Family and social determinants of school maladjustment in students with emotional disturbances and behavioral disorders from recovery schools in Bulgaria

This inquiry study is part of a comprehensive investigation on the organization and the effect of the education of students with emotional disturbances and behavioral disorders in special recovery schools. The aim for conducting the inquiry is to reveal the characteristics of the family and social background which may affect the school adaptation. The investigated group includes 254 students--192 with emotional disturbances and behavioral disorders and 62 healthy children of the same age from the settlements where the recovery schools are based. Two types of questionnaires developed by the team are used for investigating the students' family and social status--one designed for the pupils and one--for the teachers and supervisors in the schools. The inquiry for the students contains 15 questions revealing family and school environment (family relations and problems; number of children and sequential number of the problem child; parents' education and employment; school training and curriculum; social contacts in the school; school results). The inquiry, engaging the class teachers, day and night supervisors in recovery schools, contains 19 questions. There are additional questions concerning students' specific learning difficulties as well. The results made it clear that parents' divorce is the most unfavorable family determinant for school maladjustment of students with emotional disturbances and behavioral disorders. Many other factors such as the poor educational qualification and social-professional status of the parents, children number, the sequential number of the problematic child additionally impedes the relationship with the parents, thus increasing the risk of school failure and the manifestations of school maladjustment. The determined peculiarities of the family environment of students with emotional disturbances and behavioral disorders suggest targeted psychocorrective work of the school psychologist individually with the student as well as with his/her family.

Which patients talk about stressful life events and social problems to the general practitioner?

BACKGROUND

Life events and social problems are common in primary-care attenders and contribute to the high rate of emotional distress observed in this setting but are often not disclosed during the consultation. Physicians' characteristics associated with patients' disclosure of psychosocial problems are well documented, but less empirical evidence is available on the contribution of patients' variables.

METHOD

Logistic regression analyses were performed on a set of clinical and psychosocial data from 319 primary-care attenders with stressful life events and/or social problems in the presence or absence of emotional distress, in order to identify the variables that predict disclosure of such problems during the consultation.

RESULTS

Two-thirds of patients with stressful life events and social problems had mentioned them to their GP. In both sexes a positive attitude about confiding and emotional distress were the best predictors of confiding. In men they accounted for 76% of correct predictions and, in women, together with past confiding, long-lasting relationship with GP, and coexistence of life events and social problems, for 81%. A positive confiding attitude was related in males to age and severity of medical condition and in females to age and experience of past confiding.

CONCLUSIONS

In view of the high prevalence of positive attitude towards confiding the efforts by GPs should focus on the reduction of disclosure thresholds. This would require increased abilities to elicit psychosocial information and show emphatic understanding of patients' life difficulties. By contrast there is a need to promote a positive attitude in confiding that concerns only a minority of primary-care patients. More data are needed for shaping more specific strategies for these patients.

Gender differences on negative affectivity: an IRT study of differential item functioning on the Multidimensional Personality Questionnaire Stress Reaction Scale

Item response theory methods were used to study differential item functioning (DIF) between gender groups on a measure of stress reaction. Results revealed that women were more likely to endorse items describing emotional vulnerability and sensitivity, whereas men were more likely to endorse items describing tension, irritability, and being easily upset. Item factor analysis yielded 5 correlated factors, and the DIF analysis, in turn, revealed differential gender mean differences on these factors. This finding illustrates how even in an essentially unidimensional scale, comparison of group mean differences can be affected by multidimensionality caused by item clusters that share similar content. Results do not support arguments that measures of negative affective dispositions "artificially" produce gender mean differences by focusing on specific selected content areas.

Sociodemographic correlates of alexithymia

The association between alexithymia and sociodemographic variables is not well understood. Previous studies using the current 20-item and previous 26-item versions of the Toronto Alexithymia Scale (TAS) have shown inconsistent associations with age, sex, socioeconomic status, and years of education. We tested 380 subjects from the community stratified equally across sex, five age groups, and three socioeconomic classes. In addition to the TAS-20, we also administered the Levels of Emotional Awareness Scale (LEAS), a behavioral measure of the ability to be aware of and represent emotions in words, a core component of alexithymia. The TAS-20 and LEAS were each correlated with age, sex, socioeconomic status (SES), and years of education (P < .01) in the same direction and to approximately the same degree. Alexithymia (or low emotional awareness) is associated with older age, male sex, lower SES, and fewer years of education. The TAS-20 and LEAS are only slightly correlated (r = -.19, n = 380, P < .001), but their correlation is largely accounted for by their shared variance with these demographic variables. The convergence of findings with these two quite different measures and the nature of their overlap support the validity of these associations between alexithymia and sociodemographic variables.

A retrospective analysis of expressed emotion (EE) and affective distress in a sample of relatives caring for traumatically brain-injured (TBI) family members

OBJECTIVES

To examine levels of expressed emotion (EE) and affective distress in relatives caring for severely brain-injured family members.

DESIGN

The study took the form of a retrospective, observational cross-sectional analysis.

METHOD

Data on 28 relatives were reviewed. Each participant completed one affective health-related questionnaire (Leeds Scales for the Self-Assessment of Anxiety and Depression; Snaith, Bridge & Hamilton, 1976) and their EE was rated using the Camberwell Family Interview (CFI; Brown, Birley & Wing, 1972; Vaughn & Leff, 1976, modified for head-injury relatives. Participants were rated as either high or low EE. Comparative statistical analysis examined differences in affective distress between the two groups.

RESULTS

Of the 28 participants, 12 were rated high EE and 16 were rated low EE. Levels of anxiety were significantly higher among the high EE group, but levels of depression were not significantly different between the high and low EE groups. A significant correlation was found between EE and carer status, i.e. sole carers or family carers, with sole carers displaying significantly higher levels of EE than family carers. Multiple regression also revealed that carer status was most predictive of EE.

CONCLUSIONS

Discussion considers EE as a coping strategy. Further research into the predictive capability of EE as an indicator of affective distress in head-injury families is suggested.

Identification and assessment of problematic interpersonal situations for urban adolescents

Identified and developed a scale to assess problematic interpersonal situations among urban adolescents. In Study 1, problematic situations were identified by focus groups of 6th graders (N = 43). Their relevance was verified in Study 2 by assessing their reported frequency and difficulty in a sample of 6th graders (N = 457) that included mostly African American youth from low-income families. Scales representing 3 dimensions, peer provocation, perceived injustice, and environmental stressors were verified by confirmatory factor analyses. In Study 3, the internal consistency and structure of these scales were cross-validated in a sample of 7th graders (N = 459). All 3 scales were correlated with self-reported violent behavior, drug use, and anxiety and uniquely accounted for 11% to 19% of the variance. These findings have implications for identifying youth at risk for emotional and behavioral problems and for designing more relevant interventions.

Medical, cognitive, emotional, and behavioral outcomes in school-age children conceived by in-vitro fertilization

Assessed long-term effects of assisted reproduction technologies of in-vitro fertilization (IVF) and related techniques of embryo transfer (ET) on children's adjustment. 51 school-age Israeli children conceived by IVF/ET were compared with 51 control-matched children conceived spontaneously. The assessment included a comprehensive medical evaluation, a psychological examination, teachers' reports, parents' reports, and children's self-reports. As compared with controls, IVF/ET children did not reveal significant differences in physical and neurological status or on cognitive measures of IQ, visual-motor coordination, visual memory, and verbal comprehension. Nevertheless, the IVF/ET children were scored lower by teachers on measures of socioemotional adjustment in school and on self-report measures of anxiety, aggression, and depression. Among IVF/ET children, the tendency to be at a greater risk for emotional disturbances was exacerbated among boys and among children whose parents were older.

The role of head injury in cognitive functioning, emotional adjustment and criminal behaviour

In two investigations, 50% of non-violent convicted felons, who avoided incarceration by participating in a day reporting programme, reported a prior history of head injury and current problems in cognitive and emotional functioning. Only 5% of a college sample in the first investigation and 15% of a community sample in the second investigation reported prior head injury. In a third investigation, 83% of felons who had reported a history of head injury also reported a date for their head injury that preceded the date of their first encounter with law enforcement. Some participants reported no trouble with the law until after experiencing a head injury that occurred in their late thirties. Considering the research reported here and elsewhere in the literature, it appears that many serious crimes follow a head injury. One implication of the findings reported here is that many crimes might not occur if people with head injury were given prompt and comprehensive treatment after the injury.

Emotional and behavioural problems in primary school children from nuclear and extended families in Korea

The changes occurring within Korean society provide an opportunity for studying the influence of family structure on children's emotional and behavioural problems. Children aged 7-13 years from two Korean cities were assessed for emotional and behavioural problems in school by their teachers, using the Children's Behaviour Questionnaire. In Study 1, 326 children from extended families were compared with demographically matched nuclear family children in the same school classes. In Study 2, a further sample of 204 extended family children was compared with pair-matched nuclear family children, in order to replicate the findings. Children from Study 1 were followed up 2.5 years later. Children from extended families had lower behaviour problems scores and the prevalence of serious problems was lower in extended family children. These differences were most marked in relation to externalising behaviour problems and were stable over the studies and time. Grandparents in extended families may increase children's resiliency by providing sources of attachment, affection, and knowledge, as well as having indirect effects through their support of parents. Consistent with recent ideas about the cognitive bases for behaviour problems, it may be that rules for behaviour derived from traditional cultural beliefs and values are internalised by children from extended families and generalise to prevent behaviour problems in school.

Emotional stability pertaining to the game Vampire: The Masquerade

A role-playing game called Vampire: The Masquerade has been described in the popular press as etiological of antisocial behavior. The 16 PF was administered to players of the game and the years of playing the game was correlated with scores on antisocial behavior. No relationship was found with amount of exposure to the game on Factor C.

Alexithymia and somatic amplification in chronic pain

A controlled study was undertaken to assess alexithymia and somatic amplification among 50 medical outpatients with chronic pain referred for psychiatric consultation. Data were collected on demographics; DSM-IV diagnoses; and measures of anxiety, depression, and alexithymia, assessed with the Toronto Alexithymia Scale (TAS-20), as well as somatic amplification, assessed with the Somatosensory Amplification Scale (SAS). Data analysis revealed low scores on the TAS-20 and SAS for the pain patients, compared with a control group without pain. In this sample, depression and anxiety were the primary determinants of alexithymia and somatic amplification, rather than pain. These findings suggest that psychological markers for chronic pain may be different from those for other somatoform disorders.

Psychopathological and emotional deficits in myotonic dystrophy

OBJECTIVE

To evaluate psychopathological disturbances in patients with myotonic dystrophy (MD) and compare patients with MD to both patients with facioscapulohumeral dystrophy (FSHD) and healthy control subjects.

METHODS

A semistructured interview was used to determine DSM III-R criteria for major depressive episodes, dysthymic episodes, and generalised anxiety. The Montgomery and Asberg and the Hamilton depressive scales, the Covi and Tyrer anxiety scales, the Abrams and Taylor scale for emotional blunting, and the depressive mood scale were all used in the study. Subjects were also asked to complete questionnaires for physical and social anhedonia.

RESULTS

Fifteen patients with MD, 11 patients with FSHD, and 14 healthy subjects were studied. Patients with MD were not more depressed or anxious than healthy controls. Patients with FSHD were the most depressed and most anxious. However, patients with MD had significantly lower scores for expressiveness and significantly higher scores for anhedonia than the other two groups.

CONCLUSION

Patients with MD did not present significant depressive or anxious symptomatology but rather an emotional deficit. This emotional deficit may be an adaptive reaction to the threatening implications of the disease, or the effect of the CNS lesions which occur with MD, or both.

Behaviour/emotional problems in male juvenile delinquents and controls in Russia: the role of personality traits

Recent studies based on the psychobiological theory of personality by Cloninger postulate a relationship between certain personality traits and various psychopathological manifestations. To test this theory, we administered the Temperament and Character Inventory and the Youth Self-Report to 188 male delinquents from a juvenile correction centre in Northern Russia, and to 111 age-matched male controls recruited from among schoolchildren. As assumed by previous studies, psychological symptoms were primarily positively correlated with harm avoidance and negatively correlated with self-directedness. At the same time, the higher levels of aggressive and delinquent behaviour were positively correlated with novelty-seeking and negatively correlated with co-operativeness. The possible mechanisms underlying these findings are discussed.

Spontaneous complaints of long-term traumatic brain injured subjects and their close relatives

Long-term consequences of head injury for patients and families are not well known, given the complexity of variables that have to be studied. Subject's self-experience is one of these less studied aspects. The purpose of this study is to examine the spontaneous complaints of long-term brain injured adult subjects to be compared to the impression of their relatives. A total of 48 chronic head trauma subjects were studied more than 6 years after injury together with a relative, usually a mother or wife. At the beginning of the interview the participants were asked to freely refer their present complaints. In general, relatives referred more complaints about the injured subjects than the injured subjects referred about themselves. This occurred in several domains: somatic, physical, cognitive, and behavioural. Memory problems were highly reported by both groups. Somatic complaints were more frequently reported by patients and behavioural problems were more often reported by relatives. Mothers and wives had different profiles or responses. Mothers' opinions were identical to those of their TBI sons in all domains. These different results must be taken into consideration so that the real needs of patients and relatives can be addressed.

Lifetime weight cycling and psychological health in normal-weight and overweight women

OBJECTIVE

The relationship between weight cycling history and psychological health was studied in a sample of 429 normal-weight and overweight women.

METHOD

Participants were from the Healthy Women Study, a longitudinal investigation of biological and psychosocial aspects of menopause. Participants were asked to report retrospectively details on their weight cycling history in terms of the frequency and magnitude of previous weight loss episodes. Data were examined using the total cycle weight lost and the frequency of weight cycles > or = 10 lb. Self-reported measures of depression, stress, anxiety, and anger were used to evaluate psychological health.

RESULTS

For both normal-weight and overweight women, the analyses revealed no adverse relationships between weight cycling history and the psychological measures.

DISCUSSION

These findings suggest that a history of weight cycling regardless of weight status does not adversely impact psychological health.

[Emotional disorders. Stable mental health and chronic illnesses over a 10-year course in the general population]

In a comparison of extreme groups 124 german inhabitants of the city of Mannheim were investigated. They descended from a representative sample with 600 persons out of 3 years of birth (1935, 1945, 1955) in the general population (psychotic disorders were excluded). They were within a period of 10 years either in stable mental health or in chronic illness. The comparison between this two groups concerned demographic variables, development during childhood, personality, stressful life events, social network and clinical data. The ascertained prevalence is 12.7% (from n = 600) for stable mental health and 3.5% for chronic illness. The group with the highest risk of chronic diseases is those of women and men with bad achievement and small social competence.

The performance of students with disabilities in a norm-referenced, statewide standardized testing program

Hawaii uses the Stanford Achievement Test, 8th Edition (Stanford 8), to assess the academic performance of students in Grades 3, 6, 8, and 10. Three longitudinal cohorts were analyzed for achievement performance among Grades 3 to 6, 6 to 8, and 8 to 10. ANOVAs indicated significant differences in overall performance between nondisabled students and three high-incidence categories of students with disabilities (specific learning disability, emotional impairment, and mild mental retardation). Local subgroup norms were developed on the basis of Stanford 8 reading and mathematics results from 1992 to 1996 to supplement the national norms and provide an additional means of comparison to evaluate performance for these categories. The longitudinal cohorts of students with disabilities made greater gains in achievement from third to sixth grade than their national counterparts and cohort of nondisabled students in Hawaii. Between 8th and 10th grade, students with learning disabilities and emotional impairments made gains equal to or greater than their national counterparts'.

Adolescents with borderline intellectual functioning: psychopathological risk

This paper presents a qualitative analysis of cognitive and emotional functioning in intellectually borderline adolescents (IQ ranging from 71 to 84) and the consequences for personality and social development. Psychopathological risk, particularly in terms of mood disorders, conduct disorders, and intellectual deterioration, is analyzed, with the distinction made between "excited" and "inhibited" forms. Conceptualizations intellectually borderline adolescents have of their own mental functioning are described in light of the notion of cognitive self--the ability to understand and control internal and external reality. The implications for psychotherapy and rehabilitation are discussed.

Brief communication: pathological narcissism in bipolar disorder patients

The occurrence of pathological narcissism in bipolar patients, and the diagnostic relation between narcissistic personality disorder (NPD) and bipolar disorder (BD), were investigated. The Diagnostic Interview for Narcissism (DIN) was administered to bipolar patients when manic and when euthymic. The scores were compared to those of an NPD sample and a control group of general psychiatric patients. Euthymic bipolars do not exhibit a higher level of pathological narcissism or a higher prevalence of NPD than psychiatric patients in general. However, when manic, bipolar patients do appear similar to the narcissistic group, sharing 12 out of 14 of the identifying criteria for NPD. The results support the inclusion of mania in the differential diagnosis of NPD.

Behavior problems and traumatic events of unaccompanied refugee minors

OBJECTIVE

The present study examined the traumatic events and behavior symptoms of 46 unaccompanied refugee minors waiting for placement in an asylum center in Finland.

METHOD

Using all the clinical information available information about the refugee children's experiences before and during their flight and after their arrival in Finland was gathered. Children were evaluated with the Child Behavior Checklist (CBCL).

RESULTS

The refugee children had experienced a number of losses, separations, persecution, and threats. About half of the minors were functioning within clinical or borderline range when evaluated with the CBCL. Young age (< 15 years) was associated with more severe psychiatric problems. There was a lack of rehabilitative services, the staff ratio was very low and the time spent in the asylum center waiting for the placement decision was relatively long for these minors.

CONCLUSIONS

Unaccompanied refugee minors are in a highly vulnerable situation. Younger refugee children are more vulnerable to emotional distress than older children. Current procedures for dealing with asylum-seekers may contribute to high level of stress and emotional symptoms in previously traumatized refugee children. A high level of social security and mental health care does not guarantee an appropriate level of care for unaccompanied refugee children.

Alexithymia and the interpretation of hostile-provoking situations

BACKGROUND

To examine the relationship between alexithymia and the interpretation of hostility-provoking situations.

METHODS

Sixty-two college students completed the TAS-20 and the Test for the Interpretation of Provoking Situations (TIPS). The TIPS measures how accurately participants can select the most likely explanation for the occurrence of a hypothetical, potentially provoking situation; it also measures how accurately participants judge whether explanations for events are innocent or noninnocent.

RESULTS

Higher levels of alexithymia were associated with greater degrees of accuracy in interpreting the innocence of interpersonal information. The facets of alexithymia that were most strongly associated with interpretation accuracy varied by gender.

CONCLUSIONS

Alexithymia is not associated with a general affect recognition deficit. The results are consistent with social factors playing a central role in alexithymia.

Culture and somatization: clinical, epidemiological, and ethnographic perspectives

OBJECTIVES

The cross-cultural prevalence of somatization and the limitations of current nosology and psychiatric theory for interpreting cultural variations in somatization are reviewed.

METHOD

Selective review was conducted of recent research literature and research findings from an epidemiological survey and ethnographic study of help-seeking and health care utilization of a random sample of 2246 residents in a Canadian urban multicultural milieu.

RESULTS

Somatization is common in all ethnocultural groups and societies studied to date. However, significant differences in somatization across ethnocultural groups persist even where there is relatively equitable access to health care services. Analysis of illness narratives collected from diverse ethnocultural groups suggests that somatic symptoms are located in multiple systems of meaning that serve diverse psychological and social functions. Depending on circumstances, these symptoms can be seen as an index of disease or disorder, an indication of psychopathology, a symbolic condensation of intrapsychic conflict, a culturally coded expression of distress, a medium for expressing social discontent, and a mechanism through which patients attempt to reposition themselves within their local worlds.

CONCLUSION

Major sources of differences in somatization among ethnocultural groups include styles of expressing distress ("idioms of distress"), the ethnomedical belief systems in which these styles are rooted, and each group's relative familiarity with the health care system and pathways to care. Psychological theories of somatization focused on individual characteristics must be expanded to recognize the fundamental social meanings of bodily distress.

[Insecure attachment and psychosomatic skin disease]

Alexithymia is not infrequent among psychosomatic patients. The incapacity to decode one's own emotional experience implies an exacerbation of the physiological response through a recursive loop. If this vicious circle is maintained it can increase the risk of psychosomatic diseases which could be in this way regarded as functions of external meaningful events mediated by the central nervous system. The meaning varies from one individual to another and depends on his cognitive-emotional organisation. In order to study such an organisation, it can be useful to classify his mental state regarding his attachment. The authors, who previously observed an association between psychosomatic skin disease and the "non-free" mental state with regard to attachment, suggest that further studies on psychosomatic patients should be conducted applying the principles and methods of the attachment theory.

Why are depression and anxiety correlated? A test of the tripartite model

L. A. Clark and D. Watson's (1991) tripartite model groups the symptoms of depression and anxiety into 3 components: nonspecific symptoms of general distress, which do not distinguish depression and anxiety; physiologic arousal, which is relatively unique to anxiety; and anhedonia (or low positive affect), which is unique to depression. Structural equation modeling was used to test this model with self-report data from 3 different samples: outpatients seeking treatment for mood disorder, anxiety disorder, or both (n = 483) outpatients seeking treatment for substance abuse (n = 453), and college students (n = 516). The tripartite model did not fit any of the sample covariance matrices, because the nonspecific symptoms of depression and anxiety could not be adequately represented by a single General Distress factor. An alternative model, in which the Anhedonia and Nonspecific Depression factors loaded on a second-order Depression factor, while the Somatic Arousal and Nonspecific Anxiety factors loaded on a second-order Anxiety factor, produced an excellent fit in all the groups. The Nonspecific Depression and Nonspecific Anxiety factors were the most valid and specific indicators of depression and anxiety, respectively. Anhedonia and Somatic Arousal were significantly less valid measures of depression and anxiety. The implications of these findings are discussed.

The psychological adjustment of United States adopted adolescents and their nonadopted siblings

Using data from a national sample of 715 United States adoptive families, comparisons were made between adopted adolescents and birth adolescents (children born to the adoptive parents) on the Youth Self-Report (Achenbach), 8 psychological and behavioral adjustment factor scales from the Attitudes and Behaviors survey (Benson), and an identity scale (Search Institute). Multivariate, followed by univariate, analyses of variance showed significant differences between the 2 groups on the psychological factor scales of Licit Drug Use and School Adjustment. A subsample of nonclinically referred adopted adolescents were also compared to norms on the Youth Self-Report. Nonreferred adopted boys showed higher levels of adjustment than the norm group on Withdrawn behaviors. Nonreferred adopted girls showed better adjustment than the norm group on Social Problems and Withdrawn behaviors and poorer adjustment on Delinquent Behavior and Externalizing behavior. (Standardized effect sizes were in the small to moderate range.) These same patterns were evidenced when controlling for ethnicity. These data are examined within Brodzinsky's stress and coping model of adoptee adjustment and support a body of adoption research that finds a pattern of small but significant differences between adopted and nonadopted persons. The differences showing poorer adoptee adjustment in comparison to nonadoptees should not be overstated as is sometimes the case in the adoption clinical literature, and areas in which adoptees evidence higher levels of psychological functioning should be further researched.