A self-report measure of pubertal status: Reliability, validity, and initial norms

Is psychopathology associated with the timing of pubertal development?

OBJECTIVE

This investigation tested whether the timing of pubertal development was associated with concurrent and prior experiences of psychopathology (symptoms and disorders) in adolescent boys and girls.

METHOD

A large (N = 1,709) community sample of high school students were interviewed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children as adapted for use in epidemiological studies. Adolescents also completed a questionnaire battery covering a range of psychosocial variables.

RESULTS

Analyses tested whether pubertal timing was associated with present and lifetime history of mental disorders, psychological symptoms, and psychosocial functioning. As hypothesized, early-maturing girls and late-maturing boys showed more evidence of psychopathology than other same-gender adolescents.

CONCLUSIONS

Early-maturing girls had the poorest current and lifetime history of adjustment problems, indicating that this pattern of pubertal development merits attention by mental health providers and researchers.

Cardiovascular reactivity to stress and left ventricular mass in youth

We studied the relationships of cardiovascular reactivity during mental stress with left ventricular mass index in a group of prepubertal children 8 to 10 years old and in a group of peripubertal or postpubertal adolescents 15 to 17 years old. One hundred fifteen participants, varying in age group, sex, and race (black and white), took part in a laboratory stress protocol consisting of a reaction-time task, a mirror tracing task, a cold forehead challenge, and a stress interview. Cardiovascular measures included blood pressure and heart rate, as well as cardiac output, stroke volume, total peripheral resistance, and preejection period obtained noninvasively with impedance cardiography. Measures of left ventricular mass were made by echocardiography. Results indicated that across all participants, left ventricular mass index was associated with cardiovascular responses during the mirror tracing and cold forehead tasks, especially with those responses reflecting increased vasoconstriction. Subgroup analyses showed that these associations were significant for males and sometimes adolescents but not for females and children. As mirror tracing and cold forehead tasks most consistently produce alpha-adrenergic activation, the results suggest a model in which vasoconstriction due to mental stress is related to increased left ventricular mass in susceptible individuals, even at a young age.

Does background stress heighten or dampen children's cardiovascular responses to acute stress?

OBJECTIVE

Does background stress heighten or dampen children's cardiovascular responses to acute stress?

METHOD

To address this question, the cardiovascular responses to four acute laboratory stressors of 150 children and adolescents were evaluated according to their self-reported background stress level. Background stress was determined during a standardized interview and was a priori classified according to its importance, frequency, and whether it was ongoing or resolved.

RESULTS

Results showed that children and adolescents who reported important stressors or stressors that were ongoing and frequent exhibited a larger increase in diastolic blood pressure and total peripheral resistance during all four laboratory stressors than their low stress counterparts. Additional analysis showed that the results could not be accounted for by sociodemographic variables or by the personality traits measured in this study.

CONCLUSIONS

Results suggest the importance of measuring background stress in understanding an individual's acute stress response.

Hemodynamic responses to laboratory stressors in children and adolescents: the influences of age, race, and gender

The objectives of the present study were threefold: (a) to compare the patterns of hemodynamic responding of children and adolescents during behavioral challenges, (b) to examine whether previously reported cardiovascular reactivity differences between Black and White children are dependent on pubertal status, and (c) to assess whether gender differences in hemodynamic response reported for adults is similar in children. One hundred fifty-nine children (ages 8-10 years) and adolescents (ages 15-17 years), equally divided along gender and racial lines, participated in a laboratory protocol consisting of a reaction time task, a mirror tracing task, a cold forehead challenge, and a stress interview. Results indicated that adolescents responded with greater beta-adrenergic activation than did children and that gender differences in reactivity often reported for adults emerged more clearly in the adolescents than in the children. This study failed to replicate prior findings of greater vasoconstrictive responses in Black children as compared with White children.

Anxiety, antisocial behavior, and heart rate regulation in adolescent males

We explored relationships between anxiety and antisocial behavior and autonomic heart rate regulation in a homogenous sample (N = 175) of 15-year-old males. Measures of anxiety and antisocial behavior were obtained at yearly intervals over a period of 4-6 years. Components of heart rate variability associated with postural (sympathetic) and respiratory (vagal) change and transfer of respiratory to heart rate variability were estimated at age 15 using spectral analytic techniques. Anxiety and antisocial behavior were predictably related to enhanced and diminished levels of mean heart rate, respectively. Anxiety was also predictably related to enhanced sympathetic mediation of phasic postural effects on heart rate. Antisocial behavior was unexpectedly related to disruption of vagally mediated, phasic respiratory effects on heart rate. Anxiety and antisocial behavior showed distinct relationships to heart rate, and to the autonomically mediated components of heart rate variability from postural and respiratory sources. Spectral analytic techniques helped elucidate these unique regulatory patterns, suggesting utility for future research in this area.

The impact of paternal alcoholism and maternal social position on boys' school adjustment, pubertal maturation and sexual behavior: a test of two competing hypotheses

Two competing hypotheses concerning the effects of stressful environments on the onset of puberty were tested using longitudinal data for a sample of boys from low socioeconomic backgrounds. Paternal alcoholism and maternal social position were used as indicators of family stress. School placement was monitored from school entry to 14 years of age. Teachers rated the boys' disruptive and anxious behaviors, while the boys reported on parenting behaviors at 10 years of age. Pubertal maturation, age of first sexual intercourse and sexual behavior were assessed between 11 and 14 years of age. The prepubertal data indicated that boys with an alcoholic father, or a mother from a low social position, were more stressed and had more behavior problems: the boys with alcoholic fathers perceived their parents as being more punitive, and as setting fewer rules concerning their behavior; those who had at least one maladjusted parent were more often placed out of an age-appropriate regular classroom, and were rated more disruptive and more anxious by their teachers. Paradoxically, the results for the onset of puberty gave support to the two rival hypotheses. Paternal alcoholism led to a delay of male pubertal onset, as suggested by the hypothesis that stress activates the hypothalamic-pituitary-adrenal axis, and inhibits the hypothalamic-pituitary-gonadal axis. However, sons of alcoholic fathers had more frequent sexual intercourse and more sexual partners, as suggested by the evolutionary theory of socialization. High maternal social position acted as a protective factor for school placement of boys with an alcoholic father. These results challenged a key hypothesis of the evolutionary theory of socialization for males. They indicated that the link between childhood family environment, behavior development, pubertal maturation and sexual promiscuity are more complex than anticipated.

Self-assessment of sexual maturity by mid-adolescents based on a global question

The objective of this research was to investigate the use of a global question for evaluation of body development relative to age-mates in addition to graded statements on sexual maturity (SM) as part of self-reports on pubertal development. In total, 4516 adolescents answered written questions on pubertal development and the global question. They represented a normative Swedish sample. To validate these results, 100 mid-adolescents were asked to answer the statements regarding SM and the global question. This was compared with ratings made by two professional examiners for each young person. The outcome of the population study was evaluated against standard biological timetables and demonstrated adequate agreement. In the validation study, the inter-rater agreement between the professionals was excellent and so were professional ratings against those of the adolescents, with one exception: boys rating of their public hair. The global question alone gave the best agreement on pubertal progress. We can conclude that the global question is a valid tool for evaluation of pubertal development during mid-adolescence in population surveys.

Daughter and mother report of individual symptoms on the Children's Depression Inventory

PURPOSE

To examine differences between early adolescent girls' and their mothers' perceptions of girls' depressive symptoms.

METHODS

313 daughter-mother dyads completed the Children's Depression Inventory.

RESULTS

Low to modest agreement was found for most symptoms, although higher agreement was found for symptoms relating to school performance. The hypothesis that girls would report more ideational symptoms and mothers more behavioral symptoms of depression was tested; girls generally reported more ideational and behavioral symptoms when differences occurred. However, several specific ideational symptoms (feeling like crying; feeling sad; guilt; worrying) tended to be more frequently endorsed by girls and had particularly poor daughter-mother agreement. Examining third variables associated with daughter-mother agreement, girls scoring high on social desirability tended to have smaller daughter-minus-mother difference scores for ideational, but not for behavioral items; therefore, social desirability may be associated with girls underreporting ideational symptoms.

CONCLUSIONS

Mothers appear to be reliable raters of symptoms related to school functioning, but may be less aware of certain covert depressive symptoms in their early adolescent daughters.

Male testosterone linked to high social dominance but low physical aggression in early adolescence

BACKGROUND

The association of male pubertal testosterone with social dominance and physical aggression was studied in a population sample of boys followed from age 6 to 13 years to understand the origin of the links between violent behavior and gonadal hormones.

METHOD

Physical aggression was assessed from the end of kindergarten to the end of elementary school by teachers and peers (aged 6 to 12 years). Social dominance and testosterone levels were assessed at 13 years of age during a 1-day visit to a laboratory with four unfamiliar peers.

RESULTS

Boys perceived as socially dominant by unfamiliar peers were found to have concurrently higher levels of testosterone than boys perceived as less socially dominant. In contrast, boys who had a history of high physical aggression, from age 6 to 12, were found to have lower testosterone levels at age 13 compared with boys with no history of high physical aggression. The former were also failing in school and were unpopular with their peers.

CONCLUSIONS

Both concurrent and longitudinal analyses indicated that testosterone levels were positively associated with social success rather than with physical aggression. High testosterone levels in adolescent boys may thus be regarded as a marker of social success in a given context, rather than of social maladjustment as suggested in previous studies.

Controlled trial of a brief cognitive-behavioural intervention in adolescent patients with depressive disorders

Fifty-three child and adolescent psychiatric patients with depressive disorders were randomly allocated to brief cognitive-behaviour therapy (CBT) or to a control treatment, relaxation training. Forty-eight patients completed the treatment phase of the trial, which comprised 5-8 treatment sessions. Post-treatment assessments showed a clear advantage of CBT over relaxation on measures of both depression and overall outcome. However, there were no significant differences between the treatments on comorbid anxiety and conduct symptoms. At follow-up, the differences between the groups were reduced, partly because of a high relapse rate in the DTP group and partly because subjects in the relaxation group continued to recover.

Pilot study of continuation cognitive-behavioral therapy for major depression in adolescent psychiatric patients

OBJECTIVE

To determine whether continuation of cognitive-behavioral therapy (CBT-C) could prevent relapse in adolescent psychiatric patients who had remitted from major depressive disorder (MDD).

METHOD

Seventeen patients who continued to have CBT-C for 6 months after remission from MDD were compared with a historical control group of 12 cases who had no further treatment after remission.

RESULTS

Only 1 of the 17 cases who continued with CBT-C dropped out. The cumulative relapse risk during CBT-C was significantly lower (0.2) than it had been in the historical control group (0.5).

CONCLUSIONS

CBT-C warrants further investigation in a randomized, controlled trial.

Puberty questions asked by early adolescents: what do they want to know?

OBJECTIVE

We undertook the following study to document questions asked by early adolescents regarding pubertal development.

METHODS

As part of a health education program, 159 sixth-grade students (mean = 12.1 years) were surveyed to obtain their questions about puberty and their self-assessed pubertal stage. Questions were coded for content and gender specificity.

RESULTS

Of 159 initial subjects, 111 generated a total of 200 questions. A majority of the questions reflected biological topics (88%), such as genital physiology (26%) and sexuality and reproduction (26%). Only 6% addressed psychosocial questions. Both females and Asians (compared with other ethnic or racial groups) expressed greater interest in the differences between male and female development (P < .05). Prepubertal males were more concerned about general puberty than were boys in later Tanner stages (P < .05). Earlier maturing males focused on genital anatomy (P < .05).

CONCLUSIONS

We found that biological questions concerning puberty predominated over psychosocial topics, and that the gender, race or ethnicity, and stage of development determined the kinds of questions that early adolescents have about pubertal development. Health educators and clinicians may need to focus on physiologic areas to provide more meaningful information about development to early adolescents.

Self-esteem and change in body mass index over 3 years in a cohort of adolescents

Self-esteem has been hypothesized to be lower in obese adolescents relative to their normal weight peers and to be an important factor in preventing or reversing obesity. The present study examined the relationship between obesity and self-esteem cross-sectionally and prospectively over three years in a cohort of 1278 adolescents in grades 7 to 9 at baseline. Cross-sectional analyses revealed an inverse association between physical appearance self-esteem and body mass index in both males and females. In females, body mass index was inversely associated with global self-esteem, close friendship, and behavioral conduct self-esteem. In males, body mass index was inversely associated with athletic and romantic appeal self-esteem. Prospectively, in females, physical appearance and social acceptance self-esteem at baseline were inversely related to body mass index three years later. Baseline self-esteem was unrelated prospectively to change in body mass index in males. All associations were modest in magnitude. These results suggest that in a middle class white sample of adolescents, self-esteem specific to physical appearance is modestly associated with body mass index. Low self-esteem does not appear to predict the development of obesity over time.

Development of body image, eating disturbance, and general psychological functioning in female adolescents: covariance structure modeling and longitudinal investigations

OBJECTIVE

Covariance structure modeling (CSM) and longitudinal analyses were used to identify a possible causal sequence for factors that might lead to the development of body image and eating disturbance in adolescent females.

METHOD

In Study 1, subjects were measured for level of obesity, perceived weight status, maturational timing, history of being teased about weight/size, body image, eating disturbance, and global psychological functioning. Study 2 was a systematic replication of Study 1 using different indices of body image and a more comprehensive assessment of eating disturbance. In Study 3, subjects from Study 1 were reassessed at a 3-year follow-up.

RESULTS

The findings from Study 1 indicated that level of obesity and perceived weight, but not maturational timing, had a directional influence on the other variables. In addition, teasing history was significantly related to the development of body image and eating disturbance. CSM and path analyses with Studies 2 and 3 data generally replicated and extended the results from Study 1.

DISCUSSION

These findings offer important insights into possible causal sequences for the development of body image and eating disturbance.

Longitudinal patterns of heart rate and fighting behavior in 9- through 12-year-old boys

OBJECTIVE

To assess the temporal stability of heart rate and to examine its relationship with fighting behavior.

METHOD

Heart rate at ages 9 through 12 was compared to a composite measure of fighting behavior in three cohorts of low socioeconomic status boys (n = 138; two cohorts of boys who had been rated as having disruptive behavior problems in kindergarten and one normative cohort) while controlling for body size, pubertal status, and level of family adversity.

RESULTS

Heart rate showed moderate stability at 1- and 2-year intervals in two of the three cohorts. The composite fighting score was related to heart rate for 11-year-old boys in the normative cohort and 12-year-old boys in one of the disruptive cohorts.

CONCLUSION

These data support the conclusion that there is a relationship between heart rate and aggression even within a low socioeconomic status sample.

Puberty as a biological and social event: implications for research on pharmacology

Pubertal processes take place against a backdrop of multiple changes in other domains. How pubertal processes intersect with social events may place some adolescents at risk for a variety of health-related behaviors, such as substance use, eating problems and/or excessive levels of exercise, depressed affect, smoking, and drinking. All of these behaviors may influence compliance in a drug trial as well as the physiological response to a specific pharmacological treatment.

A self-administered rating scale for pubertal development

The purpose of this study was to assess the reliability and validity of a new self-rating scale to measure children's pubertal status without pictorial representations or interviews. The scale is an adaptation of an interview-based puberty-rating scale by Petersen, and included scores for each of five items rating physical development, an overall maturation measure, and a categorical maturation score designed to be similar to Tanner staging categories. Each measure was obtained from independent ratings by students and parents, and a 3-point categorical scale was also obtained from teachers. Subjects included 698 5th- and 6th-grade students (323 boys and 375 girls) from 61 schools and their parents and teachers. Fifth-grade students rated themselves and were rated by parents as less mature than 6th graders; 6th-grade girls were consistently rated more mature than boys of the same age. Significant correlations were found between parents and students for all of the measures for 6th-graders and 5th-grade girls and several measures for 5th-grade boys. This new scale is a useful tool for assessing pubertal status in settings that require noninvasive measures.

Psychosocial characteristics of adolescents with a history of suicide attempt

The purpose of this study was to identify psychosocial risk factors uniquely associated with past suicide attempts. Data assessing a large number of variables were available from a representative sample of older adolescents (N = 1,710). Most independent variables were associated with past suicide attempts; variables that remained associated with past attempts after controlling for current depression level included externalizing and internalizing problem behaviors, past psychiatric disorders, depressotypic cognitions, coping, school problems, health problems, and gender. The probability of having made an attempt increased dramatically as a function of the number of risk factors. Females had more risk factors and showed a greater vulnerability to the factors than did males.

Validity of self-report of pubertal maturation in early adolescents

Self-report measures of sexual maturation continue to be used to classify pubertal development even though their reliability remains in question. This study examined the accuracy of self-report measures by early adolescents in two settings. Standardized figured drawings depicting Tanner's sexual maturation scale (SMS) were shown to early adolescents at school (S1) and again in a clinical sitting (S2), and subjects were asked to rate their own pubertal development. Physical examination by a physician at S2 was used to corroborate sexual maturation. Participating in the study were 46 males, age 11-14 years (mean, 12.4, SD, 1.9), and 37 females, age 11-14 years (mean, 12.7, SD, 0.7). Concordance rate between physical examination and self-report of pubic hair development (males) at S1 was 58% (kappa = 0.35, p less than 0.0001) and 78% (kappa = .66, p less than 0.0001) at S2. Concordance rate of self-report of genital development at S1 and S2 was 27% (kappa = -0.06, p less than 0.49) and 44% (kappa = 0.18, p less than 0.04), respectively. Self-report of breast development demonstrated a concordance rate of 59% (kappa = 0.43, p less than 0.0001) at S1 and 72% (kappa = 0.59, p less than 0.0001) at S2. Concordance rate for self-report of pubic hair development in females was 58% at S1 (kappa = 0.42, p less than 0.0001) and 75% at S2 (kappa = 0.64, p less than 0.0001). There was a tendency for subjects to overestimate their development at early stages of maturation and underestimate development at later stages.(ABSTRACT TRUNCATED AT 250 WORDS)