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The authors concluded that their res\l‘lts lend support to the theory that social support and PSYQhological symptoms are reciprocally, not linearly, t e 1 ated across time . Other investigators have looked at relationship between so(Iial support and the transition from middle school to high sCthool. For example, Felner et al. (1982) attempted to stess whether entering high school was a difficult transition for adolescents and, if so, how to make this transition easier. They implemented a primary prevention 26 program to increase new students' social support by assigning them to a homeroom class and teacher that served as their primary source of guidance, support, and information about their new school. Results indicated that the students who participated in the project had significantly better grade point averages, more positive self-concepts, and saw the school environment as being more organized and having more teacher support. It appears then, that social support has a significant 1I'lpaczt on the relationship between the stress of school transition and subsequent adjustment. Three distinct c°mDonents of social support - number of supporters, source °f Support, and satisfaction with support - have been.shown t° be related to a variety outcomes. These outcomes have included physical health, mental health, school attendance, and grade point average. However, this literature lacks inf<3!:mation with regard to other life transitions, such as entering into adolescence, or coping with chronic parental 111t‘tess. It is unclear whether the relationships between soQial support and adjustment would remain the same when a dlEferent life transition is assessed. In addition, there 13 no information concerning how younger children adjust to 8<=hool or other life transitions. It may be the case that 'the support available to children when they are young and how they perceive and utilize that support can influence their later utilization of and satisfaction with support, 27 and consequently their adjustment. Another tactic used by researchers to investigate the nature of social support in childhood has been to examine the relationship between children's social support and "problem" behavior. This problem behavior typically has included drug and alcohol use, and teenage pregnancy. For example, Newcomb and Bentler (1988) looked at the relationships between adolescent drug use, the availability of good social supports, and a variety of outcomes, including problems with drugs, physical health, PS)~=11010gical well-being, and interpersonal relationships. Their subjects were assessed over an eight year period from “Venth and ninth grade to young adulthood. Even after cont=1:'olling for potential confounding effects, every adolescent outcome factor measured was reduced by earlier 3°c131 support. Thus, the authors concluded that their r°3ults demonstrated support for a main effect of social 8“"PIDort, and that ”difficulties in interpersonal relations 399“ to provide a surprisingly powerful indicator of 98Yehosocial dysfunction over time (p. 74)“. Other investigators have examined the relationships bQ‘tween social support and a specific type of drug, alcohol. Beer, Garmezy, McLaughlin, Pokorny, and Wernick (1987) assessed life events, family support, and alcohol use among 425 seventh grade students. They found that overall, the degree to which life events were related to alcohol use was 28 not mitigated when there was less conflict in the family environment (more family support). In addition, family conflict was negatively correlated with alcohol use for both girls and boys. However, there were some gender differences. Girls' use of alcohol was related to life events and family conflict, while boy's use of alcohol was related only to family conflict. Another significant social issue of adolescence concerns teenage pregnancy and motherhood. In one of the most referenced studies of social support in children, Barrera (1981) examined the relationship between stress, social support, and psychiatric symptoms for 86 pregnant adolescents. He found that the size and quality of social support networks influenced the association between life events and depression. More significantly, he found that girls who reported feeling satisfied with the social support they were receiving were found to have smaller relationships between life changes and depressive symptoms. Many teenage pregnancies result in girls deciding to carry their babies to term and raising them at home. Some researchers have assessed the relationship between stress, social support, and adjustment for these adolescent girls both during the pregnancy as well as after they have brought their babies home and are attempting to cope with motherhood. For example, Unger and Wandersman (1988) evaluated the psychosocial functioning of teenage girls 29 experiencing their first pregnancy during the second or third trimester of the pregnancy and again when their infants were eight months of age. They looked at the degree to which subjects reported feeling that their needs for support were satisfied. Results indicated that maternal perceptions of satisfaction with familial and partner support were associated with her overall life satisfaction when her infant was eight months old, regardless of whether these perceptions were assessed prenatally or postpartum. The above studies provide evidence of the importance of social support for adolescents confronted by particular types of stresses, such as drug use or pregnancy. Again, the importance of social support was evidenced for several different outcomes, including physical health, psychological adjustment, and interpersonal relationships. However, one point needs to be addressed which may limit the generalizability of the studies. There are vast differences in subject selection that make it difficult to compare results from various studies. First, the ages of the children assessed ranges from seventh graders to young adults in the Newcomb study, seventh grade students in the Baer group, and thirteen to eighteen years of age in the Unger study and the Barrera Study. In addition, the adolescent girls in the Unger study were predominantly black and lower class, while Beer and his colleagues used mainly white students from middle-class backgrounds. It makes 30 little sense to compare the results obtained from children of such widely varying ages and socioeconomic backgrounds because what constitutes satisfying supportive behavior may differ as a function of age, race, and/or social class, even thought the measure of support does not change. The last strategy used by childhood social support researchers has been to examine the construct of social support in children who are not experiencing any particular stressful circumstances. An example of this type of investigation is Bryant's (1985) work on sources of support in children's neighborhoods. In one of the few studies of young children's support networks, she took seven and ten year old children on a walk in their neighborhoods to identify sources of personal, familial, and neighborhood support. She found differences with respect to gender, family size, and age. First, it appeared that girls of both ages experienced more intensive relationships and a less extensive casual network of relationships than boys. Second, children from small families were more intimately involved with their parents than children from large families, while children from large families seemed to acquire more support from their grandparents and peers than did children from small families. Finally, she found that the relevance of social support in predicting socio- emotional functioning was greater at age ten than at age seven, with the lives of these older children characterized d1 Yl 31 by the development of more elaborate intrapersonal, interpersonal, and environmental sources of support. An extension of the above findings to adolescents was described by Walker and Greene (1987). Eleven to nineteen year old children attending an outpatient medical clinic for the first time reported on life stresses, family cohesion, peer supports, and psychophysiological symptoms. Several findings were noteworthy. Males and females who perceived their family as low in cohesion reported more symptoms than those who reported high family cohesion, except when the latter had a high degree of stressful life events. There were also were some interesting differences between males and females. Evidence in favor of the buffer hypothesis of social support was found for males: as negative life events increased, males with low.peer support reported more symptoms, while males with high peer support appeared to be unaffected. For low levels of life events, there was no relation between peer support and symptomatology. Therefore, it seems that peer support is critical for males only when they experience a great many stressful events. The picture was very different for females, and it may be the case that peer support is important for females regardless of how many stressful events they experience. At high levels of support, females reported few symptoms when negative life events were infrequent. As life events increased, so did symptom levels. In addition, females with 32 low peer support had consistently high symptom levels. The authors postulated that social isolation could have represented a stressor in its own right and directly contributed to symptomatology in these girls. They also noted that, due to cultural prescriptions, women are more likely to report physical symptoms that men. Other investigators have evaluated children who are under no particular stresses at the time of the study, but because of specific living conditions they are thought to be ”at risk" for developing psychopathology. One such study was done by Wertlieb and his coworkers (1987). They examined the relationship between family support and behavior symptoms in a group of six and nine year old children, a subset of these children having had experienced a marital separation or divorce in the past four years. They found that for either low or high levels of stress, lower levels of social support were associated with more behavior symptoms, while higher levels of social support were associated with fewer behavior symptoms. Thus, the authors concluded that their results supported the direct effect of social support. Finally, Cauce and her colleagues (1982) evaluated a group of adolescents who were considered to be at risk for psychopathology because of low SES. Their study examined the relationships between social support, school performance, and self-concept in ninth and eleventh grade 33 inner-city students. Based on their findings, three categories of support were identified: family support; formal support (such as teachers or clergy); and informal support (friends or other adults). For family support, it rues found that black adolescents rated their families as more supportive than either hispanic or white adolescents. In addition, younger males and older females found their families to be more supportive than older males and younger females. With regard to formal support, older adolescents found this source of support to be more helpful than younger adolescents. In addition, there was a significant age by sex by race interaction; older hispanic adolescents found “final support more helpful than did younger hispanic adOlescents, while black and white males rated formal Support as more helpful than their female counterparts, with this tzrend was reversed for hispanic adolescents. With regard to informal sources of support, females rated this 30933:: of support as more helpful than males, while black and V'kaite adolescents rated informal support as more helpful than hispanic adolescents. Social support was also related to academic functioning and Self-concept. Higher levels of informal support were related to lower academic averages and greater absenteeism. This unexpected findings may be due to the value placed on aCademic achievement in lower class environments, as well as the typical adolescent pressure to conform to one's peer 34 group. With regard to self-concept, higher levels of perceived support were associated with higher peer self- concept scores for males but not for females. In addition, for black females, high family support was related to a poorer scholastic self-concept, while the reverse held true for the other groups of adolescents. It seems, then, that there is a relationship between social support and adjustment for children who are not currently experiencing stressful life circumstances, or who are considered "at risk" because of parental marital difficulties or low SES. These relationships held up across several different outcome measures. These outcomes ranged from socio-emotional functioning to peer and family relations to psychophysiological symptoms to behavior symptoms to school functioning. As before, it is difficult to generalize from the results of the above studies for several reasons. First, one of the studies used the mothers' perceptions of how supportive the family was for the children (Wertlieb et al., 1987). This methodology is problematic, because it is unclear whether the children's perceptions were similar to or different from those of their mother's. Future research should endeavor to ascertain information about social support directly from children, so as to be sure of the usefulness of the data. 35 As with the research on life transitions and social issues, there are differences in subject composition that make comparisons between studies difficult. For example, one cannot assume that what constitutes support for a six year old is necessarily the same as for a nineteen year old. In addition, one of the studies did not interview children directly, but instead relied on mothers' reports to ascertain what was supportive for the child (Wertlieb et al., 1987). Further, differences in race and SES existed that could potentially contribute to differences in levels of support and interpretations of supportive behavior, as different ethnicities often seem to place dissimilar value on being supportive and having support (Cauce et al., 1982). It is important to note that all of the researchers -whose studies were reviewed above utilized components of social support that met the needs of their particular research. However, there may be other aspects of support that were not assessed, and which may be important to arriving at a better understanding of the relationships between children's social support, stressful circumstances, and adjustment. In a review of the social support literature, Barrera (1986) has organized the operationalizations of social support into three broad categories: social embeddedness; perceived support, and enacted support. Social embeddedness "refers to the connections (relationships) that individuals have to 36 significant others (e.g., parents, siblings, friends) in their social environments (p. 415)." It is that component of social support that has been typically measured by instruments that assess the number of supporters in one's network. Perceived support is the cognitive appraisal of being connected to and supported by others. It is represented in the literature by instruments that assess subjects' satisfaction with the support they receive. Finally, enacted support refers to the mechanisms by which individuals receive support; what people do when they provide support. Here, researchers can examine and compare different kinds of supportive responses and actions as well as the timing of these supportive behaviors. This component of social support is assessed by obtaining information about the types of supporters in peoples' networks, and the frequency with which they are in contact with those supporters. While there exist other methods for operationalizing social support, these three concepts "appear to capture meaningful similarities and differences that exist among commonly used conceptualizations (p. 438)." In his review, Barrera suggested that each different conceptualization of social support is more applicable to some models of the relationships between stress, social support, and adjustment than to others. He stated that measures of social embeddedness most likely contributed to the prediction of psychological adjustment that is 3i 37 independent of stressful life events. Measures of perceived support were consistently negatively associated with adjustment, as well as measures of life stress. Enacted support was largely positively associated with measures of adjustment and stress. It appears that to capture all the important and diverse relationships between stress, social support, and adjustment, it is necessary to include measures that represent each of these three components of social support. Rationale There is increasing evidence in the literature suggesting that the offspring of affectively disordered parents are at greater risk for developing psychopathology than the offspring of nonpsychiatrically 111 parents. These "at-risk” children are reported to have more psychiatric diagnoses (e.g., Hammen et al., 1986), more interpersonal (e.g., Weissman a Siegel, 1972) and emotional problems (e.g., Kashani et al., 1985), and more cognitive deficits (e.g., Grunebaum et al., 1978) than children of well parents. These disturbances appear as early as infancy (Lyons-Ruth et al., 1986), and seem to continue through childhood and adolescence (Kokes et al., 1980). However, the literature on the offspring of depressed parents is full of methodological inconsistencies that make conclusions based on this research difficult to substantiate. 38 In addition, not all children are equally affected by having an affectively ill parent. Some children grow and develop normally without demonstrating any of the psychopathology reported by researchers. In order to account for the differences in the ways in which children cope with living with and being raised by a depressed parent, it is necessary to establish the existence of moderator variables; variables that buffer for children the relationship between the stress of having an affectively disordered parent and healthy adjustment. Social support is a variable that has been shown to moderate the effects of different types of stressors for children and foster positive psychosocial adjustment. However, a large part of the social support literature is. flawed in part due to the lack of consensus among investigators concerning how best to conceptualize social support. Because of this lack of consensus, researchers assess only those particular components of social support relevant to their study. As a result, they often neglect elements of social support that are equally or more critical to an understanding of psychological adjustment (Barrera, 1986). In addition, there has been no systematic investigation of whether there are differences in the social support networks of the offspring of affectively 111 parents and the offspring of well parents, or if there is a relationship between social support and adjustment among the 531 Ci 1: SI: c! 39 these two groups of children. The purpose of the present research is to examine the social support networks of the offspring of depressed parents and the offspring of nondepressed parents and to determine the relationships between the elements of social support and psychiatric and behavioral adjustment for these children. This research will seek to delineate a typology of social support that assesses components of social support - social embeddedness, perceived support, and enacted support - that appear to be consistently associated with stress and adjustment (Barrera, 1986). The specific components to be assessed will include type of support, source of support, frequency of contact with support, how contact is initiated, and satisfaction with support. These components will be analyzed, both separately and together, to determine which elements of social support are most predictive of positive adjustment in these two groups of children. The present study derives from a longitudinal research project at the Laboratory of Developmental Psychology (LDP) and sponsored by the National Institute of Mental Health. Begun eight years ago, this ongoing project is an investigation of the child rearing practices and family environments of depressed and well parents and their children. The protocol of this project has included the administration of standard psychiatric interviews, cognitive 325‘. bet-a ext 28’ D! 40 tests, neuropsychological tests, self-concept assessments, behavior ratings, and life event schedules, as well as extensive observation of the family members in a naturalistic "apartment" in the laboratory. Research on the psychosocial functioning of the offspring of depressed parents as well as the research on children's social support networks typically studied dissimilar or unrepresentative populations. The LDP research project sought to rectify this flaw in several ways - First because mothers are usually the primary caretaker of their children, it is likely that depression in mothers will have more devastating consequences for children than depression in fathers. Therefore, the longitudinal Proflect recruited families where the mothers had a history °£ depression. In addition, many researchers investigating the adj“atment of the offspring of depressed parents combined ”a“? different parental diagnostic groups, as well as based the1r assessments of the parents on diagnostic systems of cluestionably reliability. Therefore, the LDP study chose to include only those parents who were diagnosed by Research maghostic Criteria, Third Edition (RDC) (Spitzer & Emu~cott, 1981) as having Bipolar, Major Unipolar, or Minor UMDhlar illness. Parents with Schizophrenia, Substance Abuse Disorders, or Antisocial Personality Disorder were e“Eluded from the sample. 41 For the present study, one additional exclusion was made; those parents with Bipolar illness were not included in the sample. It was thought that Bipolar illness, with its unpredictable high and low phases, was sufficiently different so that parental Bipolar illness may not have the same effect on children as Unipolar illness. Therefore, the parents in the present study were diagnosed as having Major Unipolar Disorder or Minor Unipolar Disorder. IBased on the Research Diagnostic Criteria (1981), the subjects of the LDP study were included in the sample based on tvchfurther subclassifications: definite and probable illness. For inclusion in the Definite Major Unipolar Disorder category, subjects must have had one or more, dlstinct periods with dysphoric mood or pervasive loss of 1mietlrest, have had dysphoric features for at least two weeks, have sought or been referred for help, and have endorsed at least five symptoms (e.g., appetite problem, sleep problem, excessive guilt, psychomotor agitation or retardation) for a current (within the past four months) °p180de and four symptoms for a past episode. The criteria for Probable Major Unipolar Disorder are the same as above e"cept that the episode may be of one to two weeks duration and that four symptoms are required for a current episode and three for a past episode. For inclusion in the Definite “lhor Unipolar Disorder category, subjects must have had an eDisode of illness in which a relatively persistent 42 depressed mood dominates the clinical picture (or is coequal with anxiety), have had an episode which lasted at least two weeks, have endorsed at least two symptoms per episode, and have had impairment in functioning, sought help, or taken medication. The criteria for Probable Minor Unipolar Disorder are the same except that the episode must have lasted at least one week. All subjects must have evidenced depressive episodes that developed with no significant signs of psychiatric disturbance in the year prior to the development of the current episode with the exception of the symptoms associated with the target disorder. The diagnosis of a spouse does not affect inclusion of a mother except if the spouse is diagnosed with Schizophrenia or Antisocial Personality Disorder; these families are not included. For inclusion in the nondepressed sample, subjects may have no RDC diagnoses at any time in the past in either parent. An episode of minor depression that occurred before the birth of any children does not necessarily disqualify a parent. Subjects with a history of therapy or minor affective disturbance may be included in the sample. In addition, subjects must not have had a serious chronic illness, postpartum, or bereavement reaction in the past year (Belmont, 1989). At the initiation of the study, the most widely used diagnostic classification system was the RDC. Subsequently, the DSM system has become the more widely used system, and 43 has been extensively revised. In order to make the most reliable and generalizable diagnoses, the LDP staff decided ' that at the current round of data collection (from which the present study derives), the parents would be diagnosed according to DSM-III-R criteria. (However, in order to make comparisons to past data, RDC diagnoses were also obtained). The assessment instruments used to obtain diagnoses for parents and children, as well as the instrument used to assess children's social support measure, are based on informant self-report. While the technique of self-report is the most widely used and perhaps the best method to yield information on psychiatric diagnoses and social network characteristics, there are problems which could limit the utility of the information obtained. Self-report instruments are subjective rather than objective measures of behavior, and are subject to various types of bias, such as demand characteristics, attempts on the part of subjects to ”look good" and therefore under-report psychopathology. These limitations will be discussed in greater detail in the discussion section. Further, many studies used subjects with widely varying age ranges. In order to study both inter- and intrafamily differences, the LDP project chose to assess two siblings from each family. At the start of the project, one sibling was between the ages of 18 and 24 months of age, and the older sibling was between five and eight years of age. The int: rela tta It. the 44 ages and the assessment times were controlled so that family interactions and child characteristics would be closely related to specific developmental periods, as well as so that a cross-sectional/longitudinal design could be employed (e.g., the younger sibling at the second assessment would be the same age as the older sibling at the second assessment). For the present study, because the nature of children's social relationships change as they approach and enter adolescence, is unlikely that social relations are the same at age eight or nine as they are at age twelve or thirteen. By using these two groups of children, it will be possible to view the development of social relations for socially disordered as well as normal children. For the present study, one group of children (both target and control) ranged in age from eight to eleven years; and the other group of children (both target and control) ranged in age from twelve to fifteen years. Wm As there have been no systematic investigations of the social support networks of the offspring of depressed parents, the first step will be to describe the composition of their networks. Because the children of depressed parents often have difficulty with interpersonal relations (e.g., Welner et al., 1977), it is possible that they do not have the social skills to seek out or maintain the necessary social support. Therefore, this study will determine the tat: iii: 45 total number of supporters as well as the amount of different types of supporters in the networks of the children of depressed mothers and control children. It is hypothesized that the offspring of depressed mothers will have fewer total supporters and fewer individual types of supporters than the offspring of control mothers. The next step will be to determine whether the children of depressed mothers differ from the children of nondepressed mothers with regard to who they nominate as supportive. Research indicates that the offspring of depressed parents seem to have particular difficulty with peer relations (e.g., Billings & Moos, 1983). It is therefore hypothesized that overall, they will nominate fewer peers as supporters than the children of well parents. However, as children approach adolescence, they begin to rely more on peers for support (Kriegler, 1987). Consequently, it is hypothesized that the adolescents of nondepressed mothers will nominate peers most often, the adolescent children of depressed mothers parents will nominate peers next often, then the younger children of nondepressed and the younger children of depressed respectively. Conversely, it is hypothesized that the younger children of depressed mothers will be likely to nominate more family members than either of the other three groups of children. 46 The next variable that will be important to investigate concerns how frequently these children are in contact with their supporters. While the issue of frequency of contact between children and supporters has not been examined in the literature, it seems plausible that the more frequently children have support available to them, the less likely they will be vulnerable to stress and psychopathology. Because almost all children are in daily contact with parents and siblings, it is hypothesized that the offspring of depressed mothers will not differ from the offspring of nondepressed mothers with regard to the amount of contact they have with their parents and their siblings. However, it is hypothesized that the children of depressed mothers will be in contact less frequently with supporters outside the family than the children of nondepressed mothers. There is evidence to suggest that the children of depressed parents are more withdrawn socially than are children of well parents (e.g., Grunebaum et al., 1978). It follows, then, that these children will be less likely to seek out and initiate contact with others in their environment. It is therefore hypothesized that the offspring of depressed mothers will be less likely to initiate contact with the supporters in their network than the offspring of nondepressed mothers. The last element of social support to be evaluated is satisfaction with the support being received. If children 47 are more skillful at initiating and maintaining social relations and interacting with people, it is likely that they will feel more satisfied with their relationships. The children of depressed parents are less proficient at developing and maintaining social ties and interacting with people (e.g., Weissman et al., 1984; Weissman & Siegel, 1972), so it is possible that they feel less satisfied with their relationships with others. Therefore, it is hypothesized that the offspring of depressed mothers will report less satisfaction with the support they are receiving than the children of nondepressed mothers. Relationship_betueen_Socia1_Snnnort_and_Adiustment Once the typological characteristics of the children's social support networks have been delineated, the relationships between social support and adjustment can be examined. Adjustment will be assessed, as it is in the LDP longitudinal project, using two standard measures of childhood functioning: psychiatric diagnoses and behavior symptoms. The first analysis will seek to determine which element of social support is most predictive of better adjustment for both groups of children. There has been no research done to ascertain which element of support is most related to adjustment. The literature suggests that perceived satisfaction with support is one of the elements of social support that may be most positively related to children's 48 adjustment (Barrera, 1981). Therefore, this study seeks to determine if satisfaction with support is the element of social support most crucial to healthy adjustment in children. It is hypothesized that for both groups of children, satisfaction with support will be the element of social support that is most predictive of positive adjustment. Once the relationship between overall social support and adjustment is determined, a more in-depth examination of the individual components of social support and their individual contribution to children's well-being will be undertaken. Each component of social support will be analyzed separately to determine which level of that component is most predictive of positive adjustment. First, there is research to indicate that the more support an individual has available to him/her, the better his/her adjustment (e.g., Weimer, Hatcher, & Gould, 1983). Therefore it is predicted that children who have larger networks will be better adjusted than children whose networks are smaller. It remains unclear whether different types of social support are differentially related to positive adjustment in children. The research to date on the relationship between type of support and adjustment in children has emphasized the importance of emotional support (e.g., Unger & Wandersman, 1988). However, there have been no direct tests 49 of the superiority of emotional support at predicting psychological functioning in children. The present study will test this hypothesis. Based on the literature, it is hypothesized that the presence of emotional support is most predictive of positive adjustment in both groups of children. As discussed earlier, children of varying ages are likely to regard different sources of support as differentially helpful. For example, Kriegler (1987) reported that young adolescent children nominated more peers as supporters than did younger children. It is possible, then, that different sources of support are related to positive adjustment for adolescents and younger children. It is hypothesized that for adolescents, support from peers is most predictive of well-being, while for younger children, support from parents is most predictive of positive functioning. The availability of support is an important factor in determining the relationship between social support and» adjustment. It appears that there is a positive relationship between the frequency with which an individual is in contact with supporters and his/her psychological adjustment (Barrera, 1986). However, the relationship between availability of support and adjustment in children is not clear. Based on the literature, it is therefore hypothesized that frequency of contact with supporters is 50 predictive of positive adjustment. If the children of depressed parents are more socially inappropriate than the children of nondepressed parents (e.g., Seifer et al., 1981), it is possible that how they seek out and initiate contact with the supporters is impaired. This impairment could take one of two forms. If the children of depressed mothers are more socially withdrawn (e.g., Grunebaum et al., 1978), they may be more likely than the children of nondepressed mothers to initiate less contact than their supporters. Conversely, if they are more emotionally needy (e.g., Weissman et al., 1972), they may be more likely than the children of nondepressed mothers to initiate more contact than their supporters. Both of these forms of contact could be problematic in relation to adjustment, because each seems to represent an imbalance, or asymmetry, in the way the children communicate. It is therefore hypothesized that the level of initiation of contact that is most predictive of positive adjustment is where children and supporters seek out each other with similar frequency. In addition, there is evidence from the literature on social support and children to suggest that satisfaction with support is an important contributor to children's health and well-being (e.g., Compas, et al., 1986). It is likely that the more satisfied children are with the support they are receiving, the better adjusted they are. However, 51 this premise has not been tested with children of depressed mothers. In order to ascertain the validity of this finding, it is hypothesized that the highest level of satisfaction with social support with be most predictive of children's adjustment. Finally, there is disagreement in the literature as to whether social support has a direct effect on adjustment or whether it acts as a buffer between stress and adjustment. If social support does act as a buffer, it is hypothesized that support will have more of an effect for the children of depressed mothers than for the children of nondepressed mothers. Hypotheses . The following hypotheses will examine various elements, or components, of social support. These elements will include number of supporters, types of support, sources of support, frequency of contact with supporters, initiation of contact with supporters, and satisfaction with support received. I. Descriptive Analyses Hypothesis 1: The offspring of depressed mothers will report fewer supporters than the offspring of nondepressed mothers. Hypothesis 2: The offspring of depressed mothers will report fewer emotional, companionship, information, and 52 tangible aid supporters than the offspring of nondepressed mothers. Hypothesis 3A: The offspring of depressed mothers will report fewer peers as supporters than the offspring of nondepressed mothers. Hypothesis 3B: The adolescent offspring of nondepressed mothers will report the most number of peers in their networks, followed by the adolescent offspring of depressed mothers, followed by the younger children of nondepressed and depressed mothers respectively. Hypothesis 4A: The offspring of depressed mothers will report the same level of contact with family members, but less contact with individuals outside the family than the offspring of nondepressed mothers. Hypothesis 4B: The offspring of depressed mothers will report being less likely to initiate contact with supporters than the offspring of nondepressed mothers. Hypothesis 5: The offspring of depressed mothers will report being less satisfied with the support they are receiving than the offspring of nondepressed mothers. II. Relationship between Social Support and Adjustment Hypothesis 6: Satisfaction with support is the element of social support that is most predictive of children's psychiatric diagnoses and behavior symptoms. Hypothesis 7: The more supporters children report, the better their adjustment will be, as assessed by psychiatric 53 diagnoses and behavior symptoms. Hypothesis 8: Emotional support is the type of support' that is the best predictor of children's psychiatric diagnoses and behavior symptoms. Hypothesis 9A: For younger children, support from parents is the source of support that is most predictive of psychiatric diagnoses and behavior symptoms. Hypothesis 98: For adolescent offspring, support from peers is the source of support that is the most predictive of psychiatric diagnoses and behavior symptoms. Hypothesis 10: The more frequently children are in contact with supporters, the better their adjustment will be, as assessed by psychiatric diagnoses and behavior symptoms. Hypothesis 11: The more shared, or mutual, the initiation of contact is between children and their supporters, the better their adjustment will be, as assessed by psychiatric diagnoses and behavior symptoms. Hypothesis 12: The more satisfied children are with the support they receive, the better their adjustment will be, as assessed by psychiatric diagnoses and behavior symptoms. Hypothesis 13: If social support is a buffer between the stress of having a depressed mother and adjustment, then social support will have more of an effect for the children whose mothers are depressed than those whose mothers are not depressed. Method As previously stated, the present study is part of a larger ongoing research project sponsored by the National Institute of Mental Health to examine the rearing practices of affectively ill and control mothers and the adjustment of their offspring. Only those measures and procedures relevant to this particular study will be discussed. Subjects. Thirty children with a depressed mother and 30 children wdth a nondepressed mother, living in or near a large east coast city, ranging in age from eight to fifteen, ‘participated in this study. There were two distinct age groups: the younger children were between the ages of eight rand eleven; and their older siblings were between the ages of twelve and fifteen. The sample consisted of mostly middle and upper-middle Class, Caucasian, intact families. There was a smaller Sample of economically deprived, inner-city, largely single Parent Black families. At the outset, the staff at the LDP had planned to have intact families of two distinct social classes: one middle class group and one lower class group. It» was found that the majority of lower class families who £11: the project criteria for depressed and nondepressed groups were fatherless; therefore the sample criteria were modified to include single mothers and their children. 54 55 At the onset of the study eight years ago, the subjects were recruited through notices placed throughout the community, including daycare centers, religious buildings, and women's centers. The notice stated that the Laboratory of Developmental Psychology at the National Institute of Mental Health was looking for mothers with children between the ages of eighteen months and two years with an older sibling between the ages of five and eight to participate in a study examining childrearing practices. A standard psychiatric instrument (Schedule for Schizophrenia and Affective Disorders-Lifetime) ((SADS-L; Endicott & Spitzer, 1979), which made diagnoses according to Research Diagnostic Criteria (RDC) was used to screen parents. Eligibility for the study was based on mother's psychiatric status: to be eligible, mothers in the target group were given a diagnosis of a major depressive disorder, either major or minor depression or bipolar disorder. Mothers in the control group had to be free of current or past psychiatric disorder. Mothers who had schizOphrenia, antisocial personality disorder, or substance abuse disorder were excluded from the sample. If the mothers were eligible, the fathers were then interviewed. Families were excluded if fathers were given a diagnosis of schizophrenia or antisocial personality disorder. Fathers in the control group had to be free of current or past psychiatric disorder. 56 For the present round of data collection, the children families were recontacted and asked to return to the laboratory for additional procedures. Each family member received $10.75 for the first hour of participation and $5.00 for each subsequent hour, based on a standard National Institutes of Health payment scale for normal volunteers (i.e., those who are not receiving any treatment at NIH). Procedure Once the families agreed to participate again, an appointment for them to come to the laboratory was scheduled. Each family spent an average of eight hours at the LDP; the procedures relevant to the present study took approximately four hours to complete. Before the initiation of any procedures, all family members read and signed consent forms. The mothers and fathers were interviewed separately, first about themselves and then about their children. The children were interviewed separately about themselves. The data werecollected, scored, and interpreted by trained personnel with either a bachelor's degree in psychology, a master's degree in clinical or developmental psychology, a doctorate in clinical psychology, or a medical degree in psychiatry. All personnel received extensive training in the administration, scoring, and interpretation of all relevant instruments, as well as training on the use of the DSM-III-R manual. The training of all personnel who of co: the as On it th. th for 57 interviewed the children was conducted by one person (WH). W Ih1_Qh1ldIsnLi_32Q1al_§EDDQL&_Q££§312nn§11£.(C880)- The C880 (Bogat, Chin, Sabbath, & Schwartz, 1983) is a questionnaire designed to assess the social support networks of children. It was selected because of its ability to conceptualize social support as a multidimensional construct that encompasses both quantitative (e.g., number of supporters) and qualitative (e.g., source of support, satisfaction with support). It consists of 16 items divided into four sections representing four types of social support: companionship; information and advice; tangible aid; and emotional support. For each type of support, there are four questions (i.e., when you go to movies, parties, video arcades, etc., who do you go with?), and subjects were asked to nominate as many as ten people for each question. On the last two pages of the questionnaire, subjects transferred the names of the supporters they had written for the 16 questions. The subjects indicated for each supporter their relationship to the supporter, the frequency of contact with that supporter, who initiates contact, and how satisfied they are with the support they are receiving. For the present study, the C880 was completed by all the children. The validity of the C880 has been shown in its ability to discriminate between younger (six to ten years old) and and Yiel 3111p asso. Intel One ( ‘th IHSII 58 older (eleven years or older) children. In addition, it has discriminated between depressed and nondepressed children, and children whose parents are undergoing marital difficulties and children whose parents' marriages are stable. (Kriegler, 1987). , . -... , ~, . . . . ... ;.. . «, — B:!1§£d.(DICA-R). The DICA-R is a structured diagnostic interview designed to assess psychiatric symptomatology in children between the ages of six and 18 (Reich, 1988). It is based on the DICA, which was developed mainly for clinical and epidemiological research (Herjanic & Campbell, 1977). The difference between the two instruments is that the DICA was designed to yield DSM-III diagnoses, while the DICA-R was designed to yield DSM-III-R diagnoses. This instrument has been designed to be administered by clinicians as well as lay people having extensive interview- specific training. The interview takes approximately one hour to complete, and can be administered to both children and parents. It yields information on the presence or absence of 185 symptoms, as well as their onset, duration, severity, and associated impairments (Herjanic & Reich, 1982). The interview is divided according to 18 DSM-III-R categories. One or more questions has been designed to assess each symptom for each disorder. Each diagnostic section has instructions that list the specific DSM-III-R instructions Ca it 0:1 IO] and 59 for arriving at a diagnosis in that section, and each section is then scored based on the specific DSM-III-R criteria for that diagnosis (Reich, 1988; Welner, Reich, Herjanic, Jung, & Amado, 1987). There are three versions of the DICA-R: the DICA-RC, for children between the ages of six and twelve; the DICA-RA, for children between the ages of 13 and 18; and the DICA-RP, for parents. All versions are the same with respect to content areas, order of items, and general wording, although some less sophisticated language may be used in the DICA-RC. The DICA-RP is supplemented by items covering pregnancy, developmental history, and medical history. For the present study, the DICA-R was completed by the children, the mothers, and the fathers. Each informant's diagnostic summary was was used individually, as well as combined (method described below) to yield a single research diagnosis. The validity of the DICA is supported by its ability to discriminate between matched samples of children referred either to pediatric or psychiatric clinics (Herjanic & Campbell, 1977; Welner, et al., 1987). Inter-interview agreement on diagnoses, using the kappa statistic and based on psychiatrist ratings, has been found to range from .76 for anxiety disorders to 1.00 for attention deficit disorder and conduct disorder (Welner et al., 1987). Interrater reliability ranges average .85 to .89 (Herjanic & Reich, 1982). Parent-child agreement on diagnoses, using the kappa 60 statistic, ranges from .49 for enuresis to .80 for conduct disorder (Welner et al., 1987). Low parent-child agreement may not necessarily reflect inadequacies on the part of the instrument. Parents may be acute observers, but they do not always have access to their children's feelings. In addition, as children mature, they engage in an increasing number of activities about which their parents do not have accurate information. The most logical way to resolve parent-child discrepancies with regard to diagnosis is to rely more heavily on the children's information concerning internal symptoms - neurotic, somatic, and psychotic symptoms - and to rely more heavily on the parents' information for observable symptoms - relationship problems, school behavior, and academic problems (Herjanic & Campbell, 1977; Reich, personal communication, 1988). For younger children, information from parents should be given more weight overall, while for older children, information from parents should be given less weight (Reich, personal communication, 1988). For the present study, interviewers administered, scored, and arrived at a final research diagnosis by employing the above outlined methods. When children and their parents were in agreement with regard to diagnosis, the final research diagnosis recorded was simply the diagnosis arrived at by each family member (child, mother, and father). When these three subjects arrived at different 61 diagnoses, the final research diagnosis was arrived at by determining whether the symptoms of that diagnosis were more' internal or observable, as well as by determining the child's age. If the symptoms were internal and the child was older (or appeared mature and insightful), then the child's diagnosis was recorded as the final research diagnosis. If the symptoms were more external and the child was younger, the parents' diagnoses were recorded as the final research diagnosis. When the interviewers had determined the final research diagnosis for each case, they gave their final form (which included the final research diagnosis along with a short paragraph elaborating on the symptoms of the child and any significant concerns) to the project child psychiatrist. ’If he had any questions, he consulted with the interviewer, and returned to the raw data if necessary to resolve any discrepancies between himself and the interviewer. The DICA was chosen because of its demonstrated reliability and validity, its correspondence with the DSM- III-R, it's straightforwardness and relative ease of administration, its ability to be administered by individuals possessing a more basic understanding of clinical issues, and its ability to yield information concerning a wide variety of symptoms and diagnoses. Tba_Acbenbach_Qhild.8ebaxior_§beckllat.(cscn). The CBCL (Achenbach & Edelbrock, 1981; 1983) is a 138 item self- 62 administered questionnaire that yields information on children's behavior problems and competencies. The items are broken down into 20 items that assess social competence and 118 items that comprise the behavior problems scale. For the present study, only the behavior problem items were used. Factor analyses of the responses to the behavior problem items by 2,300 clinic referred children yielded a different set of factors for males and females, as well as for three age groupings (4-5 years, 6-11 years, and 12-16 years). The profiles generated for each grouping consisted of eight or nine factors, depending on age (social withdrawal, depressed, immature, somatic complaints, sex problems, schizoid, aggressive, delinquent, hyperactive, uncommunicative, and obsessive-compulsive). Norms for the factor scales were collected on 1,300 normal children of diverse ethnic and socioeconomic background (Achenbach & Edelbrock, 1983). Reliability information revealed a one-week test-retest reliability coefficient of .95 and a three-month test-retest coefficients of .84 for behavior problems. Pearson coefficients across factors and age by sex groupings ranged from .61 to .96. Interparent agreement was .985 for behavior problems on a clinical sample of children (Achenbach & Edelbrock, 1983). The CBCL has demonstrated discriminant validity in differentiating clinic referred and 63 nonreferred children, hyperactive and normal children (Barkley, 1981; Edelbrock & Rancurello, 1985; Mash & Johnston, 1983), children of maritally distressed and nondistressed mothers (Bond & McMahon, 1984), depressed and nondepressed children (Seagull & Weinshank, 1984), and maltreated and control children (Salzinger, Kaplan, Pelcovitz, Samit, & Krieger, 1984). In addition, the CBCL appears useful as a screening measure for psychopathology in a primary-care pediatric setting (Costello & Edelbrock, 1985), as well as way to assess changes in conduct problems after a parent training program on child management (Webster-Stratton, 1985). For the present study, the CBCL was completed by the mothers. The factor scores were used to evaluate the nature of the differences in psychopathology between the children of depressed and well mothers. The CBCL was chosen for its reliability and validity, its ability to be quickly self—administered, and its ability to produce information based on behaviors (as opposed to the DICA's reliance more on internal symptoms). Together, the DICA and the CBCL yield a great deal of information on children's internal feelings and perceptions and external behaviors. Ase: offs: “PP numb Offs There 0n m Results I . Descriptive Analyses Results for Hypothesis 1 are presented in Table l. A t-test was performed to determine whether the offspring of dept essed mothers reported fewer total supporters than the offspring of nondepressed mothers. There were no 81<31'11ficant differences between the two groups for total s"‘DDcarters. Results for Hypothesis 2 are also presented in Table l. A Series of t-tests were performed to determine whether the Offspring of depressed mothers reported fewer emotional, companionship, information and advice, and tangible aid s“Priorters that the offspring of nondepressed mothers. There were no significant differences between the two groups for number of emotional supporters, number of companionship s‘JDporters, number of information and advice supporters, or number of tangible aid supporters. Results for Hypothesis 3A are also presented in Table 1- A t-test was performed to determine whether the offspring of depressed mothers nominated fewer peers as 8nDporters than the offspring of nondepressed mothers. There were no significant differences between the two groups on number of peers nominated as supporters. 64 65 Table l , -, ’ x 1'... e ‘ see a l 0 e ' e I e -- .‘ 7!. W. D = I M. 52. d. 52. Totaail Supporters 14.07 (3.75) 14.47 (4.02) Emotional Supporters 7.70 (3.01) 8.67 (4.57) comDanionship suDporters 10.07 (3.56) 9.13 (3.94) I"ifOIEmation/ Advice Supporters 7.13 (3.42) 7.37 (3.18) Tang ible Aid Supporters 5.67 (3.13) 5.87 (2.61) 999;: Supporters 8.83 (4.31) 8.07 (3.70) \ Results for Hypothesis 3B are presented in Tables 2A and 28. An analysis of variance was performed to determine Whether the adolescent offspring of nondepressed mothers l"35>orted the most peers as supporters, followed by the adolescent offspring of depressed mothers, followed by the YOUnger children of nondepressed and depressed mothers respectively. A two-by-two design was employed, where the cOlumn variable represented age (adolescent: age 12-16; Child; age 8-11), and the row variable represented mother PSYchiatric status. The outcome variable was the number of Peers reported as supporters. There was a significant main effect for age (E(l,59)-4.37, 95.05), whereby adolescents 66 reported more peers as supporters than younger children. There was no main effect for psychiatric status of mother, nor was there a significant interaction effect between age and psychiatric status. ——~ M £0 Chilldren (ages 8-11) Total Sample 7.59 3.26 Depressed 7.94 3.72 Control 7.17 2.81 AdOlescents (ages 12-16) Total Sample 9.72 4.62 Depressed 10.00 4.88 Control 9.42 4.52 \ Table 28 SUM OF MEAN W8 DF SQUARE F NGin Effects 76.36 2 38.18 2.47 AGE 67.54 1 67.54 4.37* GROUP 7.24 1 7.24 .47 Z-Way Interactions AGE X GROUP .13 1 .13 .01 Explained 76.49 3 25.50 1.65 Residual 866.36 56 15.47 Total 942.85 59 15.98 * 91.05 67 Results for Hypothesis 4A are presented in Table 3. A t-test was performed to determine whether the offspring of depressed mothers reported the same amount of contact with family members as the offspring of nondepressed mothers. There were no differences between the two groups on amount of family contact. A second t-test was performed to determine whether the offspring of depressed mothers reported less contact with non-family members than the offspring of nondepressed mothers. There were no differences between the two groups on amount of non-family contact. Results for Hypothesis 4B are also presented in Table 3. A t-test was performed to determine whether the offspring of depressed mothers initiated contact with their supporters less frequently than the offspring of nondepressed mothers. No significant differences were found between the two groups on initiation of contact with supporters. Results for Hypothesis 5 are also presented in Table 3. A t-test was performed to determine whether the offspring of depressed mothers reported less satisfaction with the support they receive than the offspring of nondepressed mothers. No significant differences were found between the two groups on satisfaction with support received. 68 Table 3 ' {I \ ‘e I Q- - - - e ' 0 -s Q o I e - a swimming: D = = M SD M. SD Amount of Family Contact 5.10 (.60) 4.95 (.78) Amount of Non-Family Contact 5.13 (.59) 4.97 (.77) Initiation of Supporter Contact 1.97 (.29) 2.03 (.17) Satisfaction with Support Received 4.26 (.79) 4.38 (.49) 11. Relationships between Social Support and Adjustment For the following hypotheses, the results for the CBCL are in terms of standardized T scores based on Achenbach's normed sample. Results for Hypothesis 6 are presented in Tables 4 and 5. Pearson Product Moment Correlation analyses were performed to determine if satisfaction with support received was the element of social support that best predicted adjustment ‘. Correlations between the elements of support and psychiatric diagnoses and behavior problems are presented in Table 4. There were significant negative correlations between satisfaction and Total Externalizing Problems (rs-.22, 95,05), combined overall DICA diagnoses (rs-.23, 95,05), and DICA diagnoses based on child report (rs-.30, 95,01). There was a significant negative 0‘1 I") 't, 0" 69 relationship between number of supporters and DICA diagnoses based on mother report (Ls-.28, 95.01). Amount of shared contact was negatively related to Total Externalizing Problems (rs-.26, 95.05), and DICA diagnoses based on mother report (r_=-.29, 95.01). Type of support was not significantly related to any measure of adjustment. 70 Table 4 Total Behavior Problems -.15 -.16 .20 -.16 -.33** Total Internalizing Problems -.09 -.10 .20 -.13 .32** Total Externalizing Problems -.22* -.20 .19 -.18 .33** Diagnoses- Combined Report -.23* -.22* .10 -.04 -.20 Diagnoses- Child Report .30** -.14 .02 -.10 -.04 Diagnoses- Mother Report -.18 -.28** .16 .04 -.35** Diagnoses- Father Report -004 -003 -004 005 -016 Satisfaction .05 .01 .13 .10 . 95.05 am 95.01 rec: adju am :1 Bi adj 71 In order to test whether satisfaction with support received was the element of support that best predicted adjustment, t-scores which test the difference between the above correlations were computed 3. These t-scores are presented in Table 5. Satisfaction was not a significantly better predictor for any outcome measure, nor were any other elements of support significantly better predictors of adjustment. Table 5 Satis- faction V8. Total Behavior Problems Total Internalizing Problems Total Externalizing Problems Diagnoses- Combined Report Diagnoses- Child Report Diagnoses- Mother Report Diagnoses- Father Report -.03 .07 .06 .90 -.53 .03 72 Satis- faction vs. Number___Ereonencx__Trne_____Qontact .15 .73 .16 -.04 Satis- faction vs. .06 -.23 .19 1.12 .87 Satis- faction V8. .61 1.29 -.64 .15 -068 73 Results for Hypothesis 7 are presented in Tables 4 and 6. Pearson Product Moment Correlation analyses were performed to determine if there was a significant negative correlation between number of supporters nominated and psychiatric diagnoses and behavior problems. These correlations are presented in the second column of Table 4. There was a significant negative relationship between total number of supporters and combined overall DICA diagnoses (re-.22, 95.05) and DICA diagnoses based on mother report (re-.28, 95.05). In order to better understand the particular elements contributing to the significant relationships between number of supporters and Total Externalizing Problems, the above analyses were redone using the separate behavior problem scales. Because these scales are different for boys and girls and for younger and older children, these subsequent analyses were performed for four different samples: girls ages 8-11 (n-l9); boys ages 8-11 (n-l6); girls ages 12-16 (n816), and boys ages 12-16 (n89). These results are presented in Table 6. There were no significant relationships between number of supporters and behavior Problems for boys or girls of either age. tail V (P V F AV 7 AI. A. 74 Table 6 . . ..- :- , . x u. . ... - .. B , . Wise. Girls 8-11 Boys 8-11 Girls 12-16 Boys 12-16 (n=l9) (n=16) (n=16) (n=9) Scale 1 -.12 -.08 .11 -.06 Scale 2 -.37 -.32 .02 -.02 Scale 3 -.32 -.12 -.12 -.19 Scale 4 -.22 .18 -.02 -.06 Scale 5 -.05 .19 -.08 .24 Scale 6 -.21 -.14 -.37 -.20 Scale 7 -.04 -.14 -.28 -.28 Scale 8 -.17 -.33 -.04 -.23 Scale 9 .03 -.07 - ’-.19 ‘ no Scale 9 for girls ages 12-16 75 Results for Hypothesis 8 are presented in Tables 7 and 8. To determine whether emotional support was the type of support that best predicted adjustment, Pearson Product Moment Correlation analyses were first performed 1. Correlations between type of support and psychological adjustment are presented in Table 7. There were significant positive relationships between Companionship support and Total Behavior Problems (1;.33, 95.01), Total Internalizing Problems (13.32, 95.01), and Total Externalizing Problems (r§.35, 95,01). There were no significant relationships between adjustment and Information and Advice support, Emotional support, or Tangible Aid support. 76 Table 7 Emotional Information Tangible Aid Companionship WWW— Total Behavior Problems -.16 -.10 .01 .33” Total Int ernalizing Problems --.13 -.04 .01 .32** Total 33“: ernalizing Problems -.18 -.10 .01 .35" Di~acart (re-.29, 95.05) . Ta: (as? 80 Table 9 Grand- Other Other Parent Been—ELMMWLMH Total Behavior Problems -.23 -.04 -.24 -.14 -.04 .09 Total Int ernalizing Problems -.23 -.01 -.22 -.11 -.06 .18 Total EXt ernalizing PIOblem -021 002 -027 -.03 -008 -004 Diagnoses- Combined Report -.07 .13 -.18 -.08 -.11 -.13 IDiagnoses- Child Report -.01 .24 -.29* .00 -.15 -.19 alagnoses- Other Report -.11 -.ll -.02 -.10 -.08 .02 D 1 agnos es - l"other Report .13 .21 -.18 .09 .01 -.06 Parent .00 -.01 .13 -.09 .17 * 95.05 me C the so adjust are p: :iqnii child} 81 Then, difference scores between the above correlations were computed to directly test whether parental support was i the source of support that best predicted psychological adjustment for younger children 3. These difference scores are presented in Table 10. No source of support was a significantly better predictor of adjustment for younger chi. 1dren than parental support. 82 Table 10 o - o g D 7 ' ' g ’ g o o o 9. W Parent Parent Parent Parent Parent vs. vs. vs. vs. vs. Grand— Other Other PW Total Behavior Problems .72 -.04 .38 .76 .60 T01: a1 Int: ernalizing Problems .84 .07 .49 .70 .21 Total EXternalizing Problems .69 -.26 .70 .49 .70 Diagnoses- Combined Report -.24 -.44 -.04 -_.16 -.24 Diagnoses- ‘3lxild Report -.85 -1.07 .04 -.54 -.71 Diagnoses- MOther Report .12 .34 .06 .11 .40 lDiagnoses- Father and 5UP? Pea: per 83 Results for Hypothesis 9B are presented in Tables 11 and 12. To determine whether peer support was the source of support that best predicted adjustment in older children, Pearson Product Moment Correlation analyses were first per formed ‘. These correlations are presented in Table 11. Support from peers, parents, grandparents, and other relatives were not significantly related to any outcome measure. There were significant negative relationships between support from siblings and Total Behavior Problems (La-.49, 95.01), Total Internalizing Problems (LI-.34, K- 05), and Total Externalizing Problems (Es-.61, 95.001). s\lpport from other adults was significantly correlated with Total Internalizing Problems (rs-.43, 91.05). Table 11 Total Behavior Problems Total Internalizing Problems Total Externalizing Problems Diagnoses- Combined Report Diagnoses- Child Report Diagnoses- Hother Report 0 iagnoses - Father Report Peer .10 .14 -.06 -.06 .01 -.10 -.06 .08 .13 .17 84 -.49** -.34* ..61*** -019 Grand- PW -.12 ‘006 Other .06 -.16 .16 .01 -003 -.33* Other -.43* -.13 .05 .16 -.14 .03 .02 * Q$.05 *** Q$.001 then pee: siq: Pro! 99!! 85 Difference scores between the above correlations were then computed in order to determine whether support from peers was the source of support that best predicted adjustment for older children 3. These difference scores are presented in Table 12. Support from siblings was a significantly better predictor of Total Externalizing Problems than support from peers (ta-2.67, 23.01). There were no other significant difference scores. iota Beha Prot Tote Int: Pro! iota Ext! Pro! Dia< Com‘ Rep. Dia. Chi Rep Dia Hot Rep Dia Fat Rep 86 Table 12 Peer vs. Peer vs. Peer vs. Peer vs. Peer vs. Grand- Other Other .Pazgnt.___Q1hl1nS___Qi12n5___fiili§1¥§——Adfllt—— Total Behavior Problems .17 -1.64 .39 .15 -l.04 Total Internalizing Total Externalizing Problems -.21 -2.67** -.46 -.40 -.43 Diagnoses- Combined Report .61 -.12 -.07 .71 .76 Diagnoses- Child Report -.10 -.64 -.29 .39 -.19 Diagnoses- Hother Report .45 -.27 -.05 .58 .27 Diagnoses- Father Report -.26 -.20 —.42 -.29 .11 ** 23,01 13. 921‘. 87 Results for Hypothesis 10 are presented in Tables 4 and 13. Pearson Product Moment Correlation analyses were performed to determine if there was a significant negative correlation between frequency of contact with supporters and number of psychiatric diagnoses and behavior problems. Correlations between frequency of contact and adjustment are presented in the third column of Table 4. There were no significant correlations between frequency of contact with supporters and behavior problems or DICA diagnoses. In order to better understand the specific elements contributing to the above significant relationships, the analyses were redone using the separate behavior problem scales. These analyses are presented in Table 13. There were no significant relationships between frequency of contact and behavior problems scales for children of either age or sex. table for?! Ethan Sca Sce Sc Sc 88 Table 13 . . ..- :- . . ~ -. , . .. , ... ,. W135. Girls 8-11 Boys 8-11 Girls 12-16 Boys 12-16 (nBlS) rlnalG) (nalG) (n29) Scale 1 .07 .32 -.21 .12 Scale 2 ' .06 .33 .07 .16 Scale 3 .15 .13 .05 .14 Scale 4 .12 -.05 .05 .10 Scale 5 .07 .18 .39 -.39 Scale 6 -.08 .16 .11 .13 Scale 7 -.08 .04 .23 -.15 Scale 8 .18 .29 .26 .04 Scale 9 .20 .16 ‘ -.23 ‘ no Scale 9 for girls ages 12-16 14. per sot an: m It Be 89 Results for Hypothesis 11 are presented in Tables 4 and 14. Pearson Product Moment Correlation analyses were performed to determine if there was a significant negative relationship between the amount of shared contact between subjects and supporters and number of psychiatric diagnoses and behavior problems. These correlations are presented in the last column of Table 4. There were significant negative relationships between amount of shared contact and Total Behavior Problems (LI-.34, 95.01), Total Internalizing Problems (LI-.32, 95.05), Total Externalizing Problems (rs-.33, 95,01), and DICA diagnoses based on mother report (rs-.35, 95,01). Again, the above analyses were redone using the. separate behavior problem scales to determine the unique contributions to the above significant findings. These correlations are presented in Table 14. For girls ages 8- 11, there were significant negative relationships between amount of shared contact and Scale l-Depressed (rs-.42, 95.05), Scale 2-Social Withdrawal (rs-.39, 95.05), Scale 4- Schizoid-Obsessive (IP.39,95.05), Scale S-Hyperactive (IF-.41, 95.05) and Scale 6-Sex Problems (LP-.55, 95.01). For boys ages 8-11, significant negative correlations were found between amount of shared contact and Scale 2-Depressed (rs-.45, 95.05), Scale S-Somatic Complaints (rs-.55, 95.01), Scale 7-Hyperactive (LP'.47, 95.05), Scale 8-Aggressive (rs-.58, 95.01), and Scale 9-Delinquent (rs-.60, 95.001). 3! 90 For girls ages 12-16, there were significant negative correlations between amount of shared contact and Scale 1- Anxious Obsessive (rs-.57, 95.01), Scale 2-Somatic Complaints (58-.53, 95.05), Scale 3-Schizoid (rs-.46, 95.05), Scale S-Immature-Hyperactive (rs-.48, 95.05), Scale 6-Delinquent (rs-.63, 95.01), Scale 7-Aggressive (LP-.55, 95.01), and Scale 8-Crue1 (Ls-.61, 95.01). There were no significant relationships between amount of shared contact and adjustment for boys ages 12-16. “3 "., I n— n: e Ply a: Scal Scal Sca' Sca Sca 5C6 SCE Sc; Sc. 91 Table 14 . - .. : ,- , , ., . , . .. B:hi!12£.£12hl£m_fi£§l£§. Girls 8-11. Boys 8-11 Girls 12-16 Boys 12-16 in=1915 (n316) (n=16) (n=9) Scale 1 -.42* -.30 -.57** .05 Scale 2 -.39* -.45* -.53** —.24 Scale 3 -.17 -.37 -.46* -.01 Scale 4 -.39* .01 -.42 .11 Scale 5 -.41* -.55** -.48* .16 Scale 6 —.55** -.08 -.63** .13 Scale 7 -.32 -.47* -.66** .19 Scale 8 -.24 -.58** -.61** .09 Scale 9 -.06 -.60** ‘ .15 ‘ no Scale 9 for girls ages 12-16 * 95.05 ** 95.01 92 Results for Hypothesis 12 are presented in Tables 4 and 15. Pearson Produce Moment Correlation analyses were performed to determine if there was a negative relationship between satisfaction with support received and psychiatric diagnoses and behavior problems. Correlations between satisfaction and adjustment are presented in the first column of Table 4. There were significant negative correlations between total satisfaction and Total Externalizing Problems (r=-.22, 95.05), overall combined DICA diagnoses (rs-.23, 95.05), and DICA diagnoses from child report (rs-.30, 95.01). Again, in order to better understand the unique elements contributing to the above relationships, the analyses were redone using the separate behavior problem scales. The results from these analyses are presented in Table 15. There were no significant relationships between satisfaction with support and adjustment for girls ages 8- 11. For boys ages 8-11, there were significant negative relationships between satisfaction and Scale 5-Somatic (r?- .53, 95.05), Scale 7-Hyperactive (La-.57, 95.01), and Scale 9-Delinquent (rs-.50, 95.05). For girls ages 12-16, there were significant negative relationships between satisfaction and Scale 3-Schizoid (gr-.73, 9§.001), Scale 4-Depressed Withdrawal (rs-.42, 9!.05), Scale 5-Immature-Hyperactive (Ia-.76, 95.001), Scale 6-Delinquent (rs-.64, 95.01), Scale 7-Aggressive (rs-.54, 9s.01), and Scale 8-Cruel (rs-.48, 93 95.05). There were no significant relationships between satisfaction and adjustment for boys ages 12-16. Sca Sca Sca 94 Table 15 . - - :~ , . :. - ., ... . ,. aghi¥191_219hlfim_ficil:1 Girls 8-11 Boys 8-11 Girls 12-16 Boys 12-16 (n=l9) (nalG) in=161 (n=9) Scale 1 -.07 .17 .02 .17 Scale 2 -.21 .06 -.08 .09 Scale 3 .11 -.16 -.73*** .19 Scale 4 .07 -.41 -.42* .16 Scale 5 .01 -.53* -.76*** -.29 Scale 6 -.15 -.09 -.64** .31 Scale 7 .26 -.57** -.54* -.14 Scale 8 .00 -.25 -.48* .13 Scale 9 .22 -.50* ‘ . -.06 ‘ no Scale 9 for girls ages 12-16 * 95.05 ** 95.01 *** 95,001 [E a! 95 Results for Hypothesis 13 are presented in Table 16. Mutiple regression analyses were performed to determine if social support acts as a buffer between the stress of being cared for by a depressed mother and psychological adjustment. If social support is a buffer, then it should have more of an effect for the children of depressed mothers than for the children of well mothers. In other words, the level of adjustment (degree of symptomatology) should be the same for the children of depressed and control mothers under conditions of high support. However, under conditions of low support, the children of depressed mothers should exhibit more symptomatology (i.e., have poorer adjustment) than the children of nondepressed mothers. For the present analyses, adjustment was assessed by examining separately the outcome measures from the DICA and the CBCL. Social support was assessed by adding together each child's values for various elements of support, yielding a Total Support score. Mother diagnosis was entered in the first block of the regression equation, Total support was entered in the second block, and the interaction between these two variables was entered on the third block. If the addition of the interaction term significantly increases the amount of variance accounted for (i.e., the R2 change), then the buffering hypothesis is supported. The relationships between stress, Total Support, and adjustment are presented in Table 16. v-. 1 ,D F” F’. E: ‘O‘ . of; Die Hot Re; Die Fat Rap ‘2 “i 96 Table 16 ,,_ ,- D 010; - ’0 o -_ “ to. o g ' a o. R2 Change R3 Change R2 Change 1,0. _',U"o 14- z 1:, '. 9 - 00° 4 -. '4 Total Behavior Problems .24*** .10** .00 Total Internalizing Problems .35*** .04 .00 Total Externalizing Problems .15** .13** .00 Diagnoses- Combined Report .06 .02 .00 Diagnoses- Child Report .01 .01 .01 Diagnoses- Mother Report .19*** .02 .01 Diagnoses- Father Report .04 .00 .00 M1. it! DS 99] 97 Post-Hoc Analyses. Results from earlier analyses indicated that only certain elements of social support were related to specific adjustment measures. Based on these findings, it was thought that social support may be better understood as a multidimensional rather than a unitary construct. Therefore, Hypothesis 13 was reanalysed, using separate elements of social support rather than a Total Support Score. Mutiple regression analyses were performed to determine if total number of supporters, satisfaction with support, amount of emotional support, frequency of contact with supporters, or amount of shared contact with supporters act as a buffer between the stress of being cared for by a depressed mother and psychological adjustment. There were no significant interactions between stress and support element for any of the adjustment measures; therefore, the buffering hypothesis was not supported. Discussion The purpose of the present study was two-fold. The first goal was to delineate the social network characteristics of the offspring of depressed mothers, and compare these characteristics to those of the offspring of well mothers. It was predicted that the social support networks of children whose mothers were depressed would be smaller in overall number and more restricted in composition than the networks of children whose mothers were not depressed. These differences would reflect the disordered social relationships that appear to be characteristic of children living with a depressed mother. The second goal of this study was to determine the nature of the relationships between children's social support networks and their psychological adjustment. It was predicted that the elements of support would be inversely related to measures of childhood psychological functioning. It was also predicted that particular elements of social support would be more strongly related to adjustment than other elements. The existence of these relationships would lend support to the findings of other researchers indicating psychological disturbance in the offspring of mothers with depression, as well as begin to understand the contributing factors to this disturbance. 98 are whit sat} 99 DWW The findings from the present study indicate that there is considerable variation in the social support networks of children of both depressed and nondepressed mothers. The variation exists in terms of how many supporters they report in their networks, what types of supporters they report, the different sources of support they describe, how often they are in contact with their supporters, the frequency with which they initiate contact with their supporters, and how satisfied they are with the support they receive. It is striking, however, that there were no significant differences between children of depressed and nondepressed mothers on any of the above elements of support. From the descriptive analyses, the only significant finding was that older children had more peers in their networks than younger children, regardless of maternal diagnosis. This finding is in keeping with much past research (e.g., Kriegler, 1987) which also found that as children approach and move through adolescence, they rely increasingly on peers for support. If the absence of significant differences between the children of depressed and nondepressed mothers can be taken at face value, then it is in direct conflict with much of the literature on the offspring of depressed mothers. The literature indicates that children who are raised by a depressed mother are more socially withdrawn (e.g., Welner et al., 1977), and have particular difficulty with po as we to. It Va 100 interpersonal relationships (e.g., Billings & Moos, 1983; Weissman et al., 1984). If social support is an indicator of how well a child is functioning in his/her social world, then on the basis of this study, the children of depressed mothers appear to be functioning socially on the same level as children whose mothers are not depressed. However, the literature on the offspring of depressed mothers has focused largely on the adjustment of infants and toddlers. The result of this focus is that there is little data on the adjustment of these children as they grow older. It is possible that the children of depressed mothers lag behind as toddlers, but then ”catch up" socially to the children of well mothers. It is also important to take into account the methodological shortcomings of the above cited research. It is possible that their results cannot be taken at face value. It is possible that methodological issues could account for the discrepancies between this study and previous studies. One such issue involves the use of a self-report format to assess social support. While such questionnaires are widely used in the study of both children and adult's social support networks, there are problems with this technique. Because such a questionnaire is subjective rather than objective in nature, it is difficult to ascertain the intent and motivations of the person completing it. On the C880, a child could be actively O-C Ch loo 50 101 lying, in order to create a favorable impression, or to portray his/her social world based on how (s)he wishes her network to be, rather than how his/her network really is. In addition, children often have difficulty understanding and/or expressing their feelings. Younger children especially may not possess the necessary awareness or understanding of the complex nature of their social environment to complete the questionnaire in a way that accurately reflects their social network. It is also possible that the children of depressed mothers and the children of well mothers have different expectations of what constitutes supportive behavior. The children of depressed mothers may come from such socially impoverished environments that what seems very supportive to them may appear minimally supportive to children of well mothers. Such differing expectations are obscured by the use of a self-report instrument such as the C880. Conversely, there are also advantages to using self- report measures. Other individuals, such as parents, are influenced by the same demand characteristics as their children, and may respond based on their own individual motivations. In addition, adults do not always possess a sophisticated understanding of their own feelings, let alone their children's feelings. Further, parents may simply not possess the knowledge to adequately rate the quality of their children's interactions, many of which occur away from 102 home and from their direct observation. Therefore, children may, in fact, be as good if not better reporters of their experience of social support as their parents. Based on the above discussion, future research should seek to augment and clarify information on network characteristics acquired from one only source of data. In addition to children's (or parents') reports of their networks, data from naturalistic observation, from peer reports, and/or from teacher ratings would help set to rest the questions that arise from relying solely on one source of data. In addition, questionnaires focusing on supportive behaviors rather than on network characteristics may more accurately reflect the hypothesized differences between these two groups of children. Another potential methodological complication involves the demand characteristics of the laboratory setting. The naturalistic "apartment” was designed to put families at ease, so that they would behave as they would in their own homes. However, they were aware that their behavior was being monitored. It is difficult to determine the degree to which individuals' responses were reflective of their feeling "at home", perhaps more able to admit to negative aspects of themselves, or feeling as if they needed to portray themselves as "normal". In addition, the liaison between the project and the families was a woman with whom these families maintained a relationship, albeit into M 103 intermittent, over many years. Again, family members may have felt close enough to her to more freely admit to difficulties, or conversely may have felt the need to hide problems from her for fear of disappointing her. While one can rarely remove all such demand characteristics from a setting, it is important to be aware that they do exist and serve as possible sources of influence. BWLMWWW Overall, two types of analyses were performed to examine the nature of the relationships between children's social support and their psychological adjustment. Correlational analyses were performed to determine whether such relationships existed. Then difference scores between correlations were computed to determine whether some elements of support were stronger predictors of adjustment than other elements. Correlational Analyses As predicted, significant relationships were found between many elements of social support and many measures of adjustment. These relationships were largely inverse in nature, in that the more of each support element a child reported, the fewer psychological problems were reported for that child. However, not every element of support was related to a measure of adjustment, and different elements were related to different indicators of adjustment. First, it appears that the more peOple a child considers to 104 be in his/her support network, the less likely it is that (s)he will exhibit psychological disturbance. It is possible that the more supporters children have, the greater variety of information and viewpoints to which they can be exposed. Such exposure can broaden children's knowledge base and endow them with a greater understanding of the diversity of human experiences. However, it appears that ”too much of a good thing" can be harmful. Contrary to predictions, the more frequently children were in contact with their supporters, the more psychological problems they had. This finding could be explained by the as yet largely unexplored influence of negative social support. Previous research has generally neglected to consider that support may impede, rather than foster, adjustment (Cauce, Felner, & Primavera, 1982). Findings from the present study indicate that distinct elements of social support may have different kinds of relationships with children's psychological health. The differential nature of the relationships between poBitive and negative social support and adjustment may also e"‘Dlain the finding that the more companionship supporters children reported, the poorer their adjustment was. While n°t predicted, this finding is not surprising. Peer pressure and the desire to conform is of increasing tieVelopmental importance during late childhood and early atlblescence. The more children spend time with peers, the 105 more they will be persuaded to test limits and engage in undesirable behaviors; so while they feel competent and supported socially, their adjustment suffers. The present study did not examine the relationships between proportion of peers in a network, companionship support, and psychological adjustment; this may prove a worthwhile area for future research. For emotional support, in contrast, higher levels of support were associated with lower levels of psychological disturbance. Therefore, specific types of support appear to have different relationships with children's adjustment. These findings underscore the importance of examining social support, not as a unitary phenomenon, but as a mult id imens ional construct . As different types of support are associated with various levels of psychological adjustment, so too are different sources of support. As predicted, the younger and Older children in this sample differed with regard to relationships between source of support and adjustment. However, the actual differences obtained were not those pl'edicted. For younger children, the more support they IreC=eived from parents, siblings, and peers, the less psYchological disturbance they exhibited. For older children, the more support they had from siblings and other ad“Its, the better their adjustment. The relationship between parental support and adjustment for younger children [3‘ im 106 was as predicted, and is in agreement with previous research findings (e.g., Kriegler, 1987) indicating the importance of parental support for younger children. The strong relationships between adjustment and sibling support for both groups of children were not predicted. Siblings can be considered either family support or peer support depending on the needs of a particular individual. Prior research noting the significance of family resources for children (e.g., walker & Greene, 1987) does not distinguish between types of family support (i.e., parental versus sibling support). Therefore, for younger children, support from siblings may be as important a resource, if not more important, as parental support. For older children, there is controversy in the literature over the relative importance of family versus Peer support. Some researchers have stated that the 1".portance of family support does not necessarily decline as Children approach adolescence (e.g., Walker & Greene, 1987). Consistent with this line of research, siblings are simply an extension of family support, as with younger children. other researchers have found that peers have been shown to be increasingly more important than parents as support sources (e.g., Kriegler, 1987). Based on this research, 31bit ings can be thought of as ”in-house” peers. Future research is needed to clarify the relationships for children be“tween different sources of support and adjustment, as well a: Cr the 107 as to further define these differing sources for older and younger children. Social support appears to be a ”two-way street". As it is important for children to maintain contact with their supporters, it also appears important for supporters to maintain contact with children. The present study found that the more mutual the initiation of contact with supporters was, the better children's psychological adjustment. This is consistent with research that found that psychologically impaired individuals often receive more support than they give (Leavy, 1983). For psychological health, it seems that children need to give as much as they receive in relationships. Further, satisfaction with support was also inversely related to children's adjustment, in that the more satisfied children were with the support they were receiving, the fewer psychological problems were reported for them. This finding is consistent with much of the literature on chSlldren's social support networks and adjustment (e.g., Barrera, 1981; Unger & Wandersman, 1988) that finds a strong asSocietion between satisfaction with support and several measures of psychological well-being. It is clear then, that children's subjective appraisal of their support is a crucial factor in their psychological adjustment. Finally, consideration must be given to the possibility t"at: good psychological health provides children with the 108 skills necessary to seek out and establish supportive relationships, rather than supportive relationships providing the basis for good mental health. Because much of the present research is correlational in nature, the direction of the association between support and adjustment cannot presently be ascertained. Future research should seek to clarify the mechanisms of influence that account for the relationship between social support and psychological health. Outcome Measures Results from the present study indicated that social support was associated with only some measures of psychological adjustment, and different elements of support were related to different outcome measures. The outcome measure most often related to elements of support was Total Externalizing Behaviors. DICA diagnoses based on mother report, Total Internalizing Behavior Problems, and DICA diagnoses based on child report were next most likely to be associated with support elements. DICA diagnoses based on father report were not correlated with any element of social support. It appears that, to some extent, how much an outcome measure was related to support depended on who reported on children's diagnoses and behavior problems. The lack of association between fathers' reports and support could indicate that fathers are less "tuned in” to the 9:: C0} CO C! 109 psychological worlds of their children. This explanation is consistent with the still present societal view that fathers concern themselves less with the emotional lives of their children than mothers. On the other hand, there were strong associations between CBCL Internalizing and Externalizing Behavior Problems, and DICA diagnoses, both reported by mothers, and all elements of social support. Depressed and well mothers appear more aware of their children's psychological health and their interpersonal relationships than fathers. Based on these results, it seems as if mothers and fathers may have different roles in their children's lives regardless of maternal psychiatric status, with mothers maintaining closer proximity to their children's social, behavioral, and emotional development. Sex and Age Differences In order to better understand the nature of the correlations between social support and behavior problems, analyses were performed to examine the relationships between support and the individual behavior problem scales. There were sex as well as age differences present. For girls ages 8-11, social support was correlated with social withdrawal, somatic complaints, hyperactivity, and sex problems. These findings are consistent with research indicating that women place greater value in maintaining close interpersonal relationships characterized by emotional sharing than men (Brehm, 1985), and that the importance of relationships is Cl 1a PS) fhr 110 closely related to their psychological functioning. However, the symptoms associated with social support are on the mild to moderate side of both the internalizing and the externalizing continua. It seems that social support is associated with less serious psychological problems for younger girls. Upon examination of the relationships between social support and psychological adjustment for adolescent girls, the picture is somewhat different. Social support was correlated with more problems, as well as more serious problems, including depressed-withdrawal, anxious-obsessive, immature-hyperactive, aggressive, delinquent, cruel, and schizoid. As with younger girls, these problems represent both internalizing and externalizing disorders; however, the problems reported for adolescent girls appear to reflect a greater degree of pathology. The results from the present study support the existence of a stronger relationship for older girls between social support and psychological disturbance than for younger girls. It is also possible that there may be a developmental component influencing the relationship between social support and levels of psychological problems for girls. It may be that lower levels of social support when girls are latency aged is associated with a mild to moderate degree of psychological symptomatology. As girls move into and through adolescence, social support may be a more crucial ietermi girls, acre 3 girls their nature adJUS' condu lenta lore iqqre reiai and 1 be 31 Symp‘ ti’pe: diff. girl; Exhii Socia 0ther bOys I Sven a 1982). 111 determinant of psychological health than for the younger girls, such that lower levels of support are associated with more serious psychopathology. It may be that the more years girls live with lower levels of social support, the worse their psychological health becomes. In order to clarify the nature of the relationship between social support and adjustment for girls, longitudinal research must be conducted to determine the patterns of social support and mental health over time for girls at different ages. For boys ages 8-11, social support was correlated with more externalizing disorders, such as uncommunicative, aggressive, hyperactive, and delinquent. Support was related to two internalizing symptoms, obsessive compulsive and somatic complaints. Thus, while social support seems to be somewhat more strongly related to psychological symptomatology for younger boys than for younger girls, the types of symptoms exhibited by boys and girls appear to be different. However, this is consistent with findings that girls tend to exhibit more internalizing symptoms, and boys exhibit more externalizing symptoms. For boys ages 12-16, there were no correlations between social support and any of the behavior problem scales. Other researchers have found associations for adolescent boys between social support and some measures of adjustment, such as self-concept (e.g., Cauce, Felner, & Primavera, 1982). However, it has not yet been clearly established 112 that social support is an important contributing factor to their levels of psychiatric diagnoses or behavior problems. It may be the case that social support is not as important to adolescent boya' psychiatric symptomatology as other factors, such as genetic predisposition. Developmentally, the role of social support appears to decrease for boys as they approach and move through adolescence. Thus, it appears that social support may be differentially related to psychological symptomatology as a function of children's age and sex. While some researchers have found that the relationships between social support and total number of psychological symptoms did not differ for boys and girls (e.g., Compas et al., 1986b), there has been little investigation of whether differences exist for the ‘ types of symptoms reported for boys and girls. However, these results must be interpreted with caution. The small number of children in each group limits the generalizability of the findings. Further, these age and sex groupings were established based on the results of factor analyzing the CBCL. It may be the case that such groupings are not meaningful for understanding either DICA diagnoses or social support. Future research should continue to examine social support from a developmental perspective, as well as to establish whether differences exist for boys and girls. 113 Prediction of Adjustment Beyond establishing that relationships existed between social support and psychological symptomatology, a goal of this study was to determine whether particular elements of support predicted adjustment better than other elements. Satisfaction with support, as hypothesized, was a better predictor of DICA diagnoses based on child report than frequency of contact with supporters, source of support, type of support, and initiation of contact with supporters. However, satisfaction was not a better predictor of any particular measure of adjustment. Further, no other element of social support was a stronger predictor of adjustment. In addition, support from siblings was a significantly better predictor for older children of Total Externalizing Problems than support from peers. However, sibling support was not more strongly predictive than other support sources of the remaining measures of adjustment, nor were any other support sources more predictive of the various measures of adjustment. To summarize, the results from the present study indicate that certain elements of social support are significantly related to specific aspects of children's psychological adjustment. In addition, the strength of the relationship between support and adjustment changes as a function of children's age and sex. 114 The Buffer Hypothesis The majority of significant findings to this point lend support to the direct effect model of social support, in that the more support children have had, the better their adjustment has been (i.e., the fewer psychiatric symptoms they exhibit). One hypothesis was designed to test the buffer hypothesis, to see if social support moderates the relationship between the stress of being cared for by a depressed mother and positive psychological functioning. The present study did not find support for the buffer hypothesis. This lack of results is not surprising, as the evidence in the literature in favor of the buffer hypothesis is inconsistent at best. One explanation for the lack of support for the buffer hypothesis is that, for some adjustment measures, there was no relationship between the stress of being raised by a depressed mother and psychological adjustment. Specifically, for DICA diagnoses from child report, father report, and combined report, stress did not significantly predict level of symptomatology. Without a relationship between stress and adjustment, the buffer hypothesis cannot be tested. However, relationships were found between stress and adjustment for the other adjustment measures, without demonstrating support for the buffer hypothesis. Another explanation for this failure to find evidence for the buffer 115 hypothesis is that perhaps examining social support as a unitary phenomenon was not the proper level of analyses. Based on results discussed earlier, the present study found that only certain elements of support were related to adjustment. However, analyzing the elements of social support individually did not yield results in favor of the buffering hypothesis. A different explanation for the nonsignificant findings focuses on the way in which social support was conceptualized in this study. Several researchers (Cohen, Mermelstein, Kamarck, & Hoberman, 1985; Kessler & McLeod, 1985; Procidano & Heller, 1983; Wethington & Kessler, 1986) have concluded that social support shows a more consistent stress-buffering effect when the 9919991199 of available support, rather than the support actually receivgg, is highlighted. The present study focused on received support rather than perceived support, what children reported they actually acquired in the way of tangible support rather than what they hoped or expected to acquire. Future research should continue to investigate the stress-buffering role of social support by focusing on children's perceptions of the availability of support. W There are several methodological issues inherent in the present study that may have influenced the outcome of the findings. First, the difficulties inherent in interpreting 116 a self-report measure such as the CSSO have already been addressed. Problems also exist with the two outcome measures used. The CBCL is a highly respected and widely used assessment of childhood psychopathology. One of its strengths is that it has been statistically derived; however, this is also one of its weaknesses. While the items chosen for each factor make sense statistically, they often do not make sense intuitively. For example, the factor Sex Problems for girls ages 6-11 consists of 'sex preoccupation', 'sex problems', and 'plays with sex parts too much', as well as 'prefers older children', 'feels guilty', and 'excess talk'. Although items for other factors, such as Delinquent, make more intuitive sense, there is variability among the different factors as to how well the individual items actually "fit” the factor under which they were statistically placed. Further, the same item may load on different factors depending on the age and .sex of the child. For example, the item 'suicidal talk' lloads on the Depressed factor for boys ages 6-11, but loads (on the Schizoid-Obsessive factor for girls ages 6-11. flPherefore, interpretations based on these factors, often to [plan intervention strategies, can be risky, because the name taf the factor does not necessarily represent the types of problems implied by that name, and represent the same thing for all children. intrin: leasur as we) lenta quest Sympt Whet) in ad valid disor an ad a tru DSM c “Nder: Categt Dirtic F°f ex did9no Disord. 117 The DICA was chosen to help offset some of the problems intrinsic in the CBCL. It was thought that having both measures would allow for information from several sources, as well as possess different psychometric properties. The DICA, like the CBCL, is a widely used measure of childhood symptomatology and diagnoses. The various diagnostic categories are clinically, rather than statistically, derived. However, the DSM-III-R, the diagnostic system upon which the DICA is based, was established to understand adult mental illness. Similarly, the DICA is based on a questionnaire developed to assess adult psychiatric symptomatology. However, it has not yet been established whether psychopathology in childhood mimics psychopathology in adulthood. Questions therefore can be raised about the' validity of the DICA for assessing childhood emotional disorders. It is possible that because the DICA is based on an adult classification of psychological symptoms, it is not «a.true measure of psychological problems in children. Further, there is considerable debate as to whether the I>SM classification system is the most meaningful way to landerstand and quantify mental illness. Diagnostic crategories often overlap and share symptoms, and a £>articular symptom can be present in a number of syndromes. lPor example, depression is an important component in several (liagnoses, and can range from the more mild Adjustment l>isorder with Depressed Mood to the more severe f: 5! 90m 118 Schizoaffective Disorder. In addition, the DSM system is culturally-based, and its method of classifying behavior may not be relevant to populations whose cultures are divergent from here in the industrialized west. Future investigation should seek to better understand and describe the unique aspects of individuals with psychiatric disorders rather than attempt to fit them into neat diagnostic packages. In addition to problems with the instruments used to assess childhood functioning, there are problems with the actual sample assessed. First, the sample consisted largely of middle and upper-middle class, intact families, and thus is clearly not representative of the population at large. There was one black, low 883 family in the depressed group, while none of the families in the control group were of the same SSS; given the small sample size, the inclusion of this family could represent a source of bias. In addition, the number of subjects used is too small to ensure both reliability and validity of the findings obtained. Further, in order to meet inclusion criteria, the depressed nnothers had to be non-hospitalized, as well as be free of antisocial personality disorder or drug abuse at the time of entrance into the study. This profile of maternal depression may not be representative of the population at l-arge. Similarly, the normal volunteers had to be free of alnypsychopathology. It is not clear that the 'normal' E>opulation is pathology-free. Thus, the findings obtained 119 for the present sample may not be generalizable to the larger population. Finally, problems exist with the design of the present study. The analyses that sought to establish a relationship between social support and psychological adjustment were correlational in nature. Therefore, the directionality of the relationship cannot be verified, nor can causation be determined. The causal links between support and psychopathology cannot be ascertained. Future research must establish whether social support is a leading influence in children's mental health, or whether other mechanisms are responsible for the link between support and adjustment. In addition, due to the large number of hypotheses examined, many analyses were performed. According to the Bonferroni principle, it is possible that some of the significant findings were obtained based on the number of analyses performed rather than on the actual data. In the present study, 421 separate analyses were performed, and 53 c>f those analyses reached significance at the .05 level of Significance or better. Given the number of analyses, it is Ilikely that a proportion of the findings significant at the -.05 level are spurious, and should be interpreted with Czaution. Further, the present study used a cross-sectional Ciesign. Again, the causal connections between maternal (lepression, social support, and psychological adjustment 120 cannot be clearly understood. Studies employing a longitudinal scheme must be undertaken in order to determine whether the relationships between maternal diagnostic status, social support and psychological symptomatology are different for children at different points in their development. Conclusions The present study sought to examine and clarify the role that social support plays in maintaining healthy psychological functioning in the children of depressed and well mothers. The first striking result was that no differences appeared between the children of depressed and well mothers on any element of support. If the findings from past studies which document deficiencies in the social and emotional worlds of the offspring of depressed mothers are correct, then it may be possible that the children themselves do not perceive that they are receiving any less support than the children of nondepressed mothers. They may believe that the amount and quality of support they receive is ”as good as it gets”. However, when the two groups of children were combined, the findings provided evidence in favor of a direct effect mOdel of social support, whereby the more support children had, the better their adjustment was. The more supporters in children's networks, the more mutual the support was, and the more satisfied children were with the support they rScreived, the less psychological disturbance they had. Fulrther, emotional support was more strongly related to Poasitive mental health than either tangible aid or 1"lEormation and advice support. Support from siblings was ‘31:: source of support most strongly related to positive 121 122 adjustment, even above support from parents and peers. It is clear, then, that the different elements of social support do not appear to be of equal importance in the Inaintenance of children's psychological health. Further, the presence of social support was not always associated with fewer symptoms, and the role of social support was not consistent for subgroups of the sample. The more often children were in contact with their supporters, and the more companionship support they had, the poorer their adjustment was. In addition, the strength of the relationships between social support and adjustment varied according to children's age and sex. There was no relationship between any element of support and adjustment for adolescent boys, while associations were found between support and mild to moderate psychological distress for both younger girls and boys, and stronger relationships existed between support and moderate to severe psychological disturbance for adolescent girls. Finally, the failure to consistently find an element of support that more strongly predicted children's adjustment than any other element was unexpected. It may be the case that, for children, having different types of support available rather than relying only on one type fosters the best psychological adjustment. The finding that only certain elements of social support were predictive of adjustment also suggests the possibility of another variable 123 ear variables that serve to influence the support-adjustment :relationship in this sample of children. The findings from the present study have implications for intervention and prevention with children who are deemed to be at risk for developing psychological disturbance. Increasing family support, especially sibling support, would seem to be of particular importance. For example, family therapy could work on strengthening sibling alliances as a means of reversing current symptoms or warding off future symptoms. Group work with sets of siblings using a peer counseling model could facilitate the development of social skills and mutual understanding as well as fortify sibling bonds. Whatever the method, the emphasis would be on strengthening supportive relationships to foster children's healthy psychological adjustment. It is also clear from the present study that what constitutes problematic adjustment and what works to foster positive adjustment may be dependent on children's age and sex. Intervention strategies must be tailored both to the specific problems children are experiencing (or are at risk for experiencing) and to their particular stage of development. Future research should continue to explore which elements of support are related to which types of psychological disturbance, as well as ascertain the existence of variables which are responsible for the support-adjustment link in children. 124 It is clear, then, that social support continues to be Jbest understood as a complex construct whose impact on (children's emotional health must be evaluated as a function of the nature of the support being provided as well as the characteristics of the person who receives that support. ‘Methodological issues, such as generalizability of the present sample and psychometric properties of the instruments used to assess social support and psychological adjustment, limit the generalizability of the conclusions drawn. However, the results of the present study can serve as guidelines for future research. Investigators need to continue to search for methods to promote healthy psychological functioning in children who are raised by depressed mothers, as well as determine the mechanisms which serve to protect some of these children from developing any type of psychological symptoms. The role that supportive relationships play in the evolution of emotional disturbance in children is one factor which researchers should consider in order to help answer these questions. Appendix A Children's Social Support Questionnaire (CSSO) 125 CSSQ Date Subject ID **Directions: We would like to know about the people that are important to you. There will be some questions, with blank lines after them. For each question, write the names of family members, relatives, friends, or ot er peon e on know who best answer the question. You may write up to 10 different people for each question. nggtigg £1: Who do you hang out with (for example, at their house, your house, around the neighborhood, at school, etc.)? Question 5;: Who do you think are fun peOple to talk with (for instance about things you like to do or T.V. shows, etc.)? Questign_£1: When you go to movies, parties, video arcades, etc., who do you go with? 126 ngsgion #5: Do you belong to scouts, clubs, etc., or do you do other activities with kids your age? IF yes, who are your friends at these activities? Question £5: Who gives you information or advice about religious things, like church or synagogue or god? Qggsgign_£§: Who gives you information or advice about personal things (for example, problems between you and your parents, how to make friends, etc.)? 127 99953199 #7: Who teaches you how to do things (for example, fix a bike, play a game, cook, make extra money, etc.)? Qggggign_fi§: Who talks to you about fun things to do (for example, what is a good movie to see, what is a good record to listen to, what is a good book to read, etc.)? Questiog £2: Who can you count on to help you do things that need to get done (for example, homework, fixing a toy, chores, etc.)? 128 Question #19: Who takes you to places you need to go? Quesgion #11: Who lets you borrow a little bit of money if you need it (for things like a coke, some candy, a video game, etc.)? ng§5i29_£lz: Who lets you borrow something from them if you need it (like a sweater, a jacket, a toy, a record, a book, etc.)? 129 Quesgigg £13: Who listens to you when you need to talk about something personal, something that you want to keep secret or you feel embarrassed about? Question #14: Who makes you feel better when you are upset? u s ' £ : Who cares about you? 130 Quesgion 216: Who can you really count on to always be there for you? :‘A **Directions: For the next 5 questions, circle the number next to the best answer. Question £i7: Everybody has arguments or fights sometimes. Who do you think you argue or fight with the most? 1. my mother 2.. my father 3. my sister - write name and age 4. my brother - write name and age 5. another relative - write name and relation 6. a friend in my neighborhood - write name and age 7. a friend at school — write name and age 8. another adult - write name and who it is ngsgion £18: Who do you think you argue or fight with the second most? 1. my mother 2.. my father 3. my sister - write name and age 4. my brother - write name and age 5. another relative - write name and relation 6. a friend in my neighborhood - write name and age 7. a friend at school - write name and age 8. another adult - write name and who it is 131 Qngg;inn_1i2: Who do you think you argue or fight with the least? 1. 2.. 3. 4. S. 6. 7. 8. my mother my father my sister - write name and age my brother - write name and age another relative - write name and relation a friend in my neighborhood - write name and age a friend at school - write name and age another adult - write name and who it is Question ggg: When there are fights or arguments in your house or at school or with your friends. what part do you usually play in them? 1. I usually do not take part in arguments or fights. 2. I usually start arguments or fights. 3. I usually take part in arguments or fights, but I do not start them. 4. Sometimes I start arguments or fights, sometimes I do not (about 50-50). 5. I usually try to make peace, calm everybody down. 6. I usually go to my room or outside or away from whoever is fighting. Qgg§5i9n_£;;: How do most arguments or fights that you take part in get worked out or settled? 1. I am the one who usually settles or works things out. 2. The person/people I am arguing or fighting with usually settles or works things out. 3. We usually work things out together. 4. Things do not get settled or worked out. b” v 3 0 E. - ¢ - ‘L n a ‘- - .d ’ .. .' e-u 2 " I A ‘2’fl‘- 00-....- §.‘-. :‘flflflb- 0:0“ «a- -- .I -.- levzuau z . v. - ‘0“ '00.. :2: “n - .- u an 5‘ -‘t a “ a. a L C.. y I“) 8 on» C p g. . O O . . Ina-NH ... on u I U C u p 3 s s "' u. 5 . C C c U 5 r a 3 Fl- . C G g 20‘0'8' :xgzgx 3:: 3 to: C - s=s~s~s§ :5 3 2 s O ‘O‘G‘U 5 -...... £3‘-Ualfl& A a L " U 8 «I U 0“ $8 2:: C IOU-GI 6 age -.. 0° ‘2 0.. a 0 H ‘d .0. O O‘- -1 h 00. “-— u- v.05 3‘ - 3 .00: “:3... U \ 3 .‘- ‘5§. L“.- m. 3" > Eden-95 GUn—z has 0.00 son. flhdo-uv-ogug "82050053“: “3 ‘KZUS O“ 2:.0 O O . 36—Nfl'm0‘ h .- C y a" h- In C C 3- 132 NNNNNNNNNN 8‘ —’~—’—’p"'”--'p’“- l i N. N. 1‘. '7. II. l8. n. L It 9 G 0 Q '- 9 § 85 a 0‘ ‘v- - .00 I ’0 n b. g -L - ..--.2- fine-av :‘euusug .::*-*~- .- _ . 8.92.03.- 3 a v. . -.uu would ...—u 8“ 0-2: an L‘ -6}. U h .005 a I. I-“ 0 not, 8 > C p :- ee 0 e Zinc-NH wen A H Q .0 U U 0" C d L s s U u. 5 .. r 3 § 3 e 3 & h. C C C 8 one-Inge «3600: I. I o e- .- en“ ”a- e! U. C C an 3 a ...-30005; fine-D D O gala-vb Dav-2 hub ..00 ~00 “~u——-4°U£O CG£CLU°LSU‘ “a CKZU& Gd .8 ‘Oeeee sa—unvmo N p. C p i“ h L O C p 1" Hue 133 in < ~~~~~NN~NNNNNN~ unmet. ‘<< ppp—pppppp—pp—P"-—-'-'I Appendix B Diagnostic Interview for Children and Adolescents-Revised (DICA-R) 3 131+ INTERVIEHER: (CIRCLE ONE) PERSONAL INTERVIEN.........I TELEPHO"E INTERVIEHCOOCOOOOZ OICA-R-C DSM—III-R VERSION DECEMBER. 1988 REVISED VERSION OF DICA FOR CHILDREN AGES 6-12 WENDY REICN. PH.D. ZILA HELNER, N.D. WASHINGTON UNIVERSITY DIVISION OF CHILD PSYCHIATRY 4940 AUDUBON AVENUE ST. LOUIS. NISSOURI 63110 (314) 362-2436 INTERVIEHEWS NAME DATE 0F-INTERVIEH TIME STARTED TINE ENDED Quashington University. 1988 DRAFT S-R 135 JOINT INTERVIEW GENERAL INFORMATION In this interview I am going to ask you a number of questions about yourself. Things like what you like to do and how you feel about different things. I'd like to also ask you some questions about your family. your friends and about your school. Okay? Listen now because this is really important. If i ask you a question that you don't want to answer; Just say that you don't want to answer that question. and we'll skip to the next one. (It is important, however. that you answer the questions as truthfully as possible. and remember I won't tell anyone what you tell me - not even your parent(s) unless, like I told you before. if we find out that somebody might be getting hurt. The information you give to us is confidential - that means that no one will know what you've told me DEMOGRAPHICS 1. Sex (OBSERVED) ”LEOCOOOOOCOOOI FEMLEOOOOOOOOOZ 2. Race (OBSERVED) CAUC‘SIMeeeeeeeeeeeeeeeel BLAC‘eeeeeeeeeeeeeeeeeeeez HISPMICeeeeeeeeeeeeeeeee3 ORIENTALeeeeeeeeeeeeeeeee‘ “ “ERICA" INDIANeeeeeeeeees 0THER(SPECIFY) 5 3. How old are you? 6. 136 Hhen is your birthday? Hhat grade are you in? (PROBE: HHAT GRADE DID YOU JUST FINISH? HHAT GRADE HILL YOU BE STARTING IN THE FALL?) KINDERGARTEN - 55 NOTE TD INTERVIEUER: IF SUMNER OR CHILD NOT IN SCHOOL. CODE LAST GRADE COMPLETED Can you tell me how many people live in your home at the present time? Can you tell me who they are? RECORD AGES NEXT TO NAME AND RELATIONSHIP TO CHILD(REN) IF IF Do you have any brothers or sisters who live away from home? NO. SKIP T0 0.9 YES. CONTINUE: How many brothers and sisters do you have that live away from home? 137 THE BEHAVIOR DISORDERS: Coding NOOOOOOOOOOOOOOOOIOI YESOOOIOOOOOIOOOOOOZ SOHETIHESOOOOIOOOOO3 INTRODUCTION: Child In this section I will ask you mostly about how you get along with your family and friends and what school is like. NOTE TO INTERVIEHER: THE CODING THROUGHOUT THE INTERVIEW IS: cons FOR '1 now know- - B ATTENTION DEFICIT - HYPERACTIVITY DISORDER: STANDARD PROBES Do you get in trouble for that over and over? Does your New (or the teacher) speak to you a lot about that? Has the teacher spoken to your Now about ? Has the teacher/school sent a note home? Do you think this is a big problem for you? I mean would life be a lot easier for you if this wasn't happening? A. ATTENTION DEFICIT - NYPEIACTIVE DISORDER I3. Hhen you're in school. do you have trouble sitting in your seat fer a long time? (PROBE: IN THE CLASSRODN IS THE TEACHER ALHAYS TELLING YOU TO GO BACK TO YOUR SEAT?) 14. Are people always telling you to sit still or to stop movi ng or squirming about? (PROBE: FIDGETING IN YOUR SEAT. PLAYING HITH YOUR HANDS AND FINGERS - JUST NEVER ABLE TO SIT STILL?) 15. 16. 17. 18. 19. 20. 21. 138 Is it hard for you to play quietly. either by yourself or with other kids? (PROBE: ARE PEOPLE ALHAYS TELLING YOU THAT YOU'RE TOO NOISY AND THAT YOU ARE ALHAYS RUNNING AROUND. OR THAT YOU NEVER PLAY OUIETLY?) Do people tell you that you talk all the time or that you never stop talking? Hhen you're playing by yourself or with other kids, would you say that you get restless pretty quickly and want to move on to something else? (PROBE: DO YOU GET TIRED OF DOING ONE THING EVEN IF THE OTHER KIDS DON'T HANT TO STOP? --OR-— DOES YOUR HOTHER OR DO THE OTHER KIDS TELL YOU THAT YOU NEVER STICK HITH ONE THING? Hhen you do your schoolwork or your homework. do you often find that you are daydreaming. or thinking about something else? (PROBE: DOES THE TEACHER COHPLAIN THAT YOU DON'T FINISH YOUR HORK?) Do you have problems in school because even after the teacher explains the lesson to you. you're still not sure what you're supposed to do? (PROBE: IS IT EASIER TO 00 YOUR HORK IF SONEONE LIKE A PARENT OR A TEACHER SITS DOHN HITH YOU AND EXPLAINS HHAT TO DO HHILE YOU ARE DOING IT?) Do you find that it's hard to keep your mind on your work when there are other things are going on in the same room? (PROBE: LIKE HHEN OTHER KIDS AROUND YOU TALK IN CLASS, OR IF YOU HEAR NOISES OUTSIDE?) Do people complain or get mad because you interrupt them or butt into conversations or games? 22. 23. 24. 25. 26. 27. 28. 139 Does the teacher or do your parents ever say that you start answering a question before they finish asking it? (PROBE: THAT YOU START TALKING BEFORE THEY ARE FINISHED?) Do you find it hard waiting your turn when you're playing with other children or waiting in line? (PROBE: DO YOU GET RESTLESS AND START CLOHNING AROUND OR PUSHING AHEAD IN LINE?) Do people get upset with you for doing dangerous things. like running out into the street without looking? (PROBE: CLINBING UPON THINGS THAT ARE DANGEROUS -OR- CLINBING ON SOMETHING THAT YOU NIGHT FALL OFF OF?) Do people tell you that you're messy or sloppy with your work or in the way you dress? Are you always losing things like pencils. notebooks, or papers from school? (PROBE: ARE YOU ALHAYS FORGETTING TO BRING HONE PAPERS FRON SCHOOL OR INFORNATION. FOR EXANPLE. A NOTICE ABOUT A PTA MEETING, ABOUT THE SCHOOL PLAY, ABOUT A FIELD TRIP?) Do your parents or teachers ever complain that you're not really listening to thew? IF 2 0R FEHER POSITIVES. 0. 13-27, SKIP TO OPPOSITIONAL DISORDER, O. 34, PAGE 8. IF 3 OR MORE POSITIVES. CONTINUE. How'old were you when you first had these problems that you've just told me about? (PROBE: HERE YOU LIKE THAT IN FIRST GRADE? HERE YOU ALHAYS LIKE THAT?) CODE IN YEARS 29. 30. 31. 32. 33. 140 IF RELEVANT. ASK: How old were you when you first started to get better? Did your Mom (or Dad) ever take you to a doctor because you were having these problems? IF NO. SKIP TO 0.33 [F YES. CONTINUE: Did the doctor give you any medicine to help you with these problems? IF NO. SKIP TO 0.33 IF YES. CONTINUE: Do you know the name of the medicine? RECORD Have these problems started to get better? 1H1 B. OPPOSITIQEAEIDEFIAIT DISORDER: STANDARD PROBES IS THIS A BIG PROBLEM FOR YOU? IS THIS A BIG PROBLEM FOR YOUR PARENTS? DOES IT HAPPEN OVER AND OVER? ARE YOUR PARENTS VERY UPSET ABOUT THIS? 00 THE TEACHERS COMPLAIN ALOT ABOUT YOU DOING THIS? 34. A. Do you often argue with your parents. your teachers or other adults? IF NO. SKIP TO 0.35 (F YES. CONTINUE: 8. who do you argue with the most? RECORD C. How often does it happen? EVERY DAY OR AT LEAST ONCE A HEEK.......2 TwICE A MoNTHI......IOOOOOCOOOOOOCO....03 chLE OF TINES A YEAROOIOOOOOOOOOOOOOOO‘ 35. A. Do you often lose your temper or get angry when you can't get people to do things the way that you want them done? IF NO. SKIP TO 0.36 IF YES. CONTINUE: B. How often does it happen? EVERY DAY OR AT LEAST ONCE A HEEK.......2 THICE A MONTH O0....00.000.000.0000000003 COUPLE OF TINES A YEAR..................4 36. A. Do you ever Just refuse to do things that your parents, teachers. or other adults have asked you to do? 142 IF NO. SKIP TO 0.37 IF YES. ASK: Hhat sort of things do you refuse to do? RECORD 8. How often does it happen? EVERY DAY OR AT LEAST ONCE A HEEK ....... 2 TWICE A MONTH ........................... 3 COUPLE OF TIMES A YEAR .................. 4 37. A. Do people say that you do things on purpose to annoy or bug them? (EXAMPLES: --GRABBING ANOTHER KID'S HAT OR NAKING FUNNY NOISES. THINGS LIKE THAT? --ARGUING NITH PEOPLE. PLAYING PRACTICAL JOKES. TEASING PEOPLE (LIKE MAKING FUN OF THEM OR CALLING THEN NAMES)?. IF YES. CONTINUE: B. How often does it happen? EVERY DAY OR AT LEAST ONCE A HEEK.......2 THICE A MONTHICOCOCCCCOO.0000000000000003 COUPLE OF TIHES A YEARCOOOOOOOOOOOOOCOOO‘ 38. Do you you get angry or crabby when people ask you to do things for them? (PROBE: DOES IT MAKE YOU HAD HHEN THEY ASK YOU TO RUN AN ERRAND. CLEAN YOUR ROON. OR 00 SONETNING FOR THEN?) 39. Do your parents. friends or your brother(s)/sister(s) get on your nerves a lot? (PROBE: EVERYDAY OR NEARLY EVERYDAY?) 40. 41. 42. 43. --IF --IF 44. 1143 Hhen someone does something unfair to you. do you try to get back in some mean way. like by saying mean things to them or about them? (PROBE: SAYING THINGS THAT YOU KNOH AREN'T TRUE, BLANING THEN FOR THINGS THEY REALLY DIDN'T DO?) A. Do you swear a lot or use what most people would consider to be bad language even in front of grown-ups? IF NO. SKIP TO 0.42 [F YES. CONTINUE: B. How often does it happen? EVERY DAY OR AT LEAST ONCE A HEEK.......Z wicEAmuTHCOCOICOIOOO0......0000000003 COUPLE 0F Tlnts A YEAROOCOCOOOOOOOOOOOOO‘ Everyone has troubles. problems. or things that go wrong for them. Think about your problems and troubles and tell me if they are mostly caused by peeple messing things up for you or are they mostly your own fault? (PROBE: FOR EXAMPLE, IF YOU GET A BAD GRADE AT SCHOOL, DO YOU SAY THAT THE TEACHER IS NO GOOD, OR THAT THE TEST HASN' T FAIR?) SELF To BLMEOOOO;OOOOIO.1 oTHERS TO BLANE..........2 5m: 0F BMHOOOOOOOOOCOOO3 Do people complain that you bully other children or are mean to them? NO TO 3 DR FElfiR QUESTIONS.Q 34- 43 SKIP TO NEXT SECTION. CONDUCT DISORDER. 0. 45 YES TO 4 OR NORE QUESTIO A. Let' s see. you' ve told me that you (LIST A FEH SYNPTDNS). Are these tfilngs a big problem for you. or for your parents and teachers? (PROBE: DO YOU FEEL THAT EVERYDAY YOU ARE GETTING INTO SONE KIND OF TROUBLE?) B. Has this been going on for six months or more? C. ilihv CONDUCT DISORDER: Host kids do things that get them in trouble with their parents or teachers. I am going to ask you about different ways of getting into trouble. Okay? 45. 46. 47. A. Have you ever been suspended from school? NOTE TO INTERVIEHER: IN-SCHOOL SUSPENSIONS COUNT. IF NO. THEN SKIP TO 0.46 (F YES. CONTINUE: B. How many times has it happened? 4+ TIMESOOOOOOOOOOOOZ 2-3 TIHE5000000000003 ITIHEoeoeoommmeooeo‘ C. Can you tell me why you were suspended? RECORD A. Have you ever been expelled from school (kicked out for the rest of the year)? IF NO. SKIP TO 0.47 IF YES. CONTINUE: B. Can you tell me why you were expelled? RECORD A. Have you ever skipped school (PLAYED HOOKEY/ TAKEN A DAY OFF FRON SCHOOL UITHOUT PERMISSION)? IF NO. SKIP TO 0.48 IF YES. CONTINUE: 48. 49. 50. 51. 1’45 .8. How often have you done that? 6'10‘ TIHESeeeeeeeeeeeeeez 3-5 TIHESoeeoeoooeoeeomeo3 1‘2 TIHESOOOOOOOOOOOOOOO.‘ IF NO TO 0.'S 45. 46. AND 47. SKIP TO 0. SO. IF YES TO EITHER 0.'S 45, 46. OR 47. CONTINUE. How old were y0u the first time y0u ? (were susoended, expelled, or skipped school) How old were you the last time you had any of these problems? A. Have you ever been blamed for cheating in schoolwork ? IF NO TO A. SKIP TO 0.51 A. IF. YES. CONTINUE: B. How often have you done that? 6-10 TIHES..........2 3-5 TIMESeeeeeeeeeee3 1‘2 TIHESOOOOOOOOOOO4 C. How old were you the first time this happened? D. How old were you the last time that happened? A. -Have you ever stolen anything. like money from someone's purse or shoplifted something at a store? B. Have you ever stolen things under any other circumstances? 52. 53. 1H6 IF NO. SKIP TO 0.52 IF YES. CONTINUE: C. How many times have you done this? 6.10+ TIMESeoeeeeeeeemeeez 3‘5 TI"ESeeeeeeeeeeeeeeee3 1'2 TIMESeeeeeeeeeeeeeeee4 A. Do you often lie or make up stories to get Of trouble? (PROBE: LIKE TELLING THE TEACHER THAT YOU HAD A BAD HEADACHE AND COULDN'T DO YOUR HOHEHORK HHEN YOU REALLY JUST HADN'T DONE IT?) B. Do you often tell lies for no reason at all? (PROBE: LIKE TELLING YOUR FRIENDS THAT YOU'VE NET A FANOUS PERSON HHEN YOU REALLY HADN'T - THINGS ‘ LIKE THAT?) IF NO TO A AND B. SKIP TO 0. 53. IF YES TO EITHER A OR B. CONTINUE. C. How often have you done that? 6'10+ TIHES..............2 3‘5 TINESeeeeeeeeeeeeeeee3 1'2 TIMESeeeeeeeeeeeeeeee4 D. How old were you the first time you started doing things like that? E. How old were you the last time? A. Have you ever set any fires that you weren't supposed to set? IF NO TO 0.53A. SKIP TO 0.54 IF YES. CONTINUE: B. How often have you done that? 6‘10+ TIHES..............2 3-5 TIMESeooooeeeemeeeoee3 1'2 TlflESeeeeeeeeeeeeeeee4 54. C. D. E. 11+? How old were you the first time? How old were you the last time it happened? How did it happen and what happened because of the fire(s)? RECORD IF IF ACCIDENTAL...0.00.00.00.01 DELIBERATE...............2 Have you ever run away from home overnight or longer? (MUST HAVE RUN AHAY FRON PARENTAL OR PARENT-SURROGATE'S HOHE HITHOUT LETTING PARENTS KNOH HIS/HER HHEREABOUTS) DESCRIBE: NO TO 0.54A. SKIP TO 0.55 YES. CONTINUE: How many times have you done that? 6'10+ TIMSeeeeeeeeeeeeeez 3'5 TI"ESeooeooeoeeeeeeee3 1‘2 TIMESeeeeeeeeeeeeeeee4 How old were you the first time it happened? How old were you the last time it happened? 55. 55. 1!:8 A. ihve you ever gotten into fights with other kids? (PROBE: FIGHTS NHERE YOU REALLY HIT ONE ANOTHER NOT JUST ARGUHENTS 0R SCREANING MATCHES?) IF NO TO 0.55A. SKIP TO 0.56 IF YES. CONTINUE: B. How often have you gotten into fights with kids? 6'10+ TIMES..............2 3’5 TIMESeeeeeeweeoeeeoeo3 1'2 TIHESeeeoeeeeeeeeeeeed C. Have you ever hurt someone badly in a fight - like giving them a black eye or a bloody nose? IF NO TO 0.55C. SKIP TO 0.56 IF YES. CONTINUE: D. How many times have you hurt someone in a fight? ‘-5 TI"ESeeeeeeeeeeeeeeee2 2-3 TIMESeeeeeeeeeeeeeeee3 l TI"E.................4 IF YES TO ANY FIGHTING. CONTINUE: E. Hho usually starts these fights. you or the other person? OTHER PERSO"....OO.C.OCI.1 SELFIOOOOCOOOOOOOIOOOOI..2 smE 0F 80TH00000000000003 A. Have you ever been in a fight were you've used .something in addition to your hands, such as sticks. rocks, or sharp objects? (Did you ever use a knife or a gun?) RECORD IF NO TO 0. 56A. AND YES TO 0. 55A. SKIP TO 0. 57. IF NO TO 0. 55A AND 0. 56A, SIP TO 0.58. IF YES TO 0. 56A, CONTINUE. 1159 B. How often have you done that? 3* TINES.................2 1‘2 TI"ESeeeeeeeeeeeeeeee3 C. How old were you the first time this happened? 0. HOw old were y0u the last time? 57. Did these problems with fighting last for over six months? 58. A. Have you ever mugged someone or held them up and robbed them? 4 B. How old were you the first time this happened? C. How old were you the last time? 59. A. Have you ever injured a small animal such as a cat. a dog. or a squirrel? (PROBE: TORNENTED A LARGER ANINAL. SUCH AS A HORSE OR CON? DO NOT COUNT ORDINARY INSECT KILLING. FLY SHATTING. SPIDER KILLING ETC. AND DO NOT COUNT HUNTING ACTIVITIES) IF NO TO 0.59A. SKIP TO 0. 60 IF YES, CONTINUE: 60. 61. 150 B. How often have you done that? 2'10+ TIHESeeeeeeeeeeeeeez ITIHE...................3 C. How did it happen? (THE INJURY OR DEATH OF THE ANIMAL) RECORD ACCIDENTAL. UNINTENTIONAL.....1 DELIBERATE. AND CRUEL.........2 D. How old were you the first time it happened? E. How old were you the last time it happened? A. Here you ever so angry with someone that you tried to hurt them in some way? IF NO TO Q.60A, SKIP TO 0. 61 IF YES. CONTINUE: B. Hhat did you actually do? RECORD ACCIDENTAL. UNINTENTIONAL..........1 DELIBERATE. AND CRUEL..............2 A. Have you ever wrecked someone else's property'on purpose? (PROBE: HERE ARE SONE EXAMPLES: (I) BREAKING HINDOHS IN A SCHOOL OR SONE OTHER BUILDING. (2) SCRATCHING A CAR. (3) THROHING ROCKS AT CARS) BOO...O0.0.........OOO.......OCOOOOOOOOOOOOOO0.0... 62. D. 151 How often have you done that? "10 TI"E5...............2 2'3 TIHESOOOOOIOOOOOOOOOO3 ONE TI"E000000000000000004 How old were you when it first happened? How old were you the last time it happened? Have you ever been in trouble with the police or juvenile court? c0...0....0.00.00.00.00.......OOOOOOOOOOOOOOUOOO IF NO. SKIP TO 0.63 A. IF YES. CONTINUE: D. Can you tell me what happened? RECORD E. How often has that happened? . 6‘10+ TI"ES..............Z 3's TIMESeeeeeeeeeeeeeeee3 1‘2 TI"ES................4 152 F. How old were you the first time that happened? G. How old were you the last time that happened? 153 ALCOHOL USE AND ABUSE: 63. A. Have you taken a drink of beer. wine. or other alcohol? (PROBE: DO NOT COUNT SIPS GIVEN BY PARENTS ON SOCIAL OCCASIONS) NOOOOOIOOOOOOIOCOIIII YES’COOOOOOOOOOCOOOOOZ IF NO. SKIP NEXT SECTION: CIGARETTE SMOKING. 0.85 IF YES. CONTINUE: B. How often have you taken a drink without your parents permission? (CODE MOST FREQUENT RESPONSE) EVERYDAY OR A COUPLE OF TIMES A HEEK....2 ONCE ‘ “E‘OCOOOOOOOOOOOOOO.........OOOOS ONCE A mm"..............OOCOCOOOOOCOCCG LESS m“ O’CE A"ONTHOOOOOOOOOOCCCCCOOO7 OTHER 0.0.0.0....8 C. Hhen you do drink. what do you usually have? (PROBE: 'COOLERS.‘ BEER. NINE. HARD LIQUOR?) CDDLERS BEER HINE HARD LIQUOR ‘OTHER 64. 1n51i D. Hhat's the most you drank at one time? A SIXPACK OF BEER/BOTTLE OF HINE/ 4/5 DRINKS OF HARD LIQUOR 0R NORE 2 2-3 GLASSES OF HINE/ 3-4 CANS OF BEER/ 2-3 DRINKS OF HARD LIQUOR 3 1 GLASS OF HINE/ 1 BEER/ I DRINK HARD LIQUOR E. Have you ever been drunk? NOOOOOOOOOCOOOOOOO0.0.0.01 YESOOOOOIOOOOOOOOO ..... .02 IF NO. SKIP TO 0.64 IF YES. CONTINUE: F. How many times have you been drunk? (7+ . 7) G. How old were you when you first took a drink? H. How old were you the last time? NOTE TO INTERVIENER: IF STILL DRINKING. CODE PRESENT AGE IF DRINKING DOES NOT SEEN TO BE A PROBLEN. SKIP TO NEXT SECTION. CIGARETTE SNOKING. 0.85 IF DRINKING LOOKS LIKE IT NIGHT POSSIBLY BE A PROBLEM. CONTINUE: A. Have any members of your family ever told you that you were drinking too much? B. Have any of your friends told you that they thought you were drinking too much? (PROBE: HAS ANYONE ELSE EVER TOLD YOU THAT YOU HERE DRINKING TOO NUCH?) 65. 155 C. Have you ever thought that perhaps you were drinking too much? 0. Hhen you've been drinking. have you ever gotten really angry at someone? (PROBE: SHOUTED OR YELLED AT THEN?) E. Hhen you've been drinking have you ever started thinking about all your problems and started crying? F. Have you ever had 'blackouts' - that is. you did something while you were drinking and you couldn't remember having done it? (PROBE: THE ONLY HAY YOU FOUND OUT ABOUT IT IS THAT SONEONE TOLD YOU ABOUT IT. EXANPLE: YOU CAN'T RENENBER HON YOU GOT NONE. FRIENDS SAY YOU SHOUTED AT THEN BUT YOU CAN'T RENENBER ANY SHOUTING.) IF NO TO 0. 64A-F. SKIP TO CIGARETTE SMOKING. 0. 85 6. Have you ever tried to stop or cut down on drinking but found that you couldn't? RECORD H. Have you ever feund that you needed to drink more and more in order to feel 'high'? Have you ever missed school because you had been drinking and you were too sick to go? 66. 67. 68. 69. 7D. 71. 156 Did your grades go down because your drinking interferred with your studies? Have you ever had a drink at school? (PROBE: SONE KIDS KEEP BOTTLES IN THEIR LOCKERS) Have you ever been sent home from school (0r suspended) because of drinking? SKIP TO 0. 70 Have you ever had trouble driving when you've been drinking? Example: found you were driving in the wrong lane - found that you had driven the car Up onto the sidewalk. ever go to the wrong house. ever hit a tree or scraped against a wall. A. Has there ever been a time when you needed a drink every day or nearly every day Just to keep going? IF NO. SKIP TO 0.71 IF YES. CONTINUE: B. How long did that period last? (CODE IN NEEKS) IF NO POSITIVES FROM 0. 64A THROUGH 0. 708. SKIP TO CIGARETTE SMOKING. 0. 85. IF ANY POSITIVES. CONTINUE. A. Has there ever been a time when you needed a drink every day or nearly every day Just to unwind? IF NO. SKIP TO 0.72 IF YES. CONTINUE: B. How long did that period last - when you drank to unwind? CODE IN HEEKS 72. 73. 74. 75. 76. 77. 157 Have you ever taken a drink in the morning - around breakfast time? IF NO. SKIP TO 0.73 IF YES. CONTINUE: B. How often have you done this? (7+ - 7) Have you ever had any fits or seizures after stopping or cutting down while drinking? Have you ever had the D.T.s? NOTE TO INTERVIEIER: IF RESPONDENT DOES NOT KNOH HHAT D.T.s ARE. EXPLAIN: (DELIRIUH TRENENS: That is when you saw things or heard things that weren't really there - like hallucinations. Sometimes people with D.T.s feel bugs or insects crawling all over their body.) How old were you when you first had these problems with drinking that you've told me about? How old were you the last time? IF STILL HAPPENING. CODE PRESENT AGE Have any of your friends dropped you because they said you were drinking too much? 7B. 79. 80. 81. 82. 158 A. Have you ever gotten into physical fights when drinking? IF NO. SKIP TD 0. 79 IF YES. CONTINUE: B. How many fights have you gotten into? 6-IO+ TIMES .............. 2 3-5 TIMES ................ 3 1-2 TIMES ................ 4 IF NO POSITIVES so FAR. THE INTERVIEHER HAS THE OPTION OF SKIPPING OUT OF THIS SECTION AND GOING To NEXT SECTION, CIGARETTE SMOKING. Have you ever gone on binges or benders? (PROBE: HHEN YOU KEPT DRINKING FOR A COUPLE 0F DAYS HITHOUT SOBERING UP) A C.....OOOOOOOO0.0..................OCOOOOOOOOOOOI 159 83. A. How old were you when you started drinking? 8. How old were you the last time you had a drink? 84. 160 CIGARETTE SNOKING: 85. Have you ever smoked cigarettes? IF NO. SKIP TO NEXT SECTION: GLUE SNIFFING. 0.87 IF YES. CONTINUE: 86. A. Have you ever smoked regularly - everyday? How old were you when you first started smoking? CD How old were you the last time you smoked? n 161 GLUE SNIFFING: 87. A. IF (F C. D. Have you ever sniffed glue or other fumes like hairspray to get 'high'? NO. SKIP TO NEXT SECTION. MARIJUANA. 0. 88 YES. CONTINUE: How many times have you sniffed glue or anything like that? 6.10+ T1"ES..............2 3-5 TIMESeeeeeeemeeeeemee3 1'2 TIMESeoeeeeeeeeeeeeee4 How old were you the first time you sniffed glue? How old were you the last time you sniffed glue or (USE CHILD'S HORDS)? STILL SNIFFING GLUE OR SIMILAR FUMES. CODE PRESENT AGE 162 NARIJUANA: 88. A. Have you ever smoked marijuana? IF NO. SKIP TO NEXT SECTION. STREET DRUGS. 0. 89 IF 8. IF [F C. E. YES. CONTINUE: Have you smoked marijuana more than a couple of times? NO. SKIP TO NEXT SECTION. STREET DRUGS. O. 89 YES. CONTINUE: How old were you when you first smoked marijuana? How old were you the last time you smoked it? Have you ever smoked marijuana almost every day for as long as a month or more? Did you ever find that you had to smoke more and more marijuana in order to get high? IF NO TO 0. 88 E AND F. SKIP TO STREET DRUGS, 0. 89. IF YES TO EITHER. CONTINUE. G. Hhen you've been smoking marijuana. have you ever done things you wouldn't ordinarily do? Did you find that you were hanging out mostly with other kids who smoked marijuana? I. J. L. 163 Did you find that you were staying away from everyone and just smoking marijuana on your own? when you were smoking marijuana. did your grades 90 down? Have you ever felt very anxious after smoking marijuana? Have you ever felt very suspicious after smoking marijuana - like people were doing things behind your back without telling you - leaving you out? when you've been smoking marijuana have you ever felt that time was slowing down. i.e.. 5 minutes seemed like an hour? 161+ STREET DRUGS: 89. A. Have you ever taken any llstreet drugs'? (PROBE: COCAINE. CRACK. SPEED - UPPERS. DOHNERS - THAT SORT OF THING?) Have you taken any other drugs that weren't prescribed for you by a doctor? (PROBE: 'LIKE GETTING VALIUH OR SLEEPING PILLS FROH A FRIEND. OR SHIPING SOHE FROM YOUR PARENTS' PRESCRIPTION?) RECORD ALL 'STREET DRUGS" C. D. E. IF IF How old were you the you first time you took any of these drugs? How old were you the last time? NOTE TO INTERVIEHER: IF RESPONDENT IS STILL TAKING DRUGS. CODE PRESENT AGE Have you ever taken any of these drugs 5 times or more? NO. SKIP TO NEXT SECTION. AFFECTIVE DISORDERS. 0.90 YES. CONTINUE: Hhat drugs have you taken more than 5 times? (CODE: ND - 1; YES - 2) COCAINE CRACK SPEED: SPEED OR UPPERS: AMPHETAMINE. DEXATRINE. RITALIN, ETC. I. J. K. L. 165 HEROIN PSYCHEDELICS (LSD. MESCALINE. PEYOTE. ONT. PCP) DOHNERS (LIKE SECONAL OR ANY OTHER BARBITUATES OR SLEEPING PILLS) Have you ever used any of these drugs we've been talking about everyday for say - two weeks or maybe even longer than two weeks? Has there ever been a time when you found that you were taking more and more (NAME ALL DRUGS) to feel the effect? Have you ever tried to cut down on and found that you really couldn't? Have you ever worried about the amount of you were taking and made rules for yoursel? so you wouldn't take so much? (FOR EXAMPLE. TAKING ONLY ON NEEKENDS. OR ONLY IN THE EVENING?) Have you ever felt that was taking a lot of your time? For example. 313 you find that you were spending a lot of time getting . taking . and then recovering from the eFFects? Did takin cause a lot of problems for you? For example. missing school (or job). grades going down. arguing with family or friends. or losing friends? 166 M. Did taking make you give up some of your outside actIvItIes (SPORTS. OTHER EXTRA-CURRICULAR ACTIVITIES?) N. Did you find that you were spending most of your time with other people who were taking drugs? 0. Did you ever get in trouble with the police becaUSe of ? P. Did you ever have bad side effects from the drugs - like feeling depressed. paranoid. or that you were losing your mind? IF NO. END THIS SECTION IF YES. CONTINUE: 0. Even though you were having these feelings (NAME FEELINGS) did you keep on taking anyway? 167 AFFECTIVE DISORDERS: MAJOR DEPRESSIVE DISORDER All the questions so far have been about the kinds of things you do. Now I'm going to ask you how you feel about different things. okay? 90. Are you the kind of kid who gets down or in bad moods a lot of the time? 91. A. NOT VERY OFTEN...........1 "DST OF THE TIMEOOOOCOOOOZ SOME OF THE TIME.........3 Has there ever a time in your life when you felt sad. miserable and depressed a lot more than usual? (PROBE: NOT JUST ORDINARY UPS IND DOHNS . BUT FEELING REALLY SAD) ' Has there ever a time in your life when you felt tearful or sad but you didn't know why? C. Has there ever a time in your life when you found yourself being snappish. irritable (crabby or cranky) a lot more than usual? D. You've told me . Has there anything going on in your life tEaE made you feel that way? RECORD E- How old were you when this was happening? 168 PERVASIVE ANHEDONIA: 92. 93. 94. Have you ever felt that nothing you did seemed to be any fun (even things that you used to like doing)? (PROBE: LIKE DOING THINGS HITH YOUR FRIENDS) A. Can you tell me some of your favorite things to do? (CODE: NO - 1: YES - 2) RECORD IF NO. SKIP TO NEXT SECTION. APPETITE GAIN. 0.95 IF YES. CONTINUE: B. Has there ever been a time when you didn't feel like doing any of these things? RECORD IF NO. SKIP TO APPETITE GAIN. 0. 95. IF YES. CONTINUE. C. Has there something elso going on that mad you drop ? (USE CHILD"S EXAMPLES) How old were you when this was happening? 169 SYMPTOMS: APPETITE LOSS/GAIN 95. 96. A. Sometimes when people are having a hard time. they don't feel hungry and sometimes they may even lose weight. Has there ever been a time when you were not very hungry a lot of the time? (PROBE: AT A TIME HHEN YOU HEREN'T SICK) IF NO. SKIP TO 0.96 IF YES. CONTINUE: C. IF IF IF IF D. Did you actually lose any weight? How much did you lose? (RECORD IN POUNDS) Sometimes when people feel low. instead of losing weight they find that they are hungry all of the time. Has this ever happened to you? NO. SKIP TO NEXT SECTION. SLEEP DISTURBANCES. 0.97 YES. CONTINUE: Did you actually gain weight? How much did you gain? (RECORD IN POUNDS) NO. SKIP TO SLEEP DISTURBANCE. 0.97 POSITIVE (EJT‘L‘OST'AFPETTTE‘OR FELT MORE HUNGRY). CONTINUE: Could you tell me a little more about the time(s) when you lost your appetite or were hungrier than 'usual? (CODE: NO I 1; YES I 2) IF YES. RECORD How old were you when this was happening? 170 SLEEP DISTURBANCE: 97. 98. 99. 100. Have you ever had a lot more trouble than usual falling asleep at nig t. (PROBE: NOT JUST ONE NIGHT. BUT MOST NIGHTS. SAY FOR A HEEK OR LONGER) Sometimes when kids feel sad or worried, they wake up in the middle of the night and can't get baCk to sleep even though they try. Has this ever happened to you? IF NO. SKIP TO 0.99 IF YES. CONTINUE: 8. Did it happen more than one or two times? A. Have you ever woken up early in the morning (alot earlier than usual for you), and couldn't get back to sleep no matter how hard you tried? IF NO. SKIP TO 0.100 IF YES. CONTINUE: B. Did this happen more than one or two times? A. Has there ever been a time when you were feeling sad and you slept more than usual during the day or night? IF NO POSITIVES. SKIP TO PSYCHONOTOR RETARDATION. 0.101 IF ANY POSITIVES. CONTINUE: 8. -Do you remember how long these sleeping problems lasted? CODE IN DAYS c_ How old were you when this was happening? 171 PSYCHOMOTOR RETARDATION AND/OR AGITATION: 101. Has there ever been a time when you felt more restless than usual and had difficulty sitting still? RECORD 102.A.Has there ever been a time when you felt slowed down and it took you longer to move around or do things? RECORD B.How old were you when this was happening? 172 FATIGUE: 103.A.Has there ever been a time when you've felt more tired than usual. or dragged out a lot of the time? (PROBE: LIKE YOU DIDN'T HAVE THE ENERGY TO DO ANYTHING - HHEN JUST GETTING UP AND HALKING AROUND HAS HARD TO DO. AND HHILE NOT SICK) 8. How old were you when this was happening? 173 NORTNLESSNESS OR EXCESSIVE GUILT: 104. Has there ever been a time when you felt that everything you did was wrong and nothing would ever go well for you? (PROBE: YOU FELT LIKE YOU HERE ALHAYS SAYING THE HRONG THINGS. OR THAT YOUR FRIENDS DIDN'T REALLY LIKE YOU?) (PROBE: EVERYBODY FEELS THAT HAY SOME OF THE TIME - I'D LIKE TO KNOH IF THIS HAS A LOT MORE THAN USUAL) 105.A.Has there ever been a time when you felt that everything was your fault and you felt guilty about a lot of things? (PROBES: YOU FELT YOUR FAMILY HOULD BE BETTER OFF HITHOUT YOU OR THAT IF YOUR MOTHER/FATHER HAS IN A BAD MOOD IT HAS BECAUSE OF YOU) 8. How old were you when this was happening? 17’4 TROUBLE CONCENTRATING ON INDECISIVENESS: 106. A. Has there ever a time when you couldn't keep your mind on your work and your parents and teachers complained about it a lot? (PROBE: DID IT SEEM TO YOU THAT YOU HERE DAYDREAMING A LOT?) IF NO. SKIP TO C. IF YES, CONTINUE. D. Did your grades go down when you were having problems keeping your mind on your work? Has there ever a time when you had a lot more trouble than usual making decisions? (PROBE: HHETHER TO GO OUT HITH YOUR FRIENDS OR sTAY IN. HHETHER YOU SHOULD HATCH TV OR NOT. OR HHAT YOU HANTED TO EAT OR HEAR) How old were you when this was happening? 175 SUICIDAL IDEATION: 107. 108. 109. 110. 111. 112. 113. Have you ever felt that everything in your life was going wrong and that nothing would ever be alright again? A. Have you ever wished that you were dead? 8. Have you ever thought about killing yourself? A. Did you ever have a plan about how you were going to kill yourself? IF NO. SKIP TO NANIAomA. IF YES. CONTINUE: B. Can you tell me about it? (CODE: NO - 1; YES . 2) RECORD How old were you when you first felt this way? How long did these feelings last? (CODE IN DAYS) A. Have you ever tried to kill yourself? IF NO TO 0. 113A., SKIP TO 0. 113G. 1F YES, CONTINUE. 8. Have you tried it more than dnce? 176 C. Did you see a doctor or counselor? D. Hhat did he/she say? (CODE: NO - 1; YES - 2) RECORD E. How old were you the first time you tried to kill yourself? ASK ONLY IF RELEVANT F. How old were you the last time you tried to kill yourself? G. Let's see. you've told me that you've (NAME SYMPTOMS). Did some of these tfiings happen at the same time? For instance. when you were did you also ? NOTE To INTERVIEHER: DO SYMPTOMS CLUSTER? YES__ NO_ H. Has there anything going on in your life to explain why you felt this way? YES NO RECORD 177 NANIC EPISODE: 114. 115. 116. 117. 118. Have you ever felt sung: happy. as if you were on top of the world? A, Have you ever felt 29 good that everything seemed absolutely wonderful? (IF YES. ASK TO DESCRIBE: (CODE NO - 1; YES . 2) RECORD 8. Do you remember how long that feeling lasted? (CODE IN DAYS) Have you ever felt really happy like I've asked you. and also felt crabby and irritable sometimes? IF YES. ASK T0 DESCRIBE: (CODE: NO P 1: YES - 2) RECORD IF (114. .115. OR 1116 ANSHERED POSITIVE. CONTINUE: IF NEGATIVE. SKIP TO ANXIETY DISORDERS. 0.125 Has there ever been a time when you were feeling really happy. and you slept alot less than usual because you weren't feeling tired? Has there ever been a time when you were feeling really happy, and you talked a lot more and a lot faster than usual? 119. 120. 121.A.Has there ever been a tim 178 Has there ever been a time when your thoughts or ideas were racing through your mind? (PROBE: DID YOU FEEL THAT YOUR THOUGHTS HERE COMING SO FAST THAT YOU COULDN'T EXPLAIN ONE IDEA BEFORE ANOTHER CAME INTO YOUR MIND?) Has there ever been a time when you were feeling really happy. and you found that it was hard to keep your mind on one thing at a time? (PROBE: HERE THERE TOO MANY THINGS THAT YOU HANTED TO DO AND YOU DIDN'T KNOH HHICH ONE TO 00 FIRST?) e when you were feelin really happy. and you felt like you had more 9 energy thanusual? For example. were you always running around doing things? B. Has there ever been a time when you were feeling really 122. 123. 124. happy, and your family. teachers, or friends told you that you were acting differently from your usual self? . Have you ever felt really happy, and you felt that you were a very important person. or you had special powers or could do things that other people couldn't do? . Has there ever been a time when you felt really happy, and you did things without thinking first. and you got into trouble because of how you were acting? (PROBE: DID YOU CAUSE PROBLEMS FOR YOUR FAMILY OR FRIENDS BY BEING LOUD, OBNOXIOUS. TEASING. LOOKING FOR FIGHTS?) (PROBE: DID YOU SPEND A LOT OF MONEY, BORROH FROM YOUR FRIENDS, OR DRESS IN BRIGHT COLORS (HEAR MORE MAKE-UP) MORE THAN USUAL FOR YOU?) E. Did your family, teacher, or friends think you needed to see a doctor because of how you were acting. or did your behavior interfere with doing your school work or your chores as you usually did? IF NO POSITIVES. 0. 114-121. SKIP TO SEPARATION ANXIETY, Q. 125. IF ANY POSITIVES. CONTINUE. How old were you when these things first happened? How old were you when these thin s ha time? 9 PPened the last How long did these feelings last? 179 ANXIETY DISORDERS: SEPARATION ANXIETY DISORDER: Some kids worry a lot about being away from their parents or awey from home. I'm going to ask you some questions about how you feel when you're away from your parents or away from home. 125. 126. 127. 128. 129. Has there ever been a time when you were away from your parents and you worried a lot about something bad happening to them (like they might get sick or get hurt or die)? Has there ever been a time when you really worried that something bad might happen to you (like getting kidnapped or killed). so that you couldn't see your parents again? Has there ever been a time when you refused to go to school (or tried to stay home). because you were afraid that something bad (like sickness. accident. or death) might happen to your parents while you were away? Did you ever need to have your Mom/Dad, older brother or sister. or another adult stay close to you so you could get to sleep at night. because you were afraid to be alone. Has there ever been a time in your life when you were afraid to be left all by yourself in a room in your home? 130. 131. 132. 133. 134. 135. 180 Have_you ever had a chance to visit a friend or sleep over at someone's house and refused to go. because you were afraid to leave home? Have you ever gone away from home for a few days. like visiting relatives and been so upset and worried that you went back home right away, or you wanted to go home really badly? Has there ever been a time when you had scary dreams about something bad happening to you. your parents. or other people in the family? Has there ever been a time when you had to leave home to go to school or some place else. and you got headaches or stomachaches or felt sick to your stomach or even threw up? Has there ever been a time when you threw tantrums or cried and begged your parents to stay home when they planned to go somewhere? IF NO POSITIVES FROM 0.128 THRU 134. SKIP T0 AVOIDANT DISORDER. 0.136 IF ANY POSITIVES. CONTINUE A. How old were you when you started having these feelings that we've been talking about? B. How old were you the last time you had these feelings that we've been talking about? 181 AVOIDANT DISORDER: 136. 137. 138. 139. 140. 141. Here you ever the kind of person whose feelings would get hurt if someone like a parent or a teacher told you that you made a mistake? (PROBE: HAS THERE EVER A TIME HHEN PEOPLE TOLD YOU THAT YOU HERE TAKING THINGS TOO SERIOUSLY?) Have you ever had a period of six months or more when you didn't have any close friends outside of your family? DESCRIBE Has there ever a time when you felt so shy that you couldn't make friends even though you wanted to? Has there ever a time when you found that it was easy to be with your family but awful to be with other people including other kids? (PROBE: UNLESS YOU KNEH THE PEOPLE REALLY HELL?) Has there ever a time when you wished that you could make some friends but somehow just couldn't? IF NO POSITIVES. 0.'S 136-140, SKIP T0 OVERANXIOUS DISORDER. 0. 142. IF ANY POSITIVES. CONTINUE A. How old were you when you first started to be uncomfortable around new people, or eaSle hurt when criticized? B. How old were you the last time you felt like that? 182 OVERANXIOUS DISORDER: 142. Here you ever a worrier? Has there ever been a time when you worried more than most children your age? 143. Have you ever worried a lot about things before they happen. for example. starting school in the fall. taking a test. or going to see a doctor? 144. A. Have you ever worried a lot about little things that you've done in the past. like something you've said that might have been taken the wrong way? B. Give me an example. (CODE: NO - 1: YES . 2) 145. Has there ever been a time when you worried a lot that your parents or teacher would be disappointed with your grades? 146. Has there ever been a time when you were always worried that you couldn't do things well enough to please your parents or teachers? 183 147. Have you ever actually been sick from worry. that is. you worried so much that your head hurt or your stomach got upset? 148. Have you ever worried a lot about how you looked. about what you said. or about how you acted in front of your friends? (PROBE: EVERYONE FEELS THAT HAY A LITTLE BIT, I'M TALKING ABOUT FEELING THAT HAY A LOT. MORE THAN MOST OF YOUR FRIENDS) 149. A. Has there ever been a time when you were always asking your parents or teacher to check and see if your work was done correctly? IF NO POSITIVES. 0. 142-149. SKIP TO DYSTHYMIC DISORDER, 0. 150. IF ANY POSITIVES, CONTINUE B. How old were you when you first started worrying like this? C. How old were you when you last worried like this? IF STILL HORRIED. CODE PRESENT AGE 181+ DYSTHYMIC DISORDER: Now I'm going to ask you some more questions about the way you feel. In the other set of questions. I asked you if you'd ever had a period of a couple of weeks or so. when you felt really down. Now I'm going to ask you what you were like most of the time in the past year. Some of the questions may sound like the ones you have already answered. However. I really would like you to think about them again. and answer them for me. 150. In the past year have you felt sad. blue. down in the dumps. or low for long periods of time (MONTHS)? 1r N0.ASK: Have you ever felt like that at any other time? RECORD 151. In the past year have you lost interest in almost all of your usual activities and pastimes? Ir ”0,551.: Has that ever happened to you at any other time? RECORD__7 152. In the past year. have you found yourself feeling crabby and irritable a 12£_of the time? 1r no, ASK; Have you ever felt that way any other time? 153. During the past year did you ever have trouble falling asleep. waking up in the middle of the night or very early in the morning? IF No. ASK: Have you ever had alot of trouble sleeping most nights? 154. Some kids have trouble falling asleep. but other kids sleep more than they really need to. For example. they take naps during the day. go to bed early at night. and sometimes they even sleep in class. Are you like that at all? IF NO, ASK: Have you ever slept more than you really needed to? 155. 156. 157. 158. 159. 160. 185 Have you ever had weeks or even longer when you felt tired out all the time - all dragged out - no energy? Do you often feel that you're not as good as the other kids. e.g.. not as smart. or good-looking. or as well-liked by the other kids. as good at sports. things like that? Do you have times when you just can't seem to get things done? For example. it takes you forever to do your homework. and then you get a lot of it wrong anyway? In the past year. if someone praised you or bought you a present as a reward for something. did you find that it didn't make you feel really happy and you didn't care very much about it? Do you have times when it seems like your body slows down, and you feel that you move very slowly, or don't talk very much? Are there times when your eyes fill up with tears. but you are not actually crying? 186 SIMPLE PHOBIA: 161. 162. 163. Is there anything that you are really afraid of? DESCRIBE: Have you ever had to talk in front of people (like in class) and found you were so afraid ihat you Couldn't Speak? I'm going to read you a list of things that lots of people your age are afraid of and you tell me if you've ever been afraid of them. (CODE: NO - 1; YES - 2) NOTE TO INTERVIENER: THESE THINGS SHOULD 'PARALYZE THE CHILD HITH FEAR“ DARK DOGS OR OTHER ANIMALS BUGS HIGH PLACES BEING ALONE (AT HOME DR OUTSIDE) CROHDS OTHERS (SPECIFY) 187 IF NEGATIVE FOR ALL PHOBIAS. THEN SKIP TO NEXT SECTION. OBSESSIVE CONPULSIVE DISORDER. 0.166 IF POSITIVE. CONTINUE: 164. Do you try to avoid (ASK ABOUT SPECIFIC PHOBIA THAT THE KID ANSHERED'FUSTTIVELY) or if you can't avoid it are you very miserable? 165. Could you give me an example? 188 OBSESSIVE COMPUUSIVE DISORDER: OBSESSIONS: 166. 167. Have you ever had thoughts or ideas that you couldn't keep out of your mind? (PROBE: THINGS THAT YOU DIDN'T HANT TO THINK ABOUT. BUT NO MATTER HOH HARD YOU TRIED YOU COULDN'T PUSH THEM OUT OF YOUR HEAD? DID THESE THOUGHTS KEEP COMING INTO YOUR HEAD FOR No GOOD REASON? [VERIFY THAT THE THOUGHTS ARE INTRUSIVE AND SENSELESS.]) Have you ever seen things or heard sounds that didn't make sense to you. but you couldn't shake them out of your mind? (PROBE: EVEN THOUGH THEY DIDN'T MAKE SENSE. YOU JUST COULDN'T GET RID OF THEM. NO MATTER HOH HARD YOU TRIED?) IF NO TO 0. 166 AND 167. SKIP TO COMPULSIONS, Q. 173. IF YES TO EITHER, CONTINUE. 168. 169. 170. 171. Has this a real problem for you? Did you find that you couldn't concentrate on other things, because these thoughts (images and/or sounds) kept coming back to your mind? Have you ever tried to stop these thoughts (sounds/images) by thinking of something else? These repeated thoughts that you've been having. are they your own thoughts? Hhat I mean is. are they coming from inside your head. or is it more like somebody is putting them inside your head? (CODE YES IF THOUGHTS ARE FROM INSIDE THE HEAD.) How old you were you the first time you started having these thoughts (hearing sounds/seeing images)? 189 172. How old were you the last time? TIME TO INTERVIEIER: IF STILL HAPPENING. CODE PRESENT AGE 190 COMPULSIONS: 173. I74. 175. 176. 177. 178. Have you ever found that you were doing something over and over again and you couldn't figure out why? (PROBE: SOME COMMON- EXAMPLES ARE HASHING YOUR HANDS OVER AND OVER. BECAUSE YOU'RE HORRIED YOU MIGHT HAVE GERMS ON THEM; GOING BACK OVER AND OVER TO CHECK ON SOMETHING LIKE HHETHER OR NOT YOU LEFT THE HATER RUNNING: - OR COUNTING TO 100 BEFORE YOU MAKE A TELEPHONE CALL. THINGS LIKE THAT?) RECORD IF 0.'S 166-170 ARE ALL NEGATIVE, AND 0. 173 IS NEGATIVE, SKIP TO PTSD. 0. 179. IF ANY POSITIVES. 0.'S 166-170 AND 0. 173 IS POSITIVE, CONTINUE. IF NO POSITIVES. 0.'S 166-170, BUT 0. 173 IS POSITIVE. FINISH SECTION AND RETURN TO 0. 166 AND VERIFY NEGATIVE ANSWERS. Do you feel that if you do these these things (CHILD'S HORDS) that the thoughts ‘ (NAME THOUGHTS) will stop? Do you feel in your heart of hearts that you're really spending too much time (CHILD'S HOROS)? Is (CHILD'S HORDS) a big problem for you?7 For example. does it upset you. or take too much time out of your day? How old were you when you first remember feeling that you had to do (USE CHILD'S HORDS)? How old were you the last time you had to do (USE CHILD'S HORDS)? 191 POST TRAUMATIC STRESS DISORDER: 179. Have you ever had a terrible . really frightening experience? For example: were you ever in danger of being killed? (PROBE: HERE YOU THERE HHEN SOMEONE ELSE HAS BEATEN OR KILLED ? HAS ANYONE CLOSE TO YOU COMMITTED SUICIDE? HAVE YOU EVER HAD YOUR HOUSE AND YOUR POSSESSIONS DESTROYED BY A FLOOD OR FIRE?) IF POSITIVE. DESCRIBE: IF NO. SKIP T0 EATING DISORDERS. 0.201 IF YES. CONTINUE: Now I'm going to ask you some questions about how you felt about the (TRAUMATIC EVENT). okay? 180. After the did you think about it a lot? 181. Here you thinking about it so much that you couldn't push the thoughts out of your mind? 182. After the did you dream about it over and over? 183. After the were you ever in a situation where maybe jusE for a minute or so you felt as if it were happening all over again? (PROBE: YOU FELT AS IF YOU HERE REALLY THERE?) 184. Have you ever been reall u set because you saw or heard something thaE remInaea you of the (TRAUMATIC EVENT)? 185. 186. 187. 188. 189. 190. I91. 192 Have you ever gone to a great deal of trouble to avoid things that reminded you of the (TRAUMATIC EVENT)? After the was over. did you ever find that you couldn't rememBer some things about the ? (PROBE: LIKE YOU HAD AMNESIA FOR PARTS OF THE ?) After the was over. did you feel that you just couldn't get interested in things that you used to like? (PROBE: LIKE SPORTS - FOOTBALL. SOCCER; PLAYING A MUSICAL INSTRUMENT. YOUR FAVORITE TV PROGRAM. ARCADE GAMES?) After the did you ever feel that you weren't that interestea in wfiat people said or did? (PROBE: DID YOU PREFER TO JUST GO OFF BY YOURSELF?) After the did you ever feel that you just couldn't really love anybody; that you really didn't have loving feelings about anyone any more? (PROBE: HMAT IF YOU SAH A LITTLE PUPPY OR A KITTEN. DIDN'T YOU FEEL IT HAS 'CUTE OR ADORABLE' OR DID YOU NOT FEEL MUCH ONE HAY OR THE OTHER?) After the do you remember feeling that the future dian'E Fold anything special for you? NOTE TO INTERVIEHER: IF NO POSITIVES SO FAR IN PTSD. Q, 179-190, SKIP TO EATING DISORDERS. 0.201 IF ANY POSITIVES. CONTINUE: After the did you find that you were having a lot more trouble than usual either falling asleep or staying asleep? 192. 193. 194. 195. 196. 197. 198. 199. 193 After the did you feel very irritable. a lot more than usual? Did you have outbursts of anger a lot more than usual? After the do you remember the times when you had a great Deal of difficulty concentrating a lot more than usual? ""' Did you feel restless or on edge? Do you remember ever 'jumping' when you heard a door slammed. or if someone came up behind you without you realizing it? Did you ever break into a sweat. or feel teary. when you saw something that reminded you of ? Let's see. you've told me that you (NAME POSITIVES) How long after did that start? (CODE IN HEEKSTEES'S'THAN A HEEK - 1 HEEK) RECORD How long did they last? (CODE IN MONTHS. LESS THAN 1 MONTH . 1 MONTH) 191i» 200. Hould you say that this has been a very real problem for you ? 195 EATING DISORDERS AMOREXIA MERVOSA: 201. Have you ever gone on a diet when you actually did lose weight? 202. Did other people in the family nag at you because they thought you weren't eating enough? IF NO TO 0.201 AND 0.202. SKIP TO BULIMIA. 0.213 [F YES. CONTINUE: 203. How much weight did you lose altogether? 204. How tall were you when you started losing weight? (CODE IN INCHES) 205. Did you feel that you were fat or parts of you were too fat. even when people said you were too thin? 206. Hhen you were dieting were you afraid that you might et fat again. and did you count every calorie? PROBE: HATCH EVERY MOUTHFUL?) 207. Did your parents take you to a doctor. because they were worried about you losing so much weight? 208. Hhat did the doctor say? RECORD 209. 210. 211. 212. 196 How old were you when you first started being concerned about your weight. like we've been talking about? How old were you the last time you were concerned about your weight - like we've been talking about? BOYS AND GIRLS UNDER AGE 9. SKIP TO BULIMIA, Q. 213. GIRLS OVER AGE 9. CONTINUE IF RELEVANT. Had you started your menstrual periods before you began to diet? IF NO. SKIP TO BULIMIA. 0.213 [F YES. CONTINUE: while you were losing weight. did your periods stop? 197 IDLINIA: 213. 214. 215. 216. 217. 218. 219. 220. Have you ever gone on an eating binge and eaten a really large amount of food all at one time (MUCH LARGER THAN USUAL)? IF NO. SKIP TO THE NEXT SECTION. ENURESIS. 0.221 IF YES. CONTINUE: How much did you eat? RECORD IF NO. SKIP TO THE NEXT SECTION. ENURESIS. 0.221 [F YES. CONTINUE: Did eating large amounts of food like that ever happen more than once a week? How long did that period of eating lots and lots of food at least twice a week go on? 12+ HEEKS .............. 2 5-11 NEEKS....' ......... 3 2-4 WEEKS .............. 4 Hhen you were bingeing like that. did you try to keep your weight down by taking laxatives. or making yourself throw up? Did you exercise a lot? Here you ever afraid that you couldn't stop eating? How old were you when you last ate lots and lots like we've been talking about? IF PROBLEM STILL PRESENT. CODE CURRENT AGE In 198 ENURESIS: 221. A. Do you wet the bed at night? IF NO. SKIP T0 0.222. IF YES. CONTINUE: B. How often does it happen? NIGHTLY............................1 MORE THAN ONCE A HEEK, BUT NOT EVERY NIGHT..............2 2-4 TIMES A MONTH..................3 ABOUT ONCE A MONTH.................4 LESS OFTEN THAN ONCE A MONTH.......5 IF 221A IS POSITIVE, OR IF AGE 6 0R OLDER, SKIP TO 0. 223. 222. A. Did you wet the bed after you were old enough to go to school? 8. Did this happen more than once or twice? C. How old were you the last time you wet the bed? 223. A. Have you ever wet during the day. so that you had to go change your clothes sometimes? IF 0. 223A IS POSITIVE, OR IF AGE 6 OR OLDER, SKIP TO Q. 225. B. How often does that happen? NIGHTLYOOOOOO......OOOOOOOO0.0.....1 MORE THAN ONCE A "EEK, BUT NOT EVERY NIGHT..............Z 2-4 TI"ES A "ONTHeeooooooeeeeeeoeoe3 ABOUT ONCE A MONTH.................4 LESS OFTEN THAN ONCE A HONTH.......S 22‘. 199 A. Did you wet during the day. even after you were old enough to go to school? IF NO. SKIP TO ENCOPRESIS. 0.225 IF YES. CONTINUE 8. Did this happen more than just once or twice? C. How old were you the last time you wet during the day? 200 ENCOPRESIS: D. IF E. Did you ever have a bowel movement in your pants or on the floor. or someplace besides the toilet? NO. SKIP TO SOMATIZATION, Q. 229. Did this sometimes happen after you were old enough to go to school. and at a time when you were not sick? How often has this happened? 6+ TIHESOOOOOOOOOOCOZ 3-5 TIHES...........3 1‘2 TImSeeoeeoeeeoe‘ Do you still soil in your pants sometimes? NO. SKIP TO SOMATIZATION, 0. 229. How old were you the last time it happened? 201 ED! ems om (SKIP 1r BELOH AGE 9) ENSTRUATIM: 226. A. D. 202 GENDER IDENTITY: FOR GIRLS 227. A. GENDER IDENTITY FOR DOTS 203 SONATIZATION: 229. 230. 231. 232. 233. Do you consider yourself the kind of person who gets sick a lot of the time? (MORE THAN MOST PEOPLE?) (PROBE: HEADACHES. STOMACHACHES?) Do you have to see the doctor a lot more often than other kids your age? Have you had times in your life when you've thrown up a lot (much more than usual - much more than your friends or other people your age)? Have you ever had any of the following problems: A. Feeling nauseated? (PROBE: GETTING SICK TO YOUR STOMACH EASILY?) 8. Does your stomach fill up with gas easily? C. Do you have diarrhea often? 0. Do you get sick easily from eating different foods? Have you ever had problems with severe pain in your arms or legs? 234. 235. 236. 237. 238. 239. 2‘0. 241. 242. 243. 204 Have you ever had problems with back pain? Hhat about pains in your joints (knees. elbows. ankles)? Pain when you go to the bathroom? Other pain (not including headaches)? RECORD Have you ever had trouble with shortness of breath, even though you weren't exercising? Palpitations? (Your heart pounding or beating too fast?) Chest pain? (A tight feeling or pain in the chest?) Feeling faint or lightheaded? Feel a tingling in your face or fingers? Have you ever had problems with amnesia? (That is. you couldn't remember something important that happened to you?) 205 2‘4. Did you have to take medication for medical problems? (PROBE: OTHER THAN OVER THE COUNTER OR PAIN MEDICATION?) IF YES. ASK FOR DETAILS. (IS IT MEDICALLY EXPLAINED?) RECORD 206 CHILD PSYCHOSES: 245. A. Have you ever seen things that other people couldn't see - like a vision? IF NO. SKIP TO 0.246 (F YES. CONTINUE: B. What did you see? RECORD C. Did you see just before you fell asleep or when you were waEing up in the morning? 0. Has it ever happened that when you were watching TV you felt that someone on TV was sending a special message to you and nobody else? 246. A. Have you ever heard voices talking - voices that no one else but you could hear? 3, Please tell me a little more about them. RECORD C. Do you hear more than one voice? IF NO. SKIP TO 0.247 IF YES. CONTINUE: 0. Did all the voices talk to you. or did they also talk to each other? ' ALL TALKED TO YOU........1 TALKED TO EACH OTHER...3.2 SOME OF BOTHOOOOOOCCOCOCO3 247. 248. 249. 250. 251. 207 E. Did the voices tell you to do bad things? For example. did they tell you to hurt yourself. or hurt someone else? Have you ever had the feeling that someone could read your mind? RECORD Has it ever seemed that someone could put thoughts into your head in some magical way? A. Have you ever had the feeling that people were talking about you behind your back? IF NO. SKIP TO 0.250 IF YES. CONTINUE: B. Did you think they were planning to poison you. kill you or hurt you in some way? RECORD Have you ever had any other unusual experiences. like the ones we've been talking about? IF NO POSITIVES. 0. 245-250, SKIP TO PSYCHOSOCIAL STRESSORS. Q. 253. IF ANY POSITIVES. CONTINUE. A. How old were you when first happened? 8. How Old were you the last time these things happened? 252. 208 Have you ever had these experiences at a time when you were not drinking. taking drugs. taking medicine prescribea By a doctor. or were very sick? RECORD 209 PSYCMOSOCIAL STRESSORS: Some kids have really big problems at home which worry them a lot. or keep them upset a lot of the time. I want to check what sort of problems you have at your house. 253. 254. 255. 256. A. Is there much quarreling or fighting in the family which bothers you a lot? IF NO. SKIP TO 0.254 A. IF YES. CONTINUE: B. Is the fighting mostly among the children in the family or does it involve grownups? "ONEOOOOOIOO00.000.000.001 CHILDREN MOSTLY..........2 ADULTS "OSTLYOOOCOOOOOOOOB BOTNOOOOOOOOOOOOOOO00.0.04 A. Have any close relatives separated or divorced since you can remember? IF NO. SKIP TO 0.255 IF YES. CONTINUE: B. Hi0 was it? (IF MORE THAN ONCE. CIRCLE EACH 460i): 8) NONEOOOOOOOOOOOOOOOOOO.001 PARENTS.0.0000000000000002 GRANDPARENTSOOOOOO00.0.0.3 AUNTS/UNCLESOOOOOOOCOO000‘ COUSE"Seeeeeeeeeeemeeeeees FM1LY FR‘ENDSOOOOOOOOOOOS omEROOOOO0.0.00.000000007 m“: M“ MEOOOOOOOOOOOOa Are there big money worries. like not having enough money for food or new clothes. or to pay the rent? A. Is someone in the family seriously ill. handicapped or crippled so that you worry about it? IF NO. SKIP T0 0.257 IF YES. CONTINUE: 257. £31