Parental monitoring and the prevention of child and adolescent problem behavior: a conceptual and empirical formulation

The present report accomplishes three goals. First, to provide an empirical rationale for placing parental monitoring of children's adaptations as a key construct in development and prevention research. Second, to stimulate more research on parental monitoring and provide an integrative framework for various research traditions as well as developmental periods of interest. Third, to discuss current methodological issues that are developmentally and culturally sensitive and based on sound measurement. Possible intervention and prevention strategies that specifically target parental monitoring are discussed.

The epidemiology of cerebral palsy: incidence, impairments and risk factors

PURPOSE

Describing the epidemiology of cerebral palsy (CP), its impairments and risk factors.

METHOD

Literature review 1965-2004. Search terms: Cerebral palsy, incidence, prevalence, impairments, risk factors.

RESULTS

In the last 40 years the prevalence of CP has risen to well above 2.0 per 1000 life births. In this time span the proportion of low-birthweight infants rose, the proportion of diplegia decreased, while the proportion of hemiplegia increased. CP is more prevalent in more deprived socio-economic populations. The majority of people with CP have the spastic syndrome of which the diplegic group is the smallest. Dependent on the subgroup of CP, 25-80% have additional impairments. A large proportion has some kind of cognitive impairment; the prevalence varies with the type of CP and especially increases when epilepsy is present. Epilepsy is present in 20-40%; it is most common among the hemi- and tetraplegics. Sensibility of the hands is impaired in about half. Chronic pain is reported by more than a quarter of the adults. Up to 80% have at least some impairment of speech. Low visual acuity is reported in almost three-quarters of all children. Half of all children have gastrointestinal and feeding problems. Stunted growth occurs in a quarter, while under- or overweight problems are present in half of the children. Almost 70% of people with spastic CP have abnormal brain CT findings; abnormal cranial ultrasounds is most strongly associated with hemiplegia, normal cranial ultrasounds with diplegia. The most important risk factors for CP are low birthweight, intrauterine infections and multiple gestation.

Post-traumatic stress disorder in the general population. Findings of the epidemiologic catchment area survey

There have been numerous studies of post-traumatic stress disorder in trauma victims, war veterans, and residents of communities exposed to disaster. Epidemiologic studies of this syndrome in the general population are rare but add an important perspective to our understanding of it. We report findings on the epidemiology of post-traumatic stress disorder in 2493 participants examined as part of a nationwide general-population survey of psychiatric disorders. The prevalence of a history of post-traumatic stress disorder was 1 percent in the total population, about 3.5 percent in civilians exposed to physical attack and in Vietnam veterans who were not wounded, and 20 percent in veterans wounded in Vietnam. Post-traumatic stress disorder was associated with a variety of other adult psychiatric disorders. Behavioral problems before the age of 15 predicted adult exposure to physical attack and (among Vietnam veterans) to combat, as well as the development of post-traumatic stress disorder among those so exposed. Although some symptoms of post-traumatic stress disorder, such as hyperalertness and sleep disturbances, occurred commonly in the general population, the full syndrome as defined by the Diagnostic and Statistical Manual of Mental Disorders, third edition, was common only among veterans wounded in Vietnam.

Sleep, cognition, and behavioral problems in school-age children: a century of research meta-analyzed

Clear associations of sleep, cognitive performance, and behavioral problems have been demonstrated in meta-analyses of studies in adults. This meta-analysis is the first to systematically summarize all relevant studies reporting on sleep, cognition, and behavioral problems in healthy school-age children (5-12 years old) and incorporates 86 studies on 35,936 children. Sleep duration shows a significant positive relation with cognitive performance (r = .08, confidence interval [CI] [.06, .10]). Subsequent analyses on cognitive subdomains indicate specific associations of sleep duration with executive functioning (r = .07, CI [.02, .13]), with performance on tasks that address multiple cognitive domains (r = .10, CI = [.05, .16]), and with school performance (r = .09, CI [.06, .12]), but not with intelligence. Quite unlike typical findings in adults, sleep duration was not associated with sustained attention and memory. Methodological issues and brain developmental immaturities are proposed to underlie the marked differences. Shorter sleep duration is associated with more behavioral problems (r = .09, CI [.07, .11]). Subsequent analyses on subdomains of behavioral problems showed that the relation holds for both internalizing (r = .09, CI [.06, .12]) and externalizing behavioral problems (r = .08, CI [.06, .11]). Ancillary moderator analyses identified practices recommended to increase sensitivity of assessments and designs in future studies. In practical terms, the findings suggest that insufficient sleep in children is associated with deficits in higher-order and complex cognitive functions and an increase in behavioral problems. This is particularly relevant given society's tendency towards sleep curtailment.

Developmental psychopathology: concepts and challenges

The defining features of developmental psychopathology concepts include attention to the understanding of causal processes, appreciation of the role of developmental mechanisms, and consideration of continuities and discontinuities between normality and psychopathology. Accomplishments with respect to these issues are reviewed in relation to attachment disorders, antisocial behavior, autism, depressive disorder, schizophrenia, and intellectual development. Major research challenges remain in relation to measurement issues, comorbidity, gender differences, cognitive processing, nature-nurture interplay, heterotypic continuity, continuities between normal variations and disorders, developmental programming, and therapeutic mechanisms in effective treatments.

Sturdy childhood predictors of adult antisocial behaviour: replications from longitudinal studies

Results are compared in studies of 4 male cohorts - 1 all white, 1 all black, and 2 racially representative of the population - growing up in different eras, followed past varying portions of their adult lives, living in different parts of the US. Despite sample differences and differences in sources of information and in the variables used to measure both childhood predictors and adult outcomes, some striking replications appear with respect to childhood predictors of adult antisocial behaviour. All types of antisocial behaviour in childhood predict a high level of antisocial behaviour in adulthood and each kind of adult antisocial behaviour is predicted by the number of childhood antisocial behaviours, indicating that adult and childhood antisocial behaviour both form syndromes and that these syndromes are closely interconnected. Also confirmed across studies are: (1) adult antisocial behaviour virtually requires childhood antisocial behaviour; (2) most antisocial children do not become antisocial adults; (3) the variety of antisocial behaviour in childhood is a better predictor of adult antisocial behaviour than is any particular behaviour; (4) adult antisocial behaviour is better predicted by childhood behaviour than by family background or social class of rearing; (5) social class makes little contribution to the prediction of serious adult antisocial behaviour.

Psychosis, victimisation and childhood disadvantage: evidence from the second British National Survey of Psychiatric Morbidity

BACKGROUND

Adverse early circumstances may be more common in people who later develop psychotic disorders.

AIMS

To use data from the second British National Survey of Psychiatric Morbidity to examine associations between psychotic disorders and a number of early victimisation experiences.

METHOD

Psychiatric disorders were identified through structured assessment of adults resident in private households in Britain (n=8580). Respondents were asked whether they had experienced selected events displayed on cards.

RESULTS

Compared with respondents with other psychiatric disorders or with none, the prevalence of every experience bar one was significantly elevated in those with definite or probable psychosis. The largest odds ratio was for sexual abuse. Controlling for depressed mood somewhat reduced the odds ratios for the individual experiences.

CONCLUSIONS

In people with psychosis, there is a marked excess of victimising experiences, many of which will have occurred during childhood. This is suggestive of a social contribution to aetiology.

Effect of very low birth weight and subnormal head size on cognitive abilities at school age

BACKGROUND

We tested the hypothesis that very-low-birth-weight (less than 1.5 kg) infants with perinatal growth failure whose head size is not normal by eight months of age (corrected for prematurity) have significantly poorer growth and neurocognitive abilities at school age than very-low-birth-weight children with a normal head size at eight months. We also hypothesized that these differences would persist even after control for major neurologic impairment and perinatal and sociodemographic risk factors.

METHODS

We have followed a cohort of very-low-birth-weight children since their birth during the period 1977 to 1979. At eight to nine years of age 249 children were evaluated with a neurologic examination and tests of intelligence; receptive and expressive language skills; speech, reading, mathematics, and spelling aptitude; visual and fine motor abilities; and behavior. Ages were corrected for premature birth.

RESULTS

Among these 249 very-low-birth-weight children, head size was subnormal (less than the mean -2 SD for age) at birth in 30 (12 percent), at term in 57 (23 percent), and at eight months in 33 (13 percent). As compared with the 216 children with normal head sizes, the 33 children with subnormal head sizes at the age of eight months had significantly lower mean birth weights (1.1 vs. 1.2 kg) and higher neonatal risk scores (71 vs. 53) and at the age of eight years had a higher incidence of neurologic impairment (21 percent vs. 8 percent) and lower IQ scores (mean verbal, 84 vs. 98). Even among the children without neurologic abnormalities, a subnormal head size at eight months of age was predictive of poorer verbal and performance IQ scores at eight years of age; lower scores for receptive language, speech, reading, mathematics, and spelling; and a higher incidence of hyperactivity. In multiple regression analyses to control for socioeconomic and neonatal risk factors, intrauterine growth failure, birth weight, and neurologic impairment, a subnormal head size at eight months of age had an independently adverse effect on IQ and on scores for receptive language, speech, reading, and spelling.

CONCLUSIONS

In very-low-birth-weight infants, perinatal growth failure, as evidenced by a subnormal head circumference at eight months of age, is associated with poor cognitive function, academic achievement, and behavior at eight years of age.

Behavior problems and parenting stress in families of three-year-old children with and without developmental delays

Children and adolescents with mental retardation are at heightened risk for mental disorder. We examined early evidence of behavior problems in 225 three-year-old children with or without developmental delays and the relative impact of cognitive delays and problem behaviors on their parents. Staff-completed Bayley Behavior Scales and parent-completed Child Behavior Checklists (CBCLs) showed greater problems in children with delays than in those without delays. Children with delays were 3 to 4 times as likely to have a total CBCL score within the clinical range. Parenting stress was higher in delayed condition families. Regression analyses revealed that the extent of child behavior problems was a much stronger contributor to parenting stress than was the child's cognitive delay.

Comparison of diagnostic criteria for attention-deficit hyperactivity disorder in a county-wide sample

OBJECTIVE

To examine teacher-reported prevalence rates for attention-deficit hyperactivity disorder (ADHD) based on DSM-III-R and DSM-IV in the same population.

METHOD

Teachers completed questionnaires in which they rated all their students on all DSM-III-R and DSM-IV symptoms for disruptive behavior disorders except for seven conduct disorder symptoms but including seven symptoms screening for anxiety or depression. This constituted all children in kindergarten through fifth grade in a middle Tennessee county during the 1993-1994 academic year (16 schools, 398 teachers, and 8,258 children). Also included were questions about the children's diagnosis of ADHD, treatment with stimulants, and the presence of behavior or academic problems.

RESULTS

The prevalence rates were 7.3% for ADHD (DSM-III-R); 11.4% for ADHD, total (TOT); 5.4% for ADHD, inattentive type (AD); 2.4% for ADHD, hyperactive-impulsive type (HI); and 3.6% for ADHD, combined type (CT). Factor analysis identified five factors: opposition/defiance-conduct, inattention, hyperactivity/impulsivity, anxiety/depression, and stealing-truancy. The rates of problems differed mostly between ADHD-AD and ADHD-HI (40% versus 80%) for behavior and (75% versus 23%) for academics. Few (15% to 40%) had an ADHD diagnosis or stimulant treatment (21% to 32%).

CONCLUSION

DSM-IV criteria are likely to increase the prevalence of this disorder in comparison with DSM-III-R rates, but they may better characterize its heterogeneity.

Is ADHD a risk factor for psychoactive substance use disorders? Findings from a four-year prospective follow-up study

OBJECTIVE

To evaluate whether attention-deficit hyperactivity disorder (ADHD) is a risk factor for psychoactive substance use disorders (PSUD), attending to issues of psychiatric comorbidity, family history, and adversity.

METHOD

Using assessments from multiple domains, the authors examined 140 ADHD and 120 normal control subjects at baseline and 4 years later. Drug and alcohol abuse and dependence were operationally defined.

RESULTS

No differences were detected in the rates of alcohol or drug abuse or dependence or in the rates of abuse of individual substances between the groups; both ADHD and control probands had a 15% rate of PSUD. Conduct and bipolar disorders predicted PSUD, independently of ADHD status. Family history of substance dependence and antisocial disorders was associated with PSUD in controls but less clearly so in ADHD probands. Family history of ADHD was not associated with risk for PSUD. ADHD probands had a significantly shorter time period between the onsets of abuse and dependence compared with controls (1.2 years versus 3 years, p < .01).

CONCLUSIONS

Adolescents with and without ADHD had a similar risk for PSUD that was mediated by conduct and bipolar disorder. Since the risk for PSUD has been shown to be elevated in adults with ADHD when compared with controls, a sharp increase in PSUD is to be expected in grown-up ADHD children during the transition from adolescence to adulthood.

The effect of maternal depression on maternal ratings of child behavior

There have been continuing concerns about the extent to which maternal depression may influence maternal reports of child behavior. To examine this issue, a series of structural equation models of the relationships between maternal depression and errors in maternal reports of child behavior was proposed and tested. These models assumed that (a) maternal depression was unrelated to maternal reporting behavior; (b) maternal depression causally influenced maternal reporting accuracy; (c) maternal depression was correlated with reporting accuracy. These models were fitted to data on maternal depression and multiple-informant (mother, teacher, child) reports of conduct disorder and attention deficit behaviors for a birth cohort of 12- and 13-year-old New Zealand children. The results of model fitting suggested the presence of small to moderate correlations (r = +.13 to +.40) between maternal depression and maternal reporting errors, indicating the presence of a tendency for increasing maternal depression to be associated with a tendency for mothers to over-report child behavior problems. However, independently of any effects of maternal depression on maternal reporting errors there was evidence of small but significant associations (r = .10 to .17; p < .05) between maternal depression and child conduct disorder and attention deficit behaviors.

Association of arsenic, cadmium and manganese exposure with neurodevelopment and behavioural disorders in children: a systematic review and meta-analysis

The aim of this study was to analyse the scientific evidence published to date on the potential effects on neurodevelopment and behavioural disorders in children exposed to arsenic, cadmium and manganese and to quantify the magnitude of the effect on neurodevelopment by pooling the results of the different studies. We conducted a systematic review of original articles from January 2000 until March 2012, that evaluate the effects on neurodevelopment and behavioural disorders due to pre or post natal exposure to arsenic, cadmium and manganese in children up to 16 years of age. We also conducted a meta-analysis assessing the effects of exposure to arsenic and manganese on neurodevelopment. Forty-one articles that evaluated the effects of metallic elements on neurodevelopment and behavioural disorders met the inclusion criteria: 18 examined arsenic, 6 cadmium and 17 manganese. Most studies evaluating exposure to arsenic (13 of 18) and manganese (14 of 17) reported a significant negative effect on neurodevelopment and behavioural disorders. Only two studies that evaluated exposure to cadmium found an association with neurodevelopmental or behavioural disorders. The results of our meta-analysis suggest that a 50% increase of arsenic levels in urine would be associated with a 0.4 decrease in the intelligence quotient (IQ) of children aged 5-15 years. Moreover a 50% increase of manganese levels in hair would be associated with a decrease of 0.7 points in the IQ of children aged 6-13 years. There is evidence that relates arsenic and manganese exposure with neurodevelopmental problems in children, but there is little information on cadmium exposure. Few studies have evaluated behavioural disorders due to exposure to these compounds, and manganese is the only one for which there is more evidence of the existence of association with attention deficit disorder with hyperactivity.

Predicting schizophrenia: findings from the Edinburgh High-Risk Study

BACKGROUND

The hypothesis that schizophrenia is neurodevelopmental was investigated in a prospective study of young people with a postulated 10-15% risk for the development of schizophrenia.

AIMS

To determine premorbid variables distinguishing high-risk people who will go on to develop schizophrenia from those who will not.

METHOD

A high-risk sample of 163 young adults with two relatives with schizophrenia was recruited. They and 36 controls were serially examined. Baseline measures were compared between those who did develop schizophrenia, a well control group, a well high-risk group and high-risk participants with partial or isolated psychotic symptoms.

RESULTS

Of those at high risk, 20 developed schizophrenia within 2(1/2) years. More experienced isolated or partial psychotic symptoms. Those who developed schizophrenia differed from those who did not on social anxiety, withdrawal and other schizotypal features. The whole high-risk sample differed from the control group on developmental and neuropsychological variables.

CONCLUSIONS

The genetic component of schizophrenia affects many more individuals than will develop the illness, and partial impairment can be found in them. Highly significant predictors of the development of schizophrenia are detectable years before onset.

Psychopathy and conduct problems in children: II. Implications for subtyping children with conduct problems

OBJECTIVE

To test whether the presence of callous and unemotional (CU) traits designates a unique subgroup of children with conduct problems that corresponds more closely to adult conceptualizations of psychopathy.

METHOD

A clinic-referred sample of 120 children between the ages of 6 and 13 years were assessed using parent and teacher ratings of CU traits, as well as parent and teacher report on a structured interview assessing oppositional defiant disorder (ODD) and conduct disorder (CD) symptoms.

RESULTS

A cluster analysis of the ratings of CU traits and ODD/ CD symptoms revealed four clusters of children, two of which had high rates of ODD and CD symptoms. One of these conduct problem clusters also exhibited high levels of CU traits (n = 11). These children had a greater number and variety of conduct problems, a stronger history of police contacts, and a stronger parental history of antisocial personality disorder, despite being of higher intelligence than other children with significant conduct problems (n = 29).

CONCLUSION

The presence of CU traits with significant conduct problems seems to designate a unique subgroup of antisocial children who show a very severe pattern of antisocial behavior and who correspond more closely to adult conceptualizations of psychopathy.

Motor coordination and kinaesthesis in boys with attention deficit-hyperactivity disorder

In the current study, movement ability and underlying kinaesthetic processes of boys with attention deficit-hyperactivity disorder (ADHD) were compared with a group of control children. Two groups of 16 boys with either predominantly inattentive subtype ADHD (ADHD-PI) or combined subtype ADHD (ADHD-C) were compared with 16 control boys matched on age and verbal IQ. The findings demonstrated that the children with ADHD had significantly poorer movement ability than the control children. A high percentage of children with ADHD displayed movement difficulties consistent with developmental coordination disorder. In addition, the current study found that the type and degree of movement difficulty differed between subtypes. Children with ADHD-PI had significantly poorer fine motor skill while children with ADHD-C were found to experience significantly greater difficulty with gross motor skill. The severity of the children's inattentive symptomatology was found to be a significant predictor of motor coordination difficulties. Kinaesthetic sensitivity was not found to differ significantly between the groups.

Reward dominance: associations with anxiety, conduct problems, and psychopathy in children

The associations between children's behavior and their performance on a task with a steadily increasing ratio of punished to rewarded responses was investigated in a group of clinic-referred (n = 92) and normal control (n = 40) children between the ages of 6 and 13. Clinic-referred children with an anxiety disorder played significantly fewer trials than clinic-referred children without an anxiety disorder but the response style of the anxious children did not differ from that of a normal control group. Children with severe conduct problems who had no anxiety disorder played more trials than (a) children with severe conduct problems and a comorbid anxiety disorder, (b) nonanxious children with attention-deficit hyperactivity disorder, and (c) children in the normal control group. The strongest evidence for the reward dominant response style was for nonanxious subjects with elevations on a measure of psychopathic features, irrespective of whether they also had conduct problems and irrespective of whether they were clinic-referred.

Parenting stress among families of children with attention deficit hyperactivity disorder

Prior research has shown that parenting stress levels can be quite high among families of children with attention deficit hyperactivity disorder (ADHD). This study investigated the degree to which such stress was related not only to the child's ADHD, but also to various other child, parent, and family-environment circumstances. Multimethod assessments were conducted on 104 clinic-referred children with ADHD. Data collected from these subjects were entered into hierarchical multiple-regression analyses, utilizing the Parenting Stress Index as the criterion. The results showed that the child and parent characteristics accounted for a substantial portion of the variance in overall parenting stress. The child's oppositional-defiant behavior and maternal psychopathology were especially potent predictors. The severity of the child's ADHD, the child's health status, and maternal health status also emerged as significant predictors. These findings are discussed in terms of their impact upon the clinical management of children with ADHD.

Effect of anxiety on cognition, behavior, and stimulant response in ADHD

The effect of the comorbidity of overanxious disorder (ANX) in attention deficit hyperactivity disorder (ADHD) on laboratory measures of behavior, cognition, and stimulant response was examined. Seventy-nine children who met DSM-III-R criteria for ADHD were tested further for an oppositional defiant disorder (ODD), conduct disorder (CD), or ANX. Subjects with comorbid ANX showed less impulsiveness on a laboratory measure of behavior and had longer, sluggish reaction times on the Memory Scanning Test than those without ANX. ADHD subjects with comorbid ANX were less frequently diagnosed as CD. Forty-three of the subjects completed a double-blind trial of methylphenidate; subjects with comorbid anxiety had a significantly poorer response to the stimulant than those without anxiety, while the comorbidity of ODD or CD did not affect stimulant response. The results suggest that ADHD with comorbid ANX may represent children with primary anxiety who develop secondary inattentiveness, or they may represent a different subtype of ADHD, perhaps similar to the condition of attention deficit disorder without hyperactivity under DSM-III.

Adverse associations of sleep problems in Australian preschoolers: national population study

OBJECTIVE

In contrast to school-aged children, the impact of sleep problems in preschool-aged children is not well documented. We aimed to determine relationships between preschool-aged child sleep problems and child behavior; health-related quality of life; verbal, preliteracy, and early numeracy skills; diagnosis of attention-deficit/hyperactivity disorder; and injury.

PARTICIPANTS AND METHODS

Participants included families (n = 4983) participating in the first wave of the Longitudinal Study of Australian Children, a nationally representative study of Australian children aged 4 to 5 years surveyed from March to November 2004. Measures consisted of a primary caregiver's report of whether their child had a sleep problem (none versus mild versus moderate/severe); specific sleep patterns occurring > or = 4 nights per week; health-related quality of life (by using the Pediatric Quality of Life Inventory 4.0); behavior (by using the Strengths and Difficulties Questionnaire) and parent-reported diagnosis of attention-deficit/hyperactivity disorder; and injury requiring medical attention in the past 12 months. Tests of receptive vocabulary and preliteracy/numeracy skills (by using the Who Am I? developmental assessment and the adapted Peabody Picture Vocabulary Test, 3rd Edition) were directly administered to each child.

RESULTS

Sleep problems were common, and compared with children without sleep problems, children with sleep problems had poorer child health-related quality of life, more behavior problems, and higher rates of attention-deficit/hyperactivity disorder. Difficulty going to sleep and morning tiredness had greater adverse associations than snoring or night waking.

CONCLUSIONS

Given that sleep problems are very common, the adverse outcomes shown here could affect the transition to school for a very large number of preschoolers.

An investigation into sleep characteristics of children with autism and Asperger's Disorder

OBJECTIVE

The aim of the study was to investigate the specificity of sleep problems in children with autism and further explore the currently unclear association between sleep problems and daytime behaviour.

METHODOLOGY

The Pervasive Developmental Disorder (PDD) group consisted of 31 children with autism and 7 children with Asperger's Disorder ranging in age from 44 to 152 months. The control group consisted of 36 children ranging in age from 63 to 171 months. The children were matched on age and gender, and group-matched on IQ level. A sleep diary was completed by parents over a 2-week period, in addition to several behaviour questionnaires.

RESULTS

Results showed that children in the PDD group exhibited qualitatively and quantitatively different sleep patterns to nonautistic control children.

CONCLUSIONS

The findings were discussed in light of current literature concerning circadian rhythm dysfunction, social difficulties, and abnormal melatonin levels in children with autism.

Sleep and behavior problems among preschoolers

This study described the relationship between amount of sleep and behavior problems among preschoolers. Participants were 510 children aged 2 to 5 years who were enrolled through 68 private pediatric practices. Parents reported on the amount of sleep their child obtained at night and in 24-hour periods. With demographic variables controlled, regression models were used to determine whether sleep was associated with behavior problems. The relationship between less sleep at night and the presence of a DSM-III-R psychiatric diagnosis was significant (odds ratio = 1.23, p = .026). Less night sleep (p < .0001) and less sleep in a 24-hour period (p < .004) were associated with increased total behavior problems on the Child Behavior Checklist; less night sleep (p < .0002) and less 24-hour sleep (p < .004) were also associated with more externalizing problems on that measure. Further research is needed to ascertain whether sleep is playing a causal role in the increase of behavior problems.

Self-esteem in young men: A longitudinal analysis of the impact of educational and occupational attainment

This paper analyzes relationships among self-esteem, educational attainment, and occupational status. Data from a nationwide longitudinal study of more than 1600 young men show a substantial increase in self-esteem between 19TT (when respondents were beginning tenth grade) and 1974. Reliability and construct validity data for the self-esteem measure are reported. As expected, both educational attainment and occupational status are correlated with self-esteem. Contrary to expectations, educational attainment as of 1974 is more strongly correlated with tenth grade self-esteem than with 1974 self-esteem. A path analysis led to these conclusions: (a) Self-esteem during high school has little or no direct causal impact on later educational and occupational attainment; self-esteem and attainment are correlated primarily because of shared prior causes including family background, ability, and scholastic performance. (b) Occupational status has a direct positive impact on self-esteem. (c) Post high school educational attainment has no direct impact on self-esteem and only a trivial indirect impact via occupational status. Additional findings indicate that factors associated with educational success become less central to the self-evaluations of young men during late high school and the years thereafter.