Manifestations of depressive affect in adolescence

This paper discusses the manifestations and correlates of depressive affect disorders in adolescents. It begins with some definitions and a discussion of the concept (from adult psychiatry) of depression and depressive disorders. The clinical picture of depressive disorders in adults is described, and the interrelationship is considered between them and the depressive disorders of adolescents and prepubertal children. Data are discussed regarding the external validity of adolescent depressive disorders (including their familial and biological correlates, their course and treatment outcome). Finally, the relevance of these data is summarized with regard to the process of establishing a diagnosis of a depressive disorder in adolescents.Received M.D. from Washington University. Research interests are the diagnosis and assessment of childhood psychopathology, especially Attention Deficit Disorder and Depressive Disorders.Received Ph. D. from UCLA. Research interests are language and learning disorders and childhood psychopathology.     

Outcome,psychosocial functioning,and prognostic factors in adolescent anorexia nervosa as determined by prospective follow-up assessment

The aim of this prospective longitudinal study was to examine outcome, psychosocial functioning, and prognostic factors in adolescent anorexia nervosa. Thirty-four (88%) out of a consecutive series of 39 inpatients were reinvestigated three and seven years after discharge. The patients and 34 controls matched for age, sex, and occupational status were interviewed using structured interviews on their Diagnostic Statistical Manual, third edition, revised (DSM-III-R) eating disorder diagnoses, specific eating disorder psychopathology, comorbid psychiatric disorders, and psychosocial functioning. At the seven-year follow-up 15 patients (44%) still fulfilled DSM-III-R criteria for some form of eating disorder diagnosis, 21 (62%) for some other psychiatric diagnosis. Patients with a poor outcome showed significantly more problems in most areas of psychosocial functioning than the good-outcome group, but even recovered anorectic patients had more psychosexual difficulties than healthy controls. From a large range of potential prognostic factors, only low body weight at intake and low minimum weight during course of illness proved to be of predictive value.Received M.D. from Rheinische Friedrich-Wilhelms University, Bonn. Major research interests are childhood and adolescent eating disorders including links to affective disorders.Received M.D. from Philipps University. His current interests include follow-up studies of adolescent eating disorders.Received M.D. from Philipps University. His interests are body image disturbances in eating disorders and research in neurophysiology and neuropsychology.Received M.D. from Friedrich-Alexander University, Erlangen, Germany, and Ph.D. from Rupprecht-Karls University, Tübingen. Current research interests are eating disorders, affective disorders, and early onset schizophrenia.     

The outcome of adolescent anorexia nervosa: Findings from Berlin and Sofia

As part of a multisite collaborative outcome study of eating disorders in adolescence, two samples from West Berlin and Sofia were compared. The study was based on a systematic evaluation of the clinical status during the first inpatient treatment after onset of the disorder, and personal interviews with the former patients at follow-up. Despite the differences in the cultural background, the clinical features, the diagnostic pattern, the developmental histories, the family background, and the follow-up findings were remarkably similar. The mortality rate was higher in the West Berlin than in the Sofia sample. However, the outcome in terms of the distribution of eating disorders was similar in the surviving patients of the two samples.Received M.D. and Ph.D. in psychology at the University of Hamburg, Germany. Major research interests are eating disorders, developmental psychopathology, and neuropsychiatry.Received M.D. at the University of Sofia. Major research interest is in eating disorders.     

Ten-Year outcome in adolescent onset anorexia nervosa

The purpose of the present study was to characterize the psychopathology measured ten years posttreatment in 51 women who had an adolescent onset of anorexia nervosa. Outcome status was determined using the modified categories of Ratnasuriya et al.[1991]. Anorexia Nervosa: Outcome and Prognostic Factors After 20 Years, British Journal of Psychiatry, Vol. 158, pp. 495–502). Psychopathology was assessed using a number of self-report questionnaires: Beck Depression Inventory, Hamilton Depression Inventory, Leyton Obsessionality Inventory, Social Adjustment Scale, and Minnesota Multiphasic Personality Inventory. Within this adolescent age of onset sample of anorexia nervosa, age of onset was not, in and of itself, associated with increased psychopathology at follow-up. Rather, severity of eating disorder outcome was associated with general psychopathology, with patients in the poor outcome group displaying elevations on several of the measures of psychopathology.Received Ph.D. in psychology from Rutgers Univesity. Major research interests are in eating behavior and attitudes toward foods in anorexia and bulimia nervosa, preoccupations and rituals associated with eating disorders, and comorbidity and eating disorders.Received M.D. from the University of Medicine and Dentistry in New Jersey. Research interests are in eating disorders.Received M.D. from University of Minnesota Medical School-Minneapolis, MN. Major research interests are anorexia nervosa and other eating disorders.Received M.D. from the University of Iowa—Iowa City. Research interests are in eating disorders.     

A prospective follow-up of children with anorexia nervosa

We report on a prospective follow-up (mean 3.1 years) of 22 children with anorexia nervosa (mean age at onset—12.1). Adequate information was obtained for 18 children. The specific outcome was good in 10 (55.5%), intermediate in 5 (27.8%), and poor in 3 (16.7%); none had died. No prognostic factors were identified. The findings are compared with those from the long term follow-up of a previous cohort of children with anorexia nervosa, and confirm the unsatisfactory prognosis for this age group.Major research interest concerns the etiology and treatment of eating disorders in children and adolescents.Has been with the Eating Disorders Research Team since 1992. His major interest is research methodologyHas been with the eating disorders Research Team since 1989. Her major interests are in obsessional-compulsive problems and eating disorders in children.Major research interests include eating disorders in children and adolescents, cystic fibrosis, the effects of transplantation in children and adherence to treatment. Chief Editor ofClinical Child Psychology and Psychiatry. Has been collaborating with the Eating Disorders Research Team since 1985.     

Emotional and temperamental correlates of Type A in children and adolescents

Emotional and behavioral correlates of Type A behavior in children and adolescents were examined in 184 fifth-, seventh-, and ninth-grade students, classified as high or low Type A, using self-report, teacher ratings (fifth grade only), and structured interview procedures. Measures included the Hunter-Wolf A-B Rating Scale, Behavioral Symptoms of Stress Inventory, Dimensions of Temperament Survey, Desire for Control Scale, Eysenck Personality Inventory, and the Multiple Affect Adjective Checklist. High Type A children reported significantly more stressed-related behaviors, higher levels of depression, anger, anxiety, and cognitive disorganization, and greater reactivity than Low Type A. No differences were found on measures of temperament (activity level, attention span, adaptibility, and rhythmicity), desire for control, or introversion-extroversion. Females, in general, reported significantly more behavioral stress symptoms. However, no other gender differences were found. Possible reasons for reported differences between Type A children and adults are discussed, along with gender differences in behavioral symptoms. Need for multiple measures of Type A across situation is considered along with need for controlled longitudinal studies of Type A components and the influence of contexts.Received Ph.D. from Stanford. Research interests: Adolescent problems, stress.Received Ph.D. from Stanford. Research interests: Type A, anger/hostility; AIDS prevention.Received Ph.D. from Stanford. Research interests: child & family problems, stress disorders.Received Ph.D. from Stanford. Research interests: psychoneuroimmunology.Received Ph.D. from Stanford. Research interests: pain disorders, stress.Received Ph.D. from Stanford.Received Ph.D. from Stanford. Research interests: anxiety and phobic disorders.     

Interpersonal and self-critical dysphoria and behavioral problems in adolescents

Clinical evidence suggests that various problem behaviors in adolescence can be expressions of dysphoria that have not reached threshold for the diagnosis of depressive disorders. Formulations of two major types of dysphoria distinguish between disruptions of interpersonal relatedness (e.g., feelings of loss or abandonment) and diminished self-esteem (e.g., feelings of self-criticism, failure, or guilt). Adolescents in a suburban high school were given the Achenbach Youth Self-Report, the Adolescent Depressive Experiences Questionnaire, and the Community Epidemiological Survey of Depression for Children (CES-DC). Even after level of depressive symptoms (CES-DC) was partialled out in hierarchical multiple regressions, interpersonal dysphoria significantly accounted for additional variance in predicting internalizing disorders, while self-critical dysphoria added significantly to the explained variance of both internalizing and externalizing disorders, specifically delinquency and aggression in both males and females.Ph.D., 1957, University of Chicago. Research interests: The development of mental representations, their differential impairment in various forms of psychopathology (especially depression), and their change in the therapeutic process.Ph.D., 1981, Yeshiva University. Research interests: adolescent pregnancy, depression, and ego development.Ph.D., 1968, Yale University, New Haven, Connecticut. Research interests: cognitive processes in schizophrenia, dependency and self-criticism in depression, and cognitive structural models of development and psychopathology.Ph.D., 1986, Columbia University, New York. Research interests: adolescent development.Ph.D., 1988, State University New York—Buffalo. Research interests: Language and self-representation and narcissism and borderline disorders.     

A comparison of adolescent inpatients with and without substance abuse using the Millon Adolescent Clinical Inventory

We compared clinical syndromes, expressed concerns, and personality styles of adolescent inpatients with substance use disorders (SUD; n=44) vs. without substance use disorders (non-SUD; n=61) using the Millon Adolescent Clinical Inventory. The two groups did not differ with regard to age, sex, ethnicity, functional severity, or the frequency of other major psychiatric disorders, and were drawn from the same overall sample population. SUD subjects showed significantly higher levels of delinquent predisposition and lower levels of anxiety. Consistent with these syndromal findings, we found that SUD subjects were characterized by higher levels of unruliness and social insensitivity and lower levels of submissiveness. Our findings suggest that, in severely disturbed adolescents who require psychiatric hospitalization, externalizing phenomena are closely associated with SUD. Our findings also suggest that internalizing problems also exist in SUD, although not at levels greater than that observed in non-SUD inpatients.Received Ph.D. in clinical psychology from the University of Pittsburgh. Research interests include eating and weight disorders, addictive behaviors, behavioral medicine, psychological assessment, and psychiatric comorbidity.Received Psy.D. in clinical psychology from the University of Hartford. Research interests include psychological assessment, adolescent psychopathology, and psychiatric comorbidity.Received B.A. in Psychology from Swarthmore College. Research interests include perception, developmental psychopathology, and psychosis proneness.Received Ph.D. in clinical psychiatry from DePaul University. Research interests include the assessment and treatment of substance abusing psychiatric populations.     

Cognitive factors and classification issues in adolescent depression

A review and critique of the cognitive research among adolescent depressives are presented. It is concluded that the cognitive data and other research indicate a cooccurrence of depression, anxiety and conduct disorders among adolescents. Implications for clinical classification and gender differences among these diagnoses are discussed. Suggestions are offered for how these diagnoses among adolescents relate to diagnoses during young adulthood. It is argued that the cooccurrence of disorders must be taken into account in the study of adolescent depression both as a continuous personality construct and as a diagnosed conduct disorder.This paper was prepared for the SRCD Conference on Development and Adolescent Depression, ETS and Princeton University, Princeton, NJ, June 3–6, 1987.Received Ph.D. from University of Illinois at urbana-Champaign. Research interests are in life-span factors and treatments of mood disorders.     

Body image satisfaction,dieting beliefs,and weight loss behaviors in adolescent girls and boys

Body image and weight loss beliefs and behaviors were assessed in 341 female and 221 male high school students. Estimates of body dissatisfaction varied depending on the measurement strategy used. Despite having similar weight distributions around the expected norm, girls were significantly more dissatisfied with their bodies than boys. Body Mass Index was positively related to body dissatisfaction in girls and boys, while higher exercise levels were related to higher body satisfaction in boys. Nearly two-thirds of girls and boys believed being thinner would have an impact on their lives, but the majority of girls believed this would be positive while the majority of boys believed this would be negative. Thirteen percent of female subjects reported using one or more extreme weight loss behavior at least weekly. Beliefs regarding the effectiveness of different weight loss measures were assessed. Weight loss behaviors in this Australian sample appear similar to comparable U.S. samples.Received Ph.D. from University of Tasmania. Main research interest in body image, weight loss behaviors, and eating disorders.Received Ph.D. from University of Connecticut. Main research interest in body image, eating disorders and weight loss behaviors.Dietitian degree from Melbourne University, Melbourne. Main research interest in eating practices and clinical outcome.M.D. from University of Melbourne, D.P.M. from U.K. FRC Psych. Main research interests in eating disorders.B.B.Sc.(Hons.) received from La Trobe University, Melbourne, B.A. received from University of Minnesota, Duluth. Main research interest in attitudes and attributions.B.A. Received from University of Minnesota, Duluth. Main research interest in adolescence and eating disorders.     

The relation of personality functions and adaptive skills to self-esteem in early adolescence

This paper examines the relation, in early adolescence, of competence in personality functions and adaptive skills to self-esteem. As part of a longitudinal study of adolescent personality development, a nonclinical group of 63 adolescents underwent a comprehensive assessment at age 13. Their personality functioning status was assessed by means of a semistructured psychiatric interview. A psychometric battery was administered to assess verbal and nonverbal adaptive skills. In addition, global self-esteem was assessed. The findings indicate that positive self-esteem was associated with competence in both personality functions and in adaptive skills. Both domains contributed to self-esteem to a similar degree.This study was supported by a grant from the Ministry of Community and Social Services of the Province of Ontario, Canada. This paper was presented at the annual meeting of the Canadian Academy of Child Psychiatry, Quebec City, Quebec, Canada, 1985.Received his Ph.D. from the State University of New York at Stony Brook. Research Interests include adolescent personality development and the effects of affective disorders on development.Received his M.D. from the University of Toronto. Research interests include mood disorders, personality development in adolescence, and preventive psychiatry.Received his M.D. from the University of Toronto. Research interests include adolescent personality development, effects of psychosis on personality, and psychophysiology of schizophrenia.Received his M.D. from the University of Toronto. Research interests include affective disorders in adolescence and individual psychotherapy.     

Utility of the minnesota multiphasic personality inventory personality disorder scales with adolescent psychiatric inpatients

Personality disorders play an important role in the treatment of many adult psychiatric disorders. Current research has begun to examine the role of personality disorders in adolescent psychopathology. Unfortunately, there is limited research available to document the reliability and validity of personality disorder assessment measures for use with adolescent psychiatric patients. The Minnesota Multiphasic Personality Inventory (MMPI) Personality Disorder Scales have shown adequate psychometric properties with adult samples, but have not been tested using adolescents. The present study was designed to examine the utility of the MMPI Personality Disorder Scales with 217 adolescent psychiatric inpatients. A multivariate analysis of variance revealed males scored significantly higher than females on the schizoid, narcissistic, and antisocial scales, a pattern that has been found in adult psychiatric patients. Also, the MMPI Personality Disorder Scales correlated in patterns consistent with research on adult samples. In addition, the MMPI Personality Disorder Scales were meaningfully correlated with the Tridimensional Personality Questionnaire. However, factor analysis revealed a different factor structure than that found with adults. The similarities between adolescent and adult data suggest that the assessment of personality disorders in adolescents may provide useful clinical information on the development of personality disorders.This article was presented at the American Psychological Association Convention, Toronto, Ontario, Canada, August 1993. The research was funded in part by a grant from the Charles Reiley Armington Foundation for Values in Children.Received M.A. from Case Western Reserve University. Her major research interests are in the areas of depression and personality disorders.Received Ph.D. in clinical psychology from the Ohio State University in 1986. Completed his predoctoral internship and postdoctoral fellowship at the Brown University Program in Medicine, Providence, Rhode Island. Actively involved in research on risk factors for suicide in adolescents and adults. Has published empirical studies, theoretical papers, and treatment guidelines related to suicide and its risk factors.Received his Ph.D. in Clinical Psychology from Case Western Reserve University, Cleveland, Ohio. His major research interests include depression, suicide, adolescence, and family systems issues.     

Attentional and intellectual deficits in unmedicated behavior-disordered adolescent inpatients

The authors examined the hypothesis that impairments in attention and verbal intelligence are associated with seriously maladaptive social behavior in behavior-disordered, hospitalized adolescents. Twenty-five unmedicated inpatients with disruptive behavior disorder diagnoses were rated during a one-month period for frequency of severe disruptive episodes, or critical incidents (CI); these included assaults, behavior resulting in the use of restraints, etc. All subjects independently received intelligence testing and continuous performance testing (CPT). Based on CI scores, subjects were divided into a high-CI group (CI>5; N=9) and a low-CI group (CI<4; N=16). On the CPT, the high-CI group showed more impairment in perceptual sensitivity (d; this group also had lower verbal IQ scores. (Both findings were significant at the p<.05 level.) The latter result was largely due to differences in Comprehension subtest scores. These results support the hypothesis, and may have implications for the treatment of behavior-disordered adolescents.Received M.D. from the University of Wisconsin, Major research interests are adolescent psychopathology, disruptive behavior disorders, and information processing.Received Ph.D. from the University of Wisconsin. Major research interests are outcomes measurement, psychosis proneness, and psychodiagnostic assessment.Received Ph.D. from the University of Wisconsin. Major research interests is adolescent psychopathology.Received M.A. from the State University of New York at Buffalo. Major research interests are adult attachment and mental representation.Received M.D. from the University of Pennsylvania. Major research interests are schizophrenia, personality disorders, and trauma.     

A six-year follow-up study of anorexia nervosa subjects with teenage onset

Fifty-one adolescent onset anorexia nervosa (AN) cases recruited after community screening were compared with fifty-one age-, sex- and schoolmatched cases with regard to comorbidity and personality disorders at age 21 years. All 102 cases had originally been examined at a mean age of 16 years. Outcome according to the Morgan-Russell scales was fairly similar to that reported in recent clinic-based samples. Most of the former AN cases were recovered in respect of weight but outcome in social areas was restricted. Obsessive compulsive and avoidant personality disorders and empathy disorders were very much more common in the AN than in the comparison group. Obsessive compulsive behaviors showed a high degree of stability over time and were unrelated to weight problems. Together with empathy disorders they tended to predict outcome better than the eating disorder as such. Affective disorders were common but tended to follow the course of the eating disorder rather than precede or postdate it.Received Ph.D. on Anorexia Nerevosa in Swedish Urban Teenagers at Göteborg University in 1990. Major research interests concern the epidemiology and background factors of eating disorder.Received Ph.D. in 1981 at the University of Uppsala on Neuropsychiatric aspects of perceptual, motor, and attentional deficits in seven-year-old Swedish children. Major research interests are autism, Asperger syndrome, anorexia nervosa, attention deficit hyperactivity disorder, dyslexia, mental retardation, lefthandedness, and behavioral phenotypes.Received Ph.D. in 1987 at The University of Uppsala on Deficits in Attention, Motor Control and Perception: Follow-Up from Pre-School to Early Teens. Her major research interests concern attention deficit hyperactivity disorder.     

Outcome of early onset anorexia nervosa: What do we know?

Six recent studies on the outcome of early onset anorexia nervosa (AN) are reviewed. It would appear that the intermediate term outcome of early onset AN is not different from that of later onset AN. No prognostic indicators were identified and effect of treatment is unknown. Early onset AN may be a disabling and chronic disorder for 25% of patients seen at psychiatric clinics.Received M.D. from the University of Hong Kong, Faculty of Medicine. Major research intersts are eating disorders and cross-cultural psychiatry.     

Outcome of anorexia nervosa related to treatment utilizing an adolescent medicine approach

The scientific literature suggests that outcome for adolescents with eating disorders bears little relation to the type of treatment used. Practitioners of adolescent medicine care for adolescents with eating disorders and have reported outcome in three studies, to which a fourth is added in this paper. This new sample of 34 adolescents represents consecutive admissions to an inpatient adolescent medicine unit who were then followed as outpatients by the same interdisciplinary treatment team. An average of more than 5 years after hospitalization, the group had a mean weight of 97.9% of normal and 94% were menstruating (87.5% regularly). Depending on the outcome criteria used, between one-half and two-thirds of the subjects had an excellent to good outcome, with only about 10% of subjects symptomatic at follow-up. Comparing the most recent cohort of 34 adolescents (Group II) with the older cohort of 49 subjects (Group I) reveals a trend toward behaviors associated with bulimia more commonly on entering treatment. These encouraging results suggest that adolescent medicine may offer a complementary approach to traditional methods for adolescents with eating disorders.Received M.D. from Temple University School of Medicine in Philadelphia, PA. Research interests are in bone mineral density in females with anorexia nervosa.Received M.D. from the University of Buffalo School of Medicine in Buffalo, NY. Research interests include examination of the relationship of violence and illicit substance use in adolescents and the relationship of physical abuse and bulimia nervosa.     

Sex-role identification of normal adolescent males and females as related to school achievement

The historical view of masculinity/femininity posited essentially bipolar opposites, with the presence of one set of characteristics precluding the other. More recent studies of sex-role stereotypes have defined sexual orientation within clusters of socially desirable attributes which males and females perceive as differentiating males from females. This view negates the contention that psychological sex roles are composed of bipolar opposites, and concludes that the constructs of masculinity and femininity are independent dimensions rather than a single bipolar dimension. Little is known about the sex-role functioning of adolescents, yet it is during adolescence that qualitative shifts occur in interpersonal relationships and concurrent changes occur in cognitive functioning, with adolescents shifting toward hypothetical thinking and abstract ideal notions. In view of these changes, much can be learned about adult functioning by studying the sex-role perceptions of adolescents related to familial and social variables. This study examines the sex-role perceptions that adolescents hold of fathers, mothers, ideal males, ideal females, and selves. Differences exist between male and female adolescents, and significant linkages exist between sex-role identification and academic achievement.Received Ph.D. from Miami University, Oxford, Ohio. Interest is sex-role identification as related to social adaptation and achievement.Received Ph.D. from Catholic University, Washington, D.C. Interest is in behavior disorders in adolescence.     

Family influences,school behaviors,and risk for the later development of an eating disorder

Interviews were conducted with parents of 136 female and 45 male adolescents categorized into risk groups for the later development of an eating disorder. The family and school concomitants of risk status in females were demonstrated to be different from that in males. Risk group female adolescents rated family cohesion, parent-adolescent communication processes, and overall family satisfaction more negatively than the comparison group. Mothers of moderate risk group females reported lower family cohesion than the comparison group; there were no group differences for adolescent females in fathers' ratings of family measures. However, no group differences were found on any of the family measures between male risk and comparison males. For both females and males, there were no significant group differences in family history of eating and mood disorders, or alcohol dependence. Teacher ratings indicated relatively greater internalizing tendencies in the high-risk female group.This investigation was supported by NICHD Grant Number 1R01-HD24700 awarded to Gloria R. Leon.Received Ph.D. from University at Maryla. Research interests include precursors of eating disorders and stress and coping in extreme environments. To whom correspondence should be addressed.Received M.A. from San Diego State University. Research interests include precursors of eating disorders, substance abuse, and personality.Received Ph.D. from Stanford University. Research interests include psychosocial aspects of health promotion and disease prevention.Received B.A. from University of Maine. Research interests life span development and family issues.     

Juvenile Offenders’ Alcohol and Marijuana Trajectories: Risk and Protective Factor Effects in the Context of Time in a Supervised Facility

The current study modeled trajectories of substance use from ages 15 to 20 among 1,095 male serious juvenile offenders (M age = 16.54; 42% African-American, 34% Latino, 20% European-American, and 4% other ethnic/racial backgrounds) and prospectively predicted trajectories from risk and protective factors before and after controlling for time spent in a supervised setting. Results indicated that supervised time suppressed age-related growth in substance use. Trajectories of offenders with no supervised time and low levels of supervised time increased in substance use across age, whereas offenders with high levels of supervised time showed no growth. Almost all risk and protective factors had effects on initial substance use but only adolescent history of substance use, impulse control, and psychosocial maturity had an effect on change in substance use over time. Findings highlight the importance of formal sanctions and interventions superimposed on normal developmental processes in understanding trajectories of substance use among serious juvenile offenders.

The relationship of observed maternal behavior to questionnaire measures of parenting knowledge,attitudes, and emotional state in adolescent mothers

Although relationships have been found between maternal psychological characteristics and cognitive and emotional outcomes in children, the behaviors which may mediate these relationships are seldom examined. This is especially true for adolescent mothers, whose children are thought to be at high risk for adverse outcomes. In this study, adolescent mothers in two special programs completed questionnaires measuring perception of the newborn (Neonatal Perception Inventory), knowledge of influences on child development (Infant Caregiving Inventory), and emotional state (General Health Questionnaire); they were also systematically observed while interacting with their infants in a naturalistic situation. Specific maternal behaviors were found to vary with the age of the mother and of the baby. Mothers with neutral or negative perceptions of their infants touched them less than did mothers with positive perceptions. Degree of emotional disturbance was inversely related to the amount of time that the mother looked at her infant while in physical contact.This research was supported in part by NIH Biomedical Research Support Grant No. BRS 507 RR 05445-19 to Johns Hopkins University School of Hygiene and Public Health.Received her Sc.D. in mental hygiene (comparative behavior) from Johns Hopkins University. Main interests include relationships between observable behavior and reported psychological states, and behavioral and emotional disorders of children.Received her Ph.D. in population dynamics from Johns Hopkins University. Main interests are adolescent health and pregnancy and population changes influencing perinatal health.Received her Ph.D. in psychology from George Peabody College. Main interests include parenting of infants and children's rights.Received her Ph.D. in anthropology from the University of Florida. Main interests include adolescent health and utilization of health services by children and adolescents.Received his Ph.D. in child psychology from the University of Iowa. Main interests are infant and child development, with focus on measurement of developmental status and its determinants.