Lorah D. Dorn

Defining the Boundaries of Early Adolescence: A User's Guide to Assessing Pubertal Status and Pubertal Timing in Research with Adolescents.

This article addresses pragmatic issues regarding the assessment of puberty in research on adolescent health and development. Because pubertal processes have a major effect on physical, psychological, and social development, we posit that the assessment of pubertal status is at least as important as the specification of age for characterizing adolescent participants in research studies. Yet, a sampling of recent literature shows that the majority of publications addressing health and developmental issues in adolescence lack any measure of puberty. A more comprehensive review of 447 articles reporting to have assessed puberty reveals considerable inconsistencies in methods, definitions, and conceptualizations of puberty and its stages, which highlights the need for better standardization. This article provides an in-depth review of existing methods to assess pubertal status and timing and enumerates the relative merits and shortcomings of several approaches. Conceptual and practical guidelines are provided for selecting specific measures to assess puberty with an emphasis placed on the need for these choices to be driven by the specific goals of the research.

Psychological Comorbidity and Stress Reactivity in Children and Adolescents With Recurrent Abdominal Pain and Anxiety Disorders

OBJECTIVE To compare clinical symptoms, diagnoses, and physiological measures in children and adolescents with recurrent abdominal pain (RAP) (n = 14), to a group with anxiety disorders (ANX) (n = 14) and a physically and psychiatrically healthy control group (HC) (n = 14). METHOD The cross-sectional study examined group differences in clinical symptoms of anxiety, somatic complaints, depression, and behavior problems. Physiological measures included heart rate, systolic and diastolic blood pressure, and salivary cortisol in response to the Trier Social Stress Test for Children (TSST-C). Subjects were between the ages of 8 and 16 years. RESULTS RAP and ANX subjects had comparable scores on most psychological measures, and their scores were higher (n < .05) than those of the HC. The ANX and RAP groups exhibited physiological findings that had more shared similarities than either group with the HC group. Few statistically significant group differences were noted in physiological measures, yet the pattern of findings in blood pressure and cortisol supported the use of the TSST-C and the direction of the findings was consistent with expectations. CONCLUSIONS Understanding more about comorbidity between RAP and anxiety could have important management implications, with observed congruities between the disorders suggesting treatments already demonstrated to be efficacious for pediatric anxiety and depression might be applied productively to RAP.

Participation in biomedical research : the consent process as viewed by children, adolescents, young adults, and physicians

We examined the capacity of children, adolescents, and young adults to assent and consent to participation in biomedical research, and what physician-investigators believe is important for patients in these age groups to know about such participation. The sample included 44 male and female subjects, ranging in age from 7 to 20 years, who were hospitalized to treat either pediatric cancer or obesity. The participants completed a structured interview that assessed knowledge of research participation using the elements outlined in the federal guidelines for informed consent. The study subjects were most knowledgeable about those elements of consent that assessed concrete information (e.g., freedom to ask questions, time elements involved, and the benefits of participation). They were less knowledgeable about those elements of informed consent that assessed abstract information (e.g., scientific vs therapeutic purpose of the study, and alternative treatments). Chronologic age was not related to knowledge of the elements of informed consent. The strategies that the study subjects used to reason about participation in research appeared to parallel their reasoning about other physical phenomena.

Negative affect and hormone levels in young adolescents: Concurrent and predictive perspectives.

The purpose of this study was to test hypotheses regarding (1) relations among negative affect and hormones of gonadal and adrenal origin in young adolescents, at three times of measurement, over a one-year period; and (2) stability of negative affect. The sample consisted of 10- to 14-year-old boys (N=56) and 9- to 14-year-old girls (N=52). The adolescents were assessed three times at 6-month intervals over one year. Serum levels of gonadotropins, gonadal steroids, adrenal androgens, and cortisol were assessed, as well as stage of pubertal development (Tanner criteria). The negative affect assessments consisted of self-report questionnaire and interview measures of anxiety and depressive affect, as well as mother reports of internalizing behavior problems. In the concurrent (cross-sectional) analyses, boys reporting higher levels of negative affect tended to be those at higher genital stage or older age, with lower testosterone and cortisol levels and lower dehydroepian-drosterone sulphate levels. In the longitudinal analyses, negative affect, and to a lesser extent hormone levels at the first time of measurement predicted negative affect 12 months later. The findings suggest that puberty-related hormone levels should be considered along with psychological characteristics in examining the processes involved in the development of negative affect during the pubertal years.

Psychopathology in patients with endogenous Cushing's syndrome: ‘atypical’ or melancholic features

OBJECTIVE Prolonged elevations of glucocorticoids have been linked to the affective disturbances experienced by patients with Cushings syndrome. Major depression has been most commonly reported In patients with endogenous Cushings syndrome. The purpose of this study was to determine whether these patients experience melancholic or ‘atypical’ subtype depression and to determine relations between current psychological functioning and factors such as duration and severity of Cushings syndrome.

Clinical Presentation and Course of Depression in Youth: Does Onset in Childhood Differ From Onset in Adolescence?

OBJECTIVE To simultaneously and prospectively compare the clinical presentation, course, and parental psychiatric history between children and adolescents with major depressive disorder. METHOD A group of prepubertal children (n = 46) and postpubertal adolescents (n = 22) were assessed with structured interviews for psychopathology and parental psychiatric history and followed once every 2 years for approximately 5 years. RESULTS With the exception of more depressive melancholic symptoms in the adolescents, both groups had similar depressive symptomatology, duration (average 17 months), severity of the index episode, rates of recovery (85%) and recurrence (40%), comorbid disorders, and parental psychiatric history. Female sex, increased guilt, prior episodes of depression, and parental psychopathology were associated with worse longitudinal course. CONCLUSIONS In general, major depressive disorder is manifested similarly in children and adolescents, and both groups have a protracted clinical course and high family loading for psychiatric disorders.

Depression, Cortisol Reactivity and Obesity in Childhood and Adolescence

PURPOSE Depression in childhood is associated with higher body mass index (BMI), a relative measure of overweight, and overweight is associated with cortisol reactivity, indexed by heightened secretion of cortisol in response to a stressor. The current study uses a mediation model to examine the associations between symptoms of depression, cortisol reactivity and BMI in a cross-sectional study. METHODS Children (N = 111) 8 to 13 years old and a parent completed structured interviews. The Child Behavior Checklist was used to assess symptoms of depression, and cortisol reactivity to the Trier Social Stress Test for Children was measured. Physical examinations were used to determine BMI (kg/m(2)) and pubertal stage. RESULTS Depression was positively associated with BMI in both sexes. Age and pubertal stage were not significantly associated with BMI, nor was physical activity and BMI in a model including depression. In girls, but not in boys, the association between depression and BMI was mediated by cortisol reactivity. CONCLUSIONS The current findings attest to the significance of psychologic states as potential components in models of childhood obesity, and provide conceptual and empirical support for the inclusion of cortisol reactivity in these models.

Salivary cortisol reflects serum cortisol: analysis of circadian profiles

Background: Technical hurdles limit the characterization of key hormonal rhythms. Frequent sampling increases detection of changes in magnitude or circadian and ultradian patterns, but limits feasibility for clinical or research settings. These caveats are particularly pertinent for cortisol, a hormone that displays a prominent circadian rhythm and whose magnitude is tightly regulated in the absence of biobehavioural challenge. Ideally, one would like to obtain samples non-invasively from a matrix of interest at frequent intervals. While many investigations have reported a high correlation between serum and salivary cortisol assays, the degree to which salivary cortisol reflects the circadian patterns of circulating cortisol concentrations has not been established across a 24 h period. Methods: We obtained hourly serum and salivary samples over a 24 h period in nine adults in an inpatient setting. The circadian patterns for serum and salivary cortisol were analysed by harmonic regression. Results: For all but two subjects (both on oral contraceptives), the salivary cortisol concentration was synchronous with the serum concentration, indicating that the salivary assay could be substituted for the serum assay to assess circulating rhythmicity across the 24 h time frame. Conclusions: This statistical model has distinct improvement over the correlational approach of examining serum and saliva cortisol relationships. Saliva cortisol appears to represent serum cortisol across the 24 h period, except for those on oral contraceptives.

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.

Pubertal timing and adolescent adjustment and behavior: Conclusions vary by rater

The effects of pubertal timing on adolescent development have been studied since the late 1930s, yet the research has yielded inconsistent findings. One reason for such inconsistency may be the source of the rating. The purpose of this report was to examine whether pubertal timing by self-report (SR), parent report (PR), or physical exam (PE) predicted the same aspects of adjustment and behavior problems. Fifty-two girls, age 9–14 years (M = 12.0 ± 1.6) and 56 boys, age 10–15 years (M = 12.7 ± 1.3) and their parents were enrolled in the longitudinal study. Parents completed the Child Behavior Checklist and adolescents completed the Offer Self-Image Questionnaire. Using regression, later maturing boys and girls had more adjustment and behavior problems than on-time or earlier maturers in cross-sectional analyses. Longitudinally, there were few significant relationships between pubertal timing at the first occasion of measurement and adjustment and behavior problems 1 year later. Overlap in correlates of adjustment and behavior problems across raters was not always found. More significant findings were evident between pubertal timing and adjustment and behavior problems for boys than for girls and more for ratings by PE than by SR or PR. Caution appears in order when drawing conclusions about pubertal timing and adolescent behavior when rater of pubertal development or timing of rating varies across studies. The selection of who rates pubertal development and the timing of the ratings should be based on the underlying theoretical framework guiding the hypotheses.