Psychological adjustment of adolescents with sickle cell disease: relations with demographic, medical, and family competence variables.

OBJECTIVE: Investigate the hypothesis that family competence in addressing challenges associated with sickle cell disease (SCD) contributes to adolescents' adjustment. METHOD: During routine clinic appointments, 80 adolescents (M age = 14.4 years) and their parents independently completed the Self-Report Family Inventory (SFI), which assesses family competence, and measures of adolescent adjustment problems. Information related to disease severity was obtained from clinic files. RESULTS: Regression analyses controlling for demographic and medical variables revealed that higher family competence was associated with fewer internalizing and externalizing behaviors by the adolescent; these relations were particularly true for younger adolescents and for girls. Parental reports of somatic complaints in girls were predicted by parental ratings of family competence. DISCUSSION: Interventions for adolescents with SCD should be family-centered and should focus on strengthening the family's ability to manage stressors associated with parenting an adolescent with a chronic illness.

The relationship between defense styles and personality disorders.

The relationships between personality disorder clusters and defense mechanism factors were evaluated in 31 female and 24 male psychiatric inpatients from an urban hospital, who ranged in age from 19 to 57 years. The degree to which defense factors predicted personality disorder psychopathology was assessed, with gender entered as a covariate. The degree of borderline psychopathology had the strongest relationship with the Immature defense style (F(1,54) = 9.83, R2 = .54, p < .05). The results support previous research demonstrating a stronger link between Borderline personality disorder and defense styles relative to other personality disorders.

Genetics and developmental psychopathology: 1. Phenotypic assessment in the Virginia Twin Study of Adolescent Behavioral Development.

We introduce an overlapping cohort sequential longitudinal study of behavioral development and psychopathology in a representative sample of 1412 pairs of twins aged 8 through 16 years. Multiple phenotypic assessments involve a full psychiatric interview with each child and each parent, and supplementary parental, teacher, and child interview material and questionnaires. For the first wave of assessments, the numbers of reported DSM-III-R symptoms of Major Depressive Disorder (MDD), Separation Anxiety Disorder (SAD), Overanxious Disorder (OAD), Oppositional Defiant Disorder (ODD), Conduct Disorder (CD), and Attention Deficit Hyperactivity Disorder (ADHD), assessed through interviews, confirm patterns of age and sex trends found in other epidemiological samples, but underscore their dependence on whether the child or the parent is the informant. Correlations across domains for symptoms reported by the same informant are often as large as correlations across informants for the same domain of symptoms. Factor analyses of these symptom counts, taking account of informant view and unreliability of assessment, show the high degree of correlation between SAD and OAD, between MDD and OAD, and between CD and ODD. ADHD symptoms are relatively independent of the other domains, but show moderate correlations with CD, ODD, and MDD. Factorially derived dimensional questionnaire scales, based on child, parental, and teacher reports, show patterns of relationship to symptom counts consistent with both convergent and discriminant validity as indices of liability to clinical symptoms. Across informants, questionnaire scales provide as good a prediction of symptoms as do clinical interviews. Multitrait-multimethod confirmatory factor analysis reveals the patterns of relationship between symptoms of psychiatric disorder in children taking due account of informant and unique sources of variance. Gender differences are consistent within the correlated clusters of ODD/CD and MDD/SAD/OAD, although there are disorder-specific age trends. There are large informant-specific influences on the reporting of symptoms in clinical interviews. Dimensional questionnaire scales provide a useful source of additional information. In subsequent analyses of genetic and environmental etiology of childhood psychopathology we must expect that results may differ by informant and method of assessment. Multivariate and developmental analyses that explore the sources of these differences will shed new light on the relationship between genetic and environmentally influenced vulnerability and the manifestation of psychopathology in specific circumstances.

Self and informant ratings of SCID-II Personality Disorder items for nonreferred college women: effects of item and participant characteristics.

Examined the relationship between self- and informant-ratings on Structured Clinical Interview for DSM-III-R Personality Disorders (SCID-II) items. Seventy-five female undergraduate student volunteers and their roommates also completed the Brief Symptom Inventory, Rubin's Liking Scale, and the Marlowe-Crowne Social Desirability Scale. Self-rating scores on personality disorder items were significantly higher than informant-ratings on five personality disorder scales. Participants and informants endorsed more personality disorder items rated higher on social desirability. No relationship was found between subjectivity of personality disorder scales and differences between self- and informant-ratings. Participants with higher needs for positive self-presentation rated themselves lower on nine personality disorder scales. A higher level of liking for roommates was associated with lower informant ratings for six personality disorder scales.

The genetics of children's oral reading performance.

Measures of reading achievement and verbal ability have been shown to be heritable. Additionally, recent evidence has been suggestive of a major gene effect on reading disability and for problem reading in a sample of normal readers. We report on the etiology of individual differences in oral reading performance, the Slosson Oral Reading Test (SORT), for which biometrical analyses have not been reported in the literature previously. Oral reading performance was measured in a large population-based sample of twins of the Virginia Twin Study of Adolescent Behavioral Development. Biometrical analyses of the SORT suggested that, in both males and females, 69% of the phenotypic variation was due to heritable influences and 13% of the variation due to shared environmental effects. While the relative importance of genetic and environmental influences is equivalent for males and females, males showed greater phenotypic variability than females.

The application of structural equation modeling to maternal ratings of twins' behavioral and emotional problems.

The application of structural equation modeling to twin data is used to assess the impact of genetic and environmental factors on children's behavioral and emotional functioning. The models are applied to the maternal ratings of behavior of a subsample of 515 monozygotic and 749 dizygotic juvenile twin pairs, ages 8 through 16, obtained through mailed questionnaires as part of the Medical College of Virginia Adolescent Behavioral Development Twin Project. The importance of genetic, shared, and specific environmental factors for explaining variation is reported for both externalizing and internalizing behaviors, as well as significant differences in the causes of variation in externalizing behaviors among young boys and girls. The usefulness of applying structural equation models to data on monozygotic and dizygotic twins and the potential implications for addressing clinically relevant questions regarding the causes of psychopathology are discussed.

Concurrent validity of the Minnesota Child Development Inventory with high-risk infants.

Investigated the validity and clinical utility of the Minnesota Child Development Inventory (MCDI) as a developmental screening instrument with a sample of 280 premature infants identified as medically and socioeconomically high risk for developmental delays. Correlational analyses demonstrated significant correlations between the MCDI scales and the criterion Bayley Mental Age Equivalent score. Results of a moderator multiple regression analysis indicated that parent and child characteristics have a statistically significant "moderating" influence on the validity of the MCDI although the clinical significance of this finding may be minimal. A prediction-performance matrix analysis revealed a high degree of classification specificity (92%) but a relatively low sensitivity rating (56%). Findings suggest that the MCDI is a valid and useful screening instrument for high-risk infants but should be used diagnostically only in conjunction with other measures.

Rethinking Oedipus: an evolutionary perspective of incest avoidance.

The author presents a biological hypothesis of incest avoidance. Pertinent literature from evolutionary biology, ethology, anthropology, and clinical research is reviewed. Secure early bonding to immediate kin predicts later adaptive kin-directed behaviors, including preferential altruism (kin selection) and incest avoidance. Impaired bonding predicts aberrant kin-directed behavior, including diminished altruism, neglect, and an increased incidence of incest. Failed bonding predicts the highest frequency of incest. Secure bonding to kin may function to establish adaptive kin-directed behaviors, including incest avoidance. Bonding is conceived of as the developmental foundation of a form of social attraction, here called "familial attraction," which is evolutionarily distinct from sexual attraction.

Childhood behavior problems: a comparison of twin and non-twin samples.

This study compares standardized measures of childhood behavior problems in a community-based twin sample with those for normative samples from the general population. Maternal parent ratings on the Child Behavior Checklist (CBCL) for 1824 twins were compared with the CBCL normative sample. The results indicated that twins showed small but consistently higher levels of problem behaviors. These elevations were significant for older children on both internalizing and externalizing behaviors; for younger children the elevations were significant for externalizing but not internalizing behaviors.

Children's self-statements and adjustment to elective outpatient surgery.

Children's coping self-statements, levels of anxiety, degree of behavioral adjustment, as well as levels of maternal state anxiety and parenting style, and demographic variables were used to predict the reactions of 61 children to elective day surgery. Results indicated that elective day surgery was not psychologically traumatic for most children. However, the use of negative self-statements and both low and high maternal anxiety were found to be related to increased anxiety of the children experiencing elective day surgery.

Early life events as discriminators of socialized and undersocialized delinquents.

The relationship between early life events and the socialized and undersocialized dimensions of conduct disorder was investigated. Subjects were 40 incarcerated male delinquents and their mothers. The mothers were administered the Children's Life Events Questionnaire and the Developmental Questionnaire. Youths were administered the Adolescent Parent Relations Scale. The results indicated that the undersocialized delinquents had a greater number of stressful life events during their first 4 years of life than did the socialized delinquents. Discriminant function analysis indicated that stressful life events during the 2nd and 4th years were the most important predictors of membership in the undersocialized group. The discriminant function generated was able to classify 82.5% of the sample correctly. The remaining variables did not significantly discriminate the groups.

Differential expression of pseudoconditioning and sensitization by siphon responses in Aplysia: novel response selection after training.

Nonassociative training with a noxious unconditioned stimulus (US) applied to the head or tail of freely moving Aplysia caused a qualitative change in siphon responses to midbody test stimulation, so that the midbody test responses came to resemble the unconditioned siphon response (UR) to the US when tested 1 d after exposure to the US. Such a nonassociative, US-induced transformation of test responses into responses resembling the UR has traditionally been termed "pseudoconditioning." Short-term pseudoconditioning was compared to sensitization and to habituation in a reduced preparation that used a photocell to distinguish "head-type" siphon responses from qualitatively different "tail-type" responses. Transformation of test responses (pseudoconditioning) was observed only when the type of preexisting alpha response to the midbody test stimulus was different from the UR. Sensitization, defined as a US-induced enhancement of the alpha response to the test stimulus, was observed when the initial alpha response and the UR were of the same type. General sensory facilitation was excluded as a critical mechanism for pseudoconditioning by the observation that the same midbody test response could be transformed to either a head-type or tail-type response, depending on the site of the US, and by the observation that simply increasing the intensity of the midbody test stimulus in the absence of a head or tail US did not produce similar response transformations. These studies demonstrate pseudoconditioning in a preparation amenable to analysis at the level of identified neurons, and draw attention to a distinctive and widespread form of behavioral modifiability that has been neglected by investigators of learning.

Mediating factors of stress on mothers of seriously ill, hospitalized children.

The present study examined 10 variables for their importance in mediating maternal adjustment to the stress of a child's hospitalization as measured by the State scale of the State-Trait Anxiety inventory and the Hopkins Symptom Checklist. The results showed significant mediating effects for the Trait scale of the State-Trait Anxiety Inventory, a self-report of coping, and socioeconomic status. Level of trait anxiety was the single best predictor of stress for both criterion measures.

Directional control and the functional organization of defensive responses in Aplysia.

Noxious cutaneous stimulation of anterior sites on Aplysia californica causes withdrawal and turning followed by escape locomotion. Stimulation of anterior sites causes significantly larger turning responses than does stimulation of posterior sites, so that escape locomotion is always directed away from a site of 'attack'. Later phases of escape locomotion are often the same, regardless of the site of the triggering stimulus. The defensive secretions, ink and opaline, are directed along the anterior-posterior axis at the source of noxious stimulation. Ink and opaline ejections are directed to the front or back of the animal by characteristic responses of the siphon, mantle, and parapodia. Ink and opaline are ejected by a series of coordinated pumping movements of the mantle, gill, and parapodia that closely resemble triggered 'respiratory pumping' or 'Interneuron II' episodes (Kupfermann and Kandel 1969; Byrne and Koester 1978; Hening 1982). The directed ejection of secretions from the mantle cavity in response to noxious stimulation suggests a number of potential defensive functions for these secretions including aggressive retaliation, startle display, diversion, and alarm signalling (Edmunds 1975). Taken together, our results and others' suggest an integrated scheme for the functional organization of overt defensive behavior in Aplysia, and begin to suggest testable hypotheses about the integration of defensive responses on the cellular level in this animal.

Effects of grade, gender, and hospitalization on children's medical fears.

First, fourth, and seventh graders completed a specially designed medical fears questionnaire. The effects of grade, gender, and previous hospitalization on the children's medical fears were analyzed. Gender was found to be significantly related to both the frequency and intensity of medical fears, with girls expressing more and stronger fears than boys. Fourth and seventh graders reported more medical fears than first graders. Previous hospitalization experience had no effect on the frequency or intensity of medical fears.

The Child Abuse Potential Inventory: a study of concurrent validity.

Forty-four subjects were assigned to a High or Low Abuse Potential Group based upon their Child Abuse Potential (CAP) Inventory's abuse scale scores. Each subject's heart rate (HR) and skin conductance (SC) were monitored while the subject was viewing videotape presentations of an infant smiling, crying, or quiescent. The High Abuse Potential Group had a faster peak HR throughout the videotape presentations with no significant differences among videotape segments. The Low Abuse Potential Group had a slower peak HR and had a significantly lower HR during the Smile and Cry segments than in the second Quiescent segment. The males accounted for most of the significant SC variability among tape segments. The pattern of SC responses revealed that the males were less aroused than the females, the Low Abuse Potential Group was less aroused than the High Abuse Potential group, and all four groups showed a decrease in arousal toward the end of the videotape presentations. The results provide support for the concurrent validity of the CAP inventory.

The psychological, social, and medical needs of lower socioeconomic status mothers of asthmatic children.

Extensive clinical literature describes parental reactions and stages of adjustment to chronic illnesses of their children, but such observations have not yet been empirically demonstrated. Utilizing a cross-sectional approach, the present study examined the psychological/emotional, social/instrumental, and medical/educational problems experienced by lower socioeconomic status (SES) mothers of 45 asthmatic children as a function of the length of time that had elapsed since the diagnosis of their children's illness. Data analysis indicated that the problem areas did not vary with the length of time since diagnosis. The majority of mothers reported difficulties related to their children's illness in each area.

Preoperative intervention for the reduction of anxiety in pediatric surgery patients.

Hospitalization and surgery can have adverse psychological effects on children that may be prevented by preoperative intervention procedures. The present study compared an in vivo preparation in which 3- to 9-year-old patients who were about to undergo tonsillectomy/adenoidectomy surgery experienced a preview of the procedures and equipment, a slide show condition depicting hospitalization and surgery, or a standard nursing care control group. The in vivo group was rated as significantly less anxious than the slide show and control groups at each of the three assessment points. The in vivo children also took less time to drink following surgery than the slide show and control groups.

A probability-based formula for calculating interobserver agreement.

Estimates of observer agreement are necessary to assess the acceptability of interval data. A common method for assessing observer agreement, per cent agreement, includes several major weaknesses and varies as a function of the frequency of behavior recorded and the inclusion or exclusion of agreements on nonoccurrences. Also, agreements that might be expected to occur by chance are not taken into account. An alternative method for assessing observer agreement that determines the exact probability that the obtained number of agreements or better would have occurred by chance is presented and explained. Agreements on both occurrences and nonoccurrences of behavior are considered in the calculation of this probability.