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PubMed2004

Obstetric optimality and emotional problems and substance use in young adulthood.

BACKGROUND: Pregnancy and delivery are complex processes, and isolated obstetric complications rare and often accompanied or followed by a number of others. AIMS: To study the relationship between the overall obstetric situation (as opposed to single obstetric risk factors) and emotional and substance use disorders in young adulthood, and to analyse whether these links are mediated by temperaments in childhood. STUDY DESIGN: In a prospective birth cohort (n=3162), questionnaires were sent to mothers and teachers when the child was 7-10 years old, and to the children when they were 20-25 years old. SUBJECTS: Six hundred and eighty-two cohort members with complete data sets at three ages (perinatal, childhood, and young adulthood). OUTCOME MEASURES: Emotional problems and substance use in young adulthood. MAIN RESULTS: Substance use in young adulthood was predicted better by the overall obstetrical optimality score than emotional problems were. Links studied were stronger for men than for women. CONCLUSIONS: This study demonstrated the use of an aggregated obstetrical optimality score in analysing the associations between early risk factors and emotional problems and substance use in young adulthood.

Adult↗
PubMed1991

Consultation-liaison psychiatric approach for school-refusal students in Hiratsuka City, Kanagawa Japan.

In current school health care programs, it is necessary to check not only the physical condition but also for mental disorders caused by changes of sociocultural, economic or environmental conditions and, in fact, the relative importance of the latter is increasing every year. Taking these changes into consideration, the Kanagawa Prefectural Joint Teacher-Visiting School Doctor Mental Health Committee started various activities aimed at raising the psychiatric ability of school doctors in 1983. In parallel with the activities of the Kanagawa Prefectural committee, the Hiratsuka Medical Society established the Hiratsuka City Joint Teacher-Visiting School Doctor Mental Health Committee in May 1985. In April 1988, as an extention of the activities of the Hiratsuka Committee, a counseling class for non-attending junior high school students was set up. The purpose of this class was, to provide an opportunity for school, families and medical organization to exchange information and to collaborate to provide more effective treatment and education to cope with recent advanced and prolonged cases of school refusal. In addition to Hiratsuka City, Fukuoka is engaged in practical activities under the direction of a joint committee led by the local Medical Society.

Adaptation, Psychological↗
PubMed1998

Salivary cortisol and cardiovascular activity during stress in oppositional-defiant disorder boys and normal controls.

BACKGROUND: Arousal-regulating mechanisms are important in explaining individual differences in antisocial behavior. METHODS: Alterations in salivary cortisol concentration and cardiovascular activity were studied in 21 boys with oppositional defiant disorder (ODD) and 31 normal controls (NC) during a 2-hour stressful procedure involving frustration and provocation. RESULTS: Baseline levels of heart rate (HR) were significantly lower in the ODD group, but their HR levels were higher during provocation and frustration. Cortisol levels in the ODD group were overall lower than those of the NC group, and the effect of stress seemed to be minimal and similar for both groups; however, individual differences were large. Since anxiety plays an important mediating role in cortisol response, subjects were divided into one of four groups based on the intensity of their externalizing behavior and anxiousness. Cortisol increase due to stress exposure was strongest in highly externalizing and highly anxious subjects; cortisol decrease was strongest in those subjects who were high in externalizing behavior and low in anxiousness. CONCLUSIONS: The results of the study support an important role for hypothalamic-pituitary-adrenal axis sympathetic autonomic functioning in persistent antisocial behavior in young boys.

Aggression↗
PubMed1977

Recurrent abdominal pain: gaining control of the symptom.

The treatment of recurrent abdominal pain without organic cause requires that the families involved change their focus from organic to emotional issues. This is done during a family conference with the pediatrician, in which a positive approach to the problem is outlined. Following such a plan avoids the pitfalls of continuing an inappropriate and organically oriented response to the family's needs and also avoids threatening the family with emotionally charged personal needs too soon. When the transition period is successfully negotiated, the child's symptoms often are alleviated without further psychological intervention. In cases where further psychiatric intervention is indicated, a foundation has been laid for successful treatment. Nineteen patients have been successfully treated either by the pediatrician alone or have successfully begun psychotherapy, thus preventing unnecessary medical tests and further "doctor shopping", which characteristically accompanies such cases.

Abdomen↗
PubMed1989

Depressive characteristics of physically abused children.

Physically abused and nonabused children were compared on child-completed measures of depression, hopelessness, self-esteem, and locus of control. Results indicated that, in comparison with nonabused controls, abused children evidenced more depressive symptoms, heightened externality, lower self-esteem, and greater hopelessness about the future. Group differences in depressive symptomatology were not accounted for on the basis of differences in age, sex, race, gender, IQ, or socioeconomic status. Results replicate the results of Kazdin, Moser, Colbus, and Bell (1985) derived from a sample of physically abused psychiatric inpatients and extend the generality of these findings to abused children of nonpatient status. Implications of the findings for clinical interventions, theoretical models of child depression, and future research are discussed.

Adaptation, Psychological↗
PubMed1979

The structuring of interpersonal relations in schizophrenic adolescents: a decentering analysis of Thematic Apperception Test stories.

This study tested the hypothesis that schizophrenics employ more developmentally immature levels of decentering in their structuring of interpersonal relations. A 9-point scale of interpersonal decentering, developed originally by Feffer, was applied to Thematic Appercetion Test stories produced by schizophrenic adolescents and a control group of psychiatrically disturbed patients equivalent in age and intellectual functioning. Results provided convincing support for the hypothesis tested and suggest the theoretical utility of viewing interpersonal deficit in schizophrenia from a cognitive-developmental perspective.

Adolescent↗
PubMed1989

Social support of children of divorce: direct and stress buffering effects.

This study examined the direct and stress-buffering effects of support from family adults, nonfamily adults, family children, and nonfamily children on the adjustment of 104 children of divorce. For children's reports of adjustment, significant stress-buffering (i.e., Stress x Support) interactions for support from family adults and support from nonfamily adults occurred. The lower the level of social support, the stronger the positive relation between stress and adjustment problems. In addition, at high levels of stress, children with high support from nonfamily and family adults reported fewer adjustment problems than did children with low support. However, at the lowest level of stress, children with high support from nonfamily adults were significantly more poorly adjusted than were children with low support. For parental reports of children's adjustment, support from family adults was marginally positively related to adjustment whereas support from nonfamily adults was inversely related to adjustment. Implications for intervention programs for children of divorce are discussed.

Adaptation, Psychological↗
PubMed1991

Theory-based screening for prevention: focusing on mediating processes in children of divorce.

Prevention programs in mental health theoretically can benefit from selecting participants who have a greater likelihood of developing psychological problems because of their exposure to the putative mediators targeted for change in an intervention. Screening on mediators may increase statistical power to detect program effects, enhance the cost-effectiveness of intervention trials, and decrease the possibility of iatrogenic effects. The circumstances that optimize the strategy of screening on the basis of mediating variables are discussed, and data are presented to illustrate the development of a mediational selection strategy to identify families who might best benefit from a preventive intervention for children of divorce. In addition, we present evidence that adjustment problems for children experiencing a divorce, as with most mental health problems, are not the result of one specific factor, but are jointly determined by several mediating processes that occur subsequent to the divorce. The mediational selection strategy developed illustrates the utility of measuring a set of mediational processes central to conferring risk for mental health problems to children of divorce.

Adolescent↗
PubMed1991

Comparison of mediational selected strategies and sequential designs for preventive trials: comments on a proposal by Pillow et al.

Compared the strengths and weaknesses of a novel intervention design strategy called mediational selection, proposed by Pillow et al. (1991), with designs based on a sequence of trials, that is, those which build on prior work and at each stage are administered to subjects from subpopulations who have high risk or as yet poorly quantified risk. Both designs would be most useful in short-term preventive trials. The goals behind these two approaches, however, are quite different. Mediational selection strategies attempt to improve the chances that an intervention developed to modify theoretically important mediational factors will have significant impact by selecting a subject subpopulation that is expected to benefit the most. Sequential designs attempt to identify the extent to which an intervention succeeds or fails to work in subpopulations and allows for adjustment of the intervention to these subpopulations as necessary.

Child↗
PubMed1991

Mediational screening: is the benefit worth the cost?

Argued that Pillow et al. (1991) may have overestimated the benefits of mediational screening and underestimated the costs involved in the procedure. The three benefits they suggest: increased statistical power to detect prevention effects, increased cost-effectiveness, and decreased iatrogenic effects are shown to be modest at best. Costs associated with misclassifying people as either false positives or false negatives are considered in the total cost/benefit analysis of mediational screening. Because we cannot accurately predict who will react to the occurrence of life stress by developing the conditions we are interested in preventing, universal interventions are advocated.

Adaptation, Psychological↗
PubMed1991

Mediational screening in theory and in practice.

Pillow et al.'s (1991) argument for mediational selection omits discussion of what may be the strategy's greatest advantage, the early identification of risk. The theoretical benefits to prevention of identifying developmental processes are briefly noted here. At the same time, practical limitations of mediational selection are noted, particularly in relation to establishing and interpreting the correlation found between mediational and outcome variables. It is concluded that mediational selection is one, but only one, selection strategy worthy of consideration in prevention research.

Causality↗
PubMed1991

Mediational screening as a model for prevention research.

Examined here is Pillow, Sandler, Braver, Wolchik, and Gersten's (this issue) strategy for screening prevention trial participants. The reviewer concludes that their selection strategy should increase the statistical power of prevention outcome studies, increase intervention cost effectiveness, and help to prevent their possible iatrogenic effects. Also, their model points up inadequacies in the longitudinal data on which most prevention strategies are based, and their model could well serve as a template for future research.

Child↗
PubMed1996

The relations of thematic and nonthematic childhood depression measures to defensiveness and gender.

The susceptibility of self-report and thematic measures of depression to the effects of a defensive test-taking approach was assessed among 44 child and adolescent psychiatric inpatients. It was hypothesized that scores on a measure of defensiveness would be associated with self-reported but not thematic measures of depression, and furthermore, that this finding would be more pronounced for girls than boys. Patients completed the Lie Scale of the Revised Children's Manifest Anxiety Scale (RCMAS), the Children's Depression Inventory (CDI), and the Roberts Apperception Test for Children. As predicted, RCMAS-Lie scores were significantly associated with CDI but not Roberts Depression scores, and this effect was more pronounced among females, primarily due to the high CDI scores of nondefensive girls. Implications of results for psychological assessment of children and adolescents are discussed.

Adolescent↗
PubMed1984

A model of psychological dependence in adolescent substance abusers.

Adolescent substance abuse appears to have its foundations in a distortion of perceived events at an age prior to involvement with substances. Substances are used as a compromise in an attempt to establish a lifestyle which has meaning to the individual. Because the individual's involvement with a substance has taken place during the crucial developmental phase of adolescence, and because the use of drugs alters one's perception of one's social, emotional and cognitive state, any experience during this time must, by necessity, be distorted. At the same time, other experiences, necessary for natural development into adulthood, are forsaken . Thus, certain learned skills are replaced by those learned whilst under the influence of substances or as a reaction to the substance abusing lifestyle. The latter two often being inappropriate in drug-free situations. As the abuse of substances severely hampers the individual's natural development, a model of Developmental Habilitation is the essence of change.

Adolescent↗
PubMed1983

The child sexual abuse accommodation syndrome.

Child victims of sexual abuse face secondary trauma in the crisis of discovery. Their attempts to reconcile their private experiences with the realities of the outer world are assaulted by the disbelief, blame and rejection they experience from adults. The normal coping behavior of the child contradicts the entrenched beliefs and expectations typically held by adults, stigmatizing the child with charges of lying, manipulating or imagining from parents, courts and clinicians. Such abandonment by the very adults most crucial to the child's protection and recovery drives the child deeper into self-blame, self-hate, alienation and revictimization. In contrast, the advocacy of an empathic clinician within a supportive treatment network can provide vital credibility and endorsement for the child. Evaluation of the responses of normal children to sexual assault provides clear evidence that societal definitions of "normal" victim behavior are inappropriate and procrustean, serving adults as mythic insulators against the child's pain. Within this climate of prejudice, the sequential survival options available to the victim further alienate the child from any hope of outside credibility or acceptance. Ironically, the child's inevitable choice of the "wrong" options reinforces and perpetuates the prejudicial myths. The most typical reactions of children are classified in this paper as the child sexual abuse accommodation syndrome. The syndrome is composed of five categories, of which two define basic childhood vulnerability and three are sequentially contingent on sexual assault: (1) secrecy, (2) helplessness, (3) entrapment and accommodation, (4) delayed, unconvincing disclosure, and (5) retraction. The accommodation syndrome is proposed as a simple and logical model for use by clinicians to improve understanding and acceptance of the child's position in the complex and controversial dynamics of sexual victimization. Application of the syndrome tends to challenge entrenched myths and prejudice, providing credibility and advocacy for the child within the home, the courts, and throughout the treatment process. The paper also provides discussion of the child's coping strategies as analogs for subsequent behavioral and psychological problems, including implications for specific modalities of treatment.

Adaptation, Psychological↗