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Concept: The Adolescents

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Recent reports show that fewer adolescents believe that regular cannabis use is harmful to health. Concomitantly, adolescents are initiating cannabis use at younger ages, and more adolescents are using cannabis on a daily basis. The purpose of the present study was to test the association between persistent cannabis use and neuropsychological decline and determine whether decline is concentrated among adolescent-onset cannabis users. Participants were members of the Dunedin Study, a prospective study of a birth cohort of 1,037 individuals followed from birth (1972/1973) to age 38 y. Cannabis use was ascertained in interviews at ages 18, 21, 26, 32, and 38 y. Neuropsychological testing was conducted at age 13 y, before initiation of cannabis use, and again at age 38 y, after a pattern of persistent cannabis use had developed. Persistent cannabis use was associated with neuropsychological decline broadly across domains of functioning, even after controlling for years of education. Informants also reported noticing more cognitive problems for persistent cannabis users. Impairment was concentrated among adolescent-onset cannabis users, with more persistent use associated with greater decline. Further, cessation of cannabis use did not fully restore neuropsychological functioning among adolescent-onset cannabis users. Findings are suggestive of a neurotoxic effect of cannabis on the adolescent brain and highlight the importance of prevention and policy efforts targeting adolescents.

Concepts: Cohort study, Age, Neurocognitive, Adolescence, Initiation, Neuropsychology, The Adolescents, Neuropsychological test

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Background The role of bracing in patients with adolescent idiopathic scoliosis who are at risk for curve progression and eventual surgery is controversial. Methods We conducted a multicenter study that included patients with typical indications for bracing due to their age, skeletal immaturity, and degree of scoliosis. Both a randomized cohort and a preference cohort were enrolled. Of 242 patients included in the analysis, 116 were randomly assigned to bracing or observation, and 126 chose between bracing and observation. Patients in the bracing group were instructed to wear the brace at least 18 hours per day. The primary outcomes were curve progression to 50 degrees or more (treatment failure) and skeletal maturity without this degree of curve progression (treatment success). Results The trial was stopped early owing to the efficacy of bracing. In an analysis that included both the randomized and preference cohorts, the rate of treatment success was 72% after bracing, as compared with 48% after observation (propensity-score-adjusted odds ratio for treatment success, 1.93; 95% confidence interval [CI], 1.08 to 3.46). In the intention-to-treat analysis, the rate of treatment success was 75% among patients randomly assigned to bracing, as compared with 42% among those randomly assigned to observation (odds ratio, 4.11; 95% CI, 1.85 to 9.16). There was a significant positive association between hours of brace wear and rate of treatment success (P<0.001). Conclusions Bracing significantly decreased the progression of high-risk curves to the threshold for surgery in patients with adolescent idiopathic scoliosis. The benefit increased with longer hours of brace wear. (Funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases and others; BRAIST ClinicalTrials.gov number, NCT00448448 .).

Concepts: Epidemiology, Randomized controlled trial, Scoliosis, Randomness, Arthritis, The Adolescents, Statistical terminology, Odds

36

Early life stress (ELS) consists of child family adversities (CFA: negative experiences that happened within the family environment) and/or peer bullying. ELS plays an important role in the development of adolescent depressive symptoms and clinical disorders. Identifying factors that may reduce depressive symptoms in adolescents with ELS may have important public mental health implications.

Concepts: Family, Psychology, Childhood, Adolescence, Developmental psychology, Mental disorder, The Adolescents, Carol Burnett

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Children who experience severe early life stress show persistent deficits in many aspects of cognitive and social adaptation. Early stress might be associated with these broad changes in functioning because it impairs general learning mechanisms. To explore this possibility, we examined whether individuals who experienced abusive caregiving in childhood had difficulties with instrumental learning and/or cognitive flexibility as adolescents. Fifty-three 14-17-year-old adolescents (31 exposed to high levels of childhood stress, 22 control) completed an fMRI task that required them to first learn associations in the environment and then update those pairings. Adolescents with histories of early life stress eventually learned to pair stimuli with both positive and negative outcomes, but did so more slowly than their peers. Furthermore, these stress-exposed adolescents showed markedly impaired cognitive flexibility; they were less able than their peers to update those pairings when the contingencies changed. These learning problems were reflected in abnormal activity in learning- and attention-related brain circuitry. Both altered patterns of learning and neural activation were associated with the severity of lifetime stress that the adolescents had experienced. Taken together, the results of this experiment suggest that basic learning processes are impaired in adolescents exposed to early life stress. These general learning mechanisms may help explain the emergence of social problems observed in these individuals.

Concepts: Psychology, Cognitive science, Educational psychology, Child, Learning, Knowledge, The Adolescents, Pairing

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Unhealthy eating habits in adolescence lead to a wide variety of health problems and disorders. The aim of this study was to assess the prevalence of absence of parental rules on eating and unhealthy eating behaviour and to explore the relationships between parental rules on eating and a wide range of unhealthy eating habits of boys and girls. We also explored the association of sociodemographic characteristics such as gender, family affluence or parental education with eating related parental rules and eating habits of adolescents.

Concepts: Health, Nutrition, Female, Educational psychology, The Association, Childhood, Adolescence, The Adolescents

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The negative consequences of peer victimization on psychosocial adjustment are well documented. The consequences, however, may depend on who the bullies are. In this study, we examined the consequences of same- versus other-sex victimization. The sample consisted of 4,941 Finnish adolescents (ages 14-15; 47.7% boys). We used structural equation modeling to examine both concurrent and longitudinal associations of same- and other-sex victimization with depression, negative perception of peers, and social self-esteem. Both same- and other-sex victimization were related to psychosocial adjustment. Concurrently, the victimization experiences with same-sex peers in particular were associated with generalized cognitions about peers, whereas being bullied by other-sex peers was related to adolescents' social self-esteem more strongly than victimization by same-sex peers. The longitudinal associations, in turn, showed that only being bullied by boys had carry-over effects on girls' adjustment. Other-sex victimization can have serious consequences especially on girls' psychosocial adjustment. [Supplementary material is available for this article. Go to the publisher’s online edition of the Journal of Clinical Child & Adolescent Psychology for the following supplemental resource: Complementary information on model fit indices and the nested model chi-square difference tests.].

Concepts: Psychology, Following, Model, Adolescence, The Adolescents, Peer group, Structural equation modeling, Bullying

27

The present investigation expands upon prior studies by examining the relationship between health in late adolescence and the experience of physical/sexual and non-physical dating violence victimization, including dating violence types that are relevant to today’s adolescents (e.g., harassment via email and text messaging). We examined the relationship between physical/sexual and non-physical dating violence victimization from age 13 to 19 and health in late adolescence/early adulthood.

Concepts: Present, The Association, Adolescence, The Adolescents, Past, Mobile phone, Text messaging, Instant messaging

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Family based-treatments have the most empirical support in the treatment of adolescent anorexia nervosa; yet, a significant percentage of adolescents and their families do not respond to manualized family based treatment (FBT). The aim of this open trial was to conduct a preliminary evaluation of an innovative family-based approach to the treatment of anorexia: Acceptance-based Separated Family Treatment (ASFT). Treatment was grounded in Acceptance and Commitment Therapy (ACT), delivered in a separated format, and included an ACT-informed skills program. Adolescents (ages 12-18) with anorexia or sub-threshold anorexia and their families received 20 treatment sessions over 24 weeks. Outcome indices included eating disorder symptomatology reported by the parent and adolescent, percentage of expected body weight achieved, and changes in psychological acceptance/avoidance. Half of the adolescents (48.0%) met criteria for full remission at the end of treatment, 29.8% met criteria for partial remission, and 21.3% did not improve. Overall, adolescents had a significant reduction in eating disorder symptoms and reached expected body weight. Treatment resulted in changes in psychological acceptance in the expected direction for both parents and adolescents. This open trial provides preliminary evidence for the feasibility, acceptability, and efficacy of ASFT for adolescents with anorexia. Directions for future research are discussed.

Concepts: Family, Anorexia nervosa, Eating disorders, The Adolescents, Body dysmorphic disorder, Bulimia nervosa, Maudsley Family Therapy, Body weight

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Cannabis users are more likely to have psychotic experiences (PEs). The degree to which these associations are driven by genetic or environmental influences in adolescence is unknown. This study estimated the genetic and environmental contributions to the relationship between cannabis use and PEs. Specific PEs were measured in a community-based twin sample (4830 16-year-old pairs) using self-reports and parent-reports. Adolescents reported on ever using cannabis. Multivariate liability threshold structural equation model-fitting was conducted. Cannabis use was significantly correlated with PEs. Modest heritability (37%), common environmental influences (55%) and unique environment (8%) were found for cannabis use. For PEs, modest heritability (27-54%), unique environmental influences (E=12-50%) and little common environmental influences (11-20%), with the exception of parent-rated Negative Symptoms (42%), were reported. Environmental influences explained all of the covariation between cannabis use and paranoia, cognitive disorganization and parent-rated negative symptoms (bivariate common environment=69-100%, bivariate unique environment=28-31%), whilst the relationship between cannabis use and hallucinations indicated familial influences. Cannabis use explains 2-5% of variance in positive, cognitive, and negative PEs. Cannabis use and psychotic experience co-occur due to environmental factors. Focus on specific environments may reveal why adolescent cannabis use and psychotic experiences tend to ‘travel together’.

Concepts: Genetics, Environment, Natural environment, Greek loanwords, Adolescence, Schizophrenia, Psychosis, The Adolescents

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given the increase in worldwide obesity among children and adolescents, the long-term consequences of childhood obesity on the risk of adverse health outcomes in later life has garnered increased attention. Much of the work on earlier life weight status and later life health has focused on cardiovascular-related outcomes in mid- to late-adulthood; however, little is known about the later life mental health consequences of adolescent body weight.

Concepts: Nutrition, Obesity, Child, Childhood, Adolescence, The Adolescents, Body shape, The Work