Detection of psychosocial deficits of children 9-12 years old, due to their parents divorce
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One of the greatest hopes of children, whose parents have a happy and enduring marriage, is that they will end up in such an endearing relationship. Similarly, one of the greatest fears of individuals whose parents are divorced or who have an unhappy and dysfunctional relationship is that they too, will have such an unhappy/unfulfilling marriage. These hopes and fears are common emotions of offspring who contemplate their futures and wonder of the degree to which their parent's divorce will affect their own. (2003) The effect of parental divorce on offspring has been the subject of considerable research. Previous researchers have revealed that parental divorce is associated with diminished psychological, social and physical well being (2003), one's own divorce (2000), and reduced commitment to marriage ( 2001).
Attention-deficit hyperactivity disorder (ADHD) is a familial disorder that places the children of separated parents from those children who have normal parents and family structure as these children are at the high risk for ADHD, conduct, mood and anxiety disorders. Although the pattern of psychiatric risk has been documented by prior family studies, neither the short- nor long-term outcome of the children’s behavior has been well examined. It is important to be able to document a four-year psychiatric, psychosocial and neuropsychological outcome of the children’s psychosocial deficits resulting to a serious ADHD problem as DSM-III-R structured diagnostic interviews and blind raters can be used to conduct a four-year follow-up of these children and control families for cognitive, achievement, social, school and family functioning. There were significant elevations of behavioral, mood, and anxiety disorders were found among the siblings of ADHD children. The high-risk siblings had high rates of school failure and showed evidence of neuropsychological and psychosocial dysfunction. These impairments aggregated among the siblings who had ADHD for clinically meaningful levels of psychopathology and functional impairment. In addition, there suggests that the high-risk siblings might be appropriate targets for primary preventive interventions.
Family studies of attention-deficit hyperactivity disorder find the siblings of ADHD children to be at high risk for ADHD, comorbid psychiatric disorders, school failure, learning disability, and impairments in intellectual functioning (1992; 1972; 1994;1993, 1971;1977). However, although longitudinal studies have taught people much about the course and outcome of children with ADHD, little is known about either the short or long-term outcome of their high-risk siblings and refer to these children with the term "high-risk" because the fact of being the sibling of a child who has ADHD raises the empirical probability that the sibling will experience clinically meaningful levels of psychopathology and functional impairment. As others have shown for schizophrenic (1993; 1970), mood (1987), and anxiety (1990; 1988) disorders, the study of children from families selected through ill index cases can clarify predictors of new onsets and the nature of developmental pathways to illness. Moreover, it may help to identify children at risk who would be suitable for primary prevention as the knowledge could help focus scarce societal resources toward those children at highest risk for psychiatric and cognitive disability (1992).
Thus, findings of psychometrically assessed intellectual impairment and learning disabilities strengthen the hypothesis that ADHD is familial and that the apparent risk imparted to the siblings of ADHD children does not simply reflect biases of parental report and that the siblings of ADHD children would be at increased risk for psychosocial dysfunction in multiple domains. Prior studies have not addressed the psychosocial functioning of these high-risk children. However, many studies show that ADHD and its comorbid conditions are associated with difficulties in adaptive functioning. For example, (1993) showed that children with ADHD had more impaired scores than controls on scales reflecting school behavior, use of spare time, and problems with peers, parents, and siblings. (1987) reported that impairments in these domains were also associated with conduct disorder, dysthymia, and major depression. The assessment of children's adaptive functioning has broad-range implications information on adaptive functioning provides useful and relevant data for treatment planning that adds to the information derived from assessments of psychopathology.
Scientifically, the identification of deficits in adaptive functioning may aid in the understanding of childhood psychopathological conditions. Psychiatric disorders with differing functional abilities may have varying etiologies, treatment responses, and outcomes (1984). Since problems in adaptive functioning may precede the onset of psychopathology, information on children's adaptive functioning can facilitate early identification and lead to preventive strategies (1990). In addition to psychiatric data, there assessed cognitive functioning using subtests from social functioning with the Global Assessment of Functioning (GAF) scale of the DSM-III-R and the Social Adjustment Inventory for Children and Adolescents (SAICA); dimensional measures of child syndromes as measured by the Child Behavior Checklist (CBCL) (1991). School dysfunction was assessed by documenting repeated grades, placement in special classes or need for tutoring. These assessments were identical for baseline and follow-up assessments with one exception. At baseline the Gilmore Oral Reading test assessed reading ability, be at the follow-up examinations we used the reading subtest of the WRAT-R. All cognitive, school and psychosocial assessments at follow-up were blind to baseline data collected on the same subjects.
The pattern of results on the psychosocial functioning scales of the CBCL was similar to that of the SAICA as the high-risk children were rated as more impaired on all three CBCL scales, but the differences were small. The only significant differences were for the School Problems scale at baseline and the Social Problems scale at year four. Notably, the high-risk children, but not the controls, showed significant improvement in the School Problems scale of the CBCL. Both showed improvements in the Social Functioning scale. These were significant for controls, and marginally so for the high-risk siblings. Overall functioning, as measured by the DSM-III-R GAF scale, was significantly worse among the high-risk compared with control siblings. This was so at each assessment. The mean GAF scores did not change over the follow-up period for either the high-risk or control children from having negative approaches because of parental divorce.
In the psychosocial domain, differences between the high-risk and control children were in the predicted direction but were of a relatively small magnitude. Notably, in all of the domains examined, the ADHD children of ADHD probands were clearly more impaired compared with the non-ADHD children and the control children. (1992) In the psychosocial domain, the high-risk siblings showed evidence of dysfunction on the social functioning scales of both the CBCL and the SAICA. The high-risk siblings performed poorly in both the home and at school and showed relationship problems with peers, parents, and siblings. However, the impairments in the psychosocial domain were less robust than what we observed for psychopathology and neuropsychological functioning. Although we know of no other psychosocial studies of the siblings of ADHD probands, our results are consistent with the known deleterious impact of ADHD and other psychiatric disorders on the social functioning of children (1993; 1987).
In addition to confirming prior findings that ADHD is a familial disorder, our results have clinical implications for the treatment of ADHD families. First, clinicians should be alert to the increased risk for siblings of ADHD children to have psychiatric, psychosocial disabilities that may profoundly affect family functioning and interfere with the therapeutic process. Second, even though one child is usually the reason for a family's referral, other children in the family may have problems that warrant clinical attention. Thus, the routine screening of siblings of ADHD children may be indicated. Furthermore, children in ADHD families who do not show evidence of psychiatric disability at an initial screening are at high risk for developing psychopathology in the future. This would be especially true of young children who have not yet passed through the age of risk examined in this report. These children might be appropriate targets for developing primary preventive intervention strategies. Thus, clinicians should consider the periodic screening of these high-risk siblings through childhood and adolescence. In addition, although raters were blind to the diagnosis of the children, parents were not. Another potential source of bias stems from the lack of direct interviews with children younger than twelve years old. The method for assessment of psychopathology in the children may have led to under representation of psychopathology within the group especially, in the case for "internalizing" disorders such as anxiety and depression.
However, the researchers’ assessment method had some sensitivity to these disorders because we found elevated rates of anxiety and depression in the high-risk sample. Moreover, children younger than 12 have limited expressive and receptive language abilities, inability to map events in time, limited powers of abstraction, and a limited vocabulary. Thus, there is a real question about whether the young child's self-perceptions, memories, feelings and reported behavior can be reliably assessed through self-report, especially as regards lifetime history of psychopathology (1987). Although limited, studies on the use of interview techniques among children younger than 12 show that their replies are unreliable (1987). This, in combination with comorbid psychopathology, impaired neuropsychological function, and evidence of psychosocial disability, suggests that the siblings of ADHD children are a high-risk group that might be appropriate targets for screening programs and primary preventive interventions (1998).
Although most community studies of young children have focused on psychosocial risk factors for behavioral problems in general ( 1995; 2001), little is known about psychosocial risk factors for specific DSM-based diagnoses. This is mainly because there are relatively few methods for specifically evaluating younger children (1996) and because information obtained from children of this age is considered unreliable (1985). An important exception in this field is the study of (1998), in which 9 year old children were investigated for predictors of stability and change in psychiatric disorders, based on "best estimates." The authors concluded that family context especially lower levels of family cohesion, more negative life events and negative affect by mothers contributed to the onset or maintenance of problems starting in early school years. Furthermore, only complex disruptive and emotional disorders are investigated and no attention was paid to risk factors for individual DSM diagnoses.
Psychosocial Risk Factors
The most important risk factors differentiating between children with and without disorders were low-level parental occupation, single-parent family, and occurrence of a life event. These risk factors are consistent with those found in other studies focusing on older children (1996; 1989; 1990). However, although (1990) found that risk factors discriminated between children with and without disorders rather than between children with different disorders, the results identified unique risk factors for different child psychiatric domains. A possible explanation for this difference is that the earlier studies did not have sufficient statistical power. (1990) recognized that while their sample was large enough to distinguish between children with and without disorders, the groups of children with different disorders were too small to detect statistically significant differences between the different diagnoses. Our two-stage design had the advantage of generating high rates of different diagnoses ( 2001).
During the same time period, the divorce rate has tripled so has the percentage of children across the nation living with only one parent. Since 75 percent of divorced mothers and 80 percent of divorced fathers remarry, and since the divorce rate in remarriages is higher than in first marriages, many children must not only ride out one divorce, but must navigate through the stormy seas of remarriage, only then to be knocked off course by a second divorce. As of two years after a divorce, contact with fathers’ falls off precipitously only 16 percent of all children will see their fathers at least once a week, and nearly 50 percent will have no contact with their fathers at all. Fathers will be entirely absent from the lives of almost 66 percent of these children ten years after the divorce. Divorce is not always a negative experience for children. Divorce may rescue children from a miserable and destructive home situation created by warring parents. Many children from divorced families eventually lead gratifying adult lives and create stable families of their own. Children's responses to divorce vary in relation to many factors, including their age, gender and the degree of other stresses in their lives.
Yet, divorce imposes large costs for millions of children, both immediately and over time. Immediately following the divorce, many children find themselves filled with anger, resentment, depression, and anxiety. Helplessness often overwhelms them. Many children infer that they cannot control events that deeply affect their lives. Guilt and shame may also overtake some children, as they hold themselves responsible for their parents' failed marriages. Because of such emotional turmoil, children from divorced families commonly have problems in school and difficulties with peers in the time immediately surrounding the divorce. Divorce may also fundamentally change the way children think about the future and impair their abilities to form lasting relationships and to love. Analysis of recent survey data indicates that only 43 percent of children of divorced parents say as adults that "people can be trusted," compared with 57 percent of children from non-divorced families. Children of divorced parents are also significantly more likely to state that "other people will try to take advantage of |them'" and that other people are "just looking out for themselves." Children from divorced families must often deal with the loss of one parent and also the potentially unstable status of their custodial parent. Divorced parents often grieve for years.
The Census Bureau recently released a study, by which found that children are about twice as likely to be living in poverty after their parents divorce compared with the chances of living in poverty before divorce. Gross income of custodial parents dropped an average of twenty five percent and only slightly recovered sixteen months after the divorce. Children share the difficulties of their parents following a divorce and may also become caught in their parents' cycles of suffering. A parent may be moody, arbitrary, or emotionally unavailable, compounding the problems for children who need stability, solidity, and responsiveness. Needy, fractious children in turn lock horns with parents who are often themselves needy and angry at the world. The tensions surrounding divorce may inflame sibling rivalries. Families suffering income losses due to divorce must often move to a new and frequently poorer neighborhood. Precisely when both children and custodial parents need their familiar anchors, they suffer disruptive changes.
According to a survey conducted by the National Commission on Children, parents believe that they can control their own children but not their own neighborhoods. Nearly half of all parents report that other than their homes, there is no safe place in their neighborhood for children and teens to gather. And yet at home, children spend decreasing time with their parents. Together, however, they may reverberate through the whole of a child's existence. It is one thing for a child to experience the dislocation of divorce; it is another to experience this in addition to repeated moves in and out of schools and neighborhoods. When these experiences are compounded by the presence of weapons and other threats to safety at school, including drugs and alcohol, without connection to other adults beyond mass media images, what happens to children's trust, self-confidence, and well-being? These cumulative effects not only shrink the gratifications of childhood, but undercut the development of many children into adults who can work, love, create stable families of their own, and contribute meaningfully to society. This current portrait of children's needs draws upon, and mirrors, other statements made by commissions, foundation presidents, social service professionals, and business leaders. Though no obvious solutions follow from the statements of needs and crises, these varied statements, like ours, aim to generate political will to support public or private reforms to support children.
As most efforts to describe the needs of children make dear, the condition of their parents is critical. If one or both parents face poverty, unemployment, or health problems, the child will face the same problems alongside risks of unsafe conditions and inadequate attention. Societal refusals to assure adults an annual income and to raise levels of welfare benefits to reflect the cost of living end up hurting many children. Assuring child assistance may seem to involve redressing the causes of homelessness, joblessness and illness and taking on the thus far unresolved policy debates over reviving the American economy and establishing some system of universal health coverage. Housing, crime, and drug policies would quickly crop up on this agenda as well as divorce rates, rates of unwed parenthood, infant mortality, teen homicide, and suicide. The list of unsolved social problems seems overwhelming. If these must be solved in order to have meaningful responses to the status of children, the task may seem impossible and the effort to couch the task in terms of children's needs may seem beside the point.
Moreover, the failures to locate children's needs in the larger patterns of societal issues also produce mistakes and frustrations. Provision of high quality services for children will make little difference if their parents cannot take advantage of them. Moreover, powerful evidence repeatedly establishes that parents' health and educational status are the best predictors of children's well-being. Schools could in turn develop family centers that provide various services and that are a natural referral agency for home visitors. These centers could be structured to provide activities and services for children as well as parents, such as literacy and general equivalency diploma classes. Teachers could also receive assistance and support as they do in the Comer schools as in identifying the needs of children and in connecting parents and children to the family center. To strengthen continuity, home visitors might conduct regular follow-up visits with families who have received assistance and become long-term family coordinators for a small number of especially hard-pressed families. Schools could agree to strengthen continuity by assigning children to the same homeroom teacher for at least two years about children and social change, about human capacities for imagining and creating a better world.
As stressful situations cause both subtle and dramatic cognitive, emotional, and physical responses in the body that are often manifested as perceptible symptoms (2000). Stress responses are important and adaptive in the short-term, but long-term exposure to stress may lead to somatic illness and maladaptive emotional or social functioning (2000; 2000). Child Behavior Checklist (CBCL) Problem Behavior Scale. The CBCL Problem Behavior Scale is a 122 item instrument that is not self-report, but is completed by parents of children ages 4-16 (2000). The CBCL is a widely used instrument that includes a Behavior Problem Scale and a Social Competence Scale. The Behavior Problem Scale requires parents to circle 0 = "not true" 1 = "somewhat or sometimes true," or 2 = "very true or often true" on 118 behaviors with respect to their child. Nine subscales were derived from factor analysis of scores on combined samples of over 2,300 children. Boys' subscales are labeled schizoid or anxious, depressed, uncommunicative, obsessive-compulsive, somatic complaints, social withdrawal, hyperactive, aggressive and delinquent. Girls' subscales include depressed, social withdrawal, somatic complaints, schizoid-obsessive, hyperactive, sex problems, delinquent, aggressive and cruel.
Although the CBCL is commonly used in stress research with children, parent-report instruments are limited by what parents can observe or by what children tell their parents thus, the meaning of the scores may be questioned. For example, the average correlation between parent and child ratings ranged from 0.23 to 0.44 for externalizing symptoms and from 0.07 to 0.36 for internalizing symptoms (1997). Of course, the instrument was not designed for self-report, and children may not have understood all of the words used in the instrument. Today, children experience higher levels of stress than ever before. Negative life events such as community and school violence, domestic terrorism, poverty, divorce, poor parenting skills, and school problems such as academic difficulties or friendship problems are a reality for many children. These stressful life events can cause emotional and psychological problems. Furthermore, children have little control over their environments and therefore may not be able to actively prevent or seek alleviation from stress. Still, some children, regardless of stressful life experiences, show high levels of resilience. That is, they seem to show a tremendous ability to actively handle life's demands.
(1996) found that social interest and belonging were related to adults' perceived coping resources. Because this study indicated that adults' coping resources for stress were linked to feelings of belonging, we felt it was important to examine children's level of social interest in relation to their perceptions about stress coping. It is logical that feeling connected to others and having a sense of social support would buffer feelings of stress (2000). The most severe stressful life events are often unpredictable and unavoidable and involve loss such as parental separation, death of a parent or other close person, or a close friend moving away. Other stressful life circumstances include poverty; poor housing; family, community and national violence; parental physical infirmity; parental psychiatric illness; parental alcohol dependence; family discord; and school problems such as academic hardship or friendship problems (2000). Adler believed that it was essential for individuals to possess an active approach to confronting problems and the demands of life and that social interest was critical for such an approach ( 1956).
"'Social interest' is at the heart of Adlerian psychology and is widely considered the central concept of Adlerian theory" ( 2001). (1982) stated that believed that mental health, or one's "personal success in life" (), was a function of one's social interest. (1986) Social interest is thought to be the key factor in a healthy, functional personality (1964). believed that social interest was the cornerstone of mental health (1991). School connectedness plays a critical role in the success or failure of today's middle and high school student (1996). (1998) report that "most children fail in school not because they lack the necessary cognitive skills, but because they feel detached, alienated, and isolated from others and from the educational process" ().
Furthermore, (1997) stated that students who do not feel a sense of belonging at school are at risk for gang involvement and dropping out of school. (1997) stated that a feeling of connection to school is the best predictor of adolescent well-being. (2001) reported that "students who are committed to school, feel that they belong, and trust the administration are less likely to commit violent acts than those who are uninvolved, alienated or distrustful" (). From this evidence, it appears that children with social interest, or a strong sense of belonging, cope better with stress than children with lower levels of social interest. (1986) noted that "behaviors such as empathy, understanding the points of view of others, helping others, good verbal skills, good attentional processes, reflectiveness, problem solving, inner locus of control, frustration tolerance, and success appear possible to teach." (p). Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders of childhood with approximately 3%-5% of children affected. ADHD is characterized by inattention, impulsivity, and hyperactivity. Many children will present to the primary care provider with concerns regarding ADHD behaviors. The approach to ADHD evaluation includes the history, physical exam, and use of ADHD rating scales. The use of medication to treat ADHD is an important part of management.
Observation during the office visit provides important clues regarding age appropriate behavior and development. Observe the parent-child interaction and the child for signs of ADHD inability to sit still, fidgeting, excessive activity in the exam room, and frequent interruptions during the history. Occasionally, parental expectations for a child's behavior are not developmentally appropriate and what the parent interprets as hyperactivity may be a normal activity level for that child. Frequently, parents ask for blood work or a brain scan to diagnose ADHD. It is important to explain to the parents that laboratory tests will diagnose other medical conditions that mimic ADHD, but they do not diagnose ADHD. The best way to diagnose ADHD is through the use of standardized questionnaires or rating scales; interviews with the parents, child and teachers and personal observation. In addition to helping to confirm the diagnosis of ADHD, the scores on the rating scales also help diagnose co-morbidities, which will help in determining the treatment choice. It is important to establish a specific diagnosis of ADHD, as the behaviors for each subtype of ADHD are different. This then can be translated into an individualized plan of medical and behavioral treatment (2004).
It is important for parents to know that a stimulant medicine should be tested on a trial basis. Close communication with parents, school officials, and the child to determine effectiveness is crucial in guiding medication adjustments or discontinuing the trial of medication. Informing the parents that you are available via telephone and scheduling a follow-up appointment in 1 or 2 weeks to assess how the trial of medicine is progressing is extremely helpful in alleviating parental anxiety regarding the use of stimulant medication. As with all medications, it is important to indicate that if there are untoward effects, the medication can be stopped and usually the untoward effects will disappear ( 1999). However, most children and parents would like to avoid the inconvenience of multiple doses, and sustained release products are now available for the treatment of ADHD (2002). These preparations have a smoother onset, longer duration of action, and minimize the need for multiple doses over the course of a day (2002). Some parents feel that their children do not need weekend and holiday coverage and that they can manage their children well outside the structured school setting. Parents' wishes should be accepted.
The prevalence of psychosocial as well as cognitive problems among children and youth experiencing parental divorce can be assessed through the use of an adjusted version of the Dutch rendition of the Youth Self Report – YSR (1991). Participants with low IQ scores showed significantly more internalizing and social problems than those with moderate to high scores. The adjusted YSR is recommended for screening in schools and in mental health services for children with social inactiveness for prevention of mental illness and incorporate its early intervention. Thus, investigations can be useful for these children of divorce – predicting children's postdivorce symptoms from 600 children of separated parents and also 600 from not separated children ages 9 to 12 as the independent effects on children's self-report of conduct problems, depression and parent-report of internalizing and externalizing behavior problems with implications for understanding children's social coping with their parents divorce and these children reported a decrease in internalizing symptoms on the YSR over time. Research on the YSR internalizing problem score suggests that, internalizing symptoms are rather stable over intervals of 7 months and 4 years in females, internalizing scores have been found to increase over time.
Moreover, research on adolescent depression suggests that rates of depressive symptoms increase during adolescence and that adolescents with elevated scores on measures of depressive symptoms have an increased risk of future depressive disorder. Thus, the finding that the girls displayed more internalizing symptomatology than the boys within sample is consistent with research on sex differences in depressive symptomatology that emerge during adolescence, when girls are twice as likely as boys to report depressive symptoms. There are several possible explanations for why children in both groups reported significantly lower YSR scores over time. Both intervention approaches were associated with positive change in children. It is important to note that, even in the clinician-facilitated intervention group, children were minimally exposed to direct intervention; in both intervention groups, children were in repeated contact with a supportive adult assessor and had the opportunity to discuss in detail their experiences growing up with a depressed parent. The researchers believe that the assessment package, equivalent across groups, may well account for a large portion of the effects they see in YSR scores. In addition, both intervention programs led to significant change in parents’ child-related behaviors/ attitudes. Although the amount of behavior/attitude change in clinician-facilitated parents exceeds the level of change in lecture group parents, we expect that a threshold for change was likely reached in both intervention groups, and that threshold may
well account for the decrease in YSR scores across groups.
Thus, the 600 children were diagnosed with major depressive disorder at time 4 does not indicate a failure of the intervention programs and that the increase of depression diagnoses at time 4 reflects the degree to which the sample was not sociable enough and these children reflects a sense of depressive disorder because of parental problems they face as compared to those children with intact parents. Moreover, another possible explanation for such psychosocial deficits as there are children with a strong genetic predisposition for the situation that is not altered by the intervention targeting cognitive and family relationship factors. Many instruments exist for evaluating marital discord in parents. The one most often used in research on childhood disorders has been the Locke–Wallace Marital Adjustment Scale ( 1959). Marital discord, parental separation, and parental divorce are more common in parents of ADHD children. Parents with such marital difficulties may have children with more severe defiant and aggressive behavior and such parents may also be less successful in parent training programs. Screening parents for marital problems, therefore, provides important clinical information to therapists contemplating a parent training program for such parents. Clinicians are encouraged to incorporate a screening instrument for marital discord into their assessment battery for parents of children with defiant behavior.
Review of Childhood Psychiatric Disorders
As part of the general interview of the parent, the examiner must cover the symptoms of the major child psychiatric disorders likely to be seen in ADHD children. A review of the major childhood disorders in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (1994) in some semi-structured or structured way is imperative if any semblance of a reliable and differential approach to diagnosis and the documentation of comorbid disorders is to occur (1998). The examiner must exercise care in the evaluation of minority children to avoid over diagnosing psychiatric disorders simply by virtue of ignoring differing cultural standards for child behavior. Should the parent indicate that a symptom is present, one means of precluding over identification of psychopathology in minority children is to ask the following question: “Do you consider this to be a problem for your child compared to other children of the same ethnic or minority group?” Only if the parent answers “yes” is the symptom to be considered present for purposes of psychiatric diagnosis.(1998)
As suggested in the first of these three CE courses on ADHD, adjustments may need to be made to the DSM-IV criteria for ADHD:
The children used in the DSM-IV field trial were predominantly males. Studies reliably demonstrate that parents and teachers report lower levels of those behaviors associated with ADHD in girls than in boys (1983, 1986; 1991). It is possible, then, that the cutoff points on the DSM-IV symptom lists, based as they are mainly on males, are unfairly high for females. Some latitude should be granted to females who are close to but may fall short of the diagnostic criteria by a single symptom. The specific age of onset of 7 years is not particularly critical for identifying ADHD children (1997). The field trial for the DSM-IV found that ADHD children with various ages of onset were essentially similar in the nature and severity of impairments as long as their symptoms developed prior to ages 10–12 years (1997). Thus, so stipulating an onset of symptoms in childhood is probably sufficient for purposes of clinical diagnosis.
The criterion that symptoms must be evident in at least two of three settings: home, school, work essentially requires that children have sufficient symptoms of ADHD by both parent and teacher report before they can qualify for the diagnosis. This requirement bumps up against a methodological problem inherent in comparing parent and teacher reports. On average, the relationship of behavior ratings from these two sources tends to be fairly modest, averaging about 0.30 (1987). However, if parent and teacher ratings are unlikely to agree across the various behavioral domains being rated, the number of children qualifying for the diagnosis of ADHD is unnecessarily limited, due mainly to measurement artifact. Fortunately, some evidence demonstrates that children who meet DSM criteria (1987) by parent reports have a high probability of meeting the criteria by teacher reports ( 1990). Even so, stipulating that parents and teachers must agree on the diagnostic criteria before a diagnosis can be rendered is probably unwise and unnecessarily restrictive. For now, to grant the diagnosis, clinicians are advised to seek evidence that symptoms of the disorder existed at some time in the past or present of the child in several settings rather than insisting on the agreement of the parents with a current teacher.
Thus, some clinical judgment is always going to be needed in the application of such guidelines to individual cases in clinical practice. For instance, if a child meets all criteria for ADHD including both parent and teacher agreement on symptoms except that the age of onset for the symptoms and impairment is 9 years, should the diagnosis be withheld? Given the previous discussion concerning the lack of specificity for an age of onset of 7 years and ADHD, the wise clinician would grant the diagnosis anyway. Likewise, if an 8-year-old girl meets five of the nine ADHD Inattention or Hyperactive Impulsive symptoms and other conditions are met for ADHD, the diagnosis should likely be granted given the previous comments about gender bias within these criteria. Some flexibility that must be incorporated into the clinical application of any DSM criteria. However, many ADHD children may have one or more of these disorders as comorbid conditions with their ADHD; thus the issue here is not which single and or primary disorder the child in terms of his social skills due to his parents divorce as to what other disorders have and besides, attention-deficits – ADHD is present and basically affect those children experiencing every bit of the painful situation.
TABLE 1: Differential
Diagnostic Tips for Distinguishing Other Mental Disorders from ADHD
Source: (2004) Attention-Deficit/Hyperactivity Disorder in Children: Diagnosis and Assessment
Henceforth, there were some clinicians eschewed diagnosing children, viewing it as a mechanistic and dehumanizing practice that merely results in unnecessary labeling. Moreover, they felt that it got in the way of appreciating the clinical uniqueness of each case, unnecessarily homogenizing the heterogeneity of clinical cases. Some believed that labeling a child’s condition with a diagnosis is unnecessary as it is far more important to articulate the child’s pattern of behavioral and developmental excesses and deficits in planning behavioral treatments. Furthermore, given that the protection of rights and access to educational and other services may actually hinge on awarding or withholding the diagnosis of ADHD, dispensing with diagnosis altogether could well be considered professional negligence. For these reasons and others, clinicians, along with the parent of each child referred to them, must review in some systematic way the symptom lists and other diagnostic criteria for various childhood mental disorders. Moreover, parental interview may also reveal that one parent, usually the mother, has more difficulty managing the ADHD child than does the other.
Aside, care should be taken to discuss differences in the parents’ approaches to management and any marital problems these differences may have spawned. Such difficulties in child management can often lead to reduced leisure and recreational time for the parents and increased conflict within the marriage and often within the extended family should relatives live nearby. It is often helpful to inquire as to what the parents attribute the causes or origins of their child’s behavioral difficulties, because such exploration may unveil areas of ignorance or misinformation that will require attention during the initial counseling of the family about the child’s disorder and their likely causes. Research by Wahler (1980) shows that the degree of maternal insularity is significantly associated with failure in subsequent parent training programs. When present to a significant degree, such a finding might support addressing the isolation as an initial goal of treatment rather than progressing directly to child behavior management training with that family.
A clinical diagnosis of ADHD requires impairment in the child’s functioning in at least two important areas. This area could certainly be one of them. In addition, evidence of impaired peer relationships may lead to important treatment recommendations such as participation in a peer social skills training group or a peer support group. Parents are asked if the child has trouble making or keeping friends, how the child behaves around other children and how well the child fits in at school. Parents are also asked if they have concerns about the friends with whom their child spends time. Finally, they are asked about recreational activities in which the child participates outside school and any problems that occurred during those activities. Compliance with parental requests and parental use of compensatory or motivational strategies also can be explored, especially if the clinician anticipates conducting parent training in child management skills with the family.
There were questions also substantiate evidence of impairment in family functioning as well as possible treatment recommendations for parent management training. If the interview on parent to child interactions discussed is not to be used, parents are asked to describe how quickly their child complies with parental requests, if there are discrepancies in the child’s behavior with mother and father, and if parents generally agree on how to manage their child. They are also asked to describe the types of disciplinary strategies they use and whether or not they have tried incentive systems to encourage more appropriate behavior. Parents should be questioned about the child’s ability to accomplish commands and requests in a satisfactory manner in various settings, to adhere to rules of conduct governing behavior in various situations, and to demonstrate self-control appropriate to the child’s age in the absence of adult supervision. After parents complete the scale, they can be questioned about one or two of the problem situations using the same follow-up questions as in Table 2
Table 2: Parental Interview Format for Assessing Child Behavior Problems at Home and in Public
Situation to be discussed
If a problem, follow-up questions to ask
Overall parent-child interactions
Playing with other children
Washing and bathing
When parent is on telephone
Child is watching television
When visitors are in your home
When you are visiting someone else’s home
In public places (stores, restaurants, church, etc.)
When father is in the home
When child is asked to do chores
When child is asked to do school homework
When child is riding in the car
When child is left with a baby-sitter
Any other problem situations
1. Is this a problem area? If so, then proceed with questions 2–9.
2. What does the child do in this situation that bothers you?
3. What is your response likely to be?
4. What will the child do in response to you?
5. If the problem continues, what will you do next?
6. What is usually the outcome of this situation?
7. How often do these problems occur in this situation?
8. How do you feel about these problems?
9. On a scale of 1 (no problem) to 9 (severe), how severe is this problem for you?
Source:. (2004) Attention-Deficit/Hyperactivity Disorder in Children: Diagnosis and Assessment
Some parents of ADHD children have had such chronic and pervasive management problems that upon initial questioning they may find it hard to report anything positive about their children. Getting them to begin thinking of such attributes is actually an initial step toward treatment as the early phases of parent training will teach parents to focus on and attend to desirable child behaviors (Barkley, 1997). For these children, the interview may serve merely as a time to become acquainted with the child, noting his or her manifestation, performance, developmental individuality and common demeanor.
As for these children as well as adolescents, this time can be fruitfully spent inquiring about the children’s views of the reasons for the referral and evaluation, how they see the family functioning, any additional problems they feel they may have, how well they are performing at school, their degree of acceptance by peers and classmates, and what changes in the family they believe might make life for them happier at home. As with the parents, the children can be queried as to potential rewards and reinforcers they find desirable which will prove useful in later contingency management programs. The problem is compounded by the frequently diminished self-awareness and impulse control typical of defiant children with ADHD (1994). Some report that they have many friends, have no interaction problems at home with their parents, and are doing well at school, in direct contrast with the extensive parental and teacher complaints of inappropriate behavior by these children. Because of this tendency of ADHD children to underreport the seriousness of their behavior, particularly in the realm of disruptive or externalizing behaviors (1991; 1993), the diagnosis of ADHD is never based on the reports of the child. Nevertheless, children’s reports of their internalizing symptoms, such as anxiety and depression, may be more reliable and thus should play some role in the diagnosis of comorbid anxiety or mood disorders in children with ADHD ( 1994).
Although notation of children’s behavior, compliance, attention span, activity level, and impulse control in the clinic is useful, clinicians must guard against drawing any diagnostic conclusions when the children are not problematic in the office (1981). In some instances, the behavior of the children with their parents in the waiting area prior to the appointment may be a better indication of the children’s management problems at home than is the children’s behavior toward the clinician, particularly when the interaction between child and examiner is one to one. This is not to say that the office behavior of a child is entirely meaningless. When it is grossly inappropriate or extreme, it may well signal the likelihood of problems in the child’s natural settings, particularly school. It is the presence of relatively normal conduct by the child that may be an unreliable indicator of the child’s normalcy elsewhere. However, a significant relationship exists between abnormal ratings in the clinic and abnormal ratings by the teacher: 70 percent of the children classified as abnormal in their clinic behavior were also classified as such by the teacher ratings of class behavior, particularly on the externalizing behavior dimension. Normal behavior was not necessarily predictive of normal behavior in either parent or teacher ratings. This finding suggests that abnormal or significantly disruptive behavior during a lengthy clinical evaluation may be a marker for similar behavioral difficulties in a school setting.
Aside, interviews with teachers have same merits as interviews with parents, providing a second ecologically valid source of indispensable information about the child’s psychological adjustment, in this case in the school setting. Like parent reports, teacher reports are also subject to bias, and the integrity of the informant, whether it be the parent or teacher, must always be weighed by judging the validity of the information itself. Many ADHD children have problems with academic performance and classroom behavior and the details of these difficulties need to be obtained. Initially this information may be obtained by telephone; however, when time and resources permit, a visit to the classroom and direct observation and recording of the children’s behavior can prove quite useful if further documentation of ADHD behaviors is necessary for planning later contingency management programs for the classroom. Although this scenario is unlikely to prove feasible for clinicians working outside school systems, particularly in the climate of increasing managed health care plans, which severely restrict the evaluation time that will be compensated, for those professionals working within school systems, direct behavioral observations can prove very fruitful for diagnosis, and especially for treatment planning (1992; 2003).
Given the greater likelihood of the occurrence of learning disabilities in this population, teachers should be questioned about such potential disorders. When evidence suggests their existence, the evaluation of the children should be expanded to explore the nature and degree of such deficits as viewed by the teacher. Even when learning disabilities do not exist, children who have ADHD are more likely to have problems with sloppy handwriting, careless approaches to tasks, poor organization of their work materials and academic underachievement relative to their tested abilities as the value of time should be taken with the teachers to explore the possibility of these problems.
Child Behavior Rating Scales for Parent and Teacher Reports
Child behavior checklists and rating scales have become an essential element in the evaluation and diagnosis of children with behavior problems. The availability of several scales with excellent reliable and valid normative data across a wide age range of children makes their incorporation into the assessment protocol quite convenient and extremely useful. Such information is invaluable in determining the statistical deviance of the children’s problem behaviors and the degree to which other problems may be present. As a result, it is useful to mail out a packet of these scales to parents prior to the initial appointment asking that they be returned on or before the day of the evaluation, as described earlier.
Thus the examiner can review and score the scales before interviewing the parents, allowing vague or significant answers to be elucidated in the subsequent interview and focusing the interview on those areas of abnormality highlighted in the responses to scale items. Numerous child behavior rating scales exist, and readers are referred to other reviews (1988,1990) for greater details on the requirements and underlying assumptions of behavior rating scales assumptions all too easily overlooked in the clinical use of these instruments. The fact that such scales provide a means to quantify the opinions of others, often along qualitative dimensions, and to compare these scores to norms collected on large groups of children is further affirmation of the merits of these instruments. Nevertheless, behavior rating scales are opinions and are subject to the oversights, prejudices, and limitations on reliability and validity that such opinions may have. These scales should be completed by parents and teachers. Such scales would be the BASC (1994) and the CBCL (1991), both of which have versions for parents and teachers and satisfactory normative information (1998).
The Child Attention Profile (1990) is yet another narrow-band scale specific to ADHD. It has the advantage of being drawn directly from the teacher version of the CBCL and thus benefits from the rigor of standardization and norming that went into that scale’s development (1986). Its disadvantage, like that of many of the specialized scales noted previously, is that it does not employ the precise symptom lists for inattention and hyperactivity–impulsivity from the DSM-IV. Furthermore, one of the most common problem areas for ADHD children is their academic productivity. The amount of work that ADHD children typically accomplish at school is often substantially less than that done by their peers within the same period. Demonstrating such an impact on school functioning is often critical for ADHD children to be eligible for special educational services (2003). The Academic Performance Rating Scale (1990) was developed to provide a means of screening quickly for this domain of school functioning. It is a teacher rating scale of academic productivity and accuracy in major subject areas with norms based on a sample of children from central Massachusetts ( 1991).
Self-report Behavior Rating Scales for Children
(1986) developed a rating scale quite similar to the CBCL which is completed by children ages 11 to 18 years (). Most items are similar to those on the parent and teacher forms of the CBCL except that they are worded in the first person. A later revision of this scale ( 1991) now permits direct comparisons of results among the parent, teacher, and s of this popular rating scale. Research suggests that although such self-reports of ADHD children and teens are more deviant than the self-reports of youth without ADHD, the self-reports of problems by the ADHD youth, whether by interview or the CBCL Self-Report Form, are often less severe than the reports provided by parents and teachers ( 1993; 1991). The BASC, noted earlier, also has a self-report form that may serve much the same purpose as that for the CBCL. The reports of children about internalizing symptoms, such as anxiety and depression, are more reliable and likely to be more valid than the reports of parents and teachers about these symptoms in their children (1987; 1992). For this reason, the self-reports of defiant children and youth should still be collected as they may have more pertinence to the diagnosis of comorbid internalizing disorders in children than to the defiant behavior itself.
Peer Relationship Measures
As noted earlier, children with ADHD often demonstrate significant difficulties in their interactions with peers, and such difficulties are associated with an increased likelihood of persistence of their disorder. A number of different methods for assessing peer relations have been employed in research with behavior problem children, such as direct observation and recording of social interactions, peer and subject completed sociometric ratings, and parent and teacher rating scales of children’s social behavior. Most of these assessment methods have no norms and thus would not be appropriate for use in the clinical evaluation of children with ADHD (1993). For clinical purposes, rating scales may offer the most convenient and cost-effective means for evaluating this important domain of childhood functioning. The CBCL rating forms described earlier contain scales that evaluate children’s social behavior. As discussed earlier, norms are available for these scales, permitting their use in clinical settings. Three other scales that focus specifically on social skills are the Matson Evaluation of Social Skills with Youngsters (1983), the Taxonomy of Problem Social Situations for Children (1985) and the Social Skills Rating System ( 1990).
Separate and interactive contributions of parental psychopathology and marital discord affect the decision to refer children for clinical assistance, the degree of conflict in parent–child interactions, and child antisocial behavior. The degree of parental resistance to training also depends on such factors. Assessing the psychological integrity of parents is an essential part of the clinical evaluation of defiant children, the differential diagnosis of their prevailing disorders and the planning of treatments stemming from such assessments. Thus, the evaluation of children for ADHD is often a family assessment rather than one of the child alone. It should be clear from the foregoing that the assessment of ADHD children is a complex and serious endeavor requiring adequate time, knowledge of the relevant research and clinical literature as well as differential diagnosis, skillful clinical judgment in sorting out the pertinent issues, and sufficient resources to obtain multiple types of information from multiple sources (parents, child, teacher) using a variety of assessment methods. When time and resources permit, direct observations of defiant and ADHD behaviors in the classroom could also be made by school personnel. At the very least, telephone contact with a child’s teacher should be made to follow-up on his or her responses to the child behavior rating scales and to obtain greater detail about the classroom behavior problems of the defiant child in order to address any comorbid problems often found in conjunction with ADHD in children.
A measure of verbal, non-verbal social competence and emotional intelligence By: Ronald E. Riggio
According To (1986), that the Social Skills Inventory (SSI) assesses basic social skills that underlie social competence. It evaluates verbal and non-verbal communication skills and identifies strengths and weaknesses. The instrument is useful in individual and couples counseling, management and leadership training, and health psychology.
Ø Assesses communication skills as they relate to overall social competence
Ø Clients respond to items using a five-point scale, indicating the extent to which the description of the item applies to them
Ø Scores are reported for each of the scales and a combined score is given to indicate global social intelligence
Ø Ninety items can be completed in thirty to forty minutes
Ø Efficient to score
Ø Requires an eighth grade reading level
The SSI assesses skills in these key areas
Ø Emotional Expressivity
Ø Emotional Sensitivity
Ø Emotional Control
Ø Social Expressivity
Ø Social Sensitivity
Ø Social Control
So, a social skills inventory is a factor for detecting psychosocial deficits in children ages 9-12 due to the parental divorce as it will be constructed to assess 600 children of separated parents as well as 600 children by not separated families and their school teachers as some of the factors isolated were social assertiveness, confidence and empathy as there could be two higher order factors such as Social Skill and Empathy as identified in studies.
Furthermore, validity studies revealed strong commonalities with (1986) Social Skills Inventory and a set of self-ratings and that the Social Relations Survey can also be a useful device for clinical and research application to problems involving social skills. In 1986, Riggio developed and published validity studies for a psychometric instrument, the Social Skills Inventory (SSI). This 90-item self-report instrument measures 6 sub-dimensions of social skills and interpersonal competence. In order to obtain an index of global social skill/competence, the six subscales are summed. However, (1986) asserts that the actual relationship may not be an additive one. The relation between any single social skill dimension and social effectiveness like for instance, positive or desirable social outcomes may not always be linear. Possessing too much of any one of the basic components of social skill, in relation to other key social skill components, may be dysfunctional. For example, individuals high in expressivity but lacking in skills in regulation and control may initially attract positive attention and responses from others, but they may soon be viewed as rambling, perky and impolite. Therefore, although we can speak of specific components of general social skill, these components become most important when combined with other skill components. Amount or degree of each social skill dimension is important but so, too possess a balance of the various social abilities. (1986)
The study will also explore the use of the standard deviation score and look at alternative means of scoring the SSI subscales that involve non-additive combinations of the subscales. In order to test various scoring methods, there is a need to use a database compiled by Prof. that consists of approximately 1000 adults who have been administered the SSI. The goal is to determine how best to score the SSI to determine social skill imbalances among children’s attention-deficit problems and to delve farther into non-linear models, looking for the best representation for this particular situation. (2000)
Cognitive-verbal measures of social cognition
Many approaches to understanding social cognition follow the tradition of cognition testing by developing instruments to assess individual differences in social cognition. More specifically, the tests measured the skill to decode social cues, including facial expressions, vocal inflections, posture and gestures. As later research found contradictory results (1991).
As (1991) administered several measures of social cognition and several measures of academic cognition to undergraduate students. Measures of social cognition included such tests of (1986, 1989) Social Skills Inventory (SSI), which assess six social communication skills namely: emotional expressivity, emotional sensitivity, emotional control, social expressivity, social sensitivity and social control and a social etiquette/tacit knowledge test that measured knowledge of appropriate behaviors in social situations. Also. found comparable inter correlations within measures of both academic and social cognition as they did between measures of academic and social cognition. An exploratory factor analysis suggested two factors as the researchers found enough evidence of convergent validity among the measures of social cognition, likely reflecting the complexity of the construct and the various ways it has been operationalized for this literature.
Other research has been less disparaging. (2003) reviewed the literature on the effect of divorce on children and concluded: It is important to emphasize that approximately eighty percent of children and young adults do not suffer from major psychological problems, including depression; have achieved their education and career goals; and retain close ties to their families. They enjoy intimate relationships, have not divorced, and do not appear to be scarred with immutable negative effects from divorce (). Social science research is showing that the effects of divorce continue into adulthood and affect the next generation of children as well. If the effects are indeed demonstrable, grave, and long-lasting, then something must be done to protect children and the nation from these consequences. Reversing the effects of divorce will entail nothing less than a cultural shift in attitude, if not a cultural revolution, because society still embraces divorce in its laws and popular culture, sending out myriad messages that "it's okay." It is not. Mounting evidence in the annals of scientific journals details the plight of the children of divorce. It clearly indicates that divorce has lasting effects which spill over into every aspect of life.
Children of divorced parents more frequently demonstrate a diminished learning capacity, performing more poorly than their peers from intact two-parent families in reading, spelling, and math. They have higher dropout rates and lower rates of college graduation. Divorce generally reduces the income of the child's primary household and seriously diminishes the potential of every household member to accumulate wealth. The effects of divorce are immense research shows that it permanently weakens the relationship between a child and his parents and leads to destructive ways of handling conflict and a poorer self- image. Children of divorce demonstrate an earlier loss of virginity, more cohabitation, higher expectations of divorce, higher divorce rates later in life, and less desire to have children. These effects on future family life perpetuate the downward spiral of family breakdown. Divorce impedes learning by disrupting productive study patterns, as children are forced to move between domiciles, and by increasing anxiety and depression in both parents and children. Because of its impact on stable home life, divorce can diminish the capacity to learn- -a principle demonstrated by the fact that children whose parents divorce have lower rates of graduation from high school and college and also complete fewer college courses. Divorce has significant negative economic consequences for families. The breakup of families’ leaves one parent trying to do the work of two people--and one person cannot support a family as well as two can. The result is decreased household income and a higher risk of poverty.
Divorce also wreaks havoc with children's psychological stability. When their families break up, they experience reactions ranging from anger, fear, and sadness to yearning, worry, rejection, conflicting loyalties, lowered self-confidence, heightened anxiety and loneliness, depression, suicidal thoughts, and even suicide attempts. Divorce affects all of society's major institutions, but none more than the family itself and the child's capacity to sustain family life as an adult. The severing of the relationship between mother and father rends the hearts of most children, making their own capacity to have deep and trusting relationships more tenuous. Indeed, divorce seems to perpetuate itself across successive generations. The impact on home life is so strong that children of divorced parents struggle as adults to create a positive, healthy family environment for their own children. Adults who experienced divorce as children prove less capable of breaking the cycle and instead pass on a legacy of tragedy to their children and grandchildren. Divorced mothers, despite their best intentions, are less able than married mothers to give the same level of emotional support to their children. Divorced fathers are less likely to have a close relationship with their children; and the younger the children are at the time of the divorce, the more likely the father is to drift away from regular contact with them.
Divorce diminishes children's capacity to handle conflict. One important difference between marriages that stay intact and those that end in divorce is the couple's ability to handle conflict and move toward agreement. Children of divorced parents can acquire the same incapacity to work through conflict from their parents. Many teenagers struggle with feelings of inadequacy and frequently turn these feelings into erroneous judgments of peer rejection. Daughters of divorce find it more difficult to value their femininity or believe that they are genuinely lovable. Sons of divorced parents frequently demonstrate less confidence in their ability to relate with women, either at work or romantically. The data clearly show that parents and children in intact families are much more likely to worship than are members of divorced families or stepfamilies. Moreover, following a divorce, children are more likely to stop practicing their faith. Even when they enter a new stepfamily, their frequency of religious worship does not return to its prior level.
Children whose parents divorce are exposed to more conflict and acrimony than children who grow up in stable marriages, and this may explain why the former do less well than the latter. The results indicate that parental conflict is partly but by no means completely responsible for the association between divorce and child welfare. The results also suggest that, for four of the sixteen measures of child well-being examined, children exposed to high levels of parental conflict are neither better off nor worse off, on average, when their parents divorce, while those exposed to low levels of parental conflict appear to suffer severe disadvantages when their parents separate. This suggests that, in some areas, marital relations prior to divorce help determine when the consequences of divorce are particularly harmful for children and when the consequences of divorce are relatively benign. Studies have shown that children of divorced parents are disadvantaged in a variety of ways as compared to children who grow up with both parents. They are less likely to perform well in school, more likely to exhibit behavioral problems, and more likely to have psychological and social difficulties (1993; 1991; 1991; 1994). These results are surprisingly consistent for children from different social class backgrounds and different race and ethnic groups. They also persist regardless of whether the custodial parent remarries after the divorce (1994).
One common explanation for the deleterious effects of marital disruption is that it is the parental conflict preceding divorce that is responsible for the association between divorce and child well-being. Children whose parents divorce are exposed to more conflict and acrimony than children who grow up in stable marriages, and parental conflict is related to a variety of adjustment problems in children (1994; 1988; 1990). The conflict hypothesis holds that the observed association between divorce and child well-being is spurious because of the dependence of both on parental conflict ( 1995). Parental conflict may also influence child behavior through the process of social modeling, whereby children acquire the same behavioral strategies used by their parents during conflict episodes. Conflict also may affect children indirectly by altering parent-child relationships (1991). Discord may preoccupy parents and thereby decrease parents' emotional availability as well as the consistency and effectiveness of parental discipline practices (1980). The notion that pre-divorce conflict is responsible for the problems of children of divorce is consistent with findings from cross-sectional studies that show that children in high-conflict intact families do just as poorly as children in divorced families (1986; 1989;1986).
Although parental divorce has negative effects in a number of areas, it is not associated with all the school performance indicators considered here. Children with parents who were not continuously married were no more likely to report that they disliked school and had fights at school than their peers. Divorce is also not significantly related to repeating a grade or boys' reports of school grades. It should also be noted that even on those variables with which divorce is strongly associated as the majority of children with divorced parents do not experience negative outcomes. Aside from physical injuries caused by adolescent violence, such behaviors adversely affect the learning environment, creating disruptions and an atmosphere of physical intimidation leading to anxiety and loss of focus on academic tasks and normal school socialization processes ( 1999). Adolescents who are repeatedly victimized may be prone to impulsiveness and irritability thereby lowering their threshold to strike out, especially toward younger children. In particular, adolescent victims lacking strong and supportive relationships with parents, teachers and peers are also without a source of protection or a way to appropriately seek relief from violence. They may instead lash out with aggressive or impulsive behaviors of their own in an effort to cope with on-going personal threat.
Family Social Capital
The family environment is an apparent and important source of influence on adolescent development and behavioral preferences ( 1999; 1999; 1990; 2001; 2001). (1999, 2001) found that functional characteristics of families that can influence adolescent behavior include parental participation in community organizations such as a Parent-Teacher Association (PTA) and parental awareness of their adolescent's friends and their parents. The former is an example of formal extra-familial ties from which parents draw social capital for themselves and their children. The latter establishes informal extra-familial ties that can increase the availability of social capital in the form of mutual cooperation, trust and monitoring. Close, dense extra-familial supportive networks are particularly important for maintaining existing resources in expressive functions such as physical and psychological health. Both formal and informal ties outside the family can increase the density of local supportive relationships making supervision and guidance of adolescents outside the home more likely and violent behavior less likely.
Parents are more likely to encourage independence when they believe outside sources such as teachers and other parents will monitor their adolescent's activities and report undesirable behaviors (1996; 1999; 1993). Social ties between sets of parents and between parents and teachers can usually facilitate social capital by fostering trust and reciprocity between parties. More importantly within the home, however, are the characteristics of the parent-adolescent relationship. Factors that are typically considered supportive of healthy adolescent behavior include the extent to which adolescents consider parents warm, loving and attentive and the quality of communications and overall relationship between parent and child (1996; 1996; 2000;1998; 1997; 2002).
School Social Capital
Schools provide opportunities for social capital and directly or indirectly, through these available resources, influence student behaviors (2001; 2002). Social capital factors interrelating the adolescent and school experience include extent of attachment to school (1997). For many adolescents, school is a significant hurdle and often an unpleasant challenge due to failure to meet academic or behavioral standards leading to frustration, loss of self-esteem and confidence, detachment and violent behavior. Such students may have difficulty getting along with their teachers and act out with combative or avoidance behavior due to feelings of inadequacy, isolation and vulnerability (1999). These factors also serve as resources for students because social and academic success at school opens avenues for normative group participation and healthy perceptions of belonging. Manifestations of school-related dysfunction may include lack of identification or feelings of closeness to or compassion for other students or a failure to relate to the school in general. The disaffected student may have inaccurate perceptions of prejudice, unfair treatment and so on.
Conversely, research has shown that those students who feel cared for by teachers and peers are less likely to initiate violent behaviors ( 1997). Those students are protected from aggressive tendencies associated with overt assaultive behavior as well as internalized equivalents that increase isolation and vulnerability. In short, disengaged adolescents frequently lack access to important social capital embedded in constructive interpersonal relationships with teachers and fellow students (2001; 2002), putting them at greater risk for engaging in violent behaviors. To this end, collective school activities are thought to be sources of protection for adolescents (1999). School-sponsored teams, clubs and groups can promote feelings of connectedness and camaraderie with other students and staff. To a certain extent, beneficial membership effects may be perceived as building constructive resources in lieu of passivity that breeds destructive outcomes. Participation in these activities thereby substitutes for unstructured, unsupervised and often detrimental socialization and peer influence (2002). The choice of whether to participate in healthy collective pursuits (school-sponsored) or in deviant collectivities (example: gangs) and behaviors (like, the use of substances such as alcohol) in many cases determines the likelihood of violent behaviors (2000).
Neighborhood Social Capital
(1997; 2000). Beyond objective features of the neighborhood, social connectedness, which includes involvement with Children as well as adolescents also will be influenced toward or away from violent behavior by neighborhood factors (ith other residents and local institutions such as churches or other places of worship, often plays a protective role in reducing the risk of adolescent violence. For adolescents, social connectedness may be reflected by perceptions of ease in interaction with neighbors. Protective guardianship by parents, peers and other residents reduces the likelihood of physical and psychological injury from violent perpetrators ( 2000). Active participation in neighborhood churches and related youth activities raises ethical awareness and responsibility and reduces available time for participation in harmful activities (2001). Family functioning has been associated with emotional development in children. The study of family factors is complex, with a mix of factors that are difficult to tease apart. Family structure has been associated with maladaptation in children. Family structure refers to the makeup of the family in which the child lives. (2001)
Aside, (2001) studied 192 families and 453 children the findings are similar to those of the Kellam et al. study. Complex stepfamilies and single parent households were more likely to have children with behavioral or emotional problems than intact and simple stepfamilies it means the mother or father is biologically related to all children in the family. Family structure was thought to be a proxy for exposure to psychosocial risks, such as poor parent-child relationships, parental depression, and socioeconomic adversity. Sibling similarity for maladjustment was most pronounced in the complex stepfamilies, suggesting the risk in these families is conveyed more through psychosocial stress than through shared genetic risk (2001). Similarly, (1991) found that in studies of divorce, the most consistent support was found for the role of family conflict rather than for parental separation in the development of emotional problems in children. In fact, high-conflict intact families scored lower in psychological adjustment than divorced families.
Indeed, many studies have shown parental divorce is highly associated with emotional and behavioral disturbances in children ( 1996; 1990; 2001;1998;1987). Familial depression appears to increase the risk of depression in children two to threefold (1997). However, (1996) report that risk of childhood affective disorders clustered in a relatively small number of families in which multiple risk variables occurred together. In their data, if parental depression was of short duration and not associated with other risks, there was little predictive effect. Stressful life events and social support have been studied extensively and have been shown to be risk factors for children developing behavioral problems (1990; 1994; 1999; 2000; 1991; 1998; 1986).
Family and social variables appear to play a role in increasing the risk of onset or perpetuation of mental disorders in this community sample of adolescents. Because there are no data on previous psychiatric disorders at baseline, it is not certain that the disorders diagnosed at baseline are the adolescent's first disorder. Although the association of family cohesion and undesirable life events at baseline may attenuate somewhat over time, the association of family-structure: not living with both biological parents in the home at age 12 with affective disorders remains strong in the follow-up analyses, even when controlling for baseline affective disorder status. Family structure may function as both a risk factor for depression and as a marker for families with emotionally disturbed children at risk of chronic disorder. Further research on this issue is necessary. The fact that baseline family structure is associated with baseline affective disorders at roughly the same OR as it is associated with follow-up affective disorders gives strength to the hypothesis that family structure is a key risk factor. Family structure also appears to be more important than family cohesion as a risk for affective disorder.
A study by Offord et al. (1992) did find that low family cohesion was associated with persistence of psychiatric disorders in children over time. In that study, however, family structure or divorce was not analyzed in the model. In the current study, follow-up family cohesion and undesirable life events are associated with follow-up affective disorders (data not shown). Thus, the variables appear to change over time. Although they are associated cross-sectionally with disorder, they are not useful for identifying adolescents at risk of disorder in the future (Shafii et al., 1985). Alternatively, the association may arise from social and environmental factors which are associated with both increased risk of divorce and increased risk of suicidal behavior, e.g., parental psychopathology (Beautrais et al., 1996; Brent et al., 1994). Potential modifiers of the impact of a divorce on the child's subsequent mental health include the age of the child at the time of the dissolution (Allison and Furstenberg, 1989; Amato, 1994; Chase-Lansdale et al., 1995; Palosaari and Aro, 1994), remarriage of the custodial parent (Allison and Furstenberg, 1989; Chase-Lansdale et al., 1995), frequency of contact with the nonresident parent (Amato, 1994) and the parent-child relationship (Amato, 1994; Black and Pedro-Carroll, 1993) and to examine whether such situational and familial psychosocial factors underlie and amplify divorce.
Many previous studies have reported that a marital dissolution has the most deleterious effects on the psychological well-being of children when they are very young at the time of separation (Allison and Furstenberg, 1989; Emery, 1988; 1981). Other studies (Chase-Lansdale et al., 1995) have reported that divorces during adolescence may be more deleterious. In this study, there was a tendency for the parental separation/divorce to have been a more recent event among the suicide victims, consistent with the reports of an association of life stressors, such as interpersonal losses, with suicide (Brent et al., 1993b; Gould et al., 1996; Marttunen et al., 1993; Rich et al., 1988). Unfortunately, because age at separation and years since separation are confounded in this study a common problem in most studies (Amato, 1994) it is difficult to disentangle the alternative interpretations of the findings on age at separation.
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