Grayson N. Holmbeck

Adolescent Health Psychology

In this article, a biopsychosocial model of adolescent development is used as an organizing framework for a review of primary, secondary, and tertiary prevention research with adolescent populations. During adolescence many critical health behaviors emerge, affecting future disease outcomes in adulthood. In addition, most of the predominant causes of morbidity and mortality in adolescence are unique to this period of development, indicating that health-focused interventions must be tailored specifically to adolescents. Moreover, it is during adolescence that lifelong patterns of self-management of and adjustment to chronic health conditions are established. Thus, an increased focus on adolescence in health psychology research is important both to improve the health of adolescents per se and to optimize health trajectories into adulthood.

Mediator and moderator effects in developmental and behavioral pediatric research.

The terms mediation and moderation are defined and clarified with particular emphasis on the role of mediational and moderational analyses in developmental and behavioral pediatric research. The article highlights the applicability of mediational and moderational analyses to longitudinal, intervention, and risk and protective factor research, and it provides basic information about how these analyses might be conducted. Also included is a discussion of various ways that both mediator and moderator variables can be incorporated into a single model. The article concludes with extended examples of both types of analyses using a longitudinal pediatric study for illustration. The article provides recommendations for applying mediational and moderational research in clinical practice.

Individual and Familial Influences on the Onset of Sexual Intercourse Among Urban African American Adolescents

A sample of 198 African American families, living in urban poverty, participated in a longitudinal study of adolescent sexual development beginning when children were in the 4th or 5th grade. Self-reports of family conflict and pubertal development and videotaped family interaction data were collected at 2 time points approximately 2 years apart. Youths reported on sexual debut at each time point. More boys than girls reached sexual debut early. Greater levels of family conflict predicted early sexual debut. Observational data indicated more developed preadolescents with greater family conflict and less positive affect were least likely to delay debut. Changes in pubertal development and observed family conflict were associated with early debut. Possible mediating mechanisms and implications for preventive interventions are discussed.

Dyadic Measures of the Parent-Child Relationship During the Transition to Adolescence and Glycemic Control in Children With Type 1 Diabetes

To identify aspects of family behavior associated with glycemic control in youth with type 1 diabetes mellitus during the transition to adolescence, the authors studied 121 9- to 14-year-olds (M = 12.1 yrs) and their parents, who completed the Diabetes Family Conflict Scale (DFCS) and the Diabetes Family Responsibility Questionnaire (DFRQ). From the DFRQ, the authors derived 2 dyadic variables, frequency of agreement (exact parent and child concurrence about who was responsible for a task) and frequency of discordance (opposite parent and child reports about responsibility). The authors divided the cohort into Younger (n = 57, M = 10.6 yrs) and Older (n = 64, M = 13.5 yrs) groups. Family conflict was significantly related to glycemic control in the entire cohort and in both the Younger and Older groups. However, only in the Younger group was Agreement related to glycemic control, with higher Agreement associated with better glycemic control. Findings suggest that Agreement about sharing of diabetes responsibilities may be an important target for family-based interventions aiming to optimize glycemic control in preteen youth.

A Longitudinal Examination of Familial Risk Factors for Depression Among Inner-City African American Adolescents

This research examines longitudinally associations between family risk factors and child and parent depression in 302 urban, low-income, African American adolescents (ages 9-15) and their parents across 2 waves of data collection. Diagnostic data revealed that 7.3% of parents and 3.0% of children at Time 1 and 5.4% of parents and 2.8% of children at Time 2 were clinically depressed. Regression analyses revealed that changes in family functioning were concurrently associated with changes in depression for both children and parents. Specifically, increases in conflict and decreases in parental monitoring were associated with increases in child depressive symptomatology, and increases in conflict and decreases in positive parenting were associated with increases in parental depressive symptomatology. Findings are discussed within a framework of understanding family protective factors and the prevention of depression.

Beyond the “Birds and the Bees”: Gender Differences in Sex‐Related Communication Among Urban African‐American Adolescents

The current study examined gender differences in communication about sex-related topics in a community sample of urban, African-American mothers and adolescents living in impoverished neighborhoods with high HIV rates. One hundred and sixty-two mother-adolescent dyads completed self-report measures of sex-related communication. Youth also reported on their sexual risk. We identified the range of sexual-based topics that adolescents discussed with their mothers, fathers, friends, and at school. The relationship between the frequency of sexual communication and sexual risk was examined. We also investigated congruency between adolescent and mother report about whether sexual-based discussions occurred. Consistent with prior research, girls talked to their mothers, fathers, friends, and at school about sex-related topics more than boys. Findings indicated that mothers not only communicated more frequently about sexual issues with their daughters than sons but that parental messages for girls were more protective. Greater sexual communication with mother was significantly associated with decreased HIV risk in the past 90 days and increased protection from HIV. Inconsistencies between mother and adolescent reports about sexual communication were marginally associated with decreased protection from HIV. Findings reveal the protective effect of sexual communication and the general lack of congruence between mother and adolescent reports of sexual communication.

Editorial: An Author's Checklist for Measure Development and Validation Manuscripts

A recent special issue of the Journal of Pediatric Psychology included papers focused on evidence-based assessment across several broad domains of assessment in pediatric psychology (e.g., adherence, pediatric pain, and quality of life). In one of these papers, Holmbeck et al. (2008) reviewed strengths and limitations of existing measures of psychosocial adjustment and psychopathology, concluding that many measures lacked supporting psychometric data (e.g., basic indices of reliability and validity) that would permit a complete evaluation of these measures. Given that measure development and validation papers are frequently published in JPP (Brown, 2007), it is important that we attend to guiding psychometric principles when developing and disseminating data on new measures to be employed with pediatric populations (Nunnally & Bernstein, 1994). Thus, the purpose of this paper is to present and describe a checklist for authors to use when submitting measure development papers to JPP. This checklist is included in the Appendix and is also included at the following link on the JPP website: http://www.oxfordjournals.org/our_journals/jpepsy/for_authors/measure%20development%20checklist.pdf Findings presented by Holmbeck et al. (2008) indicated that 34 of the 37 measures reviewed met pre-established “evidence-based assessment” (EBA) criteria for “well-established” measures (Cohen et al., 2008). To be considered “well-established,” a measure had to have been presented in at least two peer-reviewed journal articles by different investigatory teams, have demonstrated adequate levels of reliability and validity, and be accompanied by supporting information (e.g., a measure manual). Although most measures that we reviewed met these criteria, we also found that most of the 34 “well-established” measures were hampered by at least one major psychometric flaw and/or lacked important psychometric data. We concluded that a more fine-grained EBA classification system is needed. One important distinction in this literature relates to differences between empirically supported assessment and evidence-based assessment. This type of distinction was first discussed in the literature on clinical interventions (e.g., Spring, 2007). An empirically supported intervention is one that has demonstrated efficacy in randomized clinical trials or clinic-based effectiveness trials. An evidence-based intervention has empirical support in the manner just described, but also “integrates research evidence, clinical expertise, and patient preferences and characteristics … empirically-supported treatments (ESTs) are an important component of evidence-based practice (EBP), but EBP cannot be reduced to ESTs” (Spring, 2007, p.611). Applying these terms to the field of assessment and measure development efforts, an empirically supported assessment measure would be one that demonstrates satisfactory psychometric characteristics, broadly defined. To be evidence based, the measure should also demonstrate utility in clinical settings, be useful in making diagnoses, be sensitive to treatment effects, and/or provide incremental validity above and beyond other similar measures. Although papers in the special issue of JPP frequently referred to “evidence-based assessment” (Cohen et al., 2009), the articles included in the issue tended to evaluate the degree to which the measures were empirically-supported rather than evidence based. To be “evidence-based,” our reviews would have needed to integrate an evaluation of clinical utility, diagnostic utility, and treatment sensitivity with the empirical psychometric data presented in each review. As noted, the published reviews were more likely to focus on the latter rather than on the former. As suggested by Mash and Hunsley (2005), detailed EBA profiles would provide a complete evaluation of evidence across each of several psychometric and clinically relevant dimensions, including: (a) internal consistency, (b) test–retest reliability, (c) the availability of normative data, (d) content validity, (e) construct validity, (f) convergent and discriminant validity, (g) criterion-related validity, (h) incremental validity, (i) clinical utility, (j) diagnostic utility, and (k) treatment sensitivity. The focus on incremental validity and clinical and diagnostic utility raises the bar from a focus on “empirical support” (i.e., where the focus would tend to be primarily on psychometric data) to a broad focus on the “evidence base” for a measure. In developing the checklist that is the focus of this article, we attempted to provide a list of criteria relevant to establishing the evidence base (and not just empirical support) for a measure. In addition to shifting the focus from providing “empirical support” for a measure to providing an “evidence base” for our instruments, a checklist for measure development papers would permit JPP reviewers to evaluate such papers in the same way that reviewers of randomized clinical trials make use of the Consolidated Standards of Reporting Trials (CONSORT) checklist and flowchart (Altman et al., 2001). The CONSORT checklist contains reporting standards with respect to methodological features of and the manner in which results are reported in clinical trials. Moreover, authors are required to provide a flowchart that describes details of sample recruitment and attrition during the course of the study. Thus, a checklist for measure development papers would serve two interrelated purposes: (a) it would provide guidance to authors as they embark on the measure development process and would provide a list of criteria authors can use as they develop an evidence base for their measures, and (b) it would begin to standardize the manner in which psychometric and other assessment-related data are presented in measure development papers for this journal. Before providing a more detailed overview of the checklist, it is important to note that this checklist is rather exhaustive (see Appendix). As such, it represents what would “ideally” be expected for a measure development or validation manuscript rather than minimal criteria for such papers. No one paper can provide a complete evaluation of all important psychometric and clinically relevant dimensions that will establish once-and-for-all the evidence base for a measure. Instrument refinement is part of a measure development process that gradually builds an evidence base for a scale (see Smith & McCarthy, 1995, for suggestions on measure refinement). Indeed, the validation of any measure is a cumulative process that occurs across many different types of research studies and across research programs.

Parent Functioning in Families of Preadolescents With Spina Bifida: Longitudinal Implications for Child Adjustment

The purpose of this study was to test a strength-of-association model regarding possible longitudinal and bidirectional associations between parent functioning and child adjustment in families of children with spina bifida (n = 68) and families of able-bodied children (n = 68). Parent functioning was assessed across 3 domains: parenting stress, individual psychosocial adjustment, and marital satisfaction. Child adjustment was indexed by teacher-reported internalizing and externalizing symptoms, self-reported depressive symptoms, and observed adaptive behavior. Findings revealed that all 3 parent functioning variables predicted child adjustment outcomes, and that such results were particularly strong for externalizing symptoms. Associations between parent functioning and child adjustment tended to be in the direction of parent to child and were similar across both groups. These findings have implications for potential interventions targeted at helping families manage the transition into early adolescence in families of children with spina bifida as well as families of healthy children.

Psychosocial and family functioning in spina bifida

A developmentally oriented bio-neuropsychosocial model is introduced to explain the variation in family functioning and psychosocial adjustment in youth and young adults with spina bifida (SB). Research on the family functioning and psychosocial adjustment of individuals with SB is reviewed. The findings of past research on families of youth with SB support a resilience-disruption view of family functioning. That is, the presence of a child with SB disrupts normative family functioning but many families adapt to such disruption and exhibit considerable resilience in the face of adversity. Parents of youth with SB, and particularly those from lower socio-economic status (SES) homes, are at-risk for psychosocial difficulties. Individuals with SB are at-risk for developing internalizing symptoms, attention problems, educational difficulties, social maladjustment, and delays in the development of independent functioning. Emerging adults are often delayed in achieving milestones related to this stage of development (e.g., vocational and educational achievements). Methodologically sound, longitudinal, and theory-driven studies of family and psychosocial functioning are needed, as are randomized family-based intervention trials, to promote adaptive functioning and better psychosocial outcomes in families of individuals with SB.

Storm and stress beliefs about adolescence: Prevalence, self-reported antecedents, and effects of an undergraduate course

The purpose of the present study was to determine the prevalence and self-reported developmental antecedents of beliefs in storm and stress notions about adolescence, and to investigate the effects on such beliefs of an undergraduate course on adolescent development. Subjects were 192 college students who were enrolled in a course entitled “Psychology of Adolescence” at a large urban university. The questionnaire, which was administered at the beginning and end of the course, contained a storm and stress scale, items tapping the nature of parent-adolescent arguments, Dusek and Flahertys (1981) Self-Concept Scale, and several demographic questions. Results suggested that beliefs in storm and stress notions are quite prevalent, arguments between parents and adolescents are believed to occur quite frequently, and females endorse storm and stress beliefs more readily than do males. Moreover, subjects tended to endorse storm and stress notions more readily if they viewed themselves as being less adjusted during their own adolescence and if they reported more adjustment instability. After a course on adolescent development, the tendency to report that the typical adolescent experiences storm and stress decreased, and this decrease was more pronounced for those receiving higher grades in the course.