Editha D. Nottelmann

Young children of affectively ill parents: a longitudinal study of psychosocial development.

The course of social-emotional development of young children of affectively ill and well parents was assessed. The families were classified by mothers diagnosis: bipolar illness (N = 22), unipolar depression (N = 41), and normal (N = 37). Fathers diagnosis also was obtained. Pairs of siblings were studied; the younger was between 1 1/2 and 3 1/2 years and the older between 5 and 8 years when the study began. They were seen again 3 years later. Psychiatric assessment and mothers report were used to evaluate childrens disruptive behavior, anxiety, and depressive characteristics. The frequency of problem-level behavior changed over time in relation to mothers diagnosis. By middle and late childhood, significantly more children of affectively ill than well mothers had depressive and disruptive problems and multiple behavior problems. Offspring of unipolar mothers developed problems earlier and both siblings were more likely to have behavior problems.

Developmental processes in early adolescence: Relationships between adolescent adjustment problems and chronologic age, pubertal stage, and puberty-related serum hormone levels

Relations between adolescent psychosocial adjustment problems and markers of biologic development, including chronologic age, pubertal status, and serum hormone levels, were examined in 56 normal boys and 52 normal girls, ages 9 to 14 years. Adolescent psychosocial adjustment was assessed by adolescent self-ratings of various aspects of self-image (Offer Self-Image Questionnaire for Adolescents) and parent ratings of adolescent behavior problems (Child Behavior Checklist). The pubertal status measure used in the analyses was Tanner genital stage for boys and Tanner breast stage for girls. The hormone measures, determined by radioimmunoassay, were serum levels of gonadotropins (luteinizing hormone and follicle stimulating hormone), sex steroids (testosterone and estradiol), and adrenal androgens (dehydroepiandrosterone and its sulfate, and androstenedione). The testosterone/estradiol ratio also was computed. Overall, findings were stronger, more consistent, and more generalized for boys than for girls. For boys, adjustment problems typically were associated with a multivariate profile that may be characteristic for later maturers: relatively low sex steroid levels, or lower pubertal stage, and relatively high adrenal androgen (androstenedione) levels, frequently in conjunction with higher chronologic age. Univariate relations predominated for girls; that is, associated with adjustment problems for girls were relatively high levels of gonadotropins, relatively low levels of dehydroepiandrosterone sulfate, and relatively high levels of androstenedione on their own or in conjunction with lower pubertal stage. Higher levels of androstenedione, a steroid particularly responsive to stress, were associated with adjustment problems in both boys and girls. This relation may reflect the stress of later maturation, which could result from environmental factors, such as adolescent self-comparisons with same-age peers, or endogenous effects of hormones.

Developmental processes in early adolescence: Relations among chronologic age, pubertal stage, height, weight, and serum levels of gonadotropins, sex steroids, and adrenal androgens

Cross-sectional data are presented on 108 young adolescents (56 boys, 52 girls), ages 9 to 14 years. The measures were: for all subjects, pubertal stage (Tanner criteria for genital/breast and pubic hair stage); height and weight; serum hormone concentrations for gonadotropins (luteinizing hormone and follicle-stimulating hormone), sex steroids (testosterone, estradiol, and the computed testosterone to estradiol ratio), adrenal androgens (dehydroepiandrosterone, dehydroepiandrosterone sulfate, and androstenedione), and testosterone-estradiol binding globulin. In addition, testicular volume for boys and menarchial status for girls are reported. The study goal was to provide interrelations among these measures, based on the same sample, and examine their interchangeability. Results suggest that it would be reasonable to compare research across as well as within studies based on different markers. Multiple regression analysis showed that the strongest hormone correlates of pubertal development were androgen levels (primarily testosterone in boys and primarily dehydroepiandrosterone sulphate and androstenedione in girls). Estradiol level in girls was the strongest correlate only for menarchial status. Level of testosterone-estradiol binding globulin, which was lower at successive pubertal stages for boys and showed no consistent differences for girls, may be a useful measure for studying the developmental processes and gender differences during puberty.

The relation of relative hormonal levels and physical development and social-emotional behavior in young adolescents

The study examined the relation between timing of physical maturation and problems of adjustment and peer relations. The participants were 9-14-year-old boys (N=56) and girls (N=52). Assessments of physical maturation consisted of pubertal staging according to Tanner criteria and serum determinations of luteinizing hormone, follicle stimulating hormone, testosterone, estradiol, dehydroepiandrosterone, dehydroepiandrosterone sulfate, and androstenedione. There was approximately an equal number of boys and girls in each pubertal stage. The psychological measures were the Psychopathology and Emotional Tone subscales from the Offer Self-Image Questionnaire for Adolescents and interview questions to assess interactions with peers. Psychopathology and emotional tone (sad effect) scores were higher for boys with high-for-age adrenal androgens and lower for boys with high-for-age sex steroids. Behavioral manifestations of sexuality, interest in dating, was higher for boys with high-for-age adrenal androgens. Dating and spending time with friends were higher for boys with high-for-age gonadotropins. Psychopathology and emotional tone were higher for girls with high-for-age gonadotropins. The results indicate that high-for-age hormone level or early timing of puberty generally was related to adverse psychological consequences for boys and girls, with relations being stronger for boys than for girls.

Hormonal influences on aspects of psychological development during adolescence

Systematic study of the effects df hormones on psy ehological development of adolescents is in an embryonic state. At the folk-wisdom level, hormones have been implicated for the last few decades in the behavior changes that occur during adolescence. Research on the influence of hormones on behavior now is feasible and timely. Improvements in the sensitivity of biochemical assays have made it possible to measure minute amounts of circulating hormones in prepubertal and pubertal adolescents. Furthermore, research in the emerging field of psychoneuroendocrinology shows that hormones affect a wide array of behaviors of human bein the experiences of human beings affect hormone levels (1). Endocrine abnormalities also have been linked to many mental health disorders in adults (28). Endocrine processes involved in the develop ment of these disorders may be also linked to normal variations in mood and behavior. This paper will present a brief summary of how hormones have been conceptualized with regard to behavior and the approaches used in research to examine relations between hormones and behavior. Studies of hormones and behavior during adolescence are reviewed. In addition, questions that remain to be answered in the literature regarding

Comorbidity of Disorders in Children and Adolescents

Since the advent of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition and Third Edition, Revised (DSM-III and DSM-III-R), clinicians and investigators have shown increasing interest in the significance of comorbid disorders in children and adolescents. Coincident with a sharpened focus on comorbidity, some investigators have developed detailed data on child and adolescent comorbid diagnoses in clinical and epidemiological studies (e.g., Bird, Gould, & Staghezza, 1993; Cohen, 1993; Pfeffer & Plutchik, 1989); and comorbidity has been the subject of recent reviews of child and adolescent disorders research (e.g., Biederman, New-corn, & Sprich, 1991; Zoccolillo, 1992). Accumulating evidence suggests that comorbidity is pervasive. Concerns about weaknesses of the nosological system are being advanced to account for the high rates of comorbidity in general (Achenbach, 1990/1991; Caron & Rutter, 1991; Pfeffer & Plutchik, 1989; Rutter, 1989), as well as for the co-occurrence of specific disorders (e.g., Biederman et al., 1991; Carlson, 1990). With respect to children and adolescents, these concerns intersect with developmental and methodological issues. For the advancement of knowledge about child and adolescent disorders, it is essential that comorbidity patterns be identified and examined, not only for their implications for prognosis and treatment, but also for evaluation of the classification system on which they are based.

Evaluative communications between affectively ill and well mothers and their children.

Earlier research suggests that the natural verbal discourse of mothers with their children can be important in clarifying, verifying, and evaluating the behavior in which a child is engaged, in attributing qualities to the child, and in influencing the childs self-perceptions. We investigated the potential influences of parental affective illness (bipolar affective disorder and unipolar depression in contrast to no history of psychiatric illness) on such “labeling” behavior in a sample of 61 mothers and their older (school-age) and younger (preschool-age) children. It was hypothesized that the dispositions characterizing affective illness (specifically, negativity and disengagement) would be reflected in the labeling statements of mothers with a diagnosis as they interacted with their children. Based on videotaped interactions during a visit to a home-like laboratory apartment, labeling statements were identified in terms of speaker and person being labeled (“addressee”) and coded (positive, negative, mixed, or neutral) for judgmental and affective quality of the statement and reaction of the addressee. Data were analyzed (a) by family unit and (b) my mother to child statements. The general pattern of findings indicated, in relative terms, an excess of negativity on the part of family members in the bipolar group and a dearth of negative affect for mothers in the unipolar group. Negativity in the bipolar group appeared to be especially likely when the setting involved mothers and two male children. Additionally, findings are discussed in terms of sex differences in vulnerability to depression.

Bipolar Affective Disorder in Children and Adolescents

For many children and adolescents, psychiatric disorders are likely to have far-reaching consequences. In addition to having an immediate impact on everyday functioning, they may contribute to adjustment problems beyond childhood and adolescence by interfering with the mastery of important developmental tasks, such as regulation of emotions, acquisition of competencies, and establishing and maintaining social relationships. For this reason alone, childhoodand early adolescent-onset bipolar illness may carry greater risk for poor outcomes than bipolar illness beginning in late adolescence or adulthood. Evidence of high loadings of affective disorders in families of bipolar children and adolescents suggests further that very early onset manicdepressive illness may have a genetic basis and, because of its early manifestation, may be an especially severe and devastating form of the disorder. The Child and Adolescent Disorders Research Branch of the Division of Clinical and Treatment Research, National Institute ofMental Health (NIMH) recently convened a workshop to explore what is known about bipolar disorder in children and adolescents and set directions for future research. Four papers in this special section are based on presentations at that meeting-one on phenomenlogy (Weller et al.), rwo on

Variability in Hormone Concentrations and Self-Reported Menstrual Histories in Young Adolescents: Menarche as an Integral Part of a Developmental Process

Menarche has been considered a marker for examining interindividual differences in biobehavioral development and for separating pubertal development into 2 stages. The purpose of this study was (1) to compare hormone concentrations in pre- and postmenarcheal girls to determine whether they fit a continuous or dichotomous model of pubertal development surrounding menarche; and (2) to address methodological issues of variability in self-reports of menstrual histories and reliability in reporting age at menarche. Girls (N = 52) ages 9 to 14 years were enrolled in a longitudinal study. Blood was drawn for hormone concentrations. Menstrual-cycle information was collected by questionnaire and oral report. Discrepancies in reporting of age at menarche ranged from 0 to 18 months and variability was noted in length of cycle. There was great overlap in hormones between pre- and postmenarcheal categories. Future studies might consider menarche as the culmination of underlying developmental processes rather than as a discrete event. Limitations of each measure of puberty should be considered by investigators conducting biobehavioral studies of adolescents.

The Long and the Short of Physical Stature in Early Adolescence

The relationship between early adolescent physical stature and competence perceptions was examined in the self-ratings and teacher ratings of short-and tall-for-age boys and girls in grades 6 and 7. Approximately one half of the sixth-graders were in their last year of elementary school; the other half, and all seventh-graders, were in secondary school. The ratings were obtained with companion scales, The Perceived Competence Scale for Children and The Teachers Rating Scale of Childs Actual Competence, for cognitive, social, physical, and general competence. Physical stature effects were found in early adolescent self-ratings, in interaction with school context, but not in teacher ratings. The effects, which were stronger among girls than boys, were found in perceived social and general competence. The lowest self-ratings were those of tall girls in elementary school and short girls in secondary school. In contrast to previous research, the results of the present study suggest that self-perceptions may change with social contexts, but only longitudinal research can clarify whether these physical stature effects have consequences for self-perceptions beyond early adolescence.