Counselling skills training for adolescent health: A WHO approach to meet a global need

In recent years as public health measures such as improved sanitation, water supply, and immunization have taken effect in developing as well as economically developed countries, there has been an increase in attention to health problems arising from voluntary behaviour such as sexual activity and substance abuse rather than simply from passively acquired infection. This is of special relevance to adolescents who have generally been given lower priority in health services because they are relatively disease-free yet whose patterns of behaviour have great significance for their present and future health. However establishing or changing health behaviour during the dynamic period of adolescence can be difficult especially when the environment is rapidly changing too. This is especially so in developing countries where the traditional directive approach to guidance may need to give way to a somewhat more non-directive style of counselling in order to accommodate greater adolescent autonomy, without loss of fundamental cultural values. Because few people in developing countries are experienced in such techniques WHO has developed a module for training counselling skills for adolescent sexual and reproductive health which preserves culture specificity in a non-directive approach and uses behavioural techniques to train communication microskills.     

Staff Care and Development

Children with emotional and behaviour problems provide a daily challenge for parents, teachers and the wider community. The perception of this challenge and how to address it varies according to the assumptions made about the underlying causes of the problems. In this paper the nature of emotional and behaviour problems will be explored with a brief outline of traditional interventions adopted when difficulties arise within the context of school. The conceptual approach of systems theory is then outlined. This is followed by a critical examination of its relevance for teachers as a theory, as a language for dealing with difficulties and as an approach to intervention.     

The relation of emotional maltreatment to early adolescent competence: Developmental processes in a prospective study

ObjectivesThis investigation examined developmental pathways between childhood emotional maltreatment and adaptational outcomes in early adolescence. This study utilized a developmental psychopathology perspective in adopting a multidimensional approach to the assessment of different forms of emotional maltreatment and later adjustment outcomes. Specifically, emotional abuse (i.e., verbal criticism, hostility) and emotional neglect (i.e., psychological unavailability) were compared using a process-level analytic approach to examine if and how different forms of emotional maltreatment would contribute to adolescent adjustment via aggression and social withdrawal in middle childhood.MethodsThe current study sample is drawn from a longitudinal, prospective study of a high-risk community sample (N = 196), incorporating a multi-method and multi-informant design. Multiple mediator models were tested via bootstrapping regression techniques.ResultsBivariate correlations revealed that both emotional neglect and emotional abuse were associated with increased aggression and social withdrawal in middle childhood, and lower ratings of socioemotional competence in early adolescence. However, the mediational model, which controlled for child gender and concurrent physical and sexual maltreatment, was only significant for the contribution of emotional abuse to lower adolescent competence via social withdrawal in middle childhood. Post hoc analyses revealed that this association was only significant for boys.ConclusionsWhile social withdrawal in middle childhood significantly explained the observed relation between emotional abuse and decreased competence in adolescence, this process did not emerge as salient in understanding the relation between emotional neglect and adolescent adaptation. Furthermore, these developmental processes appeared to vary by gender. The results are in need of replication and extension to other outcome domains, but represent an important contribution to the empirical study of specific forms of emotional maltreatment.Practice implicationsEmotional maltreatment is generally overlooked and unrecognized as compared to physical or sexual forms of maltreatment. This study adds to the accumulating empirical evidence that the effects of emotional maltreatment are disabling, enduring, and should be carefully assessed by clinicians. Furthermore, this assessment should specify the particular form of emotional maltreatment that has occurred, as the results of the study indicate that developmental processes and adjustment outcomes may vary according the type of emotional maltreatment (i.e., emotional abuse, emotional neglect) that is experienced. Finally, clinicians must recognize that a single maltreatment type may vary in its impact on subsequent adjustment, as significant gender differences emerged in the current study that point to the role of individual differences that warrant further investigation.     

Childhood emotional maltreatment and later psychological distress among college students: The mediating role of maladaptive schemas

ObjectiveTheoretically, exposure to experiences of emotional abuse (EA) and emotional neglect (EN) in childhood may threaten the security of attachment relationships and result in maladaptive models of self and self-in-relation to others. The purpose of this study was to explore the extent to which EA and EN treatment by parents contributed uniquely to young adult maladaptive long-term outcome with respect to symptoms of anxiety, depression, and dissociation. The extent to which the relationships between EA and EN and later symptoms were mediated by specific internalized maladaptive interpersonal schemas was also explored.MethodsQuestionnaires completed by 301 college men and women (52% female) assessed perceptions of experiences of childhood abuse and neglect, exposure to parental alcoholism, current symptoms of psychological distress, and endorsement of maladaptive interpersonal schemas.ResultsHierarchical regression analyses revealed that perceptions of childhood EA and EN each continued to exert an influence on later symptoms after controlling for gender, income, parental alcoholism, and other child abuse experiences. Both EA and EN were associated with later symptoms of anxiety and depression and were mediated by schemas of vulnerability to harm, shame, and self-sacrifice. Only EN was related to later symptoms of dissociation; this relationship was mediated by the schemas of shame and vulnerability to harm.ConclusionThe findings are discussed from an attachment perspective, focusing on how early interactions with parents contribute to the development of internal working models of self and self-in-relation to others that influence later cognitive schemas and psychological adjustment.Practice implicationsAlthough emotional abuse and emotional neglect are the least studied of all forms of child maltreatment, they may be the most prevalent. The current findings suggest that how college students have evaluated and internalized these experiences may be even more important than the events themselves in determining the extent to which these experiences exert a long-term impact. For this reason, early intervention might be particularly important in helping to modify internal working models of the self as worthless, others as abusive, or the world as threatening and dangerous as a result of past abuse experiences. This study underscores the need for counselors to actively elicit and explore experiences of emotional abuse and neglect in clients, in addition to inquiring about other abuse experiences and types of family dysfunction.The results of this study also support existing data suggesting that internalized representational models of self and others are a key mechanism underlying the relationship between emotional maltreatment and later psychopathology. Young's schema questionnaire proved to be quite sensitive in detecting specific maladaptive schemas that mediated later difficulties with depression, anxiety, and dissociation. Targeting these negative schemas in therapy may help to ameliorate such symptoms. The therapeutic relationship provides a particularly effective context for developing more positive models of self and others, as well as providing a context to explore core relationship themes across different relationship contexts (e.g., intimate partner, parent, friend, and work relationships). In particular, if the assessment of the client reveals that dissociative symptoms are present, counselors can acknowledge the adaptive function that this strategy once served, while also addressing potential limitations to over-reliance on this coping strategy.     

A sex-disaggregated analysis of how emotional violence relates to suicide ideation in low- and middle-income countries

BackgroundIn recent years, research has increasingly focused on examining the relationship between one type of child maltreatment -- emotional violence -- and suicidal behaviors. However, the growing body of empirical evidence supporting these associations has been mostly limited to high-income contexts.ObjectiveThis study examines how exposure to emotional violence is associated with suicide ideation in childhood and adolescence in low- and middle-income countries (LMICs), and whether this association differs by sex.Participants and settingWe employ nationally representative samples of 13–24 year-old males and females from the Violence Against Children Surveys in Tanzania (conducted in 2009), Kenya (2010), and Haiti (2012).MethodsWe use logistic regressions to estimate the odds of ever reporting suicide ideation, separately, for each country; models control for self-reported exposure to emotional violence, physical violence from a caregiver, physical violence by an adult in the community, sexual violence, intimate partner violence, and age. Formal moderation by sex for each form of child maltreatment is tested using interaction terms.ResultsWe find the odds of suicide ideation are consistently and significantly greater for adolescents who report ever exposure to emotional violence. This same consistency is not observed for any other form of maltreatment across countries. The size of the relationship between emotional violence and suicide ideation is statistically significantly larger for males in Kenya only.ConclusionResearch in LMICs should explore the mediating factors linking emotional abuse in childhood and adolescence to suicide ideation in adolescence, paying special attention to whether these pathways might operate differently by sex.     

Teenage social behaviour and emotional well‐being: the role of gender and socio‐economic factors

This article draws on the Millennium Cohort Study (MCS) to examine parent ratings of social, emotional and behavioural difficulties and prosocial behaviour in pre‐ and mid‐adolescents. A series of mixed‐design ANOVAs yielded interesting results. Parent ratings of emotional difficulties in girls increased as they moved from pre‐ to mid‐adolescence whereas for boys the reverse was found. Peer problems were found to be on the rise, whereas prosocial skills decreased for 14‐year‐olds. Most importantly, significant associations were found between socio‐economic measures (that is, family income and parent education) and ratings across the domains of the Strengths and Difficulties Questionnaire, highlighting the socio‐economic specificity of behaviour and well‐being in adolescents. These findings have significant implications for understanding trends in young people's social behaviour and emotional well‐being from pre‐ to mid‐adolescence within their socio‐economic context.     

The Emergence of Solitude as a Constructive Domain of Experience in Early Adolescence

Adolescents spend one-quarter of their waking hours alone, yet the significance of this time is little understood. This study evaluates developmental a changes in the experience of solitude between late childhood and early adolescence. Four Hundred eighty-three European American fifth through ninth graders provided experience-sampling reports on their companionship and subjective states at random times over a week. The findings show, first, that time alone becomes more Voluntary across this age period. Second, time-series analysis shows that for seventh through ninth graders, but not fifth and sixth graders, solitude had a positive after effect on emotional state. Third, adolescents, but not preadolescents, who spent an intermediate amount of their time alone were better adjusted than those who spent little or a great deal of time alone. As a whole, the findings suggest that, while continuing to be a lonely time, in early adolescence solitude comes to have a more constructives role in daily life as a stratgic retreat that complements social experience.     

Child sexual abuse consequences in community samples of Latino and European American adolescents

ObjectiveResearch investigating the impact of child sexual abuse (CSA) in community samples of adolescents has been limited. This study aims to identify sexual abuse among ethnically diverse high school adolescents of both genders and evaluate their psycho-emotional consequences.MethodThrough the use of self-report instruments, a sample of 223 Latino and European American 16–19-year-old high school students were identified as either victims of CSA or as nonabused. The emotional impact of sexual abuse was also investigated among these ethnically diverse adolescent males and females.ResultsInitial findings revealed that those adolescents who gave inconsistent responses to CSA assessments questions were much more similar in patterns of psychological distress to CSA victims compared to nonabused teenagers. Prevalence analyses revealed that females (45%) were nearly two times more likely to report CSA than males (24%). Latinos (44%) were significantly more likely to experience CSA compared to European Americans (27%), and Latinas (54%) had the highest prevalence overall. Other findings indicated substantial differences in type of perpetrator. While female victims of CSA identified male perpetrators in 91.9% of cases, male victims of CSA identified female perpetrators in 52.9% of cases. Consistent with past research, sexually abused adolescents reported significantly greater psychological distress than their nonabused peers, regardless of gender or ethnic group. Gender differences emerged with females reporting greater psychological symptoms, but these differences were substantially reduced when CSA was controlled. European Americans reported greater anxious arousal symptoms compared to Latinos.ConclusionsOur findings suggest that the prevalence of CSA among adolescents is higher than existing research has noted for both males and females and particularly higher for Latinos compared to European Americans. Perpetration by females upon males may also be higher than research has noted. Our findings also revealed many ethnic and gender similarities and fewer differences in the psychological impact and circumstances of sexual abuse in this diverse sample of adolescents.Practice implicationsThe high prevalence of CSA among adolescent males and particularly Latinas emphasize the need to intervene on a community level and with parents for both prevention and intervention regarding issues of sexual victimization. The numbers of female perpetrators, especially when boys are the targets of abuse, may be higher than previously imagined and thus must be assessed tactfully and thoroughly. This study found that adolescents who reported CSA inconsistently had similar symptoms as those with confirmed CSA and therefore warrant greater attention and more persistent intervention. When treating victims of CSA, the Trauma Symptom Inventory (TSI) is effective in identifying specific areas of emotional distress to treat in sexually abused ethnically diverse male and female adolescents. Culturally relevant prevention efforts are needed for ethnically diverse children of both genders.     

青春期儿童父母性教育状况调查研究

青春期儿童的性教育是家庭性教育中的重要组成部分.青春期是儿童身体快速成熟的时期,生理和心理上发生的新变化会在生活和学习等方面给儿童带来一定的挑战.家庭性教育对于帮助他们顺利度过青春期,获得身心全面健康发展具有积极的促进作用.本文通过对处于青春期的儿童的父母进行性教育知识、性教育态度及家庭性教育开展状况调查,发现受访父母...     

Family-based care buffers the stress sensitizing effect of early deprivation on executive functioning difficulties in adolescence

We examined whether family care following early-life deprivation buffered the association between stressful life events (SLEs) and executive functioning (EF) in adolescence. In early childhood, 136 institutionally reared children were randomly assigned to foster care or care-as-usual; 72 never-institutionalized children served as a comparison group. At age 16 years, adolescents (n = 143; 54% female; 67.1% Romanian) self-reported recent SLEs, completed a battery of memory and EF tasks, and completed a go/nogo task in which mediofrontal theta power (MFTP) was measured using electroencephalogram. More independent SLEs predicted lower EF and more dependent SLEs predicted lower MFTP, but only among adolescents with prolonged early deprivation. Findings provide preliminary evidence that family care following early deprivation may facilitate resilience against stress during adolescence on EF.     

Inhibitory Control During Emotional Distraction Across Adolescence and Early Adulthood

This study investigated the changing relation between emotion and inhibitory control during adolescence. One hundred participants between 11 and 25 years of age performed a go‐nogo task in which task‐relevant stimuli (letters) were presented at the center of large task‐irrelevant images depicting negative, positive, or neutral scenes selected from the International Affective Picture System. Longer reaction times for negative trials were found across all age groups, suggesting that negative but not positive emotional images captured attention across this age range. However, age differences in accuracy on inhibitory trials suggest that response inhibition is more readily disrupted by negative emotional distraction in early adolescence relative to late childhood, late adolescence, or early adulthood.     

Emotional Autonomy Redux: Revisiting Ryan and Lynch

Ryan and Lynch have suggested that emotional autonomy in adolescence, at least as indexed by Steinberg and Silverberg's Emotional Autonomy Scale, is associated with poor family functioning and might therefore be better conceptualized as detachment. In the present study, we contrast adjustment scores among adolescents who differ in both emotional autonomy and perceptions of support in their relationship with their parents. Several thousand adolescents aged 14 through 18 completed Steinberg and Silverberg's emotional autonomy measure, a measure designed to assess the provision of support in the parent-adolescent relationship, and a number of standardized measures of adjustment. Adolescents high in emotional autonomy but low in relationship support show problematic adjustment profiles, consistent with Ryan and Lynch's interpretation of the measure as an index of detachment. Although adolescents high in both emotional autonomy and relationship support report more internal distress and behavior problems than some adolescents, they score higher on measures of psychosocial development and academic competence than their peers. Emotional autonomy in the context of a supportive adolescent-parent relationship may carry some developmental advantages as well as some deleterious consequences suggested by Ryan and Lynch.     

Loneliness,friendship quality and the social networks of adolescents with high‐functioning autism in an inclusive school setting

By definition, children with autism have poor peer relationships despite age and ability. When children enter adolescence, social problems typically worsen and feelings of loneliness and isolation may emerge. Thus, the overarching goal of the current study is to examine the social–emotional relationships of adolescents with autism and their typically developing (TD) classmates. Participants included 20 adolescents, 7 adolescents with autism and 13 TD classmates. All participants were enrolled in a drama class at a regular education high school in the Los Angeles area. Results indicate that adolescents with autism experienced significantly more loneliness than their TD classmates, had significantly poorer friendship quality in companionship and helpfulness, and had significantly lower social network status than their TD classmates. In addition, 92.4% of TD adolescents had secondary or nuclear social network centrality, which means that those adolescents were significantly connected and recognised in their classroom social structure although 71.4% of the adolescents with autism were either isolated or peripheral in their classroom. These findings imply that although inclusion in regular classrooms may allow adolescents with autism to be involved in the social structure of their classroom, they experienced more loneliness, poorer friendship quality and social network status as compared with their classmates. These results suggest that, perhaps, more intensive social skills' interventions that focus on friendship development are needed in adolescents with autism.     

The complexity of trauma response: a 4-year follow-up of adolescent Cambodian refugees

OBJECTIVE: The objective of this study was to document the psychosocial adjustment of young refugees during their adolescence and its association with the war-related trauma experienced by their family before migration. METHOD: Data were collected on 57 young Khmer resettled in Montreal and followed from early to late adolescence. The associations between premigratory exposure to political violence and postmigratory mental health and social adjustment were estimated for early, mid-, and late adolescence. RESULTS: The associations between premigratory exposure to political violence and postmigratory psychosocial adjustment fluctuated over the adolescence period. Overall, the adolescents whose families were more highly exposed to political violence tended to report a more positive social adjustment and less mental health symptoms than those less exposed. CONCLUSION: The high expectations of Cambodian parents towards their children and the preservation of traditional values despite the Khmer rouge attempts to eradicate them might contribute to explain the paradoxical association between the families' exposure to political violence and the adolescents' psychosocial adjustment in the host country. Although children and adult refugees seen in clinical setting are reminders of the negative effects of adversity, resilience should be more systematically explored in community samples to further our understanding of the long-term effects of trauma.     

The early entrance option: Academic and social/emotional outcomes

This review examines how early kindergarten entrants fare academically and socially/emotionally in their schooling. In general, the literature is pessimistic about academic achievement and social/emotional adjustment of early entrants. The exception to this seems to be when screening procedures are required to identify children with exceptional ability and to eliminate from early entrance children likely to have adjustment difficulties. Typically, the screening battery includes measurements of academic readiness, social/emotional maturity, and a physical examination, followed by a trial entrance period. Much additional research is needed to identify variables that will add significantly in predicting future school success of early entrants. However, rather than predicting which children will fit the educational system, a more effective use of educational research would be investigation into developing educational programs that are flexible in meeting the needs of each child.     

Post-traumatic stress as a pathway to psychopathology among adolescents at high-risk for victimization

ObjectiveVictimization by violence elevates adolescents’ risk for developing internalizing and externalizing psychopathology. Recent findings suggest that disruptions in developmental processes associated with post-traumatic stress (PTS) reactions may partially account for the relationship between victimization and the subsequent development of psychopathology during adolescence. The present study tested the temporal sequencing of these associations using multi-informant measurements in a large, diverse sample of adolescents at high-risk for victimization.MethodData were collected from a multi-site consortium of prospective studies, the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN). Information about 833 youth’s victimization experiences (i.e., direct, indirect, familial, and non-familial violence), PTS, and affective, anxiety, attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and conduct disorder (CD) symptoms were gathered from youth and their caregivers during biannual face-to-face interviews when youth were between the ages of 4 and 14 years, and continuously from official child protective services records.ResultsStructural equation modeling revealed that cumulative victimization contributed to elevations in youth and caregiver reported late childhood and early adolescent psychopathology. While PTS mediated the association between victimization and youth reported ADHD, ODD, CD, major depressive, and generalized anxiety symptoms during adolescence, it only mediated the association between victimization and caregiver reported affective symptoms.ConclusionsPTS reactions following childhood victimization partially accounted for escalations in psychopathology during the transition to adolescence. These findings underscore the importance of integrating trauma-informed assessment and intervention approaches with at-risk adolescents. Researchers should determine whether trauma-focused interventions sufficiently ameliorate other psychopathology among victimized adolescents or if additional interventions components are necessary.     

The Relevance of Systems Theory for Teachers Dealing with Emotional and Behaviour Problems in Schools

Children with emotional and behaviour problems provide a daily challenge for parents, teachers and the wider community. The perception of this challenge and how to address it varies according to the assumptions made about the underlying causes of the problems. In this paper the nature of emotional and behaviour problems will be explored with a brief outline of traditional interventions adopted when difficulties arise within the context of school. The conceptual approach of systems theory is then outlined. This is followed by a critical examination of its relevance for teachers as a theory, as a language for dealing with difficulties and as an approach to intervention.     

Teaching practices and student engagement in early adolescence: A longitudinal study using the Classroom Assessment Scoring System

Student engagement in schoolwork is crucial for positive academic adjustment, particularly during early adolescence. We investigated how observations of teaching practices predicted change in student behavioral and emotional engagement. In the fall, we examined teacher behavior in 54 fifth and sixth grade classrooms through external observers' reports of 11 dimensions of teachers’ practices (Classroom Assessment Scoring System, CLASS). Students reported on their behavioral and emotional engagement in the fall and spring. We found quality feedback was the strongest predictor of behavioral engagement and regard for student perspective was the strongest emotional engagement. Our findings were more nuanced for what predicts behavioral engagement, as there is evidence that other teaching practices work in conjunction with quality feedback to predict behavioral engagement.     

Language, social behavior, and the quality of friendships in adolescents with and without a history of specific language impairment

Language is drawn on extensively in friendships but has received scant attention in the developmental literature. This study compared friendship quality in 16-year-old adolescents with and without specific language impairment (SLI), testing the extent it is predicted by individual differences in social behaviors and language ability. Participants were 120 adolescents with SLI and 118 typically developing (TD) adolescents. After considering the effects of nonverbal IQ and prosocial and difficult behavior, language measures were found to be associated with friendship quality. The TD participants enjoyed normal friendships, whereas the participants with SLI were more likely to exhibit poorer quality (although 60% experienced good quality of friendships). Longitudinal analyses identified early language difficulties as predictive of poorer friendship quality in adolescence.