Coping, regulation, and development during childhood and adolescence

Outcomes From an Online Pilot Mindfulness Based Intervention with Adolescents: A Comparison by Categories of Risk

Comorbid psychiatric presentations, defined as those who present with more than one mental and/or behavioral health diagnosis at the same time, during adolescence are on the rise. Mindfulness-based interventions can alleviate psychological symptoms and improve emotion regulation in youth. Mindfulness is a multifaceted phenomenon, with five underlying facets (Observing, Describing, Acting with Awareness, Non-Judgment and Non-Reactivity of Inner Experience). Little evidence has documented which facets produce pronounced psychiatric symptom reduction for adolescents. This pilot study examined the efficacy of an online mindfulness-based intervention delivered to adolescents undergoing mental health treatment during COVID-19 to reduce psychiatric outcomes. Fifty-six adolescents (m = 14.5 years, 66.1% female) categorized as moderate-risk (treatment histories of outpatient therapy only) or high-risk (treatment histories with intensive service participation) participated in the 8-session mindfulness-based intervention. Significant reductions in psychiatric symptoms and increases in adaptive coping strategies were observed at post-test, particularly for those at moderate-risk. Multivariate stepwise regression found significant associations between mindfulness facet use and anxiety, depression, and somatic symptoms (R ² ranging from 42.5 to 52.8%). Results indicate preliminary efficacy for an online mindfulness-based intervention for adolescents, particularly those at moderate-risk, due to the introduction of new coping skills, given their history of less intense treatment. Further investigation is warranted to understand which mindfulness facet intervention components produce the most prominent outcomes.

Psychobiological foundations of coping and emotion regulation: Links to maltreatment and depression in a racially diverse, economically disadvantaged sample of adolescent girls

Adolescent risk for depression and passive or active suicidal ideation (PASI) involves disturbance across multiple systems (e.g., arousal regulatory, affective valence, neurocognitive). Exposure to maltreatment while growing up as a child or teenager may potentiate this risk by noxiously impacting these systems. However, research exploring how coordinated disturbance across these systems (i.e., profiles) might be uniquely linked to depressogenic function, and how past maltreatment contributes to such disturbance, is lacking. Utilizing a racially diverse, economically disadvantaged sample of adolescent girls, this person-centered study identified psychobiological profiles and linked them to maltreatment histories, as well as current depressive symptoms and PASI. Girls (N = 237, Mage=13.98, SD=0.85) who were non-depressed/non-maltreated (15.1%), depressed/non-maltreated (40.5%), or depressed/maltreated (44.4%) provided morning saliva samples, completed questionnaires, a clinical interview, and a neurocognitive battery. Latent profile analysis of girls' morning cortisol:C-reactive protein ratio, positive and negative affect levels, and attentional set-shifting ability revealed four profiles. Relative to Normative (66.6%), girls exhibiting a Pro-inflammatory Affective Disturbance (13.1%), Severe Affective Disturbance (10.1%), or Hypercortisol Affective Neurocognitive Disturbance (n = 24, 10.1%) profile reported exposure to a greater number of maltreatment subtypes while growing up. Girls exhibiting these dysregulated profiles were also more likely (relative to Normative) to report current depressive symptoms (all three profiles) and PASI (only Pro-inflammatory Affective Disturbance and Hypercortisol Affective Neurocognitive Disturbance). Of note, girls' cognitive reappraisal utilization moderated profile membership-depression linkages (depressive symptoms, but not PASI). A synthesis of the findings is presented alongside implications for person-centered tailoring of intervention efforts.

Temperament as a moderator of the association of cumulative risk with preadolescent appraisal and coping style

BACKGROUND

Children exposed to cumulative risk (CR) are more likely to have poor physical and psychological health across the lifespan. CR may contribute to children's adjustment, in part through its effects on appraisal and coping. Further, child temperament may alter the effects of CR on appraisal and coping.

OBJECTIVE

This study investigated the interactive and prospective effects of CR and temperament on children's appraisal and coping strategies.

DESIGN AND METHOD

In this secondary data analysis using a community sample (N=306) of preadolescents (M age = 9.5 at T1), structural equations models were conducted to examine temperament negative emotionality (NE) and effortful control (EC) as moderators of the effect of CR on both levels and proportional use of positive and threat appraisals, and active and avoidant coping.

RESULTS

Children higher in NE used more threat appraisal and avoidant coping, whereas children higher in EC used less threat appraisal concurrently and decreased in their use of threat appraisal across 1 year. Both NE and EC altered the prospective effect of CR on appraisal and coping.

CONCLUSIONS

Findings suggest temperament alters the effect of CR on appraisal and coping, implicating EC as a resource and NE as a vulnerability in changes in appraisal and coping during preadolescence.

Children Coping, Contextual Risk and Their Interplay During the COVID-19 Pandemic: A Spanish Case

The COVID-19 pandemic has changed the lives of millions of people around the globe and some of the unprecedent emerged disruptions, are likely to have been particularly challenging for young children (e.g., school closures, social distancing measures, movement restrictions). Studying the impact of such extraordinary circumstances on their well-being is crucial to identify processes leading to risk and resilience. To better understand how Spanish children have adapted to the stressful disruptions resulting from the pandemic outbreak, we examined the effects of child coping and its interactions with contextual stressors (pandemic and family related) on child adjustment, incorporating in our analysis a developmental perspective. Data was collected in April 2020, through parent-reports, during the acute phase of the pandemic and, temporarily coinciding with the mandatory national quarantine period imposed by the Spanish Government. A sample of 1,123 Spanish children (50% girls) aged 3 to 12 (Mage = 7.26; SD = 2.39) participated in the study. Results showed differences in the use of specific strategies by children in different age groups (i.e., 3-6, 7-9 and 10-12-year-olds). Despite the uncontrollable nature of the pandemic-related stressors, child disengagement coping was distinctively associated to negative outcomes (i.e., higher levels of behavioral and emotional difficulties), whereas engagement coping predicted psychosocial adjustment across all age groups. Moreover, interactively with child coping, parent fear of the future and parent dispositional resilience appear as relevant contextual factors to predict both negative and positive outcomes, but their effects seem to be age dependent, suggesting a higher contextual vulnerability for younger children. These findings might have implications for identifying individual and contextual risk and informing potential preventive interventions aimed to reduce the impact of future pandemic outbreaks on children of different ages.

The Role of Adolescence in Development Paths Toward Suicide: Specificities and Shaping of Adversity Trajectories

Purpose: Adolescence is a key period of transitions in the psychological, cognitive, neurobiological and relational domains, which is associated to high susceptibility to adverse life experiences. However, the way adolescent development alters life paths toward suicide remains unclear. Thereby, we aimed at testing whether and how adolescence interfered with the adversity trajectories of individuals who died by suicide. Methods: In a sample of 303 individuals who died by suicide, longitudinal Burden of Adversity ratings were derived from extensive psychological autopsies and life trajectory narrative interviews conducted with informants. Piecewise Joint Latent Class Models allowed the identification of patterns of adversity trajectories and tested the introduction of breakpoints in life-paths. Classes inferred from the optimal model were compared in terms of socio-demographics, psychopathology, and rate of different adverse life events. Results: The most accurate model derived 2 trajectory patterns with a breakpoint in early adolescence. In the first class (n = 39), the burden of adversity increased steadily from birth to death, which occurred at 23 (SE = 1.29). In the second class (n = 264), where individuals died at 43 years of age (SE = 0.96), the burden of adversity followed a similar trajectory during infancy but stabilized between 10 and 14 years and started to increase again at about 25. Childhood family instability, dependent events, exposure to suicide, intra-family sexual victimization and affective disorders at death were more frequent in class 1. Conclusions: A bifurcation in trajectories between early and late suicides occurs during adolescence. The dynamic pattern of adversity during this period is a key issue to understand the developmental heterogeneity in suicide risk.

Factor Structure, Reliability, and Validity of the Daily Self-Report Measure for Trauma-Related Sequelae (DSR-TRS)

The structure and psychometrics of daily self-report measures have only rarely been empirically tested. We developed the Daily Self-Report of Trauma-Related Sequelae (DSR-TRS), comprised of items assessing, in the past day: (1) posttraumatic stress disorder (PTSD) symptoms: (2) symptoms of affective-, behavioral-, relational-, somatic-, dissociative-, and self-dysregulation; and (3) stressors, mood, coping strategies, and drug and alcohol use. Psychometric analyses were conducted with data from 141 women who participated in a randomized clinical trial of two present-centered therapies for PTSD or a wait-list condition and completed at least one DSR-TRS during two 30-day periods at baseline and posttreatment/wait-list. Five DSR-TRS subscales were created based on a series of exploratory, confirmatory, and multilevel factor analyses: Positive Affect, Negative Affect, Self-Regulation, Dysregulation, and PTSD symptoms. DSR-TRS subscales had acceptable within-person and between-person reliability. Convergent and discriminant validity were supported at baseline and posttest in relation to questionnaire and interview assessment measures. Implications for research on daily self-report measures such as the DSR-TRS with trauma survivors are discussed.

The role of coping strategies in the pathway between child maltreatment and internalizing and externalizing behaviors

BACKGROUND

Child maltreatment has been repeatedly linked to internalizing and externalizing disorders, though few studies have examined the mechanisms of this pathway. Furthermore, children cope with difficult demands from their environments in a variety of ways, using emotion-focused (e.g., crying and verbal aggression), avoidant (e.g., disengaging), or problem-focused (e.g., seeking help from an adult) strategies.

OBJECTIVE

The current investigation examined if the coping strategies children employ when faced with everyday environmental stresses are a potential mechanism in the pathway between child maltreatment and internalizing and externalizing symptoms.

PARTICIPANTS AND SETTING

Participants included 198 maltreated and 222 non-maltreated children ages 4-12 who attended a day summer camp for 2 consecutive years.

METHODS

The study utilized a longitudinal design by following the children at two time points to determine if coping at Time 1 mediated the pathway between maltreatment and internalizing and externalizing symptoms at Time 2 (measured one year later).

RESULTS

Results from path analyses showed that maltreatment was associated with increased emotion-focused (b = .20, SE = .05, p < .001) and decreased problem-focused coping (b = -.25, SE = .05, p < .001). Results also indicated that emotion-focused coping represents a mechanism by which maltreated children are at increased risk for externalizing behaviors (with an indirect effect estimate of 0.023, SE = 0.053; CI: 0.004, 0.23).

CONCLUSIONS

The results highlight the impact maltreatment can have on coping strategies and that these strategies can play an important role in the development of psychopathology. This has important implications for clinicians, who could integrate reducing emotion-focused coping into intervention efforts for maltreated children.

Development and testing of the Hogan Inventory of Bereavement short form for children and adolescents

To reduce response burden for bereaved children and adolescents, we provide data on the development and psychometric testing of a short form of the Hogan Sibling Inventory of Bereavement (HSIB). The resulting measure of grief symptoms and personal growth was renamed the Hogan Inventory of Bereavement - Short Form (Children and Adolescents; HIB-SF-CA). Psychometric properties were evaluated in a sample of 86 bereaved siblings. Instrument development and validation research design methods were used. Evidence of strong reliability and convergent validity indicates that the 21-item HIB-SF-CA is comparable to the original 46-item HSIB in measuring grief and personal growth in this population.

Differences in Coping Strategies Between Young and Older Adults: The Role of Executive Functions

Executive functions (EFs) have been identified as processes in the ability to select and apply adaptive strategies for coping with stress. This study compares executive functioning, short-term memory, and coping in a sample of young and older adults with no prior diagnosis of depression and with normal cognitive function ( N = 216). The study collected measures of depression, EFs, short-term memory, and coping. Young participants scored higher than older adults on EFs and short-term memory. Moreover, in young adults, there was a prevalence of avoidance coping strategies. Scores on depressive symptomatology were found to be related to avoidant coping strategies. Older adults with higher score on inhibition used less avoidant coping. Thus, it seems that executive deficits might contribute to depression, as they affect processes for coping with stress. This finding may have implications for the role of EFs and coping in psychological well-being and successful adaptation of individuals to stressful situations.

What constitutes effective coping and efficient physiologic regulation following psychosocial stress depends on involuntary stress responses

This study utilized a random-assignment experimental design to examine the interactive contributions of youth-reported trait involuntary stress responses (ISRs) and effortful coping on physiologic reactivity and recovery patterns in preadolescent boys and girls. Fourth- and fifth-grade child-parent dyads (N=126) participated in this study. Children were exposed to the Trier Social Stress Test (TSST-C) and then to one of two randomly-assigned experimental coping conditions: behavioral distraction and cognitive avoidance. Children's ISRs were examined as predictors of salivary cortisol and alpha-amylase (sAA) reactivity as well as moderators of the effect of coping condition on cortisol and sAA recovery trajectories. Multi-level modeling analyses did not link ISRs to physiologic reactivity patterning. ISRs and coping condition interacted to predict differential physiologic recovery trajectories. In the distraction condition, children reporting high ISR levels displayed less efficient cortisol and sAA recovery than children reporting low ISR levels. Surprisingly, the opposite was found for children reporting high ISR levels in the avoidance condition. These children displayed more efficient physiologic recovery relative to their high ISR level peers in the distraction condition. Findings suggest that the efficiency of preadolescents' physiologic recovery following stress may depend on regulatory fit between children's ISR levels and cues from their coping environment.

It Is Tough and Tiring but It Works--Children's Experiences of Undergoing Radiotherapy

Approximately 300 children ages 0 to 18 are diagnosed with cancer in Sweden every year, and 80 to 90 of them undergo radiotherapy treatment. The aim was to describe children's experiences of preparing for and undergoing radiotherapy, and furthermore to describe children's suggestions for improvement. Thirteen children between the ages of 5 and 15 with various cancer diagnoses were interviewed. Data was analyzed using qualitative content analysis. The findings revealed five categories: positive and negative experiences with hospital stays and practical arrangements; age-appropriate information, communication, and guidance to various degrees; struggle with emotions; use of distraction and other suitable coping strategies; and children's suggestions for improvement during radiotherapy. An overarching theme emerged: "It is tough and tiring but it works". Some key areas were: explanatory visits, the need for information and communication, being afraid, discomfort and suffering, the need for media distraction, dealing with emotions, and the need for support. A systematic, family-centered preparation program could possible help families prepare and individualized distraction during radiotherapy could contribute to reducing distress. Further studies with interventions could clarify successful programs.

Unlocking the Black Box: A Multilevel Analysis of Preadolescent Children's Coping

This random assignment experimental study examined the intersection of children's coping and physiologic stress reactivity and recovery patterns in a sample of preadolescent boys and girls. A sample of 82 fourth-grade and fifth-grade (M_age = 10.59 years old) child-parent dyads participated in the present study. Children participated in the Trier Social Stress Test and were randomly assigned to one of two post-Trier Social Stress Test experimental coping conditions-behavioral distraction or cognitive avoidance. Children's characteristic ways of coping were examined as moderators of the effect of experimental coping condition on cortisol reactivity and recovery patterns. Multilevel modeling analyses indicated that children's characteristic coping and experimental coping condition interacted to predict differential cortisol recovery patterns. Children who characteristically engaged in primary control engagement coping strategies were able to more quickly down-regulate salivary cortisol when primed to distract themselves than when primed to avoid, and vice versa. The opposite pattern was true for characteristic disengagement coping in the context of coping condition, suggesting that regulatory fit between children's characteristic ways of coping and cues from their coping environment may lead to more and less adaptive physiologic recovery profiles. This study provides some of the first evidence that coping "gets under the skin" and that children's characteristic ways of coping may constrain or enhance a child's ability to make use of environmental coping resources.

Development of Maladaptive Coping: A Functional Adaptation to Chronic, Uncontrollable Stress

Health disparities are rooted in childhood and stem from adverse early environments that damage physiologic stress-response systems. Developmental psychobiological models of the effects of chronic stress account for both the negative effects of a stress-response system calibrated to a dangerous and unpredictable environment from a health perspective, and the positive effects of such an adaptively calibrated stress response from a functional perspective. Our research suggests that contexts that produce functionally adapted physiologic responses to stress also encourage a functionally adapted coping response-coping that can result in maladjustment in physical and mental health, but enables children to grow and develop within those contexts. In this article, I highlight the value of reframing maladaptive coping as functional adaptation to understand more completely the development of children's coping in different contexts, and the value of such a conceptual shift for coping-based theory, research, and intervention.

Executive function moderates the relation between coping and depressive symptoms

BACKGROUND AND OBJECTIVES

Identifying risk factors early in the course of depression has important implications for prevention, given that the likelihood of recurrence increases with each successive episode.

DESIGN

This study examined relations among coping, executive functioning, and depressive symptom trajectories in a sample of remitted-depressed (n = 32) and never-depressed (ND; n = 36) young adults (aged 18-31).

METHODS

Participants completed a clinical interview, a measure of coping, and tasks assessing two components of executive function - inhibition and cognitive flexibility. Participants were reassessed regarding the timing and severity of depressive symptoms that had occurred during the interval period (mean = 35.16 weeks, SD = 9.03).

RESULTS

Among ND individuals, less primary control coping (e.g., problem-solving) and greater disengagement coping (e.g., avoidance) predicted increases in depressive symptoms. Greater secondary control coping (e.g., acceptance) predicted decreases in depressive symptoms and was unrelated to depression history. Higher inhibition scores predicted less increase in depressive symptoms for individuals reporting less primary control coping or more disengagement coping. Higher cognitive flexibility scores predicted less increase in depressive symptoms among individuals reporting less secondary control coping.

CONCLUSIONS

Interventions aiming to enhance either coping strategies or executive functions may reduce risk of depression recurrence.

Adverse life events and emotional and behavioural problems in adolescence: the role of coping and emotion regulation

We tested whether emotion regulation (cognitive reappraisal and expressive suppression) and coping (distraction, avoidance, support seeking and active coping) mediate or moderate the association between change in life stress (change in number of adverse life events) and change in adolescent problem behaviour. We used prospective and retrospective longitudinal data from a community sample. We measured change in problem behaviour as emotional and behavioural problems at Time 2 controlling for emotional and behavioural problems at Time 1, a year earlier. We measured change in life stress as life stress between Times 1 and 2, controlling for total previous life stress (before Time 1). Neither coping nor emotion regulation mediated the association between change in life stress and change in problem behaviour. Avoidance and expressive suppression were related to an increase in problem behaviour. Only cognitive reappraisal moderated the effect of increase in life stress on worsening of problem behaviour, suggesting that, as expected, cognitive reappraisal was a protective factor. In adolescents who reported they habitually reappraise, the association between change in life stress and change in emotional and behavioural problems was non-significant.

Depressive and conduct disorder symptoms in youth living with HIV: the independent and interactive roles of coping and neuropsychological functioning

Emerging research suggests the importance of psychosocial characteristics (e.g., coping and social support) for positive adaptation among youth with behaviorally acquired HIV. However, little is known about how these traits interact with cognitive abilities to impact emotional and behavioral adjustment. This study examined whether coping skills and executive functioning interact in their association with psychological adjustment in HIV-positive youth. Data from Project Adolescents Living with HIV/AIDS (ALPHA), a study to examine psychosocial, behavioral and neuropsychological functioning of youth with behaviorally acquired HIV, were used. Fifty-nine participants, aged 14-23, diagnosed with HIV prior to age 20 and receiving care in one of two HIV clinics in Atlanta or New York City, were recruited, consented and enrolled. Participants completed measures of depressive symptoms (Beck Depression Inventory), conduct disorder (Adolescent Symptom Index), and use of positive and negative coping strategies (Kidcope). The Wisconsin Card Sorting Test (WCST) assessed abstract reasoning (categories completed) and cognitive inflexibility (perseverative errors). In this sample of HIV-positive youth, depressive symptoms were best predicted by an interactive combination of negative coping skills and poor neuropsychological functioning. Neuropsychological functioning (cognitive inflexibility) and negative coping skills were directly associated with conduct disorder symptoms. Results highlight the importance of including neuropsychological assessment in the evaluation of HIV-positive youth, particularly those with emotional or behavioral problems.

Coping Strategies and Adolescents: Learning to Take Care of Self and Stuttering during Treatment

The purpose of this paper is to describe coping in the context of adolescence and stuttering. Adolescents who stutter are a unique group of individuals dealing with an episodic, variable, and chronic disorder during a critical developmental stage in their lives. We provide a brief review of adolescence, coping constructs, coping during adolescence, and coping programs. We highlight the role of the speech-language pathologist is as an advocate/guide assisting adolescents who stutter develop appropriate, adaptive strategies for dealing with everyday stressors and the added potential stress associated with stuttering.

Randomized controlled trial of a family cognitive-behavioral preventive intervention for children of depressed parents

A family cognitive-behavioral preventive intervention for parents with a history of depression and their 9-15-year-old children was compared with a self-study written information condition in a randomized clinical trial (n = 111 families). Outcomes were assessed at postintervention (2 months), after completion of 4 monthly booster sessions (6 months), and at 12-month follow-up. Children were assessed by child reports on depressive symptoms, internalizing problems, and externalizing problems; by parent reports on internalizing and externalizing problems; and by child and parent reports on a standardized diagnostic interview. Parent depressive symptoms and parent episodes of major depression also were assessed. Evidence emerged for significant differences favoring the family group intervention on both child and parent outcomes; strongest effects for child outcomes were found at the 12-month assessment with medium effect sizes on most measures. Implications for the prevention of adverse outcomes in children of depressed parents are highlighted.