Suicidal Behavior in Aggressive Adolescents

We determined the number of children and adolescents who had a history of attempted suicide in two studies of a statewide sample of violent and assaultive youth. The incidence of attempted suicide (13.2 per hundred) in Study 1 (N = 800) was markedly greater than in the general population (0.5 to 3.0 per hundred). For this highly aggressive sample, older adolescents (14- to 17-year-olds) were more likely to have attempted suicide than younger adolescents, girls were more likely than boys, and White boys were more likely than Black boys. Study 2 (N = 520) replicated the incidence findings in an independent sample. In addition, the suicidal youth did not differ from the nonsuicidal, aggressive youth (individually matched on sex, race, and age) in terms of diagnosed psychopathology, intensity, or severity of aggressive acts or in terms of victimization of parents. The suicidal youth were typically diagnosed as having Conduct Disorder (80% of the boys, 65% of the girls). We found parallel patterns of diagnosis in suicidal and nonsuicidal youth. More boys than girls hanged themselves; girls tended to overdose. Both boys and girls were likely to have victimized parents, parental substitutes, and peers. The results indicated that many profoundly aggressive adolescents are at risk for suicidal behavior.     

Parental smoking cessation and adolescent smoking

OBJECTIVE: To examine the relation of parent smoking cessation to adolescent smoking and test its potential mediators. METHOD: Participants were 446 adolescents and their parents who completed a computerized measure of implicit attitudes toward smoking and questionnaires assessing smoking, parenting, and explicit attitudes. RESULTS: Parental smoking cessation was associated with less adolescent smoking, except when the other parent currently smoked. In general, ex-smoking parents showed more antismoking socialization than did smoking parents. However, in children's reports, these effects were negated if the other parent (particularly the mother) smoked. Children's reports of parents' antismoking behavior partially mediated the relation between parental smoking and adolescent smoking. Although children's implicit and explicit attitudes were unrelated to parental smoking, mothers' implicit attitudes were related to both their own smoking and their child's smoking. CONCLUSIONS: Parental smoking cessation may help lower risk for adolescent smoking. However, this benefit may be realized only if the other parent does not currently smoke. Antismoking parenting might be a useful focus in cessation interventions.     

Parent factors and adolescent sickle cell disease: associations with patterns of health service use

OBJECTIVE: To examine relationships among parent characteristics (parent-adolescent relationship, parents' illness knowledge, and parents' perceptions of illness-related burden) and use of routine and urgent health services among adolescents with sickle cell disease (SCD). METHOD: Seventy adolescents, ages 12-18, and their parents completed questionnaires assessing illness knowledge, perceptions of illness burden, parent-adolescent relationships, and adolescents' psychological functioning. Information about pain, routine services (i.e., care at home, clinic visits) and urgent service use (i.e., emergency department visits, hospitalizations) was obtained from parents and medical records. RESULTS: After we controlled for disease severity and life events, parents' perception of more illness-related stress was the strongest predictor of both types of service use. Greater parental knowledge about SCD also related to higher frequency of routine service use. Disease severity was strongly associated with frequency of urgent service use. CONCLUSIONS: Both parent characteristics and disease severity were associated with patterns of service use. Enhancing aspects of parental functioning may help families make adaptive decisions regarding health care services for SCD pain management.     

Neighborhood social processes as moderators between racial discrimination and depressive symptoms for African American adolescents

Racial discrimination is associated with numerous psychological consequences, including increased depressive symptoms for African American adolescents (Brody et al., 2006; Wong, Eccles, & Sameroff, 2003). Adolescents’ perceptions of their neighborhood can influence how youth interpret and manage racial discrimination (Sampson, Morenoff, & Gannon‐Rowley, 2002). Yet little is known about how adolescent perceptions of neighborhood cohesion and neighborhood disorganization protect or exacerbate the effects of racial discrimination, or how these effects vary by youth's gender. Therefore, the current study examined whether neighborhood social cohesion and neighborhood disorganization moderated the association between racial discrimination and depressive symptoms for African American adolescents and how the effects differ for boys and girls. Participants were 106 African American adolescents (57% female; mean age 15.14) from an urban metropolitan area. Regression analyses suggest that perceptions of neighborhood social cohesion protected against racial discrimination for boys and girls. Additionally, the results indicate that when boys perceive less neighborhood disorganization, racial discrimination has a greater influence on their depressive symptoms. Findings have implications for intervention and prevention efforts that enhance and utilize positive neighborhood social processes for youth contending with racial discrimination.     

Multimethod assessment of children's distress during noninvasive outpatient medical procedures: child and parent attitudes and factors

The present study assessed behavioral distress during noninvasive outpatient procedures in children ages 4-10 years using a multimethod approach. Factors hypothesized to exacerbate children's distress included parents' and children's attitudes toward healthcare, children's knowledge of medical settings, and parental anxiety. A total of 53 parent-child dyads were recruited from outpatient clinics, with procedural distress assessed via child report, parent report, and direct observation. Some differences emerged depending on the method used to gauge distress. Children's healthcare attitudes and knowledge were associated with observed and child-reported distress, but parent's personal anxiety was associated only with their own perceptions of children's procedural distress. Parents' attitudes toward healthcare were associated with their anxiety but not with children's behavioral distress or healthcare attitudes. Findings are discussed in terms of more consistent findings regarding children's healthcare knowledge and attitudes versus the potential need for additional research on more divergent findings regarding parents' anxiety and healthcare attitudes.     

Nonsuicidal self-injury among "privileged" youths: longitudinal and cross-sectional approaches to developmental process

This investigation examined process-level pathways to nonsuicidal self-injury (NSSI; e.g., self-cutting, -burning, -hitting) in 2 cohorts of suburban, upper-middle-class youths: a cross-sectional sample of 9th-12th graders (n = 1,036, 51.9% girls) on the West Coast and a longitudinal sample followed annually from the 6th through 12th grades (n = 245, 53.1% girls) on the East Coast. High rates of NSSI were found in both the cross-sectional (37.2%) and the longitudinal (26.1%) samples. Zero-inflated Poisson regression models estimated process-level pathways from perceived parental criticism to NSSI via youth-reported alienation toward parents. Pathways toward the initiation of NSSI were distinct from those accounting for its frequency. Parental criticism was associated with increased NSSI, and youth alienation toward parents emerged as a relevant process underlying this pathway, particularly for boys. The specificity of these pathways was explored by examining separate trajectories toward delinquent outcomes. The findings illustrate the prominence of NSSI among "privileged" youths, the salience of the caregiving environment in NSSI, the importance of parental alienation in explaining these relations, and the value of incorporating multiple systems in treatment approaches for adolescents who self-injure.     

Correlates of high expressed emotion attitudes among parents of bipolar adolescents

High expressed emotion (EE) attitudes among parents are associated with an increased likelihood of relapse among bipolar patients, but the origins of these attitudes are unclear. This study examined characteristics of bipolar disorder in adolescents that might be associated with high EE attitudes among parents. We hypothesized that an earlier onset of mood disorder and greater current illness severity would predict higher levels of criticism and emotional overinvolvement among parents. Demographic, diagnostic, and EE data were collected from interviews with parents of 44 bipolar adolescents (mean age 14.5 yrs.). Current illness severity and functioning were not associated with high-EE attitudes. Parents of girls, however, were more likely to be high in criticism than parents of boys. Parents of girls expressed more critical comments when the child had an adolescent compared to a childhood onset of bipolar disorder, whereas the reverse pattern was evident among parents of boys. We encourage prospective investigations of the developmental correlates of parental EE attitudes in larger, more heterogeneous samples of bipolar adolescents and children.     

小学生家长对儿童性虐待的认识

目的：了解小学生家长有关预防儿童性虐待的知识、态度和与子女交流的情况。方法：用自填式问卷，对某学校以班级为单位整群抽取1—5年级5个班的271名小学生家长就其对儿童性虐待问题的认识及与孩子交流的情况进行不记名调查。结果：在被调查的家长中，93．6％的家长赞成学校进行预防儿童性虐待的教育，但同时有41．5％的家长担心这种教育可能会导致儿童对“性”知道得太多。有半数左右的家长在儿童性虐待问题认识上尚存在明显差距，与孩子交流不够，只有1．8％的家长给孩子看过有关预防儿童性虐待内容的书刊或音像制品。未成年时父母与其谈论过如何预防性虐待话题的家长其知识、态度及与自己子女交流的得分均明显好于父母没有与其谈论过如何预防性虐待话题的家长的得分。结论：应重视对小学生进行预防儿童性虐待教育的研究，尽快出版相关书籍和音像制品，提高家长对儿童性虐待问题的意识。     

Effect of gender and social environment on gender role perceptions and identity: Comparative study of kibbutz and urban adolescents in Israel

The study examined perceptions of gender roles in the family and society, occupational sex-typing, and gender identity among 100 kibbutz and 66 urban adolescents in Israel. Overall, the kibbutz adolescents expressed more liberal attitudes toward gender roles in the family and society than did their urban counterparts. Likewise, they expressed less stereotyped perceptions of occupations than did the urban adolescents. Regarding gender identity, no differences were found between the two groups. Finally, the girls were more liberal than the boys in their gender role perceptions, regardless of social environment. © 1998 John Wiley & Sons, Inc.     

父母对体罚的态度与其体罚行为的关系

目的:探讨父母对体罚的态度与其体罚行为之间的关系.方法:从山东省潍坊、枣庄等四个城市选取396名父母.以体罚态度问卷(ATPP)的中文修订版测量父母对待体罚的态度,以假设故事情境测量父母的体罚行为.结果:①父亲比母亲更赞同和认可体罚这一管教方式;父亲对三类违规(谨慎、道德和社会习俗违规)儿童所实施的体罚行为显著多于母亲.②父母对谨慎违规儿童的体罚最多,对道德违规儿童的体罚次之,对社会习俗违规儿童的体罚最少.③父母对体罚的态度与他们对故事中三类违规儿童所实施的体罚行为之间均存在显著正相关.结论:父母对体罚的态度与其对不同违规儿童所实施的体罚行为之间存在密切联系.     

Parenting adolescent girls with type 1 diabetes: parents' perspectives

OBJECTIVE: To explore parents' perceptions of the impact of type 1 diabetes mellitus (DM) on the family and to better understand parent-child conflict, parental worries, and coping strategies related to the management of DM in adolescence. METHODS: Semistructured interviews were conducted with the parents of 30 adolescent girls who had DM for at least 1 year. Using standard procedures for content analysis, themes were identified from the parents' discussions. RESULTS: Although parents reported worries, conflicts, and negative impacts of the DM on their family, they also recognized positive aspects of the DM (e.g., it promotes adolescent responsibility) and had strategies to cope with its challenges (e.g., letting go of perfectionism in disease management, keeping a positive attitude). CONCLUSIONS: Findings from this study can be used by clinicians to assess parents' concerns about DM and to help them discover ways to cope with their worries and stay involved with the disease's management. Considering the parents' perspective will likely lead to parents feeling understood by the health care team and will help to reduce their worries.     

Attention-deficit/hyperactivity disordered boys' relationships with their mothers and fathers: child,mother, and father perceptions

Self-perceptions of parent-child relationship quality were examined for 142 boys with attention-deficit/hyperactivity disorder (ADHD) and 55 control boys. Parent perceptions were examined as well. Mothers and fathers of ADHD boys perceived their relationships with their children more negatively than mothers and fathers of control boys. Interestingly, despite these differences in parental perceptions, ADHD boys did not differ from control boys in their perceptions of their relationships with their parents. Further, when ADHD boys' perceptions were compared directly to those of their parents, ADHD boys' reports were positively enhanced relative to those of control parent-child dyads. Together, these results may be viewed as providing support for a positive illusory bias in the social self-perceptions of ADHD children.     

Heart rate responses to parental behavior in depressed adolescents

In order to more fully understand the abnormalities in emotional responding associated with adolescent depression we examined clinically depressed and non-depressed adolescents' physiological responses to their parents' negative emotional behavior, as indexed by their heart rate responses to parental angry and dysphoric behavior during laboratory-based interactions. Maternal angry and dysphoric behavior predicted heart rate deceleration amongst non-depressed adolescents, a response that was not observed in depressed adolescents. Fathers' angry behavior predicted significant heart rate acceleration in depressed (but not non-depressed) adolescents, whereas fathers' dysphoric behavior predicted heart rate deceleration amongst depressed but not amongst non-depressed adolescents. These findings are interpreted within the framework of orienting and defense cardiac responses, and suggest that reactivity in adolescent depression is characterized by the absence of a normative orienting response toward aversive maternal behaviors, and a defensive physiological response to aggressive paternal behavior.     

Adolescents' subjective distress over their emotional/behavioral problems

This study analyzed the relations among 151 7th- and 8th-grade adolescents' self-evaluations of the occurrence of their behavior, their own subjective distress over their behavior, their perceptions of their personal competence, their perceptions of their mothers' and fathers' distress over these behaviors, and their parents' reports of the occurrence of adolescent behaviors. As hypothesized, adolescents' self-reports of occurrence of their behaviors were significantly but moderately correlated with their subjective distress about these behaviors, and adolescents made a distinction between the occurrence of a behavior and their distress about it. Externalizing behaviors were rated by adolescents as more distressing to mothers and to fathers than to adolescents themselves, and conversely, internalizing behaviors were rated as more distressing to self than to parents. Ratings of subjective distress were significantly related to self-perceptions of behavioral conduct and self-worth, whereas parents' ratings of the occurrence of behavior were not related to these self-perceptions.     

Brief report: Adolescents' attitudes toward epilepsy: further validation of the Child Attitude Toward Illness Scale (CATIS)

OBJECTIVE: To examine adolescents' attitudes toward having epilepsy using the Child Attitude Toward Illness Scale (CATIS) and to provide further psychometric validation of the scale in this population. METHODS: Participants were 197 adolescents aged 11 to 17 years who completed the CATIS at two points and two external validation scales. Test-retest and internal consistency reliability and construct validity were computed. Analysis of variance was used to examine differences in attitudes according to gender, age, and epilepsy severity. RESULTS: Girls, older adolescents, and those with more severe epilepsy had more negative attitudes toward having epilepsy than boys, younger adolescents, and those with moderate or mild epilepsy, respectively. Psychometric analyses yielded excellent internal consistency reliability and good test-retest reliability. The CATIS was moderately correlated with self-esteem and mastery, supporting its construct validity. CONCLUSIONS: The CATIS is a useful and psychometrically sound tool to assess adolescents' attitudes toward having chronic illness.     

A longitudinal examination of male college students' perpetration of sexual assault

Self-administered surveys were completed by 197 men in college at 2 time points, 1 year apart. Men who committed sexual assault at multiple time points (repeat assaulters) had the most extreme scores on measures of hostility toward women, past sexual experiences, drinking in sexual situations, and adolescent delinquency. Nonassaulters had the least extreme scores and men who committed sexual assault at only 1 time point had scores that tended to fall in between. Repeat assaulters also expressed significantly less remorse when they described their sexual assault at Time 1 than did past assaulters who committed sexual assault only at the initial time point. These findings demonstrate the importance of initiating prevention and treatment programs in early adolescence, before longstanding attitudes and behaviors tolerant of sexual assault are established.     

Parental Self-Efficacy to Support Teens During a Suicidal Crisis and Future Adolescent Emergency Department Visits and Suicide Attempts

This study of adolescents seeking emergency department (ED) services and their parents examined parents’ self-efficacy beliefs to engage in suicide prevention activities, whether these beliefs varied based on teens’ characteristics, and the extent to which they were associated with adolescents’ suicide-related outcomes. Participants included 162 adolescents (57% female, 81.5% Caucasian), ages 13–17, and their parents. At index visit, parents rated their self-efficacy to engage in suicide prevention activities and their expectations regarding their teen’s future suicide risk. Adolescents’ ED visits for suicide-related concerns and suicide attempts were assessed 4 months later. Parents endorsed high self-efficacy to engage in most suicide prevention activities. At the same time, they endorsed considerable doubt in being able to keep their child safe if the teen has thoughts of suicide and in their child not attempting suicide in the future. Parents whose teens experienced follow-up suicide-related outcomes endorsed, at clinically meaningful effect sizes, lower self-efficacy for recognizing suicide warning signs, for obtaining the teen’s commitment to refrain from suicide, and for encouraging their teen to cope, as well as lower confidence that their teen will not attempt suicide; self-efficacy to recognize warning signs was at trend level. Despite endorsing high self-efficacy for the majority of suicide prevention activities, parents of high-risk teens expressed less confidence in their capacity to influence their teen’s suicidal behavior, which could undermine parents’ effort to implement these strategies. The relationship between parental self-efficacy and youth suicide-related outcomes points to its potential value in guiding clinical decision making and interventions.     

Parents' aggressive influences and children's aggressive problem solutions with peers.

This study examined children's aggressive and assertive solutions to hypothetical peer scenarios in relation to parents' responses to similar hypothetical social scenarios and parents' actual marital aggression. The study included 118 children ages 9 to 10 years old and their mothers and fathers. Children's aggressive solutions correlated with same-sex parents' actual marital aggression. For children with mothers who exhibited low actual marital aggression, mothers' aggressive solutions to hypothetical situations corresponded with children's tendencies to propose aggressive but not assertive solutions. In a 3-way interaction, fathers' aggressive solutions to peer scenarios and marital aggression, combined, exacerbated girls' aggressive problem solving but had the opposite effect for boys. We address the complexity, particularly with respect to parent and child gender combinations, in understanding parents' aggressive influences on children's peer relationships.     

Structured after‐school activities as a moderator of depressed mood for adolescents with detached relations to their parents

This study investigated whether participation in structured after‐school activities moderates the association between detached parent–adolescent relationships and adolescent depressed mood. A representative sample of 539 14‐year‐olds and their parents were assessed concerning adolescent participation in after‐school activities, the parent–adolescent relationship, and adolescent depressed mood. Results showed that adolescents with detached relations to their parents reported high levels of depressed mood. Adolescents who participated in after‐school activities reported low levels of depressed mood compared to adolescents not participating in such activities; however, this was primarily true of participants who perceived high support from their activity leader. Support from after‐school activity leaders was particularly important for a subgroup of youth characterized by highly detached relations to their parents. Although girls reported higher levels of depressed mood than did boys, the associated benefits of perceived support from an activity leader were consistent across gender. © 2002 John Wiley & Sons, Inc.