Molly Adrian

Emotional Dysregulation and Interpersonal Difficulties as Risk Factors for Nonsuicidal Self-Injury in Adolescent Girls

The purpose of this study was to examine a model of factors that place psychiatrically hospitalized girls at risk for non-suicidal self-injury (NSSI). The role of familial and peer interpersonal difficulties, as well as emotional dysregulation, were examined in relationship to NSSI behaviors. Participants were 99 adolescent girls (83.2% Caucasian; M age = 16.08) admitted to a psychiatric hospital. Structural equation modeling indicated the primacy of emotional dysregulation as an underlying process placing adolescents at risk for NSSI and mediating the influence of interpersonal problems through the family and peer domains. When family and peer relationships were characterized by conflict and lack of support for managing emotions, adolescents reported more dysregulated emotion processes. Family relational problems were directly and indirectly related to NSSI through emotional dysregulation. The indirect processes of peer relational problems, through emotional dysregulation, were significantly associated with NSSI frequency and severity. The findings suggest that the process by which interpersonal difficulties contribute to NSSI is complex, and is at least partially dependent on the nature of the interpersonal problems and emotion processes.

The inclusion of fathers in the empirical investigation of child psychopathology: an update.

This investigation provides an update on the inclusion of fathers in child psychopathology research. Articles published from January 1992 to January 2005 that examined parental contributions to child psychological maladjustment were identified. Each article was coded for child age, parental race, how parent gender was analyzed, type of journal, and year of publication. Overall, results replicated previous reviews (Phares & Compas, 1992), suggesting that fathers continue to be neglected in child psychopathology research. Further analyses revealed (a) higher rates of paternal research involvement as child age increased, (b) studies with a predominantly Caucasian sample included separate analyses for mothers and fathers more frequently than those with predominantly African American samples, (c) paternal research inclusion was higher in clinical compared to developmental psychology journals, and (d) over the past 6 years, more research has included fathers as participants than from the previous 7-year period (1992–1998).

Methodological Implications of the Affect Revolution: A 35-Year Review of Emotion Regulation Assessment in Children.

This investigation analyzed the methods used over the past 35 years to study emotion regulation (ER) in children. Articles published from 1975 through 2010 were identified in 42 child clinical, developmental, and emotion psychology journals. Overall, 61.1% of published ER articles relied on one method and 23.6% used two methods. Analyses revealed (a) 82.8% of published ER research occurring within the past decade; (b) higher rates of observational methods with infant and toddler/preschool samples, but more use of self-report methodology with middle childhood and adolescent samples; (c) a longer history of published ER research with samples of infants to 5-year-olds, including the use of more longitudinal design, compared with older samples; and (d) a positive association between journal impact ratings and the use of physiological and observational measurement. Review of the measurement tools used to capture ER revealed great diversity in how emotion processes are understood and evaluated.

Risk for Suicidal Ideation and Suicide Attempts Associated with Co-occurring Depression and Conduct Problems in Early Adolescence

This study investigates the early manifestation of co-occurring depression and conduct problems as a predictor of heightened risk for later suicidal ideation and behavior in a community sample of 521 adolescents. Self-reported symptoms of depression and conduct problems were evaluated in early 6th grade. Suicidal thoughts and behaviors were tracked through multiple assessments carried out over the middle school years. Compared to adolescents with depression symptoms only, conduct problem symptoms only, or low psychopathology, those with co-occurring depression and conduct problem symptoms had the highest risk for subsequent suicidal ideation, recurrent suicidal behaviors, and suicide attempts.

The internalizing pathway to adolescent substance use disorders: mediation by ruminative reflection and ruminative brooding.

Two subtypes of rumination were examined in relationship to substance use and substance use disorders in adolescents. In the 8th and 9th grade, 521 adolescents completed measures assessing depressive symptoms, conduct problems, and reflective and brooding subtypes of rumination. In 12th grade, adolescents reported substance use and were administered the substance use disorders modules from the DISC. Path analyses conducted with data from 428 participants indicated that neither depression nor rumination variables significantly affected the presence of substance use. However, indirect effects of depression through reflection and brooding were differentially related to risk of developing substance use disorders, with brooding positively associated with Marijuana Use Disorders, and reflection negatively related to both Marijuana and Alcohol Use Disorders. Pathways did not differ by sex. These findings suggest that promoting self-reflection may be an effective strategy to prevent and intervene with the development of problematic substance use.

A Conceptual Basis in Social Learning Theory

Though there is debate as to whether they are necessary or sufficient determinants, social skills are presumed to form the foundation for competence in most major models (e.g., Cavell, 1990; Crick & Dodge, 1994; Dubois & Felner, 1996; Rose-Krasnor, 1997). Once focusing on more molecular and observable units of behavior (McFall, 1982), more current conceptualizations of social skills incorporate a full range of cognitive, emotional, and behavioral skills and abilities, as well as motivational and expectancy sets (e.g., Dubois & Felner, 1996). Behind this conceptual shift was the rising influence of the social learning perspectives. The integration of these perspectives into mainstream behavioral psychology formed the basis for current cognitive-behavioral approaches and, as such, has important conceptual and applied implications for social skills assessment and intervention.

Developmental Foundations and Clinical Applications of Social Information Processing: A Review.

Social information processing has emerged as an important construct in understanding childrens interpersonal functioning. This article reviews (1) the theoretical models guiding research, (2) the development of normative and atypical social problem solving, and (3) the connection between social information processing and individual differences in functioning. Finally, this review ends with a summary of efficacy of programs aimed at preventing social information processing biases or intervening with youth who display dysfunctional social information processing skills.

Efficacy of Dialectical Behavior Therapy for Adolescents at High Risk for Suicide: A Randomized Clinical Trial

Importance Suicide is a leading cause of death among 10- to 24-year-old individuals in the United States; evidence on effective treatment for adolescents who engage in suicidal and self-harm behaviors is limited. Objective To evaluate the efficacy of dialectical behavior therapy (DBT) compared with individual and group supportive therapy (IGST) for reducing suicide attempts, nonsuicidal self-injury, and overall self-harm among high-risk youths. Design, Setting, and Participants This randomized clinical trial was conducted from January 1, 2012, through August 31, 2014, at 4 academic medical centers. A total of 173 participants (pool of 195; 22 withdrew or were excluded) 12 to 18 years of age with a prior lifetime suicide attempt (≥3 prior self-harm episodes, suicidal ideation, or emotional dysregulation) were studied. Adaptive randomization balanced participants across conditions within sites based on age, number of prior suicide attempts, and psychotropic medication use. Participants were followed up for 1 year. Interventions Study participants were randomly assigned to DBT or IGST. Treatment duration was 6 months. Both groups had weekly individual and group psychotherapy, therapist consultation meetings, and parent contact as needed. Main Outcomes and Measures A priori planned outcomes were suicide attempts, nonsuicidal self-injury, and total self-harm assessed using the Suicide Attempt Self-Injury Interview. Results A total of 173 adolescents (163 [94.8%] female and 97 [56.4%] white; mean [SD] age, 14.89 [1.47] years) were studied. Significant advantages were found for DBT on all primary outcomes after treatment: suicide attempts (65 [90.3%] of 72 receiving DBT vs 51 [78.9%] of 65 receiving IGST with no suicide attempts; odds ratio [OR], 0.30; 95% CI, 0.10-0.91), nonsuicidal self-injury (41 [56.9%] of 72 receiving DBT vs 26 [40.0%] of 65 receiving IGST with no self-injury; OR, 0.32; 95% CI, 0.13-0.70), and self-harm (39 [54.2%] of 72 receiving DBT vs 24 [36.9%] of 65 receiving IGST with no self-harm; OR, 0.33; 95% CI, 0.14-0.78). Rates of self-harm decreased through 1-year follow-up. The advantage of DBT decreased, with no statistically significant between-group differences from 6 to 12 months (OR, 0.65; 95% CI, 0.12-3.36; P = .61). Treatment completion rates were higher for DBT (75.6%) than for IGST (55.2%), but pattern-mixture models indicated that this difference did not informatively affect outcomes. Conclusions and Relevance The results of this trial support the efficacy of DBT for reducing self-harm and suicide attempts in highly suicidal self-harming adolescents. On the basis of the criteria of 2 independent trials supporting efficacy, results support DBT as the first well-established, empirically supported treatment for decreasing repeated suicide attempts and self-harm in youths. Trial Registration ClinicalTrials.gov Identifier: NCT01528020.

Examining gene-environment interactions in comorbid depressive and disruptive behavior disorders using a Bayesian approach.

OBJECTIVE The objective of this study was to apply a Bayesian statistical analytic approach that minimizes multiple testing problems to explore the combined effects of chronic low familial support and variants in 12 candidate genes on risk for a common and debilitating childhood mental health condition. METHOD Bayesian mixture modeling was used to examine gene by environment interactions among genetic variants and environmental factors (family support) associated in previous studies with the occurrence of comorbid depression and disruptive behavior disorders youth, using a sample of 255 children. RESULTS One main effect, variants in the oxytocin receptor (OXTR, rs53576) was associated with increased risk for comorbid disorders. Two significant gene × environment and one signification gene × gene interactions emerged. Variants in the nicotinic acetylcholine receptor α5 subunit (CHRNA5, rs16969968) and in the glucocorticoid receptor chaperone protein FK506 binding protein 5 (FKBP5, rs4713902) interacted with chronic low family support in association with child mental health status. One gene × gene interaction, 5-HTTLPR variant of the serotonin transporter (SERT/SLC6A4) in combination with μ opioid receptor (OPRM1, rs1799971) was associated with comorbid depression and conduct problems. CONCLUSIONS Results indicate that Bayesian modeling is a feasible strategy for conducting behavioral genetics research. This approach, combined with an optimized genetic selection strategy (Vrieze et al., 2012), revealed genetic variants involved in stress regulation (FKBP5, SERT × OPMR), social bonding (OXTR), and nicotine responsivity (CHRNA5) in predicting comorbid status.

Parental validation and invalidation predict adolescent self-harm.

This study was designed to evaluate family processes theoretically implicated in the onset and maintenance of adolescent self-harm. We focused on understanding parental validation and invalidation in response to their adolescent children to estimate the association between parental responses and self-harm in a high-risk group of adolescents. We also sought to determine the influence of psychotherapy on parental validation and invalidation over time during participation in a randomized clinical trial of psychotherapy designed to reduce self-harm. Teens (N = 38, Mage = 14.85, 94.1% female, 55.3% Caucasian, and 17.5% Latino) and their parents participated in three assessments over a 6-month period corresponding to pretreatment, midtreatment, and end of treatment in the trial. Results indicate a robust association between parental validation, invalidation, and adolescent self-harm. There were no significant associations observed between parental validation, invalidation, and adolescent suicidal ideation. Observed levels of parental validation and invalidation were not changed during the 6-month course of psychotherapy.