WK4 socw6111 - Social Science
The adolescent stage can be described as a time where there is a loss of innocence and a preentry into adulthood. A large part of being an adolescent is beginning that process of stepping out into the world and learning about oneself as a unique and autonomous individual. This movement out into the world is contingent upon the knowledge that this young person will have a safe and secure home to return to at the end of the day. If a traumatic loss or event has occurred in the adolescent’s life, there may be no safe base to which this individual can return. Attachment theory teaches us that a young person’s ability to attach/engage with peers, family, and other potential support systems is an important aspect of the developmental process. During the adolescent stage of development, assessing attachment styles is important because it provides a window into how the adolescent relates to others, which allows the clinician to choose the appropriate intervention.
For this Discussion, choose either the program case study for the Bradley family or the course-specific case study for Brady.
By Day 3
Post an application of the attachment theory to the case of either Tiffani or Brady. Discuss the connection between his or her attachment style and the exhibiting behavior. (I CHOSE TIFFANI)
R E V I E W
The multifaceted nature of prosocial behavior in
children: Links with attachment theory and
research
Jacquelyn T. Gross | Jessica A. Stern | Bonnie E. Brett |
Jude Cassidy
University of Maryland
Correspondence
Jacquelyn Gross, Department of Psychol-
ogy, University of Maryland, College Park,
MD, 20742, USA.
Email: [email protected]
Abstract
Prosocial behavior involves attempting to improve others’ welfare and
plays a central role in cooperative social relationships. Among the
manifold processes that contribute to prosocial development is the
quality of children’s attachment to their caregivers. Often, researchers
have investigated the link between secure attachment and broad indi-
ces of prosociality. Recent theory and research, however, suggest that
children’s prosocial behavior is multifaceted, with distinct correlates
and developmental trajectories characterizing specific prosocial
behaviors. We offer a theoretical model of the role of parent–child
attachment in the development of prosocial behavior, first broadly,
and then with regard to comforting, sharing, and helping, specifically.
Further, we review the empirical work on this topic from infancy
through adolescence. Overall, evidence supports an association
between secure attachment and prosociality, broadly defined, but
results vary across comforting, sharing, and helping. We discuss
potential explanations for the findings and outline directions for
future research examining the role of attachment in shaping the diver-
sity of prosocial behaviors across development.
K E Y W O R D S
attachment, emotion regulation, empathy, prosocial behavior, social
competence
1 | INTRODUCTION
Prosocial behavior involves voluntary action to improve another’s welfare; it encompasses diverse behaviors, such as
feeding a hungry child, lending a hand to a stranger, or soothing a distraught friend. Individual differences in prosocial-
ity emerge early in life and carry significant implications for social development (e.g., Eisenberg, Fabes, & Spinrad,
2006). Given the importance of prosociality in sustaining cooperative human relationships, substantial research has
focused on understanding the factors that contribute to its development. One of the most influential theories of social
Social Development. 2017;26:661–678. wileyonlinelibrary.com/journal/sode VC 2017 John Wiley & Sons Ltd | 661
Received: 26 December 2015 | Revised: 1 February 2017 | Accepted: 2 April 2017
DOI: 10.1111/sode.12242
http://orcid.org/0000-0001-7613-6826
development, attachment theory provides a useful lens for understanding early prosociality (Bowlby, 1969/1982;
Sroufe, 2005). Our goals in this paper are to provide a theoretical model of attachment’s role in prosocial development,
to synthesize research linking parent–child attachment and prosocial behavior in childhood, and to generate further
investigation of this important topic by bringing Bowlby’s (1969) theory of parent–child relationships into conversation
with modern perspectives on prosociality.
2 | ATTACHMENT AND PROSOCIAL DEVELOPMENT: A THEORETICAL
MODEL
Attachment theory (Bowlby, 1969/1982) proposes that children possess a biologically-based attachment system that
evolved to keep them in proximity to a caregiver in times of threat; caregivers, in turn, possess a caregiving system
that allows them to respond to children’s distress with help, protection, and comfort. Ainsworth (1989) defined an
attachment bond as the affectional tie of a child to her caregiver that is long-lasting, emotionally salient, person-
specific, and involves the child’s attempts to use the caregiver as a secure base from which to explore and a safe haven
in times of threat. The consistency and care with which caregivers respond to children’s needs contribute to individual
differences in the quality of children’s attachment, which are reflected in children’s behavior toward the caregiver
(Ainsworth, Blehar, Waters, & Wall, 1978). From a history of sensitive responsiveness to their needs, children develop
secure attachments, in which they seek proximity to the caregiver when distressed, derive comfort, and effectively re-
enter the world of exploration. In contrast, from a history of inconsistent or rejecting caregiving, children develop inse-
cure attachments, including avoidance—characterized by children’s downplaying of distress and failure to seek comfort
—and ambivalence—characterized by children’s high levels of distress and failure to derive comfort when it is offered.
Finally, children who have experienced frightened or frightening caregiving are thought to develop disorganized attach-
ments, characterized by the lack of a coherent strategy for regulating distress and maintaining proximity to a caregiver
(Schuengel, Bakermans-Kranenburg, & van IJzendoorn, 1999).
In Bowlby’s (1969/1982) theory, attachments to individual caregivers contribute to internal working models
(IWMs) related to these figures (i.e., learned cognitive representations of how people may be expected to behave and
a complementary representation of the self). Over time, these initial IWMs are thought to become incorporated into
generalizations about others more broadly (including representations about the nature of relationships and about
others as trustworthy and deserving of care), guiding children’s expectations and behaviors in new social situations.
Secure IWMs involve a script-like model of distress being met with care (secure base script), expectations that social
partners will be responsive, and attributions of others as generally well-intentioned (Johnson, Dweck, & Chen, 2007;
Waters & Waters, 2006). These representations predict children’s behavior in variety of domains, and likely support
children’s prosocial behavior by giving a ‘roadmap’ for how others’ needs might be addressed, and by instilling a view
of others as worthy of care, arousing altruistic motivation to meet their needs. Conversely, insecure IWMs involve
scripts, expectations, and attributions likely to undermine prosocial behavior (see Dykas & Cassidy, 2011); for example,
insecure-avoidant children are more likely to make hostile attributions about peers’ behavior (Suess, Grossmann, &
Sroufe, 1992), whereas insecure-ambivalent children are more likely to expect peers to dislike or reject them (Ziv,
Oppenheim, & Sagi-Schwartz, 2004). In other words, secure (positive) or insecure (negative) IWMs may serve as a cen-
tral mechanism through which attachment influences prosocial behavior (see Figure 1).
Another principal mechanism linking attachment to prosocial behavior is emotion regulation (Bowlby, 1973). Consid-
erable research demonstrates that, from repeated experience of coregulation with a sensitive caregiver, secure children
are better able to regulate emotion (Calkins & Leerkes, 2011; Cassidy, 1994). In turn, emotion regulation supports proso-
ciality, because children must be calm enough to focus on others’ needs (e.g., Eisenberg & Fabes, 1995). Secure children
are also more likely to demonstrate effortful control—a component of self-regulation that involves voluntary control over
emotions, attention, and behavior (Viddal et al., 2015). Like emotion regulation, effortful control has been shown to pre-
dict prosociality in children and adolescents (Aguilar-Pardo, Martínez-Arias, & Colmenares, 2013; Alessandri et al.,
2014), allowing them to inhibit play or other activities and activate other-oriented behaviors.
662 | GROSS ET AL.
Importantly, insecure children may still engage in some prosocial behaviors, but their motivations may differ from
those of secure children. For instance, an insecure-avoidant child may share a toy with a high-status peer to avoid con-
frontation, whereas an insecure-ambivalent child may help peers out of eagerness to please adult figures whose affec-
tion, she has learned, is contingent on displaying desired behavior. Although such links are amply supported in the
adult literature (see Shaver, Mikulincer, Gross, Stern, & Cassidy, 2016), attachment-related differences in children’s pro-
social motivation have been understudied. (See Eisenberg, VanSchyndel, & Spinrad, 2016, for further discussion of
children’s prosocial motivations.)
In sum, we propose a model in which secure attachment supports children’s prosocial behavior via three key
mechanisms: IWMs, emotion regulation, and effortful control, which inform children’s motivations and, in turn, proso-
cial behavior (Figure 1).
Beyond these mechanisms, attachment and prosociality are linked via common parenting antecedents. For example,
parental modeling of prosocial behavior may both scaffold children’s own prosociality (e.g., Hammond & Carpendale,
2015) and contribute to children’s attachment quality. Modeling not only encourages imitation of prosocial acts, but also
engrains prosocial values and expectations for how people treat each other (content that contributes to IWM formation).
Importantly, parents’ sensitive responding to distress appears to be the most salient factor influencing child attachment
(e.g., Leerkes, 2011); thus, secure children may be most likely to demonstrate prosociality in contexts involving others’
distress. In non-distress situations, other dimensions of parenting such as socialization likely contribute to prosociality
directly (see Padilla-Walker, 2014), or in interaction with attachment. For example, evidence suggests that parents’
socialization of prosocial moral values is more effective among secure parent–child dyads, because secure children are
more receptive to socialization efforts (Kochanska, Aksan, Knaack, & Rhines, 2004).
Additionally, the theoretical link between attachment and prosocial behavior is qualified by multiple potential mod-
erators. At the level of the child, sex, genetics, and temperament may interact with attachment to predict prosociality
(e.g., Laible, Carlo, Murphy, Augustine, & Roesch, 2014). For example, research suggests that toddlers’ temperamental
inhibition and sex interact with parenting to predict prosociality, with parenting showing the strongest influence among
temperamentally inhibited girls (Hastings, Rubin, & DeRose, 2005). Similarly, in line with differential susceptibility mod-
els, research has demonstrated that irritable infants are more affected by environmental influences for better and for
worse (for a review see Belsky, Bakermans-Kranenburg, & van IJzendoorn, 2007). Thus, for inhibited or irritable chil-
dren, secure attachment may be especially instrumental—and insecure attachment especially detrimental—to prosocial
development. In addition to gene-by-environment interactions, children’s active role in eliciting parental behaviors and
co-creating their social environment raises the possibility of gene–environment correlations predicting prosociality. For
FIGURE 1 Theoretical model of links between attachment and prosocial behavior
GROSS ET AL. | 663
example, children’s prosocial behavior has been shown to elicit greater maternal affection (Panaccione & Wahler,
1986), such that children’s prosociality may contribute to ongoing cycles of positive parent–child interactions that sup-
port both security and ongoing prosociality.
At the contextual level, the link between attachment and prosociality is also moderated by situational factors such
as the presence of others, the presence and salience of emotional cues, and the target of children’s prosocial overtures.
For example, children are less prosocial when bystanders are present (Pl€otner, Over, Carpenter, & Tomasello, 2015);
insecure children may be especially susceptible to the bystander effect, in light of findings that insecure children are
more likely to be bystanders than defenders in bullying situations (Nickerson, Mele, & Princiotta, 2008). Other research
demonstrates that some children are more prosocial toward in-group members (e.g., Yu, Zhu, & Leslie, 2016); however,
given evidence that experimental priming of attachment security attenuates in-group bias in adults (Mikulincer &
Shaver, 2001), it is possible that attachment security also reduces such in-group biases in children, making them more
likely to be prosocial across multiple contexts. Further, findings linking attachment and prosociality vary depending on
whether the target is a sibling, a peer, an experimenter, or the mother (e.g., van der Mark, van IJzendoorn, &
Bakermans-Kranenburg, 2002). When considering prosocial behavior toward mothers, maternal characteristics add fur-
ther complexity: For example, children of depressed or single mothers often demonstrate relatively high levels of pro-
social behavior (e.g., Rehberg & Richman, 1989). One study suggests that the effect of maternal depression on child
prosociality is strongest among secure children who also have behavior problems (Radke-Yarrow, Zahn-Waxler,
Richardson, Susman, & Martinez, 1994). Thus, prosociality arises from the complex interplay among child attachment
and characteristics of the social environment.
Both individual-level and contextual processes are embedded in a broader bioecological context (Bronfenbrenner,
1992), in which links among parenting, attachment, and situational variables may shift as children influence, and are
influenced by, their home, neighborhood, and cultural environments (see McGinley, Opal, Richaud, & Mesurado, 2014).
The majority of cross-cultural studies to date have linked secure attachment to children’s social competence across a
variety of domains, suggesting that security’s promotion of positive outcomes such as prosociality may be universal
(see Mesman, van IJzendoorn, & Sagi-Schwartz, 2016); at the same time, culture appears to influence which type of
insecurity emerges from a difficult parent–child relationship and which attachment relationships are most predictive of
developmental trajectory (Mesman et al., 2016). In cultures with high social density, for example, attachment to parents
may be less predictive of prosociality, whereas broader indices of social support or attachment to multiple caregivers
may be more meaningful. Culture also influences social norms for prosocial behavior and how children respond to
others’ distress (e.g., Trommsdorff, Friedlmeier, & Mayer, 2007). However, most research linking attachment and pro-
sociality to date has focused on Western cultures, in which children’s principal attachment is typically to the mother;
thus, the majority of studies reviewed here focus on child–mother attachment.
The link between prosociality and attachment must also be considered in the context of development—encompass-
ing children’s growing social-cognitive capacities and age-normative changes in social relationships. Following develop-
mental models proposed by Gottlieb (2007), Cicchetti (Masten & Cicchetti, 2010), and others (e.g., Bowlby, 1988), we
view attachment as one piece of a multidetermined pathway toward prosociality, with secure attachment as a precipi-
tating factor in a positive developmental cascade (Masten & Cicchetti, 2010) in which proximal effects of security on
children’s functioning beget further competencies that ultimately foster prosociality. The mechanisms proposed above
invite the possibility of an indirect link from attachment to prosociality that could be characterized as a cascade of
influences building in a probabilistic manner across development. For example, secure attachment early in development
may contribute to children’s ability to form meaningful peer relationships when they enter school; these relationships
may provide increased opportunities to participate in prosocial behaviors, which in turn sustain positive interactions
with peers into adolescence, reinforcing children’s views of others as good and continuing the ‘virtuous cycle’ of care.
Finally, we note that understanding the development of prosociality requires acknowledging its multifaceted
nature. Recent theory and research suggest that distinct types of prosocial behavior can be differentiated in childhood
using multiple taxonomies (e.g., Hay & Cook, 2007), with many researchers focusing on helping, sharing, and comforting
(e.g., Paulus, K€uhn-Popp, Licata, Sodian, & Meinhardt, 2013). Dunfield (2014) suggests that children develop the ability
664 | GROSS ET AL.
to recognize and respond to three types of need that call for different responses: comforting addresses the emotional
need to reduce an unpleasant affective state, sharing meets the material need to acquire a desired resource, and helping
addresses the instrumental need to complete a goal-directed action.
Growing evidence supports this taxonomy. For instance, in both longitudinal (e.g., Eisenberg et al., 1999) and con-
current investigations of prosociality in children (e.g., Dunfield & Kuhlmeier, 2013), these behaviors appear to be dis-
tinct and are often uncorrelated. Studies also find that each behavior is characterized by distinct neurophysiological
correlates (Paulus et al., 2013), developmental trajectories (e.g., Dunfield & Kuhlmeier, 2013; see Eisenberg et al.,
2006), and parenting antecedents (e.g., Brownell, Svetlova, Anderson, Nichols, & Drummond, 2013; Pettygrove,
Hammond, Karahuta, Waugh, & Brownell, 2013; Rehberg & Richman, 1989). Moreover, unique social-cognitive skills
are required for each behavior (e.g., Svetlova, Nichols, & Brownell, 2010).
Given the mounting evidence that these behaviors are distinct in children, researchers have highlighted the need
to study them as separate constructs (see Dunfield, 2014). Accordingly, understanding the role of attachment in child-
ren’s prosociality requires examining specific behaviors independently, considering whether and how attachment might
contribute to the development of each. In the following pages, we review research investigating attachment and proso-
cial behavior from a developmental perspective, beginning with general prosociality (as it has traditionally been stud-
ied), then building on the proposed model to generate hypotheses regarding specific prosocial behaviors (comforting,
sharing, and helping).
3 | ATTACHMENT AND GENERAL PROSOCIAL BEHAVIOR: EMPIRICAL
WORK
3.1 | Infancy through preschool
Among infants, toddlers, and preschoolers, evidence predominantly supports a positive association between attach-
ment security and general prosociality, although studies are too few to draw strong conclusions. Studies using parent-
reported attachment have found that preschoolers’ security was related to mother-reported prosociality directly
(Laible, 2006) and, in a second sample, indirectly via effortful control (i.e., correlated with effortful control, which in
turn correlated with prosociality; Laible, 2004), but not to teacher-reported prosociality (Lafrenière, Provost, & Dubeau,
1992). In a study using the Strange Situation Procedure (SSP; Ainsworth et al., 1978), a gold standard observational
measure of attachment, secure attachment at age two predicted prosocial behavior toward peers three years later
(Iannotti, Cummings, Pierrehumbert, Milano, & Zahn-Waxler, 1992). Another study using the SSP found that pre-
schoolers’ security was positively associated with prosocial behavior toward their mother, but only among children
with behavior problems, and in combination with maternal depression (Radke-Yarrow et al., 1994). In a sample of one-
year-olds, however, no link was observed between security in the SSP and mother-reported prosociality (Carter, Little,
Briggs-Gowan, & Kogan, 1999).
3.2 | Early and middle childhood
Research linking attachment and general prosociality in middle childhood has varied widely in its measures of attach-
ment and provides similarly varied results. In general, longitudinal studies comparing specific attachment classifications
have found meaningful differences in children’s later prosocial behavior, whereas cross-sectional studies employing
other attachment metrics have produced more mixed results. For example, eight- and nine-year-olds who had been
secure in the SSP at 15 months were rated by parents and teachers as more prosocial than those who had been
insecure-avoidant, but not insecure-ambivalent (Bohlin, Hagekull, & Rydell, 2000). Another study found that children
who were secure in the SSP at age three were rated by mothers as more prosocial in grade school than those who
were disorganized, but not insecure (Seibert & Kerns, 2015). In contrast, in a study that only compared children who
had been secure vs. insecure in the SSP (and did not differentiate specific attachment categories), no attachment-
related differences emerged in children’s prosocial interactions with younger siblings (Volling & Belsky, 1992). Using an
GROSS ET AL. | 665
observational measure of six-year-olds’ attachment security, Bureau and Moss (2010) found no links to children’s pro-
sociality as rated by teachers. In one study employing a self-report attachment measure, elementary school children’s
security with both mother and father was associated with concurrent prosociality, but only in a model including paren-
tal affection, and only for girls (Michiels, Grietens, Onghena, & Kuppens, 2010).
As children enter early and middle childhood, researchers are able to examine their representational world
through the use of narrative story-stem measures. The evidence linking attachment IWMs and general prosociality
in this age group is similarly mixed. In the study by Bohlin et al. (2000) described above, when attachment IWMs
were assessed concurrently with a story-stem task, no links to prosociality emerged (though this measure did not
differentiate insecure subtypes). Similarly, in the above study by Bureau and Moss (2010), no links were observed
between eight-year-olds’ IWMs and prosocial behavior; however, teacher-rated prosociality at age 6 predicted
children’s disorganized representations at age 8. Conversely, five-year-olds with secure IWMs were rated as more
prosocial by their teachers one year later compared to children with insecure-avoidant, but not insecure-
ambivalent, IWMs (Rydell, Bohlin, & Thorell, 2005). Among low-income, racially diverse families, five-year-olds’
attachment IWMs were related to teacher reports—but not mother reports—of prosociality (Futh, O’Connor,
Matias, Green, & Scott, 2008).
3.3 | Adolescence
Developmental shifts in attachment occur as teenagers learn how to maintain their relationships to parents while also
increasing autonomy (Allen & Tan, 2016); these shifts may be associated with changes in the nature and strength of
the links between attachment and prosociality. Importantly, developmental changes also make it possible for adoles-
cents to form attachment bonds with peers or romantic partners, such that new attachment bonds may influence pro-
sociality alongside, or in interaction with, attachment to parents.
The Inventory of Parent and Peer Attachment-Revised (IPPA-R; Gullone & Robinson, 2005) is a widely used mea-
sure assessing teens’ attachment bonds. In studies using the IPPA-R, adolescents from diverse backgrounds and cul-
tures who report greater security with parents also report being more prosocial (Andretta et al., 2015; Chan et al.,
2013; Nie, Li, & Vazsonyi, 2016; Oldfield, Humphrey, & Hebron, 2016; Thompson & Gullone, 2008; see also Keskin &
Çam, 2010). Using a similar measure, self-reported attachment to the mother, but not to the father, was correlated
with self-reported prosociality in early adolescence (Markiewicz, Doyle, & Brendgen, 2001). These studies also provide
support for the mediators proposed in Figure 1, including empathy (Thompson & Gullone, 2008) and self-control (Nie
et al., 2016), consistent with findings in the adult literature (see Shaver et al., 2016).
In the only adolescent study to use the Adult Attachment Interview (George, Kaplan, & Main, 1985), a narrative
assessment tapping individuals’ ‘state of mind with respect to attachment,’ secure/autonomous adolescents were more
likely than insecure/dismissing, but not insecure/preoccupied, adolescents to be nominated by their peers as prosocial
(Dykas, Ziv, & Cassidy, 2008).
3.4 | Summary
In summary, evidence involving children’s general prosocial behavior is equivocal. Although much of the evidence
favors a positive association with attachment, the mixed findings warrant further investigation. Support for a posi-
tive association appears to be most consistent in adolescence, perhaps due to more consistent methodology.
Notably, the adolescent evidence mirrors evidence from the adult literature linking self-reported attachment to
observational measures of prosociality (e.g., Mikulincer, Shaver, Gillath, & Nitzberg, 2005). Moreover, this associa-
tion emerged across diverse samples, including African American youths involved in the criminal justice system;
Turkish, British, Chinese, and American students; and children ranging in age from 9 to 17. An examination of
available effect sizes from the reviewed studies reveals that the magnitude of effects in childhood is less consist-
ent—ranging from small to moderate—than it is in adolescence, when effects are consistently small (with one
exception; Andretta et al., 2015).
666 | GROSS ET AL.
4 | ATTACHMENT AND THE MULTIFACETED NATURE OF PROSOCIAL
BEHAVIOR
Although the research on general prosociality sheds some light on the role of attachment in children’s capacity for
responding to others’ needs, we cannot draw conclusions about the specific behaviors they use or to which needs they
are responding. A growing consensus recognizes that many inconsistencies in the prosocial literature may be explained
by failure to consider that prosociality is a multidimensional construct (e.g., Eisenberg & Spinrad, 2014; Hay & Cook,
2007). In response, studies of parenting antecedents of prosocial behavior have increasingly adopted this view (see
Padilla-Walker, 2014), yet the literature on attachment antecedents has not evolved in the same way. Historically, stud-
ies on children’s attachment-related differences have focused on general prosociality, like the studies just reviewed, or
on comforting, reflecting the perspective that social development results in part from how children themselves have
been comforted (Bowlby, 1969/1982).
This section offers a theoretical account of how attachment may relate to specific types of prosocial behavior,
integrating the multidimensional approach used in other social development research and the model in Figure 1.
Although many dimensions of prosociality merit consideration, we focus on three behaviors that comprise a commonly
studied taxonomy (comforting, sharing, and helping; Dunfield, 2014) and yet are understudied in the attachment litera-
ture (except comforting). For each behavior, we also review evidence on links to attachment.
4.1 | Comforting
4.1.1 | Theory
Of all prosocial behaviors, comforting is perhaps most relevant to attachment theory, given that security develops in
part from children’s experiences of co-regulation by a caregiver when distressed (Bowlby, 1969/1982), and that evi-
dence suggests that parents’ effective comforting most centrally predicts secure child attachment (Leerkes, 2011).
Because attachments are formed in the context of distressing emotions, they may influence children’s behavior more
in social situations involving greater negative emotion (compared to low- or non-emotional situations; see Padilla-
Walker, 2014). Specifically, security fosters the development of cognitive and regulatory skills such as emotion regula-
tion (see Calkins & Leerkes, 2011), supporting children’s ability to respond to others’ distress (e.g., Panfile & Laible,
2012); these skills may play a lesser role in prosocial responses during low- or non-emotional situations. Although help-
ing and sharing can occur in emotional contexts (such as when a child shares a toy with a sad peer), comforting is
always a response to emotional distress, whether real or perceived, and the degree of negative emotion present in
comforting situations is typically greater.
Beyond emotion regulation, how might receiving comfort promote the ability to provide comfort? One explanation
posits that these experiences contribute to a child’s secure base script, described earlier. Cognitive scripts, or schemas,
guide expectations and behavior in new situations, such that individuals expect a series of events to occur as they
have in past situations. Thus, children with a history of sensitive care possess an implicit script of how comforting sit-
uations typically unfold: Distress elicits bids for help, which precipitate the caregiver’s recognition of the bid and sensi-
tive response, resulting in alleviation of the distress and a return to exploration (Waters & Waters, 2006). Evidence
that such scripts of expected …
Chapter 3
Assessment of Adolescents
David W. Springer and Tara M. Powell
Purpose: This chapter provides an overview of assessment tools for adolescents,
including methods of assessment, limitations of evidence-informed assessment
tools, treatment goals, and implications for social work.
Rationale: To educate students and practitioners about appropriate assessment
strategies and tools for adolescents.
How evidence-informed practice is presented: This chapter focuses on evi-
dence used in assessments with adolescents, presenting options and strategies
for choosing evidence-informed scales and assessment tools while considering
such factors as a client’s background, the clinical utility of the assessment tool,
and treatment goals.
Overarching question: What is the acceptable protocol for choosing and
implementing an assessment and treatment plan with adolescents?
‘‘They love too much and hate too much, and the same with everything
else. They think they know everything; and are always quite sure about
it; this, in fact, is why they overdo everything.’’ These words were written
by Aristotle, the ancient Greek philosopher, more than 2,300 years ago
(Rhetoric, Book II). Today’s scientific study of adolescence can be traced
back to the work of G. Stanley Hall (1904), who wrote a two-volume work
on adolescence in which he proposes that adolescence is a separate stage
of development. Now, fast-forward 100 years.
As recently as 2005, the Journal of Clinical Child and Adoles-
cent Psychology devoted a special section on developing guidelines for
the evidence-based assessment of child and adolescent disorders, where
evidence-based assessment (EBA) is ‘‘intended to develop, elaborate, and
identify the measurement strategies and procedures that have empirical
support in their behalf’’ (Kazdin, 2005, p. 548). In this special issue on
EBA, Mash and Hunsley (2005) emphasize the great importance of assess-
ment as part of intervention but acknowledge that the development of EBA
has not kept up with the increased emphasis on evidence-based treatment.
In fact, there is a significant disconnect between EBA and evidence-based
treatment. This is no small problem for those in the field. Several studies
spanning different geographical locations (such as the United States, Puerto
Rico, Canada, and New Zealand) have produced consistent results on the
prevalence of disorders among children and adolescents, with estimates
71
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72 Social Work Practice With Individuals and Families
indicating that 17% to 22% suffer significant developmental, emotional,
or behavioral problems (U.S. Congress, 1991; World Health Organization
[WHO], 2004; as cited in Kazdin & Weisz, 2003).
The developmental tasks associated with adolescence only serve to
complicate matters, because the practitioner must take into account many
interrelated domains of the adolescent’s life. Some behaviors may be con-
sidered quite normal at one age but later cross a threshold that suggests
mental illness or impairment in functioning. In addition to the importance
placed on recognizing the developmental tasks of adolescence during the
assessment process, this chapter adopts the assumptions about assessment
presented by Jordan and Franklin (1995): ‘‘(1) assessment is empirically
based, (2) assessment must be made from a systems perspective, (3) mea-
surement is essential, (4) ethical practitioners evaluate their clinical work,
and (5) well-qualified practitioners are knowledgeable about numerous
assessment methods in developing assessments’’ (p. 3). These assump-
tions serve as a guide for social workers when determining what type of
assessment protocol to implement with adolescents (and their families).
Assessment is the first active phase of treatment (Springer, McNeece,
& Arnold, 2003). Without a thorough and complete assessment, the social
worker cannot develop a treatment plan that will serve the youth and his
or her family. In this chapter, various methods of assessment, such as
interviews and the use of standardized instruments that may be useful in
assessment with adolescents, are reviewed. For a more comprehensive
review of assessment methods and tools for youth, see other excel-
lent sources, including a compilation of rapid-assessment instruments
for children and families (K. Corcoran & Fischer, 2007), an overview of
tools and methods for assessment with children and adolescents (Shaffer,
Lucas, & Richters, 1999b), and a guide to empirically based measures of
school behavior (Kelley, Reitman, & Noell, 2003; Roberts & Greene, 2009).
The special section of Journal of Clinical Child and Adolescent Psychol-
ogy referred to earlier is another excellent resource, as it examines the
EBA of pediatric bipolar disorder (Youngstrom, Findling, Youngstrom, &
Calabrese, 2005), anxiety disorders (Silverman & Ollendick, 2005), depres-
sion (Klein, Dougherty, & Olino, 2005), Attention-Deficit/Hyperactivity
Disorder (ADHD; Pelham, Fabiano, & Massetti, 2005), conduct problems
(McMahon & Frick, 2005), learning disabilities (Fletcher, Francis, Morris, &
Lyon, 2005), and autism-spectrum disorders (Ozonoff, Goodlin-Jones, &
Solomon, 2005).
After reviewing each of the articles in the special issue mentioned
earlier, Kazdin (2005, p. 549) provided a commentary where he identifies
common themes in child and adolescent clinical assessment:
1. There is no gold standard to validate assessment.
2. Multiple measures need to be used to capture diverse facets of the
clinical problem.
3. Multiple disorders or symptoms from different disorders ought to be
measured because of high rates of comorbidity.
Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and
interventions. ProQuest Ebook Central <a onclick=window.open('http://ebookcentral.proquest.com','_blank') href='http://ebookcentral.proquest.com' target='_blank' style='cursor: pointer;'>http://ebookcentral.proquest.com</a>
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Assessment of Adolescents 73
4. Multiple informants are needed to obtain information from different
perspectives and from different contexts.
5. Adaptive functioning, impairment, or, more generally, how individ-
uals are doing in their everyday lives are important to assess and are
separate from symptoms and disorders.
6. Influences (or moderators) of performance need to be considered for
interpreting the measures, including sex, age, developmental level,
culture, and ethnicity, among others.
These themes are certainly critical to the assessment of adolescents and
will be revisited throughout the remainder of the chapter.
Evidence-Based Assessment With Adolescents
There are various methods of assessment available to social work practi-
tioners that can be used with adolescents. These include, but are not limited
to, interviews, self-observation, observation by others, family sculpting,
individualized rating scales, rapid-assessment instruments, and standard-
ized assessment tools. The focus of this chapter is primarily on the use of
standardized assessment tools and interviews with adolescents.
Interviews
The assessment process typically starts with a face-to-face interview (e.g.,
psychosocial history) with the adolescent. The family should also be
involved for at least part of this interview. The interview serves several
purposes, such as an opportunity to establish rapport with the client and
allow the client to tell his or her story. Recall that one key assumption of
conducting a good assessment is to operate from a systems perspective.
Involving the family during part of the interview may help meet this goal,
because family members provide varying perspectives and are more often
than not a key factor in an adolescent’s life.
Morrison and Anders (1999) have written a useful book on inter-
viewing children and adolescents in which they advocate for a blended
interviewing style that uses both directive and nondirective techniques:
In general, nondirective, open-ended style of questioning is important during
the early stages of an initial interview, when you want to give the respondent
greatest leeway to volunteer important observations concerning the child’s or
adolescent’s behavior and emotional life. Later on, as you come to understand
the scope of your respondent’s concerns, use questions that require short answers
to increase the depth of your knowledge.
—(p. 20)
Consider the following case for illustration purposes. Ramon, a
16-year-old Hispanic male who has been diagnosed with ADHD and
Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and
interventions. ProQuest Ebook Central <a onclick=window.open('http://ebookcentral.proquest.com','_blank') href='http://ebookcentral.proquest.com' target='_blank' style='cursor: pointer;'>http://ebookcentral.proquest.com</a>
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74 Social Work Practice With Individuals and Families
oppositional defiant disorder (ODD), is brought into an agency by his
parents, because he is ‘‘failing 11th-grade Spanish and precalculus, and
he won’t listen.’’ Ramon also has threatened to run away from home
on more than one occasion. In addition to obtaining information from
Ramon’s parents that is typically covered in a psychosocial history (e.g.,
medical, developmental, social, and family history), some areas that the
social worker may cover with Ramon’s parents during an initial interview
are as follows:
• Presenting problem and specific precipitating factor (e.g., Tell me in
your own words what prompted you to bring Ramon in for help at
this point in time?)
• Attempts to deal with the problem (e.g., What has your family done
to try to deal with this problem(s)? What have you tried that has
worked?)
• Hopes and expectations (e.g., What do you hope to get out of coming
here for services? If you could change any one thing about how things
are at home, what would it be?)
In addition to these areas (with variations of the corresponding
sample questions), consider some topics that the social worker may ask
Ramon about individually:
• Peer relationships (e.g., Tell me about your friends. What do you like
to do together?)
• School (e.g., What are your favorite [and least favorite] classes at
school? What about those classes do you like [not like]?)
• Suicide risk (e.g., When you feel down, do you ever have any
thoughts of hurting/killing yourself? Do you ever wish you were
dead? How would you end your life?)
• Substance use (e.g., What do you drink/use? When was the last time
you had a drink/used? How much did you have? Have you ever
unsuccessfully tried to reduce your substance use?)
• Targeted behavior/goal setting (e.g., If there was any thing that you
could change about yourself/your life, what would it be? What do
you like most about yourself?)
These questions are meant only to illustrate the range of ques-
tions that a social worker might ask during an interview. A complete
psychosocial history would need to be conducted with Ramon.
J. Corcoran and Springer (2005) emphasize a strengths-and-skills-
based approach to engage the adolescent client in the treatment process.
This approach pulls primarily from solution-focused therapy, motivational
interviewing, and cognitive-behavioral therapy. Youths, especially those
with externalizing behavioral disorders, like Ramon, have often expe-
rienced a range of life stressors, such as poverty, overcrowded living
Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and
interventions. ProQuest Ebook Central <a onclick=window.open('http://ebookcentral.proquest.com','_blank') href='http://ebookcentral.proquest.com' target='_blank' style='cursor: pointer;'>http://ebookcentral.proquest.com</a>
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Assessment of Adolescents 75
conditions, parental divorce, incarceration of parents, community vio-
lence, and parental substance use. The practitioner’s attempt to explore
the adolescent’s feelings and thoughts around such issues is often met
with resistance. Rather than getting into a struggle with adolescents or
trying to push them in a certain direction, the strengths-and-skills-based
approach underscores building on strengths and past successes rather
than correcting past failures and mistakes. Accordingly, the interviewer
focuses on positives and solutions over negative histories and problems.
Consider some of the following interviewing tips provided by J. Corcoran
and Springer (2005, p. 136).
They propose the following options for dealing with the ‘‘I don’t
know’’ stance that adolescents take:
1. Allow silence (about 20–30 seconds).
2. Rephrase the question.
3. Ask a relationship question (adolescents sometimes feel put on the
spot by having to answer questions about themselves but can take
the perspective of others to view their behavior).
4. Say, ‘‘I know you don’t know, so just make it up,’’ which bypasses
teens’ resistance or fear that they don’t know or don’t have the right
answer. Or, using presuppositional language, say, ‘‘Suppose you did
know. . . . ’’
5. Speak hypothetically about others: ‘‘What would (prosocial peers
that teens respect) say they do to keep out of trouble (get passing
grades or get along with their parents’)?’’
J. Corcoran and Springer (2005) go on to point out that asking
evocative questions may help adolescent clients increase their readiness
for change, and they provide a recommended line of questioning to explore
the disadvantages of the status quo (e.g., ‘‘What difficulties or hassles have
you had in relation to ________?’’ ‘‘What is there about _______ that you or
other people might see as reasons for concern?’’) as well as the advantages
of change (e.g., ‘‘What would you like your life to be like 5 years from
now?’’ ‘‘If you could make this change immediately, by magic, how might
things be better for you?’’ ‘‘What would be the advantages of making this
change?’’).
Such social workers as Saleebey (1997), Clark (1998), and Lerner
(2009) recommend that practitioners incorporate a strengths-based per-
spective into their assessment approach with adolescents. Cowger (1997,
pp. 69–71) proposes specific exemplars for assessment of client strengths in
five areas:
1. Cognition (e.g., is open to different ways of thinking about things).
2. Emotion (e.g., is positive about life).
3. Motivation (e.g., wants to improve current and future situations).
Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and
interventions. ProQuest Ebook Central <a onclick=window.open('http://ebookcentral.proquest.com','_blank') href='http://ebookcentral.proquest.com' target='_blank' style='cursor: pointer;'>http://ebookcentral.proquest.com</a>
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76 Social Work Practice With Individuals and Families
4. Coping (e.g., has dealt successfully with related problem in the past).
5. Interpersonal (e.g., makes sacrifices for friends, family members, and
others).
For the complete list of exemplars, see Cowger (1997). Indeed, a thor-
ough assessment includes a deliberate examination of the client’s unique
strengths that in turn can be amplified over the course of treatment.
In addition to these interviewing strategies, more structured and
systematic interview protocols for use with adolescents are also available
to practitioners. The Diagnostic Interview Schedule for Children (DISC) is
one such interview.
The Voice Diagnostic Interview Schedule for Children
The Diagnostic Interview Schedule for Children (DISC) is a computerized
respondent-based interview that assesses more than 30 common diagnoses
found among children and adolescents, including anxiety disorders, eat-
ing disorders, mood disorders, attention-deficit and disruptive behavior
disorders, and substance-use disorders (Shaffer, Fisher, & Lucas, 1999a;
Shaffer, Fisher, Lucas, Dulcan, & Schwab-Stone, 2000). It was developed
to be compatible with the DSM-IV, DSM-III-R, and the International Classi-
fication of Diseases (ICD-10) and is organized into six diagnostic modules
that measure the major Axis I disorders and impairment. The DISC-IV
includes assessment for three time frames—the present (past 4 weeks), the
last year, and ever—with parallel versions existing for youth ages 9 to 17
(DISC-Y) and for parents or caretakers of youth ages 6 to 17 years (DISC-P).
The present-state assessment is considered to be the most accurate, because
it minimizes the risk of bias due to telescoping (Shaffer et al., 1999a). The
DISC-IV is scored by algorithms that apply Boolean logic (i.e., ‘‘and’’
and ‘‘or’’) to combine answers to component questions and is ‘‘an ideal
candidate for computerization, given the highly structured nature of the
interview, the limited response options, the complicated branching and
skipping instructions, and the need for the interviewer to keep close
track of an informant’s answers to numerous symptoms in order to ask
onset and impairment questions correctly’’ (Shaffer et al., 1999a, p. 23).
A recent voice adaptation allows youth to hear the interview over head-
phones (while also reading questions on the computer screen) and key in
responses via computer.
The Center for the Promotion of Mental Health in Juvenile Justice
at Columbia University is spearheading efforts to administer the voice
version of the DISC-IV. It has already been tested in three states (Illinois,
South Carolina, and New Jersey) with youth recently admitted to juvenile-
correction institutions, with the primary aims to more accurately assess
rates of mental-health disorders among incarcerated juveniles and to test
the feasibility of using this type of structured, self-administered mental-
health assessment with this population (Ko & Wasserman, 2002). The
Voice DISC-IV provides a ‘‘provisional’’ diagnosis for youth assessed.
Findings from initial feasibility studies indicate that the instrument is
Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and
interventions. ProQuest Ebook Central <a onclick=window.open('http://ebookcentral.proquest.com','_blank') href='http://ebookcentral.proquest.com' target='_blank' style='cursor: pointer;'>http://ebookcentral.proquest.com</a>
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Assessment of Adolescents 77
tolerated well by youth, parents, and agency staff and support its validity,
revealing that information on psychiatric status matches existing justice-
system information regarding current substance offenses (Wasserman,
McReynolds, Lucas, Fisher, & Santos, 2002b). Adaptations for detention,
correctional, and community juvenile-justice sites are ongoing in 10 other
states. The DISC-IV has also been translated into a Spanish version (Bravo
et al., 2001).
For sites that are willing and capable, the Center for the Promo-
tion of Mental Health in Juvenile Justice will provide the Voice DISC-IV
assessment software program, provide training for key personnel, offer
ongoing technical support via phone and e-mail, assist with data inter-
pretation and preparation of reports/presentations, and provide guidelines
for appropriate mental-health referral. For more detailed information, see
www.promotementalhealth.org/voicedisc.htm
Information gathered from the face-to-face interview can subse-
quently be used to inform a more in-depth assessment in targeted areas,
which, in turn, guides treatment planning. Rapid assessment instruments
and other standardized assessment protocols may prove useful for this
purpose.
Rapid-Assessment Instruments and Standardized Assessment Tools
Rapid-assessment instruments (RAIs; Levitt & Reid, 1981) are short-form,
pencil-and-paper assessment tools that are used to assess and measure
change for a broad spectrum of client problems (Bloom, Fischer, & Orme,
2006; K. Corcoran & Fischer, 2007; Hudson, 1982). RAIs are used as a
method of empirical assessment, are easy to administer and score, are
typically completed by the client, and can help monitor client functioning
over time. Given the proliferation of RAIs and standardized tools in recent
years that measure various areas of adolescent functioning, it can be an
overwhelming task to select a tool for use with an individual client. Thus,
some guidelines are provided next.
The social worker practitioner needs to take several factors into
consideration when choosing an RAI or standardized protocol for use with
clients, such as the tool’s reliability, validity, clinical utility, directness,
availability, and so on (K. Corcoran & Fischer, 2007). To the extent that
an RAI has sound psychometric properties, it helps practitioners measure
a client’s problem consistently (reliability) and accurately (validity). Using
reliable and valid tools becomes increasingly critical as one considers the
complexities surrounding assessment with adolescents who (potentially)
have comorbid disorders. A brief overview of reliability and validity is
provided next; however, the reader is referred to the following sources
for a more detailed exposition on these topics: K. Corcoran & Fischer,
2007; Crocker & Algina, 1986; Hudson, 1982; Nunnally & Bernstein, 1994;
Springer, Abell, & Hudson, 2002a; Springer, Abell, & Nugent, 2002b; Abell,
Springer, & Kamata 2009.
Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and
interventions. ProQuest Ebook Central <a onclick=window.open('http://ebookcentral.proquest.com','_blank') href='http://ebookcentral.proquest.com' target='_blank' style='cursor: pointer;'>http://ebookcentral.proquest.com</a>
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http://www.promotementalhealth.org/voicedisc.htm
78 Social Work Practice With Individuals and Families
Reliability
A measurement instrument is reliable to the extent that it consistently yields
similar results over repeated and independent administrations. A tool’s reli-
ability is represented through reliability coefficients, which range from 0.0
to 1.0. What constitutes a satisfactory level of reliability depends on how
a measure is to be used. For use in research studies and scientific work,
a reliability coefficient of 0.60 or greater is typically considered accept-
able (Hudson, 1982). However, for use in guiding decision making with
individual clients, a higher coefficient is needed. Springer et al. (2002b)
provide the following guidelines for acceptability of reliability coefficients
for use with individual clients to aid in clinical decision making:
<0.70 = Unacceptable
0.70 to 0.79 = Undesirable
0.80 to 0.84 = Minimally acceptable
0.85 to 0.89 = Respectable
0.90 to 0.95 = Very good
>0.95 = Excellent
The greater the seriousness of the problem being measured (e.g.,
suicidal risk) and the graver the risk of making a wrong decision about
a client’s level of functioning, the higher the standard that should be
adopted.
Validity
Where reliability represents an instrument’s degree of consistency, validity
represents how accurately an instrument measures what it is supposed to
measure. There are various ways to determine an instrument’s validity:
content validity (which subsumes face validity), criterion-related valid-
ity (concurrent and predictive), and construct validity (convergent and
discriminant).
The social worker must make decisions about a measure’s validity
in relationship to its intended use. In other words, the social worker must
determine whether the measure is valid for that particular client in a
particular setting at a given time. A measure may be valid for one client
but not for another.
Additional Considerations in Selecting Scales
Age and Readability
Practitioners must take into consideration the client’s age and reading
ability when selecting a scale. Scales are developed, validated, and normed
for an intended population and for specific uses. If a scale is developed
for use with adult clients, and a practitioner administers the scale to a
Holosko, M. J., Dulmus, C. N., Sowers, K. M., & Sowers, K. M. (2013). Social work practice with individuals and families : Evidence-informed assessments and
interventions. ProQuest Ebook Central <a onclick=window.open('http://ebookcentral.proquest.com','_blank') href='http://ebookcentral.proquest.com' target='_blank' style='cursor: pointer;'>http://ebookcentral.proquest.com</a>
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Assessment of Adolescents 79
13-year-old client with a fifth-grade reading level, then this scale is not
being administered properly, and the results obtained from the scale are
potentially meaningless and clinically irrelevant.
Ethnic and Cultural Diversity
A second consideration is to fully respect a client’s ethnic and cultural
background when using scales in practice. Ethnicity and culture affect
all aspects of an adolescent’s life, and acculturation experiences among
minority youth can also have a significant impact on a youth’s development
and functioning (Jordan & Hickerson, 2003).
For example, consider the following challenges associated with
assessing substance-abusing adolescents. An increasingly important issue
in adolescent substance-abuse treatment is ‘‘amenability to treatment,’’
which concerns the identification of subgroups of individuals in a target
population who are likely to be the most amenable or responsive to a
treatment (i.e., what interventions work for whom under what conditions;
Kazdin, 1995). Family influences on substance use may be particularly
profound for Latino and African American youth due to important ethnic
variations in family rules and monitoring of children in relation to risk
behaviors, such as substance use. In fact, some research suggests that these
variations may decrease risk behaviors among Latino and African Ameri-
can youth (Catalano, Hawkins, & Krenz, 1993; Li, Fiegelman, & Stanton,
2000; Vega & Gil, 1998). The Latino preference for close family proximity
may result in vulnerability when emigration from the country of origin
causes family disruption (Vega, 1990). Moreover, there is evidence that
traditional familial values can serve as a protective factor mitigating against
adolescent maladjustment (Vega, Gil, Warheit, Zimmerman, & Apospori,
1993). Gil, Wagner, and Vega (2000) have shown that the loss of famil-
ism and parental respect that accompanies greater acculturation among
Latino adolescents has negative impacts on predispositions toward deviant
behaviors and alcohol use. So, …
Mathew C. Withers, Lenore M. McWey, and Mallory Lucier-Greer
Florida State University
Parent–Adolescent Relationship Factors and
Adolescent Outcomes Among High-Risk Families
Using a stress-process and attachment the-
ory framework, we identified salient aspects
of the parent–adolescent relationship and
tested the extent to which those aspects were
longitudinally associated with depression, with-
drawal, delinquency, and aggressive behavior
outcomes among a sample of high-risk adoles-
cents (N = 498). First, four dimensions of the
parent–adolescent relationship were identified:
emotional closeness, communication, autonomy,
and conflict. Next, latent profile analyses were
conducted, and four distinct parent–adolescent
relationship profiles emerged: secure, avoidant,
anxious, and detached. Adolescent outcomes
were assessed 2 years later. Results indicated
that (a) adolescents in the avoidant and anxious
profiles demonstrated higher depression symp-
toms than did those in the secure profile, (b)
higher levels of aggression were demonstrated
in the avoidant profile, and (c) higher levels of
delinquency were demonstrated in the detached
profile. Implications for parent–adolescent rela-
tionships and family therapy interventions are
provided.
The importance of quality of parent–adolescent
relationships is well established (e.g., Steinberg,
2001). Low-quality relationships are associated
Department of Family and Child Sciences, Florida State Uni-
versity, 120 Convocation Way (Mail Code: 1491), Tallahas-
see, FL 32306 ([email protected]).
Key Words: Adolescence, at-risk, delinquency, depression,
families, parent–child relationships.
with poor adolescent adjustment, including
depression, withdrawal, aggression, and delin-
quency (Branje, Hale, Frijns, & Meeus, 2010;
Fanti, Henrich, Brookmeyer, & Kuperminc,
2008; Hair, Moore, Garrett, Ling, & Cleve-
land, 2008). Healthy family interactions may
protect adolescents from high-risk family con-
texts against negative outcomes, yet this is an
emerging area of study (Houltberg, Henry, &
Morris, 2012) and most research has focused
on community samples. Because adolescents
in higher-risk contexts exhibit higher levels
of internalizing and externalizing symptoms
(Moylan et al., 2010), it is important to iden-
tify salient dimensions of parent–adolescent
relationships in these families and examine the
extent to which those dimensions are associ-
ated with adolescent mental health outcomes.
Understanding aspects of the parent–adolescent
relationship and long-term implications for
adolescent well-being in this context can inform
intervention strategies with higher-risk families.
Despite the known importance of parent–
adolescent relationship quality, there is a lack
of specificity about what quality means. Indeed,
a variety of definitions have been used in the
conceptualization of parent–adolescent relation-
ship quality, including closeness (Ge, Natsuaki,
Neiderhiser, & Reiss, 2009), communica-
tion (Ohannessian, 2013), autonomy (Manzi,
Regalia, Pelucchi, & Fincham, 2012), and con-
flict (Briere, Archambault, & Janosz, 2013).
Research examining each of these parent–
adolescent relationship factors provides some
insight into their associations with adolescent
Family Relations 65 (December 2016): 661–672 661
DOI:10.1111/fare.12220
662 Family Relations
mental health outcomes. Specifically, higher
levels of closeness in the parent–adolescent
relationship have been found to be inversely
associated with adolescent internalizing and
externalizing symptoms (Corona, Lefkowitz,
Sigman, & Romo, 2005; Inguglia et al., 2015).
For example, findings from a study of mostly
Caucasian, middle-class, two-parent families
indicated that high parent–adolescent closeness
was correlated with fewer adolescent depressive
symptoms (Ge et al., 2009). Closeness has also
been inversely linked to adolescent antisocial
behaviors (Vieno, Nation, Pastore, & Santinello,
2009).
Communication, another dimension of the
parent–adolescent relationship, has been asso-
ciated with adolescent internalizing symptoms
(Hartos & Power, 2000) and externalizing
symptoms (Davidson & Cardemil, 2009; Hartos
& Power, 2000). Research suggests that healthy
parent–adolescent communication may be a
protective factor against negative adolescent
mental health outcomes (Ohannessian, 2013).
When adolescents perceive communication
with their parents as poor, they also report less
parental support, which, in turn, is positively
correlated with adolescent depressive symptoms
(Landman-Peeters et al., 2005). Furthermore,
better parent–adolescent communication has
been associated with lower levels of adolescent
externalizing symptoms (Davidson & Cardemil,
2009), and poor parent–adolescent commu-
nication has been linked with school-based
aggression (Lambert & Cashwell, 2004) and
decisions to engage in delinquent behaviors
(Clark & Shields, 1997).
Adolescent autonomy has frequently been
paired with one or more other dimensions of
the parent–adolescent relationship, such as
relatedness (Allen, Hauser, Eickholt, Bell, &
O’Connor, 1994), or parenting behaviors (Silk,
Morris, Kanaya, & Steinberg, 2003). The under-
lying consensus is that autonomy is a relational
construct by which adolescents gain indepen-
dence while staying connected with their parents
(Collins & Steinberg, 2008). For example, in
the context of higher levels of parental support,
more autonomy has been associated with lower
levels of internalizing symptoms (Pace & Zap-
pulla, 2013). In the event that adolescents have
too much autonomy, in the form of emotional
detachment, both internalizing and externalizing
behaviors are more likely (Ingoglia, Lo Coco,
Liga, & Lo Cricchio, 2011). Another study
examined autonomy with adolescents from
Belgium, Italy, China, and the United States
(Manzi et al., 2012), and results indicated that
for adolescents in all four countries, a lack of
decision-making autonomy was associated with
higher levels of depression symptoms.
Parent–adolescent conflict may be the most
widely researched aspect of the parent–
adolescent relationship, with results empha-
sizing the negative association between high
levels of conflict and adolescent outcomes
(e.g., Laursen, Coy, & Collins, 1998; Smetana,
Campione-Barr, & Metzger, 2006; Steinberg,
2001). For instance, adolescents with symptoms
of depression tend to have more conflictual
parent–adolescent relationships than do adoles-
cents with low levels of depressive symptoms
(Sheeber, Davis, Leve, Hops, & Tildesley, 2007).
In addition, parent–adolescent conflict has been
linked to an increase of depressive symp-
toms from early to late adolescence (Sallinen,
Ronka, Kinnunen, & Kokko, 2007). Conflict
has also been found to be associated with ado-
lescent delinquent and aggressive behaviors
(Smokowski, Bacallao, Cotter, & Evans, 2015),
and mother and adolescent negativity during
conflict are consistently and longitudinally asso-
ciated with adolescent externalizing symptoms
(Hofer et al., 2013).
Dimensions of the parent–adolescent rela-
tionship may be interrelated. Some resear-
chers, for example, have suggested that parent–
adolescent relationships delicately negotiate a
shifting balance between closeness and ado-
lescents’ increasing developmental readiness
for autonomy (Allen et al., 1994; Inguglia
et al., 2015). In addition, parent–adolescent
closeness has been positively correlated with
parent–adolescent communication (Vieno et al.,
2009), which has been inversely related to
parent–adolescent conflict (Briere et al., 2013).
Although research supports autonomy, close-
ness, communication, and conflict as important
dimensions of the parent–adolescent relation-
ship, a recent review indicated that research
examining all four factors together is lacking
(Chao & Otsuki-Clutter, 2011). Theoretically,
aspects of the parent–adolescent relationship
may differ from family to family. For instance,
one parent–adolescent relationship may involve
high levels of closeness and low levels of
conflict, whereas another parent–adolescent
relationship may be high in both closeness and
conflict. It is empirically unclear, however, if
Parent–Adolescent Relationship Factors 663
one type of parent–adolescent relationship is
of higher quality—that is, results in healthier
outcomes—than another. Therefore, the present
study was designed to identify dimensions
of parent–adolescent relationships, categorize
how different dimensions represented specific
parent–adolescent relationship profiles, and test
how each profile differentially predicted adoles-
cent outcomes 2 years later.
Background
Parent–Adolescent Relationships Among
High-Risk Families
Most parent–adolescent relationship quality
research has been based on community sam-
ples, which may underestimate the effects
of parent–adolescent relationship quality on
outcomes among higher-risk families (Jones,
Beach, & Forehand, 2001; Steinberg, 2001).
One study involving the limited research on this
topic sampled high-risk families involved with
the welfare system and did not find direct sta-
tistical associations between exposure to family
violence and adolescent internalizing and exter-
nalizing outcomes; however, maternal warmth
was directly correlated with adolescent internal-
izing symptoms (Renner & Boel-Studt, 2012).
The authors concluded that although parental
warmth may be a protective factor, a poten-
tial explanation for the nonsignificant direct
associations is that, compared to younger chil-
dren, adolescents may have more autonomy to
avoid higher-risk family contexts. The results of
another study involving a sample at risk for child
maltreatment indicated that mother–adolescent
relationship quality was negatively associated
with adolescent internalizing and externaliz-
ing symptoms (McWey, Claridge, Stevenson-
Wojciak, & Lettenberger-Klein, 2015). Addi-
tionally, among a high-risk subsample of parents
and adolescents in Australia, researchers found
high parental warmth and low parental control
and overinvolvement were associated with lower
rates of internalizing and externalizing mental
health diagnoses among adolescents (Bren-
nan, Brocque, & Hammen, 2003). In an effort to
address the need for tailored interventions aimed
at decreasing adolescent behavior problems,
results of an 8-week study found increases in
parent–adolescent relationship quality and lower
levels of family conflict at post-test were asso-
ciated with lower levels of adolescent behavior
problems (Chu, Bullen, Farruggia, Dittman, &
Sanders, 2015). Taken together, these studies
suggest specific features of parent–adolescent
relationships may buffer negative outcomes
among adolescents from high-risk contexts.
However, research examining multiple dimen-
sions of the parent–adolescent relationship
among high-risk families is limited.
Theoretical Orientation
The stress-process framework (Pearlin, Mena-
ghan, Lieberman, & Mullan, 1981) posits that
stressors include normative and nonnorma-
tive experiences that occur as single events or
as chronic stressors over time (e.g., repeated
maltreatment; Pearlin, 1989). Although these
normative and nonnormative stressors can lead
to an increase in mental health symptoms, psy-
chosocial resources, such as personal coping
and healthy interpersonal relationships, can pro-
tect against the adverse impact of stressors on
mental health (Pearlin et al., 1981). Attachment
theory (Bowlby, 1980) helps further explain the
importance of parent–adolescent relationships
as a psychosocial resource for adolescent out-
comes. Specifically, secure attachments have
been associated with a reduced risk of expe-
riencing internalizing (Duchesne & Ratelle,
2014) and externalizing (Cota-Robles & Gam-
ble, 2006) symptoms in adolescence. The
present study extends extant research by using
a stress-process and attachment theory frame-
work to examine whether specific dimensions
of parent–adolescent relationships influenced
adolescent mental health outcomes among a
sample at higher-risk for maltreatment.
Present Study
Research and theory point to the importance of
high-quality parent–adolescent relationships for
mitigating the risk of poor mental health out-
comes among adolescents (Aceves & Cookston,
2007; Hair et al., 2008; Houltberg et al., 2012).
Most research, however, either focuses on
parent–adolescent relationship quality broadly or
independently tests specific aspects (e.g.,
conflict) of the parent–adolescent relationship.
Given that parent–adolescent relationship qual-
ity buffers against risks for negative mental
health outcomes, greater refinement in the
conceptualization and assessment of parent–
adolescent relational quality is needed. Using a
664 Family Relations
stress-process and attachment theory lens, the
primary goal was to identify specific dimen-
sions of the parent–adolescent relationship and
examine how these dimensions were associated
with adolescent outcomes among a high-risk
sample. Consistent with extant research (Ge
et al., 2009; Hartos & Power, 2000; Manzi et al.,
2012; Smokowski et al., 2015), we hypothesized
that parent–adolescent relationship quality could
be characterized by four distinct dimensions:
closeness, communication, autonomy, and con-
flict. Additionally, using latent profile analysis
(LPA), we predicted parent–adolescent rela-
tionships exhibiting high closeness, healthy
communication, developmentally appropriate
autonomy, and low conflict would be associated
with low levels of adolescent mental health
symptoms 2 years later.
Method
Procedures and Sample
Procedures. Data were selected from the Lon-
gitudinal Cohort Study, which is a component
of the Project on Human Development in
Chicago Neighborhoods (PHDCN). This multi-
method longitudinal study was supported by the
National Institute of Justice to develop a better
understanding of how individual-, family-, and
community-level factors contribute to delin-
quency, criminal behavior, and mental health
outcomes over time (Earls & Buka, 1997).
Sampling for the PHDCN study began by iden-
tifying 343 ecologically diverse neighborhoods
from Chicago’s population census (Earls &
Buka, 1997). A two-stage sampling design was
then applied to generate a stratified probability
neighborhood sample (Linver, Brooks-Gunn, &
Cabrera, 2004). Racial and ethnic diversity and
socioeconomic status were the two stratification
variables used for randomization to achieve
the aim of recruiting a diverse sample (Earls
& Buka, 1997). Block units were randomly
selected, and caregivers with infants and chil-
dren ages 3, 6, 9, 12, 15, or 18 were eligible
for study inclusion (Earls & Buka, 1997). The
final PHDCN sample included 4,252 youth
and 3,465 caregivers. However, because our
focus was on adolescents, only youth from age
Cohorts 12 and 15 (Wave 1 M age = 13.34,
Wave 2 M age = 15.69) were included in the
analytic sample (N = 498, male = 52.6%). Pri-
mary caregivers were not included in Cohort
18, so they were excluded from the present
study. The overall response rate at Wave 1 was
74.3% for Cohort 12 and 71.6% for Cohort
15 (N = 1,516). The Wave 2 retention rate was
86.2% for Cohort 12 and 82.7% for Cohort 15
(N = 1,282). Trained research assistants con-
ducted in-home interviews, assessments, and
observations of parent–child interactions. We
included assessments from two points, once at
baseline and again 2 years later. Specifically,
the Home Observation for Measurement of the
Environment (Caldwell & Bradley, 1984) was
administered at Wave 1, and the Youth Self
Report (Achenbach, 1991) was administered at
Wave 2.
Sample. Because most of what is empirically
known about parent–adolescent relationships is
derived from nonclinical community samples,
we restricted the PHDCN sample to include
only higher-risk families, which we defined
as involving one or more parent-reported acts
of maltreatment on the prevalence scale of the
Conflict Tactics Scale for Parent and Child
(CTS; Straus, Hamby, Finkelhor, Moore, &
Runyan, 1998). The CTS, which assesses how
parents discipline their children, has generally
moderate levels of internal consistency, and it
has demonstrated evidence of construct and
discriminant validity (Straus et al., 1998). Con-
sistent with past researchers (e.g., Eckenrode
et al., 2000; English et al., 2009), we used the
standard prevalence cutoff score of 1 as an
indicator of the presence of maltreatment (e.g.,
hitting, throwing objects at a family member,
slapping) in the previous year.
The primary caregivers in this study included
biological mothers (85%), biological fathers
(7%), grandmothers (5%), and other family
members (3%). Nearly half (48%) of those
caregivers were married; others were single
(23%), separated (9%), divorced (11%), wid-
owed (5%), or cohabiting (4%). The analytic
sample consisted of 45% African American
caregivers, 41% Latino caregivers, 8% Cau-
casian caregivers, and 6% caregivers of another
ethnicity. Something less than a high school
diploma was the extent of formal education for
44% of primary caregivers, 13% had only a
high school diploma, 36% had attended some
college classes, and 7% had a bachelor’s degree
or more. The majority of caregivers (61%)
reported less than $30,000 in annual household
income.
Parent–Adolescent Relationship Factors 665
Measures
Internalizing and Externalizing Symptoms.
Adolescents completed the Youth Self Report
(YSR; Achenbach, 1991), a widely used
measure of self-reported internalizing and exter-
nalizing mental health symptoms. The reliability
and validity of the YSR subscales have been
well established (Achenbach & Rescorla, 2001),
and the internal consistency of the measures for
the present study was 𝛼 = .71. YSR respondents
are asked to report whether each of 119 items
are not true (0), somewhat or sometimes true
(1), or very true or often true (2) for themselves
over previous 6 months. Example items include
“I lie or cheat,” “I get teased a lot,” “I like to
help others,” and “I have nightmares.” The YSR
includes eight empirically based mental health
syndrome scales (Achenbach, 1991); we used
the depression–anxiety, withdrawal, aggressive
behavior, and delinquent behavior subscales at
Wave 2 as outcome variables.
Parent–Adolescent Relationship. The Home
Observation for Measurement of the Envi-
ronment (HOME; Caldwell & Bradley, 1984)
tool involves a 45- to 90-minute home visit
that includes an interview and observation of
the interactions between adolescents and their
primary caregivers in their natural family envi-
ronment. Response options to the 104 possible
items are yes and no. For example, an observed
item asks if the “PC [primary caregiver] encour-
ages the subject to contribute to the conversation
during the visit.” Interview questions include
whether the caregiver and adolescent talked
about current events, household rules and cur-
fews, and homework in the previous 2 weeks.
The HOME measure was chosen for this analy-
sis because of the strengths and deficits that can
be identified. The HOME was assessed during
Wave 1 (𝛼 = .77). Previous assessments of the
HOME indicated test–retest reliability as stable
over time (r = .94) and interrater agreement
as high as 90% (Caldwell & Bradley, 1984).
For the present study, specific questions were
used to examine dimensions of closeness, com-
munication, autonomy, and conflict. Closeness
involved six observed items assessing whether
the parent exhibited positive emotional behav-
iors toward the adolescent during the visit.
Communication included five observed items
where the observer answered yes if the par-
ent exhibited positive communication practices
toward the adolescent, listened to the adolescent,
or encouraged the adolescent to communicate.
Autonomy consisted of five interview items,
reported by parents, assessing whether they
perceived that they foster or inhibit adolescents’
autonomous behaviors. Last, conflict consisted
of four observed items measuring whether the
parent exhibited conflictual behaviors toward
the adolescent, such as scolding, criticizing, or
putting down. Following factor analysis, items
were summed with high scores representing
higher levels of a given construct.
Analytic Strategy
First, confirmatory factor analysis (CFA) was
conducted to examine the proposed four-factor
model of the parent–adolescent relation-
ship using Mplus 7.3 (Muthén & Muthén,
1998–2012). In the models, weighted least
squares with mean and variance adjusted
(WLSMV) estimation methods were used
instead of the default maximum likelihood
estimation, because the HOME measure used
binary responses, which leads to nonnormal
distributions. The chi-square, root mean square
error of approximation (RMSEA), comparative
fit index (CFI), and Tucker-Lewis Index (TLI)
were used to evaluate model fit; good model
fit was indicated by RMSEA values of .05 or
lower (Kline, 2011), and CFI and TLI values
greater than .90. Finally, a cutoff of .40 was
used to determine good factor loadings of the
four-factor CFA (Kline, 2011).
Next, a latent profile analysis (LPA) was
conducted. LPA is a latent variable modeling
technique that categorizes individuals into mutu-
ally exclusive subgroups based on their patterns
of responses to a set of variables (Roesch,
Villodas, & Villodas, 2010). In the present
study, closeness, communication, autonomy,
and conflict were examined to determine diverse
patterns (i.e., profiles) of parent–adolescent
interactions. Through an iterative process, LPA
tests k number of profiles against k – 1 until
the appropriate number of profiles is identified,
as indicated by a variety of statistical criteria.
Model fit is evaluated on the basis of the Akaike
information criterion (AIC), Bayesian infor-
mation criterion (BIC), sample-size adjusted
BIC (A-BIC), entropy, and the Lo, Mendell,
and Rubin likelihood ratio test (LMRT). Better
model fit is represented by a smaller AIC,
BIC, and A-BIC, as well as higher levels of
entropy and a statistically significant LMRT.
666 Family Relations
Furthermore, the size of each profile should
be at least 4% of the overall sample size. The
final profile structure was determined on the
basis of fit indices and our theoretical under-
standing of parent–adolescent relationships. To
more fully understand profile differences, we
compared mean score differences in closeness,
communication, autonomy, and conflict across
the extracted profiles.
Finally, univariate analyses of variance
(ANOVA) tests and post hoc comparisons using
Bonferroni adjustments were conducted to eval-
uate group differences in outcomes. Specifically,
these analyses enabled us to evaluate how differ-
ent configurations of parent–child relationships
longitudinally predicted adolescent depression,
withdrawal, aggression, and delinquency.
Results
A CFA was conducted to test the first hypoth-
esis that closeness, communication, autonomy,
and conflict would present as distinct dimen-
sions of the parent–adolescent relationship. The
model fit for the four-factor CFA was acceptable
(𝜒2 = 275.35, df = 184, p < .001; RMSEA = .03;
CFI = .97; TLI = .96). Table 1 presents the factor
loadings for each factor, which ranged from .43
to .99. On the basis of this information and our
a priori hypothesis, we utilized the results from
the four-factor model for subsequent analyses.
Next, means, standard deviations, and cor-
relations were examined for each variable
(Table 2). Closeness was statistically associated
with all other factors of the parent–adolescent
relationship and in the expected directions,
and communication and autonomy were neg-
atively associated with conflict. The only two
parent–adolescent relationship factors that
were not statistically associated with each
other was communication and autonomy. There
were a few unanticipated findings regarding
parent–adolescent relationship and depres-
sion, withdrawal, aggression, and delinquency.
Closeness was negatively associated with
aggression and delinquency, but it was not
statistically associated with depression or with-
drawn symptoms. Conflict was statistically
associated with depression and aggression
but not delinquency or withdrawn symptoms.
Autonomy was statistically associated with
depression but not with delinquency, aggres-
sion, or withdrawn symptoms. Communication
Table 1. Summary of Items and Factor Loadings for CFA of
Parent–Adolescent Relationships (N = 498)
Item Closeness Communication Autonomy Conflict
Strengths .87
Praises .91
Endearment .70
Positive .84
Hugs .68
Proud .87
Talk .91
Respond .79
Encouraging .78
Clear .59
Initiative .78
Self-care .71
Emergencies .49
Cleaning .61
Responsibilities .81
Organization .71
Sanctuary .43
Shout .91
Hostility .99
Physical .81
Criticize .91
was not statistically associated with any of the
outcome variables.
Next, a series of LPAs was conducted to
examine parent–adolescent relationship profiles.
Table 3 summarizes the model fit indices used
to evaluate the profiles. Comparing model fit
indices of the two-, three-, four-, and five-profile
models, the four-profile model was selected as
the best-fitting model. Each profile size in the
four-profile model was adequate for analysis.
Average latent class probabilities for most likely
latent class membership suggested that more
than 87% of the members in the any of the four
profiles were accurately classified.
The four parent–adolescent profiles were
examined on the basis of group characteristics
and classified as secure, avoidant, anxious,
and detached. One-way ANOVA tests were
conducted to examine whether mean closeness,
conflict, autonomy, and communication scores
statistically differed across profiles (Table 4).
Using Bonferroni adjustments, the secure profile
(n = 373) exhibited more closeness, commu-
nication, and autonomy and less conflict than
all other groups. The anxious profile (n = 22)
exhibited more closeness, autonomy, and
conflict than did the avoidant profile (n = 54).
Last, the detached profile (n = 49) was statisti-
cally different from the secure profile in terms
Parent–Adolescent Relationship Factors 667
Table 2. Means, Standard Deviations, and Intercorrelations for Study Variables (N = 498)
Variables M SD 1 2 3 4 5 6 7 8
1. Closeness 3.70 1.75 —
2. Communication 4.38 1.04 .52∗∗ —
3. Autonomy 5.71 0.63 .14∗∗ .08 —
4. Conflict 0.31 0.85 −.17∗∗ −.09∗ −.12∗ —
5. Depression 5.77 4.61 −.06 −.03 −.12∗ .12∗ —
6. Withdrawn 2.77 2.06 −.03 .01 −.03 .05 .64∗∗ —
7. Aggression 6.37 3.80 −.12∗∗ −.02 .07 .11∗ .43∗∗ .33∗∗ —
8. Delinquency 3.65 2.46 −.19∗∗ −.09 −.01 .06 .33∗∗ .22∗∗ .57∗ —
∗p < .05, ∗∗p < .01.
Table 3. Fit Indices for Latent Profile Models
Profiles
First Second Third Fourth Fifth
Model AIC BIC A-BIC Entropy LRT n % n % n % n % n %
2 profile 4836.82 4891.56 4850.30 .98 p < .01 457 91.8 41 8.2
3 profile 4413.72 44890.51 4432.38 .98 p = .03 419 84.3 56 11.4 22 4.4
4 profile 4222.05 4318.90 4245.90 .95 p = .04 54 10.9 49 9.8 373 75.0 22 4.4
5 profile 3650.24 3768.14 3679.26 .94 p = .27 35 7.1 48 9.6 372 74.8 28 5.7 15 2.9
Note. AIC = Akaike information criterion; BIC = Bayesian information criterion; A-BIC = sample-size adjusted BIC;
LRT = Lo-Mendell-Rubin likelihood ratio test.
of closeness, communication, and autonomy.
Compared to avoidant and anxious profiles,
the detached profile exhibited lower amounts
of closeness, communication, and conflict.
According to Cohen’s (1988) guidelines for
small, medium, and large effect sizes of f = .10,
f = .25, and f = .40, respectively, the differences
between groups in terms of the dimensions of
parent–adolescent relationship correspond to
medium effects.
Finally, one-way ANOVA tests were con-
ducted to examine whether mean differences in
adolescent outcomes differed 2 years later on the
basis of profile membership; results indicated
that there were statistical differences in longitu-
dinal outcomes for depression, aggression, and
delinquency (Table 5). Specifically, using Bon-
ferroni adjustments and in all cases compared
to the secure profile, 2 years later (a) depres-
sion was statistically higher in the avoidant
and anxious profiles, (b) aggressive symptoms
were statistically higher in the avoidant profile,
and (c) delinquency was statistically higher
in the detached profile. Using Cohen’s (1988)
guidelines, the magnitudes of these differences
were medium.
Discussion
Parent–adolescent relationships are complex.
Despite their complexity, researchers tend to
focus on parent–adolescent relationship quality
without identifying features that distinguish
higher-quality from lower-quality relationships.
This study advances the literature by examining
multiple dimensions of the …
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The ability to view ourselves from an unbiased perspective allows us to critically assess our personal strengths and weaknesses. This is an important step in the process of finding the right resources for our personal learning style. Ego and pride can be
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While you must form your answers to the questions below from our assigned reading material
CliftonLarsonAllen LLP (2013)
5 The family dynamic is awkward at first since the most outgoing and straight forward person in the family in Linda
Urien
The most important benefit of my statistical analysis would be the accuracy with which I interpret the data. The greatest obstacle
From a similar but larger point of view
4 In order to get the entire family to come back for another session I would suggest coming in on a day the restaurant is not open
When seeking to identify a patient’s health condition
After viewing the you tube videos on prayer
Your paper must be at least two pages in length (not counting the title and reference pages)
The word assimilate is negative to me. I believe everyone should learn about a country that they are going to live in. It doesnt mean that they have to believe that everything in America is better than where they came from. It means that they care enough
Data collection
Single Subject Chris is a social worker in a geriatric case management program located in a midsize Northeastern town. She has an MSW and is part of a team of case managers that likes to continuously improve on its practice. The team is currently using an
I would start off with Linda on repeating her options for the child and going over what she is feeling with each option. I would want to find out what she is afraid of. I would avoid asking her any “why” questions because I want her to be in the here an
Summarize the advantages and disadvantages of using an Internet site as means of collecting data for psychological research (Comp 2.1) 25.0\% Summarization of the advantages and disadvantages of using an Internet site as means of collecting data for psych
Identify the type of research used in a chosen study
Compose a 1
Optics
effect relationship becomes more difficult—as the researcher cannot enact total control of another person even in an experimental environment. Social workers serve clients in highly complex real-world environments. Clients often implement recommended inte
I think knowing more about you will allow you to be able to choose the right resources
Be 4 pages in length
soft MB-920 dumps review and documentation and high-quality listing pdf MB-920 braindumps also recommended and approved by Microsoft experts. The practical test
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One thing you will need to do in college is learn how to find and use references. References support your ideas. College-level work must be supported by research. You are expected to do that for this paper. You will research
Elaborate on any potential confounds or ethical concerns while participating in the psychological study 20.0\% Elaboration on any potential confounds or ethical concerns while participating in the psychological study is missing. Elaboration on any potenti
3 The first thing I would do in the family’s first session is develop a genogram of the family to get an idea of all the individuals who play a major role in Linda’s life. After establishing where each member is in relation to the family
A Health in All Policies approach
Note: The requirements outlined below correspond to the grading criteria in the scoring guide. At a minimum
Chen
Read Connecting Communities and Complexity: A Case Study in Creating the Conditions for Transformational Change
Read Reflections on Cultural Humility
Read A Basic Guide to ABCD Community Organizing
Use the bolded black section and sub-section titles below to organize your paper. For each section
Losinski forwarded the article on a priority basis to Mary Scott
Losinksi wanted details on use of the ED at CGH. He asked the administrative resident