Moderated mediation of the link between parent-adolescent conflict and adolescent risk-taking: The role of physiological regulation and hostile behavior in an experimentally controlled investigation.

Compared to childhood and adulthood, adolescence is a time of greater risk-taking behavior, potentially resulting in serious consequences. Theories of adolescent brain development highlight the imbalance between neural circuitry for reward vs. regulation. Although this imbalance may make adolescents more vulnerable to impaired decision-making in the context of heightened arousal, not all adolescents exhibit problematic risk behavior, suggesting other factors are involved. Relatedly, parent-adolescent conflict increases in mid-adolescence, and is linked to negative outcomes like substance use related risk-taking. However, the mechanism by which parent-adolescent conflict and risk-taking are linked is still unknown. Therefore, we investigated this association using a multi-method experimental design. Parent-adolescent dyads were randomly assigned to complete a discussion task together on the topic of either the adolescent's dream vacation or an adolescent-identified conflict topic. During the task, adolescent peripheral psychophysiology was measured for later calculation of heart rate variability (HRV), an index of self-regulation. Immediately after the discussion task, adolescents completed a performance-based measure of risk-taking propensity that indexes real-world risk behaviors. We hypothesized that parent-adolescent conflict would predict greater adolescent risk-taking propensity, and that increased behavioral arousal in the context of conflict, coupled with impaired self-regulation, would explain this link. Results indicated no direct effect of parent-adolescent conflict on adolescent risk-taking propensity. However, there was a significant conditional indirect effect: lower HRV, indexing worse regulatory ability, mediated the relation between conflict and risk-taking propensity but only for adolescents exhibiting behavioral arousal during the discussion task. We discuss implications for understanding adolescent risk-taking behavior.

Toward Developing Laboratory-Based Parent-Adolescent Conflict Discussion Tasks that Consistently Elicit Adolescent Conflict-Related Stress Responses: Support from Physiology and Observed Behavior.

Parent-adolescent conflict poses risk for youth maladjustment. One potential mechanism of this risk is that stress in the form of increased arousal during conflict interactions results in adolescents' impaired decision-making. However, eliciting consistent adolescent stress responses within laboratory-based tasks of parent-adolescent conflict (i.e., conflict discussion tasks) is hindered by task design. This limitation may stem from how conflict topics are assessed and selected for discussion. Within a sample of 47 adolescents (ages 14-17) and parents, we investigated whether a modified version of a conflict discussion task could elicit physiological (i.e., arousal) and behavioral (i.e., hostility) displays of adolescents' conflict-related stress responses. We assessed parent-adolescent conflict via structured interview to identify topics for dyads to discuss during the task. We randomly assigned dyads to complete a 5-minute task to discuss either a putatively benign topic (i.e., control condition) or a conflict topic while undergoing direct assessments of continuous arousal. Trained raters coded dyad members' hostile behavior during the task. Adolescents in the conflict condition exhibited significantly greater levels of arousal than adolescents in the control condition. We observed an interaction between discussion condition and baseline conflict. Specifically, higher baseline conflict predicted greater hostile behavior for adolescents in the conflict condition, yet we observed the inverse relation for adolescents in the control condition. Our modified laboratory discussion task successfully elicited both physiological and behavioral displays of adolescent conflict-related stress. These findings have important implications for leveraging experimental paradigms to understand causal links between parent-adolescent conflict and adolescent psychopathology, and their underlying mechanisms.

The developmental trajectory of perceived stress mediates the relations between distress tolerance and internalizing symptoms among youth.

The current study examines the relation between distress tolerance, perceived stress, and internalizing symptoms across adolescence. Participants included 331 youth, ages 10 to 14 at the first wave of the study, assessed annually over 5 years. A latent growth curve approach was used to test three research questions, including whether perceived stress would increase across adolescence, whether distress tolerance (as measured by a behavioral task) would predict changes in perceived stress, and whether changes in perceived stress would mediate the relation between distress tolerance and internalizing symptoms. Results suggest that, consistent with previous findings, rates of perceived stress do increase across adolescence. Further, findings indicate that distress intolerance at baseline predicted increases in perceived stress, which in turn drove increases in internalizing symptoms. These findings point to the critical role of distress tolerance in bringing about changes in depression and anxiety symptoms and suggest support for utilizing a negative reinforcement framework to understand the emergence of internalizing symptomology.

Environmental, dietary and case-control study of Nodding Syndrome in Uganda: A post-measles brain disorder triggered by malnutrition?

Nodding Syndrome (NS) is an epileptic encephalopathy characterized by involuntary vertical head nodding, other types of seizures, and progressive neurological deficits. The etiology of the east African NS epidemic is unknown. In March 2014, we conducted a case-control study of medical, nutritional and other risk factors associated with NS among children (aged 5-18years) of Kitgum District, northern Uganda (Acholiland). Data on food availability, rainfall, and prevalent disease temporally related to the NS epidemic were also analyzed. In NS Cases, the mean age of reported head nodding onset was 7.6years (range 1-17years). The epidemiologic curve of NS incidence spanned 2000-2013, with peaks in 2003 and 2008. Month of onset of head nodding was non-uniform, with all-year-aggregated peaks in April and June when food availability was low. Families with one or more NS Cases had been significantly more dependent on emergency food and, immediately prior to head nodding onset in the child, subsistence on moldy plant materials, specifically moldy maize. Medical history revealed a single significant association with NS, namely prior measles infection. NS is compared with the post-measles disorder subacute sclerosing panencephalitis, with clinical expression triggered by factors associated with poor nutrition.

Childhood emotional abuse and borderline personality features: The role of anxiety sensitivity among adolescents.

Borderline personality disorder (BPD) is a pervasive personality disorder that poses a burden for affected individuals, their family members and society as a whole. Current research suggests that early childhood abuse, including emotional abuse, may be an important predictor of later BPD symptomology. Further, an emerging body of literature suggests that anxiety sensitivity (AS) may serve as a form of emotional vulnerability and be a key variable in the relation between abuse and the development of BPD symptomatology. This literature has relied on retrospective recall of abuse and AS in adult samples. As a result, there is a dearth of literature examining these variables in adolescence, which is a developmental period in which personality traits begin to emerge. This study explored the impact of AS in the development of BPD symptoms in a group of 277 adolescents. Results suggest a significant indirect effect of emotional abuse on BPD symptoms via AS, after controlling for sex, grade and prior levels of AS (indirect effect = 0.04, standard error (SE) = 0.02 (95% confidence interval (CI) = 0.001-0.070)). These findings suggest that, among adolescents, AS may serve as an important contributor to the development of BPD symptoms. Implications for interventions and future research are further discussed.

Personality assessment inventory profile and predictors of elevations among dissociative disorder patients.

Assessing patients with dissociative disorders (DD) using personality tests is difficult. On the Minnesota Multiphasic Personality Inventory-2 ( J. N. Butcher, W. G. Dahlstrom, J. R. Graham, A. Tellegen, & B. Kaemmer, 1989 ), DD patients often obtain elevations on multiple clinical scales as well as on validity scales that were thought to indicate exaggeration yet have been shown to be elevated among traumatized individuals, including those with DD. No research has been conducted to determine how DD patients score on the Personality Assessment Inventory (PAI; L. C. Morey, 1991 ), which includes the symptom exaggeration scale Negative Impression (NIM) and the malingering scales Malingering Index (MAL) and Rogers Discriminant Function (RDF). The goals of this study were to document the PAI profile of dissociative identity disorder (DID) and dissociative disorder not otherwise specified (DDNOS) patients and to determine how the validity and Schizophrenia scales are related to other PAI scales as well as dissociation. A total of 42 inpatients with DID or DDNOS were assessed on the PAI as well as the Dissociative Experiences Scale-II. The DID/DDNOS patients were elevated on many PAI scales, including NIM and, to a lesser extent, MAL, but not RDF. Dissociation scores significantly and uniquely predicted NIM scores above and beyond Depression and Borderline Features. In addition, after we controlled for MAL and RDF, dissociation was positively associated with NIM. In contrast, after we controlled for the other 2 scales, dissociation was not related to MAL and was negatively related to RDF, indicating that RDF and, to a lesser extent, MAL are better correlates of feigning in DD patients than NIM.

What contributes to predicting change in the treatment of dissociation: initial levels of dissociation, PTSD, or overall distress?

Individuals with dissociative disorders (DDs) suffer from high levels of dissociation as well as posttraumatic stress disorder (PTSD) and general distress. No research has investigated how changes in dissociation relate to changes in other symptoms over the course of treatment in patients with DD. Using a prospective, naturalistic design, we collected reports of symptoms from a sample of therapists and their patients diagnosed with dissociative identity disorder or dissociative disorder not otherwise specified who participated in the Treatment Outcome of Patients with Dissociative Disorders study. The patients completed surveys at intake (Time 1) into the study and at 30-month follow-up (Time 4). We found that dissociative symptoms, including amnesia, depersonalization/derealization, and absorption, at the initial assessment of the study ("initial") were related to initial levels of PTSD and general distress and that changes in dissociative symptoms were related to changes in PTSD and general distress. Initial dissociation was a significant predictor of change in dissociation at 30 months when we controlled for length of time for follow-up, length of time practicing therapy, and length of time treating dissociative patients. Our results suggest that a reduction in dissociative symptoms in DD patients is associated with reductions in the overall severity of dissociative, posttraumatic stress, and distress symptoms.