Agricultural injuries among operation household members: RRIS-II 1999.

The purpose of this study was to determine the magnitude and consequences of agricultural injuries, and to reveal potential risk factors among agricultural household members. The Regional Rural Injury Study (RRIS-II) collected injury and exposure data on agricultural households of 16,538 people in Minnesota, Wisconsin, North Dakota, South Dakota, and Nebraska for each six-month period of 1999. Adjusted injury rates, consequences, and potential risk factors were identified through analyses. Selection of variables for multivariate analyses was based on a causal model. Injuries reported here occurred while the individuals were involved in activities associated with their own farm or ranch, unless otherwise stated. Estimates of injury rates and the effects of various exposures were derived by Poisson and logistic regression. These models accounted for correlation within both subject and household, and were adjusted for non-response. The rate of agricultural injury to household members on their own operation was 74.5 injuries per 1,000 persons per year. Differences in rates due to age and gender diminished when rates were calculated according to hours worked. Although only 5% of injured persons required in-patient hospitalization, 28% required emergency department treatment, and 84% required some type of professional health care. Moreover, 47% of all injuries required time off from agricultural work, and 7% required time off from non-agricultural work. In multivariate analyses, decreased risks were associated with Minnesota, and increased risks were identified for those with prior injuries and for males.This study provides a basis for further research on agricultural injuries and their prevention.

Sports and recreational injuries: regional rural injury study-II: impact on agricultural households and operations.

OBJECTIVES: To identify the incidence, severity, and potential risk factors for sports/recreational injuries incurred by children and adults in a five state, rural, Midwest, agricultural household population. METHODS: Computer assisted telephone interviews that included questions about all injuries were completed for eligible, participating households for 1999; 16,538 people participated, including 8488 children less than 20 years of age. Rates and 95% confidence intervals were calculated, and causal models guided multivariate models. RESULTS: Of a total of 2586 injuries, 1301 (50%) were not related to agricultural activity. Among these, 733 (28%) were associated with sports/recreational activities including multiple person sports (64%), general play activities (19%), and single person sports (14%). The overall rate was 46.4 injury events per 1000 persons per year. Rates for children were 99.4 for boys and 64.3 for girls. For adults (aged 20 and above), rates were 11.9 for men and 4.8 for women. For children, 93% received health care, 44% were restricted for seven or more days, and 18% lost agricultural work time of seven or more days; the respective proportions for adults were 88%, 45%, and 17%. Multivariate analysis for children showed increased risks for Nebraska residents, males, and those 10-14 or 15-19 years. For adults, increased risks were identified for males and those 20-24 years; decreased risks were observed for Nebraska residents and those 45-54 years. CONCLUSIONS: Sports/recreational activities are an important source of injury with relevant consequences for this population, including significant restricted daily activity and lost agricultural work time. Key findings provide a basis for further study to address these burdens.

Ordinary magic. Resilience processes in development.

The study of resilience in development has overturned many negative assumptions and deficit-focused models about children growing up under the threat of disadvantage and adversity. The most surprising conclusion emerging from studies of these children is the ordinariness of resilience. An examination of converging findings from variable-focused and person-focused investigations of these phenomena suggests that resilience is common and that it usually arises from the normative functions of human adaptational systems, with the greatest threats to human development being those that compromise these protective systems. The conclusion that resilience is made of ordinary rather than extraordinary processes offers a more positive outlook on human development and adaptation, as well as direction for policy and practice aimed at enhancing the development of children at risk for problems and psychopathology.

Integrating competence and psychopathology: pathways toward a comprehensive science of adaptation in development.

This paper examines the conceptual and empirical connections between competence and psychopathology, two historically rich traditions for the study of adaptation in development, and what might be gained from their integration. Historical roots of these two traditions are reviewed, then overlaps in their definition are considered, with a focus on the ways in which judgments about competence enter into the nosology of mental disorders. DSM-IV is analyzed from the perspective of competence, and the debate about "harmful dysfunction" in defining mental disorder is discussed in relation to competence. Different models explaining the empirical associations of competence and psychopathology are delineated, and illustrative empirical evidence is provided. Potential explanations include confounded concepts and methods, symptoms undermining the effectiveness of adaptation in the environment, failures in age-salient developmental tasks leading to emotional and behavioral problems, transactional influences, shared vulnerability or risk factors producing both kinds of difficulties, and more complex models. The potential benefits of integrating competence and psychopathology as two major approaches to adaptation are discussed in regard to theory, classification of mental disorder, research, and intervention.

Competence in the context of adversity: pathways to resilience and maladaptation from childhood to late adolescence.

Competent outcomes in late adolescence were examined in relation to adversity over time, antecedent competence and psychosocial resources, in order to investigate the phenomenon of resilience. An urban community sample of 205 (114 females, 90 males; 27% minority) children were recruited in elementary school and followed over 10 years. Multiple methods and informants were utilized to assess three major domains of competence from childhood through adolescence (academic achievement, conduct, and peer social competence), multiple aspects of adversity, and major psychosocial resources. Both variable-centered and person-centered analyses were conducted to test the hypothesized significance of resources for resilience. Better intellectual functioning and parenting resources were associated with good outcomes across competence domains, even in the context of severe, chronic adversity. IQ and parenting appeared to have a specific protective role with respect to antisocial behavior. Resilient adolescents (high adversity, adequate competence across three domains) had much in common with their low-adversity competent peers, including average or better IQ, parenting, and psychological well-being. Resilient individuals differed markedly from their high adversity, maladaptive peers who had few resources and high negative emotionality. Results suggest that IQ and parenting scores are markers of fundamental adaptational systems that protect child development in the context of severe adversity.

Measuring developmental changes in exposure to adversity: a Life Chart and rating scale approach.

The reliability and validity of a comprehensive, integrative strategy for assessing adversity exposure in childhood and adolescence was examined in a community-based longitudinal study of 205 children. Extensive data from multiple measures completed by adolescents and their parents regarding chronic and acute life experiences were aggregated into a Life Chart record of lifetime adversity exposure. Severity of adversity in three nonoverlapping time spans was rated by trained judges with excellent interrater reliability. As hypothesized, Family adversity predominated over all other types of adversity in childhood, remained salient into midadolescence, and showed considerable stability over time. Adversity related to an individual's own behavior and psychological functioning rose to equal prominence by late adolescence. Adversity arising from physical ailments that were independent of the individual's psychological functioning declined over time, while adversity arising from the community rose; physical and community events were uncommon for most individuals but substantial for some. Results suggest that coherent developmental trends in adversity exposure may be identified effectively through judges' ratings of severity of adversity over multiple-year time spans.

The development of competence in favorable and unfavorable environments. Lessons from research on successful children.

The development of competence holds great interest for parents and society alike. This article considers implications from research on competence and resilience in children and adolescents for policy and interventions designed to foster better outcomes among children at risk. Foundations of competence in early development are discussed, focusing on the role of attachment relationships and self-regulation. Results from studies of competence in the domains of peer relations, conduct, school, work, and activities are highlighted. Lessons are drawn from studies of naturally occurring resilience among children at risk because of disadvantage or trauma and also from efforts to deliberately alter the course of competence through early childhood education and preventive interventions. Converging evidence suggests that the same powerful adaptive systems protect development in both favorable and unfavorable environments.

The structure and coherence of competence from childhood through adolescence.

The structure and coherence of competence from childhood (ages 8-12) to late adolescence (ages 17-23) was examined in a longitudinal study of 191 children. Structural equation modeling was utilized to test a conceptual model and alternative models. Results suggest that competence has at least 3 distinct dimensions in childhood and 5 in adolescence. These dimensions reflect developmental tasks related to academic achievement, social competence, and conduct important at both age levels in U.S. society, and the additional tasks of romantic and job competence in adolescence. As hypothesized, rule-breaking versus rule-abiding conduct showed strong continuity over time, while academic achievement and social competence showed moderate continuity. Results also were consistent with the hypothesis that antisocial behavior undermines academic attainment and job competence.

Comorbidity of psychiatric diagnoses with posttraumatic stress disorder in survivors of childhood trauma.

OBJECTIVE: This study examines posttraumatic stress disorder (PTSD) symptoms, trauma exposure, gender, and diagnostic comorbidity in a sample of 59 Cambodian young adults (29 male and 30 female) who survived massive trauma as children. METHOD: Psychiatric diagnoses were made using the Structured Clinical Interview for DSM-III-R-Non-Patient version, a structured diagnostic interview, and trauma exposure was measured with a Traumatic Life Events Questionnaire. RESULTS: A significant number of those with PTSD (59%) had one or more additional DSM-III-R Axis I disorders. Major depression and generalized anxiety disorder were the most common comorbid disorders. Somatoform pain disorder was also found to coexist with PTSD but only among females. Women were also found to have higher levels of both current and lifetime PTSD symptoms. CONCLUSION: Trauma symptoms were related to exposure and exposure was related to age, but age was not related to symptoms. The findings suggest that the significant levels of comorbid diagnoses previously found to exist with PTSD in people traumatized as adults can be found among survivors of massive childhood trauma. Also, the rate of PTSD diagnoses found in this sample 15 years after the trauma of Pol Pot is comparable to findings previously reported in studies of Cambodian youths and shows that the effects of trauma experienced in childhood persist into early adulthood.

Children in homeless families: risks to mental health and development.

This study examined the psychological adjustment of 159 homeless children in comparison with a sample of 62 low-income children living at home. In each group, ages ranged from 8 to 17 years. As expected, homeless children were found to have greater recent stress exposure than housed poor children, as well as more disrupted schooling and friendships. Child behavior problems were above normative levels for homeless children, particularly for antisocial behavior. Across the 2 samples, however, behavior problems were more related to parental distress, cumulative risk status, and recent adversity than to housing status or income. Results suggest that homeless children share many of the risks and problems of other American children being reared in poverty.

Peer reputation in middle childhood as a predictor of adaptation in adolescence: a seven-year follow-up.

This investigation examines the predictive significance of peer reputation in elementary school for the quality of adaptation in adolescence. A normative sample (N = 207) of third to sixth graders was administered the Revised Class Play (RCP). Each received 3 scores (Sociability-Leadership, Aggression-Disruption, and Sensitivity-Isolation). 7 years later, 88% of these children and their parents participated in a questionnaire follow-up study utilizing a broad range of adolescent outcome measures (e.g., social and athletic competence, academic performance, behavioral symptoms, well-being). The 3 RCP scores were significantly related to both adolescent competence and psychopathology, supporting the predictive validity of the RCP as well as the continuity of general adaptation. Each dimension of peer reputation had a different pattern of prediction depending on the outcome criteria under consideration, suggesting the importance of a multidimensional approach to peer reputation. Positive peer reputation proved to be an important predictor of later adjustment. Sex differences were examined; results suggested somewhat different patterns of prediction for boys and girls, especially for the sensitive-isolated dimension.

Vulnerability, stress, and resilience in the early development of a high risk child.

A young girl at risk for schizophrenia is admitted for inpatient evaluation at age 30 months with growth failure and psychosocial retardation. Her history suggests that adverse environmental experiences, particularly the traumatic loss of primary caregivers around age 15 months, resulted in symptoms consistent with the clinical picture of anaclitic depression and associated psychosocial dwarfism. Intervention in the form of hospitalization and placement by "prescribed" adoption into a favorable caregiving environment produced dramatic recovery in growth and psychological functioning. Follow-up data document sustained positive development 3 1/2 years later. This case illustrates the power of a developmental perspective on psychopathology for conceptualizing and planning treatment for an individual child.

Competence and stress in school children: the moderating effects of individual and family qualities.

This study examined the associations of stress exposure to various aspects of school-based competence in a normative sample of 205 children aged 8-13. Potential moderators of these relations, including child attributes of sex and IQ and environmental attributes of socioeconomic status (SES) and family qualities, were also studied. Stress exposure was indexed by a life event questionnaire. Competence was assessed by teacher ratings, peer assessments and school record data. Family attributes were derived from a set of rating scales completed by interviewers after 6 hours of interviews with a parent. Results suggest that the relations of stress exposure to competence vary as a function of individual differences as well as the competence criterion. Disadvantaged children, with lower IQ and SES, and less positive family qualities, were generally less competent and more likely to be disruptive at high stress levels. Advantaged children were more competent, and with stress positively engaged in school, but were not likely to be disruptive. Boys were less socially competent than girls and, when stress was high, appeared to be less protected by positive family qualities. Causal hypotheses for future research in this area are discussed.

Correlates of social and academic competence in middle childhood.

The correlates of social and academic competence were investigated in 9-14 yr old children. Factor analysis of multiple measures of cognitive functioning, excluding IQ identified three dimensions: (1) Social Comprehension; (2) Cognitive Efficiency and (3) Divergent Thinking. The social comprehension dimension was derived from measures of humor and social cognition. Although strongly related to IQ, Social Comprehension still had a substantial unique relation to social competence in a school setting, as assessed by teachers and peers. While this dimension was the best predictor of social competence, IQ was by far the most powerful predictor of academic competence.

Humor and competence in school-aged children.

Multiple aspects of humor were evaluated in children between the ages of 10 and 14 and related to several areas of competence manifested at school. Humor measures assessed appreciation (including mirth, subjective ratings, and response sets), comprehension, and production, while competence measures included teacher ratings of classroom behavior, peer reputation, and achievement. Humor was related to competence in several ways consistent with previous theory and research: (1) through the manifestation of intellectual ability both in humor behaviors and in competent functioning; (2) through the role of mastery motivation enhancing both types of functioning; and (3) through peer relations, resulting from the effects of humor on peer acceptance or the effects of peer relations on humor behaviors. Ideas for further research relating humor to social competence, social cognition, and mastery motivation are discussed.

The study of stress and competence in children: a building block for developmental psychopathology.

This article discusses the building blocks for a developmental psychopathology, focusing on studies of risk, competence, and protective factors. The current Project Competence studies of stress and competence are described, with particular attention to the methodology and strategies for data analysis. The authors present a 3-model approach to stress resistance in a multivariate regression framework: the compensatory, challenge, and protective factor models. These models are illustrated by selected data. In the concluding section, an evaluation of the project is offered in terms of future directions for research.

Family therapy as a treatment for children: a critical review of outcome research.

The value of family therapy as a treatment for child psychopathology is considered by reviewing pertinent outcome research. Fourteen studies that met three criteria are included in the review: (a) a child or adolescent was the identified patient or referral; (b) therapy included at least one parent and the child; and (c) outcome was evaluated in terms of the child's symptoms. There are major shortcomings in most of the available data, with only two well-controlled studies. Some empirical evidence does exist that family therapy is an effective treatment for children; the data from studies of adolescents are especially encouraging. However, insufficient data are available for comparing the relative merits of conjoint family treatment and individual child therapy. If the value of family therapy as a treatment alternative or, ideally, as the "treatment of choice" for a referred individual child is to be established, more and better controlled comparative outcome studies will be necessary. Suggestions for future research are presented emphasizing the need for a developmental perspective by recommending, for example, the use of factorial designs in which the intervenaction of treatment and age can be analyzed.