In ‘Treating Adolescents Differently’, Skelton, Black, and Forsberg develop their wellbeing-based justification of the asymmetrical treatment of adolescent consent and refusal in the context of health care to justify the differential and paternalistic treatment of adolescents more generally. The core of the Skelton, Black, and Forsberg’s view is a variabilist theory of what is fundamentally and non-instrumentally prudentially good for adolescents, which includes the prudential value of what they call shielding—or the value of being insulated from full (...) responsibility for their choices. This theory of wellbeing, they argue, explains why adolescents may be treated differential and paternalistically in numerous domains. It is good for them to be shielded because it allows for a variety of freedom from making certain kinds of decisions in the absence of a safety net provided by others in supportive and caring relationships. Skelton, Black, and Forsberg argue that their account of the justification of differential and paternalistic treatment of adolescents has attractive implications for a range of cases and holds up well in the face of philosophical criticism. (shrink)

Participation in sports such as football puts youth athletes at high risk of injury. helmets cannot protect players from the possibility of traumatic brain injury, and repeated concussive injuries can lead to chronic traumatic encephalopathy later in life. in light of such facts, the morally appropriate role of physicians who treat patient-athletes comes into question. i argue that pediatricians ought to be committed to a high level of shared decision making, whereby their goal, rather than being to provide the medically (...) best advice (which, let’s be honest, would be to not play football at all), would be to provide the medically best advice in light of patients’ honestly professed plans and goals. if patient-athletes see their doctor as an ally, who wants them on the field as much as they want to be there, they will be more likely to trust their pediatrician to help in the realization of those goals, even if they report an injury. while this approach could feel like a medical betrayal, in that the physician could feel complicit in helping a patient to continue engaging in high-risk behavior, i argue that medical outcomes will be better than if patientathletes see physicians as an obstruction to their athletic goals. (shrink)

The present study examined British children’s and adolescents’ individual and perceived group evaluations of a challenger when a member of one’s own group excludes a British national or an immigrant newcomer to the school from participating in a group activity. Participants included British children and adolescents, who were inducted into their group and heard hypothetical scenarios in which a member of their own group expressed a desire to exclude the newcomer from joining their activity. Subsequently, participants (...) heard that another member of the ingroup challenged the exclusionary act by stating that they should be inclusive. Children’s and adolescents’ individual evaluations of the bystander who challenged the social exclusion of an immigrant peer were more positive than their perceived group evaluations, recognizing that groups are often exclusionary. Only adolescents but not children differed in their individual and perceived group evaluations in the social exclusion of British peers. When the newcomer was an immigrant peer, adolescents were more likely to evaluate the challenger positively in both their individual and perceived group evaluations compared to children. Further, children, compared to adolescents, were more likely to reason about social and group norms to justify their evaluations only when the excluded peer was an immigrant but not when the excluded peer was British. Adolescents were more likely to reason about fairness, rights, and equality. The findings indicate that exclusionary group norms surrounding immigrants begin in childhood. Interventions that focus on changing group norms to be more inclusive could be effective in reducing prejudicial attitudes toward immigrants in childhood. (shrink)

Background: Adolescents can be vulnerable to diminished dignity in the hospital because young people have significantly different healthcare needs than children and adults. They like to cooperate with caregivers only when they get respectful and dignified care. Care without considering dignity can adversely influence the adolescents’ recovery. However, many studies have been conducted on exploring the concept of the patients’ dignity from the adult patients and fewer studies still have explored the dignity of young people. Objective: This (...) study explores the hospitalized adolescents’ perception about dignity. Research design: A conventional qualitative content analysis method was used to explore the meaning of hospitalized adolescents’ dignity. Participants and research context: Hospitalized adolescents in general medical and surgical pediatric units were eligible to participate. Data were obtained through unstructured interviews. Purposive sampling was used and adolescents were recruited until data saturation was reached (n = 13). Ethical considerations: Ethical approval for the study was granted by the Ethics Committee of Shiraz University of Medical Sciences. Participants were provided with information about the purpose, reasons for recording interviews, voluntary participation, and confidentiality of data and interviewees. Findings: Dignity was reflected in four themes: (1) protection of personal privacy, (2) protection of autonomy, (3) respect for identity, and (4) intimate communication. Discussion and conclusion: Hospitalized adolescents stated that healthcare services should protect their personal privacy and autonomy. Also, they should respect the adolescent’s identity and communicate intimately with them to provide the dignity. Adolescence is a discrete developmental stage, with specific healthcare needs which must be addressed effectively by healthcare providers especially nurses. (shrink)

ObjectiveMisophonia is an unusually strong aversion to a specific class of sounds – most often human bodily sounds such as chewing, crunching, or breathing. A number of studies have emerged in the last 10 years examining misophonia in adults, but little is known about the impact of the condition in children. Here we set out to investigate the well-being profile of children with misophonia, while also presenting the first validated misophonia questionnaire for children.Materials and MethodsWe screened 142 (...) children using our novel diagnostic [the Sussex Misophonia Scale for Adolescents ]. This allowed us to identify a group of children already manifesting misophonia at that age – the first population-sampled cohort of child misophonics examined to date. Children and their parents also completed measures of well-being and creative self-construct.ResultsData show that children with misophonia have significantly elevated levels of anxiety and obsessive compulsive traits. Additionally children with misophonia have significantly poorer life-satisfaction, and health-related quality of life. As predicted, they show no differences in creative self-construct.ConclusionTogether our data suggest the first evidence in population sampling of poorer life outcomes for children with misophonia, and provide preliminary convergent and discriminant validation for our novel misophonia instrument. Our data suggest a need for greater recognition and therapeutic outlets for adolescents with misophonia. (shrink)

Different opinions are expressed in the literature regarding when children and adolescents can start to make decisions to participate in research and give informed consent. Nurses are frequently involved in research, either as investigators or caregivers, and must therefore have a thorough understanding of consent and related issues. In this article the issues are explored from a Canadian perspective. The argument is put forward that adolescents may be capable of a greater involvement in the research consent process (...) than is the norm. Increasing adolescents’ involvement in research has the potential to enhance their growing autonomy and capabilities. Adolescents appreciate being treated with respect and dignity by adults. This can be achieved in an environment in which protection from harm does not also mean prevention from decision making. The use of empowering processes by nurses to enhance adolescent involvement will provide benefit to adolescents in their transition to adult levels of responsibility. (shrink)

This study explores the ways in which adolescents, even so-called “mature minors”, lack adequate development of the intellectual, affective, and emotional capacities necessary morally to consent to medical research on their own behalf. The psychological and neurophysiological data regarding brain maturation supports the conclusion that adolescents are qualitatively different types of agents than mature adults. They lack full adult maturity and personal agency. As a result, in addition to the usual requirements for IRB approval, one or both parents, (...) or a legal guardian, should provide informed consent for minor children to participate in medical research. (shrink)

Developmental Task Attainment in Adolescents from Families with a Recovering Alcoholic or Active Alcoholic Father The problem under consideration is the issue of adolescent developmental tasks in families with alcohol-related problems, especially in families which contain one or more treated alcoholics. In the present work it was hypothesised that the treatment of alcoholic fathers would be one of the more important protective factors in families coping with alcoholism. The participants of the study included 91 children, aged 17-18. The (...) research sample was comprised of three groups: 31 children of active alcoholics, 30 children of treated alcoholics, and 30 children of non-alcoholic parents. In general, the results of the study highlight the roles of temperament and parenting practices in the progress of developmental tasks. The data revealed that family characteristics were correlated to the predictors of these tasks. The groups used in the study were differed according to the factors of their developmental tasks. (shrink)

‘Teachers expect parents to teach you. Parents expect teachers to teach you. So actually you learn nothing and nobody wants to talk about it’. This quote from this research study is an adolescent girls’ cry for liberation from the silence related to sexuality because of the general reluctance of adults to talk to them about it. Given the growing concerns raised about the sexual and reproductive health of adolescents in South Africa, the aim of this study was to conduct (...) research with adolescent girls as subjects in order for girls’ voices to enhance adult researchers’ understanding of children’s need for support and guidance in the context of sexuality education. The purposively selected sample included 75 participants from three diverse high schools in the Western Cape. The research was conducted using a phenomenological approach that values the lived experiences of participants as significant in contributing to the knowledge on adolescent sexuality. A qualitative interpretative research design was applied to collect the data. This article argues that adults cannot help adolescents in their sexual emancipation – to be free – if they themselves are not free. If they were free, they would have been able and willing to engage with adolescents in every aspect, which includes their sexuality. Including adolescent girls as partners in transforming sexuality education is presented as a core principle for the sexual emancipation of both adolescent girls and adults. (shrink)

Background Seeking assent from children for participation in medical research is an ethical imperative of numerous institutions globally. However, none of these organizations provide specific guidance on the criteria or process to be used when obtaining assent. The primary objective of this scoping review was to determine the descriptions of assent discussed in the literature and the reported criteria used for seeking assent for research participation in pre-adolescent children. Methods Medline and Embase databases were searched until November 2020 (...) using the term “assent” in the title or abstract. Inclusion criteria were (1) studies enrolling children which specifically described operationalization of the assent process and (2) studies of the assent process which provided a description of assent. Data collected included participant information, patient criteria for seeking assent, guidelines referenced, description of assent reported, how assent was obtained and assent information presented, and reported assent rate. For qualitative articles focusing on the assent process, important themes were identified. Results A total of 116 articles were included of which 79 (68.9%) operationalized assent and 57 studies (%) described the assent process. The most commonly reported criterion used to determine the ability of a child to assent was age (35.4%, 28/79). The reported minimal age for obtaining pediatric assent varied considerably across and within jurisdictions (5–13 years; median 7.5 years, IQR 7.0, 9.75). Cognitive ability was reported as a criterion for obtaining assent in 5.1% (4/79) of studies. Assent rates were only reported in 17.7% (14/79) of citations and ranged from 32.0 to 100%. Analysis of the 57 studies describing the assent process identified several themes, including age thresholds, assessment of capacity, variable knowledge of pediatric assent and parental roles. Conclusion We found significant variation in criteria used for assessment of patient capacity, delivery of information used to obtain assent and documentation of the assent process. While we acknowledge that individual children, settings and jurisdictions may require different approaches to obtaining assent, there should be agreement on important principles to be followed with resulting common guidance on assessing capacity, delivering information and documentation of the assent process for publication. (shrink)

Aim:The purpose of this study was to explore how adolescent patients displaying developmental trauma experience and describe meaning in life. Schnell’s model of meaning in life is applied to explore meaningfulness, crises of meaning and sources of meaning. Method: The study has a qualitative design based on individual interviews with eight adolescents aged 14–18 years in treatment in an outpatient clinic for mental health care for children and adolescents. The interviews were transcribed and analyzed using systematic text (...) condensation. Results: The adolescents related meaning in life to the experience of coherence, intrinsic values, progress and belonging, or the absence of these. Examples of sources of meaning among the informants were positive relations with meaningful others, structure and routines, moments of well-being, achieving goals related to education, work and family, and seeking something else outside oneself such as playing computer games, being engaged in politics, being with animals, having a belief in a god or being outdoors in natural surroundings. Conclusion: Although the topic of meaning in life was unknown to this group, they used sources of meaning intuitively. This group seems to have similar preferences to the general population. More knowledge is needed on how the topic of meaning in life can be useful in therapy for adolescents with development trauma. (shrink)

Growth of different body parts in humans is sensitive to different resource constraints that are mediated by parental investment. Parental investment can involve the expenditure of material, cognitive, and emotional resources on offspring. Cranial volume, an important predictor of cognitive ability, appears understudied in this context. We asked whether there are associations between growth and family structure, self-reported estimates for resource availability, and sibling number; and whether these constraints relate to head and body growth in a similar manner. We assessed (...) the associations between parental investment, height, and cranial volume in a cross-sectional study of Estonian children. Height correlated negatively with the number of siblings but this association became negligible in a model controlling for birthweight, parental heights, and mother’s age at birth. Unlike height, cranial volume was unrelated to sibling number, but it was negatively associated with self-reported meat and general resource shortage. Cranial volume was related to family structure and paternal education. Children living with both birth-parents had larger heads than those living in families containing a step-parent. Since these family types did not differ with respect to meat or general resource shortage, our findings suggest that families including both genetic parents provide non-material benefits that stimulate predominantly cranial growth. For the studied developmental period, cranial volume appeared a more sensitive marker of growth constraints than height. The potential of using cranial volume for quantifying physical impact of non-material parental investment deserves further attention. (shrink)

Adolescence is a period of life during which peers play a pivotal role in decision-making. The narrative of social influence during adolescence often revolves around risky and maladaptive decisions, like driving under the influence, and using illegal substances. However, research has also shown that social influence can lead to increased prosocial behaviors and a reduction in risk-taking. While many studies support the notion that adolescents are more sensitive to peer influence than children or adults, the developmental processes that (...) underlie this sensitivity remain poorly understood. We argue that one important reason for this lack of understanding is the absence of precisely formulated models. To make a first step toward formal models of social influence during adolescence, we first identify three prominent verbal models of social influence in the literature: social motivation, reward sensitivity, and distraction. We then illustrate how these can be translated into formal models, and how such formal models can inform experimental design and help identify developmental processes. Finally, by applying our formal models to existing datasets, we demonstrate the usefulness of formalization by synthesizing different studies with seemingly disparate results. We conclude with a discussion on how formal modeling can be utilized to better investigate the development of peer influence in adolescence. (shrink)

An adolescent’s last moment of life is an emotionally and medically complex time. Children may grapple with understanding the things happening to them and with grief of a future lost; caregivers struggle to simultaneously balance deep sorrow, hope, and love; and healthcare providers fight to maintain sound medical and ethical decision making. Increased discussion regarding adolescent end-of-life care is needed so that clinicians may better understand how to engage in ethically based medical management during these events. This holds particularly (...) true in situations where potentially conflicting ideas exist between clinicians and family members. We describe the case of an acutely and terminally ill adolescent who remained cognitively intact but with rapidly advancing multiple organ failure and whose parents requested that he remain uninformed of his critical illness and prognosis. (shrink)

Reports of children participating in hunger strikes while detained in offshore detention centres raise interrelated ethical issues and recognizable challenges for the medical decision-makers at these sites. A composite case study, informed by reports in the public domain, is employed to explore the unique challenges of consent and decision-making in these circumstances and the perennial issues inherent in adolescents’ developing capacity and autonomy. We present an amalgamated case of a fourteen-year-old adolescent who refused to consent to medical reversal (...) of her hunger strike protest. The medical team became the final arbiter when her parents, who were also in detention, could not agree with each other even after mediation. The case explores the complexity of evaluating the adolescent’s capacity to provide informed consent while influenced by the opinions of co-detainees in this extreme setting. We argue that the parents and the child had compromised decisional capacity due to the effects of detention. The challenges to the medical team are recognized and discussed. The team members faced a difficult dilemma and considered the competing values of the multiple cultural and ethical factors. Each team member integrated his or her own roles, duties, and discipline-specific professional guidelines with the primary goal of mitigating potential harms. (shrink)

Background: Waiving parent permission can be an option in some epidemiological and social research with adolescents. However, exemptions have not been uniformly considered or applied. Our aim is to critically assess the different factors that could be taken into account when making decisions about waiving active parental permission in observational research with adolescents.DiscussionIn some cases alternatives to parental permission could be applied to protect the rights of both adolescents and parents and also to assure the benefits to (...) adolescents as a group that can come from appropriately conducted studies. However, the criteria of ensuring minimal risk can be difficult to define and apply and a distinction between harm and discomfort is reviewed. Waiving active parental permission could be acceptable when the risk of harm is minimal; when the research questions are related to an activity for which adolescents are not legally considered to be children; when the risk of harm or discomfort may increase if parental permission is required; and when risk of discomfort is low because the questionnaire is not potentially offensive for some adolescents and/or for some parents.SummaryStringent rules concerning parental permission in some studies could be detrimental to adolescents. A framework and a decision tree guide are proposed to help researchers and Research Ethics Committees in their decisions on whether active parental permission must be obtained. (shrink)

The program provides psycho-social support to foster adolescents during both their placement in foster families and in transitional period of leaving care, until they manage to cope with independent living. It is concieved as a direct answer to the needs of young people disturbed by the insecure patterns of attachment, who needed an opportunity to explore and modify negative experiences and acquire more successful models on how to build and maintain relationships, how to integrate the past, develop self-esteem and (...) successfully enter the world of adults. It is based on the principles of community psychology, the concept of the group as the transitional object and group dynamics. It was created through interaction with the beneficiaries, with emphasis on their participation and linking with all relevant players on the local level. Applied methods: self-support groups, psychological workshops, supportive activities in socialization and social integration, trainings, educational courses, counselling service, co-operation with foster parents, schools, local community and participation activities with focus on campaigning for development of aftercare services. The Manual, which resulted from the programme, is prompting professionals to develop new services entitled to children and youth and to involve users themselves in the reforms of the system. (shrink)

Background The South African legal framework requires mandatory parental/legal guardian consent for all research with children. Ethics guidelines provide some reprieve by allowing RECs to grant waivers of parental or guardianship consent in certain defined circumstances. In the first instance, consent may be provided by a proxy when parents or guardians are unavailable, for example with orphaned children. In the second instance, guidelines permit adolescent self-consent when the nature of the study justifies this approach, for example, research on (...) sensitive issues like sexual behaviour or substance use. Discussion South African guidelines set several conditions that must be met for waivers to be granted. These norms overlap with those in international guidelines. However, the ethical norms, especially related to self-consent are sometimes vague. This article critically evaluates the consent norms in the national ethics guidelines and makes recommendations for reform to ethics guidelines in a way that recognises the value of child participation in research, their evolving decision-making capacity and their best interests. Conclusion Recommendations are made to harmonise ethics guidelines and law in a way that promotes child participation in research, to ensure additional protections for adolescents when self-consent is allowed, and to withdraw procedural requirements for the community endorsement of self-consent strategies. (shrink)

This paper reports two cases in Hong Kong involving two native Chinese adolescent cancer patients (APs) who were denied their rights to consent to necessary treatments refused by their parents, resulting in serious harm. We argue that the dynamics of the ‘AP‐physician‐family‐relationship’ and the dominant role Chinese families play in medical decision‐making (MDM) are best understood in terms of the tendency to hierarchy and parental authoritarianism in traditional Confucianism. This ethic has been confirmed and endorsed by various Chinese writers from (...) Mainland China and Hong Kong. Rather than giving an unqualified endorsement to this ethic, based more on cultural sentimentalism than rational moral reasoning, we warn that a strong familism in MDM, which deprives ‘weak’ family members of rights, represents the less desirable elements of this tradition, against which healthcare professionals working in this cultural milieu need to safeguard. Specifically for APs, we suggest that parental authority and family integrity should be re‐interpreted in terms of parental responsibility and the enhancement of children's interests respectively, as done in the West. This implies that when parents refuse to consent to necessary treatment and deny their adolescent children's right to consent, doctors, as the only remaining advocates of the APs' interest, have the duty to inform the state, which can override parental refusal to enable the doctors to fulfill their professional and moral obligations. In so doing the state exercises its ‘parens patriae’ power to defend the defenseless in society and the integrity of the medical profession. (shrink)

Various human rights issues arise from the intersection of adolescent motherhood and HIV. While health rights may be the most obvious means by which to address such issues through policy development and legislative means, the right to health is not the only human right that may provide recourse or relief in this regard. This article considers an unexplored avenue of approaching such issues through reliance on the right to enjoy the benefits of scientific progress. The International Covenant on Economic, Social (...) and Cultural Rights provides for the ‘right to science’ in article 15(1)(b) and more recently, as elaborated on in General Comment no. 25 of 2020. This article considers how this right can be relied upon to address issues pertaining to adolescent motherhood and HIV. Precedent from a Venezuelan Supreme Court decision is considered, as well as the normative content of the right to enjoy the benefits of scientific progress. This may be another legal means by which to hold states accountable for the health of young mothers and their children, especially as new practices, medicines and treatments emerge regarding HIV. (shrink)

The growing importance of researching online activities, such as cyber-deviance and cyber-crime, as well as the use of online tools (e.g. questionnaires, games, and other interactive tools) has created new ethical and legal challenges for researchers, which can be even more complicated when researching adolescents. In this article, we highlight the risks emerging from the current European legal and ethical landscape when researching potentially vulnerable groups, with a special focus on online research. It is not always clear how to (...) differentiate research ethics consent from consent for data processing activities: when can an adolescent independently consent to research, or when is parental consent needed? Additional problems emerge when parents do not consent to research activities, but their adolescent children do. A serious ethical challenge can arise when the parents do not communicate with researchers, but the adolescent wishes to participate, especially when weak parental oversight is coupled with research on sensitive topics. We offer some guidance on what to keep in mind when conducting online research with adolescents and highlight possible ways that these issues can be dealt with in pan-European projects. (shrink)

The pregnancy rate among teenagers has increased overall in the past years in most industrial countries, especially in urban population. The aim of our study was to estimate the incidence of adolescent deliveries in Szczecin population and to analyze problems associated with maternity in teenagers (adolescent childbearing).The study population consists of 90 teenagers, the control group contains 2707 adult women delivered between Jan. 1, 2000 and Dec. 31, 2000 at two Obstetrics Clinics of Pomeranian Academy of Medicine and Municipal Hospital (...) in Szczecin. Data on outcomes for children of adolescents were obtained from hospital documentation and anonymous questionnaires. Findings show that newborns of adolescents suffer many negative complications and problems and that pregnancy in adolescents is a clear risk for abnormal outcomes. Special programs for pregnancy prevention and intervention in adolescents should be prepared. (shrink)

IntroductionPrevious studies on metacognitive ability were explored using self-report questionnaires that are difficult to adequately measure and evaluate when the capacity for self-reference is undeveloped. This study aimed to validate the Congruency-based Metacognition Scale to measure metacognition and the feeling of confidence abilities and to investigate the development of metacognition during adolescence.MethodsThe CMS was administered to 633 child–parent pairs in Japan. The CMS metacognition score was assessed based on congruency scores between the self-report of the child from a third-person perspective (...) and the parent’s report from the first-person perspective. The CMS self-judgment accuracy score was assessed by the congruency scores between the children’s self-report from the 1PP and 3PP. For both measures, the more distant the 3PP on the self-report was from the 1PP on the parent’s report and child self-report means low ability. An exploratory factor analysis was conducted to examine construct validity and then a confirmatory factor analysis was used. Criterion validity was examined by calculating Pearson’s correlation coefficients with scores on the Beck Cognitive Insight Scale and Autism Quotient. We used intraclass correlation and Cronbach’s alpha to examine the test–retest and internal consistency reliability.ResultsBased on the results of the EFA and CFA, we adopted one factor structure with five items. The CMS metacognition and CMS self-judgment accuracy showed evidence criterion validity, exhibiting significant correlations with the BCIS self-reflectiveness and self-certainty scores, respectively. Regarding to the AQ, only the CMS metacognition score had significant correlations with the social skills and total scale score. The test–retest reliability showed adequate. Adolescents were found to have significantly lower metacognitive ability compared to young adults.ConclusionCMS could be a valid and reliable measure to examine metacognitive abilities for adolescents. (shrink)

This paper reports two cases in Hong Kong involving two native Chinese adolescent cancer patients (APs) who were denied their rights to consent to necessary treatments refused by their parents, resulting in serious harm. We argue that the dynamics of the 'AP-physician-family-relationship' and the dominant role Chinese families play in medical decision-making (MDM) are best understood in terms of the tendency to hierarchy and parental authoritarianism in traditional Confucianism. This ethic has been confirmed and endorsed by various Chinese writers from (...) Mainland China and Hong Kong. Rather than giving an unqualified endorsement to this ethic, based more on cultural sentimentalism than rational moral reasoning, we warn that a strong familism in MDM, which deprives 'weak' family members of rights, represents the less desirable elements of this tradition, against which healthcare professionals working in this cultural milieu need to safeguard. Specifically for APs, we suggest that parental authority and family integrity should be re-interpreted in terms of parental responsibility and the enhancement of children's interests respectively, as done in the West. This implies that when parents refuse to consent to necessary treatment and deny their adolescent children's right to consent, doctors, as the only remaining advocates of the APs' interest, have the duty to inform the state, which can override parental refusal to enable the doctors to fulfill their professional and moral obligations. In so doing the state exercises its 'parens patriae' power to defend the defenseless in society and the integrity of the medical profession. (shrink)

Originally published in 1969 this book analyzes the development of moral judgement in children and adolescents. Interviews were held with 360 children aged 7 to 17, with equal numbers of either sex. Original visual devices were planned to elicit judgements in moral areas known to be of universal significance, such as the value of life, cheating, stealing and lying. In addition, analyses of concepts of reciprocity, of the development of conscience and of specificity in moral judgement were (...) derived from the tests. The book inlcudes a critical survey of previous work in this field and places the research in its wider philosophical, psychological and sociological context. (shrink)

The ability to sequence individual genomes is leading to the identification of an increasing number of genetic risk factors for serious diseases. Knowledge of these risk factors can often provide significant medical and psychological benefit, but also raises complex ethical and social issues. This paper focuses on one area of rapid progress: the identification of mutations causing long QT syndrome and other cardiac channel disorders, which can explain some previously unexplained deaths in infants (SIDS) and children and adults (SUDS) (...) and prevent others from occurring. This genetic knowledge, discovered posthumously in many cases, has implications for clinical care for surviving family members who might carry the same mutations. The information obtained from genetic testing, in the context of personal and family history, can guide individually tailored interventions that reduce risk and save lives. At the same time, obtaining and disclosing genetic information raises difficult issues about confidentiality and decision making within families. We draw on the experience of the Montefiore-Einstein Center for Cardiogenetics, which has played a leading role in the genetic diagnosis and clinical management of cardiac channel diseases, to explore some of the challenging ethical questions arising in affected families with adolescent children. We focus on the related issues of (1) family confidentiality, privacy and disclosure and (2) adolescent decision making about genetic risk, and argue for the value of interdisciplinary dialogue with affected families in resolving these issues. (shrink)

Whether adolescents should be allowed to make their own medical decisions has been a topic of discussion in bioethics for at least two decades now. Are adolescents sufficiently capacitated to make their own medical decisions? Is the mature-minor doctrine, an uncommon legal exception to the rule of parental decision-making authority, something we should expand or eliminate? Bioethicists have dealt with the curious liminality of adolescents—their being neither children nor adults—in a variety of ways. However, recently there (...) has been a trend to rely heavily, and often exclusively, on emerging neuroscientific and psychological data to answer these questions. Using data from magnetic resonance imaging and functional MRI studies on the adolescent brain, authors have argued both that the adolescent brain isn't sufficiently mature to broadly confer capacity on this population and that the adolescent brain is sufficiently mature to assume adolescent capacity. Scholars then accept these data as sufficient for concluding that adolescents should or should not have decision-making authority. Two critical mistakes are being made here. The first is the expectation that neuroscience or psychology is or will be able to answer all our questions about capacity. The second, and more concerning, mistake is the conflation of decision-making capacity with decision-making authority. (shrink)

8 lectures, Stuttgart, June 12-19, 1921 (CW 302) In these eight talks on education for teenaged young people, Steiner addressed the teachers of the first Waldorf school two years after it was first opened. A high school was needed, and Steiner wanted to provide a foundation for study and a guide for teachers already familiar with his approach to the human being, child development, and education based on spiritual science. Steiner's education affirms the being of every child within the world (...) of spirit. This approach works within the context of the child's gradual entry into earthly life, aided by spiritual forces, and children's need for an education that cooperates with those forces. Some of Steiner's remarks may be controversial, but unbiased study will lead to an appreciation of the profound thought and wisdom behind what is presented here. German source: Menschenerkenntnis und Unterrichtsgestaltung (GA 302). (shrink)

Introduction: Previous findings that inattention and hyperactive/impulsive symptoms predict later peer problems have been mixed. Utilizing two culturally diverse samples with shared methodologies, we assessed the predictive power of dimensionally measured childhood IA and HI symptoms regarding adolescent peer relationships.Methods: A US-based, clinical sample of 228 girls with and without childhood diagnosed attention-deficit/hyperactivity disorder was assessed and followed 5 years later. A Norwegian, population-based sample of 3,467 children was assessed and followed approximately 4 years later. Both investigations used parent (...) and teacher reports of ADHD symptoms and peer relations. Multivariate regression analyses examined the independent contributions of IA and HI symptoms to later peer problems, adjusting for baseline childhood peer problems. We also examined childhood sex as a potential moderator within the Norwegian sample.Results: Higher levels of childhood HI symptoms, but not IA symptoms, independently predicted adolescent peer problems in the all-female clinical sample. Conversely, higher levels of IA symptoms, but not HI symptoms, independently predicted preadolescent peer problems in the mixed-sex population sample. Results did not differ between informants. Associations between ADHD symptom dimensions and peer problems within the Norwegian sample were not moderated by child sex.Discussion: Differential associations between childhood hyperactive/impulsive and inattention symptoms and adolescent peer problems were found across two diverse samples using a shared methodology. Potential explanations for different findings in the clinical vs. population samples include symptom severity as well as age, sex, and cultural factors. We discuss implications for future research, including the importance of dimensional measures of ADHD-related symptoms and the need for shared methodologies across clinical and normative samples. (shrink)

BackgroundExposure to early life stress is alarmingly prevalent and has been linked to the high rates of depression documented in adolescence. Researchers have theorized that ELS may increase adolescents’ vulnerability or reactivity to the effects of subsequent stressors, placing them at higher risk for developing symptoms of depression.MethodsWe tested this formulation in a longitudinal study by assessing levels of stress and depression during the COVID-19 pandemic in a sample of adolescents from the San Francisco Bay Area who had (...) been characterized 3–7 years earlier with respect to exposure to ELS and symptoms of depression.ResultsAs expected, severity of ELS predicted levels of depressive symptoms during the pandemic [r = 0.26, p = 0.006], which were higher in females than in males [t = −3.56, p < 0.001]. Importantly, the association between ELS and depression was mediated by adolescents’ reported levels of stress, even after controlling for demographic variables.ConclusionsThese findings underscore the importance of monitoring the mental health of vulnerable children and adolescents during this pandemic and targeting perceived stress in high-risk youth. (shrink)

UNICEF estimates that 1.6 billion children across the world have had their education impacted by COVID-19 and have attempted to continue their learning at home. With ample evidence showing a negative impact of noise on academic achievement within schools, the current pre-registered study set out to determine what aspects of the home environment might be affecting these students. Adolescents aged 11–18 took part online, with 129 adolescents included after passing a headphone screening task. They filled out a (...) sociodemographic questionnaire, followed by a home environment and noise questionnaire. Participants then completed three executive function tasks while listening to a soundtrack of either white noise or home-like environmental noise. For purposes of analysis, based on the noise questionnaire, participants were separated into quieter and noisier homes. Results revealed that measures of the home environment significantly correlated with individual perceptions of noise and task performance. In particular, adolescents coming from noisier homes were more likely to report that they studied in a noisy room and that they were annoyed by noise when studying. In terms of noise and task performance, the Flanker task revealed that while older adolescents were more efficient overall than their younger peers, those older adolescents from noisier homes seemed to lose this advantage. Additionally, reaction times for younger adolescents from noisier homes were less impacted by accuracy compared to their peers from quieter homes, though there was no difference for the older adolescents. This evidence suggests that higher in-home noise levels lead to higher rates of annoyance and may be hindering home-learning, with both younger and older adolescents being impacted. Furthermore, the long-term effect of in-home noise on adolescent executive function task performance indicates that these findings transcend the pandemic and would influence in-school learning. Limitations and advantages of online adolescent research without researcher supervision are discussed, including sociodemographics and adapting tasks. (shrink)

Parental expectations have long been studied as a factor in increasing adolescent educational aspirations, often linking these expectations to parental level of education and involvement in academic endeavours. This study further explores this relationship in a statewide Midwestern sample of parents and their adolescent children. Regression analysis and independent samples t?tests were used to predict adolescent aspirations and compare groups. Results suggest that adolescent educational aspirations can to some degree be predicted by parental expectations. Parents reported high expectations for (...) their children despite low levels of personal educational attainment. However, these high expectations were buffered by a reported unfamiliarity with college requirements and an expressed concern about college affordability and limited awareness of financial aid opportunities. Limitations and suggestions for future research and intervention are discussed. (shrink)

This research focuses on dinner conversations in family-style group care. Children, who cannot live with their biological families anymore, are given shelter in these family-style group care settings. For the development of an attachment relationship between children and their Professional Foster Parents, it is important that the children feel that they are listened to in order to get an affective and intimate relationship with the parents. In this conversation-analytic research we analysed PFPs’ involvement in multiple activities simultaneously, (...) namely listening and eating, which is referred to as ‘multi-activity’. The analyses have shown systematic ways in which PFPs coordinate their involvement in the activities of ‘doing’ listening and eating, which are when parents avert their gaze from the telling child, they break the social rule which states that hearers need to look at speakers during the telling. We found that when averting their gaze, PFPs do head nods and linguistic means or positioning their bodies in the direction of the telling child. This research contributes to knowledge about interaction between adolescents and PFPs. It further contributes to knowledge about how human beings are able to coordinate multiple activities simultaneously. (shrink)

Conducting research on adolescents raises a number of ethical issues not often confronted in research on younger children. In part, these differences are due to the fact that although assent is usually not an issue, given cognitive and social competencies, the life situations and behavior of youth make it more difficult to balance rights and privacy of the adolescents. In this article, the three ethical principles of beneficence, justice, and respect for persons are discussed in terms of (...) their application to the study of adolescents. Then, seven vignettes are presented to illustrate how these principles apply to real-life situations. How to balance the rights of adolescents and their parents is discussed, using adolescent girls and their parents for illustrative purposes. (shrink)

National education is a conscious and planned effort to help children develop their potential be spiritually strong, religious, intelligent, a strong personality and noble character and noble skills. For this reason, education not only focuses on the aspect of children’s knowledge but also on religion and morals aspects. This education begins in the family through communication patterns that are created between parents and children in the form of interpersonal communication that can increase the religiosity of adolescents. (...) Therefore, this article aims to measure the interpersonal communication within the family. The author uses quantitative methods with technical correlation to determine the relationship between two variables, namely interpersonal communication in the family and youth religiosity, and includes 303 adolescents as a sample. The data were collected using a Likert scale and processed using Excel and SPSS 16 programs in order to obtain the results that the application of good interpersonal communication in families will increase adolescent religiosity. This leads to the conclusion ‘there is a mutually influential relationship between interpersonal communication in the family and adolescent religiosity’.Contribution: This article contributes to Christian families in increasing interpersonal communication as a pattern of youth formation, because it can increase their religiosity. (shrink)

National education is a conscious and planned effort to help children develop their potential be spiritually strong, religious, intelligent, a strong personality and noble character and noble skills. For this reason, education not only focuses on the aspect of children's knowledge but also on religion and morals aspects. This education begins in the family through communication patterns that are created between parents and children in the form of interpersonal communication that can increase the religiosity of adolescents. (...) Therefore, this article aims to measure the interpersonal communication within the family. The author uses quantitative methods with technical correlation to determine the relationship between two variables, namely interpersonal communication in the family and youth religiosity, and includes 303 adolescents as a sample. The data were collected using a Likert scale and processed using Excel and SPSS 16 programs in order to obtain the results that the application of good interpersonal communication in families will increase adolescent religiosity. This leads to the conclusion 'there is a mutually influential relationship between interpersonal communication in the family and adolescent religiosity'.CONTRIBUTION: This article contributes to Christian families in increasing interpersonal communication as a pattern of youth formation, because it can increase their religiosity. (shrink)

Congenital nystagmus in infants and young children can lead to early blindness. Previous neuroimaging studies have demonstrated that EB is accompanied by alterations in brain structure and function. However, the effects of visual impairment and critical developmental periods on brain functional connectivity at rest have been unclear. Here, we used the voxel-wise degree centrality method to explore the underlying functional network brain activity in adolescents with EB. Twenty-one patients with EBs and 21 sighted controls underwent magnetic resonance imaging. (...) Differences between the two groups were assessed using the DC method. Moreover, the support vector machine method was used to differentiate patients with EB patients from the SCs according to DC values. Compared with the SCs, the patients with EB had increased DC values in the bilateral cerebellum_6, cerebellum vermis_4_5, bilateral supplementary motor areas, and left fusiform gyrus; the patients with EB had decreased DC values in the bilateral rectal gyrus and left medial orbital frontal gyrus. The SVM classification of the DC values achieved an overall accuracy of 70.45% and an area under the curve of 0.86 in distinguishing between the patients with EB and the SCs. Our study may reveal the neuromechanism of neuroplasticity in EB; the findings provide an imaging basis for future development of restorative visual therapies and sensory substitution devices, and future assessments of visual rehabilitation efficacy. (shrink)

This study focused on value transmission in the family and assessed adolescents’ acceptance of the values their parents want to transmit to them (socialisation values), identifying some factors that may affect the level of acceptance. Specifically, actual value agreement between parents, parental agreement as perceived by adolescents, parent–child closeness and promotion of child’s volitional functioning, were considered as predictors. Participants were 381 family triads (father, mother and adolescent child) from northern Italy; the adolescents (46.2% male) were all (...) high‐school students from 15 to 19 years of age. Both parents and their children filled out self‐report questionnaires. Findings showed a moderate level of acceptance in families, suggesting the presence of similarities as well as differences between parents’ socialisation values and adolescents’ personal values. All the predictors considered except parents’ actual agreement, were found to be significantly and positively related to acceptance. Implications for moral development are discussed and suggestions for education and future research are provided. (shrink)

Background Research in children is essential for them to benefit from the outcomes of research but involvement must be weighed against potential harms. In many countries and circumstances, medical research legally requires parental consent until the age of 18 years, with poorly defined recommendations for assent prior to this. However, there is little research exploring how these decisions are made by families and the ethical implications of this. Aim To explore key ethical debates in decision-making for participation of (...) class='Hi'>children and adolescents in a human papillomavirus (HPV) vaccine trial. Methods Semi-structured interviews were undertaken with Tanzanian girls (aged 9–16 years) who had participated in an HPV vaccine trial (n = 13), their parents or guardians (n = 12), and girls together with their parents (in paired parent-child interviews) (n = 6). The interviews were analysed using thematic analysis. Interview data came from a qualitative acceptability study undertaken as part of the Dose Reduction Immunobridging and Safety Study of Two Human Papillomavirus (HPV) Vaccines in Tanzanian Girls (DoRIS) trial. Results Girls and parents desired collaborative decision-making, with parents ultimately making the decision to consent. However, girls wanted a larger part in decision-making. Decisions to consent involved many people, including extended social networks, the trial team, media outlets and healthcare professionals and this resulted in conflicts to be negotiated. Deciding where to place trust was central in participants and parents considering decisions to consent and overcoming rumours about trial involvement. Conclusions Existing models of decision-making help to understand dynamics between parents, adolescents and researchers but neglect the important wider social impacts and the fundamental nature of trust. Children’s roles in discussions can be evaluated using the principles of consent: autonomy, freedom and information. Concepts such as relational autonomy help to explain mechanisms families use to negotiate complex consent decisions. Whilst interviewees supported the maintenance of legal parental consent, researchers must design consent processes centring the child to ensure that whole family decision-making processes are supported. (shrink)

In light of concerns about adolescent mental health, there is a need to identify and examine potential pathways to wellbeing in their daily lives. Outdoor environments can offer multiple pathways to wellbeing through opportunities for restoration, physical activity and socialising. However, urbanisation and new lifestyles revolving around the home and the internet are changing young people’s access, use and relationship to the outdoor environment. The authors point out how the research related to adolescents’ outdoor environments is generally not treated (...) with the same level of importance or as comprehensively as that for younger children. The aim of this paper is to pave the way for research and planning initiatives on everyday outdoor environments promoting the wellbeing of adolescents and the authors suggest ways in which perspectives from developmental psychology might inform the study of adolescents’ outdoor environments. The paper concludes by calling for an elevated focus on the role of outdoor environments in adolescents’ everyday lives as a source of wellbeing and more research that makes clear the specific attributes, activities and experiences related to places outdoors which make adolescents feel good. (shrink)

The Sundanese inhabiting West Java, the second largest ethnic group in Indonesia, are characterized by a high prevalence of child malnutrition, together with high fertility. Based on an anthropometric measurement and interview survey of 310 children aged 5s body weight, and one SES factor, i.e. mother’s occupation, were selected as the predictors of the two Z scores by regression analysis, indicating more significant effects of the biological factors than the other factors. This pattern is judged to occur in less-developed (...) and high-fertility populations. Since these two Z scores were worse in the subject children than in the under-5-year-old children from the same village, more attention should be paid to the long-lasting effects of birth-related biological factors up to pre-adolescent ages, as an insufficient nutritional status tends to damage growth and health in adolescence and adulthood. (shrink)

BackgroundHappiness is becoming increasingly relevant in recent research, including adolescents. Many studies are using the single-item measure for adolescent happiness, however, its validity is not well known. We aimed to examine the validity of this measure among adolescents in three countries from distinct European regions – Eastern, Southern, and Western.Materials and MethodsThe analysis included data from Health Behaviour in School-aged Children study from three countries and three last surveys. The total sample comprised 47,439 schoolchildren. For validity, the (...) indicators reflecting subjective health, life satisfaction, quality of life, well-being, social support, health complaints, bullying, and self-directed violence were assessed. The calculations were conducted in the total sample and by gender, age, survey year, and country.ResultsThe different indicators of concurrent and convergent validity revealed consistent correlations with happiness, with better well-being, health, and subjective perceptions being related to higher happiness. Meanwhile, health complaints, bullying behaviors, and self-directed violence were related to lower happiness. The subgroup differences were consistent across gender, age groups, countries, and survey rounds. The extent of differences was more expressed among girls.ConclusionThe single item for adolescent happiness measurement features a consistent pattern of validity concerning indicators of concurrent and convergent validity. Higher self-reported happiness is associated with better mental and physical health and well-being, and less expressed negative factors. In addition, among girls the correlations tend to be stronger than boys. (shrink)

Epilepsy surgery is the most effective therapeutic approach for children with drug resistant epilepsy. Recent advances in neurosurgery, such as the Laser Interstitial Thermal Therapy, improved the safety and non-invasiveness of this method. Electric and magnetic source imaging plays critical role in the delineation of the epileptogenic focus during the presurgical evaluation of children with DRE. Yet, they are currently underutilized even in tertiary epilepsy centers. Here, we present a case of an adolescent who suffered from DRE for (...) 16 years and underwent surgery at Cook Children's Medical Center. The patient was previously evaluated in a level 4 epilepsy center and treated with multiple antiseizure medications for several years. Presurgical evaluation at CCMC included long-term video electroencephalography, magnetoencephalography with simultaneous conventional EEG and high-density EEG in two consecutive sessions, MRI, and fluorodeoxyglucose - positron emission tomography. Video long-term EEG captured nine focal-onset clinical seizures with a maximal evolution over the right frontal/frontal midline areas. MRI was initially interpreted as non-lesional. FDG-PET revealed a small region of hypometabolism at the anterior right superior temporal gyrus. ESI and MSI performed with dipole clustering showed a tight cluster of dipoles in the right anterior insula. The patient underwent intracranial EEG which indicated the right anterior insular as seizure onset zone. Eventually LITT rendered the patient seizure free. Retrospective analysis of ESI and MSI clustered dipoles found a mean distance of dipoles from the ablated volume ranging from 10 to 25 mm. Our findings highlight the importance of recent technological advances in the presurgical evaluation and surgical treatment of children with DRE, and the underutilization of epilepsy surgery in children with DRE. (shrink)

This work is developed to explore the form of mental health education, strengthen scientific educational ideas, and improve the effect of psychological therapy. Virtual reality technology is innovatively applied in adolescent mental health treatment and education. Based on this, the mental health treatment and system design based on virtual reality technology are discussed, and the feasibility of applying VR technology to adolescent mental health education is explored. Second, the research concept of adolescent mental health is discussed. Based on the VR (...) platform setup, questionnaire survey is implemented to analyze the factors influencing the mental health of primary and secondary school students in Xi’an, Shaanxi Province, and five factors are obtained. Based on this, the adolescent mental health treatment system based on VR is designed, and the effectiveness of the system is tested and evaluated. The results show that the integrated delay of the VR equipment used is 29 ms, which can effectively provide service. There are significant differences in mental health status among adolescents of different genders, different ages, only children and non-only children, parents’ accompaniment during growing up, and urban and rural adolescents. Finally, after 3 months of psychological treatment, the mental health score of the experimental group of teenagers is 50–55 points. However, the mental health scores of the control group remain at 56–65 points, indicating that the mental health treatment system designed in this work can effectively help the adolescents to improve their mental health, thus proving the effectiveness of the system. To sum up, this work provides scientific reference for adolescent mental health education in schools. Psychological treatment system can help teenagers improve their psychological problems and promote the development of mental health education. (shrink)

While parents have traditionally provided proxy consent for minors to participate in research, this has proven inadequate for adolescents who are mentally and emotionally capable of making their own decisions. Research has proven that even young children, and certainly most adolescents, are developmentally prepared to make such decisions for themselves. The author challenges the assumption that both consent and assent are static concepts, and proposes that a sliding scale of competence be created to ascertain the adolescent's comprehension (...) of the proposed research by shifting the burden of proof to those who believe a particular adolescent is unable to provide informed consent. (shrink)

Bullying is a phenomenon that affects children and adolescents worldwide, and it has major consequences for all participants involved in these situations. In Chile, researchers have validated several instruments used to investigate aggression between peers and school violence, but there is a lack of validation of instruments to investigate bullying. The purpose of this study was to provide evidence of the validity and reliability of the Olweus Bully/Victim Questionnaire—Revised version in the Chilean context. The participants were 2,775 students (...) from schools of low, medium, and high socioeconomic status. OBVQ-R is a self-report questionnaire with 42 items, which has been used in different countries, and has adequate psychometric properties to assess the prevalence of victimization and aggression and various forms of bullying worldwide. Results confirmed the two-factor structure of the OBVQ-R and good reliability. These dimensions seem to be correlated. Comparison between OBVQ-R with the School Violence between Peers Questionnaire and the Internet Experiences Questionnaire showed some degree of agreement. The Item Response Theory analysis showed that the item about verbal bullying, in both subscales, had the lowest-severity parameters, meaning that these forms of bullying were the most prevalent. The higher-severity parameter in the victimization scale was the cyberbullying item, and the sexual bullying item showed higher severity in the perpetration subscale. The differential item functioning analysis by gender showed a trend in which boys responded with lower-severity parameters than girls. In the victimization scale, the exception was the item about spreading rumors, and in the perpetration subscale, it was the item about racial bullying. We have provided evidence of the validation of OBVQ-R among school-age children and adolescents in Chile. This study is part of a trial registered at ClinicalTrials.gov, number NCT02898324. (shrink)

Eating behaviors evolve during the first years of life as biological and behavioral processes directed towards meeting requirements for health and growth. For the vast majority of human history, food scarcity has constituted a major threat to survival, and human eating behavior and child feeding practices have evolved in response to this threat. Because infants are born into a wide variety of cultures and cuisines, they come equipped as young omnivores with a set of behavioral predispositions that allow them to (...) learn to accept the foods made available to them. During historical conditions of scarcity, family life and resources were devoted to the procurement and preparation of foods, which are often low in energy, nutrients, and palatability. In sharp contrast, today in non-Third World countries children's eating habits develop under unprecedented conditions of dietary abundance, where palatable, inexpensive, ready-to-eat foods are readily available. (shrink)

Early theorists speculated that extremely shy children, or those with anxious temperament, were likely to have anxiety problems as adults. More recent studies demonstrate that these children have heightened responses to potentially threatening situations reacting with intense defensive responses that are characterized by behavioral inhibition and physiological arousal. Confirming the earlier impressions, data now demonstrate that children with this disposition are at increased risk to develop anxiety, depression, and comorbid substance abuse. Additional key features of anxious temperament (...) are that it appears at a young age, it is a stable characteristic of individuals, and even in non-threatening environments it is associated with increased psychic anxiety and somatic tension. To understand the neural underpinnings of anxious temperament, we performed imaging studies with 18- fluoro-deoxyglucose high-resolution Positron Emission Tomography in young rhesus monkeys. Rhesus monkeys were used because they provide a well validated model of anxious temperament for studies that cannot be performed in human children. Imaging the same animal in stressful and secure contexts, we examined the relation between regional metabolic brain activity and a trait-like measure of anxious temperament that encompasses measures of BI and pituitaryadrenal reactivity. Regardless of context, results demonstrated a trait-like pattern of brain activity that is predictive of individual phenotypic differences. Importantly, individuals with extreme anxious temperament also displayed increased activity of this circuit when assessed in the security of their home environment. These findings suggest that increased activity of this circuit early in life mediates the childhood temperamental risk to develop anxiety and depression. (shrink)