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.     

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.     

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.     

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.     

Transcultural comparisons of self-image in German and United States adolescents

Based on the Offer Selfimage Questionnaire (OSIQ), the selfimage of German and United States adolescents was compared. The German study was based on OSIQ protocols from 365 adolescents in West Berlin while the American sample comprised adolescents drawn from seven cities in the United States. With respect to three scales, United States adolescents report better adjustment than do the German adolescents. These scales were Mastery of the External World, Vocational and Educational Goals, and Superior Adjustment. In general, these two Western societies share more similarities than differences in the selfimages of their adolescents.Received M.D. and Ph.D in Psychology from the University of Hamburg, Germany. Research interests are high-risk studies, child psychiatric epidemiology, and adolescence.Received M.D. from the University of Chicago. Major interests are concepts of mental health and the developmental psychology of adolescence.Received J. D. from the University of Chicago School of Law; received Ph.D. in Human Development from the University of Chicago. Research interests are adolescence and delinquency.Received Ph.D. in Psychology from the University of Chicago. Major interests are psychotherapy research and adolescence.     

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.     

Binge eating in anorexia nervosa predicts later onset of substance use disorder: A ten-year prospective,longitudinal follow-up of 95 adolescents

The cooccurrence of binge eating and increased alcohol intake and substance abuse has been reported in clinical and community epidemiological samples. To further investigate the nature and causes of this comorbidity, we examined the 10-year prospective, longitudinal course of illness in 95 nonsubstance abusing adolescents hospitalized for treatment of anorexia nervosa. Survival analysis with Cox regression was used to quantitate the cumulative risk of developing substance use disorder (SUD) as a function of patterns of binge eating vs. dietary restraint within this cohort. Subjects who were binge eating at the time of intake were robustly distinguished from restrictors, having increased risk of SUD as well as greater likelihood of having at least one first-degree relative with SUD. The findings suggest binge eating that develops in the underweight stage of anorexia nervosa may reflect developmental, biological, and genetic risk processes shared in common with SUD.Received Ph.D. in clinical psychology from the University of Pittsburgh. Research interests include the etiology, course, and treatment of eating disorders, and the natural history and treatment of juvenile mood disorders.Received R.N. from Rush-Presbyterian Hospital. Research interests are in the area of adolescent mental health treatment and the treatment of anorexia nervosa.Received R.N. from Northeastern Univeristy. Research interest is the inpatient psychiatric treatment of adolescents.Received R.N. from the University of Windsor and her M.N. from UCLA. Research interest is the outcome studies of treatment effectiveness in adolescent and adult 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.     

An eight-year follow-up: Outcome from adolescent compared to adult onset anorexia nervosa

Seventy-five women were traced and reassessed on average eight years after the onset of anorexia nervosa. All patients received treatment and 88% were hospitalized at least once. Comparisons between early (11–15 years; N=35), late (16–18 years; N=24) adolescent and adult (19–27 years; N=14) onset revealed no significant differences in outcome for age at onset. For 70% of adolescent and 42% of adult onset patients the outcome was good, meaning that the weight was within ± 15% of norm with regular cyclical menstruation,17% and 21% had an intermediate, and 9% and 21%, respectively, had a poor outcome, 5.3% had died. Taken together, 59% had physically recovered and were free of any eating disorder. Severity of illness reflected in a low body mass index, excessive exercise, and poor psychosocial functioning at intake were poor prognostic indicators;length of illness and food restriction or bulimia as eating patterns were unrelated to outcome. The observation that all women with chronic anorexia nervosa, and even a third of those who had physically recovered from anorexia nervosa, qualified for one or more psychiatric diagnoses suggests that the psychosocial correlates of anorexia nervosa require further study.Supported by grant MH ROI35585-01A1.Received an M.D.-Ph.D. degree from Albert-Ludwig University in Freiburg, Germany. Research interests have been depressive disorders, eating disorders, in particular anorexia nervosa, and more recently women's health.Received M.D. degree from the University of Illinois in Chicago, Illinois. Research interest is in preventive medicine.     

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.     

The “impulsivity index”: Its application to juvenile delinquency

An objective, composite index of impulsivity, made up of three measures of reactivity to color on the Rorschach and amount of discrepancy between performance and verbal IQ on the Wechsler Scales, is proposed. It was predicted that impulsiveness as measured by this index would be associated with self-perception of impulsivity. Moreover, it was predicted that impulsiveness, whether objectively or subjectively measured, would tend to be associated with a history of greater and more frequent delinquency. The major hypotheses were confirmed. In addition, the data suggested that delinquents from higher socioeconomic levels may be more impulsive than their lower class counterparts. Additional work on refining and validating the impulsivity index is indicated.This work has been supported by Grant No. A70-15 from the Illinois Law Enforcement Commission.Currently a Ph.D. Candidate in Human Development at the University of Chicago. Major research interest is in cognitive development during adolescence.Received M.D. from the University of Chicago. Major research interests are the developmental psychology of adolescence and the etiology of juvenile delinquency.Received M.D. from Marquette University. Major research interests are in juvenile delinquency and psychotherapy of adolescents.Currently a Ph.D. Candidate in Human Development at the University of Chicago. Major research interest is in juvenile delinquency.     

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.     

Health habits and depression in adolescence

In a study of the relationship between health habits and depression, 80 high school students, selected on an availability basis, were administered a Health Behaviors Questionnaire (HBQ) and the Beck Depression Inventory (BDI). The HBQ and the BDI significantly correlated (r=0.43p<0.01). Those who smoked were more frequently depressed than those who did not (X ²=10.5p<0.05), and those who used drugs other than marijuana were depressed more frequently than those who did not (X ²=9.2p<0.01). Mildly overweight boys (overweight by more than 5% of their ideal weight) and mildly under-weight boys (underweight by more than 5% of their ideal weight) were moreThis research was supported in part by a grant from the American Diabetes Association and by National institute of Health Grant MH 15529.Received his M.D. at George Washington School of Medicine. Major interest is interface of child psychiatry and pediatrics.Received his M.D. at Downstate Medical Center, State University of New York. Major interest is metabolic changes in adolescence.Received her M.A. from Queens College, New York. Major interest is measurement of human behavior.Received his M.D. from the University of Wisconsin. Major interest is adolescent sexuality.Received her Ph.D. in psychology from Hofstra University. Major interest is evaluation of clinical programs. depressed than boys of normal weight (p<0.02). The more pounds underweight the girls were, the more depressed they were (r=0.482, p<0.05). The closer the weight of a girl who perceived herself as overweight was to her ideal weight, the more depressed she was (r=–0.428,p<0.05).     

Rorschach differences in normal and delinquent white male adolescents: A discriminant function analysis

Rorschach productions from 38 normal and 30 delinquent White male adolescents were scored by three Ph.D. clinical psychologists according to the method given by Beck. The groups were equated for IQ, social class, and age at the time of testing. Rorschach scales representative of various personality dimensions, i.e.,R, M, F, F+, FC, CF, C, FC: CF + C, Sum C, Affective Ratio, Shading, H, andA, were subjected to a linear discriminant analysis. The results showed highly significant and accurate differentiation between the groups (p<0.0005, correct classification rate =86.8%); however, theAffective Ratio was the only scale that heavily contributed to the discrimination. The difference between the groups on this scale was attributed to the delinquents' passive cognitive style. The results also lend support to the notion that delinquents differ from normals along the dimension of impulsivity, a finding relevant to psychodynamic theories of delinquency as reflective of serious ego deficits. Fuller consideration of Rorschach symbolic content and qualitative features of response is recommended.The first two authors' contributions were equal.Currently a Ph.D. candidate in education at Loyola University, Chicago. Major research interests are psychometrics, psychodiagnostics, and statistics.Received her Ph.D. in clinical psychology from Loyola University, Chicago. Major research interests are psychodiagnosis, psychotherapy evaluation, and the etiology of delinquency.Received his M.D. from Marquette University. Major research interests are juvenile delinquency and the process of psychotherapy.     

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.     

The self-image of adolescents: A study of four cultures

This paper describes the utilization of the Offer Self-Image Questionnaire (OSIQ) for research purposes on a variety of adolescent populations and demonstrates the OSIQ's effectiveness in meaningfully separating normal, juvenile delinquent, and emotionally disturbed adolescents; older and younger teenagers; males and females. It also considers the utilization of the OSIQ in four different cultures (United States, Ireland, Australia, and Israel) and concentrates on the results obtained when the OSIQ is given adolescents in these four cultures. It discusses the findings and points to some of the methodological problems which are inherent in doing cross-cultural research.Presented at the American Educational Research Association meeting in San Francisco, California, April 20, 1976.Received his M.D. from the University of Chicago. He interned at the University of Illinois and took his psychiatric residency at Michael Reese Hospital and University of Chicago. He is a graduate of the Institute for Psychoanalysis in Chicago. Major interests have been concept of mental health and the developmental psychology of adolescence.Received his Ph.D. in human development from the University of Chicago. Research interests are adolescence and delinquency.Received his Ph.D. in psychology from the University of Chicago. Major interests are psychotherapy research and adolescence.     

Peer knowledge of and reactions to adolescent suicide

Questionnaire data were obtained from 120 high school students on their (1) knowledge of risk factors that identify potential suicidal behavior in peers, (2) attitudes toward peers who attempt or commit suicide, and (3) ability to respond appropriately to suicidal messages from peers. Overall, relatively few adolescents possessed accurate information, and many had misinformation concerning various warning signs. Furthermore, respondents expressed negative attitudes toward peers who attempt or commit suicide, and generally were unable to respond sensitively and appropriately to suicidal communications. These results have implications for suicide education programs for adolescents.This study was based on a Masters Thesis conducted by the first author under the direction of the latter two authors. Preliminary results of this investigation were presented at the Midwestern Psychological Association, Chicago, 1988.Received M.A. in clinical psychology from Loyola University. Current research interests include bulimia and alcoholism.Received Ph.D. in clinical psychology from Vanderbilt University. Primary research interests involve community psychology, prevention programs, and child psychology.Received Ph.D. from University of Chicago. Research interests include issues in adolescence and eating disorders.     

The incidence of bulimic behavior in a secondary and University school population

A survey questionnaire was instructor administered to high school and university students (n=1500) to assess the incidence of bulimic behavior. The questionnaire was tested and found to be a reliable and valid index for bulimic symptomatology. Respondents included 59% high school and 41% university level students. Data was evaluated by school, grade, sex, race, and interest area. Bulimic behavior was demonstrated at an incidence of 4.30% for the total sample. There was a nonsignificant higher incidence found in university (5.31%) compared to high school (3.98%) respondents. A significantly greater percentage of females responded with bulimic behavior than did males; however, there were no significant differences found between university and high school females. Bulimic behavior appeared to peak at Grades 11 and 13. Significantly more whites reported bulimic behavior than did blacks. Several academic interest areas not previously indicated in the literature may be more vulnerable to bulimic behavior.Received her Ph.D. from Virginia Polytechnic Institute and State University, M.P.H. from School of Public Health, University of North Carolina. Major interest is eating disorders.Received his Ph.D. from North Carolina State University. His major interest is statistical design and evaluation of Experiment Station projects.     

Locus of control in severely disturbed adolescents: Loci for Peers,Parents, Achievement,Relationships, and Problems

The validity of a multifactor conceptualization of locus of control (LOC) in severely disturbed adolescents was investigated. Ninety-two adolescents (44 female, 48 male) from a private psychiatric hospital completed the Children's Nowicki-Strickland Internal-External Locus of Control scale 3 months following admission. Five factors were found by both principal components and common factor analyses; the factors were named Peers, Parents, Achievement, Relationships, and Problems. Factors items had minimum loadings of 40, numbered 4 to 8 per factor, and accounted for 36.8% of the variance in principal components analysis and 28.5% of the variance in common factor analysis. Whereas traditional LOC was significantly related only to Global Assessment Scale (GAS) scores at admission and 3 months later, and to initial Diagnostic and Statistical Manual (3rd edition, revised) diagnosis of psychosis, individual factors were significantly related to IQ; GAS at admission, 3 months, and 15 months following admission; externalized aggression prior to admission; and diagnoses of psychosis, depression, and conduct disorder.Received doctorate in psychology from Stanford University. Current research interests include cost effectiveness and cost-benefit analysis of mental health services and substance abuse treatment programs, and cognitive determinants of premature cessation of therapy.Received doctorate in clinical psychology from George Washington University. Her current interests include individual psychotherapy with children and adolescents and research on the effectiveness of home-based services.Received doctorate in clinical psychology from George Washington University. His research interests include comorbidity of depression and conduct disorder, and outcome studies of adolescent disorders.Received M.D. from Harvard Medical School and is the former Head of Child and Adolescent Psychiatry, University of Rochester, and former Chief, Child Research Branch, National Institute of Mental Health. Major interests are inpatient adolescent treatment, family therapy, and individual psychotherapy.     

Developmental trends in television coviewing of parent-child dyads

In this study, long-term trends in joint parent-child television viewing are taken as prototype for developmental changes of the parent-child relationship during adolescence. To describe and compare trends of television coviewing in different configurations of family members, trajectories of daily television viewing, tmeasured with Nielsen-type people meters over a time period of three years, were analyzed using time series methods. The findings show the transferability of hypotheses about general developments in relations between the generations on coviewing behavior of adolescents aged 14–16 with their parents to predict differential declines in the four parent-child dyads.Received Ph.D. from Free University of Berlin in 1976. Research interests include the role of the media in child development and family relations.Received Ph.D. from Free University of Berlin in 1984. Research interests include time series analysis, television behavior, and personality.Received M.S. from Technical University of Berlin, in 1987. Research interests include role of television in political socialization.