Research in Adolescent Suicide: Implications for Training,Service Delivery,and Public Policy

Four domains of research in adolescent suicide are reviewed: (1) the role of psychopathology, (2) family history of psychopathology, (3) mental health treatments, and (4) firearms in the home. Based on the extant literature, recommendations are made for changes in training, service delivery, and public policy. Among the recommendations for training professionals are: an emphasis on diagnostic proficiency, skill and attentiveness in the assessment of the entire family unit, and assessment of the availability of firearms in the home. With respect to changes in service delivery, we recommend treatment of the entire family system, and treatment of psychiatric and substance abuse problems in the same setting, and we show the need for a continuum of intensity of care from inpatient to outpatient. With respect to policy changes, we recommended parity of mental and physical health insurance coverage, screening for psychiatrically at-risk youngsters in schools and physicians' offices, providing funding to support a continuum of care between inpatient and outpatient, and gun control laws to restrict access to handguns. We believe that these changes can result in a substantial reduction in the adolescent suicide rate.     

Through the Looking Glass: The Experiences of Two Family Therapy Trainees with Live Supervision

A thorough investigation of the literature pertaining to therapy supervision reveals that supervision has never been examined from the viewpoint of the trainee. This paper examines live supervision of family therapy from that viewpoint. It suggests that live supervision is a powerful and effective tool—a tool that engenders strong emotional responses.     

To Serve or Not to Serve: Ethical and Policy Implications

The Institute of Medicine (IOM) is one of the nation's more influential health‐related non‐profit organizations. It plays a large role in shaping health policy by commissioning panels to develop “white papers” describing research and recommendations on a variety of health topics. These white paper publications are often used to help make policy decisions at the legislative and executive levels. Such a prominent institution might seem like a natural ally for policy‐related collaborative efforts. As community psychologists, we strongly endorse efforts to positively influence public policy at the national level. However, while serving on influential panels and commissions like the IOM might seem to be very much part of the ethos of our discipline, there are occasions when such institutions are pursuing a mission that inadvertently has the potential to instigate divisive friction among community activists and organizations. A case study is presented whereby I describe my decision not to accept an invitation to serve on a controversial IOM panel. I explore the ethical challenges regarding maintaining my independence from this institution and its attempt to redefine chronic fatigue syndrome (CFS) and myalgic encephalomyelitis (ME), as well as the process of searching for alternative avenues for collaborating with community activists to influence policy related to these debilitating illnesses.     

Childhood Irritability: Predictive Validity and Mediators of Adolescent Psychopathology

Despite its transdiagnostic significance, there is modest evidence with respect to the predictive validity of childhood irritability, especially across developmental periods; similarly, little is known about explanatory factors underlying these predictions. This study had two goals: (1) to test the predictive validity of childhood irritability with respect to adolescent internalizing and externalizing problems, controlling for baseline ADHD and related psychopathology and (2) to test theoretically-derived family (i.e., parenting behavior, parenting stress) and social (i.e., peer status, social skills) constructs as explanatory factors of adolescent psychopathology. Two hundred thirty ethnically diverse (51.5% White) 5–10-year-old youth (32% female) with (n?=?121) and without (n?=?110) ADHD completed three separate laboratory-based assessments across six to seven years. Temporally-ordered predictors, putative mediators, and psychopathology outcomes were assessed using multiple informants (i.e., parent, teacher, youth) and methods (i.e., structured interviews, normed rating scales). Controlling for demographic factors, clinical correlates, and baseline psychopathology, childhood irritability uniquely predicted adolescent externalizing problems, but not internalizing problems. Next, analyses revealed that low social skills partially explained predictions of adolescent internalizing problems. However, family or social factors did not underlie predictions of adolescent externalizing problems. These preliminary findings support the predictive validity of childhood irritability with respect to early adolescent externalizing problems and implicate low social skills as a potentially unique mediator of internalizing outcomes. Intervention-induced improvements in social skills may minimize emergent psychopathology initiated by significant childhood irritability.

     

The Relationship Between Parental Alcoholism and Adolescent Psychopathology: A Systematic Examination of Parental Comorbid Psychopathology

The relationship between parental alcohol dependence (with and without comorbid psychopathology) and adolescent psychopathology was examined in a sample of 665 13-17 year-old adolescents and their parents. Results indicated that adolescents who had parents diagnosed with alcohol dependence only did not significantly differ from adolescents who had parents with no psychopathology in regard to any of the measures of psychological symptomatology (substance use, conduct disorder, and depression) or clinical diagnoses (alcohol dependence, marijuana dependence, conduct disorder, or depression) assessed. In contrast, adolescents who had parents diagnosed with alcohol dependence and either comorbid drug dependence or depression were more likely to exhibit higher levels of psychological symptomatology. In addition, adolescents who had parents diagnosed with alcohol dependence, depression, and drug dependence were most likely to exhibit psychological problems. These findings underscore the importance of considering parental comorbid psychopathology when examining the relationship between parental alcoholism and offspring adjustment.     

The Adolescent Brain and the Emergence and Peak of Psychopathology

Adolescence is a period of heightened emotionality and increased risk for mental illness, affecting as many as one in five persons. This article reviews recent human imaging and animal studies that demarcate adolescent specific changes in brain and behavior that may help to explain this period of increased risk for psychopathology. We highlight adolescence as a sensitive period when: 1) the environment has particularly strong influences on brain and behavior and 2) normative changes in brain development can lead to an imbalance between rapidly changing limbic circuitry and relatively slower developing prefrontal circuitry. This imbalance can be exacerbated by both genetic and environmental influences leading to less capacity to regulate emotions and higher risk for psychopathology. We discuss these findings in the context of understanding who may be at greatest risk for psychopathology and when and how to best treat symptoms of emotional dysregulation.     

Understanding Adolescent Substance Abuse: Prevalence,Risk Factors,and Clinical Implications

From a developmental perspective, adolescence is a time of gaining independence, experimentation, and taking risks. One area of experimentation associated with adolescence is substance use. For counselors working with adolescents who use or abuse substances, or both, it is important to understand the scope of the problem and ways to effectively work with this population. This article provides counselors with current information on adolescent substance abuse and suggestions for clinical work.     

Through the Looking Glass: No Wonderland Yet! (The Reciprocal Relationship between Methodology and Models of Reality)

This article discusses the relationship between conceptual frameworks and methodology in psychology. It is argued that our models of reality influence our research in terms of question selection, causal factors hypothesized, and interpretation of data. The position and role of women as objects and agents of research are considered in terms of a sociology of knowledge perspective. Suggestions are offered for a more reflexive psychology.     

Intergenerational Transmission of Emotion Dysregulation Through Parental Invalidation of Emotions: Implications for Adolescent Internalizing and Externalizing Behaviors

We examined parent emotion dysregulation as part of a model of family emotion-related processes and adolescent psychopathology. Participants were 80 parent–adolescent dyads (mean age = 13.6; 79 % African-American and 17 % Caucasian) with diverse family composition and socioeconomic status. Parent and adolescent dyads self-reported on their emotion regulation difficulties and adolescents reported on their perceptions of parent invalidation (i.e., punishment and neglect) of emotions and their own internalizing and externalizing behaviors. Results showed that parents who reported higher levels of emotion dysregulation tended to invalidate their adolescent’s emotional expressions more often, which in turn related to higher levels of adolescent emotion dysregulation. Additionally, adolescent-reported emotion dysregulation mediated the relation between parent invalidation of emotions and adolescent internalizing and externalizing behaviors. Potential applied implications are discussed.     

临床试验中的利益冲突：伦理和政策问题

人们对于研究人员、赞助商和研究机构三者之间的经济利益关系给予越来越多的关注,人体试验研究中的经济利益与其他利益有所不同,这种经济利益会导致偏见或诱导不正当的行为,尤其是当有从研究中获益的机会存在时,将会影响到研究人员关于应该选择哪个受试者,应该提供给受试者什么样的医疗服务,甚至应该如何正确使用受试者保密的健康信息方面的判断,由经济利益引起的明显的风险同样也会威胁公众的学术机构研究使命的支持,从处理临床试验中利益冲突的准则,什么样的经济利益是研究中的重大经济利益。准则的实施等方面进行了详尽的叙述,最后指出没有潜在受试者和公众的信任,我们就不能有效地开展研究。     

Personality Correlates of Self-Injury in Adolescent Girls: Disentangling the Effects of Lifetime Psychopathology

Adolescent non-suicidal self-injury (aNSSI) is associated with abnormal scores on personality traits, such as high neuroticism. However, no studies to date have examined personality facets of self-injury in a cohort younger than college-age. Plus, adolescent psychopathologies, especially Depressive Disorders, are associated with a similar personality profile and are highly comorbid with aNSSI. Consequently, it remains unclear whether personality provides insights about aNSSI in youth beyond that due to underlying psychopathology. 550 community-dwelling 13- to 15-year-old never-depressed adolescent girls were interviewed for lifetime aNSSI and lifetime psychopathology. Personality traits, broad domains and specific facets, were assessed by self-report. Never-depressed adolescent girls who endorse aNSSI often met lifetime criteria for psychiatric disorders (NSSI: 20/43; 46.5% vs. non-aNSSI: 131/507; 26.1%). aNSSI and lifetime psychopathology were each independently associated with several traits (e.g., high neuroticism and conscientiousness), whereas some traits only discriminated aNSSI (e.g., high melancholia, a facet of neuroticism related to sadness and negative self-evaluation) or lifetime psychopathology independent of each other (e.g., low positive emotionality; low agreeableness). Furthermore, a multivariate model identified high melancholia, high openness to experience, and low conscientiousness as incrementally independent correlates of lifetime aNSSI over and above psychiatric illness. Proneness to melancholia, interest in new things, and poor self-control incrementally track aNSSI in never-depressed adolescent girls. Importantly, this emerges early in course (13–15 years of age) and is independent of lifetime psychiatric diagnosis. Implications for updating etiological models and clinical utility of personality assessment are discussed.     

Information Related to Prenatal Genetic Counseling: Interpretation by Adolescents, Effects on Risk Perception and Ethical Implications

Being raised in the genomic era may not only increase knowledge of available genetic testing but may also have an impact on how genetic information is perceived. However, little is known about how current adolescents react to the language commonly used by health care professionals providing prenatal counseling. In addition, as risk communication is related to numbers and figures, having different educational backgrounds may be associated with variability in risk perceptions. In order to investigate these issues, a previously developed questionnaire studying different ways of being told about hypothetical anomalies in a baby and corresponding risks (Abramsky and Fletcher Prenatal Diagnosis 22(13):1188-1194, 2002) was administered to high-school students in Sweden. A total of 344 questionnaires were completed by students belonging to a natural science or a social science program. The data show that teenage participants found technical jargon and words such as rare and abnormal more worrying than the presented comparison terms. Negative framing effects and perception differences related to numeric risk formats were also present. Additionally, participants' gender and educational program did not seem to have an effect on risk assessment. In addition to reporting the questionnaire results, we discuss the ethical implications of the data based on the norm of non-directiveness and make some recommendations for practice. In general, genetic counselors should be aware that the language used within clinical services can be influential on this group of upcoming counselees.     

Emotional Dynamics in the Development of Early Adolescent Psychopathology: A One-Year Longitudinal Study

This study examined the role of the level and variability of happiness, anger, anxiety, and sadness in the development of adolescent-reported anxiety disorder symptoms, depressive symptoms, and aggressive behavior in 452 adolescents (250 male) followed from age 13 to 14. Level and between-day variability of emotions were assessed through adolescent report at 3-month intervals across a 1 year period. Level and variability of the four emotions contributed to changes in anxiety disorder and depressive symptoms more consistently than to changes in aggressive behavior. All four emotions were predictive of changes in internalizing problems, while anger played the most prominent role in the development of aggressive behavior. Variability of emotions contributed to changes in anxiety disorder symptoms, while heightened levels of negative emotions and diminished happiness contributed to changes in depression. Results suggested somewhat stronger effects of negative affect on aggressive behavior for females than for males. Results underscore the role of emotion dysregulation in the development of psychopathology.     

Provincial Nominee Programs: A Note on Policy Implications and Future Research Needs

This note focuses on the rapidly evolving role of provinces in immigrant selection through Provincial Nominee Programs (PNPs). While past years have seen their significant expansion and diversification, research and policy response seem to lag behind: literature on PNPs remains scarce. This note offers preliminary observations on the new dynamics in the immigration system arising as a result of the nominee programs. It sets out background on PNPs, situating them vis-à-vis federal skilled worker and Canadian Experience Class, outlines emerging trends, and discusses challenges associated with the increasingly complex policy landscape of the two-tiered immigrant selection system.     

Adolescent and Parent Perspectives on Ethical Issues in Youth Drug Use and Suicide Survey Research

The contributions of adolescent and parent perspectives to ethical planning of survey research on youth drug use and suicide behaviors are highlighted through an empirical examination of 322 7th-12th graders' and 160 parents' opinions on questions related to 4 ethical dimensions of survey research practice: (a)evaluating research risks and benefits, (b)establishing guardian permission requirements, (c)developing confidentiality and disclosure policies, and (d)using cash incentives for recruitment. Generational and ethnic variation in response to questionnaire items developed from discussions within adolescent and parent focus groups are described. The article concludes with a discussion of the potential contributions and challenges of adolescent and parent perspectives for planning scientifically valid and ethically responsible youth risk survey research.     

Back through the Looking Glass: On the Relationship between Intentions and Indexicals

Donnellan and Predelli have both responded to accusations that in virtue of involving intentions in their accounts of reference they are committed to ‘Humpty Dumpty’ theories of reference. I examine their responses and argue that they do not succeed in escaping this accusation. Corazza et al. (2002) propose an alternative to Predelli’s account involving linguistic conventions instead of intentions. I argue that Predelli’s responses to Corazza et al. are unsatisfactory and that the intentional theorist is obliged either to accept the Humpty Dumpty conclusion or to adopt the conventional picture, thus relegating intentions to a less significant role in their reference theory.     

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

     

From the Ethic of Hospitality to Affective Hospitality: Ethical,Political and Pedagogical Implications of Theorizing Hospitality Through the Lens of Affect Theory

The point of departure of this article is that hospitality in education has not been theorized in terms of emotion and affect, partly because its law(s) have been discussed in ways that have not paid much attention to the role of emotion and affect. The analysis broadens our understanding of the ethics and politics of hospitality by considering it as a spatial and affective relational practice. In particular, concepts from affect theory such as the notion of affective atmospheres and atmospheric walls are discussed to highlight the notion of affective hospitality. It is argued that a greater awareness of the micro-politics of hospitality in its everyday enactment in various educational settings can show educators how specific practices of hospitality work to produce affective spaces in which the socio-historical context of privilege may be interrupted. The paper concludes with a discussion of the ethical, political and pedagogical implications of affective hospitality.