The Default Position: Optimizing Pediatric Participation in Medical Decision Making

Inclusion of children in medical decision making, to the extent of their ability and interest in doing so, should be the default position, ensuring that children are routinely given a voice. However, optimizing the involvement of children in their health care decisions remains challenging for clinicians. Missing from the literature is a stepwise approach to assessing when and how a child should be included in medical decision making. We propose a systematic approach for doing so, and we apply this approach in a discussion of two challenging clinical cases. The approach is informed by a literature review, and is anchored by case studies of teenagers' refusal of clinical care, regulatory requirements for research assent, and the accepted approach to involving cognitively impaired adults in medical decisions.     

Configurations of Young Peoples’ Important Life Goals and Their Associations with Thriving

The aims of this study were to determine whether, and how, young people’s beyond-the-self life goals coexisted with other life goals, and whether having at least one beyond-the-self goal was associated with higher thriving (the Five Cs of Positive Youth Development [PYD]) and volunteering, compared to having either no goals, or goals that were only self-focused. The authors conducted latent class analyses among five school cohort groups using data from five studies (combined using integrative data analysis techniques). Across grade groups, the authors identified classes, which can generally be characterized by (1) low endorsement of goals, (2) prominence of helping others and contributing to community goals, (3) prominence of goals related to a good life (e.g., make money, friends, live an adventurous life), and (4) endorsement of most life goals. In the older two grade groups we identified additional classes: a group with a high endorsement of goals oriented at helping others and serving God/higher power in the undergraduate group, and a group with high endorsement of goals to create something new and make the world a better place in the graduate group. There were differences in the Five Cs of PYD and volunteering between the classes. The authors discuss the implications of these results for future research and practice regarding young people’s life goals.     

The Development of Latent Dimensions of Psychopathology across Early Childhood: Stability of Dimensions and Moderators of Change

Recent research has described the structure of psychopathology as including one general and multiple specific factors, and this structure has been found in samples across development. However, little work has examined whether this structure is consistent across time, particularly in young children, within the same sample. Further, few studies have examined factors that influence the magnitude of the stability of latent dimensions of psychopathology. In the present study, we examine these issues in a community sample of 545 children assessed at ages 3 and 6. In addition, we explored child temperament, parental history of psychopathology, and parenting behaviors as potential moderators of the longitudinal stability of latent dimensions of psychopathology. We found that the same bifactor model structure identified at age 3 provided an adequate fit to the data at age 6. Further, our model revealed significant homotypic stability of the general, internalizing, and externalizing specific factors. We also found evidence of differentiation of psychopathology over time with the general factor at age 3 predicting the externalizing factor at age 6. However, we failed to identify moderators of the longitudinal associations between psychopathology latent factors. Overall, our results bolster support for the bifactor structure of psychopathology, particularly in early childhood.     

Being tolerated: Implications for well-being among ethnic minorities

Tolerating or condoning practices that one finds objectionable is typically considered a positive way to negotiate intergroup differences. However, being the target of tolerance might harm well-being, which we examined in three studies (a survey and two experiments) among a total of 1,054 members of various racial/ethnic minority groups in the United States. In Study 1, we found that perceiving oneself to be tolerated on the basis of one’s ethnic group membership was associated with more negative well-being. In Study 2, we found that bringing to mind experiences of being tolerated results in less positive and more negative affect than thinking about experiences of acceptance, but more positive and less negative outcomes than thinking about overt discrimination experiences. In Study 3, we replicated the results of Study 2 while demonstrating that threat to social identity needs mediates the tolerance–well-being link. These results suggest that being tolerated is related to minority targets’ well-being in ways that are intermediate between being treated with outright discrimination and full acceptance, but that being tolerated follows a pattern closer to discrimination.     

Parent–Child Conflict Profiles in Chinese American Immigrant Families: Links to Sociocultural Factors and School‐Age Children's Psychological Adjustment

Research suggests that parent–child conflict is a salient family process in Asian immigrant families and often a stressful experience for Asian American youth due to value discrepancies between Asian and Western cultures. The present study examined ratings of parent–child conflict across conflict topics from parents' and children's perspectives in a sample of Chinese American immigrant families with school‐age children (N = 239; age = 7.5–11 years). Latent profile analyses identified three parent‐rated conflict profiles and four child‐rated conflict profiles. Parent and child conflict profiles were unrelated to each other and differentially related to family sociocultural factors and children's psychological adjustment. Parents' moderate conflict profile scored highest on parent‐rated child behavior problems and had the highest household density and lower parent Chinese orientation. Children's moderate‐specific and high conflict profiles scored higher on child‐reported behavior problems than the low conflict profile. These results highlight the need to assess family conflict from both parents' and children's perspectives and target parent–child conflict communication as a pathway to prevent or reduce behavioral problems in Chinese American children of immigrant families.     

Fear Learning in Veterans With Combat-Related PTSD Is Linked to Anxiety Sensitivity: Evidence From Self-Report and Pupillometry

Several studies have observed heightened Pavlovian fear conditioning in PTSD. However, it is unclear how fear conditioning in PTSD is related to risk factors for the disorder, such as anxiety sensitivity. Fifty-one combat-exposed veterans (20 with PTSD, 31 without PTSD) completed a differential fear conditioning task in which one colored rectangle (CS +) predicted a loud scream (US), whereas a different colored rectangle (CS-) predicted no US. Veterans with PTSD were characterized by greater anxiety to the CS + but not the CS- during acquisition and extinction, and greater US expectancy during the CS + but not the CS- at extinction. Also, veterans with PTSD had greater pupil dilation to both CSs at extinction, but not at acquisition. Anxiety sensitivity was correlated with anxiety and US expectancy in response to the CS +, but not the CS-, at both acquisition and extinction, and also with pupil diameter to both the CS + and CS- at extinction. Nearly all of these relations held when covarying for PTSD symptoms and trait anxiety. These findings suggest that increased fear conditioning in PTSD may be related to elevated anxiety sensitivity.     

Parent and Child Factors Associated with Household versus Community Adversity among Black and Hispanic Children

Journal of Child and Family Studies - The purpose of this study was to describe exposure to within-household and community adverse childhood experiences (ACEs) and to identify child- and...     

Coping strategies,stress and health of grandmothers caring for ascending and descending relatives / Afrontamiento,estrés y salud en abuelas cuidadoras de familiares ascendentes y descendentes

The progressive increase in life expectancy and the verticalization of the family mean that the provision of family care can be stressful and risky for the health of grandmothers who act as caregivers. One hundred and twenty grandmothers were interviewed in southwest Spain; they were daughters of a generation still characterized by high levels of dependence. A questionnaire with standardized psychological scales and items specifically designed for the study was used. Results showed that the burden of the instrumental and economic support had a detrimental effect on their health through stress, which in turn increased when they used coping strategies of denial and self-blame, and decreased with acceptance of reality and when they sought emotional support.     

Exploration of Cross-Cultural Couples’ Marital Adjustment: Iranian American Women Married to European American Men

This article presents a qualitative, phenomenological study which explored cross-cultural marital adjustment among intermarried Iranian American women and their European American husbands. Twelve couples participated in individual and joint interviews. Analysis of the interviews suggests that although cross-cultural differences exist between the couples, these differences were not preventing successful marital adjustment. The interviews revealed that successful marital adjustment relied heavily on certain positive features or “strengths,” which worked as buffers to cross-cultural differences. The findings of this study add to the limited literature on Iranian Americans, intermarriage, and cross-cultural marital adjustment, and have implications for counselors and marriage and family therapists working with cross-cultural couples.