Stressors and child and adolescent psychopathology: measurement issues and prospective effects.

This article reviews existing research on the association between stressors and symptoms of psychopathology in children and adolescents with a focus on measurement issues and prospective effects. The first half of the article focuses on the measurement of stressors, emphasizing checklists and interviews. Available measures of stressful experiences are reviewed and critiqued. Results of this review reveal both substantial progress (i.e., development of valid stressor assessment tools) and remaining problems (i.e., inconsistent measurement across studies). The second half of this article reviews studies that have tested for prospective associations between stressors and symptoms of psychopathology in children and adolescents. Studies that have examined the prospective effects of recent or prior stressors on current psychological symptoms, while controlling for prior psychological symptoms, are reviewed. Results overall suggest that stressors predict changes in rates of symptoms of psychopathology in children and adolescents over time. Results also suggest that symptoms of psychopathology predict changes in rates of stressors over time. Implications of these findings are that conclusive evidence now exists for the importance of stressors in the development of child and adolescent psychopathology.     

Stressors and Child and Adolescent Psychopathology: Measurement Issues and Prospective Effects

This article reviews existing research on the association between stressors and symptoms of psychopathology in children and adolescents with a focus on measurement issues and prospective effects. The first half of the article focuses on the measurement of stressors, emphasizing checklists and interviews. Available measures of stressful experiences are reviewed and critiqued. Results of this review reveal both substantial progress (i.e., development of valid stressor assessment tools) and remaining problems (i.e., inconsistent measurement across studies). The second half of this article reviews studies that have tested for prospective associations between stressors and symptoms of psychopathology in children and adolescents. Studies that have examined the prospective effects of recent or prior stressors on current psychological symptoms, while controlling for prior psychological symptoms, are reviewed. Results overall suggest that stressors predict changes in rates of symptoms of psychopathology in children and adolescents over time. Results also suggest that symptoms of psychopathology predict changes in rates of stressors over time. Implications of these findings are that conclusive evidence now exists for the importance of stressors in the development of child and adolescent psychopathology.     

Cognitive and family therapies for adolescent depression: treatment specificity, mediation, and moderation

The specificity of cognitive and family therapies, and potential treatment mediators and moderators, was examined in a randomized clinical trial for adolescent depression. After acute treatment, cognitive-behavioral therapy (CBT) exerted specific effects on cognitive distortions relative to either systemic-behavioral family therapy (SBFT) or nondirective supportive therapy (NST). At 2-year follow-up, SBFT was found to impact family conflict and parent-child relationship problems more than CBT; NST and CBT tended to show a greater reduction in anxiety symptoms than SBFT. Nonspecific therapist variables qualified few outcome analyses. No measures of cognitive distortion or family dysfunction mediated or moderated treatment outcome. As in adult studies, relatively few areas of treatment specificity or mediation were identified. The implications of these findings for clinical treatment and research in adolescent depression are discussed.     

Parent–child attachment: meta-analysis of associations with parenting behaviors in middle childhood and adolescence

Maternal sensitivity predicts mother–child attachment in young children, but no meta-analysis has investigated the link between parenting and parent–child attachment in older children. This study examined the relationship between parent–child attachment and multiple components of parenting in children 5–18 years of age. A series of meta-analyses showed that parents of children with more secure attachment are more responsive, more supportive of the child’s autonomy, use more behavioral control strategies, and use less harsh control strategies. Parents of children with more avoidant attachment were less responsive and used less behavioral control strategies. Ambivalent attachment was not significantly related to any of the parenting behaviors, and there were not enough studies to reliably test the relationship between disorganized attachment and parenting. There were few significant moderators. The findings inform new areas for future research, as well as family interventions for at-risk youth.     

Sibling relationship quality and psychopathology of children and adolescents: A meta-analysis

In the current meta-analysis, we investigated the link between child and adolescent sibling relationship quality (warmth, conflict and differential treatment) and internalizing and externalizing problems, and potential moderators of these associations. From 34 studies, we obtained 85 effect sizes, based on 12,257 children and adolescents. Results showed that more sibling warmth, less sibling conflict and less differential treatment were all significantly associated with less internalizing and externalizing problems. Effect sizes for sibling conflict were stronger than for sibling warmth and differential treatment, and associations for internalizing and externalizing problems were similar in strength. Effect sizes were moderated by sibling gender combination (stronger effects for higher percentage brother pairs), age difference between siblings (stronger effects for smaller age differences), and developmental period (stronger effect sizes for children than for adolescents). These results indicate that the sibling context is important when considering psychopathology. In addition to the overwhelming evidence of the impact of parent–child and marital relationships on child and adolescent development, the present meta-analysis is a reminder that the sibling relationship warrants more attention in research as well as in clinical settings.     

What It's Like to Be Me (Book)

Examined family moderators of the relation between everyday stressors (hassles) and behavior problems in 99 inner-city children (ages 8-12 years, M = 10.7) and their caregivers. In separate home interviews children reported on their everyday stress, perceived support from mother, and adjustment problems; mothers reported on family demographics, major life stressors, family interaction patterns, and child adjustment difficulties. Higher levels of cohesion and routines attenuated the relation between hassles and both internalizing and externalizing problem behaviors, whereas high family conflict exacerbated the risk for adjustment difficulties. For externalizing behavior, higher levels of family adaptability protected children from the impact of daily hassles. Social support from the mother did not moderate the hassle-adjustment association. Implications for interventions with families are discussed.     

Mental health issues among refugee children and adolescents

Each year, several thousand child refugees are resettled in Australia. These children have faced numerous stressors and are at increased risk for developing mental health problems including traumatic stress and a variety of emotional, behavioural, and educational difficulties. The diverse contexts in which refugee children may come into contact with mental health clinicians include school, child and adolescent mental health services, child protection services, and hospitals. This article summarises current knowledge regarding the mental health of refugee children and adolescents, distilling what is of particular relevance to Australian service providers. The stressors encountered by refugee children, psychological outcomes, appropriate interventions, and barriers to accessing services are discussed.     

Resilience to suicidality: the buffering hypothesis

Recent years have seen a growing interest into resilience to suicidality, which has been described as a perception or set of beliefs which buffer individuals from suicidality in the face of stressors. The current review extends this research by introducing the buffering hypothesis, a framework for the investigation of resilience to suicidality. The key proposal of this is that psychological resilience factors should be viewed as existing on a separate dimension to risk which acts to moderate the impact of risk on suicidality. Furthermore, like risk factors, resilience factors are bipolar, with their positive pole conferring resilience and their negative pole acting to amplify suicidality. Seventy-seven studies were identified which investigated (a) whether psychological moderators of risk exist and (b) the particular psychological constructs which may act as moderators. The review found strong support for the existence of psychological moderators and indicated a moderating impact of attributional style, perfectionism, agency and hopelessness. These findings support the buffering hypothesis and suggest that a range of psychological factors may confer resilience to suicidality. These results suggest that the identification of moderators may improve estimates of suicide risk and that the development of buffering factors could be a key focus of suicide interventions.     

Future Directions in Father Inclusion,Engagement, Retention,and Positive Outcomes in Child and Adolescent Research

Fathers make important and unique contributions to positive child development. In spite of these findings, the research literature has lagged in the study of the role and impact of fathers on child development and in the development of effective approaches and interventions for fathers. Parameters for additional study include the inclusion of fathers in treatment outcome studies, the engagement of fathers within studies once included, the retention of fathers in interventions and studies once engaged, and the appropriate measurement of father-related outcomes. A systematic review of 64 studies indicated that there is evidence that fathers have been included within multiple studies aimed at improving parenting but that there are relatively fewer studies of other targeted outcomes such as coparenting. A set of recommendations for future directions in the next generation of father-focused studies in the child and adolescent psychology literature is presented, with an emphasis on improving study of the parameters of inclusion, engagement, retention, and measurement of outcomes.     

Community violence exposure and aggression among urban adolescents: testing a cognitive mediator model

Past research has shown that exposure to violence leads to aggressive behavior, but few community‐based studies have examined theoretical models illustrating the mediating social cognitive processes that explain this relation with youth exposed to high rates of violence. This study examines the impact of community violence on behavior through cognitive mediators: normative beliefs about aggression and self‐efficacy to control aggression. Self‐report surveys were completed by two samples (cross‐sectional and longitudinal) of early adolescent, urban African American youth. Structural equation modeling was used to evaluate a theoretical model, and results demonstrated a good fit with both samples; that is more exposure to community violence was associated with more retaliatory beliefs supporting aggression, which led to less self‐efficacy to control aggression, which led to more aggressive behavior. These findings are examined in the context of community factors, and implications for prevention and intervention are discussed. © 2009 Wiley Periodicals, Inc.     

Identifying mechanisms of change in psychotherapy: Mediators of treatment outcome

We know that psychotherapy works, but the processes and mechanisms underlying therapeutic change are still largely unknown. The study of mediators and moderators of change in psychotherapy is one way to improve our understanding of mechanisms operating in psychotherapy. Consensus is slowly building on how to define both mediators and moderators of change, while there is still a controversy on strategic issues, e.g., criteria for demonstrating causality. The rationales for mediator research are discussed, as well as some of the major obstacles inherent in this research area. Finally, we present some strategic considerations for future research. Copyright © 2007 John Wiley & Sons, Ltd.     

A Longitudinal Study of Fathers’ and Young Children’s Depressive Symptoms

Considerable research has examined the effects of maternal depression on children, but few studies have focused on the relation between paternal and child depressive symptoms, particularly during early childhood. Even fewer studies have been longitudinal, leaving open questions about how paternal and child depression covary over time. The present study sought to address this gap by examining the relation between fathers’ and children’s depressive symptoms over a 3-year period. Participants were 153 preschool children with behavior problems and their parents. Three longitudinal analytic approaches were used to examine how father and child depression change together and predict one another over time. Additional analyses examined whether externalizing problems or maternal depression might account for the associations between fathers’ and children’s depressive symptoms. Changes in paternal depression significantly predicted changes in father-reported and mother-reported child depressive symptoms. These effects were evident both in year-to-year fluctuations and in linear trajectories across the 3-year period. Cross-lagged analyses suggested that these relations may have been driven by father-effects; paternal depression at one time point predicted child depression at the next time point, but child depression did not significantly predict later paternal depression. We found little evidence that externalizing problems or maternal depression accounted for the relations between fathers’ and children’s depressive symptoms. Results provide convergent evidence that fathers’ depression may play an important role in the development of depressive symptoms in young children and underscore the importance of including fathers in studies of depression in families.     

Maternal Depression,Parenting, and Youth Depressive Symptoms: Mediation and Moderation in a Short-Term Longitudinal Study

Although multiple studies find that offspring of depressed mothers are at risk for depressive disorders, there is uncertainty about the specific mechanisms that are at work—particularly with respect to modifiable factors that might be targeted for early intervention. The present work examines that parenting behaviors may operate as mediators, moderators, or independent influences on the development of youth depressive symptoms. One hundred one mothers and their early adolescent children participated in positive and negative interaction tasks. Maternal and youth self-reports of youth depressive symptoms were collected at baseline, 9-month, and 18-month assessments. Maternal history of depression was significantly associated with maternal-reported, but not youth self-reported, depressive symptomatology. Maternal positive and negative interaction behaviors in positive contexts were associated with higher youth self-reported depressive symptoms. Maternal positive interaction behaviors in positive contexts and maternal negative interactive behaviors in conflict contexts were associated with higher youth self-reported depressive symptoms. We found no evidence for maternal interaction behaviors serving as a mediator and little evidence of maternal interaction behaviors serving as a moderator of the relationship between maternal and offspring depression. Low maternal positive engagement tended to be more consistently associated with maternal- and self-reported youth depressive symptoms. The present findings suggest that characteristics of mother–child interactions that are associated with youth depressive symptomatology are pertinent to youth with and without a mother with a history of depression.     

An overview of controlled studies of anxiety disorders treatment in children and adolescents

OBJECTIVE: Although several treatments for children and adolescents with anxiety disorders are available, there are few well-controlled studies in the literature that compare these treatments for efficacy. The objective of this paper is to provide an overview of controlled treatment studies for children and adolescents with anxiety disorders. METHOD: The research literature on controlled treatment studies of anxiety disorders in children and adolescents was systematically reviewed through a search of PsycINFO and Medline. Studies that did not compare the efficacy of treatment modalities were excluded. RESULTS: This review focuses specifically on three main treatment modalities: cognitive-behavioral therapy, both individual and group; family-based interventions; and pharmacotherapy. Each of these modalities is reviewed in the context of the separate disorders as defined by DSM-III-R and/or DSM-IV. The results are especially promising for cognitive-behavioral therapy and pharmacotherapy for many of the anxiety disorders; however, there are concerns about small sample sizes, lack of described comorbidity within the groups and generalizability. CONCLUSION: While great strides have been made in the treatment of child and adolescent anxiety disorders, empirically based studies are quantitatively limited. More research is needed involving head-to-head trials of the different modalities.     

Prediction of treatment outcome from relationship variables in child and adolescent therapy: a meta-analytic review

Results from 23 studies examining associations between therapeutic relationship variables and treatment outcomes in child and adolescent therapy were reviewed with meta-analytic procedures. Results indicated that the overall strength of the relationship-outcome associations was modest and quite similar to results obtained with adults. This modest association was moderated by 1 substantive factor, type of patient problem, and 5 methodological factors, timing and source of relationship measurement, type and source of outcome, and shared versus cross-source measurement of relationship and outcome variables. Type, mode, structure, and context of treatment did not moderate associations between relationship variables and outcomes. Findings indicated that the association between the therapeutic relationship and treatment outcome was consistent across developmental levels and across diverse types and contexts of child and adolescent therapy. Recommendations for future process research on the therapeutic relationship in child psychotherapy are offered.     

Longitudinal associations between depression and functioning in midlife women

Associations between depression and impaired functioning are well known and have been documented in numerous clinical, primary care and epidemiological studies. Reviews of this research have focused on the elderly. Recent studies suggest that women become increasingly vulnerable during the menopausal transition to declines in physical and role function and increases in depressive symptoms. The purpose of the current research is to review the literature since 1966 for studies examining the association between depression and physical and psychosocial impairment in midlife women. We selected only longitudinal studies that had the potential to elucidate the nature of the complex relationship between depression and functioning. Results of the review indicate evidence for bi-directional associations between depression and functioning in middle-aged women. However, the studies are only broadly informative. Most adjusted for only a limited group of factors that could be associated with both depression and functioning. None of them directly examined potential moderators or mediators of the relationship between depression and impaired functioning.     

Tripartite dimensions of emotion in a child clinical sample: measurement strategies and implications for clinical utility

Several measurement strategies to assess the tripartite model of emotion in child and adolescent samples have been developed. However, no studies have comparatively examined the most suitable strategies in clinical samples of children and adolescents. This study involved the evaluation of 2 distinct measures of tripartite constructs relative to anxiety and depression criterion variables in a clinical sample of 226 children in Grades 1 through 12. Results indicated that the measures performed similarly overall, but some differences were pronounced enough to suggest that the measures indexed slightly different aspects of the same constructs. These differences appear consistent with the scale design of each instrument. Implications for measurement of these constructs in future research are highlighted.     

God is nowhere, God is now here: attachment activation, security of attachment, and God's perceived closeness among 5-7-year-old children from religious and non-religious homes

God's perceived closeness (GC) is greater when the attachment system is activated. This conclusion is based primarily on adult studies, but some findings suggest its validity also in childhood. Adult studies have shown GC to vary in relation to security of attachment, but child studies have been few and methodologically limited. In this study, we tested differences between securely and insecurely attached children on GC in attachment activating and neutral conditions, as well as whether parental religiousness acted as a moderator. Participants were forty 5-7-year-olds, from non-religious and Christian homes. The adapted Separation Anxiety Test was used to assess attachment. Participating children were told brief stories about visually represented children in different situations, and placed a God symbol on a felt board to represent GC to the fictional child. Results showed that GC was greater in attachment activating situations, particularly for secure children, supporting a hypothesis of internal working model correspondence between models of Self/Others and God. Although a religious type of home emerged as predictive of GC, no support was found for a moderating role of parental religiousness.     

Life events and juvenile bipolar disorder: conceptual issues and early findings

There is increasing interest in the psychosocial variables that might predict the course of child and adolescent bipolar disorder. In the literature on adult bipolar disorder, life events have been shown to be a major predictor of symptoms. In this review, we focus on studies of how life events influence the course of child and adolescent bipolar disorder. To begin, we review methodological considerations in life events research, and briefly summarize the findings regarding life events in adult bipolar disorder. Then, we discuss available studies on life events as a predictor of the course of juvenile bipolar disorder. We conclude with suggested directions for future research.     

Relation of chronic and episodic stressors to psychological distress, reactivity, and health problems

This study tested the hypothesis that exposure to chronic stressors, which reflect persistent, negative life situations, would have greater physiological, psychological, and physical health costs than exposure to episodic or intermediate-length stressors, which reflect relatively transient, negative life situations. We also tested whether cardiovascular reactivity, conceptualized as a marker of underlying pathophysiological states, would mediate the relation between chronic stress and psychological distress and illness. Participants were 75 male and 75 female college students. Compared with students experiencing few chronic life stressors, students experiencing many chronic life stressors had exaggerated cardiovascular responses to acute challenges, delayed recovery to resting levels of cardiovascular functioning after the acute challenges, elevated psychological distress levels, and they reported more illnesses. None of the outcomes was associated with the number of episodic or intermediate-length life stressors students experienced. Cardiovascular reactivity did not mediate the stress-distress or stress-illness associations. The results suggest that ongoing stressors that are static are more detrimental to health and well-being than are episodic of change-related stressors.