Evaluating the external validity of comorbid disorders in youth using rating scales and behavior observations

To evaluate the theoretical underpinnings of current categorical approaches to classify childhood psychopathological conditions, this dissertation examined whether children with a single diagnosis of an anxiety disorder (ANX only) and children with an anxiety diagnosis comorbid with other diagnoses (i.e., anxiety + anxiety disorder [ANX + ANX], anxiety + depressive disorder [ANX + DEP], and anxiety + disruptive disorder [ANX + EXT]) could be differentiated using external validation criteria of clinical phenomenology (i.e., levels of anxiety, depression, and internalizing, externalizing and total behavior problems). This study further examined whether the four groups could be differentiated in terms of their interaction patterns with their parents and peers, respectively. The sample consisted of 129 youth and their parents who presented to the Child Anxiety and Phobia Program (CAPP) housed within the Child and Family Psychosocial Research Center at Florida International University, Miami. Youth were between the ages of 8 and 14 years old. A battery of questionnaires was used to assess participants' clinical presentation in terms of levels of anxiety, depression, and internalizing and externalizing symptoms. Family and peer interaction were evaluated through rating scales and through behavior observation tasks. Statistics based on the parameter estimates of the structured equation models indicated that all the comorbid groups were significantly different from the pure anxiety disorder group when it came to depression indices of clinical phenomenology. Further, significant differences appeared mainly in terms of the ANX + DEP comorbid group relative to the other comorbid groups. In terms of Parent-child interaction the ANX + EXT and the ANX + DEP comorbid groups were differentiated from the pure anxiety disorder and ANX + ANX comorbid group when it came to the appraisal of the parent/child relationship by the parent, and the acceptance subscale according to the mother report. In terms of peer-child interaction the ANX + EXT and the ANX + DEP comorbid groups were statistically significantly different from the pure anxiety disorder only when it came to the positive interactions and the social skills as rated by mother. Limitations and future research recommendations are discussed.

Alcohol use and sexual victimization among Hispanic college women

Sexual victimization of young women typically occurs within a context of alcohol use, such that women are more likely to be victimized on days on which they consume alcohol compared to days on which no alcohol is consumed. Additionally, most research on sexual victimization of women has focused on forced sexual acts; consequently, little is known about forms sexual victimization that college women typically experience, such as brief (e.g., unwanted touching) or verbally coerced experiences (e.g., doing sexual things to prevent a partner from leaving). Finally, there is a need for more research on the processes underlying college women's drinking and the specific mechanisms through which drinking increases risk for sexual victimization. This dissertation sought to replicate recent findings of a temporal association between alcohol use and sexual victimization, and to investigate whether or not binge use increased risk for victimization, within a sample of young Hispanic college women, using repeated-measures logistic regression. This study also aimed to identify and explore typologies of victimization experiences in order to better understand types of sexual victimization common among young college women. Finally, the validity of a model of alcohol use and sexual victimization was investigated using structural equation modeling techniques. The results confirmed and extended previous research by demonstrating an increase in the conditional probability of sexual victimization on days of alcohol consumption compared with days of no alcohol consumption, and on days of binge alcohol consumption compared with days of moderate alcohol consumption. Sexual victimization experiences reported in this study were diverse, and cluster analysis was used to identify and explore specific typologies of victimization experiences, including intimate relationship victimization, brief victimization with stranger, prolonged victimization with acquaintance, and workplace victimization. The results from structural equation modeling (SEM) analyses were complex and helped to illuminate the relationships between reasons for drinking, alcohol use, childhood sexual abuse, sexual victimization, psychopathology, and acculturation-related factors among Hispanic college women. These findings have implications for the design of university-based prevention and intervention efforts aimed at reducing rates of alcohol-related sexual victimization within Hispanic populations.

Differentiation of self and emerging adulthood

Today's young people are progressing from adolescence into adulthood differently than past generations, including taking a longer time to make this transition. Some believe that the developmental markers and tasks of this transitional period are unique enough to merit the designation of a new life stage--"emerging adulthood." Recently, this new life stage of emerging adulthood has received increasing attention in the developmental literature, including attention to the probable causes for its evolution. However, little is known about specific aspects of intra- and interpersonal development that occur during emerging adulthood. The purpose of this study was to empirically assess hypothesized relations between variables associated with the psychological constructs of attachment, psychosocial maturity, and differentiation of self, in a sample of emerging adults. Structural equation modeling (SEM) analyses indicated an association between the variables measuring these constructs (anxiety, avoidance, I-position, reactivity, cutoff, fusion, identity, and intimacy). The results from structural equation modeling (SEM) analyses helped to confirmed and extended previous research by demonstrating significant associations between attachment, psychosocial maturity, and differentiation of self through the variables operationalizing these constructs. Psychosocial maturity predicted differentiation of self (with intimacy predicting emotional cutoff and identity predicting cutoff and I-position). Attachment also predicted differentiation of self (with anxiety predicting all differentiation variables, and avoidance predicting emotional reactivity and cutoff). However, associations between anxiety and cutoff and between avoidance and cutoff were mediated by psychosocial identity and intimacy, and associations between anxiety and I-position were mediated by identity. Thus, these results corroborate and elaborate previous research conducted on these constructs. Specifically, relational tendencies thought to be influenced by attachment security impact interpersonal functioning in emerging adulthood, but this association is influenced by the degree of resolution of key psychosocial tasks.

The role of temporal synchrony in the facilitation of perceptual learning during prenatal development

This study explored the critical features of temporal synchrony for the facilitation of prenatal perceptual learning with respect to unimodal stimulation using an animal model, the bobwhite quail. The following related hypotheses were examined: (1) the availability of temporal synchrony is a critical feature to facilitate prenatal perceptual learning, (2) a single temporally synchronous note is sufficient to facilitate prenatal perceptual learning, with respect to unimodal stimulation, and (3) in situations where embryos are exposed to a single temporally synchronous note, facilitated perceptual learning, with respect to unimodal stimulation, will be optimal when the temporally synchronous note occurs at the onset of the stimulation bout. To assess these hypotheses, two experiments were conducted in which quail embryos were exposed to various audio-visual configurations of a bobwhite maternal call and tested at 24 hr after hatching for evidence of facilitated prenatal perceptual learning with respect to unimodal stimulation. Experiment 1 explored if intermodal equivalence was sufficient to facilitate prenatal perceptual learning with respect to unimodal stimulation. A Bimodal Sequential Temporal Equivalence (BSTE) condition was created that provided embryos with sequential auditory and visual stimulation in which the same amodal properties (rate, duration, rhythm) were made available across modalities. Experiment 2 assessed: (a) whether a limited number of temporally synchronous notes are sufficient for facilitated prenatal perceptual learning with respect to unimodal stimulation, and (b) whether there is a relationship between timing of occurrence of a temporally synchronous note and the facilitation of prenatal perceptual learning. Results revealed that prenatal exposure to BSTE was not sufficient to facilitate perceptual learning. In contrast, a maternal call that contained a single temporally synchronous note was sufficient to facilitate embryos’ prenatal perceptual learning with respect to unimodal stimulation. Furthermore, the most salient prenatal condition was that which contained the synchronous note at the onset of the call burst. Embryos’ prenatal perceptual learning of the call was four times faster in this condition than when exposed to a unimodal call. Taken together, bobwhite quail embryos’ remarkable sensitivity to temporal synchrony suggests that this amodal property plays a key role in attention and learning during prenatal development.

Relational predictors of condom use among adolescents in outpatient substance abuse treatment

Past HIV interventions have been critiqued for their failure to incorporate relational factors linked to condom use. Furthermore, few studies have focused on the relational context of sexual risk behavior among adolescents at elevated risk for HIV/STI exposure in the context of substance use. Therefore, this study evaluated the influence of three key relational factors (rejection sensitivity, intimacy dating goals, intercourse-related anxiety) salient for understanding condom use among adolescents in outpatient substance abuse treatment in South Florida. Structural equation modeling was used to test relational factors as direct and indirect predictors of condom use. Specifically, the current study investigated the influence of rejection sensitivity and intimacy dating goals on percentage of protected intercourse, with intercourse-related anxiety modeled as a mediator of this association. ^ Results obtained from the hypothesized structural model suggest rejection sensitivity and intimacy dating goals are significant predictors of percentage of protected intercourse. As expected, rejection sensitivity was related to lower levels of percentage of protected intercourse via heightened levels of intercourse-related anxiety and was not related directly to percentage of protected intercourse. Intercourse-related anxiety was indicated as a partial mediator between rejection sensitivity and percentage of protected intercourse. In contrast, intimacy dating goals was related to lower levels of percentage of protected intercourse directly. The findings demonstrate the importance of relational factors in condom use among adolescents in outpatient substance abuse treatment. Levels of protected intercourse are likely to increase when relational factors are targeted among adolescents in this high-risk population. Implications for prevention strategies targeting this high-risk subgroup of adolescents are discussed. ^

Parent emotional functioning, parent responsiveness, and child adjustment

Over the past two decades, interest in the psychological development of children has steadily increased (Beg, Casey, & Saunders, 2007), presumably because statistics describing childhood psychological illness are alarming. Certain parent interaction styles or behaviors are known to influence child adjustment. According to attachment theory, the reason for these findings is that interaction with a caregiver informs an individual’s construction of an internal working model (IWM) of the self in relation to others in the environment. The purpose of this study was to gain a greater understanding of the factors contributing to child adjustment by examining the influence of parents’ emotional functioning and parent responsiveness to children’s bids for interaction. This dissertation tested a multivariate model of attachment-related processes and outcomes with an ethnically diverse sample. Results partially supported the model, in that parent emotional intelligence predicted some aspects of child adjustment. Overall, the study adds to knowledge about how parent characteristics influence child adjustment and provides support for conceptualizing emotional intelligence as a concrete and observable manifestation of the nonconscious attachment IWM.

Maltreatment, psychiatric symptoms and human immunodeficiency virus/sexual transmitted infection risk behavior among youth with alcohol and other drug use problems: A person-centered analysis

Multi-problem youth undergoing treatment for substance use problems are at high behavioral risk for exposure to sexually transmitted infections (STIs), including human immunodeficiency virus (HIV). Specific risk factors include childhood adversities such as maltreatment experiences and subsequent forms of psychopathology. The current study used a person-centered analytical approach to examine how childhood maltreatment experiences were related to patterns of psychiatric symptoms and HIV/STI risk behaviors in a sample of adolescents (N = 408) receiving treatment services. Data were collected in face-to-face interviews at two community-based facilities. Descriptive statistics and Latent Profile Analysis (LPA) were used to (a) classify adolescents into groups based on past year psychiatric symptoms, and (b) examine relations between class membership and forms of childhood maltreatment experiences, as well as past year sexual risk behavior (SRB). ^ LPA results indicated significant heterogeneity in psychiatric symptoms among the participants. The three classes generated via the optimal LPA solution included: (a) a low psychiatric symptoms class, (b) a high alcohol symptoms class and (c) a high internalizing symptoms class. Class membership was associated significantly with adolescents’ self-reported scores for childhood sexual abuse and emotional neglect. ANOVAs documented significant differences in mean scores for multiple indices of SRB indices by class membership, demonstrating differential risk for HIV/STI exposure across classes. The two classes characterized by elevated psychiatric symptom profiles and more severe maltreatment histories were at increased behavioral risk for HIV/STI exposure, compared to the low psychiatric symptoms class. The high internalizing symptoms class reported the highest scores for most of the indices of SRB assessed. The heterogeneity of psychiatric symptom patterns documented in the current study has important implications for HIV/STI prevention programs implemented with multi-problem youth. The results highlight complex relations between childhood maltreatment experiences, psychopathology and multiple forms of health risk behavior among adolescents. The results underscore the importance of further integration between substance abuse treatment and HIV/STI risk reduction efforts to improve morbidity and mortality among vulnerable youth. ^

Examining the effects of epiphanies on possible selves

This study examined origins of possible selves and the role of Epiphanies. Specifically, of interest was whether there are demographic or self-regulatory differences in possible selves derived from different origins. The sample consisted of 411 participants, with age ranging from 17–95. The data was taken from two previous research studies on possible selves. The first research question examined the origins of possible selves. Results indicate that possible selves are derived from Epiphany experiences along with internal and external influences, such as another person, or a particular event. The second research question determined whether there were any demographic, ethnic, or cultural differences in the origins of possible selves. Results showed age, cohort, and socioeconomic status had effects. The final research question addressed whether there were differences in the domains of possible selves derived from various origins. Results indicated differences in domains however there were no clear patterns. The first hypothesis was that possible selves derived from an Epiphany would be considered more important than those derived from other origins. This hypothesis was not supported. The second hypothesis was that hoped-for possible selves were more likely to be derived from an Epiphany experience than feared selves. This hypothesis was supported. The second hypothesis also stated that possible selves derived from an Epiphany were more likely to be balanced than selves derived from other origins and this was supported for feared selves only. Finally, the third hypothesis stated that there would be self-regulatory differences between selves derived from Epiphanies compared to other origins but this was not supported. Taken together these findings show that the origins of possible selves are important and especially those derived from epiphany. The role of an Epiphany on the formation and implementation of possible selves paves the way for important prevention programs aimed at promoting healthy development and promoting an individual’s well being.

Effects of adolescent depressive symptoms, pubertal development, and interpersonal relationship satisfaction on sexual risk behaviors in adolescent romantic couples

This study examined links between adolescent depressive symptoms, actual pubertal development, perceived pubertal timing relative to one’s peers, adolescent-maternal relationship satisfaction, and couple sexual behavior. Assessments of these variables were made on each couple member separately and then these variables were used to predict the sexual activity of the couple. Participants were drawn from the National Longitudinal Study of Adolescent Health (Add Health; Bearman et al., 1997; Udry, 1997) data set (N = 20,088; aged 12–18 years). Dimensions of adolescent romantic experiences using the total sample were described and then a subsample of romantically paired adolescents ( n = 1,252) were used to test a risk and protective model for predicting couple sexual behavior using the factors noted above. Relevant measures from the Wave 1 Add Health measures were used. Most of the items used in Add Health to assess romantic relationship experiences, adolescent depressive symptoms, pubertal development (actual and perceived), adolescent-maternal relationship satisfaction, and couple sexual behavior were drawn from other national surveys or from scales with well documented psychometric properties. Results demonstrated that romantic relationships are part of most adolescents’ lives and that adolescents’ experiences with these relationships differ markedly by age, sex, and race/ethnicity. Further, each respective couple member’s pubertal development, perceived pubertal timing, and maternal relationship satisfaction were useful in predicting sexual risk-promoting and risk-reducing behaviors in adolescent romantic couples. Findings in this dissertation represent an initial step toward evaluating explanatory models of adolescent couple sexual behavior.

Relations between acculturation and alcohol use among international students

In the current study, 226 international students attending Florida International University responded to an Web-based questionnaire that assessed self-reported scores for: acculturation, acculturative stress, alcohol use patterns, perceived peer alcohol use, and perceived injunctive social norms for alcohol use. The purpose of the study was to evaluate structural relations among this set of variables using Structural Equation Modeling (SEM) via AMOS 17.0. The results of SEM analyses documented acceptable fit of a model which hypothesized that relations between acculturation and alcohol use variables are mediated partially by acculturative stress, perceived peer alcohol use, and perceived injunctive social norms. While significant path coefficients were documented for paths between (a) acculturation and acculturative stress and (b) acculturative stress and alcohol use, the coefficients had negative signs, contrary to existing studies investigating these relations among immigrant youth. While paths between (a) perceived peer alcohol use or (b) perceived injunctive social norms and participants’ alcohol use were significant, path coefficients between acculturation and either (a) perceived peer alcohol use or (b) perceived injunctive social norms were not statistically significant. In addition, multiple-group comparisons suggested that social support had a significant moderating influence on several significant paths in the structural model. Specifically, international students reporting higher social support reported lower scores for acculturative stress and alcohol use, in contrast to their counterparts who reported lower scores for social support.

The relationship between prekindergarten social and emotional development and academic success among Hispanic children from low-income families

Social and emotional development has been considered an important factor in child development which has been placed at the end of the learning spectrum due to high stakes testing. Social and emotional development consists of the relationships an individual has with others, the level of self-control, and the motivation and perseverance a person has during an activity (Bandura, 1989). This study examined the relationship between Hispanic children’s prekindergarten social and emotional development and their academic success. Hispanic children from a large southeastern city whose parents were receiving subsidized child-care were followed from their prekindergarten year through third grade (N=1,978). Several hierarchical regressions were run to determine the relationship between children’s social and emotional development, during their prekindergarten year using the DECA (Devereaux Early Childhood Assessment), and the their academic success, as measured by kindergarten through third grade end of the year reading and mathematics academic grades, second grade SAT (Stanford Achievement Test) scores, and third grade FCAT (Florida Comprehensive Assessment Test) and NRT (Norm Referenced Test) scores. Hierarchical regressions were conducted for each grade and subject in order to control for demographics and prior achievement. The results of this study revealed that for Hispanic children from low-income families, the best predictor for academic success was the children’s prior academic achievement. Social and emotional development showed no significant predictive value for the third grade criterion variables as well as end of the year academic grades in second grade and kindergarten reading. Evidence did suggest that for first grade end of the year academic grades and kindergarten math, social and emotional development had a small predictive value. Further research must be conducted as to why social and emotional development, after controlling for demographics and previous academic achievement, bears such a small predictive value when it is clear that many professionals feel it is the most important factor for school readiness.

Life pathways of Haitian-American young adults in South Florida

This research examines the life pathways of 1.5 and second generation Haitian immigrants in South Florida. The purpose of the research is to better understand how integration occurs for the children of Haitian immigrants as they transition from adolescence to adulthood. Building upon a prior study of second-generation immigrant adolescents between 1995 and 2000, a sub-set of the original participants was located to participate in this follow-up research. Qualitative interviews were conducted as well as in-depth ethnographic research, including participant observation. Survey instruments used with other second-generation populations were also administered, enabling comparisons with the Children of Immigrants Longitudinal Study (CILS). The results indicate that educational and occupational achievements were markedly below the participants’ original expectations as adolescents. Gender figures prominently in participants’ familial roles and relationships, with men and women distinctly incorporating both Haitian and American cultural practices within their households. Contrary to previous research, these results on the identification of participants suggest that these young adults claim attachment to both Haiti and to the United States. The unique longitudinal and ethnographic nature of this study contributes to the ongoing discussion of the integration of the children of immigrants by demonstrating significant variation from the prior integration trends observed with Haitian adolescents. The results cast doubt on existing theory on the children of immigrants for explaining the trajectory of Haitian-American integration patterns. Specifically, this research indicates that Haitians are not downwardly mobile and integrating as African Americans. They have higher education and economic standing than their parents and are continuing their education well into their thirties. The respondents have multiple identities in which they increasingly express identification with Haiti, but in some contexts are also developing racialized identifications with African Americans and others of the African diaspora.

An evaluation of functional impairment among children with anxiety disorders

Despite a considerable progress in developing and testing psychosocial treatments to reduce youth anxiety disorders, much remains to learn about the relation between anxiety symptom reduction and change in youth functional impairment. The specific aims of this dissertation thus were to examine: (1) the relation between different levels of anxiety and youth functional impairment ratings; (2) incremental validity of the Children Global Assessment Scale (CGAS); (3) the mediating role of anxiety symptom reduction on youth functional impairment ratings; (4) the directionality of change between anxiety symptom reduction and youth functional impairment; (5) the moderating effects of youth age, sex, and ethnicity on the mediated relation between youth anxiety symptom reduction and change in functional impairment; and (6) an agreement (or lack thereof) between youths and their parents in their views of change in youth functional impairment vis-à-vis anxiety symptom reduction. ^ The results were analyzed using archival data set acquired from 183 youths and their mothers. Research questions were tested using SPSS and structural equation modeling techniques in Mplus. ^ The results supported the efficacy of psychosocial treatments to reduce the severity of youth anxiety symptoms and its associated functional impairment. Moreover, the results revealed that at posttreatment, youths who scored either low or medium on anxiety levels scored significantly lower on impairment, than youths who scored high on anxiety levels. Incremental validity of the CGAS was also revealed across all assessment points and informants in my sample. In addition, the results indicated the mediating role of anxiety symptom reduction with respect to change in youth functional impairment at posttest, regardless of the youth’s age, sex, and ethnicity. No significant findings were observed with regard to the bidirectionality and an informant disagreement vis-à-vis the relation between anxiety symptom reduction and change in functional impairment. ^ The study’s main contributions and potential implications on theoretical, empirical, and clinical levels are further discussed. The emphasis is on the need to enhance existing evidence-based treatments and develop innovative treatment models that will not only reduce youth’s symptoms (such anxiety) but also evoke genuine and palpable improvements in lives of youths and their families.^

The role of contingency and gaze direction in the emergence of social referencing

The current study assessed the importance of infant detection of contingency and head and eye gaze direction in the emergence of social referencing. Five- to six-month-old infants' detection of affect-object relations and subsequent manual preferences for objects paired with positive expressions were assessed. In particular, the role of contingency between toys' movements and an actress's emotional expressions as well as the role of gaze direction toward the toys' location were examined. Infants were habituated to alternating films of two toys each paired with an actress's affective expression (happy and fearful) under contingent or noncontingent and gaze congruent or gaze incongruent conditions. Results indicated that gaze congruence and contingency between toys' movements and a person's affective expressions were important for infant perception of affect-object relations. Furthermore, infant perception of the relation between affective expressions and toys translated to their manual preferences for the 3-dimensional toys. Infants who received contingent affective responses to the movements of the toys spent more time touching the toy that was previously paired with the positive expression. These findings demonstrate the role of contingency and gaze direction in the emergence of social referencing in the first half year of life.^

Evaluating heavy episodic drinking effects on educational attainment

Adolescence and emerging adulthood are transition points that offer both opportunities and constraints on individual development. The purpose of this study is threefold: First, to examine two models (i.e., young adolescents in grades 7 and 8 and older adolescents in grade 12) of heavy episodic drinking and examine how heavy episodic drinking affects subsequent educational attainment. By utilizing two different developmental transitions, i.e., middle school to high school and high school to college, it may be possible to better understand the temporal effects of alcohol use and subsequent educational attainment. The second purpose of this study is to examine how alcohol use at Time 1 may lead to the problems in the adolescent's immediate context due to alcohol (i.e., problems with parents, peers, romantic relationships, problems at school) and to examine if these problems affect educational attainment over and above alcohol use alone. The third purpose of this study is to examine the potential gender differences in these models. The study uses data from the National Longitudinal Study of Adolescent Health, which is a large scale, nationally representative school based sample of 20,745 adolescents who were interviewed in grades 7 to 12. Two longitudinal mediational models were evaluated utilizing structural equation modeling. Binge drinking and number of days drunk were used as indicators for a latent variable of heavy episodic drinking (i.e., LHED). In the 7th and 8th grade model, direct effects of LHED were found to predict educational attainment at grade 12. Additionally, in the 7th and 8th grade sample, a mediated relationship was found whereby educational attainment was predicted by problems with parents. Problems with parents were predicted by number of days drunk in the past year. In the 12th grade sample, there were no direct effects or indirect effects of alcohol on educational attainment. This study highlights the need for using a longitudinal framework when examining heavy episodic drinking's effects on educational attainment. ^