Longitudinal reliability of self-reported age at menarche in adolescent girls: variability across time and setting.

Age at menarche is critical in research and clinical settings, yet there is a dearth of studies examining its reliability in adolescents. We examined age at menarche during adolescence, specifically, (a) average method reliability across 3 years, (b) test-retest reliability between time points and methods, (c) intraindividual variability of reports, and (d) whether intraindividual variability differed by setting or individual characteristics. Girls (n = 253) were enrolled in a cross-sequential study in age cohorts (11, 13, 15, and 17 years). Age at menarche was assessed using 3 annual, in-person clinician interviews followed by 9 quarterly phone interviews conducted by research assistants. Reliability of age at menarche across time was moderate and varied by method. In-person interviews showed greater reliability (intraclass correlation coefficient [ICC] = .77) versus phone interviews (ICC = .64). Test-retest reliability in reports did not decrease across time. However, average differences in reported age varied as much as 2.3 years (SD = 2.2 years), with approximately 9% demonstrating differences greater than 4.5 years. Pubertal timing category (i.e., early, late) changed for 22.7% if categorized at the final versus the first report of age at menarche. Reliability was moderate, but average differences in reported age were notable and concerning. Using in-person clinician interviews may enhance reliability. Researchers and clinicians should be cognizant of the implications of using different methods measuring age at menarche when interpreting research findings.

Executive functioning, cortisol reactivity, and symptoms of psychopathology in girls with premature adrenarche.

The study examined the interaction between early maturational timing (measured by premature adrenarche [PA]) and executive functioning and cortisol reactivity on symptoms of psychopathology. The study included 76 girls aged 6 through 8 years (mean = 7.50, SD = 0.85) with PA (n = 40) and on-time adrenarche (n = 36). Girls completed a battery of psychological and neuropsychological tests and blood sampling for cortisol. Parents completed the Child Behavior Checklist. The results demonstrated that girls with PA with lower levels of executive functioning had higher externalizing and anxious symptoms compared to other girls. In addition, girls with PA who demonstrated increases in serum cortisol had higher externalizing symptoms than those with stable patterns. Finally, girls with PA who demonstrated decreases in cortisol reported higher depressive symptoms. The findings from this study provide important information concerning the impact of cognitive functioning and stress reactivity on adjustment to early maturation in girls with PA. The results of this research may inform screening and intervention efforts for girls who may be at greatest risk for emotional and behavioral problems as a result of early maturation.

Enhancing cross-system collaboration for caregivers at risk for depression.

In the United States, many health care systems function independently from one another. Increasing coordination across systems has the potential to vastly improve services and patient outcomes, yet implementing these changes can be challenging, requiring increased communication, interaction, and coordination across systems that typically function independently. Parental depression is one health issue that could benefit greatly from a comprehensive systems approach. The Helping Families Raise Healthy Children initiative is a cross-system quality improvement initiative aimed at improving identification and treatment of families faced with the dual challenge of caregiver depression and early childhood developmental delays. Four main techniques were used to foster and sustain cross-system collaboration and communication: cross-system trainings, regular meetings of collaborative partners, a cross-system learning collaborative for service providers, and two cross-system facilitators. The initiative achieved successful cross-system collaboration, suggesting that these methods may be used in other initiatives to foster similar types of collaboration across systems.