School absenteeism and mental health among sexual minority youth and heterosexual youth

Adolescent school absenteeism is associated with negative outcomes such as conduct disorders, substance abuse, and dropping out of school. Mental health factors, such as depression and anxiety, have been found to be associated with increased absenteeism from school. Sexual minority youth (youth who are attracted to the same sex or endorse a gay, lesbian, or bisexual identity) are a group at risk for increased absenteeism due to fear, avoidance, and higher rates of depression and anxiety than their heterosexual peers. The present study used longitudinal data to compare sexual minority youth and heterosexual youth on excused and unexcused absences from school and to evaluate differences in the relations between depression and anxiety symptoms and school absences among sexual minority youth and heterosexual youth. A total of 108 14- to 19-years-old adolescents (71% female and 26% sexual minority) completed self-report measures of excused and unexcused absences and depression and anxiety symptoms. Compared to heterosexual youth, sexual minority youth reported more excused and unexcused absences and more depression and anxiety symptoms. Sexual minority status significantly moderated the effects of depression and anxiety symptoms on unexcused absences such that depression and anxiety symptoms were stronger predictors of unexcused absences for sexual minority youth than for heterosexual youth. The results demonstrate that sexual minority status and mental health are important factors to consider when assessing school absenteeism and when developing interventions to prevent or reduce school absenteeism among adolescents.     

Sexuality education groups in juvenile detention

Several major studies have described the magnitude and character of adolescent sexual activity and sexual knowledge related to contraception and sexually transmitted diseases (Diepold & Young, 1979; Hass, 1979; Sorenson, 1973; Zelnick & Kantner, 1980). Few systematic studies have been conducted, however, which analyze the attitudes toward sexuality and contraception of delinquent adolescents who are generally school dropouts and who may engage in socially unacceptable behaviors such as running away, drug abuse, and prostitution. Delinquent youths, especially delinquent girls, have been characterized as being more sexually active and less sexually knowledgeable than their nondelinquent peers (Gibbon, 1981; Mannarino & Marsh, 1978). Despite the assumed high-risk nature of this delinquent population, few juvenile detention facilities have offered systematically evaluated coeducational sex education programs. One barrier to implementation of such programs in juvenile detention centers is the lack of a treatment or program orientation of most staff, and/or staff denial of adolescent sexuality in general, an attitude which suppresses the development of healthier sexual values and often promotes pathologic sexual interaction within institutions (Shore & Gochros, 1981). A recent survey of adolescent sexuality (Diepold, 1979) points out that teenagers' feelings about their "sexual selves" impacts greatly upon their general self-image. Low self-esteem is more frequently found among delinquents than nondelinquents (Jones & Swain, 1977; Lund & Salury, 1980), and treatment for delinquent girls often focuses on increasing self-esteem and developing assertiveness skills based on feelings of self-worth (DeLange, Lanahan, & Barton, 1981; NiCarthy, 1981). Two studies carried out with juvenile detainees from a large urban center confirmed that sexual activity among delinquent adolescents is significantly greater than that of the general adolescent population, and that the delinquents have little or no knowledge of birth control methods or venereal disease (Deisher, 1980; Schroeder, 1981). Further, these adolescents appear to endorse constricted and conventional values related to sexual activity, abortion, and relationship issues and frequently have a background of sexual abuse and prostitution. These findings form the basis of the current study which attempts to develop an effective coeducational sex education program for this population within a detention facility. This program is specifically designed for a sexually active adolescent group aged 14 to 17.     

Depressed nursing home residents' activity participation and affect as a function of staff engagement

Behavioral interventions for depression target activity engagement and increased positive reinforcement, particularly from social interaction. Nursing homes provide limited opportunity for meaningful social engagement, and have a high prevalence of depression. Often residents obtain most of their social contacts from staff members. We present intra-individual correlations among positive staff engagement, resident affect, and resident activity participation from behavior stream observations of residents who were participants in an ongoing trial of an intervention for depression. Sixteen residents were observed 6 times weekly for 8 to 45 weeks, 5 minutes per observation. Positive staff engagement during the observations was significantly correlated with resident interest and pleasure. Positive staff engagement was related to resident participation in organized group activity; however, residents tended to be more engaged and show more pleasure when in informal group activities, especially those residents receiving the behavioral treatment. Positive staff engagement was not related to time in activities of daily living. Results have implications for understanding mechanisms and potential targets of interventions for depression.     

Social anxiety disorder in childhood and adolescence: descriptive psychopathology

Although the presentation of social anxiety disorder (SAD) in adults is well documented, less is known about its clinical manifestation in children and adolescents. To date, most studies have included combined samples of children and adolescents despite the fact that this age range represents an extensive period of growth and development. This study compares and contrasts the clinical presentation of SAD among children (ages 7-12) and adolescents (ages 13-17). One hundred and fifty children (n=74) and adolescents (n=76) with a primary diagnosis of SAD participated in the study. The assessment battery included clinical ratings and behavioral observation as well as parental and self-report. The results indicate that, although the symptom presentation of children and adolescents with primary SAD shares many features, children tend to present with a broader pattern of general psychopathology, while adolescents have a more pervasive pattern of social dysfunction and may be more functionally impaired as a result of their disorder. These findings suggest that interventions for SAD need to carefully consider clinical presentation of the disorder as it manifests in childhood and adolescence.     

Persistent Heightened Cortisol Awakening Response and Adolescent Internalizing Symptoms: A 3-year Longitudinal Community Study

An atypical Cortisol Awakening Response (CAR) has been related to adult anxiety and depression, but little is known about the association between long-term atypical CAR and adolescent anxiety and depression. This study aimed to longitudinally identify subgroups of adolescents with distinct levels of CAR (i.e., adolescents with and without persistent atypical CAR) and to examine their development of anxiety and depressive symptoms over 3 successive years. A community sample of 184 Dutch adolescents (M _age?=?14.99 at T₁, 57 % boys) completed annual salivary cortisol assessments at home at time of awakening, and 30 and 60 min post-awakening (i.e., CAR) for 3 successive years. Adolescents also reported annually on their anxiety and depressive disorder symptoms. Latent Class Growth Analysis suggested two subgroups of adolescents with respect to CAR: a “low” group with stable low levels of AUC_g (Area Under the Curve with respect to the ground) over time and a “high” group with high and increasing levels of AUC_g over time. Controlling for sex, the high and low CAR groups significantly differed in depressive symptoms only, but none of the anxiety disorder symptoms. More specifically, adolescents in the high CAR group showed significantly higher mean levels of depressive symptoms over time compared to adolescents in the low CAR group. These results suggest that persistent heightened CAR is a more consistent, yet modest, correlate of adolescent depressive symptoms than anxiety disorder symptoms.     

A Meta-Analysis on the Efficacy of Technology Mediated CBT for Anxious Children and Adolescents

Several meta-analyses indicate that cognitive-behavioral therapy (CBT) via electronic/technological devices or applications (i.e., eCBT) is an effective alternative to standard therapist-delivered CBT for anxious adults. However, we know little about the efficacy of eCBT interventions for anxious children and adolescents. The present meta-analysis set out to investigate the efficacy of eCBT in comparison to standard CBT or waitlist control for anxious children and adolescents. Eight randomized controlled studies (N = 404 participants) that targeted anxiety at post-intervention and follow-up were included in the analysis. The results indicated that eCBT was as effective as standard CBT (g = .295) and more effective than waitlist (g = 1.410) in reducing anxiety symptoms. Moderation analyses revealed that anxious children and adolescents benefited the most from eCBT in the minimal therapist involvement condition (g = 2.682) in contrast to the significant therapist involvement group (g = .326). Furthermore, older participants seemed to extract greater clinical benefits from eCBT in contrast to younger participants (slope = .514). Current eCBT interventions for anxious children and adolescents appear to be promising, but require further investigation.     

Integrated Cognitive-Behavioral Therapy for Social Anxiety and HIV/STI Prevention for Gay and Bisexual Men: A Pilot Intervention Trial

Given the alarmingly high HIV and sexually transmitted infection (STI) incidence among gay and bisexual men (GBM) worldwide, there is a critical need for HIV prevention interventions specifically for GBM. Social anxiety, or anxiety about being evaluated in interpersonal situations, is a risk factor for condomless anal sex (CAS) among GBM (e.g., Hart & Heimberg, 2005; Hart, James, Purcell, & Farber, 2008). Social anxiety may also increase substance use in sexual situations, which is another risk factor for HIV/STIs in this risk group (Semple, Strathdee, Zians, McQuaid, & Patterson, 2011). The goal of the Sexual Confidence Study was to provide initial evidence of efficacy for a 10-session integrated cognitive-behavioral therapy for social anxiety, substance use management in sexual situations, and HIV sexual risk reduction for HIV-negative GBM. Diagnostic and self-report assessments were completed at baseline, posttreatment, 3-month follow-up, and 6-month follow-up. In this open trial design, we observed a 50% reduction in engagement in HIV/STI sexual risk behavior at 6-month follow-up. We also observed large uncontrolled treatment effect sizes for reductions in social anxiety disorder and problematic alcohol use. These preliminary findings suggest that the present treatment may offer an efficient way of concurrently reducing social anxiety, problematic alcohol use, and the risk of contracting HIV and STIs via CAS with serodiscordant partners among HIV-negative GBM.     

Unfamiliar Untrained Observers’ Ratings of Adolescent Safety Behaviors Within Social Interactions with Unfamiliar Peer Confederates

Adolescents experiencing social anxiety often engage in safety behaviors―covert avoidance strategies for managing distress (e.g., avoiding eye contact)―that factor into the development and maintenance of their concerns. Prior work supports the psychometric properties of the Subtle Avoidance Frequency Examination (SAFE), a self-report survey of safety behaviors. Yet, we need complementary methods for assessing these behaviors within contexts where adolescents often experience concerns, namely, interactions with unfamiliar peers. Recent work indicates that, based on short, direct social interactions with adolescents, individuals posing as unfamiliar peers (i.e., peer confederates) and without assessment training can capably report about adolescent social anxiety. We built on prior work by testing whether we could gather valid SAFE reports from unfamiliar untrained observers (UUOs), who observed adolescents within archived recordings of these short social interactions. A mixed clinical/community sample of 105 adolescents self-reported on their functioning and participated in a series of social interaction tasks with peer confederates, who also provided social anxiety reports about the adolescent. Based on video recordings of these tasks, trained independent observers rated adolescents’ observed social skills, and an additional set of UUOs completed SAFE reports of these same adolescents. Unfamiliar untrained observers’ SAFE reports (a) related to adolescents’ SAFE self-reports, (b) distinguished adolescents on clinically elevated social anxiety concerns, (c) related to trained independent observers’ ratings of adolescent social skills within interactions with peer confederates, and (d) related to adolescents’ self-reported arousal within these same interactions. Our findings support use of unfamiliar observers’ perspectives to understand socially anxious adolescents’ interpersonal functioning.     

Sexual assault: Myths and stereotypes among Australian adolescents

Myths and stereotypes about sexual assault reflect a society which excuses perpetrators of assault and blames victims for failing to control men's sexuality. Such views are well-established by early adulthood, but there is little research with adolescents. This study surveyed two hundred forty-four 14–16 year old Australian high school students (105 male, 139 female), of Anglo-European descent. Males were significantly more likely to endorse sexual assault myths, to agree that forced sex was acceptable in some situations, and to hold false stereotypes about sexual assault. Males also held more restrictive attitudes toward women's roles and endorsed a greater level of sexism in dating relationships. This suggests that male and female adolescents have differing expectations of dating relationships, which may underlie sexual assault within relationships. Assault-supportive attitudes are apparent at a young age, supporting the need for educational and social interventions targeting young people.     

Psychopathology of Adolescent Social Phobia

Sixty-three adolescents with social phobia and 43 with no psychiatric disorders were compared across a number of clinical variables. In addition to clinically impairing social fear, adolescents with social phobia had significantly higher levels of loneliness, dysphoria, general emotional over-responsiveness and more internalizing behaviors than normal controls and 57.1% of socially phobic adolescents had a second, concurrent diagnosis, 75% of which were other anxiety disorders. In addition, adolescents with social phobia were significantly less socially skilled. Though similar in some respects to childhood social phobia, adolescent social phobia has a unique clinical presentation. The importance of developmental differences on the development of age-appropriate interventions is discussed.     

An Exploratory Study of Parent-Child Communication About Sex and the Sexual Attitudes of Early,Middle, and Late Adolescents

In an attempt to examine the relationship between parent-child communication about sex and parent-adolescent attitudes about sex, 12- to 20-year-olds (N = 141) and their parents completed sexual communication and attitude questionnaires. The correlation between parents' and children's attitudes were high for all the early adolescents and low for all the middle adolescents. Only among the late adolescents was there a significant difference in the correlations between the sexual attitudes of parents and their children as a function of family communication level, with the attitudes of adolescents and parents in the high communication group being highly correlated and the attitudes of adolescents and parents in the low communication group not being significantly correlated. Middle adolescents had significantly more permissive sexual attitudes than early and late adolescents. Gender variables were also studied, but conclusions were limited due to the small number of participating fathers. All findings must be tempered with the recognition of the possible sampling bias introduced by the use of a convenience sample. It is suggested that the more responsible sexuality seen in adolescents who can talk to their parents about sex may be a function of the similarity in sexual attitudes between these late adolescents and their parents.     

Adolescent sexuality in a therapeutic community: staff countertransference issues

Issues connected with sexuality such as heterosexual relationships, homosexuality, sexual identity, and seductiveness, create conflict and countertransference dilemmas for staff who work with psychiatric patients in a therapeutic community. When the therapeutic community is composed of adolescents, these issues are exacerbated since sexual identity and sexual development are major concerns. The staff reacts strongly to the issue of self-determination and violation/infringement on a basic human need. These philosophical differences have their roots in countertransference feelings. Staff sometimes find it difficult to confront adolescents on emotionally charged issues that have a sexual coloring. A system is proposed for articulating and working through these feelings. A unique solution is posited for solving this conflictual attitude (based on object relations theory), whereby the residential treatment center serves as the analog of the home in order to allow adolescents to develop a sense of self before they can move on to the halfway house where heterosexual behavior is allowed (as part of the therapeutic process). This facilitates the meeting of the "self" with the "other." This procedure is explored in light of Sullivan's concept of intimacy.     

An exploratory study of parent-child communication about sex and the sexual attitudes of early, middle, and late adolescents

In an attempt to examine the relationship between parent-child communication about sex and parent-adolescent attitudes about sex, 12- to 20-year-olds (N = 141) and their parents completed sexual communication and attitude questionnaires. The correlation between parents' and children's attitudes were high for all the early adolescents and low for all the middle adolescents. Only among the late adolescents was there a significant difference in the correlations between the sexual attitudes of parents and their children as a function of family communication level, with the attitudes of adolescents and parents in the high communication group being highly correlated and the attitudes of adolescents and parents in the low communication group not being significantly correlated. Middle adolescents had significantly more permissive sexual attitudes than early and late adolescents. Gender variables were also studied, but conclusions were limited due to the small number of participating fathers. All findings must be tempered with the recognition of the possible sampling bias introduced by the use of a convenience sample. It is suggested that the more responsible sexuality seen in adolescents who can talk to their parents about sex may be a function of the similarity in sexual attitudes between these late adolescents and their parents.     

A cognitive‐behavioral model of anxiety disorders in children and adolescents

This study investigated a cognitive‐behavioral model of anxiety disorders in Japanese children and adolescents. Participants comprised 532 children from elementary schools and 751 adolescents from junior high schools as a community group, and 41 children and adolescents who fulfilled the criteria for childhood anxiety disorders as a clinical group. All participants completed three questionnaires about anxiety symptoms, self‐statements, and cognitive errors. While the clinical group showed more anxiety symptoms, negative self‐statements, and cognitive errors than the community group, there was no significant difference in positive self‐statements. Multigroup structural equation modeling found the presence of cognitive links for the community and clinical groups. Specifically, cognitive errors generated negative self‐statements, exacerbating a higher‐order factor (childhood anxiety) affecting six anxiety symptoms corresponding to the diagnostic criteria of psychological disorders. Mediated relationships were supported in only the community sample. Clinical implications for prevention and treatment of anxiety disorders in children and adolescents are discussed.     

Attachment style as a piedictor of sexual attitudes and behavior in late Adolescence

Abstract

This research applied attachment theory to the study of sexual attitudes and behaviors in a sample of late adolescents. Four hundred and seventy heterosexual undergraduate students completed questionnaires assessing attachment (discomfort with closeness; anxiety over relationships). relationship history, communication about sex. sexual self-efficacy and locus of control, and attitudes to condoms. Eight weeks later, participants reported on sexual behaviors occurring during the eight-week interval. and perceived risk of these activities. Both discomfort with closeness and anxiety over relationships were associated with external locus of control for sexual outcomes, and with use of drugs before sexual contact. Anxiety over relationships was linked to unsafe sex and to negative attitudes to condoms, but discomfort with closeness was associated with a more cautious approach to sexual risk-taking. Some results were qualified by gender differences. and by differences between the full sample and those who were sexually active. The findings arc discussed in terms of attachment style and its links with communication and affect regulation.

SUMMARY AND CONCLUSIONS

This study indicates that attachment dimensions are reliably related to many aspects of sexual attitudes and behaviors among late adolescents. Insecure attachment was linked to increased drug use before sexual contact. Anxiety over relationships was also linked to less safe sexual practice, but discomfort with closeness was associated with a tendency for males to be cautious about sexual risk-taking. The results support the utility of the attachment perspective on adolescent sexuality, but also highlight the complex relations between attachment dimensions and sexual outcomes. Future research would benefit from more detailed investigations of the attitudes, emotions, and cognitions which may mediate the link between attachment style and sexual behavior. For example, those who are highly anxious about their relationships may engage in more risky sexual practices because they fear that non-compliance with partners' wishes will jeopardize their relationship; the tendency to engage in drug use before sexual cpntact may reflect their attempts to boost self-confidence or to manage negative mood states. Research into these issues has the potential to explain how attachment insecurity is played out in patterns of sexual activity.     

Skills for Social and Academic Success: A School-Based Intervention for Social Anxiety Disorder in Adolescents

This paper describes Skills for Academic and Social Success (SASS), a cognitive–behavioral, school-based intervention for adolescents with social anxiety disorder. Clinic-based treatment studies for socially anxious youth are reviewed, and a strong rationale for transporting empirically-based interventions into schools, such as SASS, is provided. The SASS program consists of 12, 40-min group sessions that emphasize social skills and in-vivo exposure. In addition to group sessions, students are seen individually at least twice and participate in 4 weekend social events with prosocial peers from their high schools. Meetings with teachers provide information about social anxiety and facilitate classroom exposures for socially anxious participants. Parents attend 2 psychoeducational meetings about social anxiety, its treatment, and approaches for managing their childs anxiety. Initial findings regarding the programs effectiveness are presented. We conclude by discussing the challenges involved in implementing treatment protocols in schools and provide suggestions to address these issues.     

555例危险行为高危青少年的心理干预：来自个体辅导和团体辅导的效果对照

对有较高风险发展为危险行为青少年的高危群体实施有针对性的心理干预是非常有价值的。本研究对青少年危险行为高危人群进行结构化的个体与团体心理干预,评估两种干预的即时效果和六个月的预后情况。采用《青少年健康相关危险行为问卷》等量表对16所中职院校的学生进行筛查,共555名学生参加本研究,被随机分为个体、团体和对照组并分别进行干预。结果发现：干预后,个体心理干预组被试的危险行为水平、心理健康以及抑郁和焦虑情绪均获得显著改善,并且6个月的预后效果依然明显,而接受团体辅导干预组仅在抑郁指标上有所改善,在危险行为评分、焦虑和心理健康水平上均没有明显的改善。研究认为,对危险行为易感青少年的心理干预应以经过良好设计的个体心理干预为主、团体干预为辅的方式进行。     

When Adolescents Experience Co-Occurring Social Anxiety and ADHD Symptoms: Links With Social Skills When Interacting With Unfamiliar Peer Confederates

Adolescents with elevated social anxiety commonly experience peer-related impairments – particularly with same-age, unfamiliar peers – stemming from their avoidant behaviors. Yet, peer-related impairments are not unique to social anxiety. For example, adolescents who experience social anxiety may also experience symptoms of attention deficit/hyperactivity disorder (ADHD), which also increase risk for peer-related impairments. Relative to social anxiety, peer-related impairments linked to ADHD symptoms more likely stem from hyperactivity (i.e., approach behaviors). These distinct pathways point to adolescents with elevated social anxiety and ADHD symptoms (i.e., social anxiety + ADHD) experiencing particularly high peer-related impairments, which commonly manifest as behavioral displays of low social skills when interacting with unfamiliar peers. We tested this notion in a mixed-clinical/community sample of 134 14- to 15-year-old adolescents and their parents. Adolescents participated in a series of social interaction tasks designed to simulate how adolescents interact with same-age, unfamiliar peers. Trained observers independently rated adolescents on observed social skills within these interactions. Both parents and adolescents completed parallel surveys of social anxiety and ADHD symptoms, which we used to identify social anxiety + ADHD adolescents as well as other combinations of social anxiety and ADHD symptoms (i.e., neither, elevated on one but not the other). Adolescents with social anxiety + ADHD displayed significantly lower social skills, relative to all other groups. Among adolescents, social anxiety + ADHD may have a compounding effect on social skills. As such, therapists working with social anxiety + ADHD adolescents should probe for peer-related impairments and factors implicated in the development and maintenance of these impairments.     

Expressed attitudes of adolescents toward marriage and family life

In the U.S., modifications in family structure and in attitudes concerning marriage and family life have been numerous. Areas such as sexual behavior and alternative living arrangements have become highly varied and nontraditional compared to past generations. This study examined the attitudes of adolescents toward aspects of marriage and family life. The majority of adolescents expressed negative attitudes toward divorce and viewed marriage as a lifelong commitment. While only about a third of the adolescents expressed positive attitudes toward premarital sex, a majority indicated they would engage in sexual intercourse before marriage, or already have. Interestingly, about half of the adolescents held positive attitudes toward cohabitation. Lastly, the adolescents demonstrated a growing acceptance of premarital counseling and psychoeducational interventions regarding marriage and family life.     

Patterns of Metaperception in Adolescents with Social Anxiety: Mind Reading in the Classroom

Socially anxious adults display an interpretation bias toward anticipating threat such as a high probability of audience criticism even in nonthreatening social situations. They may also expect more negative audience reactions to self than to others acknowledging anxiety. Few studies have examined such biases in adolescents. We examined negative and positive metaperceptions (i.e., others’ perceived responses) in 13–16-year-old adolescents (n?=?655) with high vs. normal social anxiety in a hypothetical classroom scenario, in which the participants predicted the frequency of negative and positive classmate responses when imagining either themselves (self-referent metaperceptions) or a classmate (other-referent metaperceptions) with visible symptoms of social anxiety as the target persons giving a speech. We assessed social anxiety with the Social Anxiety Scale for Adolescents and metaperception using the Classroom Questionnaire of Social Anxiety and Interpersonal Cognition. Social anxiety was associated with negative self-referent metaperceptions to a greater degree than with negative other-referent metaperceptions. Compared with adolescents with normal social anxiety, those with high social anxiety (both boys and girls) predicted a broader range of negative classmate responses toward self, as compared with their predictions of negative responses toward a classmate. These group differences were observed specifically with regard to audience’s predicted covert negative responses (i.e., negative thoughts and feelings) toward self, indicating that socially anxious adolescents tend to mind-read. Minimal group differences in positive metaperceptions were observed. The results reveal target and content specificity in socially anxious adolescents’ negative metaperceptions.