Aggressive Behavior in the Adolescent Psychiatric Patient: A Clinical-Developmental Perspective

OBJECTIVE: This study examined the relationship between ego development and psychological defenses to aggressive behavior in a group of psychiatrically hospitalized adolescents. METHOD: Subjects were 245 adolescents ages 12-16, who were assessed for aggressive behaviors, assaultive incidents, ego development and defenses. RESULTS: Aggressive behavior was found to be negatively associated with ego development, regardless of age, gender or IQ. Defense styles which located the source of conflict outside of the self were associated with higher levels of self-reported aggressive behaviors. Hospital incidents of assault were associated with a lack of cognitively based defenses. CONCLUSION: Aggressive behavior is tied to the development of critical psychological processes which shape the adolescent's ability to understand themselves and their environment. The results are discussed in the context of a clinical-developmental approach to adolescent aggressive behavior.     

Individual differences in adolescent health symptoms: the effects of gender and coping

Previous studies have suggested that adult men and women experience different types and severities of physical and psychological health symptoms. This study examined whether in the case of adolescents these reported gender differences in physical and psychological health symptoms could actually be the result of differences in coping styles. Five hundred and forty-six adolescents were questioned on their coping styles and symptoms. We found gender differences in physical and psychological health symptoms (e.g. anger, depression, tension, negative moods), as well as in coping styles. We also found that the relation between health symptoms and coping varied significantly by gender. The results of this study suggest that doctors, school counselors and family therapists may want to take gender differences in coping styles into account when seeing adolescent patients for physical or psychological health symptoms, and find ways to help the adolescents cope more effectively with their stressors.     

Stress,coping, and behavioural problems among rural and urban adolescents

Rural/urban differences were studied in self-reported stress (life events, daily hassles and conflict), coping and behavioural problems in a community sample of adolescents. Despite challenging socioeconomic conditions in rural areas, levels of stress and ways of coping were similar in rural and urban adolescents. However, urban males reported more conflict and externalizing behaviours than females and rural males. Stress, coping, and behavioural problems were interrelated but approach coping did not moderate the influence of stress on psychological functioning. Results suggest that adolescents may utilize many coping strategies that serve little benefit in terms of behavioural outcomes.     

Gender and developmental effects on perceived stress, coping, somatic symptoms and psychological disorders among children and adolescents

The aim of this one-year longitudinal study was to investigate gender and developmental effects on perceived stress related to interpersonal stressors, coping strategies, somatic symptoms and psychological disorders. Additionally, associations of perceived stress and coping styles at the first assessment with psychological problems at the second measurement were examined. In total, N = 169 Austrian children and adolescents (ages 10 to 13 years) participated in this self-report study. Compared to male children and adolescents, female counterparts scored higher on perceived stress related to interpersonal stressors and on social support but evaluated a lower amount of distraction. Moreover, girls reported higher levels of somatic symptoms and anxiety/depression. Boys showed a developmental increase in anger control problems and both genders showed developmental increases in antisocial behavior. Low levels of the emotion-focused coping strategies distraction and minimization were related longitudinally to emotional and behavioral disorders. The results support gender-adjusted stress management programs applied in the primary and secondary prevention.     

Coping and depressive symptoms in adolescents with a chronic medical condition: A search for intervention targets

The aim of the present study was to find relevant coping factors for the development of psychological intervention programs for adolescents with a chronic medical condition. A wide range of coping techniques were studied, including cognitive coping, behavioral coping and goal adjustment coping. A total of 176 adolescents participated. They were contacted through social networking websites or Internet forums and through schools for children with a physical disability. Several cognitive and behavioral coping strategies and goal adjustment were found to be related to symptoms of depression. The cognitive coping strategies had the strongest influence on depressive symptoms. Especially self-blame, rumination and catastrophizing seemed to be important factors. If these findings can be confirmed, they could contribute to the focus and content of intervention programs for adolescents with a chronic medical condition.     

Mindful coping for adolescents: beneficial or confusing

As adolescence is a vulnerable transition phase, especially regarding the development of psychological symptoms, interventions promoting mental health for this age group have been called for. The “Conscious Coping” program (CC) is an intervention based on coping skills from Cognitive Behavioral Therapy, including reappraisal and emotion regulation strategies, and mindfulness practices. The aim of this study is to evaluate the CC program for adolescents by using a mixed methods approach. The quantitative approach has a comparison group design measuring mindful coping, mental ill-health and life satisfaction. Within the qualitative approach semi-structured interviews are carried out. The study sample included one intervention group (N = 40) and one comparison group (N = 41) with high school students. Overall, quantitative results suggest that the intervention group experienced a minor deterioration in life satisfaction and psychological symptoms and no statistically significant change in use of mindful coping. However, some discrepancies with the qualitative data were found. Qualitative findings indicated that participants found mindful coping strategies such as awareness and distraction useful, but that their use of such strategies to a little extent led to experienced changes in coping. Findings provide important knowledge regarding the design of interventions integrating mindfulness to promote more adequate psychological coping amongst adolescents.     

Social learning, affective state and passive coping in irritable bowel syndrome and inflammatory bowel disease

The association between the use of passive coping strategies to deal with pain and reported levels of anxiety, depression, and parental reinforcement of illness behavior was examined in individuals with Irritable Bowel Syndrome (IBS) and Inflammatory Bowel Disease (IBD). Individuals with IBS and IBD recruited primarily from outpatient clinics completed questionnaire measures of pain-coping (the Vanderbilt Pain Management Inventory, VPMI) as well as measures of anxiety and depression, parental reinforcement of illness behavior and physical symptoms. Factor analysis of the passive coping sub-scale of the VPMI indicated that it was comprised of two components corresponding to emotional and behavioral facets of passive coping. Higher levels of behavioral passive coping were associated with higher levels of parental reinforcement of illness behavior and higher levels of depression, but only amongst individuals with IBS. In contrast emotional passive coping was associated in both groups with higher levels of anxiety and depression (but not illness-related social learning). Different factors predict the use of emotional and behavioral passive coping strategies in IBS and IBD. It is suggested that illness-related social learning occurring during childhood influences the development of habitual illness behaviors and that, because of the more benign nature of symptoms in IBS, individuals with IBS may be more likely than individuals with IBD to revert to such habitual behaviors to cope with symptoms. The degree to which the emotional component of passive coping, associated with psychological distress in both groups, can be considered in terms of 'coping strategies', rather than markers of illness-related distress, is discussed.     

Adolescent vulnerability and the distress of rejection: Associations of adjustment problems and gender with control,emotions, and coping

We examined adjustment problems as risks for patterns of emotions, appraisals, and coping with rejection, and explored whether these processes could account for sex (boy/girl) differences in coping. Young adolescents (N = 669, grades 6–8) completed questionnaires, which assessed responses to peer rejection threat with two short scenarios. Using structural equation modeling to test a multivariate process model, adolescents with heightened social anxiety had the most maladaptive responses to rejection threat, including elevated emotional reactions, more self-blame, and coping using more social isolation, rumination and opposition. Adolescents reporting more depressive symptoms felt less control and anticipated using less adaptive coping (less support seeking, distraction, and negotiation), whereas aggressive adolescents responded with more anger and coped via opposition. Moreover, as anticipated, sex differences in coping, symptoms, emotions, and appraisals were found. However, coping differences between boys and girls were mostly nonsignificant after accounting for symptoms, aggression, emotional reactions, and appraisals.     

The role of coping strategies in predicting change in parenting efficacy and depressive symptoms among mothers of adolescents with developmental disabilities

Background Parents of children with developmental disabilities (DD) face greater caregiving demands than parents of children without DD. There is considerable variability in parents' adjustment to raising a child with DD, however. In line with a strengths‐based approach, this study explores coping strategies as potential mechanisms of resilience among mothers of adolescents with DD. This study examines the frequency with which mothers use various coping strategies and the extent to which those strategies moderate the relationship between adolescent behaviour problems and aspects of maternal well‐being. Both positive and negative dimensions of well‐being are explored, with maternal depressive symptoms and perceived parenting efficacy examined as outcomes cross‐sectionally and longitudinally. Methods The present study focuses on 92 mothers and their adolescents with DD. The adolescents had a wide range of diagnoses, all with continuing special needs. Data were collected from mothers through interviews and self‐administered questionnaires when their adolescents were aged 15 and aged 18. A structured assessment of the adolescent was completed during home visits at age 15. Results Mothers reported frequently using strategies of denial and planning but rarely using strategies of mental and behavioural disengagement to cope with recent stressful situations. Adolescent behaviour problems were found to contribute to greater symptoms of depression and lower feelings of parenting efficacy as well as increases in depressive symptoms over time. Mothers of sons, but not daughters, reported increases in parenting efficacy across their child's adolescent period. Above and beyond adolescent factors, several coping strategies emerged as significant predictors of mothers' symptoms of depression and perceived parenting efficacy. Moreover, use of Active Coping/Planning, Positive Reinterpretation/Growth, and Behavioural/Mental Disengagement as coping strategies moderated the impact of adolescent behaviour problems on maternal depressive symptoms. Conclusions This study extends previous findings by focusing on both positive and negative dimensions of parent well‐being during their child's adolescent period. Adolescence can be a stressful time for parents, with typical developmental tasks entailing additional strains for parents of adolescents with DD. The present findings point to several coping strategies that may reduce the impact of challenging behaviours during this period on mothers' symptoms of depression and feelings of parenting efficacy. Certain coping strategies were found to exert a greater impact on maternal well‐being for parents of adolescents with higher levels of behaviour problems, suggesting that interventions may benefit from an increased focus on this group of mothers with heightened caregiving demands.     

Differences in psychological symptoms and self-competencies in non-suicidal self-injurious Flemish adolescents

The aim of the present study was to examine differences in psychological symptoms and sense of self-competence between adolescents with and without non-suicidal self-injurious behavior. We collected data in a sample of 281 Flemish adolescents. Psychological symptoms and self-competencies were assessed by means of the Youth Self-Report (YSR) and NSSI was assessed using the Self-Harm Inventory (SHI-22). Results showed significant differences between adolescents with and without NSSI on all psychopathological subscales. Furthermore, adolescents engaging in NSSI reported significantly lower scores on social competence, but equal levels on other competencies. Results revealed that externalizing problems and attention/thought/social problems are significantly associated with NSSI. Results also showed that having a higher score on aggressive behavior or thought problems increases the chance of belonging to the NSSI group; whereas a higher score on the social competence scale decreases the chance of belonging to the NSSI group. Clinical implications of these findings are discussed.     

Sensation seeking, coping with stress, and readiness to engage in therapy: does ego development influence the psychosocial functioning of substance-abusing mothers?

Ego development, the capacity to derive coherent, nuanced meaning from one's life experiences, often has significant impact on psychosocial adjustment during adulthood. Research with nonclinical populations has indicated links between higher ego development and healthy emotional coping and interpersonal relationships. Emerging research with substance-abusing mothers suggests that higher levels of ego development are associated with improved parenting but also with increased rates of psychopathology. Less is known about how ego development is related to other psychosocial factors important for substance-abusing mothers' functioning and capacity to parent, including the proclivity to engage in risky behaviors, adaptive coping behaviors, and readiness to engage in psychotherapy. The present study examines these links. Participants included 182 methadonemaintained women who expressed interest in a randomized clinical trial testing the efficacy of a relational parenting intervention for substance-abusing mothers (Luthar, Suchman, & Altomare, 2007). Data were analyzed using a series of MANCOVAs and ANCOVAs controlling for maternal IQ and depression. Mothers with higher levels of ego development reported more adaptive coping techniques and greater readiness to engage in psychotherapy but also reported a heightened desire for strong sensations. Findings are discussed in light of mothers' psychological processes and parenting capacities. The significance of findings for developing parenting interventions for substance-abusing mothers is also discussed.     

Family Functioning and Adolescent Psychological Maladjustment: The Mediating Role of Coping Strategies

This study aims to analyze the mediating role of coping strategies in the relationship between family functioning and youth maladjustment. A community sample of 341 adolescents (M = 15.11 years old; SD = 1.71) completed self-report measures about such variables. Results showed that a perception of an inadequate family functioning was associated with the use of maladaptive coping strategies, as well as with youth psychological maladjustment. The results also revealed that rumination and support-seeking mediated the relationship between family functioning and internalizing behavior, and hostile expression of feelings played a mediating role between family functioning and externalizing behavior. No gender differences were found in the relationship between variables. This study emphasizes the importance of coping strategies used by adolescents to understand the relationship between family functioning and youth psychological maladjustment.     

The Common Sense Model in early adolescents with asthma: Longitudinal relations between illness perceptions,asthma control and emotional problems mediated by coping

Objective

The present study examined the longitudinal relations between illness perceptions and asthma control and emotional problems (i.e., anxiety, depression, stress), respectively, in adolescents with asthma. Furthermore, the mediating effects of asthma-specific coping strategies on these relations were examined, as specified in the Common Sense Model (CSM).

Methods

In 2011, 2012, and 2013, adolescents (aged 10–15) with asthma were visited at home (N = 253) and completed questionnaires about their illness perceptions, asthma-specific coping strategies, asthma control, symptoms of anxiety and depression, and perceived stress. Path analyses were used to examine the direct relations of illness perceptions with asthma control and emotional problems and the mediating effects of coping strategies cross-sectionally and longitudinally.

Results

Perceptions of less perceived control and attributing more complaints to asthma were associated with better asthma control. Perceptions of more concern, less coherence, and increased influence of asthma on emotional well-being were associated with more emotional problems. Longitudinally, perceptions of more treatment control and fewer concerns predicted less emotional problems over time. More worrying mediated the cross-sectional relation between perceiving more concern about asthma and less asthma control and the longitudinal relation between perceiving more concern about asthma and more emotional problems.

Conclusion

Illness perceptions were associated with asthma control and emotional problems; however, over time, illness perceptions only predicted changes in emotional problems. Most coping strategies did not mediate the relation between illness perceptions and outcomes. Interventions aimed to change illness perceptions in adolescents with asthma could decrease emotional problems.     

Families of adolescents and adults with autism spectrum disorders in Taiwan: The role of social support and coping in family adaptation and maternal well-being

In this study we examined differences in social support and coping between mothers of adolescents and adults with an autism spectrum disorder (ASD) in Taiwan and the United States and to investigate the effects of social support and coping strategies on family adaptation and maternal well-being. Participants were 76 Taiwanese mothers who had at least one son or daughter with an ASD (10 years old and older), and a comparison group of 325 mothers in the United States matched on the age range of the child with an ASD. Mothers completed self-administered, written questionnaires and participated in an interview. Taiwanese mothers reported significantly greater use of problem-focused and emotion-focused coping strategies than did mothers in the United States. For Taiwanese families, greater use of problem-focused coping strategies was associated with lower levels of depressive symptoms and anxiety. Emotion-focused coping mediated the relationships between ethnicity/culture and several outcome measures: family adaptability, family cohesion, and maternal depressive symptoms. The higher levels of emotion-focused coping in Taiwanese mothers appeared to account for their lower levels of family adaptability and cohesion and higher levels of maternal depressive symptoms. The results from this cross-cultural study helped determine the role of social support and coping strategies in family adaptation and maternal well-being in families of individuals with an ASD in each culture. Implications for service delivery are discussed.     

Cognitive coping in anxiety-disordered adolescents

The present study investigated differences in cognitive coping strategies between anxiety-disordered and non-anxious adolescents. In addition, the interaction effect with gender as well as differences between specific anxiety diagnoses was examined. A clinical sample of 159 anxiety-disordered adolescents and a general community sample of 370 non-anxious adolescents were recruited. Nine cognitive coping strategies were assessed in all adolescents (aged 12-16 years). Results showed that anxiety-disordered adolescents had significantly higher scores on most of the cognitive coping strategies than non-anxious adolescents. The cognitive coping strategies rumination, self-blame and catastrophizing accounted for most of the variance. Gender did not modify the results. Further analyses within the anxiety-disordered sample indicated that adolescents with a generalized anxiety disorder scored significantly higher on rumination, but not on other cognitive coping strategies, than social phobic adolescents. The results suggest that cognitive coping is a valuable target for psychological assessment and treatment in adolescents.     

Coping,Daily Hassles and Behavior and Emotional Problems in Adolescents with High-Functioning Autism/Asperger’s Disorder

Although daily hassles and coping are associated with behavior and emotional problems in non-clinical populations, few studies have investigated these relationships in individuals with high-functioning autism/Asperger’s Disorder (HFASD). This study examined the relationships between daily hassles, coping and behavior and emotional problems in adolescents with HFASD. Thirty-one adolescents with HFASD completed questionnaires assessing their coping and behavior and emotional problems, and completed an Ecological Momentary Assessment run via a mobile phone application on their coping and daily hassles. Parents completed questionnaires of the adolescents’ daily hassles, coping, and behavior and emotional problems. The disengagement coping style was associated with significantly higher levels of behavior and emotional problems regardless of respondent or methodology, suggesting it may be a valuable target for intervention.     

Adolescent coping style and behaviors: conceptualization and measurement

The developmental tasks associated with adolescence pose a unique set of stressors and strains. Included in the normative tasks of adolescence are developing and identity, differentiating from the family while still staying connected, and fitting into a peer group. The adolescent's adaptation to these and other, often competing demands is achieved through the process of coping which involves cognitive and behavioral strategies directed at eliminating or reducing demands, redefining demands so as to make them more manageable, increasing resources for dealing with demands, and/or managing the tension which is felt as a result of experiencing demands. In this paper, individual copying theory and family stress theory are reviewed to provide a theoretical foundation for assessing adolescent coping. In addition, the development and testing of an adolescent self-report coping inventory, Adolescent Coping Orientation for Problem Experiences (A-COPE) is presented. Gender differences in coping style are presented and discussed. These coping patterns were validated against criterion indices of adolescents' use of cigarettes, liquor, and marijuana using data from a longitudinal study of 505 families with adolescents. The findings are discussed in terms of coping theory and measurement and in terms of adolescent development and substance use.     

The relationship between coping and psychological well-being among people with osteoarthritis: A problem-specific approach

We examined the strategies that people with osteoarthritis (OA) use to cope with illness-related problems in four areas: household activities, leisure activities, pain management, and social relationships. We also examined the relationship between the coping strategies participants reported using upon entry to the study (Time 1) and psychological well-being reported six months later. Three hundred people, aged 50 and over, with OA participated in the study. Data were collected via two mailed questionnaires, administered at six-month intervals. We found that two of the coping strategies examined, self-criticism and social withdrawal, were used more frequently for social relationship problems than for any of the other three types of problems. None of the other coping strategies (i.e. problem solving, cognitive restructuring, social support, emotional expression, problem avoidance, turning to religion, information seeking) were used differentially across problem areas. Multivariate analyses revealed that the coping strategies people used at Time 1 significantly predicted psychological well-being, as assessed by measures of positive affect, negative affect, and depressive symptoms, six months later. However, the specific strategies that predicted positive affect were different from those that predicted negative affect and depressive symptoms. Implications of these findings for future research on coping with chronic illness are discussed.     

Sex differences in the use of coping strategies: predictors of anxiety and depressive symptoms

This study examined sex differences in the use of coping strategies and their relationship to depression and anxiety-related psychopathology. Responses on measures of coping strategies, depression, and anxiety were obtained from a carefully screened nonclinical sample (N = 107). The results demonstrated that women who used less positive reframing had higher levels of depressive symptoms compared with women who used more positive reframing and to men irrespective of their use of more or less positive reframing. In addition, women who reported the use of more self-blame had elevated levels of trait anxiety, although a similar effect was not found for men. The observed sex differences in the use of coping strategies and their association with depression and anxiety-related problems underscores differences in the clinical presentation of anxiety and depression between women and men.     

Coping and psychological distress among symptomatic HIV+ men who have sex with men

This study evaluated relations among indicators of latent coping factors and psychological distress while incorporating measures of life stress and HIV illness related factors simultaneously among 211 symptomatic, HIV+ men who have sex with men (MSM). Participants were all assessed at a single time point. A structural equations model with latent factors for approachoriented coping, avoidant-oriented coping, and psychological distress showed adequate fit. Furthermore, significant associations were identified among latent factors for approach-oriented coping, avoidance coping, and psychological distress; specifically, greater use of approach-oriented coping strategies and less use of avoidant-oriented coping were associated with lower levels of psychological distress. The model was revised to incorporate variables significantly associated with psychological distress (i.e., personal loss-total events, personal loss-controllability, and HIV-related symptoms). Relations among the coping and psychological distress latent factors remained significant. The results suggest that HIV+ MSM who do not have the coping skills or resources necessary to use adequate coping strategies to face the chronic burdens associated with HIV illness are likely to experience higher levels of psychological distress, independent of life stress and ongoing HIV-related symptoms. This work was supported by grants from the National Institute of Mental Health, including PO1 MH49548, and T32 MH18917.