To whom do adolescents turn for help? Differences between disturbed and nondisturbed adolescents.

The focus of this investigation was to 1) identify those adolescents experiencing distress; 2) examine the formal and informal helping agents that adolescents seek out for help for emotional problems; and 3) describe adolescents' perceptions of the helpfulness of selected helping agents. Adolescents (N = 497) from three high schools in a large metropolitan area in the Midwest, representing a broad socioeconomic spectrum, were administered instruments related to self-image, delinquency, symptomatology, and help seeking. The prevalence rate of disturbance was 22.3%. Results show that disturbed adolescents sought help from alcohol/drug abuse centers, teenage drop-in centers, and mental health professionals more frequently than nondisturbed adolescents. In additional, both groups frequently sought help from parents and friends and perceived this help as beneficial. Implications of these findings for the development of adolescent mental health services are discussed.

Normality and adolescence.

Diagnostic work with adolescents has always been difficult. The problem is to distinguish serious psychopathology from mild crisis. We can now say, however, that a severe identity crisis and emotional turmoil are just not part of normal growing up. Our belief is that we do not help adolescents who experience such crises or turmoil when we tell them not to worry about their problems because they are a normal part of adolescence and because they will "grow out of it." In summary, we have presented data on the self-image of a large number of adolescents. We have stressed three things. First, we used self-administered questionnaires to collect our data. Most important, our data are consistent, and they are congruent with results obtained from use of other psychologic instruments such as interviews or parents' evaluations of their children. Second, we found that the normal groups of adolescents we studied were characterized more by their similarities than by their differences. The continuity of values for all our samples over an 18-year period and across cultures was especially impressive. Third, we stressed the diversity of adolescents' view of their psychologic worlds. These youths define normal functioning and development. They reside in our communities, and before we can help their disturbed peers who need professional help, we need to know what the norm is. Only then can we correctly diagnose and successfully treat the adolescents who do seek our help.

Adolescence. What is normal?

We present in some detail what constitutes normal behavior, or mental health, among teenagers. Our data are based on the results of a specially devised psychological questionnaire by one of us (D.O.). This questionnaire has been shown to reliably distinguish mentally healthy from psychiatrically disturbed populations. Results are presented across three decades (1960s, 1970s, and 1980s), across genders, and across the high school years. A conceptual framework is presented to help the clinician working with adolescents to understand the fluctuation in psychopathology among youth. Adolescent density in the total population is shown to be a significant factor in determining the rate of disturbance among teenagers. Our research findings demonstrate that the rate of behavioral disturbance among adolescents is the same as in other parts of the life cycle. The clinician working with adolescents tends to underestimate the severity of adolescent problems because of the near-universal belief that all adolescents undergo "adolescent turmoil." We have found that adolescents who are experiencing turmoil need professional help.

Gender differences in adolescent symptomatology: a normative study.

A widespread belief that adolescence is marked by disturbance may have contributed to a lack of interest in psychiatric symptomatology in adolescents. There are few studies of adolescent gender differences. Adolescents (N = 497) from three Chicago area high schools, representing a broad socioeconomic spectrum, were administered the Offer Self-Image Questionnaire, the Delinquency Checklist, and the Symptom Checklist in which they self-report on self-image, experience of symptoms, and delinquent behavior, respectively. Results show that adolescent girls are more prone to report inwardly directed psychiatric symptomatology, such as depression and anxiety, than are adolescent boys; adolescent boys are more prone to report acting out behaviorally. Gender is an important aspect of treating adolescent patients.

Correlations of substance abuse and self-image among socially diverse groups of adolescents and clinical implications.

Two culturally diverse groups of male youths, ages 16-18, were compared with respect to self-image correlates of alcohol and drug use. Self-image was measured through use of the Offer Self-Image Questionnaire (OSIQ), a reliable, well-validated measure of adolescent self-image covering eleven separate areas of functioning. Alcohol and drug use were measured by means of the Delinquency Checklist (DCL), a self-report measure of delinquent behavior first developed by Short and Nye. The adolescents studied were culturally diverse: one group consisted of the entire junior class of an all-male, all-black Roman Catholic Parochial School located in an economically deprived urban neighborhood; the other group comprised a random sample of all the junior and senior boys in an almost all-white, upper-middle-class, suburban public high school. Results showed that in both groups drug use is associated with poor family relationships and impaired self-image. Selling drugs was more prevalent by self-report among the black, inner-city youths than it was among the white, suburban youths. Selling drugs was associated with poor impulse control, relatively low vocational and educational goals and poor coping skills. The research data is discussed in regards to its relevance to therapy of two culturally diverse groups of adolescents.

Transcultural comparisons of self-image in German and United States adolescents.

Based on the Offer Selfimage Questionnaire (OSIQ), the selfimage of German and United States adolescents was compared. The German study was based on OSIQ protocols from 365 adolescents in West Berlin while the American sample comprised adolescents drawn from seven cities in the United States. With respect to three scales, United States adolescents report better adjustment than do the German adolescents. These scales were Mastery of the External World, Vocational and Educational Goals, and Superior Adjustment. In general, these two Western societies share more similarities than differences in the selfimages of their adolescents.

Validation of police officer recruit candidates' self-reported drug use.

Three hundred and fifty-nine Chicago Police Department recruit candidates submitted urine specimens as part of a drug-screening program. Candidates were tested in two groups about a week apart. About 20% of the recruit candidates in each group evidenced drug, primarily marijuana use. As part of a psychological screening test battery all the candidates also took the Inwald Personality Inventory (IPI). The IPI contains a self-report Drug Use Scale. Drug-Positive and Drug-Negative candidates' Drug Use Scale scores were matched by age, sex, and racial/ethnic group and compared to evaluate the accuracy of self-reported drug use when screening police recruit candidates. Results showed that Drug-Positive candidates' self-reported drug use was consistently higher than that of Drug-Negative candidates. Item-level analyses showed which drug use items best discriminate between Drug-Positive and Drug-Negative candidates. Implications are drawn for use of self-report as part of a police candidate screening process.

Suicide and homicide in the United States: an epidemiologic study of violent death, population changes, and the potential for prediction.

The authors found significant positive correlations between the suicide and homicide rates for 15-24-year-olds and the proportion of 15-24-year-olds in the U.S. population from 1933 to 1982. Significant negative correlations were found for most adult age groups (35-64 years). Since future numbers of adolescents and adults can be estimated on the basis of current population data for children and preadolescents, the epidemiologic patterns for suicide and homicide may be predictable for certain age groups. However, methodologic problems are inherent in using national mortality and population data, and many years are necessary to evaluate such epidemiologic propositions.

Cross-cultural studies of sex differences in normal adolescents' self-image.

One context for understanding an adolescent's (or any other individual's) abnormal functioning is an appreciation of normal or modal functioning in the culture to which that adolescent belongs. After decades of research and clinical observation there is no consensus about what constitutes modal adolescent functioning in the United States. Much less is known about adolescent functioning in other cultures. Results were suggestive of large, cross-cultural differences in self-image among normal adolescents. In most areas American teenagers reported the best functioning while Bengali teenagers reported the worst. There were consistent gender differences in self-image across cultures, with adolescent girls showing poorer self-image than adolescent boys in many areas. Results are discussed from the point of view of difficulties in doing cross-cultural psychiatric research and the need for further research in this field.

The self-image of asthmatic adolescents.

The self-image of mildly asthmatic and severely asthmatic adolescents was compared through use of the Offer Self-Image Questionnaire (OSIQ). All those studied were seen in an outpatient private allergy practice. Comparisons were made for boys and girls separately, and the asthmatics' self-images also were compared to those of normal (nonasthmatic) subjects. Results showed no differences in self-image between mildly and severely asthmatic adolescents. Asthmatic girls' self-image was better than that of their normal counterparts in many areas. No differences between asthmatic boys' mean self-image scores and those of normal adolescent males were found. Implications were drawn for psychogenic theories of asthma and of adolescents' ability to cope with asthma, at least with asthma of the severity seen in an outpatient practice.

Hungarian adolescents' self-concept.

Hungarian and United States adolescents' self-image was studied using the Offer Self-Image Questionnaire (OSIQ). In Hungary, 1,163 younger and older male and female adolescents were studied using a Hungarian translation of the OSIQ. Analyses of endorsement patterns of OSIQ items showed that Hungarian and American adolescents endorsed many items in the same way. Similarities in endorsement patterns were much more common between the two countries than were differences. Analyses of OSIQ scales showed that for most scales younger Hungarian adolescents reported better adjustment than younger American adolescents. Differences were not as great or reversed in the older age groups. Implications for cross-cultural studies of adolescent self-image were drawn based on these results.

The self-image of physically abused adolescents.

Thirty physically abused adolescents were compared via the Offer Self-Image Questionnaire to thirty nonabused adolescents who were from a similar background. Another control group was comprised of normal adolescents tested by Offer, Ostrov, and Howard (1981). Results showed that physically abused adolescents feel worse in a number of areas when compared to nonabused adolescents. These areas include family relations, emotional stability, psychopathology, impulse control, coping skills, as well as poorer overall self-image. Implications are drawn for the professional's treatment of abused children and their responsibility to report abuse.

Family perceptions of adolescent self-image.

This study examined relationships between adolescents' self-image and perceptions of these adolescents held by their parents. It was hypothesized that parents would generally agree with their children's self-perceptions and that greater congruence between parents and their children would be associated with greater positive adolescent self-image. One hundred and six normal families participated in this study in the spring of 1981. Results showed that parents accurately perceive their adolescent children's selfimage. Specific areas of disagreement between parents and adolescents are discussed. Other results showed that mother-father agreement is associated with positive descriptions by the adolescents of their family and a positive attitude toward vocational and educational goals. Mother-child congruence scores were more highly correlated with adolescents' self-image than fatherchild congruence scores. Daughters' self-image was more highly associated with parent-child agreement than was sons' self-image.

The self-image of adolescents with acute anorexia nervosa.

The Offer Self-Image Questionnaire for Adolescents was administered to 30 female adolescents with a diagnosis of acute anorexia nervosa. Patients were divided ianto an early group (12 to 15 years; N = 15) and a late group (16 to 19 years; N = 15). The mean percent weight loss calculated as deviation from norm weight for age and height was 32%, and the mean duration of illness was 1.3 years, similar for both groups, whereas age of onset of anorexia was significantly (P less than 0.001) different. All patients differed significantly from normal adolescents by displaying disturbances in mood and self-esteem (P less than 0.05), in social relationships (P less than 0.05), and in attitude toward sex (P less than 0.05); late adolescent patients additionally showed maladjustment in impulse control (P less than 0.05), self-perception and body image (P less than 0.01), and in general psychopathology (P less than 0.05). Patients were found well adjusted with regard to moral values, family relationships, and educational goals. The lesser adjustment problems in the younger group agree well with reports finding a more favorable prognosis for patients with an early onset of anorexia nervosa.