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THESIS
I

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thesis entitled

EGO DEVELOPMENT, PSYCHIATRIC SYMPTOMATOLOGY,
AND GENDER IN AN ADOLESCENT, INPATIENT SAMPLE

presented by

JULIETI'E CAROLINE REDERSTORFF

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MA. degree in Clinical Psychologl

 

 

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6/01 c/CIRC/DateDuopfis-p. 15

EGO DEVELOPMENT, PSYCHIATRIC SYMPTOMATOLOGY, AND GENDER IN

AN ADOLESCENT, PSYCHIATRIC INPATIENT SAMPLE

By

Juliette Caroline Rederstorff

A THESIS

Submitted to
Michigan State University
in partial fulfillment of the requirements
for the degree of

MASTER OF ARTS

Department of Psychology

2003

ABSTRACT

EGO DEVELOPMENT, PSYCHIATRIC SYMPTOMATOLOGY, AND GENDER IN
AN ADOLESCENT, PSYCHIATRIC INPATIENT SAMPLE

By

Juliette Caroline Rederstorff

This study attempts to explore the relationship among Loevinger’s conception of
ego development, psychiatric symptomatology, and gender in an adolescent, psychiatric
inpatient sample (n=305). It was hypothesized that the impulsive stage of ego
development would be associated with greater amounts of aggressive behavior,
particularly among males, the conformist stage would be associated with greater levels of
depressive symptomatology, especially among females, and the self-protective stage
would be associated with greater amounts of delinquent behavior in both males and
females. However, the data did not support these hypotheses, thus suggesting continuity
among the levels of ego development. The present study also explores important
limitations of the existing body of ego development literature and Loevinger’s Sentence

Completion Test.

ACKNOWLEDGEMENTS

I would like to express my sincere gratitude to Dr. Anne Bogat, my committee
chair, for her assistance throughout my masters’ thesis. Her guidance and support were
invaluable to my professional and personal growth during this experience. I would also
like to thank Dr. Robert Caldwell for his constructive comments on my thesis and Dr.

Susan Frank for her participation in my committee and the use of her data.

iii

TABLE OF CONTENTS

LIST OF TABLES ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, )3

INTRODUCTION _____________________________________________________________________________________________________________ 1

Literature review ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, l

Ego Development ______________________________________________________________________________________ l_

Ego Development and Adolescence ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, {I

Ego Development and PsychopathologyWWW__"mm"__,____W_,__,_,_"___5_

Ego Development and Genderll

Gender and Conduct Disordersll

Gender and Depressmn13

Rationale15

Hypotheses __________________________________________________________________________________________________________ 1,8,

METHOD ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 29

SubjectSZO

Measures ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 2 .9

Demographic Information ______________________________________________________________________ 2 .Q

Ego Development ___________________________________________________________________________________ 2 _()_

Psychiatric Symptomatology _________________________________________________________________ 2 .4,

Procedures ___________________________________________________________________________________________________________ 2 _5_

RESULTS ________________________________________________________________________________________________________________________ 2Q

POST HOC ANALYSES _______________________________________________________________________________________________ 32

DISCUSSION ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 35

Potential Limitations of the SCT _______________________________________________________________________ 3 [2

Design Limitations of the Present Study40

Future D1rect10ns4l

APPENDICES _________________________________________________________________________________________________________________ 433

Appendix A: Social History Questionnaire ______________________________________________________ {If}

Appendix B: Sentence Completion Test (SCT) _______________________________________________ 4g
Appendix C: Functional Impairment Scale for Children

and Adolescents (FISCA)49

REFERENCES 67

oooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooooo

iv

LIST OF TABLES

Table 1: Demographic Characteristics of Sample ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 2.1.
Table 2: Rules for Scoring Individual Sentences ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 22
Table 3: Automatic Rules for Assigning Total Protocol Ratings to the Ogive Item
Ratings ............................................................................................................... 2 .3.
Table 4: Number of Participants Rated at Each Level of Ego Development ______________ 2_6_
Table 5: Correlations Among Major Variables ............................................................. 2.7.
Table 6: Scores on F ISCA Aggression, Depression, and Delinquency Scales as a
Function of Level of Ego Development __________________________________________________________ 2 S
Table 7 : Analysis of Variance for Aggression ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 22
Table 8: Analysis of Variance for Delinquency ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 3.9
Table 9: Analysis of Variance for Depression ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 3.1,

Table 10: Scores on FISCA Aggression, Depression, and Delinquency Scales as a
Function of Level of Ego Development, Including All Ego Development

Table 11: Analysis of Variance for Aggression, Including All Ego Development

Table 12: Analysis of Variance for Delinquency, Including All Ego Development
Levels _______________________________________________________________________________________________________________ 3 ,4.
Table 13: Analysis of Variance for Depression, Including All Ego Development
Levels ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 3 f];
Table 14: Distribution of Ego Development Levels in Three Samples of
Participants _____________________________________________________________________________________________________ 38

INTRODUCTION

Loevinger’s (1976) conception of ego development is a unique description of
moral, interpersonal, and cognitive development throughout the lifespan. Unfortunately,
research on ego development in recent years has been limited, particularly with regard to
the relationship between ego development and psychopathology. The research on
psychopathology that does exist suggests that there is greater impulsivity and aggression
among adults and adolescents who fall in the earlier (preconformist) levels of ego
development. However, this body of research has two significant limitations. First, it
neglects to examine distinctions in psychopathology that might exist between the two
stages that make up the preconforrnist level. This deficiency is particularly problematic
because Loevinger describes meaningful theoretical differences between the two stages.
A second issue inadequately addressed by the existing literature is the role that gender
may play in the relationship of psychOpathology and ego development. A solid body of
literature has suggested strong associations between gender and type of psychopathology.
Thus, it is important to consider the possibility that gender may moderate the relationship
between stage of ego development and psychopathology. The present study will explore
these issues utilizing an adolescent, psychiatric inpatient sample.
Ego Development

The term “ego” has been used by many theorists and, as such, has acquired many
meanings. When Loevinger refers to the ego, she is describing what also might be
understood as the “self.” In her conception, the ego is the frame of reference through

which all behavior is organized. This organization is not simply what the ego does, but

is what the ego is. The ego structure creates a sense of stability and coherence in an
individual’s experience of his or her world (Loevinger, 1976).

Loevinger’s conception of ego development describes ten major stages (presocial,
symbiotic, impulsive, self-protective, conformist, self-aware, conscientious,
individualistic, autonomous, integrated) that vary along four dimensions (impulse
control/character development, interpersonal relations, conscious preoccupations, and
cognitive complexity). All but the first two stages are considered to be measurable.
Stages are represented by both symbolsl (e. g., E2, E3, E4) and names (e.g., impulsive,
self-protective, conformist). Although the names suggest the most salient characteristics
present at each stage, the names are not meant to imply that the stage is only
distinguished by one characteristic, or that the characteristic is only present at one stage.
Stages cannot be defined without considering the entire constellation of characteristics
present. Further, Loevinger has stated that the four dimensions are not meant to be
examined individually, but rather they are best understood as a single dimension. They
are four facets of a single, coherent process. This integration, described as a “complexly
interwoven fabric,” is the essence of the ego (Hy & Loevinger, 1996; Loevinger, 1976).

The stages of ego development are subsumed within three higher order levels: the
preconformist, conformist, and postconforrnist levels. The preconformist level consists
of the presocial, symbiotic, impulsive (E2) and self-protective (E3) stages. The presocial
and symbiotic stages are considered to be theoretical and are not able to be measured.

Therefore, they will not be considered further here. Individuals at the E2 and E3 stages

 

‘ Loevinger’s (1976) original symbols for the stages of ego development (I-2, Delta, [-3, I-3/4, 1-4, 145, I-
5, I-6) were revised in the second edition of her scoring manual ( Hy & Loevinger, 1996) to become E-
levels (E2, E3, E4, ES, E6, E7, E8, respectively.) For clarity, the present study will use the E-level
terminology throughout this document.

of the preconformist level are impulsive and fearfirl, have stereotyped cognitive styles,
and are interpersonally dependent or exploitive. Individuals in the conformist level
(conformist [E4] or self-aware2 [E5]) are especially concerned with maintaining
interpersonal relationships. Internal states are often expressed in terms of cliches and
stereotypes. The postconforrnist level consists of the conscientious (E6), individualistic
(E7), autonomous (E8), and integrated (E9) stages. At this level, individuals cope with
inner conflict through a high degree of self-awareness and show more cognitive
complexity. Their interpersonal relationships are characterized by mutuality and respect
for individual differences (Loevinger, 1976).

Loevinger suggests that ego development is applicable to individuals across the
lifespan and is a major dimension of individual differences at all age levels. The process
of ego development is not a smooth, linear course, nor does it have a finite beginning and
end. It is best thought of as an on-going process. In fact, although Loevinger describes a
“final” stage of ego development (E9), she emphasizes that this rather uncommon stage is
not actually an endpoint, but rather “an opening to new possibilities.” Consistent with
this lifespan orientation, Loevinger has hesitated to tie specific ages to specific stages.
The descriptions of each level are written without reference to normative developmental
activities (e.g., attending school). However, she has recognized that it is theoretically
impossible for children to be at the highest level, and it is maladaptive for adults to be at
the lowest level (Loevinger, 1976). In a general sense, though, the different levels can be

thought of as different personality types, with well-functioning individuals at each level.

 

2 The self-aware stage was formerly known as the conscientious-conformist stage. The new terminology is
intended to reflect a shift in the conceptualization of this stage from merely a transitional stage to an
important stage in its own right (Hy & Loevinger, I996)

Ego Development and Adolescence

The current study will focus on ego development in adolescence. Defining the
exact boundaries of adolescence is a difficult task due to the numerous, diverse
transitions which occur during the second decade of life. In many respects, determining
when adolescence begins and ends is a matter of opinion rather than fact, with the
definition varying according to the context (Steinberg, 2002). In the present study,
adolescence will be defined as ages 12-17. The lower bound of this range reflects an age
at which individuals generally have begun the physical transformations of puberty
(Peterson, 1988). Additionally, in the United States, this age approximately coincides
with the transition from elementary school to junior high or middle school. The upper
bound of this range reflects sample availability. This age range also reflects fairly typical
sample characteristics used in the existing literature on adolescent ego development (e. g.,
Borst & Noam, 1993; Noam et al., 1994; Noam & Houlihan, 1993).

Adolescence is a time of particular interest with regard to ego development
because it involves both personality development and reorganization—the essence of ego
development. Perhaps one of the best-known descriptions of this time in life is Erik
Erikson’s concept of identity versus identity diffusion. This stage is described as the
consolidation of social roles and the integration of a variety of identities (Erikson, 1959).
The work of Susan Harter and colleagues (1997) on adolescence suggests similar issues
in the development of the self. She has suggested that young adolescents can only
construct single abstractions of the self; that is, they can only understand their identity in
one way. In mid-adolescence, individuals can compare, but not resolve, contradictory

attributes of the self. Finally, in late adolescence, the individual can integrate and resolve

seemingly contradictory attributes into a single self-concept (Harter, Bresnik, Bouchey,

& Whitesell, 1997). Although Loevinger does not directly tie specific ego development
transitions to the adolescent time period, the transformations that she describes seem
consistent with the emphasis that these theories place on reorganization and integration of
the self.

According to Loevinger, individuals typically move from the preconformist level
of functioning (E2 and E3 stages) to the conformist stage (E4) during the early
elementary school years. If the individual transitions beyond the conformist stage, he or
she is likely to do so around age 20 (Loevinger & Wessler, 1970). Thus, we would
expect adolescents to typically fall in the E4 stage, with some transitioning beyond this
stage to the E5 and E6 stages. Individuals in the conformist stage are characterized by
conformity to external rules and experience much shame and guilt for breaking these
rules. Interpersonally, they are concerned with belonging and helping, and they may
engage in superficial niceness. E4 individuals are also concerned with appearance, social
acceptability, and behavior. Finally, cognitively, they are characterized by conceptual
simplicity, stereotypes, and cliches (Loevinger, 1976). Although the conformist stage is
developmentally typical for adolescents (Loevinger & Wessler, 1976; Noam, Paget,
Valiant, Borst, & Bartok, 1994), there are liabilities in this mode of functioning, and this,
as well as earlier stages, may be conducive to developing certain types of psychiatric
symptomatology.

Ego Development and Psychopathology
Although Loevinger (1976) describes ego development independent of

chronological age, age has been the major predictor of ego development in a number of

cross-sectional and longitudinal studies of healthy adolescents (Noam et al., 1994).
While Loevinger emphasizes that psychopathology occurs at all levels of ego
development, empirical research has suggested that individuals with greater
psychopathology are found at lower levels of ego development, particularly the E2 and
E3 stages that make up the preconformist level (e. g., Frank & Quinlan, 1976; Noam,
Hauser, Santostefano, Garrison, Jacobson, Powers, & Mead, 1984; Noam & Houlihan,
1990). In one study, healthy high school students were compared to adolescent,
psychiatric inpatients. While 65% of the high school students were at or above the
conformist level, only 10% of the psychiatric control group had advanced to the same
level (Hauser, Jacobson, Noam, & Powers, 1983). In another study, only 21.1% of a
psychiatric sample fell within the conformist level or above (Noam et al., 1984). Finally,
in a third study, over 80% of psychiatric inpatients were delayed in ego development
compared to only 10% of a non-clinical control group (Noam, 1984; as cited in Noam et
aL,l984)

Research has also suggested that individuals at preconformist levels of ego
development experience greater numbers of psychiatric symptoms (Noam et al., 1984).
For example, when DSM-III diagnoses were rank-ordered according to severity among
an adolescent, psychiatric inpatient sample, the results generally suggested that as the
severity of the diagnosis increased, there were more subjects at the preconformist level
and fewer subjects at the conformist level (Noam & Houlihan, 1990). In another study,
with a similar sample, a modest, but significant inverse relationship was found between

stage of ego development and likelihood of initiating assaults, having accidents, and

making suicide attempts. Additionally, individuals at lower levels of ego development
tended to be hospitalized longer (Browning, 1986).

Unfortunately, previous research has been somewhat general and has rarely
explored possible differences in psychopathology that might exist between the E2 and E3
stages, instead combining them and analyzing them together as the preconformist level
(e.g., Noam et al., 1994). Therefore, an important goal of this study is to examine these
stages individually. Loevinger’s (1976) theory describes the E2 stage as characterized by
impulsivity, fear of retaliation, and a dependent and/or exploitive interpersonal style.
Individuals in this stage are particularly concerned with bodily feelings. Cognitively,
they exhibit stereotypy and conceptual confusion. The E3 stage is described as
characterized by a fear of being caught. These individuals are apt to externalize blame
and act opportunistically. Interpersonally, they may be wary, manipulative, and/or
exploitive. They are concerned with self-protection, advantage, and control (Loevinger,
1976)

The only study to date that examined the E2 and E3 stages separately found
important differences, consistent with theory (Frank & Quinlan, 1976). Delinquent girls
were more likely to fall into the E2 stage than were non-delinquent girls. Further,
qualitative information gleaned from interviewing the participants revealed that
objectively similar behaviors often had dissimilar meanings for E2 and E3 individuals.
For example, individuals in the E2 stage often reported fighting at random and were
easily provoked. In contrast, individuals in the E3 stage tended to fight with a specific
goal in mind and “when they had to” (Frank & Quinlan, 1976). Although this study is

clearly an important contribution to the literature, it is limited by a unique sample (i.e. all

female, minority, inner city residents), which may not be generalizable to other non-
clinical groups and psychiatric populations. Additionally, there is a need to attempt to
replicate the findings.

One explanation for the relationship between delayed ego development and
psychiatric impairment is the age-stage dysynchrony that occurs when an adolescent
attempts to meet the demands of a more mature world with a primitive frame of reference
(Noam et al., 1984). In adolescence, the individual must renegotiate relationships with
parents and peers. Coping strategies that were adequate in childhood may no longer
allow the individual to function appropriately in these complex relationships (Noam et
al., 1984). For example, in adolescence, individuals typically begin to spend more time
with peers rather than family members. They begin to look to these peers for emotional
support, and in doing so begin to establish independence and greater autonomy from their
family of origin (Larson & Richards, 1994). The adolescent must adapt to the significant
reorganization of his or her world. The preconformist adolescent is equipped with
unsophisticated models of interpersonal relationships, weak impulse control, and limited
cognitive complexity, making this reorganization a significant obstacle.

The connection between ego development and psychological functioning is even
more apparent when one considers the traits of several psychiatric diagnoses that are
prevalent among adolescents. Disruptive behavior disorders are estimated to affect
10.3% of individuals ages 9 to 17 (Shaffer et al., 1996). Several of the behaviors
associated with a diagnosis of Conduct Disorder (CD) can be construed as developmental
deficits. The lack of guilt and concern for others’ feelings and property corresponds to

the self-interest characteristic of the preconformist levels of ego development (Noam et

al., 1984). For instance, Loevinger states that individuals in the E2 stage view and value
others largely in terms of what the person will give them or do for them. Loevinger
describes individuals in the E3 stage as prone to externalizing blame for problems. They
are hedonistic and opportunistic and frequently unable to see their role in creating any
negative outcome (Loevinger, 1976).

However, focusing only on DSM-IV diagnoses to better understand ego
development and psychopathology is problematic, due to the imprecision of the DSM,
which combines both overt or aggressive (e. g., physical fighting, bullying) and covert or
delinquent (e. g., lying, theft, cheating) antisocial behaviors under the diagnosis of CD
(American Psychiatric Association, 1994). This characteristic of the CD diagnosis has
been widely criticized due to important differences in onset, correlates, and trajectories
for individuals with predominantly overt versus covert behaviors (Achenbach, 1993).
When relating antisocial behaviors to ego development, it is essential to distinguish
among these behaviors. Although both overt and covert deviance relate to the
preconformist level in a general sense, it is likely that they relate differentially to the
levels that make up the preconformist level. Specifically, individuals in the E2 stage
should engage in more impulsive behaviors, including aggression. On the other hand,
individuals in the E3 stage should have a higher level of cognitive complexity and self-
control leading them to engage in more planful, covert behaviors. It is also notable that
the age of onset for overt and covert behaviors fits neatly with the ego development
literature. As the impulsive stage of ego development precedes the self-protective stage,
the development of overt behaviors, precedes the development of covert behaviors

(Moffit, 1993). Thus, when relating conduct disorders to psychopathology,

differentiation of the E2 and E3 stages is valuable; however, with the exception of the
Frank and Quinlan (1976) study, previous research has always combined the stages (e. g.,
Gold, 1980; Noam & Houlihan, 1991).

Examining ego development among adolescents may also aid in understanding
another common adolescent psychiatric problem: depression. Major Depressive Disorder
is estimated to affect 10% of adolescents, 75% of whom are female (McFarlane,
Bellissimo, Norman, & Lange, 1994). A significant body of literature has suggested that
there are two distinct groups of individuals who experience depression: those who
experience mainly interpersonal preoccupations and those who experience mainly self-
critical preoccupations (i.e., concerns about competence and personal goals) (Blatt, 1974;
Blatt & Zuroff, 1992). Individuals classified in the interpersonal preoccupation group are
prone to view themselves as helpless, fear abandonment by others, and have an extreme
desire for closeness and nurturing by others (Blatt, 1974; Blatt & Zuroff, 1992). They
may rely strongly on social approval to maintain self-esteem (Gold, 1980). Thus, it is
hypothesized that depression occurs among interpersonally preoccupied individuals in
response to disruptions in satisfying interpersonal relationships (Blatt, 1974; Blatt &
Zuroff, 1992). The etiology of depression in the interpersonally preoccupied group is
consistent with Loevinger’s description of individuals in the E4 (conformist) level.
Previous empirical research has also supported the connection between depression and
the E4 level, suggesting that there are higher levels of depressive symptomatology among
individuals in the conformist level compared to those in the preconformist level (Gold,
1980; Noam & Houlihan, 1991). Previous literature has combined the E2 and E3 stages

into the preconformist stage when examining depressive symptomatology. This

10

consolidation has thus far prevented researchers from assessing whether symptoms occur
with equal frequency among individuals in the E2 and E3 stages. Additionally, due to the
level of cognitive complexity of E3 individuals, it seems likely that, while they will have
lower levels of depressive symptomatology than the E4 individuals, they will have higher
levels than the E2 individuals.
Ego Development and Gender

Relating psychiatric symptoms to specific stages of ego development has the potential
to increase our understanding of both. However, because gender has a unique association
with both ego development and specific forms of psychopathology, an examination of its
influence is necessary to fully understand the symptomatology during adolescence.
Block (1984) suggested that each stage of ego development can be associated with
specific stages in the development of sex role identity. Although a detailed discussion of
her theory is beyond the scope of this study, it is useful to note that she associates the
preconformist stages with the initial understanding of gender identity and the desire to
maximize personal advantage. Unfortunately, little of the empirical literature on ego
development has addressed gender-related issues. Many studies include only females
(Loevinger’s original theory was developed using women only), and even those studies
that use mixed samples frequently fail to examine gender differences (e.g. Jacobson,
Hauser, Powers, & Noam, 1984; Noam & Houlihan, 1991). One study that did consider
gender controlled for gender differences in psychopathology, rather than analyzing it as a
primary point of interest (Noam et al., 1994).

Gender and Conduct Disorders. On the other hand, a voluminous body of research

has addressed gender differences in behavioral problems. The two types of antisocial

11

behavioral problems described earlier (overt and covert), differentially affect males and
females. While overt conduct problems are more prevalent among males, covert
behavioral problems are equally prevalent in both genders (Zoccolillo, 1993). The higher
rate of both physical and verbal aggression among males is a consistent finding, even
found in cross-cultural research (Parke & Slaby, 1983).

It has been suggested that conduct problems follow two distinct pathways (Moffit,
1993). The life-course-persistent pathway is characterized by both overt and covert
behaviors, onset in early to middle childhood, and behavioral problems lasting
throughout the lifespan. The adolescence-limited pathway is characterized by a relative
absence of overt, aggressive behaviors, adolescent onset, and substantial rates of
recovery. It has been hypothesized that such conduct problems are highly influenced by
socialization and may stem from attempts to attain status and prestige by copying peers
who have been deviant since childhood (Moffit, 1993). These two pathways are pertinent
to this discussion because the life-course-persistent pathway contains a higher proportion
of males, while the adolescence-limited pathway contains roughly equal numbers of
males and females (Moffit, 1993).

Although gender differences in expression of conduct problems may be influenced by
biological and genetic factors, these differences may also be strongly influenced by
socialization patterns beginning early in life. Through socialization there is an emphasis
on agency for males and communion for females (Block, 1984). Parents may respond
with greater disapproval when young girls act aggressively (Condry & Ross, 1985). In
fact, by middle childhood, boys expect less parental disapproval and report feeling less

guilty over aggression than do girls (Perry, Perry, & Weiss, 1989). Thus, there are

12

important differences in the types of antisocial behaviors in which males and females
engage, regardless of the etiology of the behavior. Therefore, it seems probable that the
relationship between psychiatric symptomatology and level of ego development will be
particularly strong when the symptoms are consonant with common gender-related
patterns of behavior. In other words, if individuals in the impulsive stage exhibit
impulsive, under-controlled aggression, male adolescents will be more likely to exhibit
these problems because such aggressive behavior is more common. On the other hand,
the delinquent, social role violations that are expected to be associated with the self-
protective stage are likely to occur with equal frequency among both males and females.

Gender and depression. Just as there are important gender differences in antisocial
behaviors, there are notable gender differences in rates of depression in adolescence.
Studies consistently find, beginning at adolescence, that girls begin to experience more
depression than boys (Cyranowski, Frank, Young, & Shear, 2000). Although research
has suggested that hormonal fluctuations, gender roles, and societal disadvantage are
likely to play a role in this gender disparity (Cyranowski et al., 2000), research has also
suggested that female adolescents’ affiliative needs may make them particularly
susceptible to depressive symptomatology (Nolen-Hoeksema & Girgus, 1994).

As previously discussed, interpersonally preoccupied individuals may experience
depression in response to disruptions in satisfying interpersonal relationships
(Leadbeater, Blatt, & Quinlan, 1995). Females are more likely to place a greater value on
interpersonal relationships (Cyranowski et al., 2000). Although these differences in
affiliative needs are present at a young age, they increase during adolescence (Larson &

Richards, 1989). The increased desire for social connection can be a liability in

13

adolescence when social roles and structures are being redefined (Steinberg, 2002). The
work of Carol Gilligan (1982) has also explored the great value women and girls place on
social connections. She has described how in adolescence, girls are faced with a conflict
where they must sacrifice their own desires and “take themselves out of the relationship”
in order to maintain connections with others (Gilligan, 1982). Such a situation leaves the
woman’s identity and self-worth inextricably tied to interpersonal relationships and may
leave her quite vulnerable when problems occur in relationships.

As previously mentioned, literature has suggested that individuals in the conformist
stage of ego development are more likely to experience symptoms of depression (Gold,
1980, Noam & Houlihan, 1991). Further, Block (1984) has suggested that at the
conformist stage, when individuals are particularly sensitive to societal influences, there
is greater conformity to social roles, thus creating strong identity differences between
males and females (Block, 1984). While boys are encouraged to control affect, girls are
encouraged to control aggression (Block, 1984). This societal influence encourages
females to exhibit depressive, rather than aggressive, symptoms. Therefore, it is expected
that the depressive symptomatology associated with the conformist stage will be more
prevalent among females. Unfortunately, previous research has not examined this

potentially meaningful relationship between gender and ego development.

14

Rationale

Loevinger’s conception of ego development provides a meaningful framework for
understanding human behavior and development. The concept synthesizes diverse
aspects of development, including moral development, the development of interpersonal
relations and the development of cognitive complexity. Further, ego development
encompasses many clinically relevant dimensions, including impulse control,
responsibility taking, and social judgment (Hauser, 1993). Thus a better understanding
of the concept could potentially facilitate meaningful clinical applications of ego
development. While previous research has suggested that ego development is
meaningfully related to psychopathology (e. g., Frank & Quinlan, 1976; Noam, et al.,
1984; Noam & Houlihan, 1990), there are several important limitations to this literature.

Research addressing these issues has primarily been conducted by a small group
of authors (e.g. Borst & Noam, 1993; Noam, 1984; Noam & Houlihan, 1990; Noam et
al., 1984; Noam, et al., 1994). There is a need for additional researchers to replicate these
findings in a different setting.

Second, previous research has not differentiated between the E2 (impulsive) and
E3 (self-protective) stages, instead combining them as the preconformist stage and
contrasting them with the E4 (conformist) stage in data analyses. In fact, only one study
thus far has examined the distinction between the E2 and E3 stages (Frank & Quinlan,
1976). The paucity of literature on this topic is particularly problematic because

Loevinger’s theory describes important distinctions in impulsivity and cognitive

15

complexity between these stages. These distinctions may result in differences in
psychiatric symptomatology.

A third limitation of the previous literature is that the measures assessing psychiatric
status and impairment have notable weaknesses. For example, several studies have used
DSM diagnoses. This is problematic because a variety of symptoms are included under
each diagnosis and two individuals qualifying for the same diagnosis may have very
different symptom pictures. This issue is especially salient with regard to the diagnosis
of Conduct Disorder that combines both overt and covert forms of antisocial behavior
(Achenbach, 1993). Another instrument commonly used in the literature is the Child
Behavior Checklist (CBCL; Achenbach, 1991). On this measure, parents are asked to
rate descriptions such as “disobedient at school” and “nervous, highstrung, or tense”
using a rating scale in which 0 = not true, 1=somewhatlsometimes true, and 2=very true
or often true. However, the child’s score is dependent on parent’s idiosyncratic
definitions of which behaviors constitute the descriptor. For example, one parent might
define disobedience as a relatively mild misbehavior such as talking during class;
whereas another parent might define it as a very severe misbehavior, such as physical
aggression toward the teacher. Further, while one parent may rate a behavior that occurs
weekly as a somewhat true descriptor (1) another parent may rate the same situation as
very true (2).

Because fine behavioral distinctions are integral to this study, assessment of relevant
psychiatric symptomatology will be assessed by an instrument that provides detailed
information pertaining to a wide range of specific behaviors over the past three months

(the Functional Impairment Scale for Children and Adolescents—FISCA; Frank & Paul,

16

1995). This instrument includes scales that differentiate between overt and covert
behaviors. Additionally, the measure utilizes specific items that offer greater accuracy
and consistency than measures such as the CBCL. For example, parents are asked
whether their child has or has not “disobey[ed] school rules, but in ways that did not
harm others” and “on purpose destroy[ed] or seriously damage[ed] school property”
within the past three months. Additionally, several items such as, “go joy riding in a car
without permission,” are rated using a specific number of incidents (never, one time, two
times or more).

Finally, previous research has neglected to examine the influence that gender has on
both ego development and psychopathology. While some work has described gender
identity (e. g., Block, 1984) and some work has described psychopathology (e.g., F rank &
Quinlan, 1976; Noam, et al., 1984; Noam & Houlihan, 1990) and their individual
relationships to ego development, very little previous work has examined the possibility
that gender may moderate the relationship between ego development and
psychopathology. Specifically, previous research has suggested that adolescent males
are more likely to engage in aggressive acts (Zoccolillo, 1993), while adolescent females
are more likely to experience depressive symptoms (Cyranowski et al., 2000). This study
provides the opportunity to compare a large sample of both male and female adolescents’
level of ego development and psychiatric impairment—a unique contribution to the
current body of literature.

The present study will utilize a sample of 135 male and 170 female adolescent
inpatients. The inpatient nature of the sample is expected to provide a large number of

individuals in the preconformist level of ego development (Noam & Houlihan, 1991).

17

Adolescents in the sample have completed the Washington University Sentence

Completion Test (SCT; Hy & Loevinger, 1996), which is considered to be the most

appropriate way to assess level of ego development. Their parent/ guardians have

completed the FISCA (Frank & Paul, 1995) in order to describe psychiatric impairment.

This study will provide the opportunity to replicate the findings of Noam and colleagues,

and will expand upon this literature, by examining differences between the E2 and E3

stages, precisely assessing adolescent behaviors, and considering the influence of gender

on the relationship between ego development and psychopathology.

The specific hypotheses of the study are:

1.

Because of the psychiatric nature of the sample, it is expected that subjects will
fall in the E2, E3, and E4 stages, rather than largely in the E4 stage as predicted
by Loevinger’s theory.

Individuals in the E2 stage will have higher levels of under-controlled aggression
(FISCA aggression scale) than those in the E3 or E4 stages. Additionally it is
expected that there will be an interaction effect, such that males in the E2 stage
will have higher levels of under-controlled aggression than females in this stage.
Individuals in the E3 stage will have higher levels of covert antisocial behaviors,
or social role violations (FISCA delinquency scale), than those in the E2 or E4
stages.

Individuals in the E4 stage will have higher levels of depressive symptomatology
(derived from FISCA feelings and moods scale) than individuals in the E2 and E3
stages. Individuals in the E3 stage will have higher levels of depressive

symptomatology than individuals in the E2 stage. Additionally it is expected that

18

there will be an interaction effect, such that females in the E4 stage will have

higher levels of depressive symptomatology than males.

19

METHOD

Subjects

Data for this study were collected as part of a larger study of psychopathology in
adolescent psychiatric inpatients. The sample includes 305 adolescents between the ages
of 12 and 17 (Mean = 14.8 years; SD = 1.50). The participants are predominantly
Caucasian (79.9%). The sample consists of 135 male (44.3%) and 170 (55.7%) female
patients. See Table 1.
Measures

All of the following measures were completed as part of the hospital’s routine intake
procedures.

Demographic Information. Demographic information was obtained from a Social
History Questionnaire completed by the adolescent’s parent or guardian at the time of
intake. Parents provided information on the adolescent’s age, family income, parent
education, living situation (e. g., two-parent home, single-parent home, foster home, etc.),
grade, race/ethnicity, and insurance. (See Appendix A for a copy of the measure.)

Ego Development. Ego development was assessed using the Washington
University Sentence Completion Test for Measuring Ego Development (SCT; Hy &
Loevinger, 1996). The SCT consists of 36 sentence stems from which the participant
generates full sentences. Sample items include: “Education. . .,” “Men are lucky
because. . .,” and “Raising a family...” (See Appendix B for a copy of the measure.)

There is strong evidence for good reliability and validity for this measure (e. g.,
Hauser, 1976; Loevinger, 1979). Sentences are scored according to procedures outlined
in the scoring manual (Hy & Loevinger, 1996). Specific scoring rules can be found in

Table 2. Initially, each sentence is coded independently of other sentences in the same

20

protocol. When all sentences in a protocol are scored, the frequency of responses at each
stage of ego development is recorded. Then cumulative frequencies are calculated for
each stage. After cumulative frequencies are calculated, an overall ego development

stage is derived by utilizing the ogive rules presented in Table 3.

 

 

Table 1.
Demographic Characteristics of Sample
Frequency Percent Sample Size (N)
Sex 305
Male 135 44.26%
Female 1 70 55.74%
Ethnicity 268
Native American 12 4.48%
Asian 1 0.37%
Latino/a 1 6 5.97%
African American 13 4.85%
Caucasian 214 79.85%
Other 7 2.61%
Multiracial 5 l .87%
Family total income 255
Less than $8,000 28 11.0%
$8,000-Sl 1,999 40 15.7%
$12,000-$19,999 41 16.1%
$20,000—$29,999 3 1 12.2%
$30,000-$44,999 46 18.0%
$45,000-S69,999 50 19.6%
$70,000-$100,000 12 4.7%
More than $100,000 7 2.7%
Mean age 14.8 304
(SD = 1.50)
Mean length of psychiatric 13.11 days 247
hospitalization (SD = 6.06)

 

21

Table 2.
Rules for Scoring Individual Sentences.l

 

Rule 1 Match the content of the completion with one of the listed category titles.

Rule 2 Where the combination of two or more elements in a compound response
generates a more complex level of conception, rate the response one-half step
higher than the highest element.

Rule 3 Where the combination of ideas in a compound response does not generate a
higher level of conceptual complexity, rate the response in the less frequent
category, or rate the higher category.

Rule 4 In the case of a meaningful response, where there is no appropriate category
and rules 2 and 3 do not apply, use the general theory to arrive at a rating.

Rule 5 Where the response is omitted or too fragmentary to be meaningful, it is rated
E4.

 

‘ Adapted from Hy and Loevinger (1996)

22

Table 3.
Automatic Rules for Assessing Total Protocol Ratings to the Ogive of Item Ratings. "2

 

Overall ego If there are:
development stage is:

 

E93 No more than 34 ratings at E8
E8 No more than 31 ratings at E7
E7 No more than 30 ratings at E6
E6 No more than 24 ratings at E5
E5 No more than 20 ratings at E4
E2 At least 5 ratings at E2

E3 At least 6 ratings at E3

E4 Other Cases

 

' Adapted from Hy & Loevinger (1996)
2 Apply these rules in the order given, from E9 to E4
To receive an E9 rating , the E8 criterion must also be met.

23

Psychiatric Symptomatolgy. The Functionfilmjpairment Sgtle for Childrflalrd
Adolescents (Frank & Paul, 1995) is a 183-item, multidimensional parent-report
questionnaire with eight scales: aggression, thinking, home, delinquency, alcohol and
drugs, school, self-harm, and feelings and moods. Most items use “yes/no” or
"never/occasionally/often” response formats. Several additional items employ a
multiple—choice format. Sample items include “How many times in the past three months
has the child skipped school?” and “How often in the past three months did your child
have very sudden changes in mood?” (See Appendix C for a copy of the measure.) Each
FISCA domain is scored on a three point scale ranging from 1-3 indicating mild,
moderate, or severe impairment, respectively. The present study will focus on the
aggression and delinquency scales and the depression-related questions from the feelings
and moods scale.

The FISCA scoring criteria were influenced conceptually by the Child and
Adolescent Functional Assessment Scale (Hodges, 1994; Hodges, Bickman, Kurtz, &
Reiter, 1992; Hodges & Gust, 1995). Adequate internal reliability has been demonstrated
for all scales, except for the Home scale (a = .28). Alpha coefficients for all other scales
range from .54 to .87, with a mean of .73 (Frank, Paul, Marks, & VanEgeren, 2000).

Assessment of relative and absolute agreement between parent report on the
FISCA and adolescent report on a self-report version of the FISCA (FISCA-SR; Frank &
Paul, 1995) indicates satisfactory agreement (Frank, VanEgeren, Fortier & Chase, 2000).
Inter-informant correlation was strongest for the Aggression scale and weakest for the

Thinking and Feelings and Moods scales. This was consistent with predictions that

24

agreement would be stronger on variables related to overt behaviors and weaker on

variables related to the adolescents’ private thoughts and feelings.

Procedures

Data for the study were collected as part of the hospital’s routine intake
assessment. Consent to utilize assessment data for research purposes as well as treatment
planning was obtained at adolescent’s hospital admission from a parent/guardian. This
information was also presented to the adolescent when the measures were administered
and verbal assent was obtained. A parent or guardian completed the Social History
Questionnaire and FISCA at the time of the intake. During the first 24 to 36 hours of the
adolescent’s hospitalization, undergraduate extems individually administered the SCT.
Extems were trained in a small group by a university faculty member and they were
supervised at weekly group meetings. Information obtained from the questionnaires was
used by the hospital for diagnosis, treatment planning, and development of family
intervention strategies.

The SCT was scored by two raters trained according to published training exercises
(Hy & Loevinger, 1970) and supervised by an experienced coder. Once acceptable
reliability was obtained with the experienced coder (r = .71 and g = .74), the raters coded
the protocols individually. Raters met regularly to address scoring-related issues and
double-coded an additional subset of protocols (n=15) to prevent scoring drift. Overall
inter-rater reliability was comparable to previously published studies utilizing the SCT (r

= .82).

25

RESULTS
The present study included a sample of three hundred and five adolescent,

psychiatric in-patients who completed Loevinger’s Sentence Completion Test, a measure
of ego development (Hy & Loevinger, 1996; Loevinger & Wessler, 1970). The number
of subjects that fell at each ego level is presented in Table 4. As noted, 86 subjects were
rated at the E5 or E6 level and therefore were excluded from the analyses of hypotheses

two through four, which did not make predictions about these higher levels’.

Table 4.

Number of Participants Rated at Each Level of Ego Development (n=305)

 

E; E_3 £3 fi fi
Number of 30 144 45 80 6
Participants
Percent of 9.8% 47.2% 14.8% 26.2% 2.0%
Sample

 

The major variables in this study were: ego development level, aggression,
delinquency, and depression. Correlations among these variables, as well as income, age,

and length of stay, are presented in Table 5.

 

3 The E5 group will be discussed firrther in the post hoc analyses section.

26

Table 5.

Correlations Among Major Variables

 

Ego Level

Income

Age.

Len of
“—3!

Aggrssn

Delngncy

Deprssn

Ego Level

L00
(n=305)

.081
(n=255)

.250**
(n=293)

-. 144‘
(n=247)

.001
(n=305)

-.054'
(n=305)

a019
(n=302)

Income

1 .00
(n=255)

.160*
(n=255)

-.212"”“
(n=229)

-.06l
(n=255)

-.073
(n=255)

01w
(n=253)

* significant at the p<.05 level

“significant at the p<.01 level

As:

L00
(n=293)

a227**
(n=247)

-. 126*
(n=293)

-.093
(n=293)

.113
(n=290)

Length
of stay

L00
(n=247)

.134*
(n=247)

.113
(n=247)

.061
(n=244)

Aggrssn

1 .00
(n=305)

.302"
(n=305)

.084
(n=302)

Delngncy Deprssn
l .00

(n=305)

.004 l .00
(n=302) (n=302)

 

As noted in the table, level of ego development was significantly and positively

correlated with age (r=.250, p<.01), consistent with previous literature. There was also a

significant, positive correlation between aggression and delinquency (gr-.302, p<.01).

Due to missing data for individual subjects, analyses including the aggression and

depression scales contained 209 and 207 subjects, respectively. Descriptive statistics for

the aggression, delinquency, and depression scales are presented in Table 6.

27

Table 6.

Scores on FISCA Aggression, Depression, and Delinquency Scales as a Function of

Level of Ego Development and Sex

 

Aggression
(n=209)

Depression
(n=207)

Delinquency
(n=2 19)

Mean

SD

Mean

SD

Mean

SD

E2
Equals Male
n=10 n=2
2.30 2.50
1.06 0.83
Female Male
n= n=2
3.00 2.75
0.00 0.64
(n=30)

 

 

 

 

E3
Female Male
n=73 n=63
2.55 2.65
0.76 0.77
Female Male
n=72 (n=63)
2.96 2.92
0.26 0.33
(n=l44)
1.89
1.21

 

E4
Female Male
n=23 n=20
2.43 2.45
0.90 ‘ 0.80
Female Male
n=23 n=20
2.78 2.80
0.52 0.52
(n=45)
1.71
1.29

 

The first hypothesis was that, due to the psychiatric nature of the sample, subjects

would fall in the E2, E3, and E4 stages rather than largely in the E4 stage. In order to test

this hypothesis, a chi-square statistic was computed. Expected number of subjects at or

above the E4 level was set at 65% of the sample, as suggested by results of the work of

Hauser et al. (1983). Since previous work did not adequately distinguish between

subjects at the E2 and E3 levels, it was impossible to make a precise prediction with

28

regard to the expected number of subjects at each of these levels. Therefore, the E2 and
E3 levels were combined when calculating the chi-square statistic and it was expected
that 35% of the subjects would fall at this combined level. The chi-square was significant
[x2(1, 305) = 181.59, p<.01]. These results support the hypothesis that this psychiatric
sample has a greater number of individuals in the E2 and E3 levels than would be
expected in a non-psychiatric sample.

It was hypothesized that individuals in the E2 stage would have higher levels of
under—controlled aggression than those in the E3 or E4 stages. Further, it was predicted
that gender would interact with ego stage, such that E2 males would have higher levels of
under-controlled aggression than E2 females. In order to test this hypothesis, a 3 x 2
between subjects analysis of variance was conducted. The ANOVA did not result in a
significant main effect for ego development level [F(2, 208) = 1.098, MSE = .704, Q].
The interaction between level of ego development and sex also was not significant [F(2,

208) = 0.112, MSE = .0717, g] See Table 7.

 

 

Table 7.

Analysis of Variance for Aggression (n=209)

Source Df F MSE p
Ego Level 2 1.098 .704 0.336
Gender 1 0.578 .371 0.448
Ego Level x Gender 2 0.1 12 0.071 0.894
Error 203 0.641

 

29

The third hypothesis was that individuals in the E3 stage would have higher levels
of delinquent behaviors than those in the E2 or E4 stages. This hypothesis was tested
with a one-factor between subjects analysis of variance to determine whether level of ego
development (E2, E3, or E4) affected delinquency levels reported on the F ISCA. The
ANOVA did not result in a significant main effect for ego development level [E(2, 218) =

.368, MSE = .544, r_1_s_1. See Table 8.

 

 

Table 8.

Analysis of Variance for Delinquency (n=219)

Source Df F MSE p
Ego Level 2 0.368 0.544 0.693
Error 216 1.480

 

The fourth hypothesis was that individuals in the E4 stage would have higher
levels of depression than individuals in the E2 and E3 stages and individuals in the E3
stage would have higher levels of depression than individuals in the E2 stage.
Additionally, an interaction was predicted such that females in the E4 stage would have
higher levels of symptomatology than males. Depression scores were derived from a
subset of questions from the FISCA feelings and moods scale. In order to test this
hypothesis, a 3 x 2 between subjects analysis of variance was conducted. The ANOVA
did not result in a main effect for ego level [£(2, 207) = 2.420, MS_E = .365, g.
Additionally, there was not a significant interaction effect between ego level and gender

[5(2, 206) = .999, MSE = .151, 1E1. See Table 9.

30

Table 9.
Analysis of Variance for Depression (n=207)

 

 

Source Df F MSE p
Ego Level 2 2.420 0.365 0.092
Gender 1 1.702 0.257 0.193
Ego Level x Gender 2 0.999 0.151 0.370
Error 201 0.151

 

31

POST HOC ANALYSES

One surprising finding of the present study was the relatively large number of
adolescents who were at the E5 level of ego development (26.2%). Exploratory analyses
were undertaken to better understand both the E5 group and the sample utilized in this
study. Three major possibilities existed for interpreting the E5 data. First, the E5
individuals may simply be a distinct category, with their own unique patterns of
psychopathology. Second, the E5 individuals may be somewhat similar to the E4
individuals, as the E5 stage follows the E4 stage. Finally, due to the design of the SCT
scoring system, it is possible that a single response could move a protocol from an E3
rating to an E5 rating. Therefore, the E5 category may appear similar to the E3 category.

Statistical analyses of hypotheses 2-4 were re-calculated including all E-levels in
order to determine if the inclusion of the E5 individuals would suggest trends not visible
in prior analyses. However, this alteration in analyses did not result in changes in
significance of results. The results of these additional analyses are presented in Tables

10-l3.

32

 

 

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and 90: fine fins auras Guns fins mung GE 33
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:4 5205 .xom 23 “8892969 bum mo 35 mo aowogm a 8 310m Savanna you 6332909 60% <UmE no 8.80m
.3 03oF

33

Table 11.
Analysis of Variance for Aggression, Including E5 and E6 Levels (n=293)

 

 

 

 

 

 

 

 

Source df F MSE p
Ego Level 4 0.795 0.467 0.529
Gender 1 0.655 0.384 0.419
Ego Level x Gender 4 0.564 0.331 0.689
Error 283 0.587

Table 12.

Analysis of Variance for Delinquency, Including E5 and E6 Levels (n=293)
Source Df F MSE p
Ego Level 4 0.629 0.961 0.642
Error 300 1.528

Table 13.

Analysis of Variance for Depression, Including E5 and E6 Levels (n=293)

Source df F MSE p
Ego Level 4 1.479 0.237 0.209
Gender 1 0.890 0.142 0.346
Ego Level x Gender 4 0.582 0.093 0.676
Error 280 0.160

 

34

DISCUSSION

The results of this study support the hypothesis that this psychiatric sample had
greater number of individuals in the preconformist stages than would be expected in a
healthy adolescent sample. However, results did not support the other three hypotheses
of this study. There were not significant differences in aggression, delinquency, or
depression scores for the different levels of ego development. There also were not
significant differences between males and females on aggression or depression scores.

These findings suggest continuity between stages of ego development. Loevinger
has stated that no single presence of or lack of a behavior defines a stage and that ideas
present at one level of development are often present in a more complex form in later
stages (Loevinger, 1976). Although Loevinger presents a description of ego development
with clearly defined boundaries between stages, she also acknowledges meaningful
continuity among them. The results of the present study emphasize the similarities
among the E2, E3, and E4 stages.

The findings of this study also suggested similarity in psychiatric
symptomatology between male and female subjects. One possible explanation for this
finding is that the psychiatric nature of the sample created a restriction of range. All of
the adolescents were considerably impaired in one regard or another, such that they
required psychiatric hospitalization. It is possible that the influence of the subjects’
severe psychopathology was greater than the influence of the subjects’ gender roles.
Perhaps the hypothesized differences between groups would appear more readily in a

non-hospitalized or community sample.

35

A second possibility is that gender roles have not been thoroughly socialized in
this sample. First, the sample contained a large number of individuals who were at early
levels of ego development. Although Block (1984) has stated that the preconformist
stages are associated with an initial understanding of gender identity, it is plausible that
this limited understanding was insufficient to exert a measurable influence over
symptomatology. Secondly, research has suggested that the intensification of gender
roles that occurs in adolescence is directly related to the chronological age of the
adolescent (Galambos, Almeida, & Petersen, 1990). Perhaps the subjects in the present
study (mean age =14.8) were too young for the effects of gender to be pronounced.
Potential limitations of the SC T

On the other hand, it is possible that limitations of the SCT prevented the present
study from revealing differences among the levels of ego development. One explanation
is that the SCT does not sufficiently differentiate between the preconformist E2 and E3
levels. Due to the theoretically small number of individuals at these levels in the general
population, standardization samples have included relatively few of these subjects. Table
14 presents the distribution of the sample for both the original and revised manuals along
with the distribution for the present study. As noted in the table, the total number of
subjects in both standardization samples for the E2 and E3 stages was only 82 and 129,
respectively. This is strikingly smaller than the sample sizes for other stages, such as E4
and E5, which included 769 and 831 subjects, respectively (Westenberg, Jonckheer,
Treffers, & Drewes, 1998).

Not only were there few preconformist subjects in the samples used to create the

manuals, but the manuals were developed using a sample older than the sample in the

36

present study (Westenberg et al., 1998). In the original sample, 85% of the subjects were
over the age of 16. In the revised edition, the subjects were mostly college students (Hy
& Loevinger, 1996). Although Loevinger states that her theory and manual are designed
to be applicable to individuals at all age levels (Loevinger, 1976, Hy & Loevinger, 1996),
experience applying the manual to an adolescent sample, in the present study, suggests
that the manual may have meaningful limitations when applied to the unique culture of
adolescence. By definition, the conformist stage is characterized by behaviors and
attitudes that are conventional in order to promote social acceptability (Hy & Loevinger,
1996). However, socially normative thoughts and actions in adolescence are quite
different from those in adulthood. This difference may result in some conventional
adolescent responses being rated at a lower level because they would have different
implications if they had been given by adult respondents. One specific example from this
sample was that the stem “Education...” was often followed by responses such as “is
stupid” or “is boring” which would be rated level E3 under reason b (is worthless).
However, during adolescence an attitude of rejecting school may be presented to promote
an image of nonchalance and independence—socially desirable attributes. Thus, the lack

of attention to the culture of adolescence may artificially depress ego level.

37

Table 14.
Distribution of Ego Development Levels in Three Samples of Participants

 

E_2_ E_3 FA 25 E6 E2 E8-9 Total

 

1970 62 82 589 403 374 88 42 1640
manual1
1996 20 47 180 428 367 101 17 1160
manual2
Present 3 0 144 45 80 6 0 0 3 05
study

' Loevinger and Wessler (1970)

2 Hy and Loevinger (1996)

There are also ways in which the lack of attention to adolescence may inflate ego
levels. Many question stems do not have any prosocial responses scored at the E2 and
(sometimes) E3 levels. When Westenberg et al. (1998) adapted the manual for a Dutch
sample, they noticed that there were a number of E2 and E3 individuals who gave
simplistic, but prosocial responses. They proposed that such responses could be
incorporated into the manual without compromising the meaning of the E2 and E3 stages.
This has not yet occurred.

One surprising finding of the present study was the large number of adolescents
who were at the E5 level of ego development (26.2%), while a fairly small number were
E4 (14.8%). Although the precise implications of this are unknown, it seems likely that

this unexpected distribution is related to the re-conceptualization of the E5 level

38

(formerly I-3/4). Although originally the E5 level was considered to be a transitional
stage, Loevinger’s recent work emphasizes that E5 should be considered a stage in its
own right (Hy & Loevinger, 1996). The body of literature on which the present study is
based largely predates this revision and thus has not incorporated the revised conception
of the E5 level (e.g., Frank & Quinlan, 1976; Noam et al., 1984; Noam & Houlihan,
1990; Browning, 1986). Further complicating this issue are the ways in which this level
is treated in the literature. Some studies combine the E5 and E4 levels, refening to this
combined stage as “conformist” (e. g., Jacobson et al., 1984), while others consider the E5
level to be “post-conformist” (e. g., Gold, 1980). Still other studies do not clearly address
where this level has been placed in their analyses (e.g., Noam et al., 1994). The question
of whether the E5 level of ego development is, in fact, a separate level will be an
important issue to address in future studies.

Finally, although the SCT is designed to be a fairly objective measure, it does
require a certain level of skill and inference from coders. Total protocol scores are
determined by utilizing the ogive rules (see table 3). Often one response will determine
the difference between being placed in one E-level or another”. Particularly notable is
that due to the structure of the ogive rules, one answer can move a protocol from an E5 to
a E3 score, an especially problematic issue for the present study due to its emphasis on
the preconformist levels. The current scoring manual advises, “Where there is a
discrepancy between the ogive and the impressionistic [total protocol rating] it is
necessary to take a more analytic attitude...” (Hy & Loevinger, 1996). The manual

further goes on to describe trends that may aid in deciding the E-level for a protocol;

 

4 Previous manuals described a set of more complex “borderline rules,” but these were abandoned as
research suggested that they lead to more errors than improvements in ratings (Hy & Loevinger, 1996)

39

however, clinical judgment plays a significant role in the final assignment to a level. In
fact, in the most recent revision of the scoring manual Hy and Loevinger recommend that
coders have at least one year of graduate training and that all protocols be coded by at
least two coders (1996). Resources did not permit such arrangements for the present
study. It is also notable that the vast majority of previous literature also did meet this
standard. In fact, a number of studies used a single coder for the entire group of
protocols (e.g., Evans, Brody, & Noam, 2001; Hauser, 1978). It is likely that the
variability in training standards has resulted in variability in scoring outcomes among
studies. Once again, the body of literature upon which this study was developed has
some serious weaknesses that must be addressed for future work in this area to be
meaningful.
Design limitations of the present study

There are several limitations of the present study that should be considered when
evaluating results. First, the FISCA was completed by the subjects’ parents rather than
the subjects themselves. Although previous work has suggested that there is satisfactory
agreement between parent-report and child-report on the FISCA (Frank, VanEgeren,
Fortier & Chase, 2000), child completion of the measure would have added valuable
information to the study. Child-report would be of interest especially for the mood
subscale, which has shown weaker agreement than other subscales (Frank et al., 2000)
and limited variability in the present study (e. g. SD=0 for E2 females).

The F ISCA was also the only measure of psychiatric symptomatology. Multiple
measures and methods would have helped ensure that particular attributes of the FISCA

did not obscure findings. Additionally, both the FISCA and the SCT were completed

40

shortly after psychiatric hospital admission, a uniquely stressful situation. These
circumstances may have influenced parents’ F ISCA ratings of their children’s behavior.
This situation also may have influenced the child’s level of distress, compliance, and
effort while completing the SCT. Although previous work has not addressed the specific
factors associated with the psychiatric environment, some work has suggested that SCT
protocol ratings may be influenced by situational motivation (Redmore & Waldman,
1975)

Finally, previous research utilizing data from the same hospital setting suggested
that biases in hospital admission standards for males and females may have resulted in
unique sample characteristics (Frank, Poorman, VanEgeren, & Field, 1997). Generally,
males who engaged in externalizing problems only were not admitted to the psychiatric
hospital, but rather sent to juvenile court. Males were only admitted to the hospital if
they exhibited depressive symptomatology, either alone or in combination with
externalizing behaviors. Thus, the sample utilized in the present study may contain a
particularly high number of depressed, male adolescents. In contrast, female adolescents
were more likely to be admitted to the hospital if they exhibited externalizing problems.
Therefore the characteristics of this particular sample may have limited the ability to
detect gender-related interactions that may be present in other populations.

Future directions

Clearly there is much room for future work in the area of ego development,

particularly with regard to implementing stringent and consistent scoring standards. The

revised conception of the E5 level also needs to be addressed in future studies. However,

41

the most compelling implication of the present study is that the SCT manual should be
adapted to an adolescent population.

One final issue to address is the limited amount of research involving the SCT in
recent years. Perhaps this limited popularity is related to insignificant research results, as
found in the present study. Additionally, SCT training and the subsequent scoring of a
large number of protocols can be a labor-intensive process, an unattractive prospect to
many researchers. While it is possible that additional revision of the manual will address
these issues, we should not lose sight of the clinical applications of the SCT. In clinical
settings, the SCT may be used as part of a larger battery to better understand patients’
impulse control/character development, interpersonal relationships, conscious
preoccupations, and cognitive complexity. In research settings the need for clinical
judgment to interpret protocols is an obstacle and may lead to variability in findings. On
the other hand, the need for such judgment would not be problematic in a clinical

environment with emphasis on the assessment and treatment of an individual.

42

APPENDICES A-C

43

 

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45

SCT

Complete the following sentences.

1.

When a child will not join in group activities

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

2. Raising a family

3. When I am criticized

4. A man’s job

5. Being with other people

6. The thing I like about myself is
7. My mother and I

8. What gets me into trouble is

9. Education

 

 

10. When people are helpless

 

l 1. Women are lucky because

 

12. A good father

 

 

46

13.

A girl has a right to

 

 

14.

When they talked about sex, I

 

 

15.

A wife should

 

 

. I feel sorry

 

. A man feels good when

 

 

18.

Rules are

 

19.

Crime and delinquency could be halted if

 

 

20.

Men are lucky because

 

2].

I just can’t stand people who

 

22.

At times she worried about

 

23.

[am

 

 

47

24.

A woman feels good when

 

 

25.

My main problem is

 

 

26.

A husband has a right to

 

 

27.

The worst thing about being a woman

 

 

28.

A good mother

 

 

29.

When I am with a man

 

 

30.

Sometimes she wished that

 

31.

My father

 

 

32.

If I can’t get what I want

 

33.

Usually she felt that sex

 

 

34.

For a woman a career is

 

 

35.

My conscience bothers me if

 

 

36.

A woman should always

 

 

48

 

Child’s Name: I
Today’s Date:

FUNCTIONAL HWPAIRMENT SCALE FOR CHILDREN AND ADOLESCENTS (FISCA)
General Instructiofins: Your answers to this questionnaire will help us learn more about the kinds of
problems your child has been having during the pg three months. The questionnaire is for both
younger and older children, so some of the questions may not seem appropriate for your child. Please be
as honest as you can. Your answers will be kept confidential.

A. BACKGROUND INFORMATION: Please write in or put a check (I) in the box with the correct

 

 

information.
Al. Child’s sex? U Male [1 Female
A2. Your relation to the child? [1 Mother [1 Father [1 Stepmother l] Stepfather

 

 

 

l] Grandmother l] Grandfather [l Aunt [1 Uncle
D Other (explain):
A3a. Date of your child's birth? (month/day/year):
A3b. Child’s present age in years? years old
A4. Child’s grade in school? If it is 0 Preschool 0 kindergarten 0 Is! U 20d 0 3rd
- - - I] 4th I] 5th [I 6th [1 7m [1 8th
summer or the Chlld is not in [1 9m [1 10m 011m film

school, check the highest grade the
child completed to date.

 

A5a. Has the child been diagnosed
by a doctor or mental health
professional with any of the
following conditions that might
affect how well the child does in
school? (Check ALL that apply)

[l Mental retardation l] Learning disability

U Brain injury I] Speech or language disorder
[1 Attention deficit/hyperactivity disorder (ADHD)

D Other (Explain)

 

 

A5b. During the past three
months has the child been in a
special education classroom?

D No

D Yes, my child was in special education part of the school
day

[I Yes, my child was in special education all of the school day

 

A6a. Did the child’s mother (or
mother-figure in the child’s
home) .....

graduate from high school? [I Yes D No
graduate from a 4 year college? [1 Yes [I No
Put a check in this box if there is no mother in the home [1

 

A6b. Did the child’s father (or
father-figure in the child’s home)...

graduate from high school? [1 Yes I] No
graduate from a 4 year college? [I Yes [I No
Put a check in this box if there is no father in the home U

 

A6c. What is the yearly household
income in the child’s home (before
taxes)?

[1 Less than $8,000 l] $8, to 11,999 0 $12, to 19,999
0 $20, to 29,999 0 $30, to 44,999 0 $45, to 69,999
0 $70, to 100,000 I] Greater than $100,000

 

 

A7. Child’s ethnicity?
(Check ALL that apply)

 

l] Native American [l Asian [1 White, Hispanic
[1 Hispanic, Non-White 1] Black [1 White, Non-Hispanic
[1 Other (explain?)

 

49

 

 

How many times in the child’s lifetime has the
chfldn.

Xi." Béén'air'résiéci By' the-police? """"""""

 

A9. been found guilty of a crime in a court of law?

 

A10. been in a detention center or jail?

 

Al I. attempted suicide or made a suicide gesture?

 

 

Never 1 time 2 times

I] [l U
l] l] [I

"II """" U """" [I """
l] U [I

3thnas

ornuwe
---_u----4
----n .....
----U----.
-'--U--"1

 

 

Section B. SCHOOL The following questions ask about how your child has been doing in school
during the m 3 months. IF SCHOOL 18 OUT for the summer or your child just began a new school

year, think about the last 3 months of the past school

year.

 

  
 
  
  
  

1. Was your child in school at least some days
uring the past 3 months (or the last 3 months of the

2. IF NO, why wasn't your child in school at least
e of the time?

 

heck ALL that apply.

en GO TO Section C which begins on
e top of page 4.

 

1] If NO, GO TO 82
[I If Yes, Go TO BS

or nervous to go to school
Be. My child was expelled.
Ud. My child dropped out after
Be. My child dropped out after

job
[If . My child was physically ill

Uh. Other (Explain):

[1a. My child refused to go to school.
[1b. My child was too afraid, worried

reaching legal age AND is working

reaching legal age BUT does not have a

l] g. My child graduated from high school

 

(please continue on the top of page 4)

 

3. How many times during the m 3 months has
our child skipped school? Include times your child
efused to go to school, skipped school to "play hooky",
r was too worried or anxious to go to school.

Ua. Never. Go to B5

Db. Between 1 and 4 times
Dc. 5 to 10 times

Dd. 11 to 20 times

Be. More than 20 times

 

 

 

50

 

 

. Have any of the following resulted BECAUSE your Ua. My child had to serve detention 3 or more
hild did not go to school? times
[1b. My child lost course credit or was getting
Check ALL that apply) poor grades
Uc. School officials called, wrote, or sent
home

a note to complain about the absences
Ud. School officials suspended my child or

warned that my child might be suspended
or

expelled
[le None of these

 

 

 

51

 

5. During the past three months were your child's
des lower than they should have been because

our child did not really try (for example, he or she

id sloppy work or did not complete some assignments)?

D No D Yes

 

IE6. On your child’s last report card, in how many
cademic subjects did your child have an
“Unsatisfactory” (U) or failing grade (D, E, or F)?

Da. None
Db. 1 academic subject
Dc. 2 academic subjects
Dd. 3 or more but not all academic subjects
De. All my child’s academic grades were
below
average
Df. My child stopped taking academic classes
and now only takes vocational courses.

 

 

 

7. Was your child's overall or total grade point D No D Yes
verage in academic subjects LESS than "C" (below

verage or unsatisfactory?)

8. Will your child probably have to repeat the grade D No D Yes

e or she is in now?

 

 

 

 

 

 

 

During the past 3 months No Yes
B9. did your child find it hard to sit still or stay seated in class or did teachers [I ----- U- - 1
often get upset with your child for not laying attention in class? __________
BIO. did the teachers have to supervise your child more than others in the class 0 U

to get your child to behave or did they have to keep reminding your child to

follow instructions or requests?

Bl 1. did your child get in trouble a lot for not doing what the teacher asked or -0 ----- D- - d
for behaving in an inappropriate or weird way (for example, clowning, swearing,

or making silly noises)? __________
BIZ. did your child get in trouble a lot for bullying, bothering, or disturbing U U
other children at school?

 

 

52

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

During the past 3 months, did your child.... No Yes
'1'; iii hisbiyéj E35561 ’riliésI Bill in? Va}; ifiét'éih'fiét'iiirifi BEHe'ré‘E """""""" D """ U' ' ‘

814 on purpose, destroy or seriously damage school property? - ‘0 ----- D- - .

BIS. physically attack or really try to harm a teacher or student? - -1] ----- D- - ‘

Bl6. bring a gun or other weapon to school? - -D ----- D- - ‘

During the past 3 months, did your child’s behavior in school result in any of No Yes

the following? __________

817. Teachers said your child was almost impossible to manage or control in the D U

classroom.

BlS.Your child had to serve detention 3 or more times or had to see the - -0 ----- D- - ‘

principal 3 or more times.

819. School officials sent a note or letter or called home to complain about your - -D ----- D. %

child’s behavior.

820. School officials suspended your child or warned that your child might be - -0 ----- D- - ‘

suspended or expelled from school.

821. Your child was expelled or permanently removed from the school. - -0 ----- D- - ‘

 

 

 

Section C. HOME The following questions are about whether it has been hard for you to get your
child to do things at home that children your child’s age are expected to do in your family.
Younger children and children with developmental disabilities may need help with these things.
What we want to know is whether it has been hard for you to get your child to do what you expect

WITHOUT A LOT OF DEFIANCE, FIGHTING. OB EMOTIONAL UPSET.

 

  

 

 

 

the past 3 months how often have you had a very hard time
etting your child, , Never Occasionally Often
’ i.’ 'tB’u'sé in}; Erie}? """""""""""""""""""" ' ' ' 1T """ “U """ Tl ' '
F2. to get dressed? ""D' ..... D ----- D”-
“C3. to eat with utensils (a knife, fork or spoon)? - - - D ------ D ----- D - -
4. to take care of his or her hygiene? (for example, to brush his or - - - Tl- ------ D ..... D - -
er teeth, or take a bath or shower)

 

 

 

53

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

I] Never Occasionally Often
IFS. to get upinthe morning? "HU- ------ D ------ U-“
HC6. to catch the bus or get to school on time? - .. - U ------ D ------ U - - d

7. to do his or her chores? (for example, to pick up toys or - - - U ------ D ------ D - - l
lothes, do the dishes, or take out the garbage)? _ _ _ _______________
IF8. to come home on time? D U U
"C9. to use appropriate language or not swear? - - - U ------ U ------ D - - ,
“C10. to not take, damage or destroy others’ belongings? - - - Tl ------ U ------ D - - 1
11. to not hit or hurt others in the home when he or she could - - - U ------ U ------ D - -.
ot have or do something right away?

12. to mind rules about safety? (for example, turning off the - - - U ------ Tl ------ D - -.
tove)

13. During the past 3 months, how many times did your child run § Never 1 time 2 times
way overnight? : D U or more
.................................................. l
14. IF AT LEAST ONE TIME, did you know where your child was every g No Yes
ime he or she ran away? 3 D D

r

15. During the past 3 months, was your child's behavior so out of control No Yes
hat your child was removed or there was talk of removing your child from U D

our home?

16. During this time, did you have a counselor, social service worker, or - - Nd - - h - - Yes - -1
ther professional come into your home to help you manage or control your U U
hild’s behavior?

1.7 If YES, if that person had not been there to help, would your child have - - Nd - - - - - VJ -1
”teen able to stay in your home? D D

 

 

 

54

 

Section D. DELINQUENCY. If you know for sure that during the M 3 months your child did
any of the things listed below, put a check (I) in the box that shows how often the behavior
occurred. You should check "Never" if you only suspect that your child did something, but you are

not sure.

 

During the past 3 months, how often did your child...

D1. shoplift or steal something worth more than $20 when he
or she thought no one was looking?

 

D2. vandalize, deface, or paint graffiti on public or private
property?

 

D3. get a speeding ticket or citation for a moving violation?

 

D4. act so out of control that someone filed a complaint?

 

D5. get into trouble by hanging out with a gang?

 

D6. knowingly keep or try to sell stolen property worth $200 or
more?

 

D7. go joy riding in a car without permission?

 

D8. play with fire so that damage to property or people was
likely?

 

D9. on purpose, severely damage a car, school building, or
other valuable property outside the home?

 

D10. set fires on purpose to destroy property or hurt people?

 

D11. snatch a purse or wallet?

 

D12. try to get money from someone by threatening them, or
try to rob someone by beating them up?

 

D13. break into or steal something from a house, car, or
building?

 

D14. steal or try to steal a car?

 

D15. carry or sell drugs?

 

D16. threaten someone with a weapon?

 

D17. fire a gun or use a knife on someone, or severely beat or
club someone?

 

 

Never 1 time 2 times

or more
"'U """" D """" U""
"'U """" D """" U""
"'U """" fl """" U""
"’U """" D """" U""
"'U """" D """" U""
"’U """" D """" U""
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"'U """" fl """" U"'4
"'D """" fl """" U"”
"'U """" U """" U""
"'U """" D """" U""

 

 

55

 

 

 

 

 

 

 

 

 

 

 

 

 

D18. sexually abuse or molest someone, or sexually assault - - - D ------ l] """"" [I ’ ' ' ‘
someone of the same or opposite sex (includiqg date rape)? ----------------------
D19. forge something, or pass phony checks? 1] D [I
D20.killsomeoneonpurpose? "'D ------- D -------- Du"
During the past 3 months, was your child... No Yes
'fiiiféérétza'sy't'rggai‘aa ------------------------------------ n ............
D22. in court, or told to appear in court for something he or she was - — - D """" [I ' " " ‘
suspected of doing?
D23. found guilty ofbreaking the law? "'[] """" D "-1
D24- on Probation or under court supervision? ‘ ' 'n ----------- 1
1325- in a detention home or jail for breaking the law? ‘ ' ‘ D ------------

 

 

 

Section E. THINKING.

 

El. find it impossible to stop thinking certain thoughts, or have
a hard time getting certain images or pictures out of his or her
mind?

 

E2. repeat certain words or sentences over and over again?

 

E3. find it very difficult to remember things or not remember
where he or she was or what just happened?

 

E4. believe that just by thinking something he or she could
make it happen?

 

E5. draw, write, or talk about things that other people would
find really strange, weird, or gross?

 

E6. think a lot about evil spirits or believe he or she is
possessed by the devil?

 

E7. think that he or she has special or magical powers or others
have these powers?

 

 

Never Occasionally Often

"'TT """ D """" U""
"'TI """ D """"" U""
"'TI """ D """" U""
"'TI """ D """"" U"“
"'TI """ D """" U""
"'TT """" D """" U""
"’II """ D """" U"'J

 

 

56

 

During the past 3 months, how often did your child.... Never Occasionally Often

 

 

 

 

 

 

 

 

E8. act very suspicious of others or seem unable to trust - - _ D ------ D -------- D - - - 1
anyone?

E9. see or hear things that are not really there? - - - D ------ D -------- D - - - 1
E10. not know for sure whether something he or she saw or - - - D ------ D -------- D - - - .
heard was really there or just in his or her mind?

E11. believe that an outside rot-cc was putting thoughts into his ' ' ' Tl """ fl """" El ' ' ' ‘
or her mind or was making him or her do, say, or feel certain

things?

E12. become extremely confused, to the point of not knowing - - - D ------ D -------- D - - - 1
what he or she was doing? _ _ _ __________________
E13. talk in a way that other people found really weird or D D D
strange or could not understand? _ _ _ __________________
E14. repeat or echo other people's words in an almost robot- D D D

like way that you or others found very weird or strange? _ _ _ __________________
E15. do things or act in ways that other people would say are D D D

very crazy or weird?

 

 

 

 

 

7 E16. All in all, was your child’s talk, behavior, or thinking during the D IF No, Go to F1
past 3 months a good deal more strange, odd, or confused than other D IF Yes, Go to E17
children our child’s e?

 

    

 

 

Was your child’s thinking or behavior so confused or odd the No Yes
'3‘“! 9.9999151“?! '.° °. ...................
E17. your child wasinaspecial classroom oraspecialized school 1 "D -------- Du"
program?
E18. your child needed special supervision or had to be watched very D - - - -D - - - -
closely (more so than other children the same age)?

 

 

During the past 3 months, how often did each of the following
happen BECAUSE your child's thinking, talk, or behavior was Never Occasionally Often
weird or strange?

 

'éi§.'y'6u}'c'ifiid't};§ Ithithie'te'thh'té ir'iétitis'ét? hév'e' {16.3.1351 """" I] """" n """" U ' ' ' ‘
friendships?
E20. your child did not know how to act in restaurants, stores, - - - D ------- D -------- D - - - d

or other public places or people in these places complained
about your child or asked your child to leave?

 

 

 

 

57

Section F. CONTROL OF AGGRESSION.

 

During the m 3 months, how often did your child....

Fl. argue or fight with other children?

 

F2. bully, threaten, or shove other children?

 

F3. tease, ridicule, or pick on other children?

 

F4. lie, con, or take advantage of other children?

 

F5. blow up or get annoyed at other children over little things?

 

F6. act too young or immature around children the same age,
or prefer to play with younger children?

 

 

F7. have trouble getting along or find it hard to make or keep
friends with other children your child’s own age?

 

Never Occasionally Often

crusade:
DDDDDD

 

 

F8. During the past 3 months, has your child had at least one really close No

friend around the same age as your child?

 

 

 

During the past 3 months, how often did your child...

F9. have trouble getting along with adults?

 

F10. annoy others on purpose, or damage their belongings on
purpose?

 

F11. say very mean or cruel things to others?

 

F12. act very cruel to animals?

 

Fl3.do things without thinking that were dangerous and could
injure others?

 

F14.have temper tantrums or outbursts of anger?

 

F15. destroy or damage property in the home when angry?

 

F16. get very upset if he or she could not do or have something
right away?

 

 

F17. come on to someone in an inappropriate, sexual way or do
unusual or inappropriate things of a sexual nature in public?

 

Never Occasionally Often

U """" D """" 11""
U """" D '''''' IT"’
"'D """"" D """" 11""
"'U """" D """" II"‘
D """" D """" 11"‘
"'U """" D """" IT"'
U """" U """" II"‘
D """"" D """"" II"'
D """" D """" 11""

 

 

58

 

During the past 3 months, how often did your child. .. Never Occasionally Often

 

 

'fiiéfsie’t 'sexuai' ' ' 'i'y'fiéetiiéétiétis'ér'iohée,'eh'g;§é in highrisk """" ' ' ' ‘D' """" D """" n ' ' ‘
sexual behaviors, or have unprotected sex?
'131'9‘.'parti""ci;§a'teitigihéhcnmiéihit'iheitfd'ea'hirhéeihg BF ‘ ' ' " ' If """" D """" fl
bullying others?
F20. biteorthrow thm' gsat others? "“D ....... D -------- D-“
F21. physically attack or really try to hurt another child or - - D D ------- D -------- D - - .

adult living in the child’s home?

 

F22.physicaily attack 0" really try to hurt another child or - - - D ------- D """"" [I ' ' ‘
adult NOT livin in the child’s home?

 

 

 

F23. During the past 3 months, did any of the following Da. Someone suggested that your
happen BECAUSE your child's behavior was very child should be removed from
disruptive or dangerous to others? school.

Db. Your child was removed from
(Check ALL that apply) school.

Dc. Someone suggested that your
child should be removed from the
home.

Dd. Your child was removed from
the home.

De. None of these.

 

 

 

 

Section G. FEELINGS g MOODS.

 

M the as; 3 months, how often did your child... Never Occasionally Often
'Eii.’ hide Gér’y’e’u’d’dlh’e'hang' "Se’ih'hteet'i'thierEEB'thih Bihér'c’hiitireh """ U """ U """ D" ‘

the same age) for example, act very happy one moment and very sad or
angry the next moment?

 

 

 

G2. have a very hard time expressing strong feelings, such as hate, ' ' D """ D ------ D- — .
fear or love or not show any feelings at all?

G3. feel very sad, blue, or depressed? ' ‘ D ----- D ------ D' - ,
G4. find it hard to have fun, or not want to do things he or she used - - D ----- I] """" U' ’ '
to enjoy?

 

 

 

 

59

 

 

 

 

 

 

 

 

 

 

 

During the past 3 months, how often did your child. .. Never Occasionally 0M
G5. criticize or put him or herself down or feel worthless and good - _ D ------ D ------ D- - -
for nothing?
................ .1
G6. get easily upset over making a mistake because of wanting to be D D D
perfect?
................ 1
G7. become sad, withdrawn, or anxious when criticized? D D D
................ 1
G8. want to die or think seriously about committing suicide? D D D
------------------------------------------------------------------------ 4
G9. feel very anxious or afraid or worry far too much about things? D D D
G10. express feelings in a way that was so unusual, unreasonable or - - - D ----- D ------ D- - .
extreme for someone your child’s age that others saw your child as
odd or strange?
G11. get very upset about having to leave home or having to separate - - - D ----- D ------ D- - d
from a parent or someone like a parent?
612. insist on special arrangements (unusual for someone your child’s - - - D ----- D ------ D- - .
age) to make sure a parent or someone like a parent was always near
by? (for example, sleeping with or near a parent or calling home a lot to
keep from being anxious or afraid)
G13. worry far too much about gaining weight or being too fat even - - - D ----- D ------ D- - 1
though others do not think your child is too heavy or overweight?
"diffs: v'ofiiiéifrfi)’ W611 iii '15 Xidir’r """"" l] ”5712);; Q lot-df-weight-or.beco- ' ' 5.312,;th ‘
GAINING WEIGHT, did he or she... D b. throw up on purpose, use diet pills or
laxatives or exercise too much to lose
(Check ALL that apply) weight?
D c. overeat and then vomit or purge with
laxatives?
D d. if child is a girl, stop having or delay
her periods?

 

 

 

60

G. Feeiin & M and,

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

W. how often did your child... Never Oeeasiomlly on...
-615: fim-&-£l-D§lé - temion ----- ? ------------------------------- u """ D """ U - - -
616. feel keyed-nporonedge? "-D ----- D ------ U--.
617. have nightmares? "-D ----- D ------ D--.
________________ j
GI8. have trouble sleeping? D D D
G19. have headaches, stomachaches or other pairs with no medical ' - '1] """ l] """ U' ’ ‘
cause?
620° mm“PP¢“‘¢.”wantt0eat,oreattoomueh? "-D ----- D ''''' D'"
621. have difficulty concentrating? ' '- -fl ----- D ------ D- - .
622.feeltiredalot,havenoenergy,orsieeptoomuch? "‘U ---- D ------ D-"
GB-comphillofheavinessinhisorherarmsorlegs? "'fl """ I] """ D".
During the pm 3 months. did your child... No Yes
"653333;; Eat’déi Mia's}; ' . n ' no. "" .s ' ' 0', ‘ , ' m " , ' d - g - E - l - E a - g -- h - E - l I -- I; t - I! - --- ! ------- n ------ n - --
mam-2k?
st-feelvel‘ySOdordepressedatleasthalfoftheda hammer? "'u """ u"-
Dmng the 1"“ 3 months, did any of the following result BECAUSE your child No Yes
was afraid, anxious, worried, sad or depressed? Was your child so dktressed
-93! P935332; ____________________________________________________________
G26.couidnotbeinaregnlarclassroom? ]] D
G27.missedschoolorworkatleastonedayaweek(ormore)? "‘lJ """ lid
Gn-megradesthannsualorwasfailingsubjectsatschool? "-D ------ D-"
GZ9.avoldedbeingwithotherchiidrenorspentaiotlesstimewithfriends? "'l] """ u‘“
G30. refusedtoleavehometodothingswithotherpeople? "'D """ D'"

 

 

 

 

61

Section H. SELF-HARM BEHAVIORS.

 

 

 

 

 

H1. mmefl3months,didyourchildmakesoresorwoundsonhisor No Yes
her body on purpose? (for example, by scratching, picking, repeatedly punching, D D
or burning his or her skin with a cigarette)?
Ifyes, what did your child do?
----------- J
H2. aging the m 3 moutiu, did your child threaten to commit suicide? U U
H3. IFYES, did your child have am asto how he orshe would commit
suicide? D D
If yes, what was the plan?
' '4? "tir'iotiti cm """ itin'is'mcmr ’ "" rum "" , ' ' ' ' ' ’ ' ' ' ' ' ' ' it? if; childtold ' someo "" tie 'aih'o'ut iie'fiiifi.’ '
how did you find out about it? b. Someone discovered the plan even
i ufl my child did not tell. gone.

 

 

 

ide attempt (either to get attention, as a call for help, or because
or

FM] the M 3 months, did your child actually make a

l] IFNO, GOTOsectionI

she really wanted to die)? You should check (I) ”Yes" if your D 11? YES, complete questions

 

 

  
 
 

 

 

 

 

hild actually tried g if your child would have tried had someone not 6 to H14 on this page before

toppedhimorherintime. oingtopagelZ

owdidyourchiidtrytocommitsuicide?Didyourchild(orwasyourchild No Yes
to)...

'6'. 'hur't’hiiri ;- herselfwithsomethingsluirpinaway that ' m "" u " reEriiis 'i'h' ' ' ‘ ' ' If """ TI ' '
,forexample,byleadingtomajorandquickbloodloss?

7.shoothhnorherselfinawaythatMresultsindeath,foren-ple,in "IT '''' TI"

echestorhead?

8.inhale,drinkoreatsomethingthatisverypobonousordeadly,ortake "D ----- D"
ofsomethingtousuallyresultindeath?

9.dosomethingelsethatusflyresultsindflfiorexampledumpingfroma "D ..... D"
buildingorhanginghimorherselfwithathickrope?

YES, what did your child do? __ _____ __

10.meahandgun.butinawaythatwouldmhai>hnsmnnm.ror TI TI

ple,shootinghimorherseifinthelegorfoot?

 

 

 

62

 

ow did your child try to commit suicide? Did your child (or was your child
Enos-t to)...

 

11.hurthimorherselfwlthsomethingsharp,bininawaythatwould
forenmple,makingcutsonhisorherarmsthat

 

 

eaveryuallamountofsomethingthatcouldonlyleadtodeathinmuch

12.inhaie,drinkoreatsomethingthatwouid bl not indeathor
eramounts?

 

13.do something else that would moi; not result in death, for example, try
0 choke him or

withapieceofstring?

YES,whatdidyonrchilddo?

No Yes
"'D ...... .n.--
"-D' ..... .n.--
"'D ...... .D.--

 

 

before the attempt?

 

 

duringor after the attempt.

H14. When your child tried D a. in some way warn someone before actually trying?
to commit suicide, did your D b. tell someone right after the attempt in time to get help?
child... D c. keep it a secret and someone accidentally discovered the child

D d. keep it a secret and someone accidentally discovered the child

 

Section I. ALCOHOL & DRUQ USE

 

 

D2timesaweek

lenoworsuspectmy

how often.

 

 

”.th oftendidyour DNever

childdrinkalcohol? DLessthanonceamonth
DLessthanonceaweek
DOnceaweek
D2timesaweek

D30rmoretimesaweek

D Iknow or suspect my childusedaleohol,
butldonotknowhowoften.
12. Whow oftendidyour D Never 1
childhaveenoughalcoholtogetintoxicatedor DLessthanonceamonth
drunk? Diessthanoneeaweek
DOnceaweek

D30rmoretimesaweek

child used enough

alcoholtogetdrimk,butldonotknow

 

63

 

 

 

I3.Duringtheput3months,howoftendidyour
childusedrugsorinhalants?

 

l4.Duringthepest3months, how often did your
childuseenoughdrugsorinhalantstogethigh?

 

 

DNever
ULessthanonceamonth
Diessthanonceaweek
DOnceaweek
D2timesaweek
D30rmoretimesaweek

DIimoworsuspectmychilduseddrugsor
inhalants, but I do not know how often.

DIessthanonceamonth
Dlessthanonceaweek
DOnceaweek
D2timesaweek
D30rmoretimesaweek

DIimoworsuspectmychiidusedenough
drugsorinhalantstogethigh,butldonot
knowhowoften.

 

 

Ifyourchiid medflaleohd,drugs,ormhahntsdurmgthepast3mmths,pleesecompletethe

questionsonthenextpage.

Ifyourchiidflflusedanyalcohd,drngs,orinhahntsduringthepast3months,pieesegoto

the end of this quwtionnaire.

I. Alcohol & D_r_ug Use, continued. Check Yes ONLY if a problem listed below happened in the past 3

months BECAUSE your child used alcohol or drugs.

 

AsaRESULTofusingalcohol,drugsorinhalantsduringthepast3months,

15. physically or mentally crave alcohol, drugs or chemicals?

 

16.gettothepointofusingalcohol,drugs,orinhalantsinthemoruing?

 

17. have withdrawal symptoms (for example, nausea, shaking, irritability, or
depression)orusedrugsorchemicalstofunctionordothingswell?

 

18. black out or have tremors or seizures?

 

l9.failmostorallofhisorherclasses,getsuspendedorexpelledfrom
schooi,orgetfiredfromajob?

 

110. become involved in a car accident, get injured or have serious health
problem, or do something to injure others?

 

111. commit a felony or sell sex to get money for drugs or alcohol?

 

112.notdochoresornottakecareofotherresponsibilitiesathome?

 

113. get into trouble at work, for example, by fighting or arguing a lot or by
breaking important rules?

 

114.usedrugsorchemicalsordrinkonschooldaysorbeforework?

 

115.notshowup,comelate,ormissoutonhnportantactivitiesatschoolor
work,orworkbelowhkorherabilityatschooloronthejob??

 

116. break important rules at school or get into trouble with teachers or
school authorities?

 

117. miss curfew or stay out all night, get picked up by the police, have a
traffic violation, or commit a minor crime (not a felony)?

 

118. haveargumentsorfightswithfamilyorfriends,orwithdrawfromor
avoid family or friends.

 

119.loseagoodfriend,orchangehisorherfrien¢ktomostlyalcoholordrug
users?

 

120. haveminorhealthproblems(forexample, feelingtiredalotornoteating
pnuuruo?

 

121.dodrugsorusechemicakwhiledrivingordriveundertheinfluenceof
alcohol?

 

 

bk) iks
- ........ D--.
---n ...... U--.
"'D ...... U--.
---U ...... U--.
"'U """ U"’
---U .........
---D ...... D--.
---D ...... D--.
---D ...... U--.
---U ...... U--.l
_--U ...... D--.
__-D ...... U--e
---U ...... U--.
---D ...... U--.
"'U """ U"’

 

 

65

 

122. get taken advantage of sexually or get involved in sexual behavior that he
or she later regretted?

 

 

123.(IfchildisagirDriskthehealthofanunbornchildbymisusingalcohol
ordrugswhilepregnant?

 

 

 

Thank you for completing this questionnaire.

66

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