Tests of linear and nonlinear relations between cumulative contextual risk at birth and psychosocial problems during adolescence.

This study tested whether there are linear or nonlinear relations between prenatal/birth cumulative risk and psychosocial outcomes during adolescence. Participants (n = 6963) were taken from the Northern Finland Birth Cohort Study 1986. The majority of participants did not experience any contextual risk factors around the time of the target child's birth (58.1%). Even in this low-risk sample, cumulative contextual risk assessed around the time of birth was related to seven different psychosocial outcomes 16 years later. There was some evidence for nonlinear effects, but only for substance-related outcomes; however, the form of the association depended on how the cumulative risk index was calculated. Gender did not moderate the relation between cumulative risk and any of the adolescent psychosocial outcomes. Results highlight the potential value of using the cumulative risk framework for identifying children at birth who are at risk for a range of poor psychosocial outcomes during adolescence.

Do nonphysical punishments reduce antisocial behavior more than spanking? a comparison using the strongest previous causal evidence against spanking.

BACKGROUND: The strongest causal evidence that customary spanking increases antisocial behavior is based on prospective studies that control statistically for initial antisocial differences. None of those studies have investigated alternative disciplinary tactics that parents could use instead of spanking, however. Further, the small effects in those studies could be artifactual due to residual confounding, reflecting child effects on the frequency of all disciplinary tactics. This study re-analyzes the strongest causal evidence against customary spanking and uses these same methods to determine whether alternative disciplinary tactics are more effective in reducing antisocial behavior. METHODS: This study re-analyzed a study by Straus et al.1 on spanking and antisocial behavior using a sample of 785 children who were 6 to 9 years old in the 1988 cohort of the American National Longitudinal Survey of Youth. The comprehensiveness and reliability of the covariate measure of initial antisocial behavior were varied to test for residual confounding. All analyses were repeated for grounding, privilege removal, and sending children to their room, and for psychotherapy. To account for covarying use of disciplinary tactics, the analyses were redone first for the 73% who had reported using at least one discipline tactic and second by controlling for usage of other disciplinary tactics and psychotherapy. RESULTS: The apparently adverse effect of spanking on antisocial behavior was replicated using the original trichotomous covariate for initial antisocial behavior. A similar pattern of adverse effects was shown for grounding and psychotherapy and partially for the other two disciplinary tactics. All of these effects became non-significant after controlling for latent comprehensive measures of externalizing behavior problems. CONCLUSIONS: These results are consistent with residual confounding, a statistical artifact that makes all corrective actions by parents and psychologists appear to increase children's antisocial behavior due to child effects on parents. Improved research methods are needed to discriminate between effective vs. counterproductive implementations of disciplinary tactics. How and when disciplinary tactics are used may be more important than which type of tactic is used.

Prospective Associations of Child Maltreatment Subtypes With Adult Educational Attainment: Tests of Mediating Mechanisms Through School-Related Outcomes.

This study tests a developmental cascades model in which childhood maltreatment is hypothesized to influence adult educational attainment by increasing attention problems and reducing successful school experiences during adolescence. Two path models tested direct and indirect associations of childhood maltreatment with adult educational attainment. Model 1 used three parent-reported subtypes of childhood maltreatment (physical/emotional abuse, sexual abuse, neglect). Model 2 added an agency-reported measure of childhood maltreatment. Both models detected indirect effects of childhood maltreatment subtypes on adult educational attainment through attention and school discipline problems, poor school engagement, and low extracurricular involvement. Model 2 also detected a direct effect of agency-reported childhood maltreatment on the adult outcome. Regardless of the type of maltreatment or data source used, school factors mediated the associations of childhood maltreatment on adult educational attainment. Promoting school engagement and reducing disciplinary referrals for maltreated youth could improve their educational attainment over the long term.

Adherence and psychopathology in children and adolescents with cystic fibrosis.

BACKGROUND: The striking increase in the lifespan of individuals with cystic fibrosis (CF) has largely been attributed to the dramatic improvements in treatment regimens. These treatments are time intensive and may interfere with healthy development and family function. The objective of this study was to investigate the association between psychopathology and treatment adherence in children and adolescents with CF. METHODS: Structured psychiatric interviews were performed on 52 patients with CF. Additional information on family function and youth behaviors were also collected. Youth and parent reports of adherence to the CF treatments were obtained and compared with the CF teams' records. RESULTS: The mean overall adherence to the CF teams' recommendations was 77-81% for the child and parent reports, respectively. Children with anxiety disorders and families who were more cohesive showed significantly higher rates of adherence to the CF treatments. In addition, children in families with a balance of structure and flexibility also report higher levels of adherence to the CF treatments. CONCLUSIONS: Anxiety disorders in children with CF may be associated with increased adherence to the numerous CF treatment regimens. In addition, family patterns that are cohesive and balanced are better able to incorporate the CF treatments into family life.

Positive and Negative Peer Influence in Residential Care.

The potential for negative peer influence has been well established in research, and there is a growing interest in how positive peer influence also impacts youth. No research, however, has concurrently examined positive and negative peer influence in the context of residential care. Clinical records for 886 residential care youth were used in a Hierarchical Linear Model analysis to examine the impact of negative and positive peer influence on naturally occurring patterns of serious problem behavior over time. Negative peer influence, where the majority of youth in a home manifested above the average number of serious behavior problems, occurred 13.7% of the time. Positive peer influence, where the majority of youth manifested no serious problem behaviors for the month, occurred 47.7% of the time. Overall, youth problem behavior improved over time. There were significantly lower rates of serious problem behavior in target youth during positive peer influence months. Conversely, there were significantly higher rates of serious problem behaviors in target youth during negative peer influence months. Negative peer influence had a relatively greater impact on target peers' serious behavior problems than did positive peer influence. Caregiver experience significantly reduced the impact of negative peer influence, but did not significantly augment positive peer influence. Months where negative peer influence was combined with inexperienced caregivers produced the highest rates of serious problem behavior. Our results support the view that residential programs for troubled youth need to create circumstances that promote positive and control for negative peer influence.

Developmental effects of childhood household adversity, transitions, and relationship quality on adult outcomes of socioeconomic status: Effects of substantiated child maltreatment.

The degree to which child maltreatment interacts with other household adversities to exacerbate risk for poor adult socioeconomic outcomes is uncertain. Moreover, the effects of residential, school, and caregiver transitions during childhood on adult outcomes are not well understood. This study examined the relation between household adversity and transitions in childhood with adult income problems, education, and unemployment in individuals with or without a childhood maltreatment history. The potential protective role of positive relationship quality in buffering these risk relationships was also tested. Data were from the Lehigh Longitudinal Study (n = 457), where subjects were assessed at preschool, elementary, adolescent, and adult ages. Multiple group path analysis tested the relationships between childhood household adversity; residential, school, and caregiver transitions; and adult socioeconomic outcomes for each group. Caregiver relationship quality was included as a moderator, and gender as a covariate. Household adversity was negatively associated with education level and positively associated with income problems for non-maltreated children only. For both groups, residential transitions was negatively associated with education level and caregiver transitions was positively associated with unemployment problems. Relationship quality was positively associated with education level only for non-maltreated children. For children who did not experience maltreatment, reducing exposure to household adversity is an important goal for prevention. Reducing exposure to child maltreatment for all children remains an important public health priority. Results underscore the need for programs and policies that promote stable relationships and environments.

Profiles of Contextual Risk at Birth and Adolescent Substance Use.

This study examined whether there are subgroups of families with distinct profiles of prenatal/birth contextual risk, and whether subgroup membership was differentially related to adolescent substance use. Data from the Northern Finland Birth Cohort 1986 were used. A five-class model provided the most meaningful solution. Large Family Size (7.72%) and Low Risk (69.69%) groups had the lowest levels of alcohol, cigarette, and illegal drug use. Similar high levels for each of the three substance-related outcomes were found for Parent Substance Misuse (11.20%), Maternal School Dropout (4.66%), and Socioeconomic Disadvantage (6.72%) groups. Maternal smoking and drinking while pregnant and paternal heavy alcohol use were found to be key prenatal risk factors that tended to cluster together and co-occur with other prenatal risk factors differently for different subgroups of youth.

Cumulative contextual risk at birth and adolescent substance initiation: Peer mediation tests.

BACKGROUND: Children who experience multiple adversities, such as prenatal exposure to drugs and poverty, early in development are at increased risk for the early initiation of alcohol and cigarette use. However, studies that examine potentially malleable processes associated with substance use initiation in the context of exposure to cumulative stressors are scant. This study examined associations between cumulative contextual risk at birth and initiation of alcohol and cigarette use in adolescence, testing childhood peer marginalization and peer aggression and behavior problems as mediating mechanisms. Analyses further adjusted for fearfulness/inhibition and hyperactivity/distractibility to determine if the hypothesized mediating mechanisms were significant after accounting for temperamental characteristics associated with substance initiation. METHODS: Participants were 6190 adolescents from the Northern Finland Birth Cohort 1986 Study. Data were collected on cumulative contextual risk (parent reports), substance initiation (adolescent reports), childhood peer processes and behavior problems (teacher reports), and temperamental characteristics (teacher reports). Novel discrete-time survival mediation analysis was conducted to test the hypothesized mediating mechanisms. RESULTS: Initial analyses showed that the associations between cumulative contextual risk and both alcohol and cigarette initiation were mediated by childhood peer processes and behavior problems; however, the indirect effects became statistically non-significant after adding the temperament variables, which themselves predicted substance initiation. CONCLUSIONS: Targeting peer processes may not be an effective way to interrupt pathways leading from early contextual risk to substance initiation. Instead, early screening and intervention efforts to delay substance initiation may need to be tailored to the individual temperamental characteristics of targeted participants.

Gender differences in adolescents in residential treatment.

Gender differences for adolescents in residential care were examined for a sample of 2,067 youths in a large residential facility. At admission, female youths were more troubled than male youths, as shown in significantly higher Diagnostic Interview Schedule for Children (DISC) diagnoses and comorbidity rates, higher internalizing and externalizing Child Behavior Checklist scores, and significantly higher Suicide Prevention Scale hopelessness, negative self-evaluation, and suicide ideation scores. Girls had higher rates of depressive and anxiety diagnoses on the DISC at both admission and 1 year. Both genders demonstrated significant reductions in both externalizing and internalizing problem behaviors over the first year in the program. Girls had significantly higher rates of internalizing problem behavior but showed a significantly greater reduction in these behaviors than did boys. At departure, girls were rated as being more successful than boys by clinical staff. Youths did not differ by gender in their behavior on a 6-month follow-up success scale. Implications for prioritizing research addressing the needs of female adolescents in residential care are discussed.

Psychotropic medication utilization at a group-home residential facility for children and adolescents.

OBJECTIVE: The purpose of this study was to examine psychotropic medication utilization over the course of treatment for children and adolescents admitted to a large residential group-home facility for youth with emotional and behavioral disorders. METHOD: Retrospective analyses of psychotropic medication utilization at admission, during treatment, and at departure were examined for 1,010 children and adolescents consecutively admitted to the facility during 2001-2004. The relationship between psychotropic medication utilization and demographic variables, psychiatric diagnoses, objective measures of behavioral and emotional problems, in-program behavior, and ratings of program success were examined. RESULTS: The overall utilization rate was 49%, and there was a significant reduction in utilization from admission (40%) to departure (26%). Reductions were evident across all medication classes (e.g., stimulants, antipsychotics, etc.). At admission, medication utilization was related to several psychosocial variables, higher scores on measures of behavioral and emotional problems, and psychiatric diagnoses (attention-deficit/hyperactivity disorder (ADHD) and mood disorders). A small percentage (16%) of youth was prescribed novel medication during stay. Being placed on medication during treatment was related to internalizing problems on the Child Behavior Checklist (CBCL) at admission, psychiatric diagnoses, higher rates of in-program behavior problems, and poorer outcomes at departure. Youth departing on medication were more likely to be male, younger, and rated as doing more poorly in the program. They also were more likely to be placed in more restrictive settings at follow-up. CONCLUSIONS: There was a high rate of psychotropic medication utilization among this population, though utilization rates dropped significantly over the course of treatment.