Symptom Profiles of CD and ODD Among Youth With Perinatally Acquired HIV.

OBJECTIVE: Youth with perinatally acquired human immunodeficiency virus (PHIV) face increased risk for conduct disorder (CD) and oppositional defiant disorder (ODD) symptoms, and heterogeneous findings indicate that there may be subgroups of youth with PHIV differing in the quality and/or frequency of symptoms. The present study examined symptom profiles of CD and ODD among youth with PHIV and whether profiles differed in terms of parent-child and family correlates. METHODS: Participants included 314 youth with PHIV, aged 6-17 years (M = 12.88 years, SD = 3.08; 51% male; 85% Black or Latinx), and their caregivers who were recruited from 29 clinics in the US involved in the International Maternal Pediatrics Adolescent AIDS Clinical Trials (IMPAACT) Group's P1055 study. Caregivers reported on youth CD and ODD symptoms, parent-child interactions, and family environment. RESULTS: Latent class analysis indicated that a four-class model (i.e., moderate CD/high ODD, high ODD, moderate ODD, low CD/ODD) best fit the data. Ancillary analyses to validate these classes revealed differences for family cohesion and conflict; and child-centeredness, detachment, guilt-induced control, and consistency in parent-child interactions. The low CD/ODD class generally differed from other classes with additional differentiation between some higher risk profiles. CONCLUSIONS: Findings suggest that homogeneous classes of CD/ODD symptoms can be identified among youth with PHIV, and these profiles differ in terms of family processes, consistent with previous work among chronically ill youth.

Profiles of caregiving behaviors among children and adolescents with perinatally acquired HIV.

Although parenting behaviors are widely considered an important factor in the adjustment of children and adolescents with chronic physical health needs, few studies have addressed this topic as it pertains to youth with perinatally-acquired human immunodeficiency virus (PHIV). We examined profiles of child-centeredness, control through guilt, consistent discipline, and detachment, and whether these profiles differed in terms of parent- and youth-reported psychiatric disorder symptoms in a cohort of HIV infected youth (N = 314). Latent profile analyses of caregiving behaviors were conducted separately for children (6-12 years) and adolescents (13-18 years). Two profiles were identified among children: (a) moderate caregiving (87%, n = 130) and (b) high detachment caregiving (13%, n = 19), and three profiles were identified among adolescents: (a) moderate caregiving (55%, n = 88), (b) high detachment caregiving (19%, n = 30), and (c) high control through guilt caregiving (26%, n = 42). The high detachment and high control through guilt caregiving profiles displayed higher levels of parent-and youth-reported symptoms than the moderate caregiving profile. These findings suggest that caregiver behaviors of PHIV youth vary as a function of children's developmental period and differ in terms of youth psychological symptoms.

Father- and Youth-Reported Family Affective Expression Differentially Predicts Youth Internalizing and Externalizing Symptoms.

Temperamental approach is associated with adolescent internalizing and externalizing symptoms. Negative family affective expression, or problematic communication about emotions, is also associated with youth's risk for symptoms. However, it is unclear whether negative family affective expression differentially predicts symptoms based on (a) youth's temperamental approach and (b) informants' perceptions of negative family affective expression. To address these issues, we explored whether mother-, father-, and youth-reported negative family affective expression moderated the relation between youth temperamental approach and symptoms. Participants were 775 youths (71% male, 76% Caucasian) assessed at ages 10-12 (Time 1) and 12-14 (Time 2). Mothers, fathers, and youths reported on negative family affective expression and youths reported on temperamental approach at Time 1. Teachers reported on youth symptoms at Times 1 and 2. Youth- and father-reported, but not mother-reported, negative family affective expression moderated the relation between youth approach and symptoms. When youths reported higher negative family affective expression, youths lower in approach exhibited higher internalizing symptoms than youths higher in approach. In contrast, when fathers reported lower negative family affective expression, youths lower in approach exhibited higher internalizing and externalizing symptoms than youths higher in approach. Assessments and interventions for youth symptoms should include not only temperamental features, but also multiple informants' perspectives of family affective expression. Such efforts could promote greater family communication, address problematic family dynamics, and potentially attenuate risk for youth symptoms.

Negative emotional reactivity moderates the relations between family cohesion and internalizing and externalizing symptoms in adolescence.

Lower family cohesion is associated with adolescent internalizing and externalizing problems. However, there are likely individual differences in youth's responses to family processes. For example, adolescents higher in negative emotional reactivity, who often exhibit elevated physiological responsivity to context, may be differentially affected by family cohesion. We explored whether youth's negative emotional reactivity moderated the relation between family cohesion and youth's symptoms and tested whether findings were consistent with the diathesis-stress model or differential susceptibility hypothesis. Participants were 651 adolescents (M = 12.99 ± .95 years old; 72% male) assessed at two time points (Time 1, ages 12-14; Time 2, age 16) in Pittsburgh, PA. At Time 1, mothers reported on family cohesion and youth reported on their negative emotional reactivity. At Time 2, youth reported on their symptoms. Among youth higher in negative emotional reactivity, lower family cohesion predicted higher symptoms than higher family cohesion, consistent with the diathesis-stress model.