Perceptions of treatment control moderate the daily association between negative affect and diabetes problems among adolescents with type 1 diabetes

Perceived control over diabetes may serve to buffer the relationship between adolescents’ experience of daily negative affect and daily problems with diabetes. In a daily diary study including 209 adolescents (ages 10.5–15.5) with type 1 diabetes, we examined how daily affect related to daily fluctuations in experience of diabetes problems, and whether perceptions of control moderated these daily associations. Using hierarchical linear modelling, we found that day-to-day experiences of negative affect were associated with more frequent daily diabetes problems. Perceptions of treatment control moderated associations between negative affect and number of problems; negative affect was more strongly associated with number of problems among teens perceiving lower versus higher treatment control over their illness. The same pattern of association was not apparent for personal control. Results suggest that perceived treatment control may help to buffer detrimental associations between negative affect and adolescents’ ability to successfully manage their diabetes.     

Conflicts between parents and aggressive and delinquent behavior in children

The exposure of children to their parents' conflicts are a factor of substantial risk for the development of behavior problems in children. This study examines the relationship between marital conflicts and children's aggressive and delinquent behavior. The sample consisted of a total of 332 children, aged 7 to 17 years, and their mothers. The children completed the Children's Perceptions of Interparental Conflict Scale, providing information on the dimensions of the marital conflicts: frequency, intensity, no resolution, and content. The mothers completed the O'Leary Porter Scale, providing information about the frequency of conflicts, and the Child Behavior Checklist, about the aggressive and delinquent behavior problems in their children. The results indicate that parental conflicts affect sons and daughters equally, and they affect adolescents more than younger children when they are perceived by the children. However, conflicts affect all groups when the mothers perceive them.     

Evaluating the success of Caucasian fathers in guiding adolescents

The purpose of this study was to identify guidance strengths and learning needs of fathers of adolescents. Perceptions of two generations were used to determine how well fathers perform as parents and realms of knowledge they have yet to acquire. The Parent Success Indicator, a 60-item Likert-type instrument, was administered to 126 Caucasian fathers and 185 adolescents. Significant differences obtained between generations for the total inventory, some scales, and many items. The amount of time spent together had the greatest influence on how both generations evaluated father success. Findings are discussed in terms of developing a curriculum to enhance the success of fathers.     

Suicidal Adolescents' Social Support from Family and Peers: Gender-Specific Associations with Psychopathology

Perceptions of social support from family, non-family adults, and peers were examined in relation to the psychopathology reported by 220 suicidal adolescents (152 females) during a psychiatric hospitalization. Results of regression analyses showed that, among females, family support was negatively related to hopelessness, depressive symptoms, and suicidal ideation. Among males, peer support was positively associated with depressive symptoms and suicidal ideation. Across gender, more peer support was associated with more externalizing behavior problems; whereas, family support was negatively related to these problems and to alcohol/substance abuse. Paralleling normative findings, age was positively associated with peer support, and females perceived more peer support than did males. Findings extend previous research on social support to suicidal adolescents, and broaden the literature by examining extrafamilial support and a broader range of relevant psychopathology. That is, perceived social support relates to psychiatric impairment differentially by gender, and normative, age-related variations in perceptions of social support are detected even among highly impaired adolescents. Clinical implications and directions for future research are discussed.     

The Relationship Between Perceptions of Neighborhood Characteristics and Substance Use Among Urban African American Adolescents

Although the neighborhood microsystem is recognized as an important domain for adolescent development, relative to the family and peer contexts, neighborhood factors have been understudied in relation to adolescent substance abuse. In addition, recent research suggests that risk factors for adolescent substance use may differ for African Americans when compared to Caucasian youth. This study investigated the association between perceived neighborhood disorganization and later substance use, as well as possible mediators of that association, among a community sample of urban African American adolescents. Perceptions of neighborhood disorganization (i.e., violence/safety and drug activity) in grade 7 were associated with increased tobacco, alcohol, and marijuana use in grade 9. For females, this association was mediated by attitudes about drug use and perceptions of drug harmfulness. Findings highlight the importance of neighborhood contextual variables for African American substance use. Implications and directions for future research are presented.     

Involvement in traditional and electronic bullying among adolescents

The increasing availability of Internet and cell phones has provided new avenues through which adolescents can bully. Electronic bullying is a new form of bullying that may threaten adolescent social and emotional development. In this study the relation between involvement in electronic and traditional bullying was examined. Eighty-four adolescents completed questionnaires regarding their involvement in traditional and electronic bullying. Results show that students' roles in traditional bullying predicted the same role in electronic bullying. Also, being a victim of bullying on the Internet or via text messages was related to being a bully at school. Traditional victims were not found to be electronic bullies. Perceptions of the effects of and motivations for electronic bullying are discussed.     

Perceptions of treatment control moderate the daily association between negative affect and diabetes problems among adolescents with type 1 diabetes

Perceived control over diabetes may serve to buffer the relationship between adolescents' experience of daily negative affect and daily problems with diabetes. In a daily diary study including 209 adolescents (ages 10.5-15.5) with type 1 diabetes, we examined how daily affect related to daily fluctuations in experience of diabetes problems, and whether perceptions of control moderated these daily associations. Using hierarchical linear modelling, we found that day-to-day experiences of negative affect were associated with more frequent daily diabetes problems. Perceptions of treatment control moderated associations between negative affect and number of problems; negative affect was more strongly associated with number of problems among teens perceiving lower versus higher treatment control over their illness. The same pattern of association was not apparent for personal control. Results suggest that perceived treatment control may help to buffer detrimental associations between negative affect and adolescents' ability to successfully manage their diabetes.     

Perceptions of present, ideal, and future lives among Chinese adolescents experiencing economic disadvantage

Perceptions of present, ideal, and future lives among 12 Chinese adolescents experiencing economic disadvantage were examined via qualitative interviews. Results showed that most of the adolescents evaluated their present lives positively. In general, they also had positive perceptions of their future lives, although there also were some negative feelings. Although money did not play an important role in their perceptions of present lives, future lives, life goals, and ideal careers, economic sufficiency emerged as a major theme from the perspective of their ideal lives. While adolescents with better psychosocial adjustment appeared to evaluate their present lives more positively than did adolescents with relatively poorer psychosocial adjustment, no differences were found between the two groups in terms of their views on ideal and future lives.     

Dissimilarity in mother and adolescent illness representations of type 1 diabetes and negative emotional adjustment

The study explored how two measures of mother–adolescent dissimilarity in illness representations relate to negative emotional adjustment in mothers and adolescents. Eighty-four adolescents with type 1 diabetes (age 11.5–17.5) and their mothers completed the Revised Illness Perceptions Questionnaire and measures of negative emotional adjustment. Adolescents viewed diabetes as less chronic, containing fewer negative emotional representations, and that mother had less control over the illness than did mothers. Mother–adolescent mean differences in representations were not associated with negative adjustment for adolescents; mean differences in coherence were related to negative adjustment for mothers, when controlling the individual's own representations. A measure of dissimilarity based on the sum of squared differences between mother and adolescent was associated with negative adolescent adjustment when controlling adolescent's own representations, but no relations were found for mothers. Dyadic approaches to coping with chronic illness will benefit by understanding how dissimilarity in illness representations between patient and caregiver relate to adjustment.     

Relationship of family socialization processes to adolescent moral thought

The author investigated the relationship between salient family processes and adolescent moral thought among a sample of 271 adolescents and their parents. Family-process variables measured were adaptability, cohesion, and parent-adolescent communication; adolescent moral thought was measured by the influence the adolescent participants attributed to sources of moral authority. Perceptions of high family cohesion were associated with the greatest influence attributed to the family as a source of moral authority. Perceptions of high family adaptability were associated with greater influence attributed to all sources of moral authority. Parent-adolescent dyads who perceived high positive communication showed strong parent-adolescent agreement on the levels of influence attributed to all sources of moral authority. The findings (a) support the view that a strong relationship exists between family-socialization processes and the content of adolescent moral thought and (b) redress an empirical imbalance in research literature.     

The Illness Perceptions and Treatment Beliefs of Individuals with Severe Haemophilia and their Role in Adherence to Home Treatment

The majority of individuals in the UK with severe haemophilia treat themselves at home with clotting factor. The aim of this study was to examine patient's beliefs about their haemophilia, their beliefs regarding treatment with clotting factor and to assess whether relationships existed between these factors and adherence to home treatment. Patient beliefs were assessed by posting individuals with severe haemophilia A and B ( n = 104) the Illness Perceptions Questionnaire (IPQ) and the Beliefs about Medicines Questionnaire (BMQ). The final analysis was based on 65 questionnaires yielding a response rate of 63%. Adherence to the frequency and to the amount of each clotting factor dose was assessed for individuals treating prophylactically and the amount of each clotting factor dose for those only treating 'on-demand'. Adherence scores were calculated by comparing individual patient treatment records with recommended regimens. Regression analysis indicated that perceptions of illness identity and treatment necessity explained a significant amount of the variance in adherence to frequency of prophylactic infusions and that illness identity was associated with the adherence to the amount of each prophylactic dose. Further regression analysis also showed that the amount of each dose of clotting factor administered on-demand was associated with perceptions regarding the necessity of treatment. Analysis with a combined measure of adherence to dose amount indicated that patients treating on-demand or with prophylaxis who under treated, recorded significantly lower perceptions of illness consequence than individuals who were fully adherent or who over-treated. The results suggest that assessing illness perceptions, especially beliefs regarding identity , consequence and necessity of treatment, may play a valuable role in identifying which individuals are least likely to adhere to treatment.     

Unfair treatment, discrimination, and ambulatory blood pressure in black and white adolescents.

The authors tested the hypotheses that unfair treatment and its attribution to race, physical appearance, and peer group were related to elevated ambulatory blood pressure (ABP). During 2 school days, 207 Black and White adolescents wore an ABP monitor and answered questions about mood, posture, location, and activity level at the time of the ABP assessment. At a separate session, in-clinic resting blood pressure and perceptions of unfair treatment were measured. Multilevel mixed models showed that unfair treatment and its attribution to race were not associated with ABP. However, adolescents who indicated that the primary reason for unfair treatment was their physical appearance had elevated ABP. Feeling unfairly treated because of physical appearance may impact blood pressure uniquely during the adolescent transition.     

Counselling patients with AIDS-associated Kaposi's sarcoma

Kaposi's Sarcoma is a disfiguring and feared symptom of HIV disease. Structured interviews of patients, family members and health care providers were conducted in three settings: USA (11), UK (8) and sub-Saharan Africa (20). These sought to identify: (a) contextual and cultural differences; (b) the main fears of patients and others; (c) practical ways of addressing these and coping with stigma, and (d) methods for ‘inoculating’ non-KS patients against psychological distress before there is any evidence of clinical signs or symptoms. It was found that context and culture mediated social responses to KS and disfigurement. Patients in Africa seemed to be less affected than Western patients by appearance and stigma. Issues relating to secrecy were common to both groups. Compliance with treatment was good as long as it was efficacious. When no further treatment of Kaposi's sarcoma was possible, there is greater emphasis on counselling. Patients (particularly in the West) appreciated treatment of lesions on the hands and face, and advice about cosmetic applications, even if lesions on other parts of the body could not be treated. Perceptions about being able to find a new partner were reduced among Western patients with KS. Patients with KS or an associated fear may benefit from counselling in which ideas relating to stigma, secrecy, treatment, cosmetic applications, the effects on family and fears of disfigurement are discussed.     

The Fort Bragg managed care experiment: Short term impact on psychopathology

Many concerns have been raised about mental health services for children and adolescents. These concerns have included not treating those in need and providing inappropriate services to those who are treated. The continuum of care philosophy purports to remedy these problems by offering a comprehensive and coordinated range of services emphasizing community-based treatment. Services in the continuum include alternatives to trditional restrictive forms of care such as hospitalization. The provision of more appropriate care is hypothesized to improve the clinical outcomes of children treated in a continuum of care. The Fort Bragg Evaluation compared quality, use, outcome, and cost of the continuum of care model to a more traditional, fragmented system of care. This paper presents the effects of a service delivery system on short term psychopathology outcomes.     

Outcome Trajectories for Adolescents in Residential Treatment: A Statewide Evaluation

Although residential treatment represents one of the largest and most expensive components of the mental health service system for children and adolescents, little is known about the anticipated outcomes of this service. Still less is known about the trajectory through which change occurs within these settings. We examined the clinical status of 285 adolescents over a 2-year period after placement in residential treatment by the Department of Mental Health in a western state. Using a growth modeling technique, the rate of change was determined over a set of symptoms measured by the Acuity of Psychiatric Illness—Child and Adolescent Version (CAPI). Results suggest that while adolescents tended to improve overall during the course of their stays, there was considerable variation in which symptoms improved and which did not. Two symptoms actually became reliably worse with treatment. In addition, significant variation in outcomes was demonstrated across sites, with adolescents in one site getting reliably worse during the course of residential treatment. Our findings demonstrate the utility of outcomes management and have significant implications for how residential services for children and adolescents should be managed.     

Familienfunktionalität und Therapieerfolg

Background

Even though it is a treatment standard of child psychotherapy to involve the parents, hardly any research has been carried out about the impact of family functioning on treatment outcome. Aims of the present study were to investigate the change in and the prognostic power of family functioning on treatment outcome of short-term psychodynamic psychotherapy in children and adolescents.

Patients and methods

The sample consisted of 54 children and adolescents undergoing outpatient short-term psychodynamic psychotherapy. To assess family functioning, their parents were asked to complete the Family Assessment Measure (FAM).

Results

Patients from families with high levels of functioning in task accomplishment, communication and affective expression were more often treated successfully. Improvement in levels of functioning in role performance, emotionality and control were only found in the group of successfully treated patients.

Conclusion

Family functioning is a decisive factor in the differential indication of psychotherapeutic treatment in children and adolescents.     

Adherence to pharmacological treatment of non-malignant chronic pain: The role of illness perceptions and medication beliefs

The objective was to identify the degree to which illness perceptions and medication beliefs explain variations in reported adherence to medication prescribed for the treatment of non-malignant chronic pain and to test the applicability of an extended version of the self-regulatory model to the chronic pain population. A cross-sectional design included 217 clinic patients completing validated questionnaires assessing their illness perceptions, medication beliefs and reported adherence to medication. Perceptions of illness (pain) as chronic, uncontrollable and unremitting were associated with greater adherence, fewer medication concerns and a belief that treatment was necessary. Structural equation modelling supports an extended SRM for chronic pain. It suggests that patients holding perceptions of serious consequences of pain and high emotion levels have more concerns about medication and are less adherent. Perceptions of serious illness consequences are also associated with stronger beliefs about the necessity of medicines and greater adherence. Beliefs about illness and medication are associated with adherence to treatment in chronic pain and this can be explained by an extended SRM. Results are preliminary and require replication. Further studies should explore the role that emotion has on coping strategies in chronic pain. Interventions should focus on altering unhelpful beliefs that reduce adherence.     

Medikamentöse Behandlung von Adoleszenten mit paraphiler Symptomatik und einem Risiko für die Begehung von Sexualstraftaten

The diagnostics and treatment of adolescents who show paraphilic symptoms should be approached with extreme caution. The aim of this paper is to present and discuss the recently published World Federation of Societies of Biological Psychiatry (WFSBP) guidelines for the treatment of adolescents with paraphilic disorders and a risk for committing sexual offences. The basis of therapy is always a thorough diagnostic procedure and an estimation of the risk of behavior harmful to others. The basis of treatment is formed by psychosocial interventions. The indications for pharmacological therapy, in particular for antiandrogens and gonadotropin-releasing hormone (GnRH) agonists are closely controlled (e.g. only one adolescent treated with GnRH agonists was found in a study of German forensic psychiatry hospitals). The indications are guided by a high risk of substantial danger to others and with respect to the stage of puberty reached by the adolescent person. The therapy should only be carried out in collaboration with specialized pediatric endocrinologists. Administration of therapy should be regularly checked at short intervals with a strict control of the risk/benefit ratio. The guidelines also illustrate the contraindications to pharmacological treatment of adolescents with paraphilic symptoms.     

Rethinking naive realism

Philosophical Studies - Perceptions are externally-directed—they present us with a mind-independent reality, and thus contribute to our abilities to think about this reality, and to know what...     

Perceptions of attention deficit hyperactivity disorder and its treatment among children and adolescents

Little is known about how children and adolescents conceptualize psychiatric disorders and psychiatric treatment. In the current study, children and adolescents diagnosed with Attention Deficit Hyperactivity Disorder (ADHD) were interviewed about their understanding of ADHD and the medication used to treat their disorder. The participants were all taking Ritalin and ranged in age from 5 to 16 years. With increasing age, children improved in their ability to name their condition and the medication. Latency-aged children often did not perceive Ritalin as helpful while adolescents recognized some value in taking medication. Some of the adolescents were also able to describe medication side effects. The implications of these findings for patient education are discussed.