Autistic Traits and College Adjustment.

This study evaluated the association of autistic traits (RAADS-14) with academic and social outcomes among college students using data from an online survey (N = 2,736). In the academic domain, the total trait score and all subscale scores (mentalizing deficits, social anxiety, sensory reactivity) were associated with course failure and academic difficulties independent of an autism diagnosis; the total score and mentalizing deficits also predicted lower grade point average (GPA). In the social domain, the total trait score and subscale scores were associated with lower odds of having a confidant, lower friendship quality, and higher odds of social exclusion. Subgroup analyses revealed that autistic traits had more consistently negative associations with social outcomes for students without an autism diagnosis than for students with a diagnosis. Associations were also more often significant for women than men. These results support the development of programs and services for students with autistic traits regardless of diagnostic status.

COVID-19 and changes in college student educational expectations and health by disability status.

This study examines the implications of the coronavirus pandemic for college students' health and education, with special attention to variation by disability status. Disaster research supports the hypothesis that students with disabilities will experience higher-than-usual levels of pandemic-related stress, which could lead to re-evaluations of their educational expectations and declines in health. We evaluate this hypothesis by modeling changes in students' (1) mental and physical health and (2) educational expectations during the first year (spring of 2020 to spring of 2021) of the pandemic, using survey data collected from a population-based sample of college students in the state of Indiana. Although we observe across-the-board declines in both domains, students with disabilities were especially vulnerable. Mediation analyses suggest that differential exposure to financial and illness-related stressors is partially to blame, explaining a significant portion of the group differences between students with and without disabilities. We interpret these results as evidence of the unique vulnerabilities associated with disability status and its wide-ranging importance as a dimension of social stratification.

The health of college students on the autism spectrum as compared to their neurotypical peers.

LAY ABSTRACT: Studies have shown that children and older adults on the autism spectrum experience more physical and mental health problems than their neurotypical peers. Less is known about the physical and mental health of college students on the spectrum. Studying college students is important because young adults on the spectrum are enrolling in college at increasing rates and because health problems can be a barrier to succeeding in college. We collected data from 2820 students at 14 colleges and universities using an online survey, some of whom had registered for accommodations based on autism and others of whom had not. We used the data to compare the physical and mental health of students on the spectrum to their neurotypical peers. Because students with autism often report other disabilities that also affect health, we accounted for whether they experienced a learning disability, attention deficit hyperactivity disorder, sensory impairment, mobility impairment, mental health disorder, or any other disabilities. We assessed health using self-reports of how healthy they were physically and mentally, and reports of depressive symptoms, symptoms of anxiety, sleep deprivation, and binge drinking. We found that students with autism reported poorer physical and mental health, more depressive symptoms, and more symptoms of anxiety even after taking into account other disabilities they may have experienced. They were also less likely to report sleep deprivation and binge drinking. Our results argue for developing specialized services to address the physical and mental health challenges of college students on the spectrum.

The Experiences of College Students on the Autism Spectrum: A Comparison to Their Neurotypical Peers.

This study describes the academic, social, and health experiences of college students on the autism spectrum as they compare to students with other disabilities and their non-disabled, neurotypical peers. Data were from an online survey of college students at 14 public institutions (N = 3073). There were few significant differences between students on the spectrum and students with other disabilities. Both groups of students reported significantly worse outcomes than neurotypical students on academic performance, social relationships and bullying, and physical and mental health. The findings suggest that some of the challenges students on the spectrum face in college result from the stigma and social rejection associated with disability rather than from the unique characteristics of autism.

Structured Variation in Parental Beliefs about Autism.

We used data from the 2011 Survey of Pathways to Diagnosis and Services (N = 1,420) to evaluate a conceptual model linking social background (race-ethnicity, socioeconomic status [SES]) to parental distress through children's clinical profiles and parental beliefs about the nature and causes of their child's autism. Children's clinical profiles varied by social background; white children and children of more highly educated and affluent parents were less likely to experience comorbid conditions and were more likely to be diagnosed with Asperger's. Parental beliefs also varied such that parents of racial-ethnic minority children and parents of lower SES perceived their child's condition as more uncertain and were less likely to attribute it to genetic causes. Parents of Hispanic children and with lower incomes were more likely to be upset by the child's condition. Although parental beliefs had independent associations with distress, children's clinical profiles contributed more to explaining variation in distress.

Why and how inequality matters.

In this article, I share some thoughts about how we might extend the study of mental health inequalities by drawing from key insights in sociology and sociological social psychology about the nature of inequality and the processes through which it is produced, maintained, and resisted. I suggest several questions from sociological research on stratification that could help us understand unexpected patterns of mental health inequalities. I also advocate for the analysis of "generic" social psychological processes through which inequalities are produced, maintained, and resisted within proximate social environments. I consider the role of two such processes--status/devaluation processes and identity processes--in mental health inequalities. I then discuss how we can strengthen connections across subfields of the sociology of mental health by applying status and identity theories to two areas of research: (1) help-seeking and (2) the effects of mental health problems on social attainments.

Adolescent mental health, behavior problems, and academic achievement.

Prior research on the association of mental health and behavior problems with academic achievement is limited because it does not consider multiple problems simultaneously, take co-occurring problems into account, and control for academic aptitude. We addressed these limitations using data from the National Longitudinal Study of Adolescent Health (N = 6,315). We estimated the associations of depression, attention problems, delinquency, and substance use with two indicators of academic achievement (high school GPA and highest degree received) with controls for academic aptitude. Attention problems, delinquency, and substance use were significantly associated with diminished achievement, but depression was not. Combinations of problems involving substance use were especially consequential. Our results demonstrate that the social consequences of mental health problems are not the inevitable result of diminished functional ability but, rather, reflect negative social responses. These results also encourage a broader perspective on mental health by demonstrating that behavior problems heighten the negative consequences of more traditional forms of distress.

Substance Use, Distress, and Adolescent School Networks.

This study examined the associations of substance use, psychological distress, and mental health services receipt with the structure and content of adolescent school-based networks. Using data from the National Longitudinal Study of Adolescent Health, we found that substance use was associated with receiving more, but making fewer, peer nominations. It also was associated with less favorable network characteristics, such as low GPA. Services receipt was associated with receiving and making fewer nominations, less favorable network characteristics, and a lower likelihood of reciprocated best friendships. Psychological distress had fewer significant associations. All associations were modest in magnitude. Our results suggest the importance of considering multiple indicators of socioemotional problems and multiple dimensions of social networks in research on adolescent peer relations.

The association of socioemotional problems with early sexual initiation.

CONTEXT: Research on the association between socioemotional problems and early sexual initiation has not evaluated differences across types of problems, by gender, or by race or ethnicity. METHODS: Data were analyzed for a sample derived from the Children of the National Longitudinal Surveys of Youth: 1,836 youth who were 10-11 years old at the 1992, 1994 and 1996 waves. Mothers' reports of their child's socioemotional problems at age 10-11 were assessed; sexual initiation before age 15 was assessed using youth self-reports. Logistic regression analyses estimated associations between socioemotional problems and early initiation; predicted probabilities and group differences were calculated using various regression techniques. RESULTS: Twenty-six percent of youth had had intercourse before turning 15, and their average level of each problem was higher than the level of those who had not. Both internalizing problems (e.g., depression and dependency) and externalizing problems (e.g., hyperactivity and antisocial behavior) were associated with early sexual initiation (odds ratios, 1.1 and 1.2, respectively), but only externalizing problems retained significance when both types were included in the model (1.2). Among specific problems, only hyperactivity and antisocial behavior were associated with early initiation (1.2 for each). Youth with a high level of externalizing problems had a higher predicted probability of having early sex than did those with a low level (0.28 vs. 0.21). Associations between socioemotional problems and early initiation did not differ by gender or by race or ethnicity. CONCLUSIONS: Interventions should be targeted at youth with externalizing problems, especially those who engage in antisocial or hyperactive behavior, in an effort to promote positive social interactions.

The construction of fear: Americans' preferences for social distance from children and adolescents with mental health problems.

Debates about children's mental health problems have raised questions about the reliability and validity of diagnosis and treatment. However, little research has focused on social reactions to children with mental health problems. This gap in research raises questions about competing theories of stigma, as well as specific factors shaping prejudice and discrimination toward those children. Here, we organize a general model of stigma that synthesizes previous research. We apply a reduced version of this model to data from a nationally representative sample responding to vignettes depicting several stigmatizing scenarios, including attention-deficit/hyperactivity disorder (ADHD), depression, asthma, or "normal troubles." Results from the National Stigma Study-Children suggest a gradient of rejection from highest to lowest, as follows: ADHD, depression, "normal troubles," and physical illness. Stigmatizing reactions are highest toward adolescents. Importantly, respondents who label the vignette child's situation as a mental illness compared to those who label the problem as a physical illness or a "normal" situation report greater preferences for social distance, a pattern that appears to result from perceptions that the child is dangerous.

Stigmatizing attitudes and beliefs about treatment and psychiatric medications for children with mental illness.

OBJECTIVES: Data on community responses to two treatment issues critical for children and adolescents with mental health problems are addressed: stigma associated with receiving mental health care and the willingness to use psychiatric medication. METHODS: Using a representative sample of the U.S. population, the investigators interviewed 1,393 noninstitutionalized adult participants in the National Stigma Study-Children (NSS-C) (response rate 70%; margin of error +/- 4%). RESULTS: Many respondents believed that stigma results from mental health treatment during childhood (45% reported likely rejection at school) and that stigma continues to have negative ramifications into adulthood (43%). More than half (57%) were skeptical about confidentiality, and more than one-third (35%) expected parents of children with mental illness to experience self-stigma. Most respondents believed that psychiatric medications affect development (68%), give children a flat, "zombie"-like affect (53%), and delay solving "real" behavior-related problems (66%). Most (86%) believed that physicians overmedicate children for common behavioral problems. Women and persons with more education rather than less perceived less stigma resulting from treatment but reported more negative views on medication. Beliefs in medication efficacy and trust in physicians were associated with more positive cultural beliefs. CONCLUSIONS: Data on the contemporary cultural context surrounding treatment for children's mental health issues revealed substantial stigma concerns, particularly surrounding medication options. These beliefs and attitudes cannot be easily inferred from adults' sociodemographic characteristics.

Perceived dangerousness of children with mental health problems and support for coerced treatment.

OBJECTIVE: This study examined the public's beliefs regarding the potential for harm to self and others and the public's willingness to invoke coercive or legal means to ensure treatment of children. METHODS: Using data from the National Stigma Study-Children (NSS-C), which presented vignettes to 1,152 individuals, the investigators compared public perceptions of the dangerousness of children with attention-deficit hyperactivity disorder (ADHD), major depression, asthma, and "daily troubles." Multivariate analyses were used to examine the predictors of perceptions of dangerousness and the willingness to support legally enforced treatment of these conditions. RESULTS: Children with ADHD and children with major depression were perceived (by 33% and 81% of the sample, respectively) as somewhat likely or very likely to be dangerous to themselves or others, compared with children with asthma (15%) or those with "daily troubles" (13%). Over one-third of the sample (35%) were willing to use legal means to force children with depression to see a clinician. However, even more (42%) endorsed forced treatment for a child with asthma. Furthermore, individuals who labeled the child as "mentally ill" were approximately twice as likely to report a potential for violence and five times as likely to support forced treatment. CONCLUSIONS: Large numbers of people in the United States link children's mental health problems, particularly depression, to a potential for violence and support legally mandated treatment. These evaluations appear to reflect the stigma associated with mental illness and the public's concern for parental responsibility.

Comparison of public attributions, attitudes, and stigma in regard to depression among children and adults.

OBJECTIVE: This study compared public attributions and attitudes toward adult and child depression, with a focus on problem recognition, medical and social causes, help-seeking recommendations, perceptions of violence, and the use of coercion. METHODS: The investigators compared data from two special modules of the 1996 and 2002 nationally representative General Social Survey on public response to mental illness. Respondents answered questions regarding a vignette in which an adult had depression (N=193) or one in which a child had depression (N=312). RESULTS: Respondents evaluated childhood depression as more serious than adult depression (83% versus 51%, respectively) and saw a greater potential for violence toward others among children with depression (40% for children versus 30% for adults). More respondents endorsed treatment of all types, including coerced care, for children with depression. However, significantly fewer recommended talking to family and friends about a child's mental health problem. CONCLUSIONS: Americans are more concerned about children's depression than adults' depression and reveal more prejudice regarding perceptions of dangerousness. More respondents endorsed formal care than informal care and advice. However, the heightened stigma surrounding childhood depression poses unique challenges for youths with depression and their families.

Public knowledge, beliefs, and treatment preferences concerning attention-deficit hyperactivity disorder.

OBJECTIVE: This study aimed to understand the level of public knowledge about attention-deficit hyperactivity disorder (ADHD), treatment preferences for the disorder, and their sociodemographic correlates. METHODS: A short battery of questions about ADHD was included in the 2002 General Social Survey (N=1,139). In face-to-face interviews, respondents answered questions about whether they had heard of ADHD, what they knew about ADHD, their beliefs about whether ADHD is a "real" disease, and opinions about whether children with ADHD should be offered counseling or medication. RESULTS: Just under two-thirds of respondents (64%) had heard of ADHD; most could not provide detailed information about the disorder. Women and those with higher levels of education were more likely to have heard of ADHD; African Americans, members of other nonwhite racial and ethnic groups, and older respondents were less likely to have heard of ADHD. Among respondents who had heard of ADHD, 78% said they believed ADHD to be a real disease; women, white respondents, and persons with higher income most often endorsed that belief. Most respondents (65%) endorsed the use of both counseling and medication, although counseling was endorsed as a sole treatment more often than medication. There were few sociodemographic differences in treatment preferences. CONCLUSIONS: The public is not well informed about ADHD. Future media and educational efforts should seek to provide accurate information about ADHD, with a special effort to reach specific populations such as men, nonwhite minority groups, and older Americans.

Trajectories of Failure: The Educational Careers of Children with Mental Health Problems.

The authors draw on developmental psychopathology, life course sociology, and scholarship on educational processes to develop a conceptual framework for understanding the association of children's mental health problems with educational attainment. They use this framework to address two empirical gaps in prior research: lack of attention to mental health trajectories and the failure to consider diverse explanations. Using data from the Children of the National Longitudinal Surveys of Youth data set, the authors identify latent classes that characterize trajectories of internalizing and externalizing problems from childhood through adolescence. Youths in the classes vary significantly in their likelihoods of high school completion and college entry. The authors evaluate the ability of three sets of mediators to explain these patterns: academic aptitude, disruptive behaviors, and educational expectations. Educational expectations are important mediators independent of academic aptitude and disruptive behaviors. Social responses to youths' mental health problems contribute importantly to their disrupted educational trajectories.

Income inequality, race, and child well-being: an aggregate analysis in the 50 United States.

Interest in income inequality as a predictor of health has exploded since the mid-1990s. Recent analyses suggest, however, that the effect of income inequality on population health is not robust to a control for the racial composition of the population. That observation raises two interpretational questions. First, does income inequality have an independent effect on population health? Second, what does the effect of racial composition on population health mean? We use data from the Urban Institute's Assessing the New Federalism project and the Kids Count Databook to evaluate the aggregate effects of income inequality on diverse measures of child well-being (e.g., infant mortality, high school drop-out rates) in the 50 U.S. states. We replicate the finding that, net of the racial/ethnic composition of the population, the effects of income inequality are not significant. Moreover, the effects of racial composition on child well-being appear to be compositional (i.e., they reflect the less positive outcomes observed among racial/ethnic minorities) rather than contextual (i.e., representing the independent influence of social context). Whereas cross-level effects are still possible, our results cast doubt on the health relevance of these aggregate characteristics of the population.

Public attitudes toward the use of psychiatric medications for children.

Psychiatric medication use for children has increased dramatically over the past three decades. Despite substantial media attention to the issue, little is known about how the lay public feels about the use of psychiatric medications for children. Drawing on theories of medicalization, we describe and analyze Americans' attitudes towards the use of psychiatric medications generally and Prozac specifically for children described as having three types of behavioral problems. Using data from the 1998 General Social Survey's Pressing Issues in Health and Medical Care Module, we find that more Americans (57%) are willing to use psychiatric medications for children who have expressed suicidal statements than for "oppositional" behaviors (34.2%) or for hyperactivity (29.5%). Across the board, respondents are less willing to give Prozac than the general class of psychiatric medications. While socio-demographics do little to identify Americans with differing positions, the strongest and most consistent correlates of willingness to give psychiatric medications to children are trust in personal physicians, general attitudes towards psychiatric medications, and the respondent's expressed willingness to take psychiatric medications herself or himself.

Who should ask? Ethical interviewing in psychiatric epidemiology studies.

In a recent survey examining responses to life stress, difficulties were encountered by lay interviewers. These are addressed, as are ethical issues arising from the combination of survey and clinical methodologies. The issues of respondent harm and informed consent are discussed and initial strategies outlined.