Validation of an online version of the Trier Social Stress Test in a study of adolescents

INTRODUCTION

The Trier Social Stress Test (TSST) is the most widely used protocol for activating a stress response of the hypothalamic-pituitary-adrenocortical (HPA) axis and other stress-mediating systems. A number of variants of the TSST exist, including ones for children, groups, and virtual reality. All of these versions, though, require in-person assessment. The COVID-19 pandemic has made in-person assessment impossible or extremely difficult and potentially dangerous. The purpose of this study was to validate a completely remote, online, version of the TSST for children.

METHOD

A sample of 68 (27 female) 15- and 16-year old participants were administered the TSST-Online (TSST-OL) during the late afternoon hours (3-6 p.m. start time). The participants, judges (one male, one female), and experimenter (female) all joined the assessment from their own homes via the online platform, ZOOM™. Two sessions were conducted, one to obtain consent, explain procedures, work with the family to arrange the computer and room set-up for the TSST-OL and one within two weeks to conduct the procedure. The participants were trained to take their own saliva samples and a saliva sampling kit was mailed to the home in between the first and second session. The samples were then mailed to the researchers within a day of collection. The participant was observed during saliva collection to determine correct procedures were followed. Salivary cortisol, salivary α-amylase and self-reports of stress were measured multiple times over the second session.

RESULTS

rmANOVAs yielded a significant effect of trials, for cortisol, F(1.37,90.46) = 15.13, p = .001, sAA, F(2.75,146.68) = 6.91, p = .001, and self-rated stress, F(3.43,222.69) = 118.73, p = .001. There were no significant sex by trials interactions for any measure, although females reported more stress than males, F(1,65) = 9.14, p = .004. For cortisol, from baseline to expected peak (30 min after the onset of speech preparation), the Cohen's effect size was dz = 0.57. Using 1.5 nmol/l (or 0.54 μg/dl) as the criterion for a response (Miller, Plessow, Kirschaum, & Stalder, 2013), 63% of the participants produced a significant increase in cortisol.

CONCLUSIONS

The responses to the TSST-OL are consistent with in-person responses among children and adolescents (see recent meta-analysis (Seddon et al., 2020). The protocol is a viable way of assessing reactivity of the HPA axis and other stress systems without needing to bring the participant into the research laboratory. This method will be useful during periods of widespread infection. It should also work to study populations who all live too far from the research laboratory to be assessed in person.

Conceptualization and Measurement of Adolescent Prosocial Behavior: Looking Back and Moving Forward

The struggle to cast a net around the numerous ways prosocial behavior is expressed lends itself to the absence of widely accepted methods of measurement. Additionally, research intent on evaluating the psychometric properties of current approaches has been somewhat limited. Weaving together seminal as well as contemporary research, the current review focuses on how these conceptual and measurement issues pertain to adolescent studies (in an intentional effort to offset the somewhat disproportionate focus directed toward prosocial development in infants, children, and adults). Recommendations to address current limitations and attain a more nuanced understanding of the construct are presented and discussed.

The association between role model presence and self-regulation in early adolescence: A cross-sectional study

PURPOSE

Self-regulation is the capacity to regulate attention, emotion, and behaviour to pursue long-term goals. The current study examined the associations between role model presence and self-regulation during early adolescence, controlling for hopefulness, using a large population-based data set from the Tokyo Teen Cohort study.

METHODS

Adolescents, aged 12 years, identified a role model using a single item on a paper questionnaire: 'Who is the person you most look up to?' Level of hopefulness was also assessed using a single question: 'To what extent do you feel hopeful about the future of your life?' Trained investigators evaluated self-regulation.

RESULTS

Of 2550 adolescents, 2279 (89.4%) identified a role model. After adjusting for level of hopefulness, identifying a role model was associated with higher levels of self-regulation in comparison to indications of no role model. Hopeful future expectations were also associated with higher self-regulation; however, the beta coefficient was smaller than role model presence in the multivariate linear regression analysis.

CONCLUSIONS

Role model presence was significantly associated with higher self-regulation among early adolescents. Educational environments should focus on support for adolescents with no role models.

Why Digital Tools Have Not Yet Revolutionized Adolescent Health Research and What We Can Do

The promise of digital tools and devices for spurring new discoveries in adolescence research is enticing. Notably, this special section draws attention to many of the advantages that mobile and wearable devices offer for ambulatory assessment research, which have now been realized. Despite such progress, digital tools have not yet delivered on their predicted revolution of adolescent health research. I offer four reasons for why digital devices have fallen short of this predicted promise. For each barrier, I suggest parallel strategies for ensuring adolescent research benefits from Ambulatory Assessment advances. To avoid being left behind, adolescence scholarship must develop in time with innovations in digital devices and platforms, which are moving forward to support basic science and interventions in mental health.

Older Adolescents' Understanding of Participant Rights in the BlackBerry Project, a Longitudinal Ambulatory Assessment Study

For a long-term, longitudinal study that used BlackBerry smartphones for passive ambulatory assessment among older adolescents, this study focused on three areas of ethical concern: (1) adolescents' competence to give assent; (2) understanding of confidentiality, the protection of information, and project goals; and (3) awareness of procedures and benefits, and comfort with the research design. One hundred and seventy-eight participants were 17 and 18 years old (84 girls). Results suggested that participants freely gave consent and understood most, but not all of the informed consent information. Participants reported a high level of satisfaction. Participants showed less understanding of when their confidentiality would be broken and how data would be protected.

A Review of Current Ambulatory Assessment Studies in Adolescent Samples and Practical Recommendations

The use of ambulatory assessment (AA) and related methods (experience sampling, ecological momentary assessment) has greatly increased within the field of adolescent psychology. In this guide, we describe important practices for conducting AA studies in adolescent samples. To better understand how researchers have been implementing AA study designs, we present a review of 23 AA studies that were conducted in adolescent samples from 2017. Results suggest that there is heterogeneity in how AA studies in youth are conducted and reported. Based on these insights, we provide recommendations with regard to participant recruitment, sampling scheme, item selection, power analysis, and software choice. Further, we provide a checklist for reporting on AA studies in adolescent samples that can be used as a guideline for future studies.

The Varieties of Religious Significance: An Idiographic Approach to Study Religion's Role in Adolescent Development

We present a rationale and method for taking an idiographic approach to study the role religion plays in adolescent development. We theorize that adolescents harness qualitatively different aspects of religion to address idiosyncratic developmental needs. Therefore, analyzing religion's role in adolescent development necessitates a case-by-case holistic analysis. We introduce a systematic method using narratives to identify the personal ways that individuals attribute meaning in general and regarding religion in particular. We present three detailed case studies from a sample of 20 religious Israeli Jewish Orthodox emerging-adult women who provided retrospective narrative accounts of their general and religious development through adolescence. Systematic analysis reveals that religion was significant to these women in diverse and personal ways, addressing markedly different adolescent developmental needs.

Dialogue intervention to youth amidst intractable conflict attenuates stress response to outgroup

Encounter with outgroup has been shown to elicit physiological stress response and when outgroup is perceived as threatening to one's own family and community, stress is higher. In such contexts, becoming familiar and learning to empathize with the other side may reduce stress. Building on the long-lasting Israeli-Palestinian conflict, we developed an eight-week group intervention focused on dialogue and empathy and tested it within a randomized controlled trial. Eighty-eight Israeli-Jewish and Arab-Palestinian adolescents (16-18 years) were randomly assigned to intervention or control groups. Before(T1) and after(T2) intervention, one-on-one interaction with outgroup member was videotaped, cortisol levels assessed five times during a 2.5-hour session involving exposure to outgroup stimuli, and adolescents were interviewed regarding national conflict. Intervention reduced cortisol response to social contact and reminders of outgroup (F = 4.92, p = .032, Eta² = 0.109). This HPA-activity suppression was defined by two pathways. First, intervention had a direct impact on cortisol decrease; and second, intervention increased youth's behavioral empathy during one-on-one interaction with outgroup member and this empathic response mediated the effect of intervention on cortisol reduction. Adolescents' belief in the potential for reconciliation at T1 predicted greater empathy at T2. Our study provides the first evidence-based intervention for youth growing up amidst intractable conflict and demonstrates its impact on adolescents' physiological stress response to outgroup. Results contribute to research on the neurobiology of ingroup/outgroup relations, highlight the key role of dialogical empathy and social interactions for interventions targeting youth, and emphasize the importance of enhancing motivation for social inclusion for initiating positive behavioral and physiological processes. Clinical Trials Registry (NCT02122887; https://clinicaltrials.gov).

The Influence of Parent and Parent-Adolescent Relationship Characteristics on Sexual Trajectories into Adulthood

To examine sexual partner acquisition into young adulthood and to explore what characteristics of the adolescent family context might predict this change, we used growth curve modeling to examine data from a nationally representative sample of adolescents followed longitudinally over 13 years through young adulthood (N = 5385). Growth curve modeling allowed us to treat the outcome as a dynamic variable and to examine 10 potential predictors of change while accounting for the nested nature of the data. Six family characteristics emerged as predictors of mean number of partners and rate of partner acquisition, while accounting for three significant adolescent predictors. Living in a single-parent or blended family and general communication about sex predicted higher lifetime number of sexual partners in young adulthood. Parent religiosity, parent disapproval of adolescent engagement in sex, and parent-adolescent connectedness were predictive of lower lifetime number of sexual partners. By following participants into their late twenties and early thirties, we were able to detect changes in the impact of early family factors that are not apparent in studies restricted to adolescents and emerging adults. For example, parent education, parent disapproval, and parent-adolescent connectedness were associated with higher rates of partner acquisition at age 23, but faster deceleration in partner acquisition as time progressed. Communication about negative consequences of sex was not predictive, regardless of whether it was "on time" (before sexual intercourse) or not. These results reveal that parents have significant, and sometimes unexpected, influence on their children's sexual behavior that persists well into adulthood.

Alexithymic traits can explain the association between puberty and symptoms of depression and anxiety in adolescent females

Symptoms of internalizing disorders such as depression and anxiety increase in adolescence, especially in females. However, gender differences in depression and anxiety symptoms emerge only after puberty onset. Levels of alexithymia, characterized by difficulties identifying and describing one's emotions, are elevated in depression and anxiety, and fluctuate across adolescence in a gender-specific manner. This study investigated changes in alexithymia across adolescence, and explored the potential role of alexithymia in the development of depression and anxiety, separately for females and males. Accordingly, 140 adolescents aged 11 to 21 years (77 female) completed self-report measures of alexithymia, depression and anxiety, and pubertal development. For females alone, pubertal maturation was associated with alexithymic traits (specifically difficulties identifying and describing feelings), as well as symptoms of depression and anxiety. After accounting for alexithymia, the relationship between puberty and depression and anxiety was absent or reduced in females. Thus, alexithymic traits may have differential consequences for males and females, and possibly contribute towards increased depression and anxiety symptoms in females during adolescence. We propose that developmental changes in alexithymia should be considered when studying the onset and development of internalizing psychological disorders during adolescence.

Perceived Expressed Emotion, Emotional and Behavioral Problems and Self-Esteem in Obese Adolescents: A Case-Control Study

Objective

Obesity is a chronic disease which leads to medical and psychiatric complications. Family climate is a critical factor in the treatment of obesity and comorbid psychiatric disorders. In our study, perceived expressed emotion (EE), psychopathology, self-esteem and emotional and behavioural problems (BP) among obese adolescents were investigated and compared with their non-obese peers.

Methods

The subjects were 49 obese adolescents and 47 non-obese adolescents served as the control group. All participants were requested to fill out the Socio-demographic Data Form, Shortened Level of Expressed Emotion Scale, Rosenberg Self-Esteem Scale, Strength and Difficulties Questionnaire-Adolescent Form.

Results

In our study, obese adolescents showed a significant difference in perceived EE (p<0.001). Subscales of EE, such as Lack of Emotional Support (p<0.001), intrusiveness (p<0.001), irritability (p<0.001), self-esteem (p<0.001), emotional and BP (p<0.001), attention deficit-hyperactivity disorder (p<0.001), problems in peer relationships (p<0.001) and social skills (p<0.001) were significantly worse when compared with the control group. There was a strong relationship between EE and emotional and BP and self-esteem.

Conclusion

The higher rate of perceived EE, psychopathology and low self-esteem among obese adolescents showed that obesity prevention and treatment are also crucial for good mental health in adolescents. The important role of the family in mental health of obese adolescents was emphasized. It was shown that identification of risk factors in childhood that promote obesity should be done so that targeted intervention and prevention programs can be developed.

Investigating the Comparability of Two Multi-Item-Scales for Cyber Bullying Measurement

In current cyberbullying literature, researchers assess the phenomenon using a large variety of measurement approaches. This poses a problem in light of comparability of study results. The most common approaches are singular global questions or multi-item scales that list several forms of cyberbullying. Such lists contain either different types of actions or different types of media. This study explores different measurement approaches. Two multi-item scales, one listing different actions and one listing different media, are compared to investigate whether they measure the same latent construct. Confirmatory factor analysis is used to model one factor for each of the multi-item scales. In the first study, the items cover victimization experiences while in the second study they cover estimation of severity. Results show that the two different multi-item scales measure the same latent construct. These results have a substantial impact on the future of cyberbullying research with regard to study comparability.

Open-ended responses from early adolescents: Method matters

This study investigates whether the length and pattern of early adolescents' (N = 261) responses to open-ended self-reflective questions varied according to data collection method: paper and pencil versus online survey. Adolescent students' (N_paper = 157; N_computer = 104) responses from a suburban, United States sample of fifth grade students were significantly longer on computerized surveys than on paper surveys. Students provided higher quality responses (i.e., lexically richer) on the computerized survey. Findings were consistent when responses were relevant to two subject areas: mathematics and reading. Results suggest that the use of computerized survey methods in psychological research with early adolescent samples is both appropriate and valuable.

Adolescent psychopathology in times of change: Introduction to the special issue

The aim of this special issue is to understand better the many changes in adolescent psychopathology have taken place over the last decades. The factors associated with adjustment problems and psychopathology in adolescence today are not necessarily the same as the factors that predicted problems and psychopathology in the past. But the basic strategies for connecting negative experiences with adolescent psychopathology remain as important today as they were for understanding adolescent psychopathology decades ago. This is well exemplified in the studies included in this Special Issue. What all this studies have in common is that parenting and the family environment are assumed to play a key role in adolescents' adjustment and psychopathology. Finally, given that all papers in this special issue are based on conference presentations at the 15th Biennial Conference of the European Association for Research on Adolescence (EARA), some more information on that conference in included in this introduction.

Adolescent values for immunisation programs in Australia: A discrete choice experiment

Objectives

The importance of adolescent engagement in health decisions and public health programs such as immunisation is becoming increasingly recognised. Understanding adolescent preferences and further identifying barriers and facilitators for immunisation acceptance is critical to the success of adolescent immunisation programs. This study applied a discrete choice experiment (DCE) to assess vaccination preferences in adolescents.

Methods

This study was conducted as a cross-sectional, national online survey in Australian adolescents. The DCE survey evaluated adolescent vaccination preferences. Six attributes were assessed including disease severity, target for protection, price, location of vaccination provision, potential side effects and vaccine delivery method. A mixed logit model was used to analyse DCE data.

Results

This survey was conducted between December 2014 and January 2015. Of 800 adolescents aged 15 to 19 years, stronger preferences were observed overall for: vaccination in the case of a life threatening illness (p<0.001), lower price vaccinations (p<0.001), mild but common side effects (p = 0.004), delivery via a skin patch (p<0.001) and being administered by a family practitioner (p<0.001). Participants suggested that they and their families would be willing to pay AU$394.28 (95%CI: AU$348.40 to AU$446.92) more for a vaccine targeting a life threatening illness than a mild-moderate illness, AU$37.94 (95%CI: AU$19.22 to AU$57.39) more for being vaccinated at a family practitioner clinic than a council immunisation clinic, AU$23.01 (95%CI: AU$7.12 to AU$39.24) more for common but mild and resolving side effects compared to rare but serious side effects, and AU$51.80 (95%CI: AU$30.42 to AU$73.70) more for delivery via a skin patch than injection.

Conclusions

Consideration of adolescent preferences may result in improved acceptance of, engagement in and uptake of immunisation programs targeted for this age group.

Strategies for fostering basic psychological needs support in high quality youth leadership programs

Youth leadership programming has become an increasingly common context to foster basic psychological needs and promote youth development. The purpose of this qualitative study was to explore strategies involved in fostering youth needs support within six leadership programs. Two leaders and 30 youth participated in semi-structured interviews to better understand the strategies used to foster needs support. Findings revealed that leaders were able to foster a sense of relatedness among youth through building trusting adult-youth relationships and nurturing an inclusive environment. Maximizing choice and negotiating youth voice helped to foster youth's autonomy. Finally, creating a task-oriented climate and providing intentional opportunities for skill-building helped to foster youth's competence. Findings suggest that training for leaders is critical in understanding what, and how strategies should be employed to help foster youth needs support in leadership programming. Limitations and future directions are outlined.

The validity of the multi-informant approach to assessing child and adolescent mental health

Child and adolescent patients may display mental health concerns within some contexts and not others (e.g., home vs. school). Thus, understanding the specific contexts in which patients display concerns may assist mental health professionals in tailoring treatments to patients' needs. Consequently, clinical assessments often include reports from multiple informants who vary in the contexts in which they observe patients' behavior (e.g., patients, parents, teachers). Previous meta-analyses indicate that informants' reports correlate at low-to-moderate magnitudes. However, is it valid to interpret low correspondence among reports as indicating that patients display concerns in some contexts and not others? We meta-analyzed 341 studies published between 1989 and 2014 that reported cross-informant correspondence estimates, and observed low-to-moderate correspondence (mean internalizing: r = .25; mean externalizing: r = .30; mean overall: r = .28). Informant pair, mental health domain, and measurement method moderated magnitudes of correspondence. These robust findings have informed the development of concepts for interpreting multi-informant assessments, allowing researchers to draw specific predictions about the incremental and construct validity of these assessments. In turn, we critically evaluated research on the incremental and construct validity of the multi-informant approach to clinical child and adolescent assessment. In so doing, we identify crucial gaps in knowledge for future research, and provide recommendations for "best practices" in using and interpreting multi-informant assessments in clinical work and research. This article has important implications for developing personalized approaches to clinical assessment, with the goal of informing techniques for tailoring treatments to target the specific contexts where patients display concerns. (PsycINFO Database Record

The validity of the multi-informant approach to assessing child and adolescent mental health

Child and adolescent patients may display mental health concerns within some contexts and not others (e.g., home vs. school). Thus, understanding the specific contexts in which patients display concerns may assist mental health professionals in tailoring treatments to patients' needs. Consequently, clinical assessments often include reports from multiple informants who vary in the contexts in which they observe patients' behavior (e.g., patients, parents, teachers). Previous meta-analyses indicate that informants' reports correlate at low-to-moderate magnitudes. However, is it valid to interpret low correspondence among reports as indicating that patients display concerns in some contexts and not others? We meta-analyzed 341 studies published between 1989 and 2014 that reported cross-informant correspondence estimates, and observed low-to-moderate correspondence (mean internalizing: r = .25; mean externalizing: r = .30; mean overall: r = .28). Informant pair, mental health domain, and measurement method moderated magnitudes of correspondence. These robust findings have informed the development of concepts for interpreting multi-informant assessments, allowing researchers to draw specific predictions about the incremental and construct validity of these assessments. In turn, we critically evaluated research on the incremental and construct validity of the multi-informant approach to clinical child and adolescent assessment. In so doing, we identify crucial gaps in knowledge for future research, and provide recommendations for "best practices" in using and interpreting multi-informant assessments in clinical work and research. This article has important implications for developing personalized approaches to clinical assessment, with the goal of informing techniques for tailoring treatments to target the specific contexts where patients display concerns. (PsycINFO Database Record

Using arterial spin labeling to examine mood states in youth

INTRODUCTION

Little is known about the neural correlates of mood states and the specific physiological changes associated with their valence and duration, especially in young people. Arterial spin labeling (ASL) imaging is particularly well-suited to study sustained cerebral states in young people, due to its robustness to low-frequency drift, excellent interscan reliability, and noninvasiveness. Yet, it has so far been underutilized for understanding the neural mechanisms underlying mood states in youth.

METHODS

In this exploratory study, 21 healthy adolescents aged 16 to 18 took part in a mood induction experiment. Neutral, sad, and happy mood states were induced using film clips and explicit instructions. An ASL scan was obtained following presentation of each film clip.

RESULTS

Mood induction led to robust changes in self-reported mood ratings. Compared to neutral, sad mood was associated with increased regional cerebral blood flow (rCBF) in the left middle frontal gyrus and anterior prefrontal cortex, and decreased rCBF in the right middle frontal gyrus and the inferior parietal lobule. A decrease in self-reported mood from neutral to sad condition was associated with increased rCBF in the precuneus. Happy mood was associated with increased rCBF in medial frontal and cingulate gyri, the subgenual anterior cingulate cortex, and ventral striatum, and decreased rCBF in the inferior parietal lobule. The level of current self-reported depressive symptoms was negatively associated with rCBF change in the cerebellum and lingual gyrus following both sad and happy mood inductions.

CONCLUSIONS

Arterial spin labeling is sensitive to experimentally induced mood changes in healthy young people. The effects of happy mood on rCBF patterns were generally stronger than the effects of sad mood.

Emotion recognition specialization and context-dependent risk of anxiety and depression in adolescents

BACKGROUND

Some adolescents function poorly in apparently benign environments, while others thrive despite hassles and difficulties. The aim of this study was to examine if adolescents with specialized skills in the recognition of either positive or negative emotions have a context-dependent risk of developing an anxiety or depressive disorder during adolescence, depending on exposure to positive or harsh parenting.

METHODS

Data came from a large prospective Dutch population study (N = 1539). At age 11, perceived parental rejection and emotional warmth were measured by questionnaire, and emotion recognition skills by means of a reaction-time task. Lifetime diagnoses of anxiety and depressive disorders were assessed at about age 19, using a standardized diagnostic interview.

RESULTS

Adolescents who were specialized in the recognition of positive emotions had a relatively high probability to develop an anxiety disorder when exposed to parental rejection (Bspecialization*rejection = 0.23, P < 0.01) and a relatively low probability in response to parental emotional warmth (Bspecialization*warmth = -0.24, P = 0.01), while the opposite pattern was found for specialists in negative emotions. The effect of parental emotional warmth on depression onset was likewise modified by emotion recognition specialization (B = -0.13, P = 0.03), but the effect of parental rejection was not (B = 0.02, P = 0.72). In general, the relative advantage of specialists in negative emotions was restricted to fairly uncommon negative conditions.

CONCLUSIONS

Our results suggest that there is no unequivocal relation between parenting behaviors and the probability to develop an anxiety or depressive disorder in adolescence, and that emotion recognition specialization may be a promising way to distinguish between various types of context-dependent reaction patterns.

[Check-ups and screening for young people: what is reasonable with respect to psychiatric disorders?]

BACKGROUND

Severe mental illnesses become manifested early in life. First episodes are suffered in young adulthood at the latest and early symptoms and signs are often already reported in childhood and adolescence. Therefore, it is exactly these adolescents and young adults who have to be reached to detect signs early.

OBJECTIVES

In this article the check-ups and screening procedures routinely offered for this target group as well as the role of groups of persons who accompany young people in a variety of contexts are illustrated. Potential extensions with elements and structures for the early recognition of severe mental illnesses are outlined.

RESULTS

With the integration of psychiatric peculiarities and drug consumption into the diagnostic battery of the first adolescence healthcare examination (Jugendgesundheitsuntersuchung J1), the often already established familiarity of young persons and the waiving of costs by the health insurances, the J1 seems to be well-suited to provide a rough screening for precursor stages and risk factors for the development of severe mental illnesses and for the detection of a suspected manifest mental disorder. The primary role of most persons working with young people is to be a contact partner and to help transferring the person to the adequate service. Several early recognition centers were founded in Germany to offer low-threshold contact services in the view of existing barriers to care for help-seeking young persons and to provide the complex diagnostics.

CONCLUSIONS

The adolescence healthcare examinations can be a useful element for early detection of mental disorders and damaging behavior if the utilization rate is high and actions taken in case of suspected beginning disorder/damaging behavior are evaluated. To date, screening instruments for psychiatric disorders should not be used in wide population classes without group-specific targets and without direct contact between therapists and patients. Already established preventive services and initiatives should be interlinked. The health effects of the actions have to be analyzed.

[Early detection to prevent mental illness during adolescence: ethical and theoretical considerations]

In the face of changes that characterise adolescence, a number of youth experience ill-being, as part of a normal developmental process. For some of them, however, this ill-being may represent early signs of a psychopathological process. Regarding depression and psychosis, such early signs are non-specific, which complicates and delays treatment. In addition, issues such as stigmatization and unfamiliarity with these psychopathologies represent major obstacles to treatment access. Attempts to early detection, which involves identifying risk factors in order to provide support and follow-up, making an effort to take these clinical signs seriously, while at the same time avoiding to mistake a normal developmental process for a pathological condition.

Friends or foes? Relational dissonance and adolescent psychological wellbeing

The interaction of positive and negative relationships (i.e. I like you, but you dislike me - referred to as relational dissonance) is an underexplored phenomenon. Further, it is often only poor (or negative) mental health that is examined in relation to social networks, with little regard for positive psychological wellbeing. Finally, these issues are compounded by methodological constraints. This study explores a new concept of relational dissonance alongside mutual antipathies and friendships and their association with mental health using multivariate exponential random graph models with an Australian sample of secondary school students. Results show male students with relationally dissonant ties have lower positive mental health measures. Girls with relationally dissonant ties have lower depressed mood, but those girls being targeted by negative ties are more likely to have depressed mood. These findings have implications for the development of interventions focused on promoting adolescent wellbeing and consideration of the appropriate measurement of wellbeing and mental illness.

Understanding students' perceptions of a high school course designed to enhance school connectedness

BACKGROUND

This study was a part of an evaluation of a 4-year high school course to enhance students' school connectedness from freshman to senior year with primarily an Asian and Pacific Islander student body in Hawai'i. The purpose of this study was to understand how the course may impact students' sense of school connectedness and identify factors important in course effectiveness.

METHODS

Focus group guides were developed in collaboration with course instructors. Approximately 70 students from each grade level were randomly selected to participate in focus groups. All focus groups occurred during the 30-minute lunch period and lunch was provided.

RESULTS

Focus groups conducted with 67 students revealed that students perceive teachers to play an essential role in the effectiveness of the course. Students also viewed the small class size and staying in the same class for all 4 years as important components in supporting the relationship-building aspect of the course, which enhances students' level of academic motivation and school involvement. Suggestions for ways that teachers can help build students' sense of school connectedness through the course included integrating their personal experiences into the lessons and facilitating more interactive discussions and team-building activities.

CONCLUSION

Our findings suggest that students recognize the course as a valuable opportunity to build personal relationships that are essential to their sense of school connectedness. Schools should make more effort at incorporating strategies that build students' sense of school connectedness by providing relationship-building opportunities.

Assessing resilience: a review of measures across the life course

Through this systematic review the authors analyze scales used to measure resilience in individuals across the life course. The scales were obtained according to a priori inclusion criteria through searches using electronic databases, cited references, and requests to human services researchers currently engaged in research utilizing a resiliency theory framework. Eleven measurement tools meeting study inclusion criteria were located within the existing literature. Currently validated instruments measure specific populations and vary in length and format. The need for an analytical approach to measuring resilience is long overdue. This assessment is intended to aid social work practitioners working with populations that have faced adversity.

Comparing factor structures of adolescent psychopathology

Research on the structure of adolescent psychopathology can provide information on broad factors that underlie different forms of maladjustment in youths. Multiple studies from the literature on adult populations suggest that 2 factors, Internalizing and Externalizing, meaningfully comprise the factor structure of adult psychopathology (e.g., Krueger, 1999) and presumably represent broad vulnerability for co-occurring disorders. Though this research was partially inspired by early work with children and adolescents (e.g., Achenbach & Edelbrock, 1984), the role of substance use in these models of youth psychopathology has not been fully explored. Toward this goal, we recruited 223 youths (10-17 years of age, M = 14.2) from mental health agencies and the community. We found evidence for a 3-factor model of youth psychopathology, including Internalizing (depression, generalized anxiety), Externalizing (conduct disorder, attention deficit, oppositional defiant disorder), and Substance Use (alcohol and cannabis). The 3-factor model showed the best fit to the data relative to other factor models tested, including across subsamples of adolescents who differed on level of psychopathology (treatment vs. community samples). Implications for the structure of adolescent psychopathology, including important developmental considerations, are discussed.

A longitudinal examination of factors predicting anxiety during the transition to middle school

The transition from elementary to middle or junior high school is commonly regarded as a period of stress and turmoil for young adolescents, and has been associated with changes in anxiety and other psychological problems. However, less is known about risk and resilience factors that may predict these changes. This study examined changes in anxiety, as well as predictors of these changes among 77, predominantly Caucasian (88%), male and female (52%) adolescents from Grades 6 to 8. Repeated measures analysis of variance was conducted to examine the predicted grade and gender differences. Multiple regression analyses were conducted to examine the prediction of eighth grade anxiety symptoms by sixth grade self-worth, perceived social acceptance, and social support, as well as the potential moderating role of gender in these relations. Results suggested a significant decrease in anxiety, particularly social anxiety, over this period for boys but not girls. Examination of predictors of changes in anxiety suggested that, in general, global self-worth, social acceptance, and gender were each associated with overall and social anxiety. Findings are integrated with extant literature on developmental changes associated with anxiety and school transitions and clinical implications of these findings are discussed.

Six-year follow-up of a preventive intervention for parentally bereaved youths: a randomized controlled trial

OBJECTIVE

To evaluate the efficacy of the Family Bereavement Program (FBP) to prevent mental health problems in parentally bereaved youths and their parents 6 years later.

DESIGN

Randomized controlled trial.

SETTING

Arizona State University Prevention Research Center from November 2002 to July 2005.

PARTICIPANTS

Two hundred eighteen bereaved youths (89.34% of 244 enrolled in the trial 6 years earlier) and 113 spousally bereaved parents.

INTERVENTIONS

The FBP includes 12 group sessions for caregivers and youths; the literature control (LC) condition includes bereavement books for youths and caregivers.

MAIN OUTCOME MEASURES

Comparisons of youths in the FBP and LC on a measure of mental disorder diagnosis, 5 measures of mental health problems, and 4 measures of competent functioning; and comparisons of spousally bereaved parents on 2 measures of mental health problems.

RESULTS

Youths in the FBP as compared with those in the LC had significantly lower externalizing problems as reported by caregivers and youths (adjusted mean, -0.06 vs 0.13, respectively; P = .02) and on teacher reports of externalizing problems (adjusted mean, 52.69 vs 56.27, respectively; P = .001) and internalizing problems (adjusted mean, 47.29 vs 56.27, respectively; P = .002), and they had higher self-esteem (adjusted mean, 33.93 vs 31.91, respectively; P = .005). Parents in the FBP had lower depression scores than those in the LC (adjusted mean, 5.48 vs 7.83, respectively; P = .04). A significant moderated program effect indicated that for youths with lower baseline problems, the rate of diagnosed mental disorder was lower for those in the FBP than in the LC.

CONCLUSION

This study demonstrates efficacy of the FBP to reduce mental health problems of bereaved youths and their parents 6 years later.

TRIAL REGISTRATION

clinicaltrials.gov Identifier: NCT01008189.

A typology of youth participation and empowerment for child and adolescent health promotion

Research suggests that increasing egalitarian relations between young people and adults is optimal for healthy development; however, the empirical assessment of shared control in youth-adult partnerships is emerging, and the field still requires careful observation, identification, categorization and labeling. Thus, our objective is to offer a conceptual typology that identifies degrees of youth-adult participation while considering the development potential within each type. We use an empowerment framework, rooted in evidence-based findings, to identify five types of youth participation: (1) Vessel, (2) Symbolic, (3) Pluralistic, (4) Independent and (5) Autonomous. The typology is constructed as a heuristic device to provide researchers, practitioners and policy-makers with a common language for articulating degrees of youth participation for optimal child and adolescent health promotion.

Youth ReACT for Social Change: a method for youth participatory action research

Although participatory action research has become an increasingly popular method with youth, involving them in problem identification, analysis, intervention, and/or feedback, few PAR projects tend to involve youth in all of these phases-particularly the data analysis phase. Yet involvement in the data analysis phase of a research effort can help to promote critical awareness of the targeted issues, potentially increasing the effectiveness of subsequent PAR stages. In addition, although many YPAR projects aim to promote the critical consciousness of their youth participants, some projects struggle to promote this awareness, often because the methods used are not well matched to the developmental needs of their participants. In this paper we present the ReACT Method, a PAR approach specifically designed to promote local knowledge production and critical consciousness by engaging youth in the problem identification, data analysis, and feedback stages of research. Given the lack of attention in the literature to the methods used for engaging youth in these processes, we provide detailed descriptions of the methods we developed to engage youth in problem identification and qualitative data analysis.

Long-Term Outcomes of an Australian Universal Prevention Trial of Anxiety and Depression Symptoms in Children and Youth: An Evaluation of the Friends Program

This study evaluated the long-term effectiveness of the FRIENDS Program in reducing anxiety and depression in a sample of children from Grade 6 and Grade 9 in comparison to a control condition. Longitudinal data for Lock and Barrett's (2003) universal prevention trial is presented, along with data from 12-month follow-up to 24- and 36-month follow-up. Results of this study indicate that intervention reductions in anxiety reported in Lock and Barrett were maintained for students in Grade 6, with the intervention group reporting significantly lower ratings of anxiety at long-term follow-up. A significant Time x Intervention Group x Gender Effect on Anxiety was found, with girls in the intervention group reporting significantly lower anxiety at 12-month and 24-month follow-up but not at 36-month follow-up in comparison to the control condition. Results demonstrated a prevention effect with significantly fewer high-risk students at 36-month follow-up in the intervention condition than in the control condition. Results are discussed within the context of prevention research.

Conceptualization and measurement of coping during adolescence: a review of the literature

PURPOSE

The purpose of this review was to examine the conceptualization and measurement of coping in adolescent research.

DESIGN

A review of the literature published and abstracted in four scientific databases was undertaken between July 2008 and June 2009 with the following key words: adolescent(s), cope/coping, stress(ors), and adaptation/psychological.

METHODS

A total of 367 articles were initially identified, and review of published abstracts yielded 104 empirical articles to retrieve and examine more closely for inclusion. Criteria for inclusion in the review were that the study (a) measured coping, (b) presented original data, (c) primarily targeted adolescent participants, (d) was reported in English, and (e) was published between 1998 and June 2009. Fifty-nine subsequent articles were organized using a matrix approach that facilitated cross-study comparisons of purpose, sample, and dependent variables.

FINDINGS

Fewer than half of the studies reviewed included a specific statement defining coping. Instead, many authors described coping in the context of stress response by identifying particular types or ways of coping or naming specific coping strategies used. The theoretical frameworks guiding examination of coping varied across studies. A range of measures, congruent with adolescent developmental processes, were used to assess adolescent coping. A wide range of stress-related risks or conditions were examined, including psychological stressors such as eating disorders, suicidal ideation, and depression; physical stressors such as chronic illness, HIV infection, sports participation, violence, or sexual abuse; familial stressors such as domestic violence or interparental conflict; social stressors such as romantic relationships or difficulties in settings such as school, prison, or a homeless shelter; and societal stressors such as discrimination.

CONCLUSIONS

Coping is an important construct in understanding how adolescents react to the extensive stressors and adjustments they experience. Coping is a complex construct yet worthy of examination because it can be a critical point of intervention in the health trajectory of adolescents and young people. Research is needed to advance the conceptualization and measurement of adolescent coping such that interpretation of findings across studies is enhanced. In this way, future research, including interventions targeting coping, will work synergistically to advance the science and adolescent well-being.

CLINICAL RELEVANCE

Nursing and other healthcare providers working with adolescents understand the need for interventions that promote use of healthy coping strategies and minimize unhealthy coping. Findings from this study demonstrate the state of coping conceptualization and measurement in adolescent research and indicate a need for research that will advance the science and improve the usefulness of adolescent coping data.

Factors associated with use of evidence-based practice strategies in usual care youth psychotherapy

The purpose of this study was to gain an understanding of how therapists providing usual care (UC) psychotherapy are using elements of treatment common to evidence-based practices (EBPs) for children with disruptive behavior disorders (DBPs) and to identify client and therapist characteristics that may be associated with EBP strategies directed toward children and those directed to their caregivers. Results indicate that certain child, family, and therapist characteristics are associated with use of EBP strategies; however, much of the variability in practice was not explained by the variables examined. These findings highlight the complexity of UC psychotherapy and provide directions for future research on implementation of EBPs in UC.

Psychometric properties of the Swedish PedsQL, Pediatric Quality of Life Inventory 4.0 generic core scales

AIM

To study the psychometric performance of the Swedish version of the Pediatric Quality of Life Inventory (PedsQL) 4.0 generic core scales in a general child population in Sweden.

METHODS

PedsQL forms were distributed to 2403 schoolchildren and 888 parents in two different school settings. Reliability and validity was studied for self-reports and proxy reports, full forms and short forms. Confirmatory factor analysis tested the factor structure and multigroup confirmatory factor analysis tested measurement invariance between boys and girls.

RESULTS

Test-retest reliability was demonstrated for all scales and internal consistency reliability was shown with alpha value exceeding 0.70 for all scales but one (self-report short form: social functioning). Child-parent agreement was low to moderate. The four-factor structure of the PedsQL and factorial invariance across sex subgroups were confirmed for the self-report forms and for the proxy short form, while model fit indices suggested improvement of several proxy full-form scales.

CONCLUSION

The Swedish PedsQL 4.0 generic core scales are a reliable and valid tool for health-related quality of life (HRQoL) assessment in Swedish child populations. The proxy full form, however, should be used with caution. The study also support continued use of the PedsQL as a four-factor model, capable of revealing meaningful HRQoL differences between boys and girls.

Parenting and psychological adjustment of adolescent immigrants in Israel

Parental and familial factors and their association with adolescents' mental health were examined among former Soviet Union (FSU) immigrants and nonimmigrants in Israel. Questionnaires regarding parental control, inconsistency, and rejection, in addition to adolescent-family connectedness and psychological disorders, were administered to 83 FSU immigrants and 106 nonimmigrant adolescents. According to the results, FSU adolescents are less connected to their families, experience their parents as less warm and more inconsistent in their childrearing behavior, report that their mothers subject them to a higher level of control, and the psychological disorders among them are more widespread than among nonimmigrant adolescents. Maternal control, maternal temporal inconsistency, and maternal and paternal rejection were associated with psychological disorders only among nonimmigrant adolescents. No such association was found among FSU adolescents, suggesting that FSU mental health problems are associated with immigration and cultural and social factors, rather than parental and familial factors. A comprehensive intervention program is required to provide support and assistance to help immigrants overcome their psychological distresses.

Coping and coping effectiveness in relation to a competitive sport event: pubertal status, chronological age, and gender among adolescent athletes

An aim of this paper was to discover whether athletes of different pubertal status, chronological age, and gender reported distinct coping strategies in response to stress during a competitive event in their sport. A secondary aim was to examine pubertal status group, chronological age, and gender differences in coping effectiveness. Participants were adolescent athletes (n = 527), classified as beginning-pubertal (n = 59), midpubertal (n = 189), advanced-pubertal (n = 237), and postpubertal (n = 22). Findings revealed that there were small, but significant differences in how athletes of different pubertal status and chronological age coped. There were also significant differences between how athletes of different pubertal status perceived the effectiveness of their coping strategies. Interestingly, our results suggested that the relationship between pubertal status and coping and coping effectiveness is different from the relationship between chronological age and coping and coping effectiveness.

Parent-child acculturation, parenting, and adolescent depressive symptoms in Chinese immigrant families

Using a sample of 388 father-adolescent and 399 mother-adolescent dyads in Chinese immigrant families, the current investigation tested Portes and Rumbaut's (1996) assertion that generational dissonance may indicate a family context that places children at increased risk for adverse outcomes. Study findings suggest that a high discrepancy in father-adolescent acculturation levels relates significantly to more adolescent depressive symptoms. The study further demonstrates that the quality of the parenting relationship between fathers and adolescents operates as a mediator between father-adolescent acculturation discrepancy and adolescent depressive symptoms. Specifically, a high level of discrepancy in American orientation between fathers and adolescents is associated with unsupportive parenting practices, which, in turn, are linked to more adolescent depressive symptoms. These relationships are significant even after controlling for the influence of family socioeconomic status and parents' and adolescents' sense of discrimination within the larger society.

Predictors of mental health among adolescents from immigrant families in Portugal

The aims of this study were to investigate the degree of mental health problems among adolescents with immigrant background in Portugal and the factors that may predict mental health problems. The study sample consisted of 755 immigrant adolescents from seven ethnocultural groups (Cape Verdeans, Angolans, Indians, Mozambicans, East Timorese, Sao Tomese, and Guineans) and 320 native Portuguese adolescents. Generally, most respondents did not report major psychological adjustment problems. Adolescents from immigrant families reported fewer mental health problems than their native Portuguese counterparts, and girls reported more mental health problems than did boys. Predictive factors-sociodemographic, intercultural contact, and psychosocial adjustment variables-were significantly linked to youths' mental health. Major predictors of poor psychological adjustment were perceived discrimination, social difficulties, and behavioral problems. As expected, different factors explained the psychological adaptation of adolescents by gender. Implications of the study for counselors are discussed.

Family economic stress and academic well-being among Chinese-American youth: the influence of adolescents' perceptions of economic strain

This study examined the pathways by which family economic stress influenced youth's educational outcomes in a sample of 444 Chinese American adolescents (M ages = 13.0, 17.1 years at waves 1 and 2, respectively). Using latent variable structural equation modeling, results across two waves of data, spanning early to late adolescence, demonstrated that the influence of parent report of economic stress on youth academic achievement (i.e., GPA), school engagement, and positive attitudes about education was mediated through youth's perceptions of family economic strain and self-reports of depressive symptoms. These relationships were observed to remain significant after accounting for selection bias using individual fixed-effects models. Finally, youth's perceptions of family economic strain were found to more strongly predict depressive symptoms during later, as compared to earlier, adolescence; all other modeled relationships were equivalent across the two time periods. Implications for expanding theoretical tenets of the Family Economic Stress Model are discussed.

A longitudinal study of family obligation and depressive symptoms among Chinese American adolescents

The purpose of this 2-year, 3-wave longitudinal study of Chinese American adolescents was to examine how family obligation behaviors and attitudes change over time; how gender, nativity, and birth order predict these trajectories; and whether family obligation relates to depressive symptoms. Findings suggest that family obligation behaviors decreased over the 2-year period but that family obligation attitudes were stable. Moreover, foreign-born adolescents reported higher levels of family obligation behavior than U.S.-born adolescents, and firstborn adolescents reported higher family obligation attitudes than laterborn adolescents. There were no gender differences in family obligation behaviors or attitudes. The findings also suggest that initial higher levels of family obligation were associated with subsequently fewer depressive symptoms. Finally, changes in family obligation behaviors related to changes in depressive symptoms over time such that increasing family obligation behaviors related to decreasing depressive symptoms. The results highlight the importance of understanding the role of family obligation to Chinese American adolescents' mental health.

A process model of adolescents' triangulation into parents' marital conflict: the role of emotional reactivity

This study examined adolescents' emotional reactivity to parents' marital conflict as a mediator of the association between triangulation and adolescents' internalizing problems in a sample of 2-parent families (N = 416)[corrected]. Four waves of annual, multiple-informant data were analyzed (youth ages 11-15 years). The authors used structural equation modeling and found that triangulation was associated with increases in adolescents' internalizing problems, controlling for marital hostility and adolescent externalizing problems. There also was an indirect pathway from triangulation to internalizing problems across time through youths' emotional reactivity. Moderating analyses indicated that the 2nd half of the pathway, the association between emotional reactivity and increased internalizing problems, characterized youth with lower levels of hopefulness and attachment to parents. The findings help detail why triangulation is a risk factor for adolescents' development and which youth will profit most from interventions focused on emotional regulation.

A latent class factor approach to identifying subtypes of juvenile diversion youths based on psychopathic features

Latent class factor analysis allows for the estimation of a dimensional construct such as psychopathy through factor analysis while also examining the heterogeneity of the sample. We report the results of a latent class factor analysis examining the psychometric structure of a widely used measure of psychopathy, as well as internalizing (i.e. anxiety) and externalizing indices, among diversion program youths involved in an intervention study. The results indicated that four subgroups of adolescents existed in the data: one with high psychopathic features and externalizing problems, but low anxiety; one with moderately high affective and behavioral psychopathic features and externalizing problems, but low anxiety; one with moderately high interpersonal and behavioral psychopathic features, externalizing problems, and anxiety; and one with very low psychopathy scores, anxiety, and externalizing problems. The validity of these subgroups was assessed comparing prior family problems, substance use, and offending measures, and one-year follow-up measures of recidivism, detention days, substance use, and program completion. This study offers partial support for the existence of psychopathy subgroups and has implications for future studies of psychopathy typologies. In addition, this study employed a methodology for classification that permits consideration of the dimensional nature of a construct, and as such has implications for a variety of research areas.

Evaluation of a school-based internship program for Chinese immigrant adolescents in the United States

The experiences of five Chinese immigrant adolescents who became participatory action researchers (PAR) (Fine et al,, 2002) through a school-based internship program in the United States are analyzed and presented. Evaluation of the project was conducted using content analysis of student researchers' journal entries. Discovery Oriented Approach analysis (Mahrer & Boulet, 1999; Mahrer 1988) was implemented and revealed the following main domains: Learning and Growth, Program Evaluation, Adjustment and Coping, Identity Development and Social Role, Pride, Social Support, Empathy, and Group Process. Implications for conducting PAR with ethnic minority populations are discussed in the context of the participants' experiences with cultural adjustment.

Investigation of profiles of risk factors for adolescent psychopathology: a person-centered approach

Latent variable mixture modeling was used to identify subgroups of adolescents with distinct profiles of risk factors from individual, family, peer, and broader contextual domains. Data were drawn from the National Longitudinal Study of Adolescent Health. Four-class models provided the most theoretically meaningful solutions for both 7th (n = 907; 48% boys) and 11th (n = 1039; 51% boys) graders. The 4-class solution for 7th graders included low risk (LR; 66%), socioeconomic disadvantage (SD; 19%), peer high risk (PHR; 9%), and family high risk (FHR; 6%) groups. Similarly, the 4-class model for 11th graders included LR (32%), SD (43%), high risk (HR; 21%), and FHR (4%) groups. Subgroup membership predicted reported levels of depressive symptoms and conduct problems both concurrently and over time. Strengths and potential limitations of using latent variable mixture modeling to investigate risk profiles for adolescent psychopathology are discussed.

Cultural considerations in adolescent suicide prevention and psychosocial treatment

Ethnic groups differ in rates of suicidal behaviors among youths, the context within which suicidal behavior occurs (e.g., different precipitants, vulnerability and protective factors, and reactions to suicidal behaviors), and patterns of help-seeking. In this article, the authors discuss the cultural context of suicidal behavior among African American, American Indian and Alaska Native, Asian American and Pacific Islander, and Latino adolescents, and the implications of these contexts for suicide prevention and treatment. Several cross-cutting issues are discussed, including acculturative stress and protective factors within cultures; the roles of religion and spirituality and the family in culturally sensitive interventions; different manifestations and interpretations of distress in different cultures; and the impact of stigma and cultural distrust on help-seeking. The needs for culturally sensitive and community- based interventions are discussed, along with future opportunities for research in intervention development and evaluation.

Psychosocial issues in adolescents with cancer

Cancer in adolescents is uncommon and when it occurs raises a number of unique challenges for both the patient and their families. Adolescence is a period of time of significant physical and emotional changes and a diagnosis of cancer during this time has a major impact on their psychological and physical development. In this review we will look at the psychosocial issues facing adolescents who have cancer. We will address adolescent development, issues related to informed consent and assent, initial responses to the diagnosis of cancer, quality of life and the experience of the adolescent with cancer, psychological adjustment, support systems, body image issues, sexuality, education, hope, and treatment compliance.