Risk For Adjustment Difficulties Research Articles

The Perils of Not Being Attractive or Athletic: Pathways to Adolescent Adjustment Difficulties Through Escalating Unpopularity.

Adolescents who lack traits valued by peers are at risk for adjustment difficulties but the mechanisms responsible for deteriorating well-being have yet to be identified. The present study examines processes whereby low athleticism and low attractiveness give rise to adolescent adjustment difficulties. Participants were public middle school students (ages 10 to 13 years, Mage = 11.54, SDage = 1.00) in the USA and Lithuania (300 girls, 280 boys; 52.7% girls). Self-reports of alcohol misuse and loneliness were collected three times during an academic year (M = 12.3 week intervals). Athleticism, attractiveness, unpopularity, and peer rejection were assessed through peer nominations. Full longitudinal mediation analyses examined direct and indirect pathways from stigmatized traits (i.e., low athleticism, low attractiveness) to adjustment difficulties (i.e., alcohol misuse, loneliness) through two indices of low peer status: unpopularity and rejection. The results indicated that the possession of stigmatized traits predicted escalating unpopularity, which, in turn, predicted increasing adjustment difficulties. Similar indirect associations did not emerge with rejection as a mediator, underscoring the unique role of power and prominence (and the lack thereof) in socioemotional development. The findings underscore the adjustment risks and interpersonal challenges that confront children and adolescents who lack traits valued by peers.

Parenting with a Life-Limiting Illness

Parents with life-threatening illness face unique challenges in their dual roles as patients and parents. They are at risk for depression, parenting stress, and impaired family functioning, and their children are at risk for adjustment difficulties. In addition to treatment of depression and other mental health issues, patients may also benefit from evidence-informed guidance addressing the challenges of parenting while ill. Consultations should be tailored to each family, with consideration of children's developmental stage and temperament. Clinical recommendations for communication about a parent's anticipated death, helping children spend meaningful time with an ill parent, and legacy leaving are provided.

Positive Parenting Moderates the Association between Temperament and Self-Regulation in Low-Income Toddlers

Self-regulation develops rapidly during the toddler years and underlies many important developmental outcomes, including social-emotional competence and academic achievement. It is important to understand factors that contribute to early self-regulation skills among children at risk for adjustment difficulties in these domains, such as children growing up in poverty. The current study examined mother-reported child temperament (negative affect, effortful control) and observed maternal parenting (during a mother-child free play) as contributing factors to toddlers' observed self-regulation during delay of gratification tasks at 27 months (snack delay) and 33 months (gift delay). Participants were 198 toddlers (M age = 27 months; 53% boys; 48% non-Hispanic white) and their mothers from low-income families. Mothers' negative parenting characterized by negative affect, hostility, and negative control was associated with poorer self-regulation contemporaneously. Toddlers' lower negative affect and higher effortful control predicted better self-regulation at 33 months, but positive parenting characterized by positive affect and sensitivity moderated these associations at both time points. Specifically, we found a buffering effect of high positive parenting among toddlers with a temperamental risk and a deleterious effect of low positive parenting despite toddlers' temperamental strength. Results highlight the importance of positive parenting for fostering the development of self-regulation among toddlers growing up with poverty-related and child-level risks.

Do grandparents matter? Intergenerational relationships between the closest grandparents and Malaysian adolescents

ABSTRACTA close connection with a grandparent can interact with an adolescent’s experience of life stressors to increase or decrease their risk for negative outcomes. Traditional filial values may be linked to closer grandparent–grandchildren interactions in Asian cultures, such as Malaysia. This study examined how grandparental involvement and emotional closeness moderated the associations between life stressors and adjustment difficulties among adolescents in Malaysia (n = 643 adolescents). Hierarchical regression analysis showed that greater proximal and distal life stressors were associated with more adjustment difficulties of adolescents. Moreover, emotional closeness with the closest grandparents moderated the association between adolescent distal adversities and adjustment difficulties. Specifically, the contribution of accumulative stress from adverse life events on the risk of adjustment difficulties among adolescents may be alleviated when adolescents perceived high levels of emotional ties with the closest grandparents. These findings suggest that grandparents can directly relate to grandchildren’s adjustment through engaging emotional relationships. Our study shed lights on the interpretation of the contribution of grandparents to adolescent outcomes and the development of adolescents’ resilience in the face of adversity within the Malaysian cultural context.

Depression Trajectories of Antenatally Depressed and Nondepressed Young Mothers: Implications for Child Socioemotional Development

ObjectivesThis study explores the longitudinal trajectories of depressive symptoms in young mothers and investigate the consequences of maternal depression for children's birth outcomes and behavioral adjustment. HypothesisAntenatal depression puts children of young mothers at risk for adjustment difficulties by adversely impacting birth outcomes and maternal symptoms after birth. MethodsData were drawn from a three-wave randomized, controlled trial of a statewide home visiting program for young primiparous women. A subsample of women (n = 400) who were prenatal at intake was used in the analysis. Mothers were divided into an antenatally depressed group (ADG; 40%) and a healthy group (HG) based on their symptoms at intake. Mothers reported depressive symptoms at intake and 12- and 24-month follow-up, and filled out a checklist of child behavior problems at 24 months follow-up. Perinatal and birth outcomes were derived from the Electronic Birth Certificate collected by the State Department of Public Health at discharge from the hospital. ResultsADG and HG had similar pregnancy characteristics and birth outcomes, but ADG reported more child behavioral problems. Multigroup latent growth curve analysis provided evidence for distinct depression trajectories. A mediation hypothesis was not supported. In both groups, steeper increase in symptoms over time predicted more mother-reported child behavioral problems. ConclusionsFindings are consistent with studies linking antenatal depression with post-birth symptoms, underscoring the importance of prenatal screening for depression.

Mothers’ trajectories of depressive symptoms across Mexican-origin adolescent daughters’ transition to parenthood.

This study draws from a life-course perspective in examining trajectories of mothers' depressive symptoms across their adolescent daughters' adjustment to parenthood in 204 Mexican-origin families using latent class growth analysis. Four distinct trajectories were identified based on mothers' depressive symptoms before the birth and 10 and 24 months postpartum. Two trajectories were characterized by stable levels of depressive symptoms but were differentiated in their levels of symptoms (i.e., High/Stable and Low/Stable). The remaining two trajectories were characterized by changes from pre- to post-birth, with one group exhibiting increases in depressive symptoms (i.e., Low/Post-Birth Increase) and the other group characterized by decreases in depressive symptoms (i.e., Low/Post-Birth Decrease). Consistent with a risk and resilience perspective, mothers with more disadvantaged socioeconomic circumstances and fewer intrapersonal resources (i.e., self-esteem, ethnic identity affirmation) were more likely to be members of the High/Stable group. In addition, daughters of mothers in the High/Stable group were more likely to have lower self-esteem as compared with daughters in the other three groups. Collectively, these findings suggested that the High/Stable group was at risk for adjustment difficulties from the third trimester to two years postpartum. In contrast, membership in the Low/Post-Birth Decrease trajectory group was associated with lower depressive symptoms and higher self-esteem for mothers and daughters. Findings point to the need to identify mothers who are at risk for depressive symptoms during their adolescent daughters' pregnancy and offer prevention and intervention programs that reduce risks and enhance protective factors.

Determining Risk Factors for Internalizing Problem Behavior: The Screening Instrument for Adolescents of Parents with Chronic Medical Condition

A large body of evidence suggests that the risk for adjustment difficulties in children of parents with a chronic medical condition (CMC) depend on a number of demographic, illness-related, child adaptational, and family characteristics. In particular, internalizing problems are common in children with parental CMC. This longitudinal study describes the development and psychometric properties of the Screening Instrument for Adolescents of Parents with Chronic Medical Condition (SIAPCMC), a measure intended to assess the risk for future clinical internalizing problems. Based on a meta-analysis and empirical research, risk factors for internalizing problem behavior were identified and converted into a set of key questions. Finally, questions with high predictive value for internalizing problems were selected, yielding an 8-item measure. The SIAPCMC items cover caregiving characteristics, daily hassles affecting personal life, child report of stress, active problem solving, and quality of parent attachment. From 149 adolescents (age range = 10–20 years, mean age = 15.5, number of families = 104) who participated at Time 1, 120 adolescents also completed questionnaires 1 year later (Time 2). Adolescents filled in a test battery including the SIAPCMC and the Youth Self-Report. The SIAPCMC showed excellent reliability (Cronbach’s alpha = .88–.90) and satisfactory repeated measures correlation (r = .67) over 1 year. The indices for construct and predictive validity were good. The SIAPCMC proved to be sensitive in identifying children with future internalizing problems. Our results indicate that the SIAPCMC has sound psychometric properties. The SIAPCMC should be further tested in clinical and non-clinical settings to ground its practical use for prevention of future internalizing problems.

Differential Outcomes of Adolescents with Chronically Ill and Healthy Parents

Approximately 10% of children grow up with a parent who has been diagnosed with a chronic medical condition (CMC) and seem to be at risk for adjustment difficulties. We examined differences in behavioral, psychosocial and academic outcomes between 161 adolescents from 101 families with a chronically ill parent and 112 adolescents from 68 families with healthy parents, accounting for statistical dependence within siblings. Children between 10 and 20 years and their parents were visited at home and filled in questionnaires. Multilevel analyses showed that 20–60% of the variance in most adolescent outcomes was due to the family cluster effect, especially in internalizing problem behavior, caregiving variables and quality of parent attachment. Conversely, the variance in stress and coping variables and grade point average (GPA) was mainly due to individual characteristics. Adolescents with parents affected by CMC displayed more internalizing problems than the comparison group and scored higher on frequency of household chores, caregiving responsibilities, activity restrictions, isolation, daily hassles and stress. In addition, their grade point average was comparatively worse. No group differences in externalizing problems, coping skills and quality of parent attachment were found. In conclusion, the family cluster effect largely explains adolescent outcomes and should be accounted for. Adolescents with parents affected by CMC are subject to an increased risk for internalizing problems, adverse caregiving characteristics, daily hassles, stress and a low GPA. According to a family-centered approach, school counselors and health care practitioners should be alert to adjustment difficulties of children with a chronically ill parent.

Monitoring Device Acceptance in Implantable Cardioverter Defibrillator Patients Using the Florida Patient Acceptance Survey

Patient device acceptance might be essential in identifying patients at risk for adverse patient-reported outcomes following implantation of an implantable cardioverter defibrillator (ICD). We examined the validity and reliability of the Florida Patient Acceptance Scale (FPAS) and identified correlates of device acceptance in a Dutch cohort of ICD patients. Patients with a first-time ICD (N = 272, mean age = 59.2 ± 11.9, 82% men) recruited from the Erasmus Medical Center, Rotterdam, or the Medisch Spectrum Twente, Enschede, The Netherlands completed the FPAS, the Type D Scale, and the Hospital Anxiety and Depression Scale. Exploratory and confirmatory factor analyses indicated that eliminating three items from the FPAS, leaving 12 items contributing to three factors, is equivalent to the original four-factor version of the FPAS. The abbreviated FPAS had a high internal consistency both for the total scale and all subscales, with Cronbach's alphas ranging from 0.76 to 0.82. Anxiety (odds ratio [OR]: 9.75; 95% confidence interval [CI]: 2.38-39.87; P = 0.002), depression (OR: 2.96; 95% CI: 0.98-8.93; P = 0.05), and the distressed (Type D) personality (OR: 5.04; 95% CI: 1.50-16.92; P = 0.01), but not demographic and clinical factors including shocks, were significant independent correlates of poor device acceptance. A shortened 12-item, three-factor version of the FPAS was shown to be a valid and internally consistent instrument to assess device acceptance in Dutch ICD patients. Psychological but not clinical factors were the primary correlates of device acceptance, which underlines the importance of taking into account the patient's psychological profile when seeking to identify patients at risk for adjustment difficulties after ICD implantation.

Academic Giftedness and Alcohol Use in Early Adolescence.

Adolescence is a period of development particularly vulnerable to the effects of alcohol use, with recent studies underscoring alcohol's effects on adolescent brain development. Despite the alarming rates and consequences of adolescent alcohol use, gifted adolescents are often overlooked as being at risk for early alcohol use. Although gifted adolescents may possess protective factors that likely inhibit the use of alcohol, some gifted youth may be vulnerable to initiating alcohol use during adolescence as experimenting with alcohol may be one way gifted youth choose to compensate for the social price (whether real or perceived) of their academic talents. To address the dearth of research on alcohol use among gifted adolescents the current study (a) examined the extent to which gifted adolescents use alcohol relative to their nongifted peers and (b) examined the adjustment profile of gifted adolescents who had tried alcohol relative to nongifted adolescents who tried alcohol as well as gifted and nongifted abstainers. More than 300 students in seventh grade (42.5% gifted) participated in the present study. Results indicated gifted students have, in fact, tried alcohol at rates that do not differ from nongifted students. Although trying alcohol was generally associated with negative adjustment, giftedness served as a moderating factor such that gifted students who had tried alcohol were less at risk than their nongifted peers. However, evidence also suggests that gifted adolescents who tried alcohol may be a part of a peer context that promotes substance use, which may place these youth at risk for adjustment difficulties in the future.

Children's Adjustment and Prosocial Behaviour in Step‐, Single‐parent, and Non‐stepfamily Settings: Findings from a Community Study

The adjustment and prosocial behaviour of 4-year-old children and their older siblings growing up in step-parent or single-parent families, or with two biological parents, was investigated within a longitudinal community study, the Avon Longitudinal Study of Pregnancy and Childhood (ALSPAC). Mean differences in mothers' perception of adjustment were found for children in different family settings, with higher levels of problems and lower prosocial scores reported for those in single- and step-parent families than those in non-stepfamilies. Individual differences within each family setting were marked. With the exception of single parenthood, which remained a risk indicator for the 4-year-olds, the contribution of family type to differences in adjustment and prosocial behaviour largely disappeared when account was also taken of negativity in family relationships, maternal age, education level, depressive symptomatology, and history of previous live-in relationships, mothers' support networks, and the family's current financial and housing circumstances. Boys remained more at risk for adjustment difficulties than girls when this range of factors was taken into account. The limitations and implications of these findings on a community sample, a first step in a programme of research into family processes in children's adjustment, are discussed.

Predictors of Coping with Pain in Mothers and Their Children with Sickle Cell Syndrome

This study examined predictors of strategies used to cope with pain in children with sickle cell disease and their mothers. Disease severity, socioeconomic status, child adjustment and adaptive behavior, maternal psychopathology, and family functioning were examined in 55 mother-child dyads to determine the predictive potential of these factors on engagement and disengagement coping. While controlling for socioeconomic status and psychopathology in the mothers, 15% of the variance in engagement coping was predicted by family adaptability. Disengagement coping was predicted by internalizing symptoms exhibited by the child, including a negative and pessimistic attributional style, which accounted for nearly one fifth of the variance. Finally, mothers who reported more active strategies for coping with their child's pain were more likely to endorse greater use of techniques to prevent and effectively manage pain in their children. Neither coping strategy was predicted by severity of disease presentation in the children, suggesting the importance of psychosocial factors in adapting to childhood chronic illness and that severity of disease may not necessarily be a marker for families at risk for adjustment difficulties. Findings were interpreted to support a systemic family model in promoting active and adaptive engagement coping in caretakers of children with sickle cell syndrome.

Family Resources as Resistance Factors for Psychological Maladjustment in Chronically Ill and Handicapped Children

The hypothesis that their psychological adjustment is related in part to resources present in their families was investigated in 153 children, age 4-16, who had one of five chronic physical disorders: juvenile diabetes, juvenile rheumatoid arthritis, chronic obesity, spina bifida, or cerebral palsy. Their mothers completed standardized psychometric instruments to measure specific dimensions of family psychological and utilitarian resources and of child adjustment. Variation in children's psychological adjustment was related both to their psychological and utilitarian family resources. Psychological family resources contributed uniquely to the prediction of adjustment beyond that provided by utilitarian family resources. These results are discussed as having implications for the identification of chronically ill and handicapped children at risk for adjustment difficulties.