Voluntary assent in biomedical research with adolescents: a comparison of parent and adolescent views

An informed consent and voluntary assent in biomedical research with adolescents is contingent on a variety of factors, including adolescent and parent perceptions of research risk, benefit, and decision-making autonomy. Thirty-seven adolescents with asthma and their parents evaluated a high or low aversion form of a pediatric asthma research vignette and provided an enrollment decision; their perceptions of family influence over the participation decision; and evaluations of risk, aversion, benefit, and burden of study procedures. Adolescents and their parents agreed on research participation decisions 74% of the time, yet both claimed ultimate responsibility for the participation decision. Both rated most study procedures as significantly more aversive than risky. Parents were more likely to rate aspects of the hypothetical study as beneficial and to provide higher risk ratings for procedures. Disagreements concerning research participation decisions and decision-making autonomy have implications for the exercise of voluntary assent in biomedical research.     

Toward a further understanding of assent

Arranging assent opportunities is an increasingly common strategy for involving clients in therapeutic decisions within behavior analysis. Recent behavior-analytic articles have helped create a basic behavioral definition and conceptualization of assent, but much more guidance is needed for practitioners and researchers interested in embedding assent into their practices. The purpose of this article is to advance the conceptualization and understanding of assent and assent practices by refining previous definitions and conceptualizations of assent and providing six essential considerations for embedding assent into practice. The six considerations consist of determining the applicability and feasibility of assent, assessing assent-related skills, arranging assent procedures and teaching assent-related skills, arranging fair choices, selecting opportunities to assess assent, and informally assessing assent. Following the discussion of the considerations for assent practices, we issue a call for specific topics of research on assent.     

Family functioning and the adolescent mother: a systems approach

This study examines unwanted adolescent pregnancy and early childbearing within the context of the family system. Fifty pregnant adolescents and their families were interviewed prenatally and again during the postpartum period. Utilizing the concepts of structural family theory and therapy as described by Minuchin, certain characteristics of family style and structure of organization were rated. These family variables were then related to aspects of the adolescent mother's adaptation postpartum. Boundaries, in terms of degree of intrusiveness and differentiation, were related to such variables as whether the adolescent is maintained in the household and to her continuing relationship with the baby's father. Similarly, the family's style of dealing with conflict was related to the relationship between the adolescent parents, among other outcome variables. Implications of the findings both for working with these families and for further research are discussed, and issues are raised about hypothesized relationships between independent and dependent variables which were not borne out.     

Children's competence for assent and consent: a review of empirical findings

This narrative review summarizes the empirical literature on children's competence for consent and assent in research and treatment settings. Studies varied widely regarding methodology, particularly in the areas of participant sampling, situational context studied (e.g., psychological versus medical settings), procedures used (e.g., lab-based vs. real-world approaches), and measurement of competence. This review also identifies several fundamental dilemmas underlying approaches to children's informed consent. These dilemmas, including autonomy versus best interest approaches, legal versus psychological or ethical approaches, child- versus family-based approaches, and approaches that emphasize consent versus those that emphasize assent, have implications for the measurement of children's competence and interpretation of findings. Recommendations for future research in the area of children's informed consent include the use of diverse samples and control groups, development of multidimensional and standardized measures of competence, utilization of multidimensional and standardized measures of competence, utilization of observational methods and longitudinal designs, examination of noncognitive aspects of children's competence and comparison of children's competence for treatment and research decisions.     

Through their own eyes: a media-based group approach to adolescent trauma

This paper describes the process of two groups of students from high schools located in the immediate vicinity of the World Trade Center grappling to make sense of the events of September 11 through the creation of a documentary chronicling their experiences. The process of creating these videos mirrored the process and curative factors of a psychotherapy group in a non-stigmatizing, innovative, and accessible format, one generated by the students themselves with the assistance of professionals in the visual and performing arts. After reviewing the literature on the potential impact of violence on adolescents and the use of group treatment, especially in school settings, as an optimal choice for this population, we describe the distinctive process of the two separate groups of students, each culminating in different expressions of their very personal experience of September 11. We understand and contextualize their process through the lens of the therapeutic dynamics and elements of group work.     

Stability and change in adolescent spirituality/religiosity: a person-centered approach

Although there has been a substantial increase over the past decade in studies that have examined the psychosocial correlates of spirituality/religiosity in adolescence, very little is known about spirituality/religiosity as a domain of development in its own right. To address this limitation, the authors identified configurations of multiple dimensions of spirituality/religiosity across 2 time points with an empirical classification procedure (cluster analysis) and assessed development in these configurations at the sample and individual level. Participants included 756 predominately Canadian-born adolescents (53% female, 47% male) from southern Ontario, Canada, who completed a survey in Grade 11 (M age = 16.41 years) and Grade 12 (M age = 17.36 years). Measures included religious activity involvement, enjoyment of religious activities, the Spiritual Transcendence Index, wondering about spiritual issues, frequency of prayer, and frequency of meditation. Sample-level development (structural stability and change) was assessed by examining whether the structural configurations of the clusters were consistent over time. Individual-level development was assessed by examining intraindividual stability and change in cluster membership over time. Results revealed that a five cluster-solution was optimal at both grades. Clusters were identified as aspiritual/irreligious, disconnected wonderers, high institutional and personal, primarily personal, and meditators. With the exception of the high institutional and personal cluster, the cluster structures were stable over time. There also was significant intraindividual stability in all clusters over time; however, a significant proportion of individuals classified as high institutional and personal in Grade 11 moved into the primarily personal cluster in Grade 12.     

The psychosocial etiology of adolescent drug use: a family interactional approach

The purpose of this monograph was to propose a framework, family interactional theory, for explaining the psychosocial aspects of adolescent drug use. Three themes are stressed: (a) the extension of developmental perspectives on drug use, (b) the elucidation of family (especially parental) influences leading to drug use, and (c) the exploration of factors that increase or mitigate adolescents' vulnerability to drug use. We present a developmental model with two components; the first deals with adolescent pathways to drug use, and the second incorporates childhood factors. The model was tested in two studies: one cross-sectional study of 649 college students and their fathers, and one longitudinal study of 429 children and their mothers. The subjects were given self-administered questionnaires containing scales measuring the personality, family, and peer variables outlined in the model. The results of each study supported the hypothesized model, with some differences between parental influences. We also found that individual protective factors (e.g., adolescent conventionality, parent-child attachment) could offset risk factors (e.g., peer drug use) and enhance other protective factors, resulting in less adolescent marijuana use. Implications of the findings for prevention and treatment, future research, and public policy are discussed.     

Interspecies justice: agency,self-determination,and assent

Philosophical Studies - In this article, we develop and defend an account of the normative significance of nonhuman animal agency. In particular, we examine how animals’ agency interests...     

Revelations of adolescent mothers: an intensive case-study approach

An intensive case-study approach was utilized with a sample of low-income females (19 black, 1 white) enrolled in a program for adolescent mothers. Audiotaped interviews examined self-image, gender role beliefs, relationships, ways of knowing, and future plans. Participants revealed a positive self-image, an association of womanhood with motherhood, an ability to picture themselves in a variety of future roles and relationships, negative attitudes toward men, matriarchal family structures, and subjective ways of knowing. The results were interpreted in the context of identity formation. Limitations included the presence of white interviewers and confounding effects of program participation. The findings have implications for future research in relationship and courtship patterns of the black subculture and the role of motherhood in identity development.     

Medical decision-making and minors: issues of consent and assent

The physician-patient relationship has been described as an egalitarian partnership in which patients and physicians work together to make healthcare decisions. Although adults receive considerable encouragement to become active participants in medical decision-making, children and adolescents often have little voice in such decisions and are granted limited access to confidential medical care. After a brief discussion of legal perspectives on informed consent, the present review examines the developmental literature on children and adolescents' capacities to make medical decisions that are informed, voluntary, and rational. The purposes and benefits of assent are identified. Remaining questions of how to evaluate capacity and balance parental and minor autonomy are explored.     

Treatment of the disturbed adolescent: A family system approach

Adolescence is a period of turbulence for the young person as well as his family. This particular transition phase requires changes of adaptation for all family members to facilitate the unique needs of growth of the adolescent. This article will discuss certain characteristics and factors which make some families more vulnerable in this period: e.g., a family's structure, catastrophic or unusual events within or outside the family, regardless of whether they occur in the present or have taken place in the past. Case examples are given to illustrate how a systemically oriented family therapy approach can enable these families to become unstuck, resulting in the adolescent's ability to enter the next life phase, and the family's achieving once again a new equilibrium.Gerda L. Schulman, LL.D., M.S., is Associated Professor of Family Therapy in the advanced clinical program at Hunter College; School of Social Work, and teaches in the doctoral program at Adelphi University SSW.This paper is adapted from a presentation on November, 18, 1983, at the Long Island Jewish Hillside Medical Center.     

Recent evaluations of the peer-led approach in adolescent sexual health education: a systematic review

CONTEXT: Peer-led interventions have become a popular method of providing sexual health education to adolescents, but the efficacy of this approach and the methodological quality of recent trials have not been systematically reviewed. METHODS: Electronic and hand searches were conducted to identify quasi-randomized and randomized controlled trials of peer-led adolescent sexual health education published from 1998 to 2005. Studies were eligible if they had an appropriate comparison group, provided preintervention and postintervention data, and reported all outcomes. Study results were summarized and, where appropriate, pooled; in addition, 10 aspects of studies' methodological quality were assessed. RESULTS: Thirteen articles met the inclusion criteria. Pooled, adjusted results from seven trials that examined the effects of peer-led interventions on condom use at last sex found no overall benefit (odds ratio, 1.0). None of the three trials that assessed consistent condom use found a benefit. One study reported a reduced risk of chlamydia (0.2), but another found no impact on STI incidence. One study found that young women (but not young men) who received peer-led education were more likely than nonrecipients to have never had sex. Most interventions produced improvements in knowledge, attitudes and intentions. Only three studies fulfilled all 10 of the assessed quality criteria; two others met nine criteria. CONCLUSIONS: Despite promising results in some trials, overall findings do not provide convincing evidence that peer-led education improves sexual outcomes among adolescents. Future trials should build on the successful trials conducted to date and should strive to fulfill existing quality criteria.     

Hub Group: an innovative approach to group therapy in a short-term inpatient adolescent unit

Two and one-half years of Hub Group have shown that short-term, ward-based, heterogeneously mixed adolescent groups can work. Backed by a behaviorally based privilege system, Hub Group contracting methods facilitate rapid investment in group therapy, are flexible enough to accommodate change, and provide a meaningful ritual that involves all group members in promoting change for the individual. Hub Group's method of self-rating and rewards promotes objectivity in self-evaluation. The contracts' images are compact, but all encompassing, providing a continuum along which to move in developing greater responsibility and productive functioning for the adolescents. There are distinct advantages and disadvantages to mixed levels of functioning within the same group. The nurturance and tolerance for others fostered by Hub Group is a primary advantage. Despite the obvious disadvantages of rapid turnover, common issues such as acceptance, attachment, and separation are ever present to be addressed. Leadership must be either supportive or confrontive, but always active in these groups. Hub Groups have shown that with the support and supervision of IDTU's administrative staff, diversely trained staff can comfortably perform multiple roles within the unit and be effective as group leaders.     

Rethinking communication apprehension: a Myers-Briggs perspective

This study is an examination of relationships between Myers-Briggs personality type preferences, based on Jungian theory, and communication apprehension. Results showed that participants who preferred introversion or sensing reported significantly higher levels of communication apprehension in general and across the group, dyadic, meeting, and public contexts than did participants who preferred extraversion or intuition. In addition, participants who preferred feeling reported higher levels of communication anxiety in the public context than those who preferred thinking. Findings support the assumption that communication apprehension is biologically based, suggest that the Myers-Briggs type preference framework offers an alternative way of understanding communication apprehension, and point out the need for new approaches to understanding the phenomenon of communication apprehension.     

Co-occurring delinquency and depressive symptoms of adolescent boys and girls: a dual trajectory modeling approach

Co-occurring trajectories of delinquent behavior and depressive symptoms and their correlates were examined in a longitudinal sample of 985 middle-adolescent boys and girls (mean age = 15.54 years at Time 1). Dual trajectory analysis was used to identify the co-occurring trajectories. For boys (n = 472), 4 delinquency and 4 depression trajectory groups were found. For girls (n = 513), 3 delinquency and 3 depression trajectory groups were identified. The linkage between co-occurring trajectories was higher for girls than for boys. Stressful life events and childhood precursors of the outcomes predicted trajectory group membership for both genders fairly consistently. Findings suggest heterogeneity in developmental courses of delinquent behavior and depressive symptoms across adolescent boys and girls.