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This chapter focuses on empirically supported interventions for common problems that may arise during clinical work with adolescents presenting with medical problems. The reader will be introduced to a review of the current research literature regarding psychological interventions for adolescents, with specific emphasis on evidence-based interventions for treatment adherence and assisting patients and their families in transitioning from pediatric to adult care. The reader will then be provided with an example behavior contract for adherence and empirically supported assessments for adherence. Beneficial resources are identified that can be utilized to assist with treatment adherence and the transition of medical care from the pediatric to adult clinic.
Smartphone ownership estimates indicate the vast majority of young people are engaging with smartphone devices. The medium offers a promising opportunity for psychologists to connect with young people seeking help to traverse challenges with mental health, behaviour, learning and wellbeing. However, the views of young people using apps alongside face-to-face therapy remain largely unexplored. Given that clients make the single strongest contribution to therapeutic outcomes it is important to consider the perspectives of adolescents in clinical settings. Using semistructured qualitative interviews, the experiences of seven Australian secondary school-aged adolescents (12–18 years) involved in app-integrated therapy were explored. Thematic analysis resulted in the identification of eight key themes: Between-sessions, Introduction, Responsive, Age, Mindfulness-Meditation, Connection, Knowledge, and App features. Recommending apps appears to encourage young people to take ownership of their therapy, affording opportunities for self-reflection and rehearsal of valuable skills. Further research focused on understanding the views of young people utilising apps with therapy is needed to maximise potential therapeutic benefits. Preliminary practice recommendations and future research directions are proposed.
Critics have tended to dismiss Wharton’s depictions of children as victims of their parents’ misbehavior (Paul Marvell of The Custom of the Country) to optimistic symbols of the future (Nettie Struther’s baby in The House of Mirth), failing to take into account the complexity of children as characters. In fact, Wharton’s novels are populated with children – typically girls – marked by suggestions of gender queerness; transgression, seduction, and aggression; age-impropriety; and ethnic ambiguity. From “The Valley of Childish Things” (1896) to “A Little Girl’s New York” (1938), Wharton emphasizes the absence of childhood innocence and the resistance of children to linear development. Wharton’s children are rarely innocent, frequently knowing, and resistant to narratives of linear development. Concentrating on the novels The Reef (1912) and The Children (1928), and touching on other works by Wharton, I demonstrate how this theme flows throughout the author’s corpus.
Pubertal timing matters for psychological development. Early maturation in girls is linked to risk for depression and externalizing problems in adolescence and possibly adulthood, and early and late maturation in boys are linked to depression. It is unclear whether pubertal timing uniquely predicts problems; it might instead mediate the continuity of behavior problems from childhood to adolescence or create psychological risk specifically in youth with existing problems, thus moderating the link. We investigated these issues in 534 girls and 550 boys, measuring pubertal timing by a logistic model fit to annual self-report measures of development and, in girls, age at menarche. Prepuberty internalizing and externalizing behavior problems were reported by parents. Adolescent behavior problems were reported by parents and youth. As expected, behavior problems were moderately stable. Pubertal timing was not predicted by childhood problems, so it did not mediate the continuity of behavior problems from childhood to adolescence. Pubertal timing did not moderate links between early and later problems for girls. For boys, early maturation accentuated the link between childhood problems and adolescent substance use. Overall, the replicated links between puberty and behavior problems appear to reflect the unique effects of puberty and child behavior problems on the development of adolescent behavior problems.
Subclinical adolescent alcohol use is highly prevalent and may have deleterious effects on important psychosocial and brain outcomes. Prior research has focused on identifying endophenotypes of pathological drinking, and the predictors of normative drinking remain understudied. This study investigated the incremental predictive value of two potential psychophysiological endophenotypes, P3 amplitude (an index of decision making) and midfrontal theta power (a correlate of attentional control), for prospectively predicting the expression and initiation of alcohol use emerging in adolescence.
A large (N = 594) epidemiological sample was prospectively assessed at ages 11/14/17. Alcohol/substance use was assessed at all ages via a computerized self-report inventory. EEG was recorded at age-14 during a visual oddball task to elicit P3 and theta.
Reduced target-related P3 and theta at age-14 prospectively predicted drinking at age-17 independent of one another. Among alcohol-naive individuals at age-14, attenuated P3 and theta increased the odds of new-onset alcohol behaviors 3 years later. Importantly, the endophenotypes provided significant incremental predictive power of future non-clinical alcohol use beyond relevant risk factors (prior alcohol use; tobacco/illicit drug initiation; parental alcohol use disorder).
The current report is the first of our knowledge to demonstrate that deviations in parietal P3 and midfrontal theta prospectively predict the emergence of normative/non-pathological drinking. P3 and theta provide modest yet significant explanatory variance beyond prominent self-report and familial risk measures. Findings offer strong evidence supporting the predictive utility of P3 and theta as candidate endophenotypes for adolescent drinking.
Given the heterogeneity of depression the Research Domain Criteria Framework suggests a dimensional approach to understanding the nature of mental illness. Neural reward function has been suggested as underpinning the symptom of anhedonia in depression but how anhedonia is related to aversion processing is unclear.
To assess how the dimensional experience of anhedonia and depression severity relate to reward and aversion processing in the human brain.
We examined adolescents and emerging adults (n = 84) in the age range 13–21 years. Using a dimensional approach we examined how anhedonia and depression related to physical effort to gain reward or avoid aversion and neural activity during the anticipation, motivation/effort and consummation of reward and aversion.
As anhedonia increased physical effort to gain reward decreased. As anhedonia increased neural activity decreased during effort to avoid in the precuneus and insula (trend) and increased in the caudate during aversive consummation. We found participants with depression symptoms invested less physical effort than controls and had blunted neural anticipation of reward and aversion in the precuneus, insula and prefrontal cortex and blunted neural activity during effort for reward in the putamen.
We show for the first time that both physical effort and neural activity during effort correlate with anhedonia in adolescents and that amotivation might be a specific deficit of anhedonia irrespective of valence. Future work will assess if these neural mechanisms can be used to predict blunted approach and avoidance in adolescents at risk of depression.
The mental health of children and young people can be disproportionally affected and easily overlooked in the context of emergencies and disasters. Child and adolescent mental health services can contribute greatly to emergency preparedness, resilience and response and, ultimately, mitigate harmful effects on the most vulnerable members of society.
To assess physical health needs of adolescent in-patients by routine monitoring. A retrospective analysis of case notes was conducted on a 6-month intake to generic and secure adolescent mental health units in Greater Manchester, UK.
Fifty individuals were admitted (52% female, average age 15.84 years). Diagnoses varied and 66% were prescribed medications before admission. All had a physical health assessment, which identified various physical health risk factors. Average body mass index was 25.99 (range 15.8–44), and increased during in-patient treatment for 84% of individuals who had their body mass recorded more than once. A total of 28% of individuals smoked. Lipids and prolactin levels were elevated across the sample.
This evaluation strengthens the argument to optimise physical healthcare for adolescent in-patients and develop physical health interventions, particularly given that we observed elevated lipids and prolactin. Physical health and well-being may not be prioritised when assessing and managing young peoples' mental health, despite their increased vulnerability for comorbid conditions.
The mediational sequence from body dissatisfaction through dieting to bulimia—often referred to as the “restraint pathway”—has been validated in numerous samples of adolescent girls, but the prevalence rate of bulimic pathology pales in comparison to rates of body dissatisfaction and dieting in this risk group. This discrepancy indicates that the restraint pathway may only apply to adolescent girls possessing certain characteristics or experiencing certain circumstances. Accordingly, the current study examined the moderating roles of thin-ideal internalization, interoceptive deficits, and age by using self-report data from a community sample of 353 middle school (n = 115), high school (n = 112), and college girls (n = 126). We found that (a) body-dissatisfied girls who reported high, versus low, thin-ideal internalization engaged in greater dietary restraint; (b) only dieters who reported high interoceptive deficits and were of college age expressed bulimic symptoms; and (c) the mediating effect pertained only to college girls with high interoceptive deficits, but was strongest for those who reported high, versus low, thin-ideal internalization. These results suggest that the restraint pathway's precision may be fine-tuned through greater sensitivity to potentiating factors and developmental context. Theoretical, empirical, and practical implications are discussed.
The Nak’azdli Whut’en, a First Nations community in northern British Columbia, recognized the importance of preserving Elders’ wisdom and sharing cultural knowledge and oral traditions across generations. We report learnings from an intergenerational digital storytelling workshop led by the Nak’azdli Health Centre in partnership with community organizations and academic partners. Framed by a participatory action design in accordance with the Ownership, Control, Access, and Possession (OCAP®) principles, a 10 session workshop was created and piloted. WeVideo technology was used to facilitate knowledge sharing between elementary school students and Elders. Through storytelling, the Elders shared their wisdom and knowledge. The students recorded the stories and added imagery and sounds to capture their understandings in a digital format. Thus, Elders and students worked in partnership to co-create digital stories to create a cultural legacy for future generations. This workshop aligned with the British Columbia school curriculum, fostered intergenerational relationships between Elders and youth, helped preserve cultural identity, and facilitated opportunity for meaningful contribution for Elders and youth to their community.
To determine feasibility and efficacy of an Emergency Department Violence Intervention Program (EDVIP) to reduce violence related injuries in youth.
One hundred and thirty youth aged 14–24 presenting to an emergency with violence related injury were randomized in parallel to receive EDVIP for 1 year (n = 65) or a waitlist control (n = 65). The primary outcome was to determine feasibility. Secondary outcomes are incidence, number/severity of repeat violence related injury, justice and education systems interactions, substance misuse and mental health presentations, and ED length of stay (LOS).
This study established feasibility in recruitment, outcomes collection and safety. Fidelity and adherence measures required optimization during the study. Efficacy analysis of EDVIP vs. the control group demonstrates an absolute decrease of 10.4% in repeat violence related injury (13.7% vs. 24.1%) (p = 0.15), reduction in new interactions in the justice system (OR = 0.36 (0.07–1.77)), improved engagement in education (11.8% EDVIP vs. 7.6% control, p = 0.42) and no change in repeat visits for substance or mental health. LOS decreased by 59.5 min (p = 0.21).
This program is feasible for ED implementation and for completion of a future RCT to measure effectiveness.
The characterisation of proteome and peptidome of adolescent mothers’ breast milk brings important information to both mother’s and infant’s health; however, it has not been investigated. Bioactive peptides derived from milk proteins have numerous functions. The bioactivity of breast milk peptides includes anti-inflammatory and antimicrobial activities and regulation of gastrointestinal function. We aimed to characterise the proteome and peptidome of mature breast milk of adolescent mothers and investigate whether it is affected by lactational period. We used a combination of electrophoretic and nano-scale LC-quadrupole time-of-flight MS/MS (nLC-Q-TOF-MS/MS) techniques and bioinformatics to explore the proteome of human skimmed milk expressed by lactating adolescents in two groups according to postpartum period (up to 3 and over 5 weeks postpartum). This is the first study that analysed the proteome of adolescent mothers’ breast milk produced during two periods of lactation using 1D-electrophoresis combined with nLC-Q-TOF-MS/MS analysis. Our results showed that the protein composition of adolescent milk varies independently of lactation stage and showed high inter-individual variation. A total of 424 proteins were identified in skimmed milk, of which 137 proteins were common to both groups. Most of the peptides found in adolescents’ breast milk were not derived from major proteins in milk. Association maps showed several interactions between groups of peptides that pointed to the relevance of breast milk peptides to neonatal defensive system.
Values—the motivational goals that define what is important to us—guide our decisions and actions every day. Their importance is established in a long line of research investigating their universality across countries and their evolution from childhood to adulthood. In adolescence, value structures are subject to substantial change, as life becomes increasingly social. Value change has thus far been understood to operate independently within each person. However, being embedded in various social systems, adolescents are constantly subject to social influence from peers. Thus, we introduce a framework investigating the emergence and evolution of value priorities in the dynamic context of friendship networks. Drawing on stochastic actor-oriented network models, we analyze 73 friendship networks of adolescents. Regarding the evolution of values, we find that adolescents’ value systems evolve in a continuous cycle of internal validation through the selection and enactment of goals—thereby experiencing both congruence and conflicts—and external validation through social comparison among their friends. Regarding the evolution of friendship networks, we find that demographics are more salient for the initiation of new friendships, whereas values are more relevant for the maintenance of existing friendships.
Mental disorders cause high burden in adolescents, but adolescents often underutilise potentially beneficial treatments. Perceived need for and barriers to care may influence whether adolescents utilise services and which treatments they receive. Adolescents and parents are stakeholders in adolescent mental health care, but their perceptions regarding need for and barriers to care might differ. Understanding patterns of adolescent-parent agreement might help identify gaps in adolescent mental health care.
A nationally representative sample of Australian adolescents aged 13–17 and their parents (N = 2310), recruited between 2013–2014, were asked about perceived need for four types of adolescent mental health care (counselling, medication, information and skill training) and barriers to care. Perceived need was categorised as fully met, partially met, unmet, or no need. Cohen's kappa was used to assess adolescent-parent agreement. Multinomial logistic regressions were used to model variables associated with patterns of agreement.
Almost half (46.5% (s.e. = 1.21)) of either adolescents or parents reported a perceived need for any type of care. For both groups, perceived need was greatest for counselling and lowest for medication. Identified needs were fully met for a third of adolescents. Adolescent-parent agreement on perceived need was fair (kappa = 0.25 (s.e. = 0.01)), but poor regarding the extent to which needs were met (kappa = −0.10 (s.e. = 0.02)). The lack of parental knowledge about adolescents' feelings was positively associated with adolescent-parent agreement that needs were partially met or unmet and disagreement about perceived need, compared to agreement that needs were fully met (relative risk ratio (RRR) = 1.91 (95% CI = 1.19–3.04) to RRR = 4.69 (95% CI = 2.38–9.28)). Having a probable disorder was positively associated with adolescent-parent agreement that needs were partially met or unmet (RRR = 2.86 (95% CI = 1.46–5.61)), and negatively with adolescent-parent disagreement on perceived need (RRR = 0.50 (95% CI = 0.30–0.82)). Adolescents reported most frequently attitudinal barriers to care (e.g. self-reliance: 55.1% (s.e. = 2.39)); parents most frequently reported that their child refused help (38.7% (s.e. = 2.69)). Adolescent-parent agreement was poor for attitudinal (kappa = −0.03 (s.e. = 0.06)) and slight for structural barriers (kappa = 0.02 (s.e. = 0.09)).
There are gaps in the extent to which adolescent mental health care is meeting the needs of adolescents and their parents. It seems important to align adolescents' and parents' needs at the beginning and throughout treatment and to improve communication between adolescents and their parents. Both might provide opportunities to increase the likelihood that needs will be fully met. Campaigns directed towards adolescents and parents need to address different barriers to care. For adolescents, attitudinal barriers such as stigma and mental health literacy require attention.
To explore dietary differences according to socio-economic and sociocultural characteristics of adolescents and young adults.
A systematic review was conducted.
The main search source was MEDLINE, consulted between January 2012 and March 2017. Quality of selected studies was assessed based on dietary measurement method, sample selection, socio-economic indicator choice and statistical modelling.
Cross-sectional and longitudinal studies, assessing relationships between socio-economic status and dietary intake (patterns, scores and food groups) in the 10- to 40-year-old general population of high-income countries, were selected.
Among the 7250 reports identified, forty were selected, seventeen of which were of high quality; their conclusions, related only to adolescents, were combined and presented. The most favourable dietary patterns, higher dietary scores, greater consumption of fruits, vegetables and dairy products, and lower consumption of sugary sweetened beverages and energy-dense foods, were associated with better parental socio-economic status, particularly in terms of higher education. Migrant status was associated with plant-based patterns, greater consumption of fruits and vegetables and of sugary sweetened beverages and energy-dense foods. For the other food groups, and for young adults, very few high-quality studies were found.
The socio-economic gradient in adolescent diets requires confirmation by higher-grade studies of a wider set of food groups and must be extended to young adult populations. Future nutritional interventions should involve the most vulnerable adolescent populations, taking account of socio-economic status and migration.
The Beijing Twin Study (BeTwiSt), which was established in 2006, is an ongoing study aiming to investigate the genetic and environmental etiology of adolescent psychopathology. Resting-state brain imaging datasets have been examined for same-sex twins, and other psychological traits and emotional and behavioral variables have been examined for all twins. Based on the registry, the main findings regarding the etiological mechanism underlying adolescent development, magnetic resonance imaging results, and genetic and environmental influences on other psychological traits have been published. This article summarizes the key findings in these three areas and discusses future plans for the BeTwiSt.
This study revisits the premature autonomy model by examining parents’ use of positive behavior support (PBS) practices on a daily timescale to better understand underlying processes in developmental changes in family disengagement and the implications for adolescent problem behavior and substance use. This study included 151 9th and 10th grade adolescents (61.5% female) and their caregivers, who participated in a baseline assessment, a 21-day daily diary burst, and a 1-year follow-up assessment. Four key findings emerged: (a) on days when parents used more PBS, adolescents felt more close and connected to their caregivers; (b) adolescents who exhibited a larger-magnitude of change in connectedness with caregivers in relation to variation in positive parenting (termed fragile connectedness) were at higher risk for antisocial behavior, deviant peer involvement, and substance use one year later; (c) individual differences in initial levels of antisocial behavior and effortful control accounted for between-person variation in fragile connectedness; and (d) day-level adolescent anger and parent–adolescent conflict predicted within-family variation in parents’ use of PBS. Implications for the premature autonomy model and intervention science are discussed.
Processed foods and fatty, sugary snacking products, such as fizzy drinks and desserts, have become more popular, causing a desire to replace meals with snacks worldwide. High-sugar and fat-rich food components have been reported to be associated with increased level of dental caries as well as underweight and overweight. The aim of the present cross-sectional population-based study was to analyse the eating behaviours of young, healthy Finnish males in association with oral health and BMI, considering self-reported and residential background factors.
Finnish Defence Forces, Finland.
The used clinical data were gathered from 13 564 Finnish conscripts born in the beginning of the 1990s through clinical check-ups. In addition, about 8700 of the conscripts answered a computer-assisted questionnaire (‘Oral Health of the Conscripts 2011’ data) about their background information and health habits.
There was distinct variation in dietary patterns. Eating breakfast, regular physical exercise and daily tooth brushing all decreased the odds for restorative dental treatment need (decayed teeth), whereas smoking and drinking fizzy drinks for quenching thirst increased it. Eating breakfast and dinner were each associated with lower BMI, but smoking increased the odds for higher BMI (≥25 kg/m2).
Regular, proper meals and especially eating breakfast decreased the odds for both dental caries and high BMI (≥25 kg/m2).
We investigated how initial conflicts in adolescent romantic relationships escalate into serious forms of conflict, including intimate partner violence (IPV). We focused on whether adolescents’ micro-level interaction patterns, i.e., coercion and positive engagement, mediated between conflict and future IPV. The sample consisted of 91 heterosexual couples, aged 13 to 18 years (M = 16.5, SD = 0.99) from a diverse background (42% Hispanic/Latino, 42% White). Participants completed surveys about conflict at Time 1, and they participated in videotaped conflict and jealousy discussions. At Time 2, participants completed surveys about conflict and IPV, and an average daily conflict score was calculated from ecological momentary assessments. Multilevel hazard models revealed that we did not find support for dyadic coercion as a risk process leading to escalations in conflict. However, a higher likelihood of ending dyadic positive behaviors mediated between earlier levels of conflict and a latent construct of female conflict and IPV. Classic coercive dynamics may not apply to adolescent romantic relationships. Instead, not being able to reinforce levels of positivity during conflict predicted conflict and IPV as reported by females. The implications of these findings for understanding coercion in the escalation from conflict to IPV in adolescent romantic relationships are discussed.
To understand how exposure to victimization during adolescence and the presence of comorbid psychological conditions influence substance use treatment entry and substance use disorder diagnosis from 14 to 25 years old among serious juvenile offenders, this study included 1,354 serious juvenile offenders who were prospectively followed over 7 years. Growth mixture modeling was used to assess profiles of early victimization during adolescence (14–17 years). Discrete time survival mixture analysis was used to assess time to treatment entry and substance use disorder diagnosis. Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) were used as predictors of survival time. Mixture models revealed three profiles of victimization: sustained poly-victimization, moderate/decreasing victimization, and low victimization. Youth in the sustained poly-victimization class were more likely to enter treatment earlier and have a substance use diagnosis earlier than other classes. PTSD was a significant predictor of treatment entry for youth in the sustained poly-victimization class, and MDD was a significant predictor of substance use disorder diagnosis for youth in the moderate/decreasing victimization class. Therefore, substance use prevention programming targeted at youth experiencing poly-victimization in early adolescence—especially those who have PTSD or MDD—is needed.