Search

In broad strokes, we have reviewed family contexts and adjustment of adolescent ego development. We concluded with group portraits, the salient family and individual characteristics of adolescents who followed six paths of ego development. There are strong differences in development--the profound arrests and the dramatic progressions. Although these composite pictures provide us with clearer ideas about each of the paths, we do not yet have a detailed understanding of how adolescents following the varied paths experience the world and relate in their families. Certain questions can only be pursued with this information. For instance, are there ways that parents of the steady conformist adolescents speak and behave that restrain their sons' and daughters' separation from the family? Or do the profoundly arrested teenagers provoke their parents to be less encouraging of their differences from other family members? These questions, touching on complex interactions flowing between parents and adolescents, require a closer look inside the families of teenagers following these paths of arrest and advance. In a work soon to be published, we listen closely to the voices of 13 adolescents and their parents, in solo and while together as a family. These narratives convey the message that paths of individual development are embedded within the intricate matrix of family relationships. The teenagers and their families closely and often poignantly illustrate the ways in which adolescents and parents handle the central dilemma posed during this phase of the life cycle: how to separate from the family and reaffirm one's place within it.

This study reports the development of adaptive processes in two groups of adolescents assessed initially and 2 years later with clinical research interviews. Students from a public high school (N = 44) and inpatients on an adolescent psychiatric ward (N = 51) formed the two subject groups. The psychiatrically hospitalized group had significantly improved scores after a 2-year interval on four of six adaptive process Summary Scales: Task Orientation, Relatedness, Self Knowledge, and Inner Synthetic Functions. However, these higher scores did not reach the levels of the high school group at either point of assessment. The scores in the high school group remained stable over time except for an increase in the area of Self Knowledge. The value of this interview-derived assessment, in comparison to other forms of measurement, is discussed, and consideration is given to factors which contribute to the differences between groups.

The present study had three main objectives: (1) to develop and validate scales of young adult social competence in two domains, close relationships and social groups, using peer ratings of California Q-sort (Block, 1974; Kremen & Block, 2002) items; (2) to test the hypothesis that social competence is associated with young adult well-being and ego development; (3) to test the hypothesis that close relationship competence aligns more closely than social group competence with young adult functioning. Psychometric data on peer ratings of social competence are presented. For 133 young adults, peer ratings of social competence were correlated in expected directions with indices of functioning (e.g., self-worth, education, psychological distress, criminal behavior, and ego development). Associations were generally stronger for competence in close relationships than in social groups.

Adolescent ego-development trajectories were related to close-relationship outcomes in young adulthood. An adolescent sample completed annual measures of ego development from ages 14 through 17. The authors theoretically determined and empirically traced five ego-development trajectories reflecting stability or change. At age 25, the sample completed a close-relationship interview and consented for two peers to rate the participants’ego resiliency and hostility. Participants who followed the profound-arrest trajectory in adolescence reported more mundane sharing of experiences, more impulsive or egocentric conflict-resolution tactics, and less mature interpersonal understanding in their young adult relationships, and their young adult peers described these participants as more hostile. Participants who attained or maintained higher levels of ego development in adolescence reported more complex sharing of experiences, more collaborative conflict-resolution strategies, and greater interpersonal understanding, and their young adult peers rated them as less hostile and as more flexible.

The severity of child psychiatric disorders is commonly associated with child language delays. However, the characteristics of these associations in the fast-growing population of bilingual children remain unknown. To begin to address this gap, we studied a unique sample of Spanish-English bilingual children with significant parent-reported psychopathology (n = 29), focusing on their language proficiencies and psychiatric severity using the Child Behavior Check List. We present cross-sectional analyses of associations of general and specific language proficiency in Spanish and English with the severity of specific psychiatric syndromes. We found Spanish language-proficiency scores to have negative correlations with a wide range of psychiatric symptoms, particularly externalizing (i.e., delinquency and aggression) symptoms (r = -.38 to -.61, por = .05). English scores were similarly associated. Dual language tests covering multiple specific language dimensions explained a large proportion (51%) of overall variance in aggression symptoms and also important proportions (40%) of total and attentional symptoms. While children's proficiency levels in both Spanish and English showed similar associations with the symptom severity measures (explaining close to 20% of the symptom variance; r(sp) = -.44, p.01), these proficiency levels explain nonconverging variance in children's symptomatology. The findings suggest that clinical evaluation of language functioning is often needed in such populations and that it should be comprehensive and include both languages. Such thorough evaluation of bilingual children suffering from psychopathology will help us to precisely identify (1) language deficits, (2) specific relations of these deficits to the child's psychopathology, (3) differential implications of communication at home (e.g., in Spanish) and at school (e.g., in English) for clinical presentation and the child's competence in those differing contexts, and (4) language of choice for therapy, evaluation, and educational services. The findings are discussed in the context of clinical and conceptual implications and future research needs.

In this report, we drew on data from an ongoing longitudinal study that began in 1978 (Hauser, Powers, Noam, Jacobson, Weiss, & Folansbee, 1984). Focusing on late, young-adult life among individuals who were psychiatrically hospitalized during adolescence, we examined markers of resilience empirically defined in terms of adult success and well-being. The study includes a demographically similar group recruited from a public high school. Major goals were to (a) develop preliminary models of adaptive functioning among adults in their 30s, (b) examine the extent to which adults with histories of serious mental disorders can be characterized by these models, and (c) explore predictors of successful adult lives from indicators of individuals' psychosocial adjustment at age 25.Results showed significant cohort effects on indexes of adaptive functioning, especially for men. Findings suggest that social relations as well as self-views of competence and relatedness play important roles in characterizing adjustment during the adult years. In addition, indexes of psychosocial adjustment as well as symptoms of psychiatric distress and hard drug use at age 25 made a difference in adult social functioning and well-being, providing hints of possible mechanisms likely to facilitate the ability to "bounce back" after a difficult adolescence.

This study examines links between attachment states of mind and relationship schemas in a sample of 40 young adults, half of whom were hospitalized as adolescents for psychiatric treatment. Participants were interviewed about their closest relationships, and, using the Core Conflictual Relationship Theme method, their narratives about these relationships were analyzed for the relative frequency with which they expressed wishes for closeness and for autonomy in relation to others. Participants were also administered the Adult Attachment Interview and were classified with respect to security of attachment. Security of attachment was associated with the relative frequency with which participants expressed wishes for autonomy in their narratives about close relationships, even after accounting for current levels of psychological functioning and history of serious psychopathology in adolescence. Security of attachment was not associated with the relative frequency with which participants expressed wishes for closeness. The study suggests that core relational wishes for autonomy are linked specifically with subtypes of insecure attachment. These findings extend what is known about connections between the representation of early attachment relationships and the wishes and needs expressed in current relationships with significant others.

This Special Issue represents a major product of a National Institute of Mental Health (NIMH) sponsored workshop, held October 19-20,1992, in Bethesda, Maryland. Consistent with accelerating interest in the understanding of affective processes during the adolescent period, the Behavioral, Cognitive, and Social Processes Research Branch of NIMH generously supported several meetings to plan the workshop, the workshop itself, and the sustained subsequent efforts to transform the 2 days of talks and discussions into a coherent volume that could be distributed to our scientific colleagues. The major goal of the workshop, organized by Stuart Hauser and Lynne Huffman, was to explore multilevel approaches to research on affective processes during the adolescent period, including psychophysiological, behavioral, intrapsychic, interactional, and sociocultural perspectives. Experts and discussants were invited to discuss conceptual advances that might be facilitated by an integration and cross-fertilization of basic...

Observed parent–adolescent autonomy struggles were assessed as potential predictors of the development of peer-rated hostility over a decade later in young adulthood in both normal and previously psychiatrically hospitalized groups of adolescents. Longitudinal, multireporter data were obtained by coding family interactions involving 83 adolescents and their parents at age 16 years and then obtaining ratings by close friends of adolescents' hostility at age 25 years. Fathers' behavior undermining adolescents' autonomy in interactions at age 16 years were predictive of adolescents-as-young-adults' hostility, as rated by close friends at age 25 years. These predictions contributed additional variance to understanding young adult hostility even after accounting for concurrent levels of adolescent hostility at age 16 years and paternal hostility at this age, each of which also significantly contributed to predicting future hostility. Results are discussed as highlighting a pathway by which difficulties attaining autonomy in adolescence may presage the development of long-term difficulties in social functioning.

Objectives: To study the social and family characteristics of patients with insulin-dependent diabetes mellitus with irregular versus continuous clinical follow-up and to study the medical outcomes of patients with these follow-up patterns. Methods: An onset cohort of 61 children and adolescents with insulin-dependent diabetes mellitus and their parents were studied. Aspects of their social and family environment were assessed at study inception and examined in relation to frequency of follow-up early in the course of the illness. Follow-up was dichotomized so that patients with continuous follow-up were compared with patients with irregular follow-up, who were defined as those missing 1 full year of planned medical appointments during the second through fourth years after diagnosis. Patients with irregular and continuous follow-up were compared in terms of acute metabolic complications, glycemic control, and retinopathy status during a 10-year period. Results: Compared with individuals with continuous follow-up, patients with irregular clinical visits were more likely to be from families of lower socioeconomic class levels, have a parental history of separation and divorce, and were members of families that reported being least openly expressive of positive emotions. Poor glycemic control in year 1 was associated with irregular follow-up in years 2 through 4. Patients with irregular follow-up continued to have worse glycemic control in years 2 through 4 than patients with continuous follow-up. However, in years 7 and 10 their glycemic control no longer differed from patients with continuous follow-up. More episodes of diabetic ketoacidosis occurred in the irregular follow-up group. Finally, retinopathy occurred more frequently among those in the irregular follow-up group. Conclusion: Early irregular clinical follow-up should be considered a risk factor for complications of insulin-dependent diabetes mellitus. (J Pediatr 1997;131:727-33)

OBJECTIVE To evaluate the psychological adjustment of young adults with IDDM in comparison with similarly aged individuals without chronic illness. RESEARCH DESIGN AND METHODS An onset cohort of young adults (n = 57), ages 19–26 years, who have been followed over a 10-year period since diagnosis, was compared with a similarly aged group of young adults identified at the time of a moderately severe, acute illness (n = 54) and followed over the same 10-year period. The groups were assessed at 10-year follow-up in terms of 1) sociodemographic indices (e.g., schooling, employment, delinquent activities, drug use), 2) psychiatric symptoms, and 3) perceived competence. In addition, IDDM patients were examined for longitudinal change in adjustment to diabetes. RESULTS The groups differed only minimally in terms of sociodemographic indices, with similar rates of high school graduation, post-high school education, employment, and drug use. The IDDM group reported fewer criminal convictions and fewer non-diabetes-related illness episodes than the comparison group. There were no differences in psychiatric symptoms. However, IDDM patients reported lower perceived competence, with specific differences found on the global self-worth, sociability, physical appearance, being an adequate provider, and humor subscales. The IDDM patients reported improving adjustment to their diabetes over the course of the 10-year follow-up. CONCLUSIONS Overall, the young adults with IDDM appeared to be as psychologically well adjusted as the young adults without a chronic illness. There were, however, indications of lower self-esteem in the IDDM patients that could either portend or predispose them to risk for future depression or other difficulties in adaptation.

In this paper we determine whether individual and family psychosocial functioning predicts the risk for recurrent acute diabetic complications. An onset-cohort of 61 children and adolescents with Type 1 diabetes received conventional diabetes care. Episodes of ketoacidosis and of severe hypoglycemia were recorded for 8 years, and glycaemic control was measured by glycohaemoglobin. Measures of psychosocial functioning of the patient and parents were obtained during the first year. Over 8 years, 28% of subjects had at least one episode of ketoacidosis, and 21% had at least one episode of hypoglycaemia. The odds of observing recurrent hypoglycaemia versus recurrent ketoacidosis was 14 times greater in boys than in girls (Fisher's exact test p

An onset cohort of children and adolescents with insulin-dependent diabetes mellitus (IDDM) and their parents were studied. Aspects of family environment were evaluated at study inception, and their influence on the initial level of, and change in, glycemic control over 4 years was examined. Family measures of expressiveness, cohesiveness, and conflict were linked to differences in the longitudinal pattern of glycemic control. In particular, the encouragement to act openly and express feelings directly (expressiveness) seemed to ameliorate deterioration of glycemic control over time in both boys and girls. Boys were especially sensitive to variations in family cohesiveness and conflict; those from more cohesive and less conflicted families showed less deterioration in glycemic control. This study demonstrated the important influence of family psychosocial factors present at diabetes onset on glycemic control in children and adolescents over the first 4 years of IDDM.

This study examined links between processes of establishing autonomy and relatedness in adolescent-family interactions and adolescents' psychosocial development. Adolescents in 2-parent families and their parents were observed in a revealed-differences interaction task when adolescents were 14, and adolescents' ego development and self-esteem were assessed at both 14 and 16. Developmental indices were strongly related to autonomy and relatedness displayed by both parents and adolescents. Significant variance was explained even after accounting for the number and quality of speeches of each family member as rated by a different, well-validated family coding system. Increases in adolescents' ego development and self-esteem over time were predicted by fathers' behaviors challenging adolescents' autonomy and relatedness, but only when these occurred in the context of fathers' overall display of autonomous-relatedness with the adolescent. The importance of the mutually negotiated process of adolescents' exploration from the secure base of parental relationships is discussed.

Cross-sectional and longitudinal findings drawn from a 4-year longitudinal study of an onset cohort of preadolescents and early adolescents with insulin-dependent diabetes and their families are presented. Patient and parent perceptions of the family environment near the time of diagnosis are used to examine patterns of adherence in the first year of illness as well as over the four follow-up years. We found that family conflict, cohesion, and organization were strongly associated with independently rated first-year adherence levels. The strongest predictor of longer term adherence was family conflict, as experienced by the patients. In addition, parents' and youngsters' perceptions of family cohesion predicted improved adherence as well as overall higher levels of patient adherence. The findings are discussed with respect to the clinical implications of discovering those family characteristics that can, shortly after diagnosis, predict short- and long-term adherence. In addition, we present planned investigations intended to further clarify paths from family perceptions to individual diabetes behaviors.

An onset cohort of adolescents and children with insulin-dependent diabetes mellitus was studied over a 4-year period. Individual patient psychosocial and demographic factors were assessed at study inception and used to examine aspects of adherence over the follow-up. We found that initial assessment of patient coping (defense level, adaptive strength, and locus of control) and adjustment at study inception were predictive of the level of patient adherence to diabetic regimen over the 4 years of study. Psychosocial variables predicted adherence outcomes independent of patient age. This was found for three domains of adherence, i.e., diet, insulin adjustment, and metabolic monitoring, and for the composite index derived from the separate adherence scales. Preadolescents (ages 9-12) at study entry were more adherent than patients who were already adolescent (ages 13-16) when diagnosed. Using multiple regression, three factors (age, adjustment, ego defense level) accounted for 47% of the variance in adherence. No factors were predictive of change in adherence during the follow-up. Thus, psychosocial characteristics of diabetic children assessed shortly after diagnosis predicted typical or average adherence over a 4-year period. Identification of such characteristics may be useful in developing strategies for intervention early in the course of illness.

Background Adolescents with early psychiatric hospitalization are likely to be at a significant risk for long-term difficulties. Objective To examine early adulthood outcomes of psychiatrically hospitalized adolescents. Design Inception cohort recruited from 1978 to 1981 and observed until 2002. Setting Northeastern United States. Participants Adolescents (aged 12-15 years) from 2 matched cohorts were recruited and assessed repeatedly across 20 years: 70 psychiatrically hospitalized youths and 76 public high school students. Main Outcome Measures Death, emotional distress, high school completion, and educational attainment. Results Psychiatrically hospitalized youths were significantly more likely to die and to report higher levels of emotional distress. Hospitalized youths were significantly less likely to graduate from high school and complete college and graduate school. Conclusions The association between psychiatric symptoms sufficient to result in psychiatric hospitalization during adolescence and later mortality, emotional distress, high school completion, and educational attainment is striking. Further study is needed to identify and understand linkages between adolescent psychiatric impairment and decrements in adult functioning, particularly the processes that may underlie these linkages. Increasing school completion and educational attainment among hospitalized youths may minimize decrements in adult adaptation.

This paper compares the coping strategies of two groups of families coping with unusual stresses: families of diabetic adolescents and families of adolescents who were psychiatrically hospitalized in early adolescence. The coping strategies of these two groups of families are also compared to the coping strategies of a group of families of non-patient adolescents. Analyses indicate that families of ill adolescents find a greater variety of coping strategies helpful than families of non-patient adolescents, in particular relying more heavily on community resources. The coping of the families of adolescents with a history of psychiatric illness was characterized by greater family passivity and less confidence in family problem-solving ability. The coping of families with diabetic adolescents was characterized by greater reliance on active internal and external means of responding to stress, such as reframing family problems, using church and religious resources, and seeking support from extended family. Implications of these results are discussed in the context of the particular stresses with which these special families cope.

This study explores the impact of diabetes mellitus upon aspects of adolescent development. Using specific assessment techniques and interviews, we followed ego development and self-esteem variables. Clinical considerations suggest that both personality dimensions are important for the understanding of diabetic adolescents. The significance of ego development is implied in many case reports, which note the disruption in individual coping that frequently follows the onset of diabetes. Clinical observations and empirical studies have also commented upon diminished self-esteem in diabetic patients. Our sample consisted of male and female diabetic adolescents, whose average age was 13. All patients completed Loevinger's sentence completion test of ego development and the Coopersmith self-esteem inventory. Previous studies have indicated favorable reliability and validity for both instruments. A subgroup of the sample was also interviewed. The ego development and self-esteem scores were contrasted with two groups of similar age adolescents who had previously completed these same tests, and a control group. The diabetic adolescents were clearly at lower levels of ego development than the nondiabetic groups. These lower stages were not correlated with duration of illness. A second finding was that the boys were at lower levels of ego development than the girls, regardless of age or illness duration. Self-esteem scores were associated with both illness duration and ego development. Subjects at the lowest levels of ego development also had the lowest self-esteem. Study of the interviews revealed that the patients at these lower ego development levels manifested concrete, more stereotyped, and resigned responses than those patients at the higher ego development stages.

In this paper we consider family aspects of adolescent resilience. It has long been known that there are children who, despite exposure to significant risk factors, show few or no signs of developmental impairment. These children are referred to as "invulnerable' or resilient. A rapidly expanding literature deals with these unexpectedly favorable developmental outcomes. We explore linkages between adolescent development, an important stressor (chronic illness in adolescence), and a key psychosocial environment (the family). Following a broad review of resiliency research, we focus upon what is known about the varying impacts of a specific chronic illness, diabetes, upon adolescent development. In addition, we consider how the family magnifies, diminishes, or otherwise transforms the impact of this illness upon the adolescent patient. Finally, we describe an ongoing research program investigating diabetic adolescent development within the family.

The adolescent's experience in groups and institutions is determined in important ways by the nature of the authority in these settings. To study adolescent relationships with those in authority positions we have used methods of participant observation in small groups. In two different settings we served as consultants for regularly meeting groups of adolescents and adults. On an adolescent psychiatric ward, these groups included patients, the ward administrator, and the head nurse. In a comparison setting from a private day school the groups comprised students, a school administrator, and a teacher. In this paper we report findings from the school study, where one of us (STH) met as a consultant with three groups over a total of 1/2 years. The observations we discuss primarily concern the various coping strategies used by the groups'faculty members. Attempts to abandon school role behaviors were common among the faculty members of the groups. Our observations suggest that these repeated efforts to either abandon or blur their roles represented modes of coping with a highly stressful situation. Examples of these stresses and the coping strategies are detailed within the paper, together with illustration of how the consultant unwittingly participated in such role shifts.

For structural-developmental psychology to be useful in investigating the relationship between adolescent development and family interaction, its perspective must be expanded to include the role of affect and of cognitively inhibiting behaviors in producing environments for development.

Family communication patterns were examined in relation to adolescents' gender and ego development pathways using sequential analysis techniques. Thirty-two adolescents from a suburban Boston high school participated in a discussion of moral dilemmas with both their mothers and fathers. The family discussions were scored with the Constraining and Enabling Coding System. During the following 4 years, the adolescents' levels of ego development were assessed with the Loevinger Sentence Completion Test. Sequential and nonsequential analyses revealed variations in family communication patterns associated with adolescent gender, parent gender, and adolescent ego development pathway. Family communication patterns that suggest separation occurred more often with conformist pathway sons and post conformist pathway daughters, while communication patterns that suggest closeness occurred more often with conformist pathway daughters and post conformist pathway sons. The results are discussed in terms of recent work on gender-role socialization and adolescent psychosocial development.

In psychodynamic psychiatry and psychoanalysis, the concept of ego development is important for both clinical and theoretical work. It has been difficult, however, to derive techniques which meaningfully measure ego development for use in clinical research. The Loevinger Sentence Completion Test has been found reliable and valid, but no study has shown it directly pertinent to clinical perspectives. Our research investigated clinically relevant correlates of ego development, using the Loevinger test followed by videotaped interviews of 98 adolescent girls, to discover how certain character styles predicted to be associated with different ego levels would be expressed in interpersonal interactions. Our results were consistent with clinical and theoretical descriptions of adolescents from varying ego development levels. These findings emphasize the relevance and usefulness of the ego development measure for clinical research and studies of the life cycle.

Self-esteem as measured by the Coopersmith Self-Esteem Inventory [Coopersmith, S. (1967),The Antecedents of Self-Esteem, Freeman, San Francisco] and ego development as measured by the Washington University Sentence Completion Test [Loevinger, J., and Wessler, R. (1970),Measuring Ego Development, Vol. I, Jossey-Bass, San Francisco] were evaluated in three groups of early adolescents: diabetic patients, nonpsychotic psychiatric patients, and a nonpatient group of high-school students. We found that low levels of ego development were associated with low levels of global and domain-specific self-esteem in all three subject groups. Levels of self-esteem among diabetic patients were not significantly different from those of nonpatients. While psychiatric patients had significantly lower self-esteem levels than the other groups, this difference was accounted for by preconformists, i.e., those at the lowest stages of ego development. Psychiatric patients reaching higher ego levels showed self-esteem levels indistinguishable from those of the diabetics and nonpatients.