Neighborhood context and adjustment in African American youths from single mother homes: the intervening role of hopelessness

African American youths from single mother homes are more likely to live in neighborhoods characterized by greater risk and fewer resources than youth from two parent homes or European American youths; in turn, such adverse conditions are associated with increased adjustment problems. Despite this well-established vulnerability, relatively little is known about variables linking neighborhood context to youth adjustment. With the aim of identifying a potential youth-focused intervening variable amenable to intervention, this study examined the intervening role of hopelessness in the association between neighborhood context and adjustment problems in a sample of 171 African American youths (11-16 year olds) from single mother homes. Findings revealed direct associations between neighborhood context and youth adjustment, as well as indirect associations through youth hopelessness, although findings varied by the marker of neighborhood context (sense of community or perceived crime) and adjustment (internalizing or externalizing problems). Building on prior work noting that hopelessness is amenable to psychosocial intervention, the present findings suggest that hopelessness may afford a valuable target for prevention and intervention programming among African American youths from single mother homes in the context of adverse neighborhood conditions.     

Who are the comorbid adolescents? Agreement between psychiatric diagnosis,youth, parent,and teacher report

The investigators examined the rates of psychiatric comorbidity for externalizing and internalizing behavior problems, using semistructured diagnostic interview and parent, teacher, and youth report on the Achenbach checklists. The study also evaluated the effects of conjunctive, compensatory, and disjunctive data combination strategies. Using the same data and identical diagnostic thresholds, between 5 and 74% of 189 youths presenting to an outpatient clinic were identified as having comorbid internalizing and externalizing problems. Parent report and semistructured interview indicated the highest comorbidity rates. Despite good cross-source agreement (rs .29–.58), there was very little agreement about which specific youths presented with comorbid internalizing and externalizing problems (kappas .14–.40). Results also indicate that single DSM-IV disorders, such as bipolar disorder, can manifest comorbid patterns of behavior problems on checklists.     

Linking Foster Family Characteristics and Mental Health Symptoms of Youth in Care

Youth in foster care are disproportionately at risk for developing internalizing and externalizing problems (Lawrence et al., 2006); however, a history of maltreatment prior to foster care placement does not automatically result in poor mental health outcomes. Among non-foster care youth, the quality of family interactions has been related to adjustment outcomes, such that low family cohesion and high family conflict is associated with poor mental health symptoms (Caples & Barrera, 2006). While little is known about these constructs in foster care placements, they may help explain the variance in internalizing and externalizing problems for youth in foster care. The present study aimed to examine whether characteristics of the foster care environment (i.e., conflict, cohesion) across various placement types (i.e., traditional foster homes, group-care settings) could help explain the link between previous maltreatment exposure and mental health problems. The sample included 178 youth in foster care (M_age?=?15.18, SD?=?1.76) and their foster caregivers living in the Midwest. Youth participants completed self-report measures about prior maltreatment history, current family environment characteristics, and youth internalizing symptoms. Foster caregivers completed measures on current family environment and youth externalizing symptoms. Results indicated that caregiver report, but not youth report, of family cohesion was negatively associated with youth report of internalizing problems. When examining the indirect effects, youth report of family conflict partially accounted for the link between youth self-report of maltreatment and internalizing symptoms (B?=?0.106, 95% CI?=?0.026–0.186). Caregiver report of family conflict fully accounted for the association between youth self-report of maltreatment and caregiver report of youths’ externalizing symptoms (B?=?0.108, 95% CI?=?0.005–0.211). Findings highlight the importance of utilizing multiple informants when measuring foster family environment and suggest that family conflict is particularly salient for the mental health of youth in foster care.

     

Seesaw Discipline: The Interactive Effect of Harsh and Lax Discipline on Youth Psychological Adjustment

Although extant research documents the negative consequences of harsh and lax discipline for youth, little empirical attention has been devoted to understanding the impact when parents utilize both strategies. As such, the current study was designed to explore the interaction of harsh and lax discipline on youth internalizing and externalizing symptoms in three developmental periods (early childhood, middle childhood, and adolescence). Participants were 615 parents (55 % female) and one of their 3–17 year old children (45 % female). Parents provided reports of their harsh and lax parenting tactics as well as offspring internalizing and externalizing symptoms. Multiple linear regression analyses were utilized to examine the relations between the interaction of harsh and lax parenting on youth symptoms. The interaction between harsh and lax discipline was significantly related to youth internalizing, but not externalizing, problems in the both the young and middle childhood samples and marginally significant in the adolescence sample: seesaw discipline—a novel construct indicative of high levels of both harsh and lax discipline—was associated with the highest levels of youth internalizing problems. Parents who engage in seesaw parenting have children and adolescents who are more likely to evidence internalizing symptoms. Such findings may inform prevention and intervention efforts that target dysfunctional discipline.     

Parenting contributors to early emerging problem behaviour in children of mothers in methadone maintenance treatment

This study explored whether variations in parenting provided by mothers with substance‐abuse disorders are related to behaviour problems in their young children and whether specific parenting practices are associated with specific types of behaviour problems. Mother‐reported and observational assessments were used to examine contributions of parenting behaviour and home environment to internalizing and externalizing behaviour problems in 150 preschool children of mothers receiving methadone‐maintenance treatment for heroin addiction. In multivariate analyses, mother‐reported child externalizing behaviour was related to greater maternal harshness and to mother history of illicit drug use during pregnancy but not other features of substance use and treatment history. Observer‐coded child internalizing behaviour was related to less maternal sensitivity and less provision of learning activities in the home. Additionally, mother report of her own psychopathology symptoms was related to mother‐reported, but not observer‐coded, child internalizing and externalizing problems. Findings suggest that women in substance abuse treatment should receive parenting interventions and that interventions should focus on increasing maternal sensitivity, reducing harshness, and providing children with cognitively stimulating environments. Findings also suggest that the need for attention to ongoing mental health problems of women in substance abuse treatment—both for their own well‐being and the well‐being of their children.

Highlights

• This study explored whether variations in parenting provided by mothers with substance‐abuse disorders are related to behavior problems in their young children.
• Maternal harshness was related to child externalizing behavior, low sensitivity, and low provision of learning opportunities to child internalizing problems.
• Findings suggest that women in substance abuse treatment should be provided access to parenting interventions.

     

Understanding the Effects of Victimization: Applying General Strain Theory to the Experiences of LGBQ Youth

Using a statewide probability sample of lesbian, gay, bisexual, and queer (LGBQ) youth (N = 484), this study uses a general strain theory framework to better understand the processes that connect LGBQ youths’ experiences with victimization, negative outcomes, and social support. Results show that while victimization reliably predicts negative outcomes, including poor academic performance, substance use, and suicidality, the moderating effects of social support are unreliable and contrary to theoretical expectations. Reconceptualizing social support from a moderating variable to social isolation, an independent variable, helps elucidate the role of social support in LGBQ youths’ experiences with negative outcomes. Implications are discussed.     

A Review of Pediatric Nonpharmacological Sleep Interventions: Effects on Sleep,Secondary Outcomes,and Populations With Co-occurring Mental Health Conditions

Sleep problems are common in school-age children and linked to numerous negative outcomes. Sleep disturbances are particularly common in children with mental health disorders, such as attention-deficit/hyperactivity disorder, depression, and anxiety. Despite frequent use of nonpharmacological pediatric sleep interventions to treat common sleep problems, there is a paucity of research on whether these interventions are effective. Further, it is unclear whether by targeting sleep, these interventions lead to broader improvements in the domains of functioning that are commonly affected by poor sleep. The present review includes 20 studies that evaluated nonpharmacological sleep treatments for school-aged youth, including 5 studies specifically focused on youth with externalizing or internalizing problems. Multimodal approaches consisting of psychoeducation and sleep hygiene in combination with other components were effective at treating insomnia and general sleep problems in typically developing samples. The addition of behavioral parent training to sleep interventions was effective for youth with externalizing problems, whereas incorporating cognitive strategies into sleep interventions for youth with internalizing problems was found to be ineffective. A variety of secondary outcomes were examined, with the strongest support emerging for improvement in anxiety and behavioral problems. Implications for clinical practice and future research directions are discussed.     

Family‐Based Preventive Interventions: Can the Onset of Suicidal Ideation and Behavior Be Prevented?

Suicide is the second leading cause of death for youth aged 10–24. Research informed prevention efforts have the opportunity to decrease risk for suicidal ideation and behavior before it is manifested. Indeed, there is a small body of research findings demonstrating both proximal and distal effects of preventive interventions delivered in childhood and adolescence on suicidal ideation and/or behavior. These efforts build off of other secondary analyses of prevention research that has demonstrated benefits for multiple types of youth outcomes. This supplement provides “proof of concept” that family‐based preventive interventions aimed at reducing a number of risk factors for suicide (e.g., substance use, externalizing, and internalizing behavior) can prevent suicidal ideation and behaviors.     

The Role of Stress Exposure and Family Functioning in Internalizing Outcomes of Urban Families

Although research suggests that stress exposure and family functioning are associated with internalizing problems in adolescents and caregivers, surprisingly few studies have investigated the mechanisms that underlie this association. To determine whether family functioning buffers the development of internalizing problems in stress-exposed families, we assessed the relation between stress exposure, family functioning, and internalizing symptoms among a large sample of inner-city male youth and their caregivers living in poverty across five waves of data collection. We hypothesized that stress exposure and family functioning would predict development of subsequent youth and caregiver internalizing problems and that family functioning would moderate this relation, with higher functioning families demonstrating greater resiliency to stress exposure. We used a longitudinal, prospective design to evaluate whether family functioning (assessed at waves one through four) activated or buffered the effects of stress exposure (assessed at wave one) on subsequent internalizing symptoms (assessed at waves four and five). Stress from Developmental Transitions and family functioning were significant predictors of depressive symptoms and anxiety in youth; however, family functioning did not moderate the relation. Family functioning mediated the relation between stress from Daily Hassles and internalizing outcomes suggesting that poor parenting practices, low structure, and low emotional cohesion activate depression and anxiety in youth exposed to chronic and frequent everyday stressors. Surprisingly, only family functioning predicted depressive symptoms in caregivers. Results validate the use of a comprehensive, multi-informant assessment of stress when investigating internalizing outcomes in youth and support using family-based interventions in the treatment and prevention of internalizing.     

Relation Between Parent Psychiatric Symptoms and Youth Problems: Moderation through Family Structure and Youth Gender

Links between parents’ psychiatric symptoms and their children’s behavioral and emotional problems have been widely documented in previous research, and the search for moderators of this association has begun. However, family structure (single versus dual-parent households) has received little attention as a potential moderator, despite indirect evidence that risk may be elevated in single-parent homes. Two other candidate moderators—youth gender and age—have been tested directly, but with inconsistent findings across studies, perhaps in part because studies have differed in whether they used youth clinical samples and in which informants (parents vs. youths) reported on youth problems. In the present study, we examined these three candidate moderators using a sample of exclusively clinic-referred youths (N?=?333, 34 % girls, aged 7–14,) and assessing youth problems through both parent- and youth-reports. Both family structure and youth gender emerged as robust moderators across parent and youth informants. Parent symptoms were associated with youth internalizing and externalizing problems in single-parent but not dual-parent homes; and parent symptoms were associated with youth internalizing problems among boys, but not girls. The moderator findings suggest that the risks associated with parent psychopathology may not be uniform but may depend, in part, on family structure and youth gender.     

The Impact of Community Mental Health Programs for Australian Youth: A Systematic Review

Australia has undergone significant youth mental health reform over the past 10 years, leading to numerous studies examining the effects of community-based mental health care programs for Australian youth. However, no synthesis of this literature currently exists. Therefore, this systematic review aimed to: (1) describe the types of community-based mental health programs that have been delivered to Australian youth in the past 10 years; and (2) examine their impact in improving young people’s mental health symptomology and psychosocial functioning. A systematic search of the peer-reviewed literature was conducted. Studies were included if they evaluated the extent to which such programs improved mental health symptomology (e.g., depression, anxiety, substance use) and/or psychosocial outcomes (e.g., social functioning, school engagement, employment) for Australian youth aged 10–25 years. Thirty-seven studies were included. Four types of community-based youth mental health care programs were identified: therapy (n?=?16), case management (n?=?9), integrated ‘one-stop-shop’ (n?=?6) and lifestyle (n?=?6) programs. The majority of therapeutic programs were effective in reducing mental health symptomology. Case management and integrated approaches consistently yielded significant improvements in both symptomology and psychosocial outcomes. Lifestyle programs were effective in alleviating depressive symptoms, but inconclusive for other outcomes. This review provides support for youth-friendly, systemic, multidisciplinary and integrated assertive outreach models of community mental health care to improve outcomes for young Australians experiencing mental health concerns. Several recommendations for future research are provided to strengthen the local evidence-base supporting community mental health programs to ultimately enhance young people’s life trajectory.

     

Developmental aspects of delinquency and internalizing problems and their association with persistent juvenile substance use between ages 7 and 18.

Analyzed longitudinal data from 3 samples of the Pittsburgh Youth Study on boys ages 7 to 18 to examine the co-occurrence of persistent substance use with other problem behaviors, including attention deficit hyperactivity disorder (ADHD), persistent delinquency, and persistent internalizing problems (i.e., depressed mood, anxiety, shy or withdrawn behavior). In preadolescence, persistent substance users also tended to be persistent delinquents, and half of this group displayed persistent internalizing problems as well. In adolescence, a third of the persistent substance users did not manifest other persistent problems. Across the samples, the least common substance users were those who manifested persistent internalizing problems only. Logistic regression analyses showed that persistent substance use in preadolescence was predicted by persistent delinquency and internalizing problems and in adolescence by persistent delinquency only. The combination of persistent substance use and delinquency was predicted by oppositional defiant disorder in middle childhood and by persistent internalizing problems in middle to late childhood. ADHD was not a predictor of persistent substance use (and delinquency) in any of the analyses. Results are discussed in terms of developmental models of multiproblem youth with an eye on improving early interventions.     

Reducing the Risk of Internalizing Symptoms among High‐risk Hispanic Youth through a Family Intervention: A Randomized Controlled Trial

Familias Unidas is an intervention that has been found to be efficacious in preventing and reducing substance use, sexual risk, and problem behaviors among Hispanic youth. While it does not specifically target youth internalizing symptoms, the intervention works to strengthen parenting and family factors associated with reduced risk of internalizing symptoms (i.e., depression, anxiety symptoms). This study examines the effects of Familias Unidas on internalizing symptoms among high‐risk youth, as well as the role of family level factors in the intervention's effects. A total of 242 12–17‐year‐old Hispanic youth with a history of delinquency and their primary caregivers were recruited from the school and juvenile justice systems, and randomly assigned to the Familias Unidas intervention or community practice control. A linear latent growth model was used to examine intervention effects on the trajectory of adolescent internalizing symptoms from baseline to 6 and 12 months post‐baseline. Results show that the Familias Unidas intervention was more efficacious than control in reducing youth internalizing symptoms. Baseline youth externalizing and internalizing symptoms did not moderate the intervention's effects on the trajectory of youth internalizing symptoms. While parent – adolescent communication did not significantly moderate the intervention's effects, changes in parent – adolescent communication mediated the intervention's effects on internalizing symptoms, showing stronger intervention effects for youth starting with poorer communication. Findings indicate that the Familias Unidas intervention can reduce internalizing symptoms among high‐risk Hispanic youth, and that improving parent – youth communication, a protective family factor, may be one of the mechanisms by which the intervention influences youth internalizing symptoms.     

Internalizing and Externalizing Problem Behavior: a Test of a Latent Variable Interaction Predicting a Two-Part Growth Model of Adolescent Substance Use

Externalizing symptoms robustly predict adolescent substance use (SU); however, findings regarding internalizing symptoms have been mixed, suggesting that there may be important moderators of the relationship between internalizing problems and SU. The present study used a longitudinal community sample (N?=?387, 55% female, 83% White) to test whether externalizing symptoms moderated the relationship between internalizing symptoms and trajectories of alcohol and marijuana use from early (age 11–12 years old) to late (age 18–19 years old) adolescence. Two-part latent growth models were used to distinguish trajectories of probability of use from trajectories of amount of use among users. Results suggested that externalizing symptoms moderated the association between internalizing symptoms and probability of alcohol, but not marijuana use. The highest probability of alcohol use was observed at high levels of externalizing symptoms and low levels of internalizing symptoms. A negative protective effect of internalizing symptoms on probability of alcohol use was strongest in early adolescence for youth high on externalizing symptoms. Although moderation was not supported for amount of use among users, both domains of symptomology were associated with amount of alcohol and marijuana use as first-order effects. High levels of externalizing symptoms and low levels of internalizing symptoms were associated with high levels of amount of use among users. These findings suggest that developmental models of substance use that incorporate internalizing symptomology should consider the context of externalizing problems and distinguish probability and amount of use.     

Homeless Youths and Young Adults in Los Angeles: Prevalence of Mental Health Problems and the Relationship Between Mental Health and Substance Abuse Disorders

Although understanding of the subsistence patterns, service utilization, and HIV-risk behaviors of homeless youths and young adults is increasing, relatively little is known about the epidemiology of mental health problems in this group or the relationships between mental health problems and substance use. This study measured symptoms of depression, low self-esteem, ADHD, suicidality, self-injurious behavior (SIB), and drug and alcohol use disorder in a sample of homeless youth and young adults living in Hollywood, CA. Results indicated extremely high prevalences of mental health problems, as compared with corresponding rates of mental health problems found among housed youths in previous studies. Prevalence of mental health problems differed by age and ethnicity. African Americans were at lower risk of suicidal thoughts and SIB than were those of other ethnicities. Older respondents and females were at increased risk of depressive symptoms, and younger respondents were at increased risk of SIB. Previous history of sexual abuse and/or assault was associated with increased risk of suicidality and SIB. Risk factors for drug abuse disorder included ethnicity other than African American, homelessness for 1 year or more, suicidality, SIB, depressive symptoms, and low self-esteem. Risk factors for alcohol abuse disorder included male gender, white ethnicity, homelessness for 1 year or more, suicidality, and SIB. Extremely high rates of mental health problems and substance abuse disorders in this sample suggest the need for street-based and nontraditional mental health services targeted toward these youths and young adults.     

An Examination of Triarchic Psychopathy Constructs in Female Offenders

This study sought to expand scientific knowledge on psychopathic personality traits in female offenders by evaluating the relationship between MMPI–2–RF triarchic scales and self-reported external variables in a sample of 205 female offenders. Results indicated that boldness was inversely related to internalizing dysfunction, including suicidal behavior, psychosis, youth conduct problems, problems stemming from alcohol use, and a history of outpatient mental health treatment. Meanness was positively related to internalizing dysfunction as well as youth conduct problems, anger, prison disciplinary reports, and psychosis. Disinhibition was associated with a history of abuse in childhood, suicidal behavior, internalizing dysfunction, problems associated with alcohol and drug use, family history of mental illness, prison disciplinary reports for violence, number of previous criminal charges, and anger. Consistent with views of psychopathy as a configural condition, interactive effects of boldness with disinhibition and meanness were observed for multiple key external variables (e.g., conduct problems, substance use, nonsuicidal self-injurious behavior). This study provides further evidence for the triarchic conceptualization of psychopathy in female offenders and lends additional support for the validity of MMPI–2–RF triarchic psychopathy scales.     

Does community violence exposure moderate the associations between maternal spanking and early child behavior problems?

A robust research literature links parental spanking with negative behavioral outcomes for children, however, it remains unclear whether conditions in the community may moderate the associations between spanking and behavior problems in early childhood. In the current study, we examined whether community violence exposure moderated the associations of maternal spanking with externalizing and internalizing behavior problems of young children. The sample used in this study was urban families and their children ages 3–5 (n = 2,472). We used fixed effects regression models, which yield stronger statistical control for baseline behavior problems, selection bias, and omitted variables bias. Mother's spanking was associated with elevated levels of both externalizing (β = .037, p < .001) and internalizing (β = .016, p < .001) behavior problems. Community violence exposure also predicted higher levels of externalizing (β = .071, p < .01) and internalizing (β = .043, p < .05) behavior problems. Community violence exposure did not moderate the associations between maternal spanking and behavior problems. Professionals working with families should promote the use of nonphysical disciplinary practices, regardless of the level of violence and crime in the community in which the family resides.     

Effects of A Parenting-Focused Mindfulness Intervention on Adolescent Substance Use and Psychopathology: A Randomized Controlled Trial

Substance use and psychopathology symptoms increase in adolescence. One key risk factor for these is high parent stress. Mindfulness interventions reduce stress in adults and may be useful to reduce parent stress and prevent substance use (SU) and psychopathology in adolescents. This study tested the feasibility and effects of a mindfulness intervention for parents on adolescent SU and psychopathology symptoms. Ninety-six mothers of 11–17 year olds were randomly assigned to a mindfulness intervention for parents (the Parenting Mindfully [PM] intervention) or a brief parent education [PE] control group. At pre-intervention, post-intervention, 6-month follow-up, and 1-year follow-up, adolescents reported on SU and mothers and adolescents reported on adolescent externalizing and internalizing symptoms. Primary intent to treat analyses found that the PM intervention prevented increases in adolescent SU over time, relative to the PE control group. The PM intervention also prevented increases in mother-reported externalizing symptoms over time relative to the PE control group. However, PM did not have a significant effect on internalizing symptoms. PM had an indirect effect on adolescent-reported externalizing symptoms through greater mother mindfulness levels at post-intervention, suggesting mother mindfulness as a potential intervention mechanism. Notably, while mothers reported high satisfaction with PM, intervention attendance was low (31% of mothers attended zero sessions). Secondary analyses with mothers who attended?>??=?50% of the interventions (n?=?48) found significant PM effects on externalizing symptoms, but not SU. Overall, findings support mindfulness training for parents as a promising intervention and future studies should work to promote accessibility for stressed parents.

Clinical Trials Identifier: NCT02038231; Date of Registration: January 13, 2014

     

Adolescent Gender and Age Differences in Responsiveness to Functional Family Therapy

The current study contributes to a sparse literature on moderators of Functional Family Therapy (FFT) by examining whether responsiveness to FFT, measured by a broad range of outcomes, varies by adolescent gender, age, and their interaction. This study was informed by 687 families (n, adolescents = 581; n, caregivers = 933) and utilized a pre–post comparison design. Fixed-effects regressions with gender, age, and their interaction included as explanatory variables were conducted to calculate the average change in youth mental health, callous–unemotional traits, academic outcomes, substance use, and family functioning. Moderation analyses revealed that according to parent report, girls had significantly greater improvements in peer problems and family functioning, and boys benefited more in increased liking of school. There were differential effects by age, such that older youth had less beneficial mental health outcomes and a smaller decrease in frequency of hash use. The gender by age interaction was significant for adolescents’ report of mental health and family functioning outcomes, which suggests that girls benefit from FFT less than boys during early adolescence, but benefit more than boys in late adolescence. This finding adds to literature which has evidenced that family functioning is particularly important for girls by suggesting that FFT is important for improving older girls’ mental health and family functioning in particular. The study’s results expand the examination of outcomes of FFT to include academic outcomes, and provide insight into key factors that should be considered in addressing adolescent behavioral problems and family functioning.     

The Third Rail of Family Systems: Sibling Relationships, Mental and Behavioral Health, and Preventive Intervention in Childhood and Adolescence

Sibling relationships are an important context for development, but are often ignored in research and preventive interventions with youth and families. In childhood and adolescence, siblings spend considerable time together, and siblings’ characteristics and sibling dynamics substantially influence developmental trajectories and outcomes. This paper reviews research on sibling relationships in childhood and adolescence, focusing on sibling dynamics as part of the family system and sibling influences on adjustment problems, including internalizing and externalizing behaviors and substance use. We present a theoretical model that describes three key pathways of sibling influence: one that extends through siblings’ experiences with peers and school, and two that operate largely through family relationships. We then describe the few existing preventive interventions that target sibling relationships and discuss the potential utility of integrating siblings into child and family programs.