A neural network approach to identifying adolescent adjustment.

This study examined the relationship between the quality of adjustment in adolescents and a set of psychiatric diagnoses, personality traits, parental bonding, and social support variables. One hundred fifty adolescents were administered the Millon Adolescent Personality Inventory, the Parental Bonding Questionnaire, the Social Support Questionnaire, and the Diagnostic Interview for Children and Adolescents. A neural network approach was then utilized, and it was found that several of the variables (e.g., Major Depressive Disorder, Conduct Disorder, and Societal Conformity) had a significant role in classifying adolescents into three groups: maladjusted, nominally adjusted, and well-adjusted.

Individual characteristics and peer relations of psychiatrically hospitalized aggressive youths: implications for treatment.

OBJECTIVE: This study identified individual and peer-relations problems of inpatient youths who are aggressive, and whether youths who are aggressive in two settings have greater treatment needs than youths who are aggressive in one setting only. METHODS: 85 youths aged 10 to 16 years who were consecutively admitted to a psychiatric facility served as participants. Based on ratings by parents and hospital staff, youths were identified as aggressive in the community only, aggressive in the hospital only, aggressive in both settings, or nonaggressive. Dependent measures consisted of youth self-reports and ratings by parents and hospital staff. RESULTS: Youths who demonstrate aggressive behavior in two settings have more nonaggressive behavior problems, more disturbed peer relations, and more hostile thinking than do nonaggressive youths, and some youths, although they may behave aggressively during hospitalization, have similar treatment needs as nonaggressive youths. CONCLUSIONS: Mental health professionals who work with youths in psychiatric settings need to develop treatment plans that directly address the more severe externalizing problems, hostile thinking, and peer problems of aggressive youths over and above that of nonaggressive youths, and should be aware that youths who behave aggressively during hospitalization may not have problems more severe than those of nonaggressive youths.

Perceived family characteristic differences between depressed and anxious children and adolescents.

BACKGROUND: The present study compared anxious vs. depressed children's and adolescents' perceptions about their family environment. METHODS: One hundred inpatient youngsters were interviewed for the study. Of these participants, 21 who met criteria for a depressive disorder without an anxiety disorder and 18 who met criteria for an anxiety disorder without a depressive disorder were compared on several self-report family measures. These measures included the Family Adaptability and Cohesion Evaluation Scales-II (FACES-II), Family Strengths, and Social Support Questionnaire-Revised (SSQS-R). RESULTS: Youngsters with depressive disorders reported having less pride in their families and perceived their families as being less adaptable to problems than did anxious children. Also, depressed children expressed lower levels of satisfaction with their social network than did anxious children. LIMITATIONS: The fact that our study only included reports from inpatient youngsters, families of anxious and depressed children may differ in the way family members relate to one another and in the way they deal with everyday problems. CONCLUSIONS: Based on the evidence obtained in this study, anxiety and depression may be two distinct internalizing disorders with specific family characteristics.

"Anxious suicidality": a new subtype of childhood suicide ideation?

The current study examined the presence of anxiety in children with suicide ideation. From a sample of 100 inpatients, children who displayed suicide ideation (n = 27) were selected and divided into two groups, high and low anxiety. Findings indicated that children with suicide ideation and anxiety were less happy and satisfied, experienced more negative life events, and were more distractible and intense than children with suicide ideation only. Additionally, according to their self-reports, parents of children with high anxiety reported more obsessive-compulsive and anxiety symptoms as well as greater hostility than parents of children with low anxiety. The authors have identified a subgroup of children with suicide ideation who are highly anxious and can be termed as experiencing "anxious suicidality."

Family characteristics and behavior problems of suicidal and non-suicidal children and adolescents.

The present study examined familial and individual variables in youngsters at high risk for suicide and non-suicidal youngsters. One hundred inpatient children and adolescents completed a battery of questionnaires including, FACES II, Family Strengths, and Problem Behavior Scales, to assess family dysfunction and individual behavior problems. The results indicated that suicidal youngsters have lower pride in their families and perceived them as less adaptable than non-suicidal youngsters as indicated by scores on the Family Strengths and FACES II, respectively. Scores on the Problem Behavior Scales indicated that suicidal youngsters also exhibited self-inflicted behaviors, withdrawal from others, little interest in activities, poor concentration, and difficulties with sleeping. In addition, youths at risk for suicide were more likely to be diagnosed with a mood disorder, including major depressive disorder and dysthymia, as well as substance abuse and phobias. These findings suggest that suicidal youngsters' negative perceptions of their families and their maladaptive behaviors should be given special attention in designing appropriate interventions. In this way, treatment would likely be effective by providing appropriate coping skills and preventing future suicidal attempts in high risk youngsters.

Disease and family contributors to adaptation in juvenile rheumatoid arthritis and juvenile diabetes.

OBJECTIVE: Research in the areas of pediatric rheumatology and pediatric chronic illness has emphasized comprehensive models of adaptation involving risk and resistance factors. This study examined adaptation, within this framework, among a large sample of children with chronic illness and children without chronic illness. METHODS: A comprehensive battery of adaptation measures was administered to a sample of 107 children with juvenile rheumatoid arthritis, 114 children with insulin-dependent diabetes mellitus, and 88 healthy controls. RESULTS: Medical diagnosis was associated with mothers' depression and a composite measure of parental (mother and father) distress and passive coping. Children's emotional and behavioral functioning was not related to medical diagnosis, but mothers' depression and parental distress were associated with child behavior problems. CONCLUSION: Because parental distress was associated with child functioning, interventions to ameliorate parental distress may have beneficial effects on the children's behavior and on parents' reactions to their children.

Trajectories of adaptation in pediatric chronic illness: the importance of the individual.

This study used individual growth modeling to examine individual difference and group difference models of adaptation. The adaptation of 27 children with juvenile rheumatoid arthritis (JRA) and 40 children with insulin-dependent diabetes mellitus (IDDM) was tracked for 18 months from diagnosis. A control group of 62 healthy children was followed over the same time period. Clustering procedures indicated that child and family adaptation could be described by a number of distinct adaptation trajectories, independent of diagnostic group membership. In contrast, parental adaptation trajectory was associated with diagnostic group membership and control over disease activity for the JRA group and with diagnostic group membership for healthy controls. The observation of common patterns across trajectory sets, as well as the finding that trajectories were differentially related to a number of variables of interest, support the use of trajectories to represent adaptation to chronic disease.

Parental hostility: impact on the family.

This study examined the effects of parental hostility on the families of 100 psychiatrically hospitalized children. Parents and their children were administered an assessment battery. The results for families who scored high on parental hostility were compared to families with low parental hostility. Parents who exhibited high hostility scored differently on a variety of temperament constructs (e.g., lower adaptability, worse mood, and lower rhythmicity) than parents who scored low in hostility. High parental hostility was also associated with an elevated level of family relation problems, which includes family effectiveness and cohesion.

Hopelessness in inpatient youths: a closer look at behavior, emotional expression, and social support.

OBJECTIVE: To examine the individual and family characteristics of children and adolescents with high levels of hopelessness. METHOD: One hundred inpatient youngsters participated in the study. Several measures, including the Hopelessness Scale for Children, Problem Behavior Scale of the Scales of Independent Behavior, Social Support Questionnaire-Revised, Pediatric Anger Expression Scale, and Differential Emotions Scale, were used to compare differences between youngsters who scored high or low on hopelessness. RESULTS: The results indicated that youngsters with high hopelessness scores tended to perceive their families and peers as providing little support, to express their anger overtly and aggressively, and to demonstrate more negative emotions than youngsters with low hopelessness scores. CONCLUSIONS: Hopelessness in youths appears to be associated with a specific pattern of behavioral and emotional problems. Clinical implications of the findings include integrating anger management, emotional expression interventions, and involving the family in treatment to enhance the social support network of youngsters with high levels of hopelessness.

Dysthymic disorder in clinically referred preschool children.

OBJECTIVE: This clinical and descriptive study examined the existence, phenomenology, and frequency of dysthymic disorder in a sample of clinically referred preschool children. In addition, the frequency of DSM-IV symptoms and the alternative research criterion for dysthymic disorder were investigated. METHOD: Three hundred consecutive preschool admissions (aged 2 to 6 years) to a child development unit were given a comprehensive evaluation by a treatment team. Data were collected from multiple informants based on the suitability of each source. RESULTS: The findings indicated that eight children met criteria for dysthymic disorder according to the DSM-IV criteria and the alternative research criterion for dysthymic disorder. CONCLUSIONS: The results support the existence of dysthymic disorder in preschool-age children. Recommendations are made for future versions of DSM as well as the appropriateness and significance of various sources of information, such as the child, parents, teachers, and clinician observations, for the evaluation of symptoms of dysthymic disorder in preschoolers.

Intrafamilial homicide committed by juveniles: examination of a sample with recommendations for prevention.

The current study examines a sample of 112 adolescents convicted of murder. From this sample, 11 adolescents who murdered a member of their family were chosen for in-depth examination. All participants were convicted as an adult for murder and received a prison sentence. Characteristics of the crimes were explored, including demographic information, relationship to victim, motive, and weapon used in the commission of the crime. Additionally, DSM diagnosis information was available for some participants. A majority of the homicides (N = 8) were committed with a gun that was available in the home. More than half of the subjects murdered a parent or parental figure and the most salient characteristic was the presence of a chaotic family life prior to the homicide. No single motive was dominant, indicating that intrafamilial homicide is the culmination of a number of factors, including abuse and psychopathology. Based on the findings, recommendations are provided to address the needs of youth who are at risk for committing violent crimes such as intrafamilial homicide.

Transactional patterns of child, mother, and father adjustment in insulin-dependent diabetes mellitus: a prospective study.

Utilized both interview and self-report methods to examine transactional patterns of child, mother, and father adjustment in a sample of children and adolescents with insulin-dependent diabetes mellitus (IDDM). Overall, levels of child and parental adjustment were relatively stable over the 1-year study period. Regression analyses revealed that increases in fathers', but not mothers', distress over time contributed significant incremental variance to poorer subsequent children's adjustment, after controlling for demographic (age, gender, and SES) and disease parameters (illness duration and metabolic control). Decline in fathers' adjustment was a significant predictor of better mothers' adjustment at follow-up; child adjustment was not significantly associated with mothers' adjustment. Variations in both children's and mothers' adjustment made significant, independent contributions to predicting subsequent fathers' adjustment. Findings illustrate the transactional nature of relationships that exist in families of children with IDDM and underscore the importance of family systems or biobehavioral family treatment approaches in the clinical management of children with chronic illnesses.

Psychometric properties and clinical utility of the scale for suicide ideation with inpatient children.

The purpose of the current study was to examine the psychometric properties and clinical utility of the Scale for Suicide Ideation (SSI) for children. The SSI was administered to 100 children who were hospitalized. Data were not used from 13 subjects due to the presence of a psychotic disorder or IQ less than 70, leaving 87 participants. The SSI was examined regarding its internal consistency, concurrent validity, construct validity, and factor structure when used with children. Based on the findings, the SSI appears to have adequate psychometric properties and can be used by clinicians and researchers examining children in an inpatient setting. Recommendations for clinicians are included to help make the SSI more functional in use for children.

Relationship of personality, environmental, and DICA variables to adolescent hopelessness: a neural network sensitivity approach.

OBJECTIVE: This study identified critical factors from a set of psychiatric diagnoses, personality traits, and family and social support variables that relate to hopelessness in adolescents. METHOD: One hundred fifty adolescents were selected in a systematic sample from 1,700 high school students; they completed the Millon Adolescent Personality Inventory, the Parental Bonding Questionnaire, the Social Support Questionnaire, the Hopelessness Scale for Children and were interviewed by trained clinicians on the Diagnostic Interview for Children and Adolescents. Selected variables were chosen for a back-propagation neural network model and for subsequent sensitivity and statistical analysis. RESULTS: Sensitive adolescents and adolescents with less impulse control scored high on hopelessness. Forceful adolescents were less hopeless. CONCLUSIONS: Using the neural network models, the authors suggest that assertive training as well as group activities that increase cooperativeness may ameliorate hopelessness.

Sex differences in anger expression, depressed mood, and aggression in children and adolescents.

The current study examined anger expression styles and their relationship to levels of depressed mood and aggressive behavior in male and female children and adolescents. Measures of anger, anger expression, and depressed mood were collected from both children and their parents. Hierarchical multiple regressions revealed that anger expression significantly predicted sadness but not aggression for females, after accounting for age and anger level. Among males, anger expression was important in predicting aggression but not sadness, whereas age and anger level best predicted sadness. These results suggest that age, anger level, and anger expression may be risk factors for depression and aggression among children and adolescents. Sex appears to be an important factor in anger expression styles and related depression and aggressive behavior.

An examination of family functioning utilizing the circumplex model in psychiatrically hospitalized children with depression.

The purpose of the current study was to explore the relationship between childhood depression and family functioning. 11 children with depression and 11 children without depression were compared via scores on the adaptability and cohesion dimensions of the FACES-III-K. Children with depression reported significantly less cohesive and more disengaged (displaying emotional separateness and lack of closeness) families than children without depression. Cohesion (the emotional bonding and individual autonomy of family members), but not adaptability, appears to be an important factor in the relationship between family functioning and childhood depression. Clinicians are advised to use treatments designed to help alleviate low family cohesion for children with depression.

Characteristics of anger expression in depressed children.

OBJECTIVES: To examine anger expression styles in depressed and nondepressed children and to investigate whether the relation between depression and anger expression was mediated by family variables. METHOD: From a sample of 100 psychiatric inpatient children, 11 depressed children and 11 matched nondepressed psychiatric controls were compared on two self-report measures, the Pediatric Anger Expression Style and the Family Adaptability and Cohesion Evaluation Scales-III-K. RESULTS: Depressed children reported significantly more difficulty maintaining cognitive control of their anger than did nondepressed children who were psychiatric inpatients. Family cohesion and adaptability were not found to have an effect on this relationship. No significant differences were found with respect to the tendency to deny or suppress anger or the tendency to express anger aggressively. CONCLUSIONS: Depressed children experienced more difficulties expressing their anger using a controlled/cognitive style than nondepressed (externalizing) children. The lack of a mediating role of family variables suggests that anger expression styles may be more related to the characteristics of depression in children, a finding that has clinical implications for addressing treatment of depressed children.

Perceived family and social support: impact on children.

OBJECTIVE: The purpose of this study was to investigate the relation of children's perceived family and social support to their behavior and hopelessness. METHOD: Subjects were 100 child psychiatric inpatients who completed a series of self-report measures, including the Social Support Questionnaire-Self Report, the Scales of Independent Behavior, and the Hopelessness Scale for Children. RESULTS: Children who perceived lower levels of family and social support were more withdrawn or inattentive and were more harmful to others, damaging to property, and uncooperative. In addition, children who reported fewer supportive persons in their lives had higher levels of hopelessness. CONCLUSIONS: These data emphasize the connection between social support systems, psychopathology, and hopelessness. These relationships may indicate that children need a sense that they are cared for and supported if they are to avoid serious problems and feelings of hopelessness.

Assessing anger expression in children and adolescents.

Anger expression styles are associated with psychological and physical well-being among adults. Little is known about the role of anger expression in children's functioning. This lack of knowledge has resulted, in part, from a lack of validated tools for anger expression measurement. The Pediatric Anger Expression Scale-3rd edition (PAES-III; Jacobs, Phelps, & Rohrs, 1989; Jacobs & Kronaizl, 1991) has been proposed as a reliable and valid assessment instrument of anger expression styles. The PAES-III includes three scales that measure anger turned inward, anger expressed outwardly, and anger controlled cognitively or behaviorally. We evaluated the psychometric properties of this instrument when it is administered verbally to children with juvenile rheumatoid arthritis, children with juvenile diabetes mellitus, and healthy children. Internal consistency was adequate for anger-in and anger-out, but marginal for anger-control. Concurrent validity was supported for the total sample. A principal components analysis suggested a four-factor model of anger expression. Overall, the PAES-III was found to have psychometric limitations. Use of a modified PAES-III may facilitate pediatric behavioral medicine research addressing risk factors for maladjustment among children with chronic illnesses.

Detecting dysfunctional behavior in adolescents: the examination of relationships using neural networks.

We describe a neural network that models the effect of personality, social, and environmental variables on hopelessness in adolescents. A sensitivity analysis suggests the effect that variation in each of the input variables will have on the output. Clinical implications are that health professionals can focus their attention on the variables most likely to impact upon the outcome.