Autism is the fastest growing serious developmental disability in the United States and more children will be diagnosed with autism this year than with AIDS, diabetes, and cancer combined (Autism Speaks, 2013). Supporting and caring for the child with autism can be devastating socially and emotionally for the families (Neely, Amatea, Doan, & Tannen, 2012). The purpose of this study is to investigate the changes in the life of families that have a child diagnosed with autism. Four families were interviewed in this qualitative study and each was from East Tennessee. These different families were led by a mother and father, a grandmother, and two divorced mothers. Through this research, I learned how each family was impacted by autism. Autism dramatically affected each family and each was impacted in many different aspects of life.

Many adults suffering from mental health problems often report that the onset of these concerns began in adolescence, highlighting the importance of identifying and treating mental health concerns from an early age. In high schools, some students are identified as having externalizing or internalizing disorders. The majority of these students, especially those with internalizing symptoms, go untreated. One potential reason may be that limited school resources are used to correct behavior problems, leaving those with internalizing disorders to silently suffer, which often exacerbates the issues. Recent research suggests many individuals have high levels of resilience which can be taught, and which positively contributes to mental health. Social emotional learning (SEL) is one approach to teaching resilience. In this study we implemented an SEL program called Strong Teens at the high school level. The high school identified students with internalizing symptoms and provided them with this curriculum, intended to reduce those symptoms. We used a time series design to evaluate changes in internalizing symptoms (e.g., depression, anxiety, and withdrawal) and resilience. Results indicated that with the implementation of the Strong Teens curriculum, student levels of internalizing symptoms decreased from pretest to posttest, according to self-report. Teacher reports did not indicate any significant change in internalizing symptoms or resilience. This study supports the findings o fthe Strong Teens curriculum as a generalizable program which significantly reduces internalizing symptoms.

Cigarette smoking and depressive symptoms are two problems that affect adolescents’ health. Although it has been well-documented that a relationship exists between these two concerns, most researchers have used self-report methods to study smoking behaviors. While adolescents are typically accurate when reporting depressive symptoms, they tend to be less accurate reporting smoking. Moreover, research supporting the Prototype Willingness Model (PWM) has shown that the social cognitions of willingness to smoke, and the prototypes or images of smokers are predictors of smoking in adolescents. Little is known about the association between social cognitions and depressive symptoms in adolescence. In this study, I examined the relationship between cigarette smoking and depressive symptoms in high school students using a biological measure of cigarette smoking. First, I investigated whether depressive symptoms and cigarette smoking were related in a sample of 440 high school sophomore students from Iowa. Then, using data from 264 of the same participants, I examined whether smoking during or before the sophomore year of high school predicted depressive symptoms a year later when participants were in their junior year of high school. Conversely, I also examined whether depressive symptoms during the sophomore year of high school predicted cigarette smoking in the junior year of high school. Finally, I studied the relationship between social cognitions (i.e., prototypes and willingness) and depressive symptoms. An additional section explored whether the social cognitions predicted cigarette smoking. The findings did not provide evidence supporting a relationship between cigarette smoking and depressive symptoms when smoking was measured by a biological measure. Only self-report of smoking cigarettes significantly predicted depressive symptoms during the sophomore year of high school. Cigarette smoking during or before the sophomore year of high school did not predict depressive symptoms a year later. Similarly, depressive symptoms reported in the sophomore year of high school did not predict cigarette smoking a year later. For the social cognitions, willingness to engage in smoking behaviors and the prototypes or images adolescents have about teenagers who smoke were significantly associated with depressive symptoms. Only willingness to engage in smoking behaviors was a significant predictor of cigarette smoking. These results support the idea that the relationship between depressive symptoms and cigarette smoking varies when using different methodologies to assess smoking status. Also, the finding that social cognitions correlates with depressive symptoms could motivate further investigation. This work can also alert adults about other ways in which elevated depressive symptoms in adolescents may influence their perceptions.

Internalizing disorders cause serious psychological problems for many adolescents. The effects can be both debilitating and long lasting. However, assessment of internalizing disorders has been plagued by limited measurement strategies. Historically, individual measures were developed to assess the narrow-band symptoms that are subsumed under the broad construct of internalizing disorders (e.g., depression, anxiety, somatic complaints, and social withdrawal). Recently, the Internalizing Symptom Scale for Adolescents has been created. The Internalizing Symptom Scale for Adolescents is a short screening measure that includes newer models of affect such as the tripartite model of affect. Additionally, there has been limited research on the relationship between self-concept and internalizing disorders. Although the inverse relationship between depression and self-concept is well documented, the relationship between self-concept and other internalizing syndromes is essentially unknown. The present study addressed the underlying factor structure of the Internalizing Symptom Scale for Adolescents. A factor analysis using principal axis extraction with varimax rotation was conducted. A two-factor solution was identified as superior to any other factor solution considered. The two factors accounted for 34.2% of the total variance in the Internalizing Symptom Scale for Adolescents scores and were identified as Factor 1, Negative Affect/General Distress and Factor 2, Positive Affect. The two-factor solution of the Internalizing Symptom Scale for Adolescents provided some support for Watson and Clark's tripartite model of affectivity. The present study also considered the relationship between the Internalizing Symptom Scale for Adolescents and the Multidimensional Self-Concept Scale. Bivariate correlations were run to evaluate the relationship between internalizing symptoms and self-concept. The correlations ranged from moderate to large (-.42 to -.78) and were inversely related as expected. Multiple regression analyses were conducted to determine if the Multidimensional Self-Concept Scale subscales could predict internalizing symptoms. The combined predictors accounted for 62% of the variance in the Internalizing Symptom Scale for Adolescents. These findings indicate that self-concept is a robust predictor for internalizing disorders. The study provides evidence for the use of the Internalizing Symptom Scale for Adolescents a s a pscyhometrically sound measure for assessing internalizing disorders in adolescents. Implications of this study for clinical practice and directions for future research are discussed.

<p>Motivation deficits remain an unmet treatment need in schizophrenia. Recent preclinical research has identified novel mechanisms underlying motivation deficits, namely impaired effort-cost computations and reduced future reward-value representation maintenance, that may serve as more effective treatment targets to improve motivation. The main aim of this study was to test the feasibility and preliminary effectiveness of a translational mechanism-based intervention, MEMS (Mobile Enhancement of Motivation in Schizophrenia), which leverages mobile technology to target these mechanisms with text-messages. Fifty-six participants with a schizophrenia-spectrum disorder were randomized to MEMS (<i>n</i> = 27) or a control condition (<i>n</i> = 29). All participants set recovery goals to complete over eight-weeks. The MEMS group also received personalized, interactive text-messages each weekday to support motivation. Retention and engagement in MEMS was high: 92.6% completed 8 weeks of MEMS, with an 86.1% text-message response rate, and 100% reported that they were satisfied with the text-messages. Compared to the control condition, the MEMS group had significantly greater improvements in interviewer-rated motivation and anticipatory pleasure and obtained significantly more recovery-oriented goals at the end of the 8-week period. There were no significant group differences in performance-based effort-cost computations and future reward-value representations, self-reported motivation, quality of life, functioning, or additional secondary outcomes of positive symptoms, mood symptoms, or neurocognition. Results suggest that MEMS is feasible as a relatively brief, low-intensity mobile intervention that could effectively improve interviewer-rated motivation, anticipatory pleasure, and recovery goal attainment in those with schizophrenia-spectrum disorders. </p>

The project examines hypermasculine attitudes and depressive symptoms in emerging adult males. Recent research has suggested that although males have historically reported lower rates of depressive symptoms than females (Boticello, 2009), emerging adulthood may be a time when males are at an increased risk of developing depressive symptoms due to fear of failing to fulfill traditional masculine roles (e.g., breadwinner) and failure to achieve intimate romantic partnerships as a result (Oliffe et al., 2010). Some males may attempt to cope with these negative feelings by adopting maladaptive and exaggerated hypermasculine attitudes. Hypermasculine attitudes are associated with a variety of negative outcomes including violence toward women and substance abuse (Mosher & Sirkin, 1984). Substance use is also associated with depressive symptoms as a form of self-medication (Joiner et al., 1992) and masculinity in the college social context (Iwamoto et al., 2011). Hypermasculinity was originally conceptualized as a personality trait, but more recent research has examined it as a reactive coping strategy (Cunningham & Meunier, 2004). Furthermore, there is also evidence that hypermasculine attitudes may be more multidimensional and that different profiles of hypermasculine attitudes may be associated with different behavioral and psychological outcomes (Burke, Burkhart, & Sikorski, 2004). 328 males ages 18-25 who attend college completed the survey. The results do not support the hypothesized profile of hypermasculine attitudes. However, analysis of demographic characteristics did yield one large homogeneous cluster (n =213) for whom hypermasculine attitudes may be serving as a reactive coping strategy for depressive symptoms, and another large heterogeneous cluster (n = 115) for whom hypermasculine attitudes may not be serving as a coping strategy for depressive symptoms. / acase@tulane.edu

Apathy, defined as a decrease in purposeful or goal-directed behavior, is common in many neurological disorders. The assessment of apathy in these disorders is important as apathy is associated with differential engagement and response to treatment and future cognitive and functional decline. Although apathy is often described as including three separate symptom dimensions, reflecting diminished interest, action, and emotional expression, investigations of the factor structure of apathy symptoms have been limited by the use of scales which do not comprehensively assess all of three of the proposed dimensions. The current study aimed to develop a novel informant report measure of apathy symptoms, investigate the factor structure of apathy symptoms, and examine the relationship of different types of apathy symptoms to several clinically relevant variables. Participants included 249 informants who reported on an individual with (n=210) or without (n=39) a neurological or psychiatric condition. Results showed the best fitting model of apathy symptoms was a bifactor model in which apathy could be represented as a global dimension with three separate, specific symptom factors reflecting diminished interest and initiative, asociality, and diminished emotional and verbal expression. In general, apathy was associated with poorer cognitive functioning, greater functional impairment, and higher caregiver distress. The specific symptom factors differed somewhat in their association with those same variables, highlighting the utility of measuring different types of symptoms in addition to overall apathy. Future work will refine the apathy measure developed in this study and test the obtained bifactor symptom model in an independent sample.

To date, the most common pharmacological treatments for dementia are cholinesterase inhibitors and N-methyl-D-aspartate receptor antagonists (antidementia medications), which are associated with a delay in the progression of the cognitive and functional symptoms. Studies of the effects of antidementia medications on neuropsychological symptoms (NPS) show varying results. Presence of NPS can also affect the amount of time caregivers spend with persons with dementia, which can affect informal costs of the condition. This project used extant data from the longitudinal, population-based Cache County Study on Memory and Aging (CCSMA) and the Dementia Progression Study (DPS), which included permanent residents aged ≥ 65 of Cache County, Utah. Linear mixed models were used to assess the association between antidementia medications with informal costs and NPS. The first study examined whether antidementia medications were associated with a decrease in informal costs. Use of antidementia medications was not significantly associated with informal costs (expβ = .79, p = .090). When restricting the sample to only the participants who were of mild dementia severity at baseline, antidementia medications were associated with a 28% decrease in informal costs (expβ = .72, p = .039). The second study evaluated whether antidementia medications were associated with a decrease in NPS. Results indicated that use of antidementia medications was associated with a 28% increase in NPS (expβ = 1.28, p < .001). However, this association was no longer significant with the inclusion of covariates, in particular, the use of psychotropic medications. Use of any psychotropic medication was significantly associated with a 30% increase in Neuropsychiatric Inventory (NPI) score. Overall, the use of antidementia medications may not significantly reduce informal costs or NPS. The use of antidementia medications may reflect patterns of use that are prompted by severity of dementia and NPS.

Native American youth often experience high rates of environmental risk factors that may put them at increased risk for developing psychological problems, yet research within this high-risk population is severely limited. The present study was designed to provide information on the rate of psychological symptoms in a sample of Native American youth, and evaluate the impact of environmental factors (risk, protective, and cultural) on psychological disorder symptoms over time. Data were collected with a sample of Native American youth using the Youth Self Report, the Substance Abuse Subtle Screening Inventory-Adolescent 2, and a researcher-designed Biodemographic Questionnaire. Findings indicate that clinically significant levels of depression and anxiety from the Native American adolescent sample were similar to levels found in the general population of adolescents, while clinically significant levels of conduct disorder and substance use disorders were higher than rates found in the general population. Findings with respect to the impact of environmental factors indicate that higher scores on the overall risk index were associated with higher levels of all four psychological disorder symptom scales. However, high scores on the protective index were associated with lower levels of depression and conduct disorder symptoms but unrelated to anxiety and substance use. The overall cultural index was unrelated to all four psychological symptom scales. When subscales were examined, only the risk subscales were related to psychological disorder symptoms. Results from the longitudinal analysis indicated that the risk, protective, and cultural index scores at Time 1, as a group, were predictive of anxiety, conduct disorder, and substance symptoms at Time 2, but unrelated to Time 2 depression scores. However, individually, the three index scores were generally not predictive of psychological symptoms with the exception of a positive association between Time 1 risk index scores and substance symptoms at a later date.

Although a vast literature attests to the belief that psychosocial disturbance is an important component of functional gastrointestinal disorders (FGID), the relation of life stress, psychological distress and personality to the development of these disorders is poorly understood. The broad objective of this thesis is to provide data on relations between psychosocial factors and FGID, especially irritable bowel syndrome (IBS) and functional dyspepsia (FD), in representative outpatient samples. Issues not previously addressed are examined in a series of studies. The first two studies are concerned with relations between psychosocial factors, extraintestinal (somatic) symptoms and the number and type of FGID syndromes present at consultation and, in IBS patients, the prospective relation of psychosocial factors to changes in symptom intensity over 16 months. The last three studies relate psychosocial factors to gastrointestinal (GI) transit, motor, and sensory function in FGID, abnormalities in these parameters representing the putative origin of symptoms in FGID. In total, 350 patients participated, representing a 95% participation rate. Important features of the methodology include the use of a recently standardised symptom-based classification system for FGID, an objective and reliable interview-based life stress instrument (The Life Events and Difficulties Schedule), and sophisticated and sensitive technologies to assess GI transit, motor and sensory function. Novel measures, which conceptually take into account the chronic, fluctuating and recurrent course of IBS and FD syndromes, and the tendency of these syndromes to coexist, are also included. Thus, measures of symptom outcome assess the number of syndromes present, while the symptom intensity variable reflects the severity and frequency of both FD and IBS symptoms, if both are present. Similarly, with respect to altered transit, and motor and sensory function, physiological outcome variables reflect not only the presence of an abnormality but the number of regions affected, and the type and number of abnormalities present. Cross-sectional findings showed for the first time that psychosocial disturbance is associated with FGID symptomatology in a quantitative manner, that chronic life stress threat is central to this process and this stress-related process is a prominent feature of a particular group of syndromes (ie IBS/FD) defined primarily by the presence of pain and discomfort. A combination of psychological, social and biological factors combined to predict the number of FGID syndromes present at entry into the study. Prominent among them was an angry, reactive and anxious (neurotic) personality, chronic life stress threat, increased coping, poor emotional support and increased age. In addition to a greater number of FD/IBS syndromes, individuals with an anger-reactive response style had experienced more intense pain and discomfort, and displayed more complete sensorimotor disturbance. Longitudinal data demonstrated (also for the first time) the strength, consistency and unequivocal direction of the relation of chronic threat to symptom intensity over time. Almost all of the within subject variance in symptom intensity levels (assessed on 3 occasions over a 16 month period) was explained by the severity of chronic threat during the previous 6 months or more. For 76% of IBS patients, the presence vs the absence of one or more highly threatening chronic stressors predicted with considerable precision, the long-term clinical outcome. Thus, no patient exposed to even one such stressor improved clinically (ie by at least 50%) over the follow-up period, while in contrast, all patients who improved clinically did so in the absence of such a stressor. For 24% of patients, however, failure to improve clinically could not be explained by any psychological, social (including life stress) or demographic factor included in this study. Key risk indicators of a poor outcome at 16 months were identified - chronic life stress threat, the severity of baseline GI symptomatology, and female gender. Life stress is important because it alone determined the magnitude and direction of change in symptom intensity over time, while the severity of baseline GI symptomatology revealed the extent of improvement required to achieve a recovery, and female gender predicted the presence of a larger number of FD/IBS syndromes in women long-term. Widespread hypomotility, which was almost exclusive to women in this study, represents one factor that may inhibit improvement (or rate of improvement) for women over time. Finally, these findings have identified a psychophysiological subgroup, with underlying psychosocial, motor (and perhaps also sensory) dysfunctions that are more specific for women than men, and which does not seem to be distinctive of any particular FGID subgroup.