Child and adolescent dysfunction and paths toward maladjustment: Targets for intervention

This article discusses a range of conditions that reflect maladjustment or untoward functioning of children and adolescents. The scope of psychological dysfunctions, at-risk behaviors, and untoward conditions that affect children and adolescents are highlighted. Clinical dysfunctions that emerge in early development, the importance of considering development in identifying dysfunction, and changing patterns of dysfunction are discussed. Examples of at-risk behaviors (e.g., substance use and abuse, sexual activity, delinquent and antisocial acts) and conditions to which youths are exposed (e.g., physical and sexual abuse and neglect, changes in family constellations, and homelessness) are illustrated to convey the breadth of threats to child and adolescent development. The article ends with a discussion of the critical role of basic research to understand mechanisms underlying dysfunction and adjustment, and of evaluation (assessment) in clincal, treatment, and service programs designed to help youth and their families.     

Predictors of risky sexual behavior in African American adolescent girls: implications for prevention interventions

OBJECTIVE: To describe empirically the risky sexual behavior of an at-risk sample of adolescent girls, to assess psychosocial correlates of risky behavior, and to examine the utility of applying a risk and protective model to predicting teens' risky sexual behavior. METHOD: Participants included 158 African American girls, ages 12 to 19, who were receiving medical care in an adolescent primary care clinic. Teens completed measures of depression, conduct problems, substance use, peer norms, social support, HIV knowledge, sexual self-efficacy, and sexual behavior. RESULTS: Teens in this sample reported high rates of risky sexual behaviors, including early sexual debuts and frequent unprotected sexual encounters with multiple partners. African American girls who reported high rates of substance use and who reported that their peers engaged in risky behaviors also reported engaging in high rates of risky sexual behaviors. Little support was obtained for protective factors (HIV knowledge, social support, sexual self-efficacy) moderating the relations between risk factors and adolescents' risky sexual behavior in this sample. CONCLUSIONS: Teens presenting in primary care settings in urban environments seem to be at high risk for HIV, STDs, and substance abuse, and risk reduction strategies should be introduced during the preteen years. An interdisciplinary model of care in primary care settings serving adolescents is clearly indicated, and prevention-oriented interventions aimed at reducing risky behaviors and preventing the development of more significant health, mental health, or substance abuse disorders are needed.     

The effects of child abuse and race on risk-taking in male adolescents.

This study explores the effects of abuse on the risk-taking behaviors of 2973 black and white adolescent males, 412 of whom were sexually or physically abused. Surveys on mental and physical health, risk-taking behaviors and attitudes, and family living were administered to 9th and 12th graders in an urban midwestern state. The surveys included questions on past history of sexual and physical abuse. More black than white males reported experiencing incest, extrafamilial sexual abuse, and physical abuse. As for outcome risk-taking behaviors, blacks were more likely to use illegal substances, run away, skip school, attempt suicide, force partners into sex, and commit violent acts; however, the racial effects decreased when abuse histories were taken into consideration. Whites were more likely to drink and drive, and to drink before having sex; abuse history did not decrease this racial effect. Abuse but not race was predictive of drinking and of having serious drinking problems. The results point to the importance of pediatricians, psychologists, and other healthcare workers, as well as those in the legal and criminal justice system screening for a history of abuse among adolescents who demonstrate these or other risk-taking behaviors.     

Behavioral changes of adolescents in drug abuse intervention programs

Reduction of problem behaviors (drug and alcohol use, school problems, and legal involvement) by Mexican-American youth (N = 326) during their first 3 months in drug abuse intervention programs was related negatively to peer drug use during the program and was related positively to the amount of family support available during the program, participation in program activities, and a background of religious involvement. These findings support previous research that has shown the importance of peer influences and commitment to conventional structures of family and religion in relation to adolescent problem behaviors. These findings suggest that two goals that adolescent drug abuse programs should stress are working heavily on developing positive peer relations and family support while they encourage disassociation from deviant friends.     

The role of child gender,problem behaviors,and the family environment on maternal depressive symptoms: findings from mothers of substance abusing runaway adolescents

This study examined the relation between maternal depressive symptoms and adolescents' problem behaviors, moderated by adolescent gender, as well as the association between maternal depressive symptoms and the family environment characteristics above and beyond child variables. Data were collected from 137 mothers of runaway adolescents with alcohol and/or substance abuse problems. Results showed that both internalizing and externalizing problem behaviors of adolescent girls, as opposed to problem behaviors of boys, were significantly associated with maternal depressive symptoms. In addition, higher family cohesion was significantly related to lower maternal depressive symptoms even after controlling for adolescent problem behaviors. However, no significant relationship was found between family conflict and maternal depressive symptoms. These findings indicate that both adolescents' problem behaviors and mothers' perceptions of the family environment are associated with maternal depressive symptoms, highlighting the potential utility of the family systems theoretical framework for understanding and intervening mothers' emotional problems in the family context. © 2011 Wiley Periodicals, Inc.     

Attachment,autonomy, and multifinality in adolescent internalizing and risky behavioral symptoms

A diathesis-stress interaction model is used to describe multifinality in adolescent internalizing and risky behavioral outcomes. Problematic behavior associated with adolescent insecure preoccupation (a diathesis) was expected to interact with the level of maternal autonomous discourse (a stressor) to predict specific adolescent outcomes. Assessments of adolescent preoccupied attachment organization, observations of maternal displays of autonomy in mother-adolescent interactions, and adolescent reports of internalizing symptoms and risky behaviors were obtained at age 16. As predicted, maternal autonomy in the mother-adolescent relationship helped to explain multifinality in dysfunctional symptoms among preoccupied adolescents. Adolescent preoccupation was more strongly linked to internalizing behavior when mothers demonstrated low levels of autonomy in interactions with their adolescents and more strongly linked to risky behavior when mothers displayed extremely high levels of autonomy. Implications for autonomy processes in increasing our understanding of how adolescent insecure-preoccupation relates to profiles of specific problems during adolescence are discussed as is the importance of exploring the role of attachment in different contexts.     

Pathways from child maltreatment to internalizing problems: perceptions of control as mediators and moderators.

Using a prospective longitudinal design, we examined internalizing problems and perceptions of control in a community sample of 785 children, 59 of whom had been maltreated. Children's internalizing problems and perceptions of control were measured via self-report at annual assessments in third grade through seventh grade (modal ages 9-13 years). Children's experiences of multiple types of maltreatment were rated based on social service records, using a standard coding system. Results of longitudinal analyses examining the roles of specific types of maltreatment (neglect, harsh parenting, and sexual abuse) revealed that neglect and sexual abuse were each associated with more internalizing problems, especially among children who experienced both these maltreatment types. Neglected children reported higher levels of perceived external control than other children did. Sexual abuse was associated with higher levels of perceived external control, but only among children who had also been neglected. Results of mediation analyses showed that higher levels of perceived external control accounted substantially for associations between specific maltreatment types and children's internalizing problems. Results of moderator analyses revealed that, among maltreated children, greater perceived internal control predicted fewer internalizing problems, suggesting that perceived internal control functioned as a protective factor. Children maltreated early in life were less likely to have this protective characteristic. Results are discussed in terms of their implications for understanding the developmental consequences of specific and co-occurring types of maltreatment.     

Maternal drug abuse versus maternal depression: vulnerability and resilience among school-age and adolescent offspring

In this study of 360 low-income mother-child dyads, our primary goal was to disentangle risks linked with commonly co-occurring maternal diagnoses: substance abuse and affective/anxiety disorders. Variable- and person-based analyses suggest that, at least through children's early adolescence, maternal drug use is no more inimical for them than is maternal depression. A second goal was to illuminate vulnerability and protective processes linked with mothers' everyday functioning, and results showed that negative parenting behaviors were linked with multiple adverse child outcomes. Conversely, the other parenting dimensions showed more domain specificity; parenting stress was linked with children's lifetime diagnoses, and limit setting and closeness with children's externalizing problems and everyday competence, respectively. Results are discussed in terms of implications for resilience theory, interventions, and social policy.     

Psychological adjustment, substance use, HIV knowledge, and risky sexual behavior in at-risk minority females: developmental differences during adolescence

OBJECTIVE: To assess developmental differences in the psychological functioning, substance use, coping style, social support, HIV knowledge, and risky sexual behavior of at-risk, minority adolescent girls; to assess developmental differences in psychosocial correlates of risky sexual behavior in older and younger adolescents. METHOD: Participants included 164 minority teens, ages 12-19, who were receiving medical care in an adolescent primary care clinic. Teens completed measures of psychological adjustment, substance use, coping style, social support, religious involvement, and HIV knowledge and attitudes. In addition, they answered questions regarding their sexual history, family situation, school status, and psychiatric and legal history. RESULTS: Younger teens (ages 12-15) reported more symptoms of depression and earlier sexual debuts than older teens (ages 16-19). However, older teens reported significantly more substance use and were more likely to have been pregnant and to have contracted a sexually transmitted disease (STD) than younger teens. Older teens also reported more religious involvement and using more adaptive coping strategies than younger teens. Developmental differences in the correlates of risky behaviors were also found between younger and older teens. Specifically, conduct problems and substance use were significantly associated with risky sexual behavior for younger teens, but not for older teens. Similarly, younger teens whose peers were engaging in risky behaviors reported engaging in more risky sexual behaviors; however, these same relations were not found for older teens. CONCLUSIONS: Young minority adolescents exhibiting conduct problems and using substances seem to be at highest risk for contracting HIV and STDs as a result of risky sexual behavior. Prevention interventions should target teens in high-risk environments during late elementary school or early middle school to encourage teens to delay intercourse, practice safer sex, and avoid drug and alcohol use. An interdisciplinary model of care in primary care settings is clearly indicated to provide these services to at-risk youths.     

Ethnicity, desirable responding, and self-reports of abuse: a comparison of European- and Asian-ancestry undergraduates

One thousand fifty-two (582 non-Asian, 470 Asian) university students were assessed regarding levels of physical abuse, emotional abuse, sexual abuse, neglect, and socially desirable responding. Differences between Asian-ancestry and European-ancestry students in self-reported incidence and expression of abuse were evaluated, as was gender and the relation between self-reported abuse and socially desirable responding. Asian-ancestry men and women reported higher levels of physical abuse, emotional abuse, and neglect than did their Euro-ancestry counterparts, and Euro-ancestry women reported a higher incidence of sexual abuse than did Asian-ancestry women. Across ethnicity, men reported higher levels of physical abuse and neglect but lower levels of sexual abuse than did women. Socially desirable responding was not related to measures of abuse. Findings are discussed in terms of cultural influences on child-rearing and disciplinary practices.     

Child abuse and neglect and the development of mental disorders in the general population.

Child abuse and neglect have repeatedly been shown to be risks for psychiatric and personality disorders. However, much of this evidence is based on retrospective reports of adults. In addition, little is known about the developmental course of psychopathology among those exposed to child maltreatment. In this study, we report mental disorders assessed from early childhood to adulthood in those later identified as victims of abuse or neglect by official or self-report. Findings show elevated rates of mental disorders and symptoms in each of four groups relative to the normative sample. Groups included those who had been victims of physical abuse or neglect according to official report and those who had been victims of physical or sexual abuse by self-report. As expected, the maltreated groups were quite different demographically from the community comparison sample, especially those with official reports. The group with retrospective self-reports of physical abuse differed only modestly from the comparison group on the symptom and disorder measures, while the sexually abused group showed the most consistently elevated patterns, even after controls for demographic differences were taken into account. The disorder and symptom patterns differed both by group and by age: neglect cases showed a partial remission in adulthood, while official physical abuse cases showed an increasingly consolidated pattern of antisocial and impulsive behavior.     

Maternal depression,paternal psychopathology,and adolescent diagnostic outcomes

The authors examined the relationship between maternal depression, paternal psychopathology, and adolescent diagnostic outcomes in a community sample of 522 Australian families. They also examined whether chronic family stress, father's expressed emotion, and parents' marital satisfaction mediated the relationship between parental psychopathology and adolescent outcomes. Mother's education, child's gender, and family income were covaried in all analyses. Results revealed that maternal depression and paternal depression had an additive effect on youth externalizing disorders. In addition, maternal depression interacted with both paternal depression and paternal substance abuse in predicting youth depression but not youth nondepressive disorders. Chronic family stress and father's expressed emotion appeared to mediate the relationship between parental psychopathology and youth depression.     

Childhood body-focused behaviors and social behaviors as risk factors of eating disorders

BACKGROUND: The risk factors for adolescent eating disorders are poorly understood. It is generally agreed, however, that interactions with one's body and interactions with others are two important features in the development of anorexia and bulimia nervosa. Therefore, we assessed a variety of childhood body-focused behaviors and childhood social behaviors in eating-disordered patients as compared to non-eating-disordered subjects. METHOD: We compared 50 female inpatients with eating disorders (anorexia or bulimia nervosa), 50 female inpatients with polysubstance dependence, and 50 nonpatient female control subjects with no history of eating or substance abuse disorders (all defined by DSM-IV criteria), using a semi-structured interview of our own design. We asked questions about (1) childhood body-focused behaviors (e.g. thumb-sucking) and body-focused family experiences (e.g. bodily caresses), and (2) childhood social behaviors (e.g. numbers of close friends) and family social styles (e.g. authoritarian upbringing). RESULTS: Many body-focused measures, such as feeding problems, auto-aggressive behavior, lack of maternal caresses, and family taboos regarding nudity and sexuality, characterized eating-disordered patients as opposed to both comparison groups, as did several social behaviors, such as adjustment problems at school and lack of close friends. However, nail-biting, insecure parental bonding, and childhood physical and sexual abuse were equally elevated in both psychiatric groups. CONCLUSION: It appears that eating-disordered patients, as compared to substance-dependent patients and healthy controls, show a distinct pattern of body-focused and social behaviors during childhood, characterized by self-harm, a rigid and 'body-denying' family climate, and lack of intimacy.     

Physical and sexual abuse: risk factors for substance use among young Hungarian women

The authors used a multistage stratified sampling method to conduct a cross-sectional survey of a nationally representative sample of 3,615 Hungarian women aged 15 to 24 years to acquire epidemiologic data on physical and sexual abuse and analyze the relationship between abuse and health-risk behaviors. Just over 30% of the young women reported having experienced some type of abuse in their lifetimes. All maladaptive coping strategies, especially sedative use, were more prevalent among those who had experienced physical abuse. The prevalence of smoking, drinking alcohol, and experimenting with drugs was closely related to both physical and sexual abuse. Having experienced abuse is an important factor in young women's development of risky health behaviors. Clinicians should screen for abuse in this age group to prevent behaviors that lead to long-term health problems.     

Exposure to partner violence and child behavior problems: a prospective study controlling for child physical abuse and neglect,child cognitive ability,socioeconomic status,and life stress

Previous research suggests an association between partner violence and child behavior problems. However, methodological shortcomings have precluded the formation of directional conclusions. These limitations include failure to control for the effects of child physical abuse and general life stress, employment of nonrepresentative samples from battered women's shelters, and reliance on a single contemporaneous reporter, usually the mother, for information on both independent and dependent measures. This study used prospective, longitudinal data (N = 155) and multiple informants to examine the relation between maternal reports of partner violence in the homeand teacher- and youth-report ratings of concurrent and prospective child behavior problems. Hierarchical multiple regression analyses were used to control for the effects of child physical abuse, child physical neglect, socioeconomic status, child cognitive ability, and life stress. The contribution of partner violence to child behavior problems was confirmed for boys' (n = 81) externalizing problems and girls' (n = 74) internalizing problems. Child developmental status at the time of exposure further influenced these relations. For boys, behavior problems in middle childhood were most strongly related to contemporaneous partner violence, whereas behavior problems among both boys and girls at age 16 were most strongly related to partner violence exposure during the preschool years.     

Interpersonal and family functioning of female survivors of childhood sexual abuse

The empirical literature that addresses the association between childhood sexual abuse (CSA) and the interpersonal functioning of female survivors within their adult family context is critically examined. Specifically, research on relationship difficulties, problems in attachment, marital conflict and divorce, secondary traumatization, sexual dysfunction, maternal attitudes and functioning, and the heightened risk for having children who themselves are sexually abused is reviewed. There is converging evidence in both clinical and community samples that, compared to other women, female CSA survivors do experience more relationship problems and more problems in sexual functioning. Based on community samples, there is an indication that CSA survivors experience problems in marital functioning and attachment. Beyond this, little sound research has addressed the issues of secondary traumatization, maternal attitudes, maternal functioning, or intergenerational patterns of abuse. The use of specificity designs, improved sampling strategies, and standardized, psychometrically strong measures in future research would greatly improve the quality of our knowledge on the interpersonal and family functioning of CSA survivors.     

Childhood maltreatment, posttraumatic stress symptomatology, and adolescent dating violence: considering the value of adolescent perceptions of abuse and a trauma mediational model.

The present study, utilizing both a child protective services and high school sample of midadolescents, examined the issue of self-report of maltreatment as it relates to issues of external validity (i.e., concordance with social worker ratings). reliability (i.e.. overlap with an alternate child maltreatment self-report inventory; association of a self-labeling item as "abused" with their subscale item counterparts), and construct validity (i.e., the association of maltreatment with posttraumatic stress symptomatology and dating violence). Relevant theoretical work in attachment, trauma, and relationship violence points to a mediational model, whereby the relationship between childhood maltreatment and adolescent dating violence would be expected to be accounted for by posttraumatic stress symptomatology. In the high school sample, 1329 adolescents and, in the CPS sample, 224 youth on the active caseloads completed comparable questionnaires in the three domains of interest. For females only, results supported a mediational model in the prediction of dating violence in both samples. For males, child maltreatment and trauma symptomatology added unique contributions to predicting dating violence. with no consistent pattern emerging across samples. When considering the issue of self-labeling as abused. CPS females who self-labeled had higher posttraumatic stress symptomatology and dating violence victimization scores than did their nonlabeling, maltreated counterparts for emotional maltreatment. These results point to the need for ongoing work in understanding the process of disclosure and how maltreatment experiences are consciously conceptualized.     

Health compromising behaviors among Chinese adolescents: role of physical abuse, school experience, and social support

This study examined the influence of immediate social environment on health compromising behaviors (HCB) among 6564 high school students in China. Results showed that physical abuse by parents was a major risk factor that accounted for high rates of HCB. Perceived positive school experience and social support were protective factors associated with low rates of HCB. These two protective factors also buffered the adverse influence of abuse on the practice of individual HCB. In particular, parental abuse was associated with sexual experimentation, non-fatal self-harm, and suicide behaviors only at low levels of protective factors.     

Childhood and adolescent sexual abuse and subsequent sexual risk behavior: evidence from controlled studies, methodological critique, and suggestions for research

Childhood and adolescent sexual abuse (CSA) is associated with a wide variety of adverse psychological and health outcomes, including negative sexual health outcomes. In this paper, we review the literature investigating the relation between CSA and subsequent sexual risk behaviors among men and women. Previous research has found a relatively consistent association between CSA and higher rates of sexual risk behaviors, particularly sex trading, more sexual partners, and an earlier age of first intercourse. However, there are a number of limitations to this research, including lack of a consistent definition of CSA, failure to investigate gender as a moderator, and possible confounding of the CSA experience with some of the sexual behavior outcome variables. Further, although there appears to be an association between CSA and later sexual risk behavior, researchers have not established whether this association is causal. Suggestions for future research and implications for clinical practice are discussed.     

Dissociation, PTSD, and substance abuse: an empirical study

Few studies have examined the relationship between posttraumatic stress disorder (PTSD), substance use disorder, and dissociation. We studied 77 women with current PTSD and substance dependence, classified into high- versus low-dissociation groups per the Dissociative Experiences Scale. They were compared on trauma- and substance-related symptoms, cognitions, coping skills, social adjustment, trauma history, psychiatric symptoms, and self-harm/suicidal behaviors. We found the high-dissociation group consistently more impaired than the low-dissociation group. Also, the sample overall evidenced relatively high levels of dissociation, indicating that even in the presence of recent substance use, dissociation remains a major psychological phenomenon. Indeed, the high-dissociation group reported stronger expectation that substances could manage their psychiatric symptoms. The high-dissociation group also had more trauma-related symptoms and childhood histories of emotional abuse and physical neglect. The discussion addresses methodology, the "chemical dissociation" hypothesis, and the need for a more nuanced understanding of how substances are experienced in relation to dissociative phenomena.