age of 17 years, and 76% were female. Subjects were asked to recall the importance they placed on 13 items in deciding to join the REACH study (recruitment) and to remain on study (retention). Factors that might explain the judgment placed on the items were analyzed using the nonparametric Wilcoxon Rank-Sum test or the Kruskall-Wallis test. RESULTS: The five most important factors for study recruitment were identical to those chosen for retention by participants. The factors were: (a) quality medical care, (b) caring staff, (c) health education, (d) privacy/confidentiality, and (e) altruism. Items judged least important were social activities, compensation, transportation, and food/meals. Subject characteristics (gender, age, HIV status) were not associated with statistically different mean judgment scores at recruitment and retention, although clinical site showed significant variation. Factors that could render subjects vulnerable (health insurance, family finances) were not associated with related items. CONCLUSIONS: Adolescents found quality health care and care team characteristics critically important in considering research participation. Attention to privacy and the opportunity to be altruistic were also important. Compensation for participation was not a significant factor for recruitment and retention of this adolescent cohort. This study demonstrates that adolescents apply sound criteria in evaluating research participation and do not appear to be unduly affected by compensation.

Adolescent↗
PubMed2002

The Adolescent Food Habits Checklist: reliability and validity of a measure of healthy eating behaviour in adolescents.

OBJECTIVE: Amid concerns about the quality of young people's diets, this paper describes the development of a measure of healthy eating behaviour for use with adolescents. DESIGN: Items for the measure were selected from a larger pool on the basis of responses from a pilot study. The 23-item checklist was validated using measures of dietary fat and fibre intake, fruit and vegetable consumption, dietary restraint, nutrition knowledge and a measure of family income. SETTING: Participants came from seven secondary schools in the north-west of England. SUBJECTS: A total of 1822 adolescents aged between 13 and 16 y took part in the study, representing 84% of those invited to participate. RESULTS: Correlations between measures indicate a good level of convergent validity, and the checklist is also shown to have high internal and test-retest reliability. CONCLUSIONS: The focus on choices available to adolescents means that the checklist will provide a useful addition to food frequency-type approaches to the measurement of adolescent eating behaviour. SPONSORSHIP: This research was funded by the Medical Research Council and the Economic and Social Research Council's Health Variations Programme.

Adolescent↗
PubMed1999

A review of the sociopolitical context of adolescent mental health and adolescent mental health nursing in Australia.

Examination of their sociopolitical situatedness, in Australia, allows adolescent mental health and adolescent mental health nursing to be understood within a broader context. This examination takes place through a review of: (i) epidemiology, (ii) health funding and services, (iii) training and education, (iv) research, and (v) nurse education. Implications arising from this review are presented. Questions are raised regarding the sociopolitical standing of adolescent mental health, and suggestions are made regarding future imperatives for adolescent mental health nursing.

Adolescent↗
PubMed1996

Legal rights and responsibilities of adolescents and staff in Victorian Child and Adolescent Mental Health Services.

OBJECTIVES: The aim of the paper is to clarify the legal rights of adolescent patients, guardians and staff in Victorian Child and adolescent Mental Health Services (CAMHS). Victorian CAMHS have now been 'gazetted' and can admit patients on an involuntary basis under the amended Mental Health Act 1986 (MHA). The MHA applies equally to young people under the age of 18 years, which has raised some confusion about who has the right to consent to treatment. METHOD: Staff of CAMHS inpatient units have recently posed questions to the Victorian chief psychiatrist. These have included clarification of when the MHA may be appropriately used for adolescents, what is the clinician's duty of care, how to assess young people's capacity to consent to treatment, how to manage some patient groups, and what is the role of the courts in treatment decisions. The author provides a view on each of these matters, based on recent literature and confirmed by legal opinion. RESULTS: Some matters of fact are presented and advice is provided. CONCLUSIONS: Services must seek the informed consent of guardians and adolescents and, for those young people with major psychiatric disorders who require treatment and are unable to consent, the amended MHA provides clearer direction for the use of involuntary treatment. Where units offer admission to provide assessment and stabilisation, a clear explanation about the treatment goals, and the role of restraint and medication in managing behaviour is essential at the outset of the admission process.

Adolescent↗
PubMed1999

Long-term consequences of adolescent health behaviors: implications for adolescent health services.

The authors discuss the evidence supporting the effectiveness of adolescent preventive services to influence health outcomes, the magnitude of the long-term consequences of adolescent health-compromising behaviors, and their implications for health policies. Particular attention is given to the contribution that behaviors participated in or begun during adolescence have on long-term health, including cancer and heart disease. They postulate the health benefits that might accrue from the widespread implementation of comprehensive adolescent preventive services, assuming a conservative estimate of effectiveness, could be significant.

Adolescent↗