Adrienne Sheldon-Keller

Attachment Organization and History of Suicidal Behavior in Clinical Adolescents.

One hundred thirty-three adolescents in psychiatric treatment participated in a case-comparison study investigating the association of attachment patterns with a history of suicidal behaviors. The comparison group comprised 64 adolescents who had never experienced suicidal ideation or behaviors; the case group included 69 adolescents with histories of suicidal behavior (n = 53) and severe suicidal ideation (n =16). Attachment patterns were assessed using the Adult Attachment Interview. In accordance with definitions provided in the scoring system, 86% of case and 78% of comparison adolescents in psychiatric treatment had experienced attachment-related trauma. Lapses in the monitoring of reasoning or discourse occurred during the attempted discussion of these events in 73% of adolescents in the case group but in only 44% of adolescents in the clinical comparison group (p = .002), suggesting that cognitive disorganization may be an important variable mediating between traumatic experience and suicidal behavior. Female adolescents and older adolescents were significantly more likely than other adolescents to be in the case group. Preoccupied attachment, in interaction with unresolved-disorganized attachment, was associated with the case group, whereas dismissing attachment was associated with the comparison group.

Prevalence of HIV-related risk behaviors and STDs among incarcerated adolescents

PURPOSE To determine the HIV-related risk behaviors and STDs in a population of incarcerated adolescents in order to strategically target education and prevention efforts. METHODS A single point-in-time prevalence study based on an analysis of intake medical records of 1,215 incarcerated youth were analyzed for HIV risk behaviors and STD history. RESULTS Incarcerated adolescents report high rates of risk behaviors for HIV infection and STDs, with 75% reporting three or more sex partners, 25% never using condoms and 19% having a current diagnosis of at least one STD. Significantly more females than males reported a history of STDs and had higher rates of current diagnoses of chlamydia/non-gonococcal urethritis, trichomonas and gonorrhea. CONCLUSIONS Ethnic/racial and gender differences were found in risk behaviors for STDs among a sample of incarcerated adolescents.

Adolescent Attachment Questionnaire: A Brief Assessment of Attachment in Adolescence.

The Adolescent Attachment Questionnaire (AAQ), a brief questionnaire to assess attachment characteristics in adolescents, was developed and validated in a large normative sample (n = 691) and a sample of 133 adolescents in psychiatric treatment. The AAQ is a self-report questionnaire consisting of 3 scales of 3 statements each, with Likert-type responses from strongly disagree to strongly agree. The Availability scale assesses the adolescents confidence in the availability and responsiveness of the attachment figure. TheGoal-Corrected Partnershipscale assesses the extent to which the adolescent considers and is empathetic to the needs and feelings of the attachment figure. The Angry Distress scale taps the amount of anger in the adolescent–parent relationship. All scales demonstrate satisfactory internal reliability and agreement between scores for adolescents (n = 91) from the normative sample who completed the AAQ twice. Adolescents in the clinical sample also completed the Adult Attachment Interview (AAI); the AAQ demonstrated high convergent validity with the AAI.

Assessing attachment: convergent validity of the adult attachment interview and the parental bonding instrument

OBJECTIVE The aim of this study was to determine whether or not the Parental Bonding Instrument (PBI) can provide information about parent-child attachment that is comparable to information obtained from the Adult Attachment Interview (AAI), a more complex measure of attachment. METHOD One hundred and thirty emotionally and/or behaviourally disturbed adolescents (73 male, 57 female; ages 13-19 years, x = 15.3 +/- 1.47 years) participating in a study of attachment and suicidality completed the PBI and the AAI. Data from these measures were compared within participants. RESULTS Maternal care and overprotection on the PBI differed significantly by AAI attachment classification (F3,122 = 2.79, p = 0.012), with autonomous participants showing the most optimal and unresolved participants the least optimal PBI results. Maternal love and maternal involvement/role reversal on the AAI were significant predictors of maternal care and maternal overprotection, respectively, on the PBI (R2 = 0.15; R2 = 0.16). These predictions improved when AAI scales measuring idealisation and involving anger towards the mother were included in the regression analyses (R2 = 0.35; R2 = 0.20). Autonomous participants on AAI showed the highest scale correlations across instruments. CONCLUSIONS Attachment information obtained from the PBI and the AAI is comparable in participants with optimal attachment histories, but not in participants showing idealisation or anger towards their mothers. Caution is, therefore, advisable when using the PBI to obtain attachment information in clinical samples where suboptimal attachment histories are likely.

The assessment of dimensions relevant to adult reciprocal attachment

The development and potential clinical uses of the Adult Attachment Dimensions Questionnaire is described. The seven scales of the Adult Attachment Dimensions Questionnaire relate to the aspects of a relationship formed to promote and maintain security. The underlying theory is founded on John Bowlbys work on the attachment behavioural system. The empirical validation was accomplished through three studies involving a clinical group and a non clinical group in a hospital setting and respondents to a community survey. Psychometric validation included measures of internal reliability, test-retest reliability, and construct validity through factor analysis. The resultant 35 item questionnaire should be useful to both clinicians and researchers interested in the characterization of the attachment system for adults.

The provision of services for rural youth with serious emotional and behavioral problems: Virginia's comprehensive services act

The problems of the delivery of mental health and social services to rural children and adolescents encapsulate many of the problems in the larger health care system. Consequently, many of the principles underlying the Presidents Health Security Plan are applicable to the reformation of this more specialized service system. The experience of the Commonwealth of Virginia in implementing the Comprehensive Services Act (CSA) highlights the scope of vision needed to transform an existing service delivery system into a coordinated system of care on a state-wide scale.