John D. Guerry

Peer Influence and Nonsuicidal Self Injury: Longitudinal Results in Community and Clinically-Referred Adolescent Samples

Research suggests that adolescents’ engagement in nonsuicidal self-injurious (NSSI) behaviors may be increasing over time, yet little is known regarding distal longitudinal factors that may promote engagement in these behaviors. Data from two longitudinal studies are presented to examine whether NSSI may be associated with peer influence processes. Study 1 included 377 adolescents from a community-based sample; Study 2 included 140 clinically-referred adolescents recruited from a psychiatric inpatient facility. In Study 1, adolescents’ NSSI was examined at baseline and one year later. Adolescents’ nominated best friend reported their own levels of NSSI. In Study 2, adolescents’ NSSI was examined at baseline as well as 9 and 18-months post-baseline. Adolescents’ perceptions of their friends’ engagement in self-injurious behavior (including suicidality) and depressed mood also were examined at all three time points. Baseline depressive symptoms were measured in both studies; gender and age were examined as moderators of peer influence effects. Results from both studies supported longitudinal peer socialization effects of friends’ self-injurious behavior on adolescents’ own NSSI for girls, but not for boys, even after controlling for depressive symptoms as a predictor. Study 1 suggested socialization effects mostly for younger youth. Results from Study 2 also suggested longitudinal socialization effects, as well as peer selection effects; adolescents’ NSSI was associated with increasing perceptions of their friends’ engagement in depressive/self-injurious thoughts and behavior. Findings contribute to the nascent literature on longitudinal predictors of NSSI and to work on peer influence.

In Search of HPA Axis Dysregulation in Child and Adolescent Depression

Dysregulation of the hypothalamic–pituitary–adrenal (HPA) axis in adults with major depressive disorder is among the most consistent and robust biological findings in psychiatry. Given the importance of the adolescent transition to the development and recurrence of depressive phenomena over the lifespan, it is important to have an integrative perspective on research investigating the various components of HPA axis functioning among depressed young people. The present narrative review synthesizes evidence from the following five categories of studies conducted with children and adolescents: (1) those examining the HPA system’s response to the dexamethasone suppression test (DST); (2) those assessing basal HPA axis functioning; (3) those administering corticotropin-releasing hormone (CRH) challenge; (4) those incorporating psychological probes of the HPA axis; and (5) those examining HPA axis functioning in children of depressed mothers. Evidence is generally consistent with models of developmental psychopathology that hypothesize that atypical HPA axis functioning precedes the emergence of clinical levels of depression and that the HPA axis becomes increasingly dysregulated from child to adult manifestations of depression. Multidisciplinary approaches and longitudinal research designs that extend across development are needed to more clearly and usefully elucidate the role of the HPA axis in depression.

Longitudinal Prediction of Adolescent Nonsuicidal Self-Injury: Examination of a Cognitive Vulnerability-Stress Model

Virtually no longitudinal research has examined psychological characteristics or events that may lead to adolescent nonsuicidal self-injury (NSSI). This study tested a cognitive vulnerability-stress model as a predictor of NSSI trajectories. Clinically-referred adolescents (n = 143; 72% girls) completed measures of NSSI, depression, attributional style, and interpersonal stressors during baseline hospitalization. Levels of NSSI were reassessed 3, 6, 9, 15, and 18 months later. Latent growth curve analyses suggested that a cognitive vulnerability-stress interaction significantly predicted increases in NSSI between 9 and 18 months post-baseline. This association remained significant while considering the longitudinal association between depressive symptoms and NSSI; results were not significantly mediated by depressive symptoms at 9 months.

Adolescent Social Phobia in Clinical Services

The normal course of adolescence presents many developmental challenges at the biological, psychological, and interpersonal level (Steinberg 2004; Levpuscek 2006). The onset of puberty, increasing complexity of peer relationships and increased expectations at home, school, and often work, can make successful transition through adolescence complex even for the most well-adjusted teen. Social anxiety disorder (SAD) in adolescence exacerbates these challenges exponentially. As such, study of SAD during this developmental stage is of particular importance, given that SAD frequently onsets during adolescence and disrupts functioning and quality of life throughout the life span (Brown et al. J Abnorm Psychol 110:49–58, 2001; Burstein et al. J Am Acad Child Adoles Psychiatry 50:870–880, 2011; Rosellini et al. J Psychopathol Behav Assess 35:356–365, 2013). This chapter provides an overview of the ways in which adolescence provides fertile ground for the development and exacerbation of SAD, focusing on the particular challenges unique to this developmental stage at the biological, cognitive, behavioral, and interpersonal level. Next, we review the ways in which empirically supported treatments and interventions have been tailored to meet those challenges in this age group. The chapter also addresses how recent sociocultural changes and contemporary research have increased awareness of how these challenges can extend and develop during emerging adulthood. Finally, we discuss new frontiers in empirically supported treatments to engage the challenges accompanying this newly recognized developmental stage transition.

Launching Anxious Young Adults: A Specialized Cognitive-Behavioral Intervention for Transitional Aged Youth

Purpose of ReviewThere has been growing clinical and research attention to the unique developmental stage of emerging adulthood. This stage is a time of significant change and growth for all individuals, as it includes identity exploration, emotional, behavioral, and financial independence from caregivers, and completion of educational or vocational requirements.Recent FindingsAnxiety disorders are the most common mental health diagnoses among emerging adults, and individuals suffering from these disorders often experience compounding functional impairments across health, financial, and social domains. While evidence-based treatments exist for both child/adolescent anxiety disorders and adult anxiety disorders, no specialized assessment or treatment methods have been established for the unique period of emerging adulthood.SummaryOur review examines literature pertinent to anxiety disorders in emerging adulthood and describes a novel, specialized intervention to address the unique challenges faced by anxious emerging adults. The Launching Emerging Adults Program (LEAP) is a developmentally informed cognitive-behavioral treatment model that aims to simultaneously reduce anxiety symptoms and promote independence. We conclude with a discussion of lessons learned and future directions.