Adolescents' perceptions of the quality of interpersonal relationships and eating disorder symptom severity: The mediating role of low self-esteem and negative mood.

Few studies have examined how the perceived quality of multiple interpersonal relationships is related to eating disorder (ED) symptom severity in adolescents and how psychological variables might influence these associations. The aim of this study is to determine whether the perceived level of trust, communication, and alienation in the relationship with one's mother, father, and peers are predictive of ED severity in adolescent females and to test the mediating effects of low self-esteem and negative mood on these associations. Adolescent females aged 12 to 18 (N = 186) with a diagnosis of Anorexia Nervosa (Restrictive; AN-R or Binge/Purge; AN-B/P) completed self-report measures evaluating the perceived quality of interpersonal relationships, ED symptom severity, low self-esteem, and negative mood. Multiple regressions revealed that the level of perceived alienation in the relationship with one's mother and peers was positively associated with ED symptom severity. Low self-esteem and negative mood acted as mediators of these associations. Considering that a high level of perceived alienation in the relationship with one's mother and peers appears to be associated with more severe ED symptoms through its impact on self-esteem and mood, improvements in the quality of these interactions are likely to be an effective target of intervention among adolescents.

[Identification of promising practices in the treatment of anorexia nervosa]. / Identification des pratiques prometteuses dans le traitement de l'anorexie mentale.

Anorexia nervosa concerned, firstly, because this disorder is associated with many medical complications and secondly, because it is linked with a poor prognosis. Given these facts, it is imperative that effective treatments be available for anorexia nervosa. This article aims to present a systematic review of the literature on the best therapeutic modalities in the field of anorexia nervosa. Among these, we find outpatient treatment, importance of multidisciplinary team and various therapeutic approachs, like familial therapy.

Characteristics of Sexually Abused Children and Their Nonoffending Mothers Followed by Child Welfare Services: The Role of a Maternal History of Child Sexual Abuse.

Considering the importance of mother's support in the adaptation of a sexually abused child, it is relevant to determine if the mothers and children involved in an intergenerational cycle of child sexual victimization differ from dyads in which only the child has been abused. The purpose of this study was to compare mother-child dyads with sexually abused children according to whether the mother had herself been victim of child sexual abuse. The sample included 87 dyads with sexually abused children aged 3-18 years old and their mothers (44 reporting maternal and child abuse), followed by social welfare services of the province of Quebec (Canada). The two groups of mothers were compared on their past family abuse experiences and past family relations, their mental health history, their current psychological distress, their parenting behaviors, and their current levels of family functioning. Children were compared on their adaptation. Multivariate analyses indicated that mothers reporting child sexual abuse were more likely to report more other maltreatments in their childhood and greater prevalence of lifetime history of alcohol abuse disorders, dysthymia, and panic disorder compared with mothers who had not experienced CSA. Compared to children whose mothers had not experienced CSA, those whose mothers had experienced CSA showed higher rates of problems behaviors and were more likely to report having been sexually abused by a trusted person. These results highlight the specific clinical needs for the assessment and treatment for sexually abused children whose mothers experienced child sexual abuse.

Persistence of problematic sexual behaviors in children.

The purpose of this study was to identify personal and family predictors and correlates of persistence of problematic sexual behaviors (PSB) in children. Participants were the families of 49 children (ages 4-11 years) referred by Child Protective Services in 4 administrative districts of Quebec. Caregivers completed interviews and questionnaires twice at a 1-year interval. Results showed that 43% of children persisted with PSB. When age was controlled, greater exposure to sexualized behaviors in the family proved both a correlate and a predictor of PSB persistence in children 12 months later. Externalizing problems and somatic complaints emerged as correlates of PSB as well. Maltreatment subtypes did not predict PSB persistence.

What my body looks like and what my body can do: A self-perception explanation of excessive exercise in young adults with anorexia and/or bulimia.

The present study examined the relationships between quantitative and qualitative dimensions of excessive exercise (EE) with the physical self-perception's dimensions and perceptual perspectives of body image (i.e., allocentric/3rd person and egocentric/1st person perspectives). The eLoriCorps Immersive Body Rating Scale 1.1, the very short form version of the Physical Self-Inventory and the Exercise and Eating Disorder test were used. The study includes 36 people with anorexia and/or bulimia seeking an external and specialized transdisciplinary program for eating disorders. Results show a different correlational profile of physical self-perceptions depending on the dimension (qualitative or quantitative) used to define EE. Differences in the perspectives used to assess body dissatisfaction (allocentric or egocentric) were also found. Perceived physical appearance was the key predictor of the qualitative dimension of excessive exercise. Findings suggest that EE in patients with an eating disorder could be explained by the feeling of competence not only related to physical appearance but also to physical abilities.

Externalizing problems and problematic sexual behaviors: same etiology?

The study sought to determine whether maltreatment subtypes, family sexuality, and personal characteristics predicted and distinguished child problematic sexual behaviors (PSB) and externalizing problems (EP). Participants were families of 188 children, 6-11 years old, referred by child welfare services in four Quebec districts. Caregivers completed interviews and questionnaires. Results suggested that family environment and maltreatment subtypes had partially different impacts on PSB and EP. When EP and gender were controlled, younger children in a sexualized family environment and those verbally victimized were more likely to exhibit PSB. When PSB and gender were controlled, verbal abuse and neglect emerged as predictors of EP. Potential implications for child PSB research and interventions are discussed.

[Characteristics of adolescent offenders receiving services in juvenile centers in Québec (Centres jeunesse du Québec, CJQ)]. / Caractéristiques des jeunes contrevenants qui reçoivent des services dans les Centres jeunesse du Québec.

This study aims at establishing a comparative psychological profile of male and female adolescents at the moment of the application of measures in juvenile centers in Québec (centres jeunesse du Québec, CJQ) as well as their family and social characteristics. The study compares 213 adolescents (12-17 years old) receiving services in CJQ in accordance with the juvenile offenders act (Loi sur les jeunes contrevenants), with 213 adolescents from high schools of impoverished neighbourhoods. Results reveal serious problems of adaptation, external disorders and interiorized disorders and a regular substance abuse among many juvenile offenders. These problems are much more frequent in CJQ than within the juvenile population. The situation of these adolescents is worrisome, given that a high prevalence of depression and sexual victimisation is also observed in females. Finally, families whose adolescent receives services in CJQ have less financial, personal and social resources, as well as more difficulty exercising their parental role compared to parents in the general population. In conclusion, recommendations are proposed concerning psychosocial services necessary for these adolescents and their families.

The impact of serial transitions on behavioral and psychological problems among children in child protection services.

This study focuses on the impacts of serial transitions on externalized and internalized behavior disorders, anxiety, and depression among children in child protection services. The research was carried out with a sample of 741 children. The findings demonstrate that the number of times a family is blended is a stronger predictive factor for children's adjustment than is the family structure at the time of the interview. In predicting externalized and internalized behavior problems among children, however, the effect of family structure disappears in favor of the variables associated with family functioning and family climate.

[Examination of the clinical, familial and personal characteristics on homelessness of at-risk adolescents]. / Examen des caractéristiques cliniques, familiales et personnelles associées à l'itinérance cachée d'adolescent(e)s en difficulté.

OBJECTIVE: Our research pertains to juveniles coming under the responsibility of the Centres jeunesse du Quebec (delinquency and youth protection regional services). Some of these teenagers fled their family and made use of their social network to cope with residential instability. These youths were then in a situation of "hidden homelessness", sleeping neither in the streets nor at shelters. Two objectives are pursued: 1) a comparison of youth's and parent's evaluations of significant dimensions of their family life, and 2) an identification of the adolescents' characteristics (clinical, familial and individual) related to their "hidden homelessness". METHOD: Using bivariate analysis, a group of adolescents who had experienced homelessness was paired (on sex, age and urban or rural areas of origin) to a sample of non-homeless youths. The analysis uses both adolescents and parent/caretaker reports on measures of family characteristics and adolescent self-reports on measures of clinical and personal characteristics. FINDINGS: Our results show 1) that, in general, adolescents report a higher level of parental maltreatment and more problems related to the family dynamics and their relationship with their parents than their parents do; 2) that hidden homelessness of distressed youths is generally associated with the same familial risk factors as the ones identified by the studies concerning street youths; 3) in contrast to some other comparative studies, the homeless adolescents in our study did not differ from the non-homeless youths as to the importance of the depressive diagnostic and the use of hard drugs.

[Victimization and problems of behavior. Two components of profile types of runaway adolescents]. / [La victimisation et les problémes de comportement. Deux composantes de profils types de fuguerus adoloescents]

OBJECTIVE: This study examines the relationship between two explanatory factors connected to the phenomena of runaways and the homeless among adolescents: behavioral problems of youths and parental violence to which they are subjected. The study demonstrates that these two factors are independently related to the different categories of homeless and runaway adolescents. METHODOLOGY: The data was collected from 130 adolescents (12 to 17 years of age) who were runaways for short periods on a recurring basis. Two subgroups were formed: Group A consisted of 79 adolescents who did not exhibit behavioral problems; Group B consisted of the other 51 who did exhibit them. The two groups had certain similar family characteristics (income levels, parents' occupations, structure and stability of the family). RESULTS: The bivariate analyses reveal significant differences between the two groups of runaways relating to: (1) gender, (2) a diagnosed conduct disorder, (3) affiliations with deviant peers, and (4) experiences of parental violence. The discriminant analysis demonstrates that these four variables clearly differentiate the two groups of runaways and predict the appropriate group membership for 84% of the cases. Therefore, the members of Group B have a higher probability of being diagnosed as having a conduct disorder, being male, and associating with delinquent peers. This group had not experienced a higher level of parental violence. The opposite is true for the members of Group A. CONCLUSION: Our study demonstrates that parental violence and behavioral problems are variables that are independently related to the defined categories of runaways. Therefore, these variables do not constitute, as some thinkers have claimed, the components of a unique dynamic able to explain the phenomenon of the runaway. Our results vitiate the doubts sometimes expressed by researchers about the importance of parental violence to the phenomenon of adolescent runaways.

[Children with conducts disorder and using psychoeducational services: a social, psychological and family portrait]. / Enfants manifestant un trouble des conduites et utilisant des services psychoéducatifs : un portrait social, familial et psychologique.

Contemporary studies suggest that most of the children who manifest conducts disorder also present personal as well as family problems. This is particularly true for children whose disorder is precocious. The identification of personal characteristics as well as social and family risk and protection factors associated with children with such problems are of great use for intervention planning and service organization for them and their families in Québec. In consequence, the objectives of this study are to identify the social, family and psychological factors that characterize children presenting conducts disorder. To do so, 62 children in treatment between the ages of 7 and 12 and with a diagnosis of conducts disorder are compared with 36 children of the same age without such diagnosis. Results show that children with conduct problems come from less stable and cohesive families as well as a lower socio-economic level. Moreover, their network of social support is less developed. The study reveals that the parents of children with conducts disorder use punishment more often. Finally, the research demonstrates that the children of this group have a much higher probability of presenting an exteriorized disorder (66 %) than the children of the other group (8 %). All these distinctive characteristics allows to correctly classify 93,8 % of the children of this study in the 2 groups. The results indicate the need to improve the parents'educational practices, increase the child's social network as well as reduce the conducts of opposition and inattention of the child. Finally, the complexity of the problems raised with the child and families commands a concerted professional intervention.

[Symptomatology and psychosocial adaptation in adolescents with depressive disorder and comorbid disruptive behaviour disorder]. / Symptomatologie et adaptation psychosociale des adolescents ayant un trouble dépressif cooccurrent a un trouble de comportement perturbateur.

OBJECTIVE: To describe symptomatology and specific psychological, social, and academic adaptation in adolescents with depressive disorder and comorbid disruptive behaviour disorder, as well as their family situation. METHOD: Using binomial logistic regressions, this study compares adolescents with depressive disorder and comorbid disruptive behaviour disorder (n=25) with adolescents with the same behaviour problems but no comorbid depressive disorder (n=99). Sex-specific interaction impacts are examined. RESULTS: While both groups have several similar characteristics, youth with a dual diagnosis have more oppositional symptoms and poorer self-esteem. Analyses show no interaction impact from sex variable. CONCLUSIONS: Adolescents in both groups would benefit from similar interventions regarding disruptive behaviour disorders and some related problems, such as using psychoactive drugs, socializing with delinquent peers, and difficulty functioning in school. Adolescents with a comorbid depressive disorder need special attention, given the more significant oppositional symptomatology and the poorer self-esteem.

Factors associated with homelessness of adolescents under supervision of the youth protection system.

There are two factors that limit our knowledge of the risk factors associated with homelessness among runaway adolescents, namely (1) the samples used are often composed of youth homeless service users and/or youths living on the streets (visible homelessness), whereas most adolescents in fact use "private" resources (hidden homelessness), and (2) failure to use an adequate control group to identify risk factors associated specifically with homelessness. Our study compares the characteristics of two groups of youths under the supervision of the youth protection system, according to the presence or absence of periods of homelessness. The results throw light on the factors underlying the shift from "at risk" to "homeless", showing that youths with experience of homelessness are more likely to have been placed in substitute home environments, have experienced significant relationship difficulties with one of their parents (deterioration of the parent/youth relationship and parental abuse) and to have been diagnosed with behavioural disorders. The findings suggest that the decision to place young people under supervision is based more on the dynamic between risk factors rather than on the existence of behavioural problems.

The role of depression and dissociation in the link between childhood sexual abuse and later parental practices.

Research has yielded contradictory results on the relationship between childhood sexual abuse and later parental functioning. This study was undertaken to specify the link between childhood sexual abuse and maternal parenting, while taking into account mothers' childhood physical and emotional traumas and current depressive and dissociative symptoms. Data were collected through self-report measures completed by 93 French-speaking Canadian mothers of children aged 6 to 11 years referred to Youth Protection Services. Parental behaviors examined included involvement with the child, use of positive reinforcement, lack of monitoring and supervision of the child, inconsistency in applying discipline, and use of corporal punishment. Mothers' perception of the quality of the relationship with her child was also assessed. In addition, history of abuse and neglect, depression and dissociation were respectively measured with the Childhood Trauma Questionnaire, the Diagnostic Interview Schedule Simplified, and the Dissociative Experiences Scale. The short-form of the Marlowe-Crowne Social Desirability Scale was used to control for respondent bias aimed at minimizing their problems. Mothers' current depressive symptoms were not found to predict any of the parental dimensions measured. Results from multiple hierarchical regressions pointed to dissociative symptoms as the key predictor of parental practices and attitudes. More specifically, dissociative symptoms predicted the use of positive reinforcement, lack of monitoring and supervision of the child, inconsistency in applying discipline, and use of corporal punishment. Dissociation also mediated the association between childhood maltreatment (physical and emotional abuse and neglect) and inconsistency in applying discipline. Implications for research and practice are discussed.

Frequency of mental health disorders in a sample of elementary school students receiving special educational services for behavioural difficulties.

OBJECTIVE: Despite being essential for defining and planning special educational services, very few data are available in Quebec regarding the nature and extent of behavioural difficulties presented by children who receive special educational services at school. This study provides a picture of the frequency of disruptive behaviour disorders (that is, attention-deficit hyperactivity disorder [ADHD], oppositional defiant disorder [ODD], and conduct disorder [CD]) and internalized disorders (including generalized anxiety disorder [GAD] and major depressive episode [MDE]) in a sample of elementary school students receiving special educational services for behavioural difficulties (n = 324). METHOD: In this descriptive study, we established the presence of mental health disorders according to teacher-, parent-, and child-reported data that were obtained using structured diagnostic interviews based on DSM-IV criteria. We also examined prevalence rates by sex and age group. RESULTS: Three-quarters of the students met the criteria for ADHD, one-half for ODD, and one-third for CD. About 14% of the students presented with a GAD or met the criteria for an MDE in the past year. Only 2% of the students presented with an internalized disorder without a comorbid disruptive behaviour disorder. CONCLUSIONS: Our results suggest that among students receiving special educational services for behavioural difficulties, a large proportion may have difficulties severe enough to meet the criteria for at least one DSM-IV disruptive behaviour disorder. Such findings may underscore the need to develop more collaboration between the mental health and education sectors in rehabilitating these children.