Group Care Worker Behavior and Adolescents' Internalizing and Externalizing Problems in Compulsory Residential Care

In the present study, group care workers' behavior toward adolescents' problem behavior was measured. The sample consisted of 126 adolescents (M age = 15.80, SD = 1.23, 56% boys), residing in a new Dutch compulsory residential treatment program. Latent growth curve analyses revealed that group care workers exerted more structuring and controlling behavior toward adolescents with externalizing problems and more warmth and support toward adolescents with internalizing problems. No associations were found between group care workers' behavior and the adolescents' treatment progress. Clinical implications of these findings and suggestions for future research are discussed.     

Emotion Regulation Related to Children's Future Externalizing and Internalizing Behaviors

PROBLEM: Emotion regulation in children is a construct with important theoretical and clinical implications for healthcare providers, yet currently there is not a reliable and valid instrument that can be easily administered to young children. METHODS: The study was based on interviews with 126 children ages 5.5–12 years from a longitudinal study conducted over 4 years. Reliability, internal construct, and discriminant and predictive validity were examined. FINDINGS: The study was able to distinguish between two types of emotions, sadness and anger, and provided evidence that outcomes may be different for each of these emotion dysregulations. CONCLUSIONS: This study provides empirical evidence that an interview with children as young as 5.5 years can provide researchers with a reliable and valid measure of emotion regulation.     

Childhood Maltreatment Exposure and Disruptions in Emotion Regulation: A Transdiagnostic Pathway to Adolescent Internalizing and Externalizing Psychopathology

Child maltreatment is a robust risk factor for internalizing and externalizing psychopathology in children and adolescents. We examined the role of disruptions in emotion regulation processes as a developmental mechanism linking child maltreatment to the onset of multiple forms of psychopathology in adolescents. Specifically, we examined whether child maltreatment was associated with emotional reactivity and maladaptive cognitive and behavioral responses to distress, including rumination and impulsive behaviors, in two separate samples. We additionally investigated whether each of these components of emotion regulation were associated with internalizing and externalizing psychopathology and mediated the association between child maltreatment and psychopathology. Study 1 included a sample of 167 adolescents recruited based on exposure to physical, sexual, or emotional abuse. Study 2 included a sample of 439 adolescents in a community-based cohort study followed prospectively for 5 years. In both samples, child maltreatment was associated with higher levels of internalizing psychopathology, elevated emotional reactivity, and greater habitual engagement in rumination and impulsive responses to distress. In Study 2, emotional reactivity and maladaptive responses to distress mediated the association between child maltreatment and both internalizing and externalizing psychopathology. These findings provide converging evidence for the role of emotion regulation deficits as a transdiagnostic developmental pathway linking child maltreatment with multiple forms of psychopathology.     

Glycemic Control, Coping, and Internalizing and Externalizing Symptoms in Adolescents With Type 1 Diabetes: A cross-lagged longitudinal approach

OBJECTIVE

This study examines how active coping and withdrawal, psychological (internalizing and externalizing) symptoms, and glycemic control (A1C values) influence each other across time in adolescents with type 1 diabetes.

RESEARCH DESIGN AND METHODS

One hundred and nine adolescents participated in a four-wave longitudinal study spanning four years (mean age at Time 1 was 13.77). Patients were visited at home and completed questionnaires measuring coping and psychological symptoms. The treating physicians were contacted to obtain A1C values. Cross-lagged path analysis from a structural equation modeling approach was used for data analysis.

RESULTS

Clinically meaningful pathways between coping and glycemic control were found across time. Active coping prospectively predicted lower A1C levels, which, in turn, predicted active coping. Higher A1C levels and higher psychological symptoms consistently predicted avoidance coping across time. Finally, psychological symptomatology constituted an important link in the observed longitudinal chain of effects. More specifically, higher A1C values and symptomatology at Time 1 positively predicted withdrawal at Time 2, which, in turn, positively predicted symptomatology at Time 3. Next, symptomatology at Time 3 positively predicted higher A1C values at Time 4, thus coming full circle.

CONCLUSIONS

Coping with everyday stress, psychological symptoms, and glycemic control were interrelated across time. Evidence was obtained for reciprocal pathways and mutually reinforcing mechanisms, indicating the need to monitor coping strategies and psychological symptoms along with glycemic control in optimizing clinical care in adolescents with type 1 diabetes.Adolescence can be a challenging time when individuals have to deal with several developmental tasks such as growing independent from parents and developing mature peer relationships. Having type 1 diabetes imposes multiple additional demands on the adolescent, invading every aspect of his or her life. Diabetes management requires a great deal of self-discipline and is perceived as being highly stressful (1). Consequently, several studies suggest that adolescents with diabetes are at a greater risk than their healthy peers for developing psychological symptoms (such as internalizing and externalizing symptoms, which are both being assessed in this study) or even psychiatric disorders (e.g., depressive disorder) (2–4). However, other studies did not find increased levels of psychological symptoms in these adolescents (5,6), which could signal their increased competence in managing their illness and coping with age-specific developmental tasks. Psychological symptoms (such as internalizing or, more specifically, depressive symptoms) can negatively influence glycemic control through physiological channels and/or through behavioral pathways thereby reducing treatment adherence (4,7). In turn, such symptoms can also be a consequence of poorly controlled diabetes (e.g., due to repeated stressful episodes of severe diabetic ketoacidosis and diabetic microvascular complications such as retinopathy) (3,8–10). As such, the relationship between psychological symptoms and glycemic control is hypothesized to be a reciprocal one.Several studies have shown that many adolescents have difficulty coping with various illness-specific and everyday stressors, show low adherence with their prescribed treatment, and/or poor glycemic control (11,12). Seiffge-Krenke et al. (13,14) distinguished between functional and dysfunctional coping. Functional coping refers to efforts to manage a problem by actively seeking support, taking concrete actions, or reflecting on possible solutions. Dysfunctional coping includes efforts to withdraw from or deny the existence of the stressor and to avoid seeking solutions and, as such, risk exacerbating the effects of stress (11). Adolescents using active coping skills were less likely to show a worsening in their glycemic control, implying that their coping competencies had a protective effect (15). The consistent use of withdrawal or avoidance coping has been linked to increases in psychological symptoms in community samples (16). In sum, adolescents with diabetes who use withdrawal coping may be at risk for psychological symptoms and poor glycemic control. Some have suggested that these relationships may be reciprocal (1).     

Children''s Asthma, Internalizing Problems, and Social Functioning: An Urban Perspective

PROBLEM: Asthma may serve as a risk factor for higher levels of psychosocial problems in urban school-aged children. METHOD: Interview data were collected from 48 children (27 with asthma and 21 without asthma) and their mothers. FINDINGS: Asthma did not function as a risk factor for psychosocial problems in this sample. Children with more symptoms of depression and anxiety experienced poorer social functioning, regardless of their health status. CONCLUSION: These results highlight the importance of examining co-occurring difficulties in psychosocial development among urban children in order to design interventions that minimize the impact of such challenges.     

Coping as a Moderator of Relations Between Reactivity to Interpersonal Stress, Health Status, and Internalizing Problems

Coping moderation of relations between involuntary stress-reactivity, health status, and internalizing problems was tested in sociotropic college students responding to a standardized laboratory interpersonal stressor. Coping moderated relations between heart rate reactivity and health status, with primary control engagement coping, secondary control engagement coping, and disengagement coping all serving as buffers. Primary control also buffered the link between self-reported arousal and health status, and secondary control coping buffered the link between self-reported arousal and health status and internalizing problems. Coping and involuntary responses to the standardized laboratory stressor were correlated with measures of naturalistic coping and involuntary stress-reactivity. Benefits of linking laboratory and naturalistic coping research are highlighted, along with implications of the interaction of involuntary stress-reactivity and coping.     

Transitioning Youth With Attention Deficit Hyperactivity Disorder to Adult Health Care

Attention deficit hyperactivity disorder (ADHD) is one of the most common childhood neurodevelopmental diseases and nearly two thirds of children with ADHD have symptoms that persist into adulthood. Approximately 750,000 children with special health care needs transition from pediatric to adult health care annually in the United States. For youth with ADHD, organized, coordinated, and systematic care transition from pediatric to adult health care providers is essential to prevent negative consequences related to unmanaged ADHD symptoms and to optimize health and promote maximum functioning. The Got Transition model's 6 core elements provide a guide to support successful transition for adolescents with ADHD.     

Parental and Family Factors as Predictors of Threat Bias in Anxious Youth

The present study examined the relative predictive value of parental anxiety, parents’ expectation of child threat bias, and family dysfunction on child’s threat bias in a clinical sample of anxious youth. Participants (N = 488) were part of the Child/Adolescent Anxiety Multi-modal study (CAMS), ages 7–17 years (M = 10.69; SD = 2.80). Children met diagnostic criteria for generalized anxiety disorder, separation anxiety and/or social phobia. Children and caregivers completed questionnaires assessing child threat bias, child anxiety, parent anxiety and family functioning. Child age, child anxiety, parental anxiety, parents’ expectation of child’s threat bias and child-reported family dysfunction were significantly associated with child threat bias. Controlling for child’s age and anxiety, regression analyses indicated that parents’ expectation of child’s threat bias and child-reported family dysfunction were significant positive predictors of child’s self-reported threat bias. Findings build on previous literature by clarifying parent and family factors that appear to play a role in the development or maintenance of threat bias and may inform etiological models of child anxiety.     

A Meta-Analytic Review of Mental Health Interventions Targeting Youth with Internalizing Disorders in Juvenile Justice Facilities

There is general agreement in the research literature that youth in juvenile justice facilities are more likely to experience mental health disorders than their general population peers. The purpose of this systematic review and meta-analysis was to evaluate the methodological characteristics and effectiveness of mental health interventions delivered in juvenile justice settings on symptoms associated with internalizing disorders. The 11 studies included in the current review incorporated pretest-posttest research designs and were conducted with juveniles in secure facilities that reported outcome measures of depression, anxiety, posttraumatic stress disorder, or internalizing disorders. Meta-analytic findings indicate mixed results for interventions affecting internalizing symptoms and varying results between studies implementing an experimental design compared to those using a single group non-experimental design. Additionally, no studies examined how interventions could be incorporated into daily activities in juvenile justice facilities, such as school and classroom activities. Lastly, the limited number of studies included in the current review indicates a continued need for further experimental research on the effectiveness of mental health interventions delivered to youth in juvenile justice facilities.     

Mediators for Internalizing Problems in Adolescents of Parents with Chronic Medical Condition

Parents’ chronic medical condition (CMC) is related to internalizing problem behavior in adolescents. Following the transactional stress and coping (TSC) model of Hocking and Lochman, our study examines whether the effect of illness and demographic parameters on the child’s internalizing problems is mediated by the ill parent’s quality of life, family functioning, and child adaptational processes. Participants were 160 adolescents (52 % female, mean age?=?15.1 years) from 100 families affected by parental CMC. Children completed a test battery including the Youth Self-Report. Family functioning was determined with the Interactional Problem Solving Inventory (marital functioning) and the Inventory of Parent and Peer Attachment (alienation from parents). Child adaptational processes were composed by cognitive processes, methods of coping, and child report of stress. Ill parents completed the Medical Outcome Study Short-Form and the Beck Depression Inventory, assessing quality of life. We used structural equation modeling to investigate the tenability of the TSC model. After a series of step-by-step modifications, the TSC model for children with parental CMC fitted the data closely. The ill parent’s quality of life, family functioning, and children’s daily hassles and stress mediated the effect of parental CMC on adolescent internalizing problems. Children’s active problem solving and social support seeking were not directly related to internalizing problems but significantly interfered with children’s self-esteem and stress. Child adaptational processes should be accorded a central role in support programs and interventions for children with parental CMC. Health practitioners and teachers are recommended to be alert for support needs in children.     

Adverse Childhood Experiences (ACEs) and Internalizing Mental Health,Pain, and Quality of Life in Youth With Chronic Pain: A Longitudinal Examination

The aims of this longitudinal study were to 1) identify categories of adverse childhood experiences (ACEs) (ie, neglect, abuse, household dysfunction in childhood) that increase risk for internalizing mental health problems, pain-related impairment, and poorer quality of life and 2) examine the moderating role of posttraumatic stress symptoms (PTSS) in these associations, in a clinical sample of youth with chronic pain. At 2 timepoints, youth (N = 155; aged 10–18 years) completed measures of exposure to ACEs, PTSS, depressive and anxiety symptoms, pain intensity, pain interference, and quality of life. Multivariate analyses of variance, linear mixed modeling, and moderation analyses were conducted. Results from cross-sectional and longitudinal analyses were similar; youth with a history of 3+ ACEs reported significantly higher PTSS, depressive and anxiety symptoms, and poorer quality of life than youth with no ACE history. Results also revealed differences in functioning between youth exposed to different types of ACEs (ie, maltreatment only, household dysfunction only, both, none). Finally, PTSS was found to moderate the association between ACEs and anxiety and depressive symptoms. Findings underscore the influence that ACEs can have on the long-term functioning of youth with chronic pain as well as the important role of current PTSS in this association.PerspectiveThis study found that the risk of poorer outcomes imposed by ACEs at baseline remains longitudinally and that posttraumatic stress symptoms (PTSS) moderate the relationship between ACEs and anxiety and depressive symptoms in youth with chronic pain. These results underscore the importance of assessing for ACEs and PTSS alongside chronic pain in youth.     

实施整体化护理中应注意沟通问题

随着社会的进步 ,人民生活水平得到了提高 ,就医需求也随之发生了变化 ,病人对健康和自我护理知识的需求有较高的期望。新的医学模式和整体护理的开展满足了病人的这一需求。在整体护理的实施过程中 ,如何有效地运用护理程序 ,更好地与病人沟通 ,促进病人的早日康复是护理人员的期望。然而在实践中 ,由于多种原因 ,实际效果并不令人满意 ,直接影响着整体护理的实施。下面将我院开展整体化护理总结的经验报告如下。1　重视与病人的初次见面护士与病人初次见面时要有心理准备 ,端庄大方 ,态度和蔼 ,争取在最初见面时给病人留下一个好印象。可…     

浅谈实施整体护理应注意的问题

社会的发展、医学的进步 ,客观上对护理学科提出了新的要求 ,要使我国护理学科有一个质的飞跃 ,必须更新观念 ,以改革传统的医疗为中心的功能制护理 ,实施以病人为中心的整体护理。有效的健康教育可以提高病人的自我保健能力 ,降低并发症和致残率 ,促进病人早日康复 ,提高生命质量[1] ,从而也提高了医疗和护理质量。现将我院开展整体护理的体会介绍如下。1　领导重视、护理管理人员的观念更新是开展整体护理关键　　领导重视 ,强化支持体系是实施整体护理的先决条件。在开展整体护理过程中 ,主管院长积极开发医院领导层 ,提高认识 ,加大对其…     

Behaviour Problems Among Children with Down's Syndrome: Prevalence,Persistence and Parental Appraisal

Changes over time in the pattern of behaviour problems shown by 91 children with Down's syndrome, together with maternal appraisal of the seriousness of reported problems, were investigated through questionnaires completed by mothers. Fifty-four individual behaviours were studied at mean ages 9 years 2 months and 13 years 9 months. There was a significant decline in the overall frequency of behaviour problems and in some disturbed behaviours, sleeping and toileting problems, and over-activity. Only one problem-lying-became more common. However, many problems were found to be persistent among the same children. While mothers viewed relatively few behaviours as definite problems, a minority faced a multiplicity of perceived problems at both points in time. Running away was a common problem which particularly concerned mothers. Sleeping problems were generally seen as less problematic by Time 2, while stealing had become more so. Some individual problems were associated with the gender, age and developmental level of the children. Results suggest that behaviour problems may become set relatively early in life, and that families may benefit from help in preventing and dealing with problems well before the teenage years.     

Behavior Problems in Relation to Sustained Selective Attention Skills of Moderately Preterm Children

Attention skills may form an important developmental mechanism. A mediation model was examined in which behavioral problems of moderately preterm and term children at school age are explained by attention performance. Parents and teachers completed behavioral assessments of 348 moderately preterm children and 182 term children at 8 years of age. Children were administered a test of sustained selective attention. Preterm birth was associated with more behavioral and attention difficulties. Gestational age, prenatal maternal smoking, and gender were associated with mothers’, fathers’, and teachers’ reports of children’s problem behavior. Sustained selective attention partially mediated the relationship between birth status and problem behavior. Development of attention skills should be an important focus for future research in moderately preterm children.     

Validating a Mobile Eye Tracking Measure of Integrated Attention Bias and Interpretation Bias in Youth

Cognitive Therapy and Research - This study sought to validate a real-world speech task designed to assess attention and interpretation bias in an integrated and ecologically valid manner. Thirty...