Manfred H. M. van Dulmen

Behavior problems in postinstitutionalized internationally adopted children

Using the Child Behavior Checklist (CBCL), the rate and type of behavior problems associated with being reared in an institution prior to adoption were examined in 1,948, 4- through 18-year-old internationally adopted children, 899 of whom had experienced prolonged institutional care prior to adoption. The childrens adoptions were decreed between 1990 and 1998 in Minnesota. Binomial logistic regression analyses revealed that early institutional rearing was associated with increased rates of attention and social problems, but not problems in either the internalizing or externalizing domains. Independent of institutional history, children who were adopted >or=24 months had higher rates of behavior problems across many CBCL scales, including internalizing and externalizing problems. In general, time in the adoptive home, which also reflected age at testing, was positively associated with rates of problem behavior. Thus, there was little evidence that the likelihood of behavior problems wane with time postadoption. Finally, children adopted from Russia/Eastern Europe appeared at greater risk of developing behavior problems in several domains compared to children adopted from other areas of the world.

Casual Sexual Relationships and Experiences in Emerging Adulthood

Casual sexual relationships and experiences (CSREs) such as hookups, one-night stands, friends with benefits relationships, and booty calls have received increasing attention in the past decade. This review examines the role of CSREs during emerging adulthood, as well as similarities and differences among the different types of CSREs. Furthermore, we examine the predictors and positive and negative consequences of engaging in CSREs. While research in the area of CSREs has provided important information about the development and course of these relationships/experiences, future research should focus on exploring these relationships/experiences using an integrated theoretical perspective and longitudinal methods, in diverse, noncollege samples.

Regression Models for Count Data: Illustrations using Longitudinal Predictors of Childhood Injury

OBJECTIVE To offer a practical demonstration of regression models recommended for count outcomes using longitudinal predictors of childrens medically attended injuries. METHOD Participants included 708 children from the NICHD child care study. Measures of temperament, attention, parent-child relationship, and safety of physical environment were used to predict medically attended injuries. RESULTS Statistical comparisons among five estimation methods revealed that a zero-inflated Poisson (ZIP) model provided the best fit with observed data. ZIP models simultaneously model dichotomous and continuous outcomes of count variables, and different constellations of predictors emerged for each aspect of the estimated model. CONCLUSIONS This study offers a practical demonstration of techniques designed to handle dependent count variables. The conceptual and statistical advantages of these methods are emphasized, and Stata script is provided to facilitate adoption of these techniques.

Cognitive function and treatment adherence in older adults with heart failure.

Objective Treatment recommendation and guidelines for patients with heart failure (HF) can be complex, and past work has shown that patients with HF demonstrate low rates of adherence to recommended health behaviors. Although previous work has identified several medical, demographic, and psychosocial predictors of the capacity to adhere to treatment recommendations of persons with HF, little is known about the contribution of cognitive impairment to reported treatment adherence in this population. Methods A total of 149 persons with HF (mean [standard deviation] = 68.08 [10.74] years) completed a brief fitness assessment and neuropsychological testing. Treatment adherence was assessed using the Heart Failure Compliance Questionnaire, a brief measure that asks participants to report their adherence to a variety of recommended health behaviors (i.e., medication management, diet, and exercise, among others). Results The percentage of participants who reported poor overall adherence was 16.1%, with particularly high rates of nonadherence to dietary and exercise recommendations. Hierarchical regression analyses adjusting for possible confounds revealed that reduced performance on attention (&bgr; = .26, p = .01), executive function (&bgr; = .18, p = .04), and language (&bgr; = .22, p = .01) was associated with poorer overall adherence. Follow-up analyses showed that these cognitive domains were associated with behaviors such as keeping doctor appointments, medication management, and dietary recommendations (p < .05 for all). Conclusions The current findings demonstrate that cognitive function is an independent contributor to adherence in older adults with HF. Prospective studies that objectively measure treatment adherence are needed to clarify these findings and identify possible strategies to improve outcomes in this population. Trial Registration: clinicaltrials.gov Identifier: NCT00871897.

Randomized controlled trial of mindfulness-based stress reduction for prehypertension.

Objective Mindfulness-based stress reduction (MBSR) is an increasingly popular practice demonstrated to alleviate stress and treat certain health conditions. MBSR may reduce elevated blood pressure (BP). Treatment guidelines recommend life-style modifications for BP in the prehypertensive range (systolic BP [SBP] 120–139 mm Hg or diastolic BP [DBP] 80–89 mm Hg), followed by antihypertensives if BP reaches hypertensive levels. MBSR has not been thoroughly evaluated as a treatment of prehypertension. A randomized clinical trial of MBSR for high BP was conducted to determine whether BP reductions associated with MBSR exceed those observed for an active control condition consisting of progressive muscle relaxation (PMR) training. Methods Fifty-six men (43%) and women (57%) averaging (standard deviation) 50.3 (6.5) years of age (91% white) with unmedicated BP in the prehypertensive range were randomized to 8 weeks of MBSR or PMR delivered in a group format. Treatment sessions were administered by one treatment provider and lasted approximately 2.5 hours each week. Clinic BP was the primary outcome measure. Ambulatory BP was a secondary outcome measure. Results Analyses were based on intent to treat. Patients randomized to MBSR exhibited a 4.8-mm Hg reduction in clinic SBP, which was larger than the 0.7-mm Hg reduction observed for PMR (p = .016). Those randomized to MBSR exhibited a 1.9-mm Hg reduction in DBP compared with a 1.2-mm Hg increase for PMR (p = .008). MBSR did not result in larger decreases in ambulatory BP than in PMR. Conclusions MBSR resulted in a reduction in clinic SBP and DBP compared with PMR. Trial Registration ClinicalTrials.gov identifier: NCT00440596.

Psychosocial predictors and outcomes of loneliness trajectories from childhood to early adolescence.

Using latent class growth analysis, we were interested in investigating how experiences of loneliness emerge in distinct developmental patterns over the course of middle childhood and adolescence (NICHD Study of Early Child Care, N = 832). Second, we examined the role of demographic, mental health, and behavioral variables in association with these discrete patterns of loneliness. Loneliness was measured at 3 time points: age 9, age 11, and age 15. Results indicated five discrete trajectories of loneliness from middle childhood to adolescence. Most children exhibited a stable and low level of loneliness over time. The remaining children were split among moderate increasing, high increasing, decreasing, and chronic loneliness groups. Ethnicity, income, age 7 social skills, age 7 depression, and age 7 aggression were associated with trajectory membership. In addition, the loneliness trajectories predicted self-reports of social skills deficits, depression, aggression, and suicidal ideation at age 15.

Changes in Loneliness during Middle Childhood Predict Risk for Adolescent Suicidality Indirectly through Mental Health Problems

We investigated whether changes in loneliness during middle childhood as well as from middle childhood into adolescence were associated with adolescent self-harm behaviors and suicidal thoughts using a community sample of 889 participants. Multivariate logistic regressions indicate that the relationship between changes in loneliness and suicidality is no longer statistically significant once depression and externalizing behavior problems are included as controls. Follow-up analyses indicate that increases in loneliness indirectly affect self-harm behaviors and suicidal thoughts through depression and externalizing behavior problems. These findings are consistent with other studies on peer relationships and adolescent suicidality, suggesting that experiences with peers indirectly affect risk for suicidality through mental health problems. These findings highlight the importance of considering how experiences in middle childhood peer relationships affect risk for suicide in consecutive developmental periods, particularly adolescence.

Analyzing multiple informant data on child and adolescent behavior problems: Predictive validity and comparison of aggregation procedures

We compared the predictive validity of five aggregation methods for multiple informant data on child and adolescent behavior problems. In addition, we compared the predictive validity of these aggregation methods with single informant scores. Data were derived from the Minnesota Longitudinal Study of Parents and Children (N = 175). Maternal and teacher reports of child behavior problems were obtained at ages 7 and 16 using the Child Behavior Checklist (CBCL) and Teacher Report Form (TRF). Adolescent self-report of child behavior problems was obtained at age 16 (Youth Self-Report). Adolescent psychopathology data was obtained at age 17.5 using a semi-structured diagnostic interview (The Kiddie Schedule for Affective Disorders and Schizophrenia; K-SADS). Results generally showed that the latent variable performed better in predicting adolescent psychopathology compared to the other aggregation methods and single informant scores. The other aggregation methods did not, however, outperform the single informant scores.

Thinking meta-theoretically about the role of internalization in the development of body dissatisfaction and body change behaviors

Internalization of societal standards of physical attractiveness (i.e., internalization of the thin ideal for women and internalization of the mesomorphic ideal for men) is a widely studied and robust risk factor for body dissatisfaction and maladaptive body change behaviors. Substantial empirical research supports internalization as both a mediator and a moderator of the relation between societal influences and body dissatisfaction. In this paper, a primer on mediation and moderation is followed by a review of literature and discussion of the extent to which internalization can theoretically fulfill the roles of both mediation and moderation. The literature review revealed a stark contrast in research design (experimental versus non-experimental design) when alternate conceptualizations of internalization are adopted. A meta-theoretical, moderated mediation model is presented. This model integrates previous research and can inform future empirical and clinical endeavors.

Self-Harm and Suicide Attempts among High-Risk, Urban Youth in the U.S.: Shared and Unique Risk and Protective Factors

The extent to which self-harm and suicidal behavior overlap in community samples of vulnerable youth is not well known. Secondary analyses were conducted of the “linkages study” (N = 4,131), a cross-sectional survey of students enrolled in grades 7, 9, 11/12 in a high-risk community in the U.S. in 2004. Analyses were conducted to determine the risk and protective factors (i.e., academic grades, binge drinking, illicit drug use, weapon carrying, child maltreatment, social support, depression, impulsivity, self-efficacy, parental support, and parental monitoring) associated with both self-harm and suicide attempt. Findings show that 7.5% of participants reported both self-harm and suicide attempt, 2.2% of participants reported suicide attempt only, and 12.4% of participants reported self-harm only. Shared risk factors for co-occurring self-harm and suicide attempt include depression, binge drinking, weapon carrying, child maltreatment, and impulsivity. There were also important differences by sex, grade level, and race/ethnicity that should be considered for future research. The findings show that there is significant overlap in the modifiable risk factors associated with self-harm and suicide attempt that can be targeted for future research and prevention strategies.