Adult Social Functioning Research Articles

The Adolescent Relational Dialectic and the Peer Roots of Adult Social Functioning

The long-term import of a fundamental challenge of adolescent social development-establishing oneself as a desirable peer companion while avoiding problematic behaviors often supported within peer groups-was examined in a community sample of 184 adolescents, followed from ages 13 to 23, along with parents, peers, and romantic partners. The dialectical nature of this challenge appeared in findings that autonomy vis-à-vis peer influences predicted both long-term success avoiding problematic behavior but also more difficulty establishing strong adult friendships. Conversely, being a desirable peer companion in adolescence predicted more positive adult relationships but also greater alcohol use. Adolescents who established themselves as both desirable companions and as autonomous vis-à-vis peers were rated as most successful by their parents at age 23.

Health and Social Functioning of Adults With Intellectual Disability and Autism

AbstractThere is little information on the mental health needs of adults with intellectual disability (ID) and autism spectrum disorders (ASDs). Such evidence is much needed for the development of more effective mental health services for this group. The aim of this study is to compare adults with ID and ASD receiving specialist mental health services with participants without ASD. Data were collected from the anonymized case records of a clinic‐based population in South East London. Health and social functioning were measured using the Health of the Nation Outcome Scale for people with Learning Disability (HoNOS‐LD). A review of case records identified 371 service users in receipt of specialist mental health care who were eligible for the study. There were 117 people (32% of the sample) with a clinical diagnosis of ID and ASD. Participants with ASD were younger, more likely to be male, less likely to live independently and had more severe ID than those without ASD. Furthermore, those with ID and ASD were less likely to be diagnosed with a psychiatric disorder but had significantly higher scores on the HoNOS‐LD (indicating lower health and social functioning) than those without ASD. A significant proportion of adults with ID who are in receipt of specialist mental health services also have a clinical diagnosis of ASD. This group has different mental health needs compared with those without ASD. The authors note the need for a more personalized approach to service delivery with a focus on improving social functioning and behavioral impairments.

Adults with congenital or acquired facial disfigurement: Impact of appearance on social functioning

This study evaluates the impact of congenital and acquired facial disfigurement on social functioning in adults and whether this differs from adults without facial disfigurement. Moreover, the predictive value of objective and subjective appearance on social functioning is explored.Fifty-nine adults with severe congenital facial disfigurement, 59 adults with traumatically acquired facial deformities in adulthood, and 120 adults without facial disfigurement, completed the Scale for Interpersonal Behaviour, Social Avoidance and Distress Scale, and Visual Analogue Scale for facial appearance satisfaction.The impact of congenital and acquired facial disfigurement on social functioning in adults is similar and significantly differed from the reference group. The level of stress evoked by interpersonal behaviour, and social anxiety and distress were not significantly different between the groups. Only the patient’s subjective appearance was a predictor of social functioning.Avoiding stress caused by stigmatization and uncertainty about reactions of others, leads to less frequent interpersonal behaviour in adults with facial disfigurement. The fact whether the deformity is congenital or acquired in adulthood has no influence on social functioning. Patient’s satisfaction with facial appearance is more important than the objective severity of the deformity; in this context realistic expectations of the patient considering additional surgery are important.

Relationship between childhood adversity and clinical and cognitive features in schizophrenia

Childhood adversity is associated with elevated risk for a wide range of adult psychiatric disorders, and has significant and sustained negative effects on adult behavioural and social functioning. Elevated rates of childhood adversity have been reported for people with a diagnosis of schizophrenia. The aim of the present study was to assess rates of retrospectively reported childhood adversity among adults with schizophrenia and to examine the relationship between childhood adversity and clinical and cognitive features. Data were available for 408 schizophrenia participants and 267 healthy control participants recruited through the Australian Schizophrenia Research Bank (ASRB). History of childhood adversity was obtained using the Childhood Adversity Questionnaire (CAQ). A five-factor solution was identified from the CAQ. Schizophrenia participants reported experiencing more childhood adversities than controls. In both groups, those reporting childhood adversity were more likely to be female and older. Among participants with schizophrenia, positive symptom severity and fewer years of education were associated with childhood adversity. Lower IQ scores and personality traits were associated with reporting a greater number of childhood adversities and with adversity sub-types of abusive, neglectful and dysfunctional parenting. The rate of childhood adversity reported in this sample was high which suggests greater exposure to adverse childhood events among participants with schizophrenia in comparison with healthy controls. We identified unique groups amongst CAQ items that provided a salient framework from which to investigate the connection between childhood adversity and clinical and cognitive features.

Mindfulness Based Stress Reduction (MBSR) for Improving Health, Quality of Life, and Social Functioning in Adults

Mind-body interventions to manage stress-related health problems are of widespread interest. One of the best known methods is mindfulness-based stress reduction (MBSR), and MBSR courses are now offered by health services, as well as in social and welfare settings. In this systematic review, we report on the effects of MBSR interventions on health, quality of life, and social functioning. From the more than 3,000 potentially relevant references identified in two extensive searches, we included 31 relevant studies with an overall total of 1,942 participants, each of whom had been randomised to receive MBSR or other treatment strategies (most often a waiting list control). We utilised all outcome data published in the selected studies using a new statistical method for calculating the effect size. This method addressed the problems presented by the interdependence of many measurements of outcomes. 26 of the 31 studies were identified as having data suitable for meta-analysis. MBSR was found to have a moderate and consistent positive effect on mental health outcomes in both patients selected with somatic problems and with mild to moderate psychological problems, and among participants recruited from community settings. MBSR interventions improved outcomes measuring different aspects of personal development and quality of life. The effects on somatic health outcomes were somewhat smaller. No adverse effects were described. Few studies were found that evaluated the impact of MBSR on social functioning, such as the ability to work.

Efficacy and Tolerability of Pharmacotherapies for Attention-Deficit Hyperactivity Disorder in Adults

This review examines the evidence regarding the efficacy and tolerability of long- and short-acting stimulant medications, as well as the non-stimulant medications atomoxetine and bupropion in the treatment of adult attention-deficit hyperactivity disorder (ADHD). Effect sizes in adults appear to be of almost the same magnitude as in school-age children when robust doses are used. There are adequate data demonstrating short-term efficacy and safety of medication in ADHD during adulthood but long-term studies are lacking, particularly in view of concerns regarding cardiovascular adverse events. There is some evidence that stimulant medication can improve driving performance in adults with ADHD. The extent to which medication may improve academic, occupational and social functioning in adults with ADHD is unclear, and future research should investigate these outcomes. Medication treatment of adults with ADHD in sports is controversial. Both stimulant and non-stimulant medications seem to be well tolerated. Monitoring of pulse and blood pressure is recommended with these drugs because of their cardiovascular effects. There have been extremely rare case reports of sudden death in adults and children treated with stimulants and atomoxetine, but it is difficult to clearly establish causality. In view of reports of treatment-related suicide-related behaviour with atomoxetine, it is recommended that adults should be observed for agitation, irritability, suicidal thinking, self-harming or unusual behaviour, particularly in the first months of treatment, or after a change of dose. ADHD in adults continues to remain an under-recognized disorder in many parts of the world and there is a lack of specialist clinics for assessment and treatment of adult ADHD. Studies to date have failed to show efficacy of medications in the treatment of ADHD in the substance misuse population. There is little evidence so far to suggest an increased misuse of stimulants or diversion amongst substance misusers; however, data are insufficient to draw firm conclusions. Further work is necessary to evaluate effective treatments in subgroups such as the substance misuse population, those with multiple co-morbidities and different ADHD subtypes.

ADHD in Adults

To review the literature describing impairments in educational, occupational, and social functioning in adults with attention-deficit/hyperactivity disorder (ADHD), current treatment trends, and factors that may influence the abuse potential of long-acting medications used to treat ADHD in adults. A MEDLINE search was conducted to identify articles relating to functional impairments and treatment options for adults with ADHD, as well as the abuse potential of ADHD medications. ADHD is one of the most common psychiatric behavioral disorders in children, and its symptoms have been shown to persist into adulthood. Symptoms of ADHD may occur at home, school, work, or in social situations, and symptom occurrence in these different settings can have a profound negative impact for adults with ADHD. Impairments in educational, occupational, and social functioning in adults with ADHD have been described and are summarized in this review article. Although long-acting medications are more frequently prescribed for children with ADHD than short-acting medications, adults with ADHD are equally likely to be treated with short- and long-acting medications. While all medications used to treat ADHD in adults have potential for abuse, there are a number of factors that may contribute to a lower potential for abuse for long-acting agents compared with immediate-release medications. Impairments from ADHD can be chronic and persistent and they can affect daily educational, occupational, and personal functioning. Adults, in particular, have responsibilities that can extend into the late evening hours so that clinicians need to consider medication duration of action when selecting a pharmacotherapy intervention for adults with ADHD.

Early Childhood Predictors of the Social Competence of Adults with Autism

Longitudinal research into adult outcomes in autism remains limited. Unlike previous longitudinal examinations of adult outcome in autism, the twenty participants in this study were evaluated across multiple assessments between early childhood (M = 3.9 years) and adulthood (M = 26.6 years). In early childhood, responsiveness to joint attention (RJA), language, and intelligence were assessed. In adulthood, the parents of participants responded to interviews assessing the adaptive functioning, autistic symptomology and global functioning of their children. RJA and early childhood language predicted a composite measure of adult social functioning and independence. Early childhood language skills and intelligence predicted adult adaptive behaviors. RJA predicted adult non-verbal communication, social skills and symptoms. Adaptive behaviors changed with development, but symptoms of autism did not. Additional factors associated with adult outcomes are discussed.

PROTOCOL: Mindfulness Based Stress Reduction (MBSR) for improving health and social functioning in adults

PROTOCOL: Mindfulness Based Stress Reduction (MBSR) for improving health and social functioning in adults

Personality – a resource or risk for successful development

Personality as a resource or risk for development was discussed in the light of the results of the ongoing Finnish Jyväskylä Longitudinal Study of Personality and Social Development (FJYLS) which the author has conducted since 1968 when the participants (N = 369, b. 1959) were 8 years of age. A general hypothesis presented within a two-dimensional framework of self-control and activity was that the child's high self-control of emotions and behavior would be associated with adaptive behavior in adulthood. The results have provided evidence in support for and limitations to the hypothesis. High self-control was a resource and low self-control was a risk for development, but there were gender differences that came out consistently in variable-oriented and person-oriented analyses. A resource factor for male adult social functioning was, compared to females, a broader construct of self-control in childhood covering both more passive (compliant) and active (constructive) behavior; only active well-controlled (constructive) behavior was a resource for female functioning. A risk factor for female functioning was low self-control combined with passivity (internalizing behavior), whereas low self-control combined with activity (externalizing behavior) was a risk factor for male functioning. Childhood self-control was not directly associated with adult psychological functioning such as well-being but indirectly through social functioning such as career development. Low self-control in childhood was an antecedent of criminal behavior but only for those male offenders who committed offences in adulthood, not for those who had limited their offending to adolescence.

Timing of parenthood in relation to other life transitions and adult social functioning

The timing of having one's first child, in relation to the timing of other transitions into adulthood and to social functioning, was investigated based on the Finnish Jyväskylä Longitudinal Study of Personality and Social Development, conducted from age 8 (173 females and 196 males) to 42. Results showed that in women, relatively early (< 25 years) motherhood was associated with the early timing of all studied transitions (move from parental home, intimate relationship, education, full-time job); in men, early fatherhood was associated only with the early start of an intimate relationship. In women, but not in men, early parenthood was linked to a lower level of education, lower occupational status, an unstable career line, and heavier alcohol drinking. In the long run, early motherhood lessened its significance for occupational status. Furthermore, differences in education and drinking between women with early motherhood and women with late motherhood disappeared when school success was controlled for, and differences in career stability disappeared when low self-control was controlled for.

An innovative framework for psychosocial assessment in complex mental capacity evaluations

This study describes an innovative tool developed by the Regional Capacity Assessment Team (RCAT) to assess unique psychosocial factors related to capacity evaluations. Capacity is a socio-legal construct entailing the ability to understand choices, appreciate consequences and follow through (or direct a surrogate) with chosen options. RCAT's targeted psychosocial assessment includes medico-legal factors, social history and supports, coping skills, religious/cultural factors and risk of abuse. RCAT completes the psychosocial assessment to determine whether a full capacity assessment is required (referral disposition) and to determine the impact of an adult's social functioning on their decision-making capacity (capacity determination). RCAT's psychosocial assessment protocol was developed after a comprehensive literature review of capacity assessment and incorporates recommended practices in geriatric social work and psychology. This study will synthesise the pertinent literature, discuss cultural interviewing processes significant to capacity, caregiver assessment and describe the tool itself. Suggestions for future research and appropriate implementation of this tool are provided.

Attention-Deficit/Hyperactivity Disorder in Adults: Evidence-Based Recommendations for Management

Attention-deficit/hyperactivity disorder (ADHD) is associated with impairments in educational, occupational, neuropsychological, and social functioning in adults. Successful diagnosis and treatment of the disorder in adults can be a challenge because recent and integrative clinical guidelines are lacking and diagnostic criteria are based on making a retrospective diagnosis of childhood-onset ADHD. To develop evidence-based recommendations for the treatment of ADHD in adults, the scientific literature was reviewed, including primary clinical studies, meta-analyses, and available clinical guidelines. Studies show that stimulant therapy is highly effective and safe in the management of ADHD in adults, with similar response rates to those reported in children at doses that are equivalent on a mg/kg basis. Long-acting stimulants, such as OROS® methylphenidate (OROS® MPH, Concerta®), dexmethylphenidate (d-MPH, Focalin®), and mixed amphetamine salts extended release (MAS XR, Adderall XR®), have durations of action of up to 10 to 12 hours, which permit once-daily dosing. For adults with ADHD who do not respond to stimulant therapy or who have a comorbid condition in which a stimulant is contraindicated, the nonstimulant atomoxetine (Strattera®) may be an appropriate alternative. For many adults, cognitive-behavioral therapy in addition to pharmacotherapy may improve treatment response. Attention-deficit/hyperactivity disorder medications may increase blood pressure and heart rate in adults, so patients should be monitored.

Predicting young adult social functioning from developmental trajectories of externalizing behaviour

The long-term consequences of child and adolescent externalizing problems often involve a wide spectrum of social maladaptation in adult life. The purpose of this study was to describe the predictive link of child and adolescent externalizing developmental trajectories to social functioning in adulthood. Social functioning was predicted from developmental trajectories of parent-reported aggression, opposition, property violations and status violations that were defined in a longitudinal multiple birth cohort study of 2,076 males and females aged 4-18 years. Social functioning was assessed using self-reports by young adults aged 18-30 years. Linear and logistic regression analyses were used to describe the extent to which developmental trajectories are prospectively related to social functioning. Children with high-level trajectories of opposition and status violations reported more impaired social functioning as young adults than children with high-level trajectories of aggression and property violations. Young adults who showed onset of problems in adolescence reported overall less impaired social functioning than individuals with high-level externalizing problems starting in childhood. Overall, males reported more impaired social functioning in adulthood than females. However, females with persistent high-level externalizing behaviour reported more impairment in relationships than males with persistent high-level externalizing behaviour. The long-term consequences of high levels of opposition and status violations in childhood to serious social problems during adulthood are much stronger than for individuals who show only high levels of aggressive antisocial behaviours.

Effects of alcohol exposure during development on play behavior and c-Fos expression in response to play behavior

Developmental exposure to alcohol can produce characteristic physiological and cognitive deficits, often termed Fetal Alcohol Spectrum Disorder (FASD). More recently, social deficits have been shown to occur both in FASD and animal models of FASD; the behavioral and neural bases of these deficits remain to be determined. It was hypothesized that changes in sensory processing may in part underlie the social deficits seen in FASD. This study used a rat model of FASD and social play, a behavior critical to adult social functioning, to begin to examine this hypothesis. Somatosensory cues from dorsal contact to the nape of the neck, critical to the initiation of pinning, were systematically degraded by administration of different doses of xylocaine, a topical anesthetic. Neuronal activity after 1 h of play was assessed by measurement of c-Fos immunoreactivity (IR) in different brain regions. Ethanol-exposed rats showed an increased frequency of pinning during social play and were more sensitive to the degradation of somatosensory cues compared to the control groups, suggesting difficulties in processing somatosensory cues. Neuronal activity in the somatosensory cortex induced by play was significantly decreased in the ethanol-exposed group compared to the non-treated group. The c-Fos IR in the nucleus accumbens was altered in a sexually dimorphic manner in the ethanol-exposed group. Thus, the behavioral and brain measures are consistent with the hypothesis that ethanol exposure during development induces alterations in social play via deficits in processing somatosensory cues that are important to social play.

Markers of Resilience and Risk: Adult Lives in a Vulnerable Population

In this report, we drew on data from an ongoing longitudinal study that began in 1978 (Hauser, Powers, Noam, Jacobson, Weiss, & Folansbee, 1984). Focusing on late, young-adult life among individuals who were psychiatrically hospitalized during adolescence, we examined markers of resilience empirically defined in terms of adult success and well-being. The study includes a demographically similar group recruited from a public high school. Major goals were to (a) develop preliminary models of adaptive functioning among adults in their 30s, (b) examine the extent to which adults with histories of serious mental disorders can be characterized by these models, and (c) explore predictors of successful adult lives from indicators of individuals' psychosocial adjustment at age 25. Results showed significant cohort effects on indexes of adaptive functioning, especially for men. Findings suggest that social relations as well as self-views of competence and relatedness play important roles in characterizing adjustment during the adult years. In addition, indexes of psychosocial adjustment as well as symptoms of psychiatric distress and hard drug use at age 25 made a difference in adult social functioning and well-being, providing hints of possible mechanisms likely to facilitate the ability to "bounce back" after a difficult adolescence.

An interpersonal analysis of adult attachment style: circumplex descriptions, recoiled developmental experiences, self-representations, and interpersonal functioning in adulthood.

Previous research suggests that the structure of adult attachment is dimensional, but the specific dimensions remain unclear. Given its relational nature, studies should examine attachment structure in association with conceptually related interpersonal constructs. The interpersonal model (Kiesler, 1996) provides an integrative framework to examine this structure and associations between dimensions of attachment security (i.e., Anxiety and Avoidance) and: 1) the dimensions of the interpersonal circumplex, 2) the five-factor model of personality, 3) recollections of mothers and fathers, and 4) current self-processes and adult social functioning. In two samples of undergraduates, the Anxiety and Avoidance dimensions were associated with a hostile-submissive interpersonal style. Canonical correlation analyses revealed that dimensions representing combinations of Anxiety and Avoidance, and roughly corresponding to the dimensions from Secure (i.e., low Anxiety and Avoidance) to Fearful (i.e., high Anxiety and Avoidance) attachment and from Preoccupied (i.e., high Anxiety and low Avoidance) to Dismissive (i.e., low Anxiety and high Avoidance) attachment related to the interpersonal constructs. The Secure to Fearful dimension (i.e., overall attachment security) seemed to share relatively more variance with the interpersonal constructs. These dimensions were associated with theoretically consistent characteristics, recollections of early experiences with parents, self-representations, and social functioning.

The Brief Adult Assessment Scale: A Validation Study

Objective: The Brief Adult Assessment Scale (BAAS) is a multidimensional assessment scale designed for use by practitioners and researchers that measures the severity of client problems in 16 areas of adult personal and social functioning. This article describes the BAAS; provides information about its administration, scoring, and interpretation; and reports findings with regard to the psychometric characteristics of the scale. Methods: Data from 291 adult participants were collected and used to assess the scale’s psychometric properties. Results: Findings suggest that the BAAS has strong internal consistency, good factorial and content validities, and preliminary construct validity. Conclusions: Although further research must examine the scale’s known-groups concurrent validity and clinical cutting scores, the BAAS appears to be appropriate for use by social workers as an aid to diagnosis, treatment planning, and evaluation.

Family education seminars and social functioning of adults with chronic aphasia

Aphasia affects functional activities and participation in social roles years after onset. Some group and individual programs have reported success in improving social activities and perceived wellness. These programs typically last several weeks or months. A short, 2-day seminar style program designed for adults with chronic aphasia and their families is described in this report. Six-month follow-up data from participant pairs demonstrates a significant improvement in functional activity level, improved knowledge of aphasia, and improved family relationships. Nonparticipant pairs did not demonstrate any changes over the same period. These findings replicate and extend those of a previous study on the same 2-day seminar [Top. Stroke Rehabil. 2 (1995) 53.]. The results of this study demonstrate the important outcomes of even a very brief program designed to address the long-term psychosocial needs of adults living with aphasia and their families. Educational objectives: As a result of this activity, the participant will be able to: (1) describe a brief family education seminar for adults with chronic aphasia; (2) discuss outcomes in family adjustment, community reintegration, and activities of daily living associated with participation in a family education seminar; and (3) evaluate areas of programming and outcomes that should be addressed in future research.

Analogue observational methods in the assessment of social functioning in adults.

This article provides a clinically oriented overview of analogue observational methods used in the assessment of problematic social functioning, specifically skill deficits and social anxiety. This article emphasizes role-play assessment methods, the predominant method used in clinical settings. An examination of the psychometric characteristics of analogue assessment methods is presented, followed by a review of procedural and structural considerations that may impact the quality of assessment data. Of special concern are the potential impacts of instructional variables, structured versus ideographic role-played situations, confederate characteristics and behavior, molar and molecular levels of assessment, self-ratings versus clinician ratings of functioning, and physical attractiveness. Finally, published and empirically evaluated analogue observation tests are critically reviewed with an emphasis on features that may impact their utility in clinical practice.