Gil G. Noam

Convergence of DSM-III diagnoses and self-reported symptoms in child and adolescent inpatients

A systematic study of the relationship between empirically-derived diagnoses and symptom patterns is reported in a sample of 160 preadolescents and adolescents consecutively admitted to a psychiatric inpatient setting. Results show that the DSM-III diagnoses generated using the child version of the Diagnostic Interview Schedule for Children (DISC-C) were significantly associated with several factor analytically-derived symptom scales of the Achenbach and Edelbrock Youth Self-Report. The results included the finding of significant associations for conduct disorders with the delinquency scale, for affective disorders with the depressed scale, and for both affective and anxiety disorders with the broad-band internalizing scales. This study suggests implications about diagnostic categorizations and construct validity as well as implications for clinical evaluation.

The corpus callosum and lateral ventricles in children with attention-deficit hyperactivity disorder: A brain magnetic resonance imaging study

There has been an increasing interest in alterations of corpus callosum (CC) morphology in children with attention-deficit hyperactivity disorder (ADHD), since abnormalities in specific areas of the CC may reflect differences in corresponding regions of the brain from which interhemispheric fibers originate (Giedd et al 1994; Hynd et al 1991; Semrud-Clikeman et al 1994). Results reported to date have been inconsistent (Giedd et al 1994; Hynd et al 1991; Semrud-Clikeman et al 1994), and these divergent findings may arise from several sources, including different diagnostic inclusion criteria for a disorder with extensive comorbidity, different comparison populations, and different age or gender composition of the study populations. We now report on the area of the CC and its seven subdivisions in a large number of children with ADHD (n = 51). In addition, we have measured the volume of the anterior and posterior lateral ventricles (LV) in this population, as we hypoth-

Protecting and Promoting: An Integrative Conceptual Model for Healthy Development of Adolescents

Resilience and positive youth development have substantial overlap and offer complementary perspectives on fostering healthy youth development. However, these two areas have not yet been fully integrated into a unified approach, one that has the potential to build on the interconnectedness of risk, protection, and assets within the ecological systems affecting adolescent development. This article draws on extant research to delineate linkages between the risk and resilience and positive youth development literatures. School-related outcomes are examined within an integrative conceptual model delineating eight developmental domains useful for future research on underlying mechanisms associated with healthy outcomes, as well as prevention and intervention efforts.

Clinical and Developmental Perspectives on Adolescent Coping

Although the development of appropriate coping strategies has been understood as an essential element of healthy adjustment, few studies have demonstrated the link between coping and psychological development. Similarly, research on adolescents with behavioral problems has neglected coping as an important variable in understanding and treating these conditions. This study examines the relationships between psychological development, coping strategies and symptoms in a sample of 302 psychiatrically hospitalized adolescents, ages 12–16. Subjects completed the Adolescent Coping Orientation for Problem Strategies Questionnaire, (A-COPE), the Youth Self Report symptom checklist (YSR), and Loevingers measure of ego development. Results showed that Avoidance and Ventilation were associated with increased behavior problems and lower levels of ego development. Problem solving and interpersonal strategies were associated with fewer symptoms and higher levels of development. Significant gender differences were found with girls using more interpersonal coping and boys using more physically active strategies. Gender differences were also found in the relationship of coping strategies to both symptomatic behavior and development. The results are discussed in the context of a developmental approach to adolescent psychopathology.

Ego development in perspective: Structural stage, functional phase, and cultural age-period models

Abstract Ego development is emerging as one of the more important areas of research in developmental psychology. This paper presents a structural stage approach to ego development and distinguishes it from two other models of ego development, which are termed functional phases and cultural ages . Two subtypes are also delineated within the structural stage approach—a monodomain and a multisubdomain—and the latter is argued for. These concepts are then illustrated through an analysis of four prominent ego development theories—those of Robert Selman, Robert Kegan, Jane Loevinger, and Erik Erikson. The important similarities and critical differences of the theories are clarified, which enables the authors to present a summary integration.

Psychopathology as adaptive development along distinctive pathways.

Contrary to the standard assumption that psychopathology stems from developmental immaturity (retardation, fixation, regression), people diagnosed with psychopathology typically develop along distinctive pathways in which they build complex, advanced skills. These pathways are based on adaptation to trauma, such as maltreatment, or to problems in affective-cognitive regulation, such as those in autism. They do not fit normative developmental frameworks. Research has characterized several types of distinctive pathways, especially those arising from maltreatment; they are marked by normal developmental complexity but distinctive affective-cognitive organization. In one study sexually abused depressed adolescent girls admitted for treatment in a mental hospital described themselves-in-relationships with age-appropriate, complex developmental levels equal to those of both nonabused depressed girls and other adolescents. At the same time, they showed a powerful negativity bias contrasting with the positivity biases of other girls. Many of them produced dramatic switches in affective-cognitive organization across assessments contrasting with the similar organization showed by other girls. In another study toddlers from maltreating families showed a consistent negativity bias in play and representations of interactions. We show how to portray these distinctive developmental pathways through the example of Hidden Family Violence, in which people dissociate their private violent world from their public, good-citizen world.

Comparison of DISC with Clinicians' DSM-III Diagnoses in Psychiatric Inpatients

A sample of 163 children and adolescents, consecutively admitted to a large, private psychiatric teaching hospital, was interviewed using the child version of the Diagnostic Interview Schedule for Children (DISC-C). Patients, ages 12 to 16, were interviewed during the first month of admission. Kappa coefficients were obtained from cross-tabulated frequencies of DISC and clinician diagnoses. Agreement between clinical and DISC diagnoses was generally poor across diagnostic categories. In general, when algorithms of a higher threshold were used, the percentage of patients in a particular diagnostic group was closer to the percentage diagnosed by the clinician. Discussion focuses on factors that may contribute to the discrepancy between number and type of diagnoses that the DISC yields compared to those made by the clinicians.

Adolescent suicidality: A clinical-developmental approach

This study investigates the relation of ego development, age, gender, and diagnosis to suicidality among 219 adolescent psychiatric inpatients. Using the Diagnostic Interview Schedule for Children, adolescents were classified as suicide attempters or as nonsuicidal and were categorized into three diagnostic groups: affective disorder, conduct disorder, or mixed conduct-affective disorder. Ego development measurement was used to assess developmental maturity. Chi-square analyses demonstrated a relation between suicide attempts and developmental complexity. Attempters were more likely to be diagnosed with affective or mixed conduct-affective disorders and to be girls. Suicidality was not associated with age in this sample. Log-linear analyses demonstrated the interplay of known suicide risk factors with the important new dimension of developmental level.

Sex Differences within the Family: Studies of Adolescent and Parent Family Interactions.

Sex differences in verbal family interactions were investigated in a group of 79 adolescents and parents from normal and psychiatric settings. The analyses were designed to study these differences in both generations, parent and adolescent. Parent and adolescent interactions with one another were observed in a semistructured, revealed-differences family discussion. All of the individual speeches were then scored with our Constraining and Enabling Coding System (CECS). Initial predictions involved both adolescent and parent differences. These hypotheses were only partially confirmed. The strongest findings pertained to parent sex differences, as we found strikingly higher levels of cognitive enabling speeches expressed by fathers and significantly more speeches addressed to fathers. We discuss several alternative interpretations of these findings. Perspectives included in our considerations are direction of effect and influences of task/context upon the expression of family sex differences.

Conduct and affective disorders in developmental perspective: A systematic study of adolescent psychopathology

This study examined the relationship of psychiatric diagnoses to gender, IQ, and ego development level in an inpatient sample of 269 adolescents. It was found that adolescents with an affective disorder diagnosis, in contrast to those with a diagnosis of conduct or mixed affective-conduct disorder, were more likely to (a) be female, (b) have higher IQ scores, and (c) have higher ego development levels. No significant age differences were found between groups. Comparisons between the single diagnosis and mixed disorder groups indicated that the mixed disorder group is characterized by the most severe symptoms found in each of the pure affective and conduct disordered groups. A relationship between type of DSM-III diagnosis and ego development level in adolescence was demonstrated after controlling for the effects of age, gender, and IQ. These results are offered as an explication of the developmental dimensions inherent in DSM-III psychiatric diagnoses.